Malaria control insecticide residues in breast milk: the need to consider infant health risks

The Association between Long-Term DDT or DDE Exposures and an Altered Sperm Epigenome-a Cross-Sectional Study of Greenlandic Inuit and South African VhaVenda Men

BACKGROUND

The organochlorine dichlorodiphenyltrichloroethane (DDT) is banned worldwide owing to its negative health effects. It is exceptionally used as an insecticide for malaria control. Exposure occurs in regions where DDT is applied, as well as in the Arctic, where its endocrine disrupting metabolite, p , p ' -dichlorodiphenyldichloroethylene (p , p ' -DDE) accumulates in marine mammals and fish. DDT and p , p ' -DDE exposures are linked to birth defects, infertility, cancer, and neurodevelopmental delays. Of particular concern is the potential of DDT use to impact the health of generations to come via the heritable sperm epigenome.

OBJECTIVES

The objective of this study was to assess the sperm epigenome in relation to p , p ' -DDE serum levels between geographically diverse populations.

METHODS

In the Limpopo Province of South Africa, we recruited 247 VhaVenda South African men and selected 50 paired blood serum and semen samples, and 47 Greenlandic Inuit blood and semen paired samples were selected from a total of 193 samples from the biobank of the INUENDO cohort, an EU Fifth Framework Programme Research and Development project. Sample selection was based on obtaining a range of p , p ' -DDE serum levels (mean = 870.734 ± 134.030  ng / mL ). We assessed the sperm epigenome in relation to serum p , p ' -DDE levels using MethylC-Capture-sequencing (MCC-seq) and chromatin immunoprecipitation followed by sequencing (ChIP-seq). We identified genomic regions with altered DNA methylation (DNAme) and differential enrichment of histone H3 lysine 4 trimethylation (H3K4me3) in sperm.

RESULTS

Differences in DNAme and H3K4me3 enrichment were identified at transposable elements and regulatory regions involved in fertility, disease, development, and neurofunction. A subset of regions with sperm DNAme and H3K4me3 that differed between exposure groups was predicted to persist in the preimplantation embryo and to be associated with embryonic gene expression.

DISCUSSION

These findings suggest that DDT and p , p ' -DDE exposure impacts the sperm epigenome in a dose-response-like manner and may negatively impact the health of future generations through epigenetic mechanisms. Confounding factors, such as other environmental exposures, genetic diversity, and selection bias, cannot be ruled out. https://doi.org/10.1289/EHP12013.

Postnatal exposure to organic pollutants in maternal milk in north-western Spain

Evaluation of postnatal exposure to organic pollutants is especially important for suckling infants during breastfeeding, a crucial perinatal growth period when organs and hormonal systems develop. We determined levels of 60 pollutants, including organochlorine pesticides (OCPs), organophosphorus pesticides (OPPs), pyrethroids (PYRs), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and polybrominated diphenyl ethers (PBDEs), in 81 breast milk samples from breastfeeding mothers from Santiago de Compostela (north-western Spain). For most detected organic pollutants, levels were correlated with the season of milk sampling, maternal age at delivery, and place of residence. Dietary consumption habits (eggs, molluscs, and vegetable oils) were also correlated with OCP, OPP, PCB, PBDE and PYR levels. We also assessed the risk to infant health of exposure to organic pollutants in breast milk. PAHs, OCPs, OPPs, and PYRs accounted for almost 95% of the targeted organic pollutants in the samples analysed.

Occurrence of pyrethroids in the atmosphere of urban areas of Southeastern Brazil: Inhalation exposure and health risk assessment

