Types and Toxicity Levels of Pesticides: A Study of an Agricultural Area in Brebes Regency
Introduction: Previous studies found that young children, children, pregnant women, and farmers are at risk of pesticide exposure. Organophosphate pesticides are detected in children's urine, but other types of pesticides, their toxicity classification, and their toxicity level have not been identified. Hence, this study aims to identify types and toxicity levels of pesticides that are possible causes of health problems in an agricultural area. Methods: The population of the study were 1,017 households in two villages of an agricultural area of Brebes Regency, Indonesia. The data were collected from 166 participants using a cross-sectional design involving questionnaires to identify the characteristics of the respondents and observations to identify the pesticide, pesticide packaging, and pesticide residue in their houses. The toxicity levels of the pesticides were identified based on the pesticide toxicity classification recommended by the World Health Organization (WHO). Potential health problems due to pesticides were subsequently identified based on literature reviews. Results and Discussion: According to the results, organophosphate, carbamate, and pyrethroid pesticides were found in 30.7% of the respondents' houses. The toxicity levels of the pesticides ranged from highly hazardous (Ib) to unlikely presenting acute hazard (U). The potential health problems due to pesticides varied from poisoning symptoms to genetic disorders and polymorphisms. Conclusion: There were three types of pesticides with toxicity levels ranging from highly hazardous to unlikely presenting acute hazard in the agricultural area in Brebes Regency
Dahiri B, Martín-Reina J, Carbonero-Aguilar P, Aguilera-Velázquez JR, Bautista J, Moreno I. Impact of Pesticide Exposure among Rural and Urban Female Population. An Overview. International Journal of Environmental Research and Public Health. 2021;18(18):1–17. https://doi.org/10.3390/ijerph18189907
Budiyono B, Suhartono S, Kartini A. Factors of Organophosphate Pesticide Exposure on School Children in an Agricultural Area, Indonesia. Jurnal Kesehatan Masyarakat. 2021;16(3):428–438. https://doi.org/10.15294/kemas.v16i3.26030
Pironti C, Ricciardi M, Proto A, Bianco PM, Montano L, Motta O. Endocrine-disrupting Compounds: An Overview on their Occurrence in the Aquatic Environment and Human Exposure. Water (Switzerland). 2021;13(10):1–32. https://doi.org/10.3390/w13101347
Suhartono S, Kartini A, Subagio HW, Budiyono, Utari A, Suratman S, et al. Pesticide Exposure and Thyroid Function in Elementary School Children Living in an Agricultural Area. International Journal of Occupational and Environmental Medicine. 2018;9(3):137–144. https://doi.org/10.15171/ijoem.2018.1207
Winarni S, Denny HM, Dharminto, Arifan F, Suwondo A, Kartini A, et al. Risk Factors of Infertility Cases Among Shallot Farmers. Malaysian Journal of Public Health Medicine. 2020;21(1):160–168. https://doi.org/10.37268/mjphm/vol.21/no.1/art.723
Widyawati SA, Suhartono S, Mexitalia M, Soejoenoes A. The Relationship Between Pesticide Exposure and Umbilical Serum IGF-1 Levels and Low-Birth Weight: A Case-Control Study in Brebes, Indonesia. International Journal of Occupational and Environmental Medicine. 2020;11(1):15–23. https://doi.org/10.15171/ijoem.2020.1809
Istiklaili F, Suwandono A, Suhartono S, Widyorini E, Saputro D. Risk Factors Affecting Attention Deficit Hyperactivity Disorder Among Early Childhood in The Agricultural Area in Indonesia. Indian Journal of Public Health Research and Development. 2019;10(1):417–421. https://doi.org/10.5958/0976-5506.2019.00083.4
Hernández AF, Lozano-Paniagua D, González-Alzaga B, Kavvalakis MP, Tzatzarakis MN, López-Flores I, et al. Biomonitoring of Common Organophosphate Metabolites in Hair and Urine of Children From an Agricultural Community. Environment International. 2019; 131(104997):1–12. https://doi.org/10.1016/j.envint.2019.104997
López-Gálvez N, Wagoner R, Quirós-Alcalá L, Horne YO Van, Furlong M, Avila E, et al. Systematic Literature Review of The Take-Home Route of Pesticide Exposure via Biomonitoring and Environmental Monitoring. International Journal of Environmental Research and Public Health. 2019;16(12):1–24. https://doi.org/10.3390/ijerph16122177
World Health Organization. The WHO Recommended Clasification of Pesticides by Hazard and Guidelines to Classification 2009. Stuttgart: World Health Organization; 2009. 1–81 p. https://apps.who.int/iris/bitstream/handle/10665/44271/9789241547963_eng.pdf?sequence=1&isAllowed=y
Hassaan MA, Nemr A El. Pesticides: Formulants, Distribution Pathways and Effects on Human Health – A Review. The Egyptian Journal of Aquatic Research. 2020;46(3):207–220. https://doi.org/10.1016/j.ejar.2020.08.007
Kalyabina VP, Esimbekova EN, Kopylova K V., Kratasyuk VA. Pesticides: Formulants, Distribution Pathways and Effects on Human Health – A Review. Toxicology Reports. 2021;8(1):1179–1192. https://doi.org/10.1016/j.toxrep.2021.06.004
Pathak VM, Verma VK, Rawat BS, Kaur B, Babu N, Sharma A, et al. Current Status of Pesticide Effects on Environment, Human Health And it's Eco-Friendly Management as Bioremediation: A Comprehensive Review. Frontiers in Microbiology. 2022;13(962619):1–29. https://doi.org/10.3389/fmicb.2022.962619
Aldini GM, Trisyono YA, Wijonarko A, Witjaksono W, Putter H De. Farmers' Practices in Using Insecticides to Control Spodoptera exigua Infesting Shallot Allium cepa var. aggregatum in the Shallot Production Centers of Java. Jurnal Perlindungan Tanaman Indonesia. 2020;24(1):75–81. https://doi.org/10.22146/jpti.47893
Adiyoga W, Khaririyatun N, Murtiningsih R. Criteria of Pesticide Selection in Shallot Pest-disease Control in Brebes Regency, Central Java. E3S Web of Conferences. 2022;361(03005):1–16. https://doi.org/10.1051/e3sconf/202236103005
Safitri YA, Hasanah U, Salamiah S, Samharinto S, Pramudi MI. Distribution of Major Diseases of Shallot in South Kalimantan, Indonesia. Asian Journal of Agriculture. 2019;3(2):33–40. https://doi.org/10.13057/asianjagric/g030201
Astuti LTW, Daryanto A, Syaukat Y, Daryanto HK. Analisis Resiko Produksi Usahatani Bawang Merah pada Musim Kering dan Musim Hujan di Kabupaten Brebes (Risk Analysis of Shallot Farming Production in the Dry and Rainy Seasons in Brebes Regency). Jurnal Ekonomi Pertanian dan Agribisnis. 2019;3(4):840–852. https://doi.org/10.21776/ub.jepa.2019.003.04.19
Mequanint C, Getachew B, Mindaye Y, Amare DE, Guadu T, Dagne H. Practice Towards Pesticide Handling, Storage and its Associated Factors Among Farmers Working in Irrigations in Gondar Town, Ethiopia, 2019. BMC Research Notes. 2019;12(1):1–6. https://doi.org/10.1186/s13104-019-4754-6
Loha KM, Klous G, Lamoree M, Boer J de. Pesticide Use and Practice of Local Farmers in The Central Rift Valley (CRV) 0f Ethiopia: Implications for The Environment and Health Hazards. International Journal of Pest Management. 2022;1(1):1–14. https://doi.org/10.1080/09670874.2022.2135180
Mubushar M, Aldosari FO, Baig MB, Alotaibi BM, Khan AQ. Assessment of Farmers on Their Knowledge Regarding Pesticide Usage and Biosafety. Saudi Journal of Biological Sciences. 2019;26(7):1903–1910. https://doi.org/10.1016/j.sjbs.2019.03.001
Imoro ZA, Larbi J, Duwiejuah AB. Pesticide Availability and Usage by Farmers in The Northern Region of Ghana. Journal of Health & Pollution. 2019;9(23):1–8. https://doi.org/10.5696/2156-9614-9.23.190906
Mergia MT, Weldemariam ED, Eklo OM, Yimer GT. Small-scale Farmer Pesticide Knowledge and Practice and Impacts on the Environment and Human Health in Ethiopia. Journal of Health & Pollution. 2021;11(30):1–19. https://doi.org/10.5696/2156-9614-11.30.210607
Nguyn TM, Thanh NT, Havukainen J, Hannaway DB. Pesticide Use in Vegetable Production: A Survey of Vietnamese Farmers' Knowledge. Plant Protection Science. 2018;54(4):203–214. https://doi.org/10.17221/69/2017-PPS
Tudi M, Li H, Li H, Wang L, Lyu J, Yang L, et al. Exposure Routes and Health Risks Associated with Pesticide Application. Toxics. 2022;10(6):1–23. https://doi.org/10.3390/toxics10060335
Simaremare SRS, Hung CC, Yu TH, Hsieh CJ, Yiin LM. Association between Pesticides in House Dust and Residential Proximity to Farmland in a Rural Region of Taiwan. Toxics. 2021;9(8):1–11. https://doi.org/10.3390/toxics9080180
Kuiper G, Young BN, Wemott S, Erlandson G, Martinez N, Mendoza J, et al. Factors Associated with Levels of Organophosphate Pesticides in Household Dust in Agricultural Communities. International Journal of Environmental Research and Public Health. 2022;19(2):1–17.
