Status of legislation and regulatory control of public health pesticides in countries endemic with or at risk of major vector-borne diseases

Background: Legislation and regulation of pesticides used in public health are essential for reducing risks to human health and the environment.Objective: We assessed the global situation on legislation and regulatory control of public health pesticides.Methods: A peer-reviewed and field-tested questionnaire was distributed to 142 member states of the World Health Organization (WHO); 113 states completed the questionnaire.Results: Legislation on public health pesticides was absent in 25% of the countries. Where present, legislation often lacked comprehensiveness, for example, on basic aspects such as labeling, storage, transport, and disposal of public health pesticides. Guidelines or essential requirements for the process of pesticide registration were lacking in many countries. The capacity to enforce regulations was considered to be weak across WHO regions. Half of all countries lacked pesticide quality control laboratories, and two-thirds reported high concern over quality of products on the market. National statistics on production and trade of pesticides and poisoning incidents were lacking in many countries. Despite the shortcomings, WHO recommendations were considered to constitute a supportive or sole basis in national registration. Also, some regions showed high participation of countries in regional schemes to harmonize pesticide registration requirements.Conclusions: Critical deficiencies are evident in the legislative and regulatory framework for public health pesticides across regions, posing risks to human health and the environment. Recent experience in some countries with situational analysis, needs assessment, action planning, and regional collaboration has signaled a promising way forward.     

Pesticide exposure, risk factors and health problems among cutflower farmers: a cross sectional study

This was a cross-sectional study which aimed to determine associations between hematologic indices such as red blood cell cholinesterase (RBC) and mean corpuscular volume (MCV), with illnesses related to pesticide exposure among cutflower farmers in La Trinidad, Benguet. One hundred two (102) randomly selected cutflower farmers underwent comprehensive, personal physical health and laboratory examinations and answered a questionnaire on work practices and illness. Majority were males (52%) and most belonged to the 20–35 age group (45%). Majority of exposed farmers were symptomatic, with most common complaints being headache (48%), easy fatigability (46.1%) and cough (40.2%). Analysis showed that RBC cholinesterase levels were positively associated with age (p = 0.02), and selling pesticide containers (p = 0.008). number of years of using pesticides (p = 0.022), use of contaminated cloth (p = 0.033), incorrect mixing of pesticides (p = 0.041), sex (p = 0.002) and illness due to pesticides (p = 0.005) were correlated with abnormal MCV. Significant associations were also found for hemoglobin, hematocrit, RBC, white blood cell (WBC) and platelet count. Predictors of RBC cholinesterase were years of pesticide use (p = 0.037) and abnormalities on health (p = 0.029). The findings of the study can be used for information dissemination and pesticide reduction programs for the cutflower farmers.     

Crime in Trinidad and Tobago: the effect of alcohol use and unemployment.

OBJECTIVE: The purpose of this study was to determine whether unemployment and alcohol consumption were associated with different types of crime in Trinidad and Tobago. METHODS: This study made use of secondary data from the Central Statistical Office of Trinidad and Tobago for the period 1990-1997. Pearson product moment correlations and stepwise multiple regression analysis were used to identify significant predictors of crime. RESULTS: Unemployment accounted for 69.2% of the variance for serious crimes. Beer available for home consumption explained 64% of the variance for minor offenses, and both unemployment and beer available for home consumption accounted for 92.2% of the variance for minor crimes. CONCLUSIONS: This study provides information that is potentially useful for developing public policies for unemployment and for the sale of beer for home consumption, both of which are associated with crime in Trinidad and Tobago. Reductions in beer available for home consumption-a major public health concern-would significantly reduce the occurrence of minor offenses in this country. Further research is needed on the relationship between unemployment and crime.     

Health care for the disadvantaged: some preliminary observations of health centres in Trinidad and Tobago

This study seeks to identify background characteristics of the people who utilise health centre services in Trinidad and Tobago and to investigate their perceptions of the services offered. Data were obtained through a survey of health centre users distributed throughout Trinidad and Tobago. Multi-stage sampling was used to select 1500 health centre users and structured interviews were conducted on regular clinic days by trained personnel. Results indicate that there are fairly high levels of patient satisfaction with health centres in Trinidad and Tobago and that the more disadvantaged groups (the elderly, women and the unemployed) utilise these services more frequently. Results also show variations with respect to care received, frequency of attendance, amount willing to pay, services that need improving and doctor's willingness to listen to problems.     