The occurrence of organochlorine pesticides (OCPs) used decades ago for vector control in urban areas is still reported as a threat to human health. Pyrethroids emerged as a replacement for OCPs in sanitary campaigns and are currently the main insecticides used for vector control worldwide, with prominent use as agricultural and household insecticides, for veterinary and gardening purposes, and as wood preservative. This study aimed to assess the occurrence, seasonal variation, and potential sources of pyrethroids in ambient air of two urban regions of Southeastern Brazil, along with the potential health risks to local populations via inhalation exposure. Pyrethroids were sampled by polyurethane foam passive air samplers and their concentrations were determined by gas chromatography coupled with electron capture negative ionization mass spectrometry (GC/ECNI-MS). Atmospheric pyrethroid concentrations (hereinafter reported in pg m^-3) were considerably higher than those reported by previous studies worldwide. Cypermethrin (median: 2446; range: 461-15 125) and permethrin (655; 19-10 328) accounted for 95% of the total measured pyrethroids in ambient air. The remaining fraction comprised smaller amounts of bifenthrin (46; <limit of detection (LOD)-5171), deltamethrin (58; <LOD-564), phenothrin (7; <LOD-22) and fenvalerate (0.3; <LOD-3). Bifenthrin, deltamethrin and permethrin were linked to local sources, while cypermethrin, fenvalerate and phenothrin had more prominent regional contributions. In broad terms, most pyrethroids showed no clear seasonal trend. The concentrations and hazard quotients (HQs) showed the following order of occurrence and magnitude: urban > urban-industrial > background areas. HQs increased with decreasing age group, but deterministic and probabilistic estimates did not identify direct health risks for any group. Nevertheless, since only inhalation exposure was considered in this work, other pathways should be investigated to provide a more comprehensive risk assessment of the human exposure to pyrethroids.

Diabetes and Toxicant Exposure

The worldwide prevalence of obesity has near tripled between 1975 and 2016. Diabetes was the direct cause of an estimated 1.6 million deaths in 2015. Diabetogens, otherwise known as toxicants that cause insulin resistance in animal models and humans as a result of pancreatic β-cell damage include the persistent organochlorine pesticides trans-nonachlor, oxychlordane, and DDE -the main metabolite of DDT, as well as another class of persistent organic pollutants, polychlorinated biphenyls (PCBs). Other toxicants that are now considered diabetogens: BPA, arsenic, phthalates, perfluorinates (PFOS), diethyl hexyl phthalate (DEHP), and dioxin (TCDD) are commonly found in the blood and urine in the CDC NHANES populations and presumed to also be commonly found in the U.S. population as a whole. A review of the literature on the risk for diabetes in epidemiologic studies considering these toxicants, challenges for clinicians using lab testing for these diabetogens, and the necessary interventions for lowering body burden of persistent toxicants are discussed.

Air contamination by legacy and current-use pesticides in Brazilian mountains: An overview of national regulations by monitoring pollutant presence in pristine areas

In the last decades, research regarding the dynamics of pesticides has grown, even in remote regions. Due to long-range atmospheric transport, environmental persistence and toxicological potential of organochlorine pesticides (OCPs), similar characteristics of current-use pesticides (CUPs) and their massive use in Brazil, these contaminants have become a major concern for environmental and human life. Thus, this study aimed to evaluate subgroups or individual chemicals of OCPs and CUPs, which could have travelled over two Conservation Unit sites in the Rio de Janeiro state. The study was carried out for 24 months, (2013-2015), in Itatiaia National Park (INP) and in the Serra dos Órgãos National Park (SONP), at ∼2400 and ∼2200 meters above sea level, respectively. The study was based on atmospheric passive sampling (polyurethane foam disks). Target pesticides were detected by means of gas chromatography device coupled with mass spectrometry (GC-MS). Significantly higher concentrations were measured in SONP when compared to INP. However, in broad terms, the contamination profile was quite similar for both national parks: The highest concentrations of endosulfan (INP - 1275 pg m^-3 and SONP - 3202 pg m^-3) were followed by cypermethrin (INP - 148 pg m^-3 and SONP - 881 pg m^-3) and chlorpyrifos (INP - 67 pg m^-3 and SONP - 270 pg m^-3). In agreement with previous studies, the atmospheric concentrations of legacy OCPs showed background air levels. The decrease of endosulfan over the years was highlighted with a parallel increase of chlorpyrifos, suggesting a collateral effect of the national bias of permissive and massive use of agrochemicals. CUPs seemed to behave like pseudo-persistent pollutants (pseudo-POPs). This is the first report of atmospheric concentrations of pyrethroids in Brazilian mountain regions, and possibly the first to investigate them in the air in South America or in any mountain region in the world.