https://doi.org/10.3390/ijerph19020862
Alkon A, Gunier RB, Hazard K, Castorina R, Hoffman PD, Scott RP, et al. Preschool-Age Children's Pesticide Exposures in Child Care Centers and at Home in Northern California. Journal of Pediatric Health Care. 2022;36(1):34–45. https://doi.org/10.1016/j.pedhc.2021.09.004
Msibi SS, Chen CY, Chang CP, Chen CJ, Chiang SY, Wu KY. Indoor Air Exposure to Multiple Agricultural Pesticides Potentially Posing the Highest Risk to Young Children. Aerosol and Air Quality Research. 2021;21(9):1–18. https://doi.org/10.4209/aaqr.210062
M. Figueiredo D, Nijssen R, J.M. Krop E, Buijtenhuijs D, Gooijer Y, Lageschaar L, et al. Pesticides in Doormat and Floor Dust From Homes Close to Treated Fields: Spatio-Temporal Variance and Determinants of Occurrence and Concentrations. Environmental Pollution. 2022;301(119024):1–14. https://doi.org/10.1016/j.envpol.2022.119024
Zaller JG, Kruse-PlaíŸ M, Schlechtriemen U, Gruber E, Peer M, Nadeem I, et al. Pesticides in Ambient Air, Influenced by Surrounding Land Use and Weather, Pose a Potential Threat to Biodiversity and Humans. Science of the Total Environment. 2022;838(156012):1–12. https://doi.org/10.1016/j.scitotenv.2022.156012
Dereumeaux C, Fillol C, Quenel P, Denys S. Pesticide Exposures for Residents Living Close to Agricultural Lands: A Review. Environment International. 2020;134(105210):1–14. https://doi.org/10.1016/j.envint.2019.105210
Pawestri IN, Sulistyaningsih E. Neurobehavioral Performance of Indonesian Farmers and its Association With Pesticide Exposure: A Cross-Sectional Study. Clin Epidemiol Glob Heal [Internet]. 2021;11(100754):1–5. https://doi.org/10.1016/j.cegh.2021.100754
Mwabulambo SG, Mrema EJ, Vera Ngowi A, Mamuya S. Health Symptoms Associated with Pesticides Exposure Among Flower and Onion Pesticide Applicators in Arusha Region. Annals of Global Health. 2018;84(3):369–379. https://doi.org/10.29024/aogh.2303
Barrón Cuenca J, Tirado N, Barral J, Ali I, Levi M, Stenius U, et al. Increased Levels of Genotoxic Damage in a Bolivian Agricultural Population Exposed to Mixtures of Pesticides. Science of the Total Environment. 2019;695(133942):1–12. https://doi.org/10.1016/j.scitotenv.2019.133942
Piccoli C, Cremonese C, Koifman R, Koifman S, Freire C. Occupational Exposure to Pesticides and Hematological Alterations: A Survey of Farm Residents in The South of Brazil. Ciíªncia & Saúde Coletiva. 2019;24(6):2325–2340. https://doi.org/10.1590/1413-81232018246.13142017
Manfo FPT, Mboe SA, Nantia EA, Ngoula F, Telefo PB, Moundipa PF, et al. Evaluation of the Effects of Agro Pesticides Use on Liver and Kidney Function in Farmers from Buea, Cameroon. Journal of Toxicology. 2020;2020(2305764):1–10. https://doi.org/10.1155/2020/2305764
Richardson JR, Fitsanakis V, Westerink RHS, Kanthasamy AG. Neurotoxicity of Pesticides. Acta Neuropathologica. 2019;138(3):343–362. https://doi.org/10.1007/s00401-019-02033-9
Shearer JJ, Sandler DP, Andreotti G, Murata K, Shrestha S, Parks CG, et al. Pesticide Use and Kidney Function among Farmers in The Biomarkers of Exposure and Effect in Agriculture Study. Environmental Research. 2021;199(111276):1–8. https://doi.org/10.1016/j.envres.2021.111276