Risk assessment of exposure to pesticides through dietary intake of vegetables typical of the Mediterranean diet in the Basque Country

This study examined estimated dietary exposure among the Basque Country Autonomous Community (northern Spain) to pesticides resulting from dietary intake of unprocessed vegetables. Samples were collected according to a sampling plan established previously, which was performed taking into account statistical factors, such as the population distribution, the point of sale, (local shops or supermarkets), the season and the consumption frequency of each vegetable. A total of 221 samples were analyzed using gas chromatography tandem mass spectrometry (GC–MS/MS), and liquid chromatography tandem mass spectrometry (LC–MS/MS). Results showed that 48.0% of the samples contained no pesticide residues, while 52.0% contained pesticides, and 6.8% of all samples showed residues above the maximum residue limit (MRL). As for the pesticides detected, 56 different active substances were detected, including fungicides and insecticides as the main pesticide types. All of the positive samples were collected in local-area shops. The potential risk to the consumers through vegetable intake was estimated by calculating the Hazard Quotient (HQ), showing ranges between 0.001–0.214%. These results indicate that the exposure to pesticides from vegetable intake among Basque consumers did not raise health concerns.     

Epidemic scabies in four Caribbean islands, 1981-1988

Scabies infestation has been reported to the PAHO/WHO Caribbean Epidemiology Centre (CAREC) from Trinidad and Tobago (T&T), Grenada, Dominica, the Turks and Caicos Islands (T&CI) and, more recently, St Lucia. Epidemic scabies was being reported from T&CI in 1981 (1200/100,000 population), but there were no reports from T&T until 1982 (8/100,000). The first phase of the bimodal epidemic in Grenada occurred between 1982 and 1984 (132/100,000) and the explosive second phase from 1985 to 1987 (474-699/100,000). In T&T there was a low incidence of scabies until 1985 (0-59/100,000) and in Dominica the rate fluctuated (67-14/100,000) during the same period. From 1986 to 1988, scabies infestation reached epidemic proportions in T&T (410-709/100,000) and fluctuated in Dominica (108-117/100,000). In Tobago alone, scabies was not reported until March 1986, and by December the incidence rate was 105/100,000; by 1988 it had increased to 1124/100,000 population. Although no secondary infections have been reported from Grenada, Dominica, T&CI or St Lucia, T&T has reported increased streptococcal skin infections and epidemic post-streptococcal acute glomerulonephritis (PSAGN). The observed trend of increasing scabies infestation, increasing streptococcal isolates from skin lesions, and increasing PSAGN in T&T is noteworthy.     

Evaluation of methods for monitoring the potential exposure of small children to pesticides in the residential environment

A nine-home pilot study was conducted to evaluate monitoring methods in the field that may be used to assess the potential exposures of children aged 6 months to 5 years to pesticides found in the home environment. Several methods, some of which were newly developed in this study, were tested for measuring pesticide residues in indoor air, carpet dust, outdoor soil, and on the children's hands. Information was also collected on household characteristics, pesticides used and stored at the residence, and children's activities.Pesticides were detected at all nine study homes. With the exception of one home, at least one pesticide was detected in all matrices sampled at each house. Of the 30 target pesticides, 23 were detected during the study. The most frequently detected pesticides were chlordane, chlorpyrifos, dieldrin, heptachlor, and pentachlorophenol. The greatest number of pesticides and highest concentrations were found in carpet dust. The results of these investigations will be discussed in terms of performance of the methods and the distribution of pesticides across the various media sampled.This paper has been reviewed in accordance with the U.S. Environmental Protection Agency's peer and administrative review policies and approved for presentation and publication. Mention of trade names or commercial products does not constitute endorsement or recommendation for use.     

Organophosphate resistance in Trinidad and Tobago strains of Aedes aegypti

Aedes aegypti larvae from 8 sites in Trinidad and 1 in Tobago were assayed against temephos, malathion, and fenthion using the Centers for Disease Control and Prevention time-mortality-based bioassay method. Resistance ratios (RRs) and resistance thresholds (RTs) for each insecticide were calculated in relation to the Caribbean Epidemiology Center reference susceptible strain. Results showed that the Haleland Park and Tobago strains were susceptible to fenthion and malathion, respectively (RRs < 1), while the San Fernando strain had a high RR (33.92) to malathion. All other strains had low-level resistance to fenthion and malathion. Resistance to temephos was more intense with 4 strains showing high-level resistance. The established RT was 60 min for fenthion, 75 min for bendiocarb, and 120 min for temephos and malathion. At the RTs, all Trinidad strains were resistant to temephos (11.50-74.50% mortality), 7 resistant to fenthion (21.25-78.75% mortality), and 5 resistant to malathion (56.25-77.50% mortality). The other strains were incipiently resistant (80-97% mortality). Despite the discrepancies between the RR levels and RT status, it is evident that the organophosphate insecticide resistance is prevalent in Trinidad and Tobago populations of Ae. aegypti. These results suggest that operational failure could soon occur and alternative strategies should be developed and implemented to reduce the probability of further selection pressure on resistant Ae. aegypti populations in Trinidad and Tobago.     

Same-visit HIV testing in Trinidad and Tobago

Background  

The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC.     

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago.

OBJECTIVE: To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. METHODS: Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. RESULTS: A total of 3 170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37-1.97), and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. CONCLUSIONS: Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.     

Dietary intake among adults in Trinidad and Tobago and development of a quantitative food frequency questionnaire to highlight nutritional needs for lifestyle interventions

Primary objective To create a food list and develop a draft quantitative food frequency questionnaire (QFFQ) for Trinidad and Tobago.

Methods and procedures A mixed sampling method was used to obtain a representative sample and trained interviewers administered 24-h dietary recalls. Portion sizes were assessed and the most frequently reported foods were tabulated.

Main outcomes and results Results are from 155 men and 169 women aged 21–64 years. The most frequently reported food items were: full-cream milk (64%), rice (61%), and sweetened fruit drinks (50%). Carbonated drinks were consumed by 28%. The most frequently consumed fruits were banana (23%) and citrus (22%); < 20% consumed a vegetable food item. The final QFFQ contains 146 items: 19 breads/cakes/cereals; seven rice/pastas/noodles; 12 dairy; 26 meats/poultry/fish/soy products; 15 fruits; 34 vegetables; six legumes; 11 other; 12 drinks; four alcoholic drinks.

Conclusions A list of commonly consumed foods in Trinidad and Tobago was obtained and a draft QFFQ was prepared.     

Influence of pesticide regulation on acute poisoning deaths in Sri Lanka

OBJECTIVES: To assess in a developing Asian country the impact of pesticide regulation on the number of deaths from poisoning. These regulations, which were implemented in Sri Lanka from the 1970s, aimed to reduce the number of deaths - the majority from self-poisoning - by limiting the availability and use of highly toxic pesticides. METHODS: Information on legislative changes was obtained from the Ministry of Agriculture, national and district hospital admission data were obtained from the Sri Lanka Health Statistics Unit, and individual details of deaths by pesticide poisoning were obtained from a manual review of patients' notes and intensive care unit records in Anuradhapura. FINDINGS: Between 1986 and 2000, the total national number of admissions due to poisoning doubled, and admissions due to pesticide poisoning increased by more than 50%. At the same time, the case fatality proportion (CFP) fell for total poisonings and for poisonings due to pesticides. In 1991_92, 72% of pesticide-induced deaths in Anuradhapura were caused by organophosphorus (OP) and carbamate pesticides - in particular, the WHO class I OPs monocrotophos and methamidophos. From 1991, the import of these pesticides was reduced gradually until they were banned for routine use in January 1995, with a corresponding fall in deaths. Unfortunately, their place in agricultural practice was taken by the WHO class II organochlorine endosulfan, which led to a rise in deaths from status epilepticus - from one in 1994 to 50 in 1998. Endosulfan was banned in 1998, and over the following three years the number of endosulfan deaths fell to three. However, at the end of the decade, the number of deaths from pesticides was at a similar level to that of 1991, with WHO class II OPs causing the most deaths. Although these drugs are less toxic than class I OPs, the management of class II OPs remains difficult because they are, nevertheless, still highly toxic, and their toxicity is exacerbated by the paucity of available facilities. CONCLUSION: The fall in CFP amidst a rising incidence of self-poisoning suggests that Sri Lanka's programmes of pesticide regulation were beneficial. However, a closer inspection of pesticide-induced deaths in one hospital revealed switching to other highly toxic pesticides, as one was banned and replaced in agricultural practice by another. Future regulation must predict this switching and bear in mind the ease of treatment of replacement pesticides. Furthermore, such regulations must be implemented alongside other strategies, such as integrated pest management, to reduce the overall pesticide availability for self-harm.     

