Malaria Control Insecticide Residues in Breast Milk: The Need to Consider Infant Health Risks

By Bouwman, Hindrik; Kylin, Henrik | Environmental Health Perspectives, October 2009 | Go to article overview
Save to active project

Malaria Control Insecticide Residues in Breast Milk: The Need to Consider Infant Health Risks

Bouwman, Hindrik, Kylin, Henrik, Environmental Health Perspectives

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 dichlorodiphenyltrichioroethane (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.

KEY WORDS: DDT, IRS, pyrethroid, vector control, WHOPES. Environ Health Perspect 117:1477-1480 (2009). doi:10.1289/ehp.0900605 available via [Online 1 May 2009]


The unintentional exposure of people to sometimes unacceptably high levels of chemicals may (regrettably) be the only current and effective option available under certain circumstances. In 2004, an estimated 350-500 million people contracted malaria globally, of whom more than a million died (80-90% in Africa) [World Health Organization (WHO) 2007a; WHO and UNICEF 2005]. It is the cause of 18% of all deaths of children < 5 years of age in Africa and causes many other debilitations such as anemia, increased susceptibility to other diseases, and premature births. The WHO recommends three primary interventions for malaria control: diagnosis and treatment, insecticide-treated nets (ITN) and other materials, and indoor residual spraying (IRS) (WHO 2006b). For the foreseeable future, IRS with insecticides will remain one of the major methods with which to control malaria in many countries of Africa and elsewhere (WHO 2006b). The recommendations of insecticides are based on a process conducted by the World Health Organization Pesticide Evaluation Scheme (WHOPES) (WHO 2008), which includes the evaluation of human and environmental safety of these chemicals for use in malaria control (WHO 2006b). One of the IRS insecticides is dichlorodiphenyltrichloroethane (DDT), but 11 others are also recommended, with permethrin included as a treatment for ITNs (Table 1).

Table 1. Insecticides recommended by WHO, with associated parameters.

Insecticide           Type             Use     IRS dosage     Maximum
                                              (g/[m.sup.2])  applied
                                                             (g) per
                                                               at 42

Alpha-cypermethrin  Pyrethroid       IRS/ITN   0.02-0.03        1.26

Bendiocarb          Carbamate        IRS        0.1-0.4        16.8

Bifenthrin          Pyrethroid       IRS      0.025-0.050       2. 

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Cite this article

Cited article

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Malaria Control Insecticide Residues in Breast Milk: The Need to Consider Infant Health Risks


Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?