Poisoning the children: Study shows mothers give DDT to their children from breastmilk


Too many in the U.S. bury their heads in the sands about the issues, but researchers in Spain and Mozambique wondered whether indoor residual spraying (IRS) with DDT, to fight malaria-carrying mosquitoes, might produce harms to children in those homes.  They studied the issue in homes sprayed with DDT in Mozambique.

It turns out that young mothers ingest DDT and pass a significant amount of it to their children when the children breast feed.

The study itself is behind Elsevier’s mighty paywall, but the abstract from Chemosphere is available at no cost:

Concentration of DDT compounds in breast milk from African women (Manhiça, Mozambique) at the early stages of domestic indoor spraying with this insecticide

Maria N. Manacaa, b, c, Joan O. Grimaltb, Corresponding Author Contact Information, E-mail The Corresponding Author, Jordi Sunyerd, e, Inacio Mandomandoa, f, Raquel Gonzaleza, c, e, Jahit Sacarlala, Carlota Dobañoa, c, e, Pedro L. Alonsoa, c, e and Clara Menendeza, c, e

a Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique

b Institute of Environmental Assessment and Water Research (IDÆA-CSIC), Jordi Girona 18, 08034 Barcelona, Catalonia, Spain

c Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Rosselló 132, 4a, 08036 Barcelona, Catalonia, Spain

d Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003 Barcelona, Catalonia, Spain

e Ciber Epidemiología y Salud Pública, Spain

f Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique

Received 6 November 2010;

revised 19 March 2011;

accepted 1 June 2011.

Available online 20 July 2011.

Abstract

Breast milk concentrations of 4,4′-DDT and its related compounds were studied in samples collected in 2002 and 2006 from two populations of mothers in Manhiça, Mozambique. The 2006 samples were obtained several months after implementation of indoor residual spraying (IRS) with DDT for malaria vector control in dwellings and those from 2002 were taken as reference prior to DDT use. A significant increase in 4,4′-DDT and its main metabolite, 4,4′-DDE, was observed between the 2002 (median values 2.4 and 0.9 ng/ml, respectively) and the 2006 samples (7.3 and 2.6 ng/ml, respectively, p < 0.001 and 0.019, respectively). This observation identifies higher body burden intakes of these compounds in pregnant women already in these initial stages of the IRS program. The increase in both 4,4′-DDT and 4,4′-DDE suggest a rapid transformation of DDT into DDE after incorporation of the insecticide residues. The median baseline concentrations in breast milk in 2002 were low, and the median concentrations in 2006 (280 ng/g lipid) were still lower than in other world populations. However, the observed increases were not uniform and in some individuals high values (5100 ng/g lipid) were determined. Significant differences were found between the concentrations of DDT and related compounds in breast milk according to parity, with higher concentrations in primiparae than multiparae women. These differences overcome the age effect in DDT accumulation between the two groups and evidence that women transfer a significant proportion of their body burden of DDT and its metabolites to their infants.

Highlights

► DDT increases in pregnant women at the start of indoor spraying with this compound. ► Rapid transformation of DDT into DDE occurs in women after intake of this insecticide. ► The DDT increases in breast milk of women due to indoor spraying are not uniform. ► Breast milk DDT content in primiparae women is higher than in multiparae women. ► Women transfer a high proportion of their DDT and DDE body burden to their infants.

“Primiparae” women are those with one child, their first; “multiparae” women are those who have delivered more than one child.

Without having read the study, I suggest there are a few key points this research makes:

  1. Claims that DDT has been “banned” from Africa and is not in use, are patently false.
  2. Spraying poisons in homes cannot be considered to have no consequences; poisons in in very small concentrations get into the bodies of the people who live in those homes.
  3. We should not cavalierly dismiss fears of harms to humans from DDT, because it appears that use of even tiny amounts of the stuff exposes our youngest and most vulnerable children.
  4. Beating malaria has no easy, simple formula.

Women, even poor women in malaria-endemic areas, should not have to worry about passing poisonous DDT or its breakdown products to their children, through breastfeeding.  The national Academy of Sciences was right in 1970:  DDT use should be stopped, and work should be hurried to find alternatives to DDT.

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4 Responses to Poisoning the children: Study shows mothers give DDT to their children from breastmilk

  1. Porllock Junior says:

    Always something new out of Africa; nothing new under the Sun. The ancients were pretty smart.

    In this case, what’s not new: Around 1970, you could buy a lot of interesting posters on Telegraph Avenue. It was also the time when people had got serious in this advanced country about the hazards of DDT. One poster, which regrettably I didn’t buy at the time, showed a pair of breasts and a warning label, quite true, that “Milk in these containers may contain DDT in quantities unsafe for infants.”

