OCCUPATIONAL HEALTH DISORDERS OF PESTICIDES AMONG EXPOSED CHILDREN IN AGRICULTURE (MENOUFIYA GOVERNORATE) Gaafar MA et al. Presented by Ahmed Ismail, MD,

OCCUPATIONAL HEALTH OCCUPATIONAL HEALTH DISORDERS OF PESTICIDES AMONG DISORDERS OF PESTICIDES AMONG

EXPOSED CHILDREN IN EXPOSED CHILDREN IN AGRICULTURE AGRICULTURE

(MENOUFIYA GOVERNORATE)(MENOUFIYA GOVERNORATE)

Gaafar MA et al.Gaafar MA et al.

Presented by Presented by Ahmed Ismail, MD, MSAhmed Ismail, MD, MS

INTRODUCTIONINTRODUCTION

Cotton Crop In EgyptCotton Crop In Egypt

Nearly one third of the Egyptian work force is employed Nearly one third of the Egyptian work force is employed in agriculture.in agriculture.Cotton Crop is one of the strategic crops in Egypt.Cotton Crop is one of the strategic crops in Egypt.Cotton agriculture relies on children and adolescents.Cotton agriculture relies on children and adolescents.Pesticides are used in Egypt on large scale with huge Pesticides are used in Egypt on large scale with huge amounts of pesticides being applied.amounts of pesticides being applied.Children and adolescents work as pesticide applicators.Children and adolescents work as pesticide applicators.

Farahat et al., (2003)Farahat et al., (2003)::Adult Pesticide mixer, loader & applicators.Adult Pesticide mixer, loader & applicators.Neurobehavioral deficits in the exposed vs. control: Neurobehavioral deficits in the exposed vs. control: Similarities, BVRT, Similarities, BVRT, Digit Span, Letter Cancellation test, Digit Symbol, Trail making A and B.Digit Span, Letter Cancellation test, Digit Symbol, Trail making A and B.

Personality symptoms of neuroticism. Personality symptoms of neuroticism. Neurological symptoms, Neurological symptoms,

e.g. dizziness, numbness.e.g. dizziness, numbness.

Amr et al., (1999Amr et al., (1999):):Adult pesticide applicators and formulators.Adult pesticide applicators and formulators.Superficial or deep sensory loss and decrease or lost reflexes in Superficial or deep sensory loss and decrease or lost reflexes in their ankle or ankle and knee.their ankle or ankle and knee.Poor appetite, insomnia, low energy or fatigue, low self-esteem, Poor appetite, insomnia, low energy or fatigue, low self-esteem, poor concentration and feelings of hopelessness.poor concentration and feelings of hopelessness.

Health effects in cotton workers in Egypt

Research on adolescent workers Rohlman et al., (2006):

Adult and adolescent farm workers in USA.

Neurobehavioral deficit is associated with longer duration of working and pesticide handling: Selective Attention, Match-to-Sample, Symbol-Digit, and Reaction Time.

Aim of the StudyAim of the Study

The aim is to examine the health disorders arising The aim is to examine the health disorders arising from seasonal occupational exposure of agricultural from seasonal occupational exposure of agricultural

children applying pesticides in children applying pesticides in Menoufiya governorate.Menoufiya governorate.

Subjects and MethodsSubjects and Methods

ParticipantsChildren, 9-18 years old, “< 15” and “ > 15”.Exposed: pesticide applicators.Control: matched on age, SES, and educational level.

Pesticide applicationThe season extends from June to September. Fields are sprayed 4 times, about 30 days.Workday from 8 am-12 pm, then 3-7 pm.

Spraying timeSpraying time Type of pesticideType of pesticide FunctionFunction

June 6 – June 18June 6 – June 18 OrganochlorineOrganochlorine Growth stimulatorGrowth stimulator

June 30 – July 5June 30 – July 5 OrganophosphateOrganophosphateUreaUrea

Boll weevilBoll weevil

July 17 – July 22July 17 – July 22 PyrethroidPyrethroid White flies andWhite flies and Boll weevilBoll weevil

August 15 – August 25August 15 – August 25 OrganophosphateOrganophosphateUreaUrea

Boll weevilBoll weevil

Spraying Schedule

Informed consentInformed consent from the children and from the children and their guardian.their guardian.Questionnaire, medical history and Questionnaire, medical history and occupational exposure history.occupational exposure history.Medical Examination.Medical Examination.S. Cholinesterase (OP biomarker).S. Cholinesterase (OP biomarker).Neurobehavioral Test Battery:Neurobehavioral Test Battery: Information, Information, Similarities, Arithmetic, Digit Span, Digit Symbol, Block Similarities, Arithmetic, Digit Span, Digit Symbol, Block Design, BVRT, Trail Making part A, Trail making part B Design, BVRT, Trail Making part A, Trail making part B and Eysenck Personality Questionnaireand Eysenck Personality Questionnaire ..

Procedure

The tests of significanceThe tests of significance: t-test, chi-squared test, : t-test, chi-squared test, and Pearson correlation. and Pearson correlation.

Multiple linear regressionMultiple linear regression (age and years of (age and years of education).education).