Gatto NM, Ogata P, Lytle B. Farming, Pesticides, and Brain Cancer: A 20-year Updated Systematic Literature Review and Meta-Analysis. Cancers. 2021;13(17):1–24. https://doi.org/10.3390/cancers13174477
Pluth TB, Zanini LAG, Battisti IDE. Pesticide Exposure and Cancer: an Integrative Literature Review. Saúde em Debate. 2019;43(122):906–924. https://doi.org/10.1590/0103-1104201912220
Mdeni NL, Adeniji AO, Okoh AI, Okoh OO. Analytical Evaluation of Carbamate and Organophosphate Pesticides in Human and Environmental Matrices: A Review. Molecules. 2022;27(3):1–21. https://doi.org/10.3390/molecules27030618
Setiawan F, Nurdianto AR, Tena HAB, Yudianto A, Sunariani J, Basori A, et al. Molecular Toxicology of Organophosphate Poisoning. Jurnal Ilmiah Kedokteran Wijaya Kusuma. 2022;11(1):87–95. https://doi.org/10.30742/jikw.v11i1.1596
ÄŒadež T, Kolić D, Å inko G, Kovarik Z. Assessment of Four Organophosphorus Pesticides as Inhibitors of Human Acetylcholinesterase and Butyrylcholinesterase. Scientific Reports. 2021;11(21486):1–11. https://doi.org/10.1038/s41598-021-00953-9
Åžimşek ZÖ. Effects of Organophosphate Poisoning on Endocrine System in Long-Term: A Pilot Study. Erciyes Medical Journal. 2019;41(1):33–36. https://doi.org/10.14744/etd.2019.19122
Berg ZK, Rodriguez B, Davis J, Katz AR, Cooney R V., Masaki K. Association Between Occupational Exposure to Pesticides and Cardiovascular Disease Incidence: The Kuakini Honolulu Heart Program. Journal of the American Heart Association. 2019;8(19):1–9. https://doi.org/10.1161/JAHA.119.012569
Javeres MNL, Habib R, Laure NJ, Shah STA, Valis M, Kuca K, et al. Chronic Exposure to Organophosphates Pesticides and Risk of Metabolic Disorder in Cohort From Pakistan and Cameroon. International Journal of Environmental Research and Public Health. 2021;18(5):1–13. https://doi.org/10.3390/ijerph18052310
Paul KC, Chuang YH, Cockburn M, Bronstein JM, Horvath S, Ritz B. Organophosphate Pesticide Exposure and Differential Genome-wide DNA Methylation. Science of the Total Environment. 2018;645(1):1135–1143. https://doi.org/10.1016/j.scitotenv.2018.07.143
Melanda VS, Galiciolli MEA, Lima LS, Figueiredo BC, Oliveira CS. Impact of Pesticides on Cancer and Congenital Malformation: A Systematic Review. Toxics. 2022;10(11):1–18. https://doi.org/10.3390/toxics10110676
Seesen M, Lucchini RG, Siriruttanapruk S, Sapbamrer R, Hongsibsong S, Woskie S, et al. Association Between Organophosphate Pesticide Exposure and Insulin Resistance in Pesticide Sprayers and Nonfarmworkers. International Journal of Environmental Research and Public Health. 2020;7(21):1–13. https://doi.org/10.3390/ijerph17218140
Ramírez-Santana M, Zúñiga-Venegas L, Corral S, Roeleveld N, Groenewoud H, Velden K Van Der, et al. Reduced Neurobehavioral Functioning in Agricultural Workers and Rural Inhabitants Exposed to Pesticides in Northern Chile and its Association with Blood Biomarkers Inhibition. Environmental Health. 2020;19(1):1–13. https://doi.org/10.1186/s12940-020-00634-6
Salazar-Flores J, Pacheco-Moisés FP, Ortiz GG, Torres-Jasso JH, Romero-Rentería O, Briones-Torres AL, et al. Occupational exposure to organophosphorus and carbamates in farmers in La Cienega, Jalisco, Mexico: oxidative stress and membrane fluidity markers. Journal of Occupational Medicine and Toxicology. 2020;15(1):1–11. https://doi.org/10.1186/s12995-020-00283-y
