Hindrik Bouwman

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.

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.

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

Background In many parts of the world, deliberate indoor residual spraying (IRS) of dwellings with insecticides to control malaria transmission remains the only viable option, thereby unintentionally but inevitably also causing exposure to inhabitants. Because mothers are exposed to insecticides via various routes, accumulated residues are transferred to infants via breast milk, in some cases exceeding recommended intake levels. Except for dichlorodiphenyltrichloroethane (DDT), safety of residues of other insecticides in breast milk has not been considered during World Health Organization Pesticide Evaluation Scheme (WHOPES) evaluations. However, very little is known of the health risks posed by these chemicals to infants who, in developing countries, breast-feed for up to 2 years. Objective We evaluated the need for WHOPES to include breast milk as a potentially significant route of exposure and risk to infants when evaluating the risks during evaluation of IRS insecticides. Discussion We present evidence showing that neurologic and endocrine effects are associated with pyrethroids and DDT at levels equal or below known levels in breast milk. Conclusions Because millions of people in malaria control areas experience conditions of multiple sources and routes of exposure to any number of insecticides, even though lives are saved through malaria prevention, identification of potential infant health risks associated with insecticide residues in breast milk must be incorporated in WHOPES evaluations and in the development of appropriate risk assessment tools.

Long-term decreases in persistent organic pollutants in South African coastal waters detected from beached polyethylene pellets

Polyethylene pellets provide a convenient means to monitor Persistent Organic Pollutants (POPs) in marine systems. Pellets collected between 1984 and 2008 at three South African beaches were analysed for PCB, HCH and DDT. Concentrations of all three POPs decreased over the last two decades, although this signal was less clear for PCBs, and further monitoring is needed to assess trends in this family of compounds. DDT concentrations at two sites were higher than previous records for southern Africa, but there is no evidence of a link to the ongoing use of DDT for malaria control. HCHs concentrations were lower than in pellets from the east coast of southern Africa, suggesting that this pesticide was mainly used in the eastern part of the region. Our study demonstrates the potential for International Pellet Watch to track temporal as well as geographical patterns in the abundance of POPs in marine environments.

Polycyclic Aromatic Hydrocarbons (PAHs) in Soil and Sediment from Industrial, Residential, and Agricultural Areas in Central South Africa: An Initial Assessment

Polycyclic aromatic hydrocarbons (PAHs) are of global concern due to their ubiquitous presence, toxicity, and carcinogenicity. No data on PAHs in soils from South Africa have been published, even though it has the largest economy and industrial base in Africa. During this initial assessment, the levels of PAHs were determined in soils and sediments collected from central South Africa, specifically targeting industrial, residential, and agricultural areas. Analysis was performed by gas chromatography/mass spectrometry (GC/MS). The total concentration of PAHs (Σt-PAH) ranged between 44 and 39,000 ng/g, dw and the concentration of carcinogenic PAHs (Σc-PAH) ranged between 19 and 19,000 ng/g, dw. Pyrogenic processes were the most likely sources, with minimal petrogenic contributions. PAH levels were in the same range as levels reported from other countries, and the majority of the sites did not exceed Canadian environmental quality guidelines. Based on assumptions for dermal contact and ingestion of PAH-contaminated soil, we provisionally calculated only a small increase in cancer risk, but additional PAH inhalation could add considerably to this risk. Our data indicates a need for more analysis in industrial and residential areas, and should include air.

Chlorinated, brominated, and fluorinated organic pollutants in Nile crocodile eggs from the Kruger National Park, South Africa

Repeated annual episodes of Nile crocodile deaths in two isolated areas of the Kruger National Park prompted the investigation of possible organohalogen pollutant involvement. Crocodile eggs were collected close to one of the mortality sites (Gorge) as well as from a crocodile farm (CF) as reference. ∑DDT was significantly higher in Gorge (450ng/g wm) than in CF eggs (85ng/g wet mass). Percentage DDT of ∑DDT was significantly higher in CF (14 per cent) than in Gorge eggs (5 per cent). Mean ∑DDT was almost 70 times higher than mean ∑PCB in Gorge eggs. HCB, β-HCH, mirex, brominated flame retardants (BFRs), and perfluorinated compounds (PFCs) occurred at lower concentrations. We believe that the BFR and PFCs data represent the first published results for any crocodile egg. Thickening of the outer eggshell layer of Gorge eggs was significantly associated with higher concentrations of ∑DDT. Concentrations of ∑DDT and other pollutants were in the same range as eggs from elsewhere, where there were no mortalities. Concentrations of ∑DDT in eggs from healthy Australian crocodiles were of the same orders of magnitude as the current study, making it highly unlikely that the concentrations of pollutants measured in the present study would have caused or substantially contributed towards the mortalities observed. Concerns about reproduction and behaviour remain. As large predators, crocodilians are at the apex of the freshwater aquatic food web. More research is needed to guide measures to manage African freshwater systems so that it will also sustainably accommodate these large, long-lived animals.