Early-life exposure to p,p'-DDT and p,p'-DDE in South African children participating in the VHEMBE study: An assessment using repeated serum measurements and pharmacokinetic modeling

BACKGROUND

The World Health Organization recommends indoor residual spraying (IRS) of insecticides (including dichlorodiphenyltrichloroethane [DDT]) to fight malaria vectors in endemic countries. There is limited information on children's exposure to DDT in sprayed areas, and tools to estimate early-life exposure have not been thoroughly evaluated in this context.

OBJECTIVES

To document serum p,p'-DDT/E levels in 47 mothers and children participating in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), a study conducted in an area where IRS insecticides are used annually, and to evaluate the precision and accuracy of a published pharmacokinetic model for the estimation of children's p,p'-DDT/E levels.

METHODS

p,p'-DDT/E levels were measured in maternal serum at delivery, and in children's serum at 12 and 24 months of age. A pharmacokinetic model of gestational and lactational exposure was used to estimate children's p,p'-DDT/E levels during pregnancy and the first two years of life, and estimated levels were compared to measured levels.

RESULTS

The geometric means of children's serum p,p'-DDT/E levels at 12 and 24 months were higher than those of maternal serum levels. Regression models of measured children's p,p'-DDT/E levels vs. levels estimated with the pharmacokinetic model (which only accounted for children's exposure through placental transfer and breastfeeding) had coefficients of determination (R2) ranging from 0.75 to 0.82. Estimated p,p'-DDE levels were not significantly different from measured levels, whereas p,p'-DDT levels were overestimated by 36% at 12 months, and 51% at 24 months.

CONCLUSION

Results indicate that children living in a sprayed area have serum p,p'-DDT/E levels exceeding their mothers' during the first two years of life. The pharmacokinetic model may be useful to estimate children's levels in the VHEMBE population.

Fish consumption from urban impoundments: What are the health risks associated with DDTs and other organochlorine pesticides in fish to township residents of a major inland city

Organochlorine pesticides (OCPs) in South Africa have for the most part been banned, except dichlorodiphenyltrichloroethane (DDT) which is still used as malaria vector control. The aim of this study was to determine OCP residues in the aquatic fauna of one of South Africa's most populated areas, Soweto. Risk to human health through OCP exposure via fish consumption was investigated. Clarias gariepinus was chosen as bioindicator because it is an apex predator that is in abundance, but is also a valued food source. Dichlorodiphenyltrichloroethanes (DDTs), hexachlorocyclohexanes (HCHs), and chlordanes (CHLs) were detected in the fish tissue with the DDTs being the most prevalent at all sites. Of the three locations, Fleurhof, Orlando, and Lenasia, the latter location's fish had the highest ΣOCP load, ranging between 81 and 1190ng/gwm. The DDTs were determined to be from historic use, whereas the CHL levels indicated more recent inputs. Although the possibility of illegal use cannot be excluded completely, the presence of OCPs outside of their allowed areas of use indicate that these compounds not only stay in the aquatic systems long term, but may be of concern in areas previously not considered high risk areas. The OCP residues in C. gariepinus from the study area pose an extremely high risk to human health when consumed, and has a cancer risk as high as 1 in 10. This potential problem should be kept in consideration when developing national health and conservation strategies.

Breast milk intake and mother to infant pesticide transfer measured by deuterium oxide dilution in agricultural and urban areas of Mexico

Vector-borne diseases have increased pesticide use in urban areas (UA) and agricultural areas (AA) in Mexico. Breast milk can be contaminated by pesticide exposure. The objective of the study was to measure breast milk intake by deuterium oxide dilution as well as organochlorine and pyrethroid transfer from mother to infant in AA and UA of Sonora, Mexico. Human milk intake was determined by the 'dose-to-mother' technique using deuterium oxide (D₂O) dilution. Mothers' body composition was also assessed by this technique and the intercept method. Pyrethroids (deltamethrin, cypermethrin and cyhalothrin) and organochlorine pesticide residues (p,p'- DDT, p,p'- DDE, p,p'- DDD) in breast milk samples were measured by gas chromatography. Sixty-two lactating women and their infants participated in the study, 32 lived in the UA and 30 lived in the AA. Breast milk intake was approximately 100 mL higher in the AA than in the UA 799 ± 193 and 707 ± 201 mL/day, respectively (p < 0.05). The concentrations of p,p'- DDT and cypermethrin levels in breast milk were higher in the UA than in the AA (p < 0.05 and p = 0.001, respectively). None of the pyrethroids and organochlorine pesticides studied surpassed the Acceptable Daily Intake (ADI) in milk for humans according to EPA and FAO/WHO. In conclusion, breast milk intake was higher in the AA compared to the UA. The p,p'- DDT and cypermethrin levels in breast milk were higher in the UA compared to the AA. Since pesticide levels in human milk did not exceed the ADI, breastfeeding is still a safe practice and should be encouraged.