Rives C, Fougerat A, Ellero-Simatos S, Loiseau N, Guillou H, Gamet-Payrastre L, et al. Oxidative Stress in NAFLD: Role of Nutrients and Food Contaminants. Biomolecules. 2020;10(12):1–69. https://doi.org/10.3390/biom10121702
Nejatifar F, Abdollahi M, Attarchi M, Roushan ZA, Deilami AE, Joshan M, et al. Evaluation of hematological indices among insecticides factory workers. Heliyon. 2022;8(3):1–6. https://doi.org/10.1016/j.heliyon.2022.e09040
Bao W, Liu B, Simonsen DW, Lehmler HJ. Association Between Exposure to Pyrethroid Insecticides and Risk of All-Cause and Cause-Specific Mortality in the General US Adult Population. JAMA Internal Medicine. 2020;180(3):367–374. https://doi.org/10.1001/jamainternmed.2019.6019
Sobolev VE, Sokolova MO, Jenkins RO, Goncharov N V. Molecular Mechanisms of Acute Organophosphate Nephrotoxicity. International Journal of Molecular Science. 2022;23(16):1–28. https://doi.org/10.3390/ijms23168855
Chung Y-L, Hou Y-C, Wang I-K, Lu K-C, Yen T-H. Organophosphate Pesticides and New-onset Diabetes Mellitus: From Molecular Mechanisms to a Possible Therapeutic Perspective. World Journal of Diabetes. 2021;12(11):1818–1831. https://doi.org/10.4239/wjd.v12.i11.1818
Rajender Kumar K, Liyaqat Shareef M. A Study Profile of Deaths Due to Carbamate Poisoning and its Management in Hyderabad Region. Indian Journal of Forensic and Community Medicine. 2021;6(4):233–239. https://doi.org/10.18231/j.ijfcm.2019.050
Zhang J, Guo J, Wu C, Qi X, Jiang S, Zhou T, et al. Early-life Ccarbamate Exposure and Intelligence Quotient of Seven-year-old Children. Environment International. 2020;145(106105):1–7. https://doi.org/10.1016/j.envint.2020.106105
Hansen MRH, Jí¸rs E, Sandbí¦k A, Sekabojja D, Ssempebwa JC, Mubeezi R, et al. Organophosphate and Carbamate Insecticide Exposure is Related to Lung Function Change among Smallholder Farmers: A Prospective Study. Thorax. 2021;76(8):780–789. http://dx.doi.org/10.1136/thoraxjnl-2020-214609
Piel C, Pouchieu C, Carles C, Béziat B, Boulanger M, Bureau M, et al. Agricultural Exposures to Carbamate Herbicides and Fungicides and Central Nervous System Tumour Incidence in the Cohort AGRICAN. Environment International. 2019;130(104876):1–11. https://doi.org/10.1016/j.envint.2019.05.070
Klatka BZ, TerpiÅ‚owski M, OrzeÅ‚ AK, Janeczko D, HoÅ‚owczuk M, Tchórz M, et al. Severe Carbamates Intoxicationof 43-year-old Farmer – Case Report. Annals of Agricultural and Environment Medicine. 2021; 28(2):358–360. https://doi.org/10.26444/aaem/121067
Jurewicz J, Radwan P, Wielgomas B, Radwan M, Karwacka A, KaÅ‚użny P, et al. Exposure to Pyrethroid Pesticides and Ovarian Reserve. Environment International. 2020;144(106028):1–5. https://doi.org/10.1016/j.envint.2020.106028
HoÅ‚yÅ„ska-Iwan I, Szewczyk-Golec K. Pyrethroids: How They Affect Human and Animal Health? Medicina (Kaunas). 2020;56(11):1–5. https://doi.org/10.3390%2Fmedicina56110582
Ye X, Liu J. Effects of Pyrethroid Insecticides on Hypothalamic-Pituitary-Gonadal Axis: A Reproductive Health Perspective. Environmental Pollution. 2019;245(1):590–599. https://doi.org/10.1016/j.envpol.2018.11.031
Burns CJ, Pastoor TP. Pyrethroid Epidemiology: a Quality-Based Review. Critical Reviews in Toxicology. 2018;48(4):297–311. https://doi.org/10.1080/10408444.2017.1423463
