Peripheral neuropathy and the limits of personal protective equipment in an agrochemical-exposed mining-farming community in south-east Nigeria: a cross-sectional study
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Objectives
To estimate the prevalence of objective peripheral neuropathy, and to test whether self-reported use of personal protective equipment (PPE) is associated with lower neuropathy risk, among adults attending a community hospital in a Nigerian population exposed to both agrochemicals and mining.
Design
Clinic-based cross-sectional study (June–November 2025), reported per STROBE.
Setting
Infant Jesus Community Hospital, Ishiagu, Ebonyi State, a community combining smallholder farming with granite and lead–zinc mining.
Participants
285 adults (≥18 years) attending the outpatient screening department; people with known diabetes were excluded.
Main outcome measures
Peripheral neuropathy on the Michigan Neuropathy Screening Instrument (MNSI) examination — an instrument validated in diabetic populations — defined a priori as an abnormal 10 g monofilament test or absent/reduced ankle reflexes; three alternative case definitions were pre-specified. PPE use was scored 0–12. Associations were estimated by multivariable logistic regression adjusted for age and sex.
Results
The proportion screening positive was 47.0% (95% CI 41.2–52.8) under the primary definition and ranged from 29.8% to 56.8% across definitions. PPE use was near-absent (89.1% never used gloves; 43.2% used none) and showed no detectable protective association (adjusted OR 0.97 per point, 95% CI 0.88–1.06). Men used PPE more than twice as often as women (55.1% vs 24.5%, p<0.001), yet neuropathy did not differ by sex (41.6% vs 49.5%, p=0.27). Only age was associated with neuropathy (adjusted OR 1.02 per year, p=0.02).
Conclusions
Nearly half of the adults sampled screened positive for peripheral neuropathy, and protective equipment showed no detectable protective association. Because PPE use was near-absent, the study cannot separate ineffective protection from too little protection to measure, and the cross-sectional design precludes causal inference. The equal burden across sexes despite markedly unequal protective behaviour is consistent with community-wide environmental exposure; reducing the total toxic load is a plausible priority that direct exposure measurement should now test.