Urinary Concentrations of Insecticide and Herbicide Metabolites among Pregnant Women in Rural Ghana: A Pilot Study

Use of pesticides by households in rural Ghana is common for residential pest control, agricultural use, and for the reduction of vectors carrying disease. However, few data are available about exposure to pesticides among this population. Our objective was to quantify urinary concentrations of metabolites of organophosphate (OP), pyrethroid, and select herbicides during pregnancy, and to explore exposure determinants. In 2014, 17 pregnant women from rural Ghana were surveyed about household pesticide use and provided weekly first morning urine voids during three visits (n = 51 samples). A total of 90.1% (46/51) of samples had detectable OP metabolites [geometric mean, GM (95% CI): 3,5,6-trichloro-2-pyridinol 0.54 µg/L (0.36–0.81), para-nitrophenol 0.71 µg/L (0.51–1.00)], 75.5% (37/49) had detectable pyrethroid metabolites [GM: 3-phenoxybenzoic acid 0.23 µg/L (0.17, 0.32)], and 70.5% (36/51) had detectable 2,4-dichlorophenoxyacetic acid levels, a herbicide [GM: 0.46 µg/L (0.29–0.73)]. Concentrations of para-nitrophenol and 2,4-dichlorophenoxyacetic acid in Ghanaian pregnant women appear higher when compared to nonpregnant reproductive-aged women in a reference U.S. population. Larger studies are necessary to more fully explore predictors of exposure in this population.

Modeling the dynamics of DDT in a remote tropical floodplain: indications of post-ban use?

Significant knowledge gaps exist regarding the fate and transport of persistent organic pollutants like dichlorodiphenyltrichloroethane (DDT) in tropical environments. In Brazil, indoor residual spraying with DDT to combat malaria and leishmaniasis began in the 1950s and was banned in 1998. Nonetheless, high concentrations of DDT and its metabolites were recently detected in human breast milk in the community of Lake Puruzinho in the Brazilian Amazon. In this work, we couple analysis of soils and sediments from 2005 to 2014 at Puruzinho with a novel dynamic floodplain model to investigate the movement and distribution of DDT and its transformation products (dichlorodiphenyldichloroethylene (DDE) and dichlorodiphenyldichloroethane (DDD)) and implications for human exposure. The model results are in good agreement with the accumulation pattern observed in the measurements, in which DDT, DDE, and DDD (collectively, DDX) accumulate primarily in upland soils and sediments. However, a significant increase was observed in DDX concentrations in soil samples from 2005 to 2014, coupled with a decrease of DDT/DDE ratios, which do not agree with model results assuming a post-ban regime. These observations strongly suggest recent use. We used the model to investigate possible re-emissions after the ban through two scenarios: one assuming DDT use for IRS and the other assuming use against termites and leishmaniasis. Median DDX concentrations and p,p'-DDT/p,p'-DDE ratios from both of these scenarios agreed with measurements in soils, suggesting that the soil parameterization in our model was appropriate. Measured DDX concentrations in sediments were between the two re-emission scenarios. Therefore, both soil and sediment comparisons suggest re-emissions indeed occurred between 2005 and 2014, but additional measurements would be needed to better understand the actual re-emission patterns. Monte Carlo analysis revealed model predictions for sediments were very sensitive to highly uncertain parameters associated with DDT degradation and partitioning. With this model as a tool for understanding inter-media cycling, additional research to refine these parameters would improve our understanding of DDX fate and transport in tropical sediments.