Mörtl M, Vehovszky Á, Klátyik S, Takács E, GyÅ‘ri J, Székács A. Neonicotinoids: Spreading, Translocation and Aquatic Toxicity. International Journal of Environmental Research and Public Health. 2020;17(6):1–24. https://doi.org/10.3390/ijerph17062006
Thompson DA, Lehmler HJ, Kolpin DW, Hladik ML, Vargo JD, Schilling KE, et al. A Critical Review on the Potential Impacts of Neonicotinoid Insecticide Use: Current Knowledge of Environmental Fate, Toxicity, and Implications for Human Health. Environmental Science: Process & Impacts. 2020;22(6):1315–1346. https://doi.org/10.1039/c9em00586b
Schmidt S. Promotional Consideration: A Potential Mechanistic Link Between Neonicotinoid Insecticides and Hormone-Dependent Breast Cancer. Environmental Health Perspectives. 2018;126(11):10–11. https://doi.org/10.1289/EHP4097
Verebová V, Želonková K, HoleÄková B, StaniÄová J. The Effect of Neonicotinoid Insecticide Thiacloprid on The Structure and Stability of DNA. Physiological Research. 2019;68(Suppl.4):S459–S466. https://doi.org/10.33549/PHYSIOLRES.934385
Kara M, Öztaş E, Özhan G. Acetamiprid-induced Cyto-and Genotoxicity in the AR42J Pancreatic Cell Lbine. Turkish Journal of Pharmaceutical Sciences. 2020;17(5):474–479. https://doi.org/10.4274/tjps.galenos.2019.89719
Zhang D, Lu S. Human Exposure to Neonicotinoids and the Associated Health Risks: A Review. Environment International. 2022;163(107201):1–13. https://doi.org/10.1016/j.envint.2022.107201
Chung MJ, Mao YC, Hsu CT, Chung MC, Wang TJ, Yu TM, et al. A Fatal Case of Chlorfenapyr Poisoning and the Therapeutic Implications of Serum Chlorfenapyr and Tralopyril Levels. Medicina. 2022;58(11):5–10. https://doi.org/10.3390/medicina58111630
Han SK, Yeom SR, Lee SH, Park SC, Kim H Bin, Cho YM, et al. A Fatal Case of Chlorfenapyr Poisoning Following Dermal Exposure. Hong Kong Journal of Emergency Medicine. 2019;26(6):375–378. https://doi.org/10.1177/1024907918782065
Kim JH, Park NH, Park JY, Kim SJ. Magnetic Resonance Imaging and Clinical Features of Chlorfenapyr-induced Toxic Leukoencephalopathy: A Case Report. Journal of the Korean Society of Radiology. 2020;81(4):985–989. https://doi.org/10.3348/jksr.2020.81.4.985
Ren Y, He X, Yan X, Yang Y, Li Q, Yao T, et al. Unravelling the Polytoxicology of Chlorfenapyr on Non-Target HepG2 Cells: The Involvement of Mitochondria-Mediated Programmed Cell Death and DNA Damage. Molecules. 2022;27(17):1–15. https://doi.org/10.3390/molecules27175722
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. Copyright of all journal manuscripts is held by the Jurnal Kesehatan Lingkungan.2. Formal legal provisions to access digital articles of electronic journal are subject to the provision of the Creative Commons Attribution-ShareAlike license (CC BY-NC-SA), which means that Jurnal Kesehatan Lingkungan is rightful to keep, transfer media/format, manage in the form of databases, maintain, and publish articles.
3. Published manuscripts both printed and electronic are open access for educational, research, and library purposes. Additionally, the editorial board is not responsible for any violations of copyright law.
JKESLING by UNAIR is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.