Time trends in cancer risk and pesticide exposure, a long-term follow-up of Danish gardeners

OBJECTIVES: Occupational exposure to petrochemical pesticides was high during the first 10-15 years after their introduction in the late 1940s, and, during these years, many cases of intoxication occurred. In the 1960s, the use and marketing of pesticides was regulated to reduce exposure to these substances, and, since 1970, substantial exposure has been rare in Denmark. The present study aimed at investigating the extent to which these alterations have influenced the cancer risk of gardeners. METHODS: A historical cohort of 3156 male gardeners was followed from May 1975 until 2002 with regard to cancer incidence. RESULTS: The cancer incidence was significantly below the national average [standardized incidence ratio (SIR) 0.86, 95% confidence interval (95% CI) 0.79-0.94], but an analysis by birth cohort indicated marked differences with a downward tendency for younger birth cohorts. Among the gardeners born prior to 1915, significant increases were found for leukemia (12 cases, SIR 2.33, 95% CI 1.32-4.10) and soft tissue sarcoma (3 cases, SIR 5.87, 95% CI 1.89-18.20). CONCLUSIONS: Gardeners constitute a healthy worker group, but an increased risk of soft tissue sarcoma and leukemia is indicated for people born prior to 1915, a finding that may reflect substantial pesticide exposure during the late 1940s and the 1950s. Among the gardeners born in 1915 or later, no excess cancer risk was found. The latter finding suggests a cancer-preventive effect for safety recommendations and improved technical devices with respect to pesticide application, along with legislative control measures to reduce pesticide exposure.     

Systemic antibiotic sales and WHO recommendations,India

ObjectiveTo analyse sales of fixed-dose combination and single antibiotics in India in relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales.MethodsWe extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics.FindingsThere were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended.ConclusionThe sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited.     

Evidence for the interruption of transmission of lymphatic filariasis among schoolchildren in Trinidad and Tobago

This study was carried out to provide some evidence for the interruption of transmission of lymphatic filariasis (LF) among schoolchildren in Trinidad and Tobago. A cross-sectional survey for LF antigenaemia was performed among 63 (13.2%) of the 479 primary schools located in eight administrative (and geographical) regions of Trinidad and Tobago. From these communities, 2597 schoolchildren aged 6-12 years were sequentially selected for a survey of bancroftian antigenaemia. From each child, 100 microl (finger-prick) whole blood sample was applied to a Binax immunochromatographic card test (ICT), and read for the presence of antigenaemia. The ICT results showed a negative finding for LF antigenaemia and suggest that LF transmission has been interrupted in the survey areas.     

Policy and Research Recommendations Emerging from the Scientific Evidence Connecting Environmental Factors and Breast Cancer

Abstract

A substantial body of evidence links environmental exposures to increases in breast cancer incidence over the past decades. State and federal legislative initiatives that could help prevent breast cancer include: federal standards to achieve consistency in radiation-emitting medical and dental equipment; improved state quality assurance standards for radiation-emitting equipment; federal and state exposure limits for electromagnetic radiation; an overhaul of the federal Toxic Substances Control Act to reduce unsafe chemical exposures; strengthened premarket health and safety testing and regulation of pesticides; a federal ban on the manufacture, distribution and sale of consumer products containing bisphenol A and phthalates; and strengthened oversight and regulation of the cosmetics industry. We recommend public and private investment in research on low dose exposures, mixtures, and the timing of chemical exposures, as well as the development of health tracking and biomonitoring programs designed to link data from pollution surveillance systems with disease registries.     