Risk of DDT residue in maize consumed by infants as complementary diet in southwest Ethiopia

Infants in Ethiopia are consuming food items such as maize as a complementary diet. However, this may expose infants to toxic contaminants like DDT. Maize samples were collected from the households visited during a consumption survey and from markets in Jimma zone, southwestern Ethiopia. The residues of total DDT and its metabolites were analyzed using the Quick, Easy, Cheap, Effective, Rugged and Safe (QuEChERS) method combined with dispersive solid phase extraction cleanup (d-SPE). Deterministic and probabilistic methods of analysis were applied to determine the consumer exposure of infants to total DDT. The results from the exposure assessment were compared with the health based guidance value in this case the provisional tolerable daily intake (PTDI). All maize samples (n=127) were contaminated by DDT, with a mean concentration of 1.770 mg/kg, which was far above the maximum residue limit (MRL). The mean and 97.5 percentile (P 97.5) estimated daily intake of total DDT for consumers were respectively 0.011 and 0.309 mg/kg bw/day for deterministic and 0.011 and 0.083 mg/kg bw/day for probabilistic exposure assessment. For total infant population (consumers and non-consumers), the 97.5 percentile estimated daily intake were 0.265 and 0.032 mg/kg bw/day from the deterministic and probabilistic exposure assessments, respectively. Health risk estimation revealed that, the mean and 97.5 percentile for consumers, and 97.5 percentile estimated daily intake of total DDT for total population were above the PTDI. Therefore, in Ethiopia, the use of maize as complementary food for infants may pose a health risk due to DDT residue.

Permethrin and its metabolites affect Cu/Zn superoxide conformation: fluorescence and in silico evidences

Permethrin and its metabolites affect the structure and activity of Cu/Zn superoxide dismutase (SOD), as it results from intrinsic fluorescence, 8-ANS fluorescence techniques and in silico studies.

High levels of DDT in breast milk: intake, risk, lactation duration, and involvement of gender

We investigated presence and levels of DDT in 163 breast milk samples from four South African villages where, in three of them, malaria is controlled with DDT-sprayed indoors. Mean ΣDDT levels in breast milk were 18, 11, and 9.5 mg/kg mf (milk fat) from the three DDT-sprayed villages, respectively, including the highest ΣDDT level ever reported for breast milk from South Africa (140 mg/kg mf). Understanding the causes for these differences would be informative for exposure reduction intervention. The Provisional Tolerable Daily Intake (PTDI) for DDT by infants, and the Maximum Residue Limit (MRL) were significantly exceeded. DDT had no effect on duration of lactation. There were indications (not significant) from DDT-sprayed villages that first-born female infants drink milk with more ΣDDT than first-born male infants, and vice versa for multipara male and female infants, suggesting gender involvement on levels of DDT in breast milk - requiring further investigation.

Pyrethroids: a new threat to marine mammals?

The present study constitutes the first investigation to demonstrate pyrethroid bioaccumulation in marine mammals, despite the assumption that these insecticides are converted to non-toxic metabolites by hydrolysis in mammals. Twelve pyrethroids were determined in liver samples from 23 male franciscana dolphins from Brazil. The median concentration values for total pyrethroids were 7.04 and 68.4 ng/g lw in adults and calves, respectively. Permethrin was the predominant compound, contributing for 55% of the total pyrethroids. Results showed a distinct metabolic balance of pyrethroids through dolphin life. High loads are received at the beginning of their lives and, when they reach sexual maturity, these mammals seem to degrade/metabolize pyrethroids. Maternal transfer of these compounds was also evaluated through the analysis of breast milk and placenta samples. Pyrethroids were detected in both matrices, with values between 2.53-4.77 ng/g lw and 331-1812 ng/g lw, respectively. Therefore, for the first time, a study shows mother-to-calf transfer of pyrethroids by both gestational and lactation pathways in dolphins.