Holm’s correction of p-value. Holm’s correction of p-value.

Statistical methodsStatistical methods

Results

Only 8% reported use of Personal Protective Only 8% reported use of Personal Protective Equipment; higher exposure.Equipment; higher exposure.

The mean number of days worked this season The mean number of days worked this season was 20 days.was 20 days.

The mean number of years worked as The mean number of years worked as applicators was 5 years.applicators was 5 years.

Participant characteristicsParticipant characteristics

group < 15 year > 15 year

N Mean SD t- test N Mean SD t-test

Age exposed 30 12.77 2.45.63

20 16.82 .86.06

control 30 12.47 2.67 20 16.83 .85

Years of education

exposed 30 5.47 2.96.53

20 7.30 5.20.74

control 30 5.87 2.94 20 8.45 4.56

Weight in Kg exposed 30 36.57 6.50 2.39* 20 52.35 6.22 3.66*

control 30 42.20 11.16 20 62.3 10.44

Height in m exposed 30 1.28 .08 4.20* 20 1.50 .10 .73

control 30 1.38 .11 20 1.53 .14

BMI exposed 30 21.73 2.00 .22 20 23.23 .63 3.87*

control 30 21.59 2.67 20 26.90 4.1

Smoking N0. % 2 No. % 2

exposed 15 53.6 .27 11 52.4 .1

control 15 46.9 15 47.4

1 ) Demographic data in the two groups1 ) Demographic data in the two groups

Neurobehavioral PerformanceNeurobehavioral Performance

2) Neurobehavioral performance in the participants < 15 years.

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20

40

60

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120

140

tests

mean

exposed

control

3) Neurobehavioral performace in the participants > 15 years

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120

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tests

mean

exposed

control

Personality characteristicsPersonality characteristics4) Personality proplems in the participants < 15

years.

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6

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18

measures

me

an

exposed

control

5) Pesonality proplems in the participants > 15 years

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Psychoticism neuroticism extraversion criminality lie scale

personality proplems

mea

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exposed

control

6) S. Cholinesterase in the two groups

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50

100

150

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300

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AChE in < 15 y AChE in > 15 y

groups

me

an

exposed

control

Correlations with neurobehavioral performanceCorrelations with neurobehavioral performance

Only one test (Trail making) had a significant Only one test (Trail making) had a significant correlation with S. Cholinesterase.correlation with S. Cholinesterase.

All neurobehavioral tests were significantly All neurobehavioral tests were significantly correlated with the no. of days worked this season.correlated with the no. of days worked this season.

All neurobehavioral tests were significantly All neurobehavioral tests were significantly correlated with the no. of years worked.correlated with the no. of years worked.

Neurological symptomsNeurological symptoms

7) Neurological symptoms in the participants

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35

symptoms

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exposed

control

8) Neuromuscular signs and symptoms in the participants

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35

Arthralgia Low backpain

Fatigue Musclepower

Anklereflex

Knee reflex Superficialsensation

Deepsensation

symptoms and signs

per

cen

t

exposed

control

Relations with neurological symptomsRelations with neurological symptoms

Exposed participants reporting neurological Exposed participants reporting neurological symptoms had a significantly decreased level symptoms had a significantly decreased level of S. Cholinesteraseof S. Cholinesterase (Arthralgia, Low back pain, Fatigue, Ankle and (Arthralgia, Low back pain, Fatigue, Ankle and

Knee reflexes, and Superficial sensation).Knee reflexes, and Superficial sensation).

The more years worked was significantly The more years worked was significantly correlated with the reporting of more correlated with the reporting of more neurological symptoms neurological symptoms (Blurred vision, Dizziness, Headache, Feeling (Blurred vision, Dizziness, Headache, Feeling

depressed, Arthralgia, Low back pain, Tremors, Fatigue, Muscle power, Ankle and knee depressed, Arthralgia, Low back pain, Tremors, Fatigue, Muscle power, Ankle and knee reflexes, and Superficial sensation).reflexes, and Superficial sensation).

ConclusionsConclusions

The exposed group had significantly lower The exposed group had significantly lower neurobehavioral performance.neurobehavioral performance.The exposed group reported significantly more The exposed group reported significantly more personality problems.personality problems.The exposed group had a significant lower level of The exposed group had a significant lower level of S. cholinesterase.S. cholinesterase.The exposed group reported significantly more The exposed group reported significantly more neurological symptoms and signs.neurological symptoms and signs.The longer the participants applied pesticides the The longer the participants applied pesticides the worse their performance on the neurobehavioral worse their performance on the neurobehavioral tests and the more symptoms they reported.tests and the more symptoms they reported.

These results show the adverse effects of pesticide These results show the adverse effects of pesticide on children.on children.

These findings along with the results in adult These findings along with the results in adult workers (Farahat et al., 2003), demonstrate the need workers (Farahat et al., 2003), demonstrate the need for education and training for Egyptian cotton for education and training for Egyptian cotton workers.workers.

These results and recommendations will be These results and recommendations will be presented to the Agricultural ministry.presented to the Agricultural ministry.

Thank Thank YouYou

Ahmed IsmailAhmed Ismail