新疆北湾地区药物处理蚊帐对蚊虫击倒效果研究

目的通过药物处理蚊帐对蚊虫进行击倒实验,在北湾地区室内环境中通过药物处理蚊帐对蚊虫快速击倒效果进行研究。方法研究中选用经BASF药物处理蚊帐、20次洗涤的BASF药物处理蚊帐、5ml有效成分10％的奋斗呐处理的普通蚊帐（WHO推荐）,普通军用蚊帐作为对照,在野外环境中用吸蚊器采集当地优势蚊种刺扰伊蚊分别放入4种处理蚊帐中,观察4种处理蚊帐对当地蚊虫的首数击倒、半数击倒、全数击倒时间,最后比较分析4种处理蚊帐对当地主要蚊种的快速击倒效果。结果在对当地主要蚊种刺扰伊蚊的快速击倒效果上,经药物处理的BASF蚊帐〉清洗20次药物处理的BASF蚊帐〉WHO推荐的奋斗呐处理的蚊帐。3种处理蚊帐在7min以内都能形成对蚊虫的首数击倒,3种蚊帐在首次击倒时间上差异无统计学意义（F＝2．375,P=0．174）,在17min内形成半数击倒,BASF药物处理蚊帐与奋斗呐处理蚊帐在时间上差异有统计学意义（P=0．036）;BASF2种处理蚊帐在27min内可以全部击倒蚊虫,奋斗呐处理的蚊帐则要54min才能全部击倒蚊虫,BASF2种处理蚊帐与奋斗呐处理蚊帐间差异均有统计学意义（P〈0．001）。结论经过药物处理的蚊帐比不经任何处理的普通蚊帐对蚊虫击倒效果要好,适当选择药物处理蚊帐可以为北湾边防部队提供有效的保护。     

安徽省铜陵市2009年食品安全风险监测结果分析

作者通过对27类1901份食品及相关产品检测结果分析,总合格率为88.6%;食品安全主要风险产品为：非发酵豆制品、酱腌菜、卤菜、保健食品、水发产品、干货、蛋制品、调味品、面粉及制品、本地姜制品、蔬菜、瓶（桶）装水等;主要风险因素为：微生物超标、农药和二氧化硫等残留、添加非食用物质、食品添加剂超标、重金属污染;不合格产品主要生产场所为：本地食品加工小作坊、食品摊贩自制或改制、餐饮业自制、药店（保健食品）、蔬菜批发市场;主要销售场所为集贸市场、商店商场、餐饮服务业、药店（保健食品）和食品加工小作坊。     

Acute pesticide poisoning in the UK and information and training needs of general practitioners: recording a conundrum.

A postal questionnaire of all general practitioners (n = 68) in a District Health Authority was undertaken to identify the information and training they had received on acute pesticide poisoning. Fifty-six (82%) replies were received. The responses showed that 33 (59%) had not seen the standard Department of Health Guide to acute pesticide poisoning and only 20 (36%) of the respondents thought that their practice had a copy of this publication. None of those surveyed had ever used Health and Safety Executive Guidance Notes on pesticides. Ten practitioners (18%) reported that they had at some time diagnosed a case of acute pesticide poisoning and three (5%) had done so in the last two years. Only three respondents (5%) considered they had sufficient information to diagnose all the main pesticides listed in the Department of Health Guide but 24 (43%) considered they had sufficient information to diagnose rodenticide poisoning. Twenty-three (41%) considered they had insufficient information to diagnose any acute pesticide poisoning category. The sources of information used in cases of suspected acute pesticide poisoning were the National Poisons Information Services (e.g., Guy's Hospital) for 30 (54%); Accident and Emergency Departments for 19 (34%); and industry for nine (16%). Four (7%) considered they had sufficient training as a medical student to diagnose cases of acute pesticide poisoning and four (7%) considered they had sufficient training since graduating to diagnose such cases. Some of the problems related to the identification and diagnosis of acute pesticide poisoning are discussed and a number of specific recommendations are made to improve the information and training available to general practitioners.(ABSTRACT TRUNCATED AT 250 WORDS)