    Good times, those. If, of course, one was not in Vietnam or guilty of being Black While in the South.

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  2. Ed Darrell says:

    Interested in U.S. policies on malaria? You may also want to take a look at some of the material at the Global Health Delivery Project, specifically their recommendations on how the U.S. should deal with malaria aid:

    Recommendations in Malaria Policy to the Obama Administration

    Started by Arlan Fuller on 16 Nov 2009
    Last edited by Robert Szypko on 26 Jul 2011

    In the U.S., a coalition of global health advocacy organizations has come together to consider how US development assistance for health should be structured in the future. The Francois-Xavier Bagnoud Center for Health and Human Rights, a partner of the Global Health Delivery Project, was a contributor in this effort. The group recently launched a report, “The Future of Global Health: Ingredients of a Bold and Effective U.S. Initiative,” as the first effort to define expectations for President Obama’s planned Global Health Initiative (GHI), now being developed through an interagency team led by Deputy Secretary of State Jacob Lew. Since the announcement of the initiative in May 2009, the GHI consists only of a limited number of known elements; fundamental aspects such as scope, targets, timelines, and specific costing data have yet to be finalized. The language of a broad and realistic vision of what the U.S. can accomplish, however, is encouraging. The new advocacy report tries to fill in some of these missing details and describe policy and funding needs for a U.S. government response that will help lead the world to universal access to comprehensive healthcare in developing countries.

    On the subject of malaria, what should be asked of the United States? While the Roll Back Malaria Partnership’s Global Malaria Action Plan sets out very ambitious and concrete targets, the United States’ goals within this global effort are not as clear. To policy makers and implementers, alike, what should be expected of U.S. involvement in global malaria efforts? Are the targets and recommendations outlined below accurate?

    The report recommends that the U.S. be a strong leader in the fulfillment of global targets and live up to its pledges to support, by 2015:
    • Purchasing and distributing 730 million LLINs;
    • Achieving a mortality rate near zero for all preventable deaths and a 75% reduction in malaria burden in the original 15 PMI countries;
    • Expanding PMI malaria support to at least 10 more countries and malaria control program strengthening to the Democratic Republic of the Congo and Nigeria;
    • Continuing universal coverage with effective interventions: ITNs, IRS, diagnosis, and provision of ACTs and IPTs;
    • Ensuring global and national mortality is near zero for all preventable deaths and global incidence level is reduced by 75% from 2000 levels;
    • Achieving the malaria related Millennium Development Goal of halting and beginning to reverse the incidence of malaria with a focus on all PMI focus countries and regions where USAID and PMI are supporting national and regional malaria control programs; and
    • Eliminating malaria in eight to ten countries by 2015, continuing with all countries in the pre-elimination phase today and working with countries to receive certification of malaria elimination by the World Health Organization.

    The report also recommends a key set of policy changes needed to ensure that U.S. global malaria programs and the Global Health Initiative can be most effective:

    Strengthen Health Systems
    • Continue to focus on strengthening health systems to deliver integrated services, particularly maternal and child health programs.

    Comprehensive Evaluation
    • Encourage the Global Malaria Coordinator and the Interagency Coordinating Task Force to comprehensively evaluate all programs to determine effective and ineffective programs and policies; use these findings to promote best practices with all malaria funding recipients.

    Support the Global Fund
    • Increase support to the Global Fund and encourage other nations to fulfill their funding commitments.

    Resource Support
    • Increase resources to support normative work and technical assistance provided by the World Health Organization and Roll Back Malaria Partnership, supporting countries in regional strategy development and achieving universal coverage targets through PMI, USAID, and CDC, as consistent with the Hyde-Lantos U.S. Global Leadership for HIV, TB and Malaria, P.L. 110-293.

    Re-Emphasize Monitoring and Research
    • Expand emphasis on drug and insecticide resistance monitoring and research.

    Improve Country Coordination
    • Enhance the sustainability of interventions by continuing to improve alignment with in-country national priorities and existing implementation strategies.

    Continued Commitment to Research and Development
    • Continue leadership in research – vaccine development, drug resistance research, new drug development.

    Thank you in advance for any feedback or suggestions you can offer. For further information about the report, please visit http://www.theglobalhealthinitiative.org.

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  3. Ed Darrell says:

    It’s a really odd claim. During the Bush administration, the policy was that USAID money could not be used to purchase DDT, but no one was proud of the policy or would explain why it existed. USAID eventually dropped the policy as part of the President’s malaria initiative, which has been continued under Obama.

    Here’s USAID’s statement saