Academic journal article Bulletin of the World Health Organization

Agricultural Pesticide Exposure and Perinatal Mortality in Central Sudan

Academic journal article Bulletin of the World Health Organization

Agricultural Pesticide Exposure and Perinatal Mortality in Central Sudan

Article excerpt


Perinatal mortality is high in developing countries, and although precise levels are difficult to gauge because of underreporting, it is estimated that there are about 7 million perinatal deaths per annum in developing countries (1). Numerous biological and social factors contribute to perinatal mortality, but with increasing industrial development and modernization of agriculture, occupational and environmental factors are becoming more important.

Pesticides comprise a wide range of compounds, including insecticides, fungicides and herbicides (2). Although such substances are used extensively in developing countries and there are numerous reports of acute toxic exposures in adults (3-5), few studies of the reproductive effects of pesticides have been conducted. One such investigation of cotton-field workers in India reported a decrease in male fertility and increased rates of spontaneous abortions, stillbirths, neonatal deaths, and birth defects among the wives of men exposed to pesticides (6). In Colombia, moderate increases in spontaneous abortion, congenital malformation, and prematurity rates have been reported among females who worked in horticulture, where a variety of pesticides were used (7).

Most studies on the reproductive effects of pesticide exposures have been carried out in developed countries. For example, two Canadian studies reported increased stillbirth rates among women employed in agricultural or horticultural work (8) and among women workers exposed to low levels of pesticides or germicides (9). Another Canadian investigation found an increased risk of stillbirths among mothers exposed to pesticides during the second trimester of pregnancy, and noted variations in stillbirth rates associated with seasonal exposure to pesticides (10). Also, in Sweden an excess of perinatal deaths has been observed among agricultural workers (11).

The Gezira Scheme in central Sudan is the largest and oldest agricultural project in the country, with around 0.8 million hectares of land under irrigation. Traditionally, cotton was the main cash crop, but recently wheat, sorghum, groundnuts, and vegetables have been introduced. Extensive aerial and ground spraying is carried out to protect these crops, and there are numerous cases of adult pesticide poisoning (12).

The current study was designed to assess the risk factors contributing to perinatal mortality and low birth weight in central Sudan, and in this article we address the association between perinatal mortality and exposure to agricultural pesticides.

Materials and methods

Hospital- and community-based studies were conducted concurrently in central Sudan. Wad Medani and Sennar, the main referral hospitals in the area, were chosen for the hospital investigation. Surveillance all births in these hospitals was carried out and a case-control study was performed in which the cases were stillbirths (defined as birth of a dead child of birth weight >500 g) and the controls were a sample of normal liveborn infants of birth weight [is greater than or equal to]2500 g. The study was conducted between March 1989 and June 1990.

The community study covered all six health centres located between Wad Medani and Sennar cities. These health centres represent the approximate catchment area of the two hospitals and each provides routine primary care, a senior midwife (health visitor), and antenatal and postnatal care. The health visitors also supervise village midwives who conduct home deliveries and provide antenatal care at the health centre. All 34 midwives and the health visitors who worked in the health centres participated in the investigation - a community, midwife-based, surveillance and follow-up study. A cohort of all midwife assisted births over the period April 1989 to March 1990 was identified and followed postnatally. Perinatal deaths (i.e., stillbirths + early neonatal deaths in the first week of life) were compared with liveborn nortnal-birth-weight infants who survived the early neonatal period. …

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