Estimation of human body concentrations of DDT from indoor residual spraying for malaria control

Inhabitants of dwellings treated with DDT for indoor residual spraying show high DDT levels in blood and breast milk. This is of concern since mothers transfer lipid-soluble contaminants such as DDT via breastfeeding to their children. Focusing on DDT use in South Africa, we employ a pharmacokinetic model to estimate DDT levels in human lipid tissue over the lifetime of an individual to determine the amount of DDT transferred to children during breastfeeding, and to identify the dominant DDT uptake routes. In particular, the effects of breastfeeding duration, parity, and mother's age on DDT concentrations of mother and infant are investigated. Model results show that primiparous mothers have greater DDT concentrations than multiparous mothers, which causes higher DDT exposure of first-born children. DDT in the body mainly originates from diet. Generally, our modeled DDT levels reproduce levels found in South African biomonitoring data within a factor of 3.

Prenatal exposure to DDT in malaria endemic region following indoor residual spraying and in non-malaria coastal regions of South Africa

Exemption was granted by the Stockholm Convention in 2004 for use of DDT by indoor residual spraying (IRS) as a malaria vector control. South Africa endorsed the use of DDT in its Malaria Control Programmes in malaria endemic regions and IRS remains a primary method of controlling malaria transmitting mosquitoes in this country. This study examines the impact of IRS on the levels of DDT and its metabolites in maternal blood of delivering women as a measure of prenatal exposure. We report on the concentrations of DDT and its metabolites (p,p'- DDE, p,p'-DDT, o,p'-DDE, o,p'-DDD, p,p'-DDD, and o,p'-DDT) in maternal plasma of 255 delivering women residing in three sites along Indian Ocean, namely in malaria endemic where IRS takes place, low risk and non-malaria sites. Concentrations of measured compounds were found to be significantly higher in the malaria endemic site (p=0.0001): the geometric mean concentration (95% confidence intervals; n=91) for o,p'-DDE was 9 ng/g lipids (7-10); for p,p'-DDE, 3840 ng/g lipids (3008-4902); for o,p'-DDD, 8 ng/g lipids (6-9); for p,p'-DDD, 26 ng/g lipids (20-32); for o,p'-DDT, 168 ng/g lipids (127-221) and for p,p'-DDT, 2194 ng/g lipids (1706-2823). These compounds were also detected in women residing in other sites but in lower concentrations. The maternal characteristics, age, IRS, number of children and breastfeeding were significantly associated for both p,p'-DDE and p,p'-DDT levels in the malaria area where exposure through IRS is predominant. There was no association between maternal characteristics and DDT levels in the low risk and non-malaria area. Results presented are of particular value to the policy decision makers and regulatory toxicology organizations as they characterise the extent of controlled exposure to DDT used exclusively for IRS purposes. Furthermore, findings of this study will form a base for further investigation of foetal exposure to pollutants.

Public health concern behind the exposure to persistent organic pollutants and the risk of metabolic diseases

Background

Persistent organic pollutants (POPs) are hazardous chemicals omnipresent in our food chain, which have been internationally regulated to ensure public health. Initially described for their potency to affect reproduction and promote cancer, recent studies have highlighted an unexpected implication of POPs in the development of metabolic diseases like type 2 diabetes and obesity. Based on this novel knowledge, this article aims at stimulating discussion and evaluating the effectiveness of current POP legislation to protect humans against the risk of metabolic diseases. Furthermore, the regulation of POPs in animal food products in the European Union (EU) is addressed, with a special focus on marine food since it may represent a major source of POP exposure to humans.

Discussion

There is mounting scientific evidence showing that current POP risk assessment and regulation cannot effectively protect humans against metabolic disorders. Better regulatory control of POPs in dietary products should be of high public health priority.

Summary

The general population is exposed to sufficient POPs, both in term of concentration and diversity, to induce metabolic disorders. This situation should attract the greatest attention from the public health and governmental authorities.

Development and application of an indirect competitive enzyme-linked immunosorbent assay for the detection of p,p'-DDE in human milk and comparison of the results against GC-ECD

1,1-Dichloro-2,2-bis(p-chlorophenyl) ethylene (p,p'-DDE) is the major metabolite of insecticide 2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane (p,p'-DDT) and a persistent organic pollutant (POPs) with concerns regarding its bioaccumulation and persistence in the environment and food chain. In the present study, an indirect competitive enzyme-linked immunosorbant assay (ic-ELISA) specific for the detection of p,p'-DDE is described. In hapten synthesis, 2,2'-bis(4-chlorophenyl)ethanol and glutaric anhydride were used as precursor and spacer arm, respectively. The hapten was then conjugated to bovine serum albumin (BSA) as immunogen for mouse immunization and also conjugated to ovalbumin as coating antigen for ELISA. The developed ic-ELISA was used for detecting p,p'-DDE in human milk samples and validated against the results from conventional gas chromatography-electron capture detection (GC-ECD). Coefficients of variation (%CV) of ELISA were 5.7-10.4% for intra-assay and 10.6-19.6% for interassay variations. The Pearson correlation coefficient of p,p'-DDE concentrations between ic-ELISA and GC-ECD was r = 0.766, which was in an acceptable range. The results indicate that the developed assay could be an alternative analytical tool for monitoring p,p'-DDE in lipimic matrices such as human milk.

Pyrethroid use-malaria control and individual applications by households for other pests and home garden use

Presence of pyrethroid insecticides in human breast milk and in thatch wall material of dwellings from Southern Africa subtropical area (Manhiça, Mozambique) was investigated to assess potential pyrethroid route of human exposure. Human breast milk samples were collected during 2002 when pyrethroids were widely used as insecticides for mosquito bed nets in Mozambique for malaria control. The median concentration value of total pyrethroids ranged between 87 and 1200ng/glw, with λ-cyhalothrin being the most predominant pyrethroid in human breast milk contributing for 35% of the total amount. Moreover, and for the first time, an isomer-specific enrichment was found in human breast milk, showing a selective isomeric accumulation or metabolism in the human body. Based on the calculated pyrethroid concentrations in human breast milk, the daily ingestion rate of pyrethroid was estimated. The nursing infant dietary intake ranged from 0.67 to 9.0μg(kg of body weight)(-1)day(-1). In addition, thatch materials collected after the reintegration of dichlorodiphenyltrichloroethene (DDT) as insecticide residual spraying (IRS) in Mozambique, showed the presence of pyrethroids with concentration values ranging between 6.9 and 700ng/gdw. In thatch material as well as in human breast milk, pyrethroid contamination was mainly attributed to the agriculture usage of this insecticide knowing that agriculture represent the 80% of the economy in Mozambique. However, a possible usage of this insecticide as IRS in Mozambique cannot be excluded despite their low efficiency for malaria control. The continued use of these compounds (both for agriculture and malaria prevention) and the ingestion rates calculated from the breast milk concentrations indicate that these insecticides cannot be overlooked for the assessment of the lactation risks of breastfeeding infants from the Manhiça region.

Knowledge and practices of in-home pesticide use: a community survey in Uganda

Many communities in low-income countries use in-home pesticides for the control of pests. Such use is often inadequately controlled. In this study, 100 households in Kireka ward, Wakiso district in Uganda were involved in a cross-sectional survey to assess pests, knowledge, and use patterns of pesticides. A structured pretested questionnaire was administered via personal interviews, and observational checklists were used. Mosquitoes were the most prevalent pests (83%), followed by cockroaches (69%) and rats (52%). Pesticides were the most preferred method for pest control (98%), with insecticide spray being the most common form of application (71.4%). Pesticide application was inappropriately done in many households mainly due to inadequate knowledge on use. Only 48% of the respondents read manufacturer's instructions for use. Information on what pesticide to use was obtained from friends (53.1%), points of sales (48%). Educational interventions particularly at points of sale would be a critical avenue for promoting safe use of pesticides in households.

DDT and malaria prevention: addressing the paradox

BACKGROUND

The debate regarding dichlorodiphenyltrichloroethane (DDT) in malaria prevention and human health is polarized and can be classified into three positions: anti-DDT, centrist-DDT, pro-DDT.

OBJECTIVE

We attempted to arrive at a synthesis by matching a series of questions on the use of DDT for indoor residual spraying (IRS) with literature and insights, and to identify options and opportunities.

