Adverse reproductive and child health outcomes among people living near highly toxic waste water drains in Punjab, India.
BACKGROUND
Environmental influence plays a major role in determining health status of individuals. Punjab has been reported as having a high degree of water pollution due to heavy metals from untreated industrial effluent discharge and high pesticide consumption in agriculture. The present study ascertained the association of heavy metal and pesticide exposure on reproductive and child health outcomes in Punjab, India.


METHODS
A cross-sectional community-based survey was conducted in which 1904 women in reproductive age group and 1762 children below 12 years of age from 35 villages in three districts of Punjab were interviewed on a semistructured schedule for systemic and general health morbidities. Medical doctors conducted a clinical examination and review of records where relevant. Out of 35 study villages, 25 served as target (exposed) and 10 as non-target (less exposed or reference). Effluent, ground and surface water, fodder, vegetables and milk (bovine and human) samples were tested for chemical composition, heavy metals and pesticides.


RESULTS
Spontaneous abortion (20.6 per 1000 live births) and premature births (6.7 per 1000 live births) were significantly higher in area affected by heavy metal and pesticide pollution (p<0.05). Stillbirths were about five times higher as compared with a meta-analysis for South Asian countries. A larger proportion of children in target area were reported to have delayed milestones, language delay, blue line in the gums, mottling of teeth and gastrointestinal morbidities (p<0.05). Mercury was found in more than permissible limits (MPL) in 84.4% samples from the target area. Heptachlor, chlorpyriphos, beta-endosulfan, dimethoate and aldrin were found to be more than MPL in 23.9%, 21.7%, 19.6%, 6.5% and 6.5% ground water samples respectively.


CONCLUSIONS
Although no direct association could be established in this study, heavy metal and pesticide exposure may be potential risk factors for adverse reproductive and child health outcomes.
School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 162001, India. jsthakur64@gmail.com
Jarnail Singh
JS
Thakur
Shankar
S
Prinja
Dalbir
D
Singh
Arvind
A
Rajwanshi
Rajendra
R
Prasad
Harjinder Kaur
HK
Parwana
Rajesh
R
Kumar
D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D006304:Health Status; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D019216:Metals, Heavy / Q000032:analysis / Q000633:toxicity*; D010575:Pesticides / Q000032:analysis / Q000633:toxicity*; D047928:Premature Birth / Q000453:epidemiology*; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*
D019216:Metals, Heavy; D010575:Pesticides; D014874:Water Pollutants, Chemical