Chlorinated, brominated and fluorinated organic pollutants in African Penguin eggs: 30 years since the previous assessment.

The African Penguin population has drastically declined over the last 100 years. Changes in food availability due to over-fishing and other oceanographic changes seem to be major causes. However, it has also been 30 years since organic pollutants as a potential factor have been assessed. We analysed penguin eggs collected in 2011 and 2012 from two breeding colonies 640 km apart: Robben Island near Cape Town on the Atlantic Ocean coast, and Bird Island near Port Elizabeth on the Indian Ocean coast of South Africa. We quantified organochlorine pesticides, brominated flame retardants, and perfluorinated compounds (PFCs). Compared to 30 years ago, concentrations of ΣDDT have remained about the same or slightly lower, while ΣPCBs declined almost four-fold. The use of DDT in malaria control is unlikely to have contributed. PFCs were detected in all eggs. Indications (non-significant) of eggshell thinning associated with ΣDDT and ΣPCB was found. It seems therefore that the concentrations of measured organic pollutants the African Penguin eggs are not contributing directly to its current demise, but concerns remain about thinner shells and desiccation. Effects of combinations of compounds and newer compounds cannot be excluded, as well as more subtle effects on reproduction, development, and behaviour.

First report of the concentrations and implications of DDT residues in chicken eggs from a malaria-controlled area

In malaria-endemic areas, where DDT is still used for vector control by indoor residual spraying (IRS), the concentrations of DDT in human blood and breast milk are high, and there are indications of human health impacts. To identify the possible avenues of exposure reduction, we created the concept of a Total Homestead Environment Approach (THEA). THEA characterizes the interactions between DDT, humans, and the biota within and around homesteads. One dietary route of human exposure and uptake of DDT, namely, chicken egg consumption, has to our knowledge never been studied. The ΣDDT in eggs from a DDT-sprayed village ranged between 5200 and 48,000 ng/g wm (wet mass), with a median of 11,000 ng/g wm. On a lipid mass-basis (lm), the mean ΣDDT for eggs from the sprayed village was 100,000 ng/g lm. The maximum egg concentration observed was three orders of magnitude higher than the median. The acceptable daily intake (ADI) was not exceeded based on the consumption of three eggs per week for a 60 kg person. This equates to an intake of 0.089 g DDT per person per year. Chicken egg consumption is therefore a possible target for exposure reduction, probably best achieved by reducing the DDT concentrations in soils.

Implications for health education and intervention strategies arising from children's caregivers concerns following successful malaria control

Malaria is still responsible for 10% of the total disease burden in Africa. This study was an empirical investigation addressing the extent to which, and the ways in which, sociocultural, family-based, demographic and economic circumstances in a poor rural African environment influence levels of active malaria infection risk awareness. Face-to-face interviews were conducted and the questions included both open-ended questions allowing for unprompted replies and closed fixed-answer alternative (prompted) items. The adult female responsible for the day-to-day care of the children in 156 homesteads (60 in each of two malaria villages and 36 in a reference village) was interviewed. The families received financial assistance but little physical support from the fathers. Unemployment, poverty, crime and clean water were perceived as the main, unprompted threats, and everyday awareness appeared to exclude the potentially serious disease threats of malaria. Only when malaria was prompted did the concerns rise to 52% and 38% in the sprayed villages. The apparent discrepancy between actual daily and potential future threats significantly increases the difficulty of mobilising communities for preventive action regarding potential threats. The lack of community involvement in an existing community-passive malaria control system may become a problem when promoting new/additional measures to reduce exposure to indoor residual spraying chemicals.

Preliminary assessment of contaminants in the sediment and organisms of the Swartkops Estuary, South Africa

Urban estuaries are susceptible to metal and organic pollution, yet most remain understudied in South Africa with respect to the presence, concentrations and distribution of contaminants. Metal and organic chemical concentrations were assessed in sediment and organisms from different trophic levels in the lower reaches of the Swartkops Estuary. Species sampled included Upogebia africana (Malacostraca: Upogebiidae), Gilchristella aestuaria (Clupeidae), Psammogobius knysnaensis (Gobiidae), Mugil cephalus (Mugilidae), Lichia amia (Carangidae), Argyrosomus japonicus (Sciaenidae), Pomadasys commersonnii (Haemulidae) and Larus dominicanus (Avis: Laridae). This study is one of the most comprehensive studies to date assessing pollution levels in a food web in estuaries in South Africa. Due to biomagnification, higher concentrations of Arsenic, Lead, Mercury and Cadmium were found in the juveniles stages of popular angling fishes. High concentrations of Cadmium and Arsenic were recorded in the liver of L. amia, A. japonicus and P. commersonnii which exceed international quality food guidelines. Eggs from the gull, L. dominicanus, showed detectable concentrations of PCBs.