DISCUSSION

Overall, community health is significantly improved through all available malaria control measures, which include IRS with DDT. Is DDT "good"? Yes, because it has saved many lives. Is DDT safe as used in IRS? Recent publications have increasingly raised concerns about the health implications of DDT. Therefore, an unqualified statement that DDT used in IRS is safe is untenable. Are inhabitants and applicators exposed? Yes, and to high levels. Should DDT be used? The fact that DDT is "good" because it saves lives, and "not safe" because it has health and environmental consequences, raises ethical issues. The evidence of adverse human health effects due to DDT is mounting. However, under certain circumstances, malaria control using DDT cannot yet be halted. Therefore, the continued use of DDT poses a paradox recognized by a centrist-DDT position. At the very least, it is now time to invoke precaution. Precautionary actions could include use and exposure reduction.

CONCLUSIONS

There are situations where DDT will provide the best achievable health benefit, but maintaining that DDT is safe ignores the cumulative indications of many studies. In such situations, addressing the paradox from a centrist-DDT position and invoking precaution will help design choices for healthier lives.

Assessment of nonoccupational exposure to DDT in the tropics and the north: relevance of uptake via inhalation from indoor residual spraying

BACKGROUND

People who live in dwellings treated with indoor residual spraying (IRS) of DDT [1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane] for disease-vector control in the tropics and indigenous populations in the Arctic who consume marine mammals experience high nonoccupational exposure to DDT. Although the use of DDT in IRS is rising, the resulting nonoccupational exposure is poorly characterized.

OBJECTIVES

We have provided a comparative assessment of exposure to DDT and its metabolites in the general population of the tropical and northern regions and in highly exposed populations in these regions.

METHODS

We compiled > 600 average or median DDT concentrations from the peer-reviewed literature, representing > 23,000 individual measurements in humans, food, air, soil, and dust. We use Monte Carlo sampling of distributions based on these data to estimate distributions of population- and route-specific uptake. We evaluate our exposure estimates by comparing them with biomonitoring data.

RESULTS

DDT concentrations are highest in people living in IRS-treated houses and lowest in the northern general population, differing by a factor of about 60. Inuits and the general population in the tropics have similar concentrations. Inhalation exposure explains most of the difference in concentration between the highly exposed and the general population in the Tropics. Calculated exposure levels are consistent with human biomonitoring data.

CONCLUSIONS

Nonoccupational inhalation exposure is a relevant exposure pathway for people living in homes treated by IRS of DDT. Continued monitoring of time trends and DDE to DDT ratios in the Tropics and in the North is needed to identify a possible slowdown in concentration decline and the influence of ongoing DDT use.

Human exposure to persistent organic pollutants in West Africa--a temporal trend study from Guinea-Bissau

BACKGROUND

Humans, independent on where they live, are exposed to complex and various mixtures of chemicals, including persistent organic pollutants (POPs). The variability of the exposure depends on sources of the chemicals and is influenced by e.g. geography, social and cultural heritage. While exposures to POPs are frequently studied in populations from developed industrial countries, very little is known on levels and trends of POPs in developing countries, especially in Africa.

OBJECTIVES

The aim of the present study was to investigate levels and temporal trends of POPs in adults from Guinea-Bissau.

METHODS

Serum samples were obtained from an open cohort of police officers in Guinea-Bissau. Repeated samples from 33 individuals were obtained at five time points between 1990 and 2007, in all 147 samples. Pooled serum samples were extracted and cleaned-up prior to analysis by gas chromatography and mass spectrometry. The concentration of 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (4,4'-DDT) and its metabolites, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs) and hexachlorocyclohexanes (HCHs) were determined.

RESULTS

The major POP found in all samples was 1,1-dichloro-2,2-bis(4-chlorophenyl)ethene (4,4'-DDE) followed by 4,4'-DDT. 4,4'-DDE, 4,4'-DDT, PCBs and beta- and gamma-HCH were significantly decreasing over time. The PBDEs were found at low concentrations, with an increasing temporal trend for BDE-153.

CONCLUSION

National and international management may be behind the observed decreased organohalogen compound concentrations in humans from Guinea-Bissau from the early 1990's and onwards, similarly to the development of these compounds in humans from industrial countries. In contrast, PBDEs follow a trend of increasing concentrations even though at low levels.