Abstract
BackgroundResearch on reproductive health effects on children from low-level, long-term exposure to pesticides currently used in the agricultural industry is limited and those on neurobehavioral effects have produced conflicting evidence. We aim at investigating the association between pesticide exposure on the reproductive health and neurobehavior of children in South Africa, by including potential relevant co-exposures from the use of electronic media and maternal alcohol consumption.MethodsThe design entails a prospective cohort study with a follow-up duration of 2 years starting in 2017, including 1000 school going children between the ages of 9 to 16 years old. Children are enrolled with equal distribution in sex and residence on farms and non-farms in three different agricultural areas (mainly apple, table grapes and wheat farming systems) in the Western Cape, South Africa. The neurobehavior primary health outcome of cognitive functioning was measured through the iPad-based CAmbridge Neuropsychological Test Automated Battery (CANTAB) including domains for attention, memory, and processing speed. The reproductive health outcomes include testicular size in boys and breast size in girls assessed in a physical examination, and blood samples to detect hormone levels and anthropometric measurements. Information on pesticide exposure, co-exposures and relevant confounders are obtained through structured questionnaire interviews with the children and their guardians. Environmental occurrence of pesticides will be determined while using a structured interview with farm owners and review of spraying records and collection of passive water and air samples in all three areas. Pesticide metabolites will be analysed in urine and hair samples collected from the study subjects every 4 months starting at baseline.DiscussionThe inclusion of three different agricultural areas will yield a wide range of pesticide exposure situations. The prospective longitudinal design is a further strength of this study to evaluate the reproductive and neurobehavioural effects of different pesticides on children. This research will inform relevant policies and regulatory bodies to improve the health, safety and learning environments for children and families in agricultural settings.
Highlights
Research on reproductive health effects on children from low-level, long-term exposure to pesticides currently used in the agricultural industry is limited and those on neurobehavioral effects have produced conflicting evidence
Study participants are examined at baseline in 2017 and at follow-up in 2019 using the same exposure survey and pesticide biomonitoring exposure measures, as well as the same health outcome measure tools including the CAmbridge Neuropsychological Test Automated Battery (CANTAB), Fig. 1 Illustration of the data collection exposure, health outcome tools and timeline in the cohort study reproductive measures including i) Tanner staging - a physical examination of the male and female reproductive system ii) reproductive hormone levels and iii) anthopometric measurements, Health Related Quality of Life (HRQOL, referred to as KIDSCREEN), Headache Impact Test (HIT-6) and Problematic Mobile Phone use (MPPUS-10)
Pesticide exposure will be characterised and compared according to following five different levels: (i) self-reported exposure obtained with the participant questionnaire; (ii) self-reported exposure obtained with the guardian questionnaire; (iii) concentration of metabolites and active ingredients measured in urine and hair samples of children; (vi) collected spraying plans and records from farm-owner interviews (to establish pesticide emission profiles for apple, table grapes, wheat and citrus farms and develop a Crop Exposure Matrix (CEM); and (v) measured concentration of active ingredients in passive air and water samples
Summary
The design entails a prospective cohort study with a follow-up duration of 2 years starting in 2017, including 1000 school going children between the ages of 9 to 16 years old. The reproductive health outcomes include testicular size in boys and breast size in girls assessed in a physical examination, and blood samples to detect hormone levels and anthropometric measurements. Information on pesticide exposure, co-exposures and relevant confounders are obtained through structured questionnaire interviews with the children and their guardians. Environmental occurrence of pesticides will be determined while using a structured interview with farm owners and review of spraying records and collection of passive water and air samples in all three areas. Pesticide metabolites will be analysed in urine and hair samples collected from the study subjects every 4 months starting at baseline
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