Agricultural chemical exposures and birth defects in the Eastern Cape Province, South Africa: a case-control study.
BACKGROUND
South Africa is one of the major users of pesticides on the African continent. The Eastern Cape is the second largest province in South Africa. There has been growing concern about the occurrence of certain birth defects which seemed to have increased in the past few years. In this paper we investigate associations between exposure to agricultural chemicals and certain birth defects. Few such studies have been undertaken in the developing world previously.


METHODS
Between September 2000 and March 2001 a case - control study was conducted among rural women in the area of the Eastern cape to investigate the association between women's exposure to pesticides and the occurrence of birth defects. Information on birth defects was obtained from the register of the Paediatrics Department at the Cecilia Makiwane Hospital in Mdantsane, one of the largest referral hospitals in the province. The cases were children who were diagnosed with selected birth defects. The controls were children born in the same areas as the cases. Exposure information on the mothers was obtained by interview concerning from their activities in gardens and fields. Data were analysed using conditional logistic regression.


RESULTS
A total of 89 case mothers and 178 control mothers was interviewed. Babies with birth defects were seven times more likely to be born to women exposed to chemicals used in gardens and fields compared to no reported exposure (Odds Ratio 7.18, 95% CI 3.99, 13.25); and were almost twice as likely to be born to women who were involved in dipping livestock used to prevent ticks (OR 1.92, 95% CI 1.15, 3.14). They were also 6.5 times more likely to be born to women who were using plastic containers for fetching water (OR 6.5, 95% CI 2.2, 27.9). Some of these containers had previously contained pesticides (OR 1.87, 95% CI 1.06, 3.31).


CONCLUSIONS
These findings suggest a link between exposure to pesticides and certain birth defects among the children of rural South African women who work on the land. Education programmes for women alerting them to the dangers to their babies from the use of pesticides and alternative farming methods and elimination of the reuse of pesticide containers are indicated as preventive measures.
Heeren
Gudrun A
GA
Department of Public Health, Cecilia Makiwane Hospital, Mdantsane, P,O, Box 691, East London 5200, South Africa. aheeren@asc.upenn.edu
Tyler
Joanne
J
Mandeya
Andrew
A
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000383:Agriculture; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D015386:Hazardous Substances / Q000633:toxicity*; D006801:Humans; D007231:Infant, Newborn; D018811:Maternal Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D016017:Odds Ratio; D010575:Pesticides / Q000633:toxicity*; D011247:Pregnancy; D012042:Registries; D012044:Regression Analysis; D012423:Rural Health / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
D015386:Hazardous Substances; D010575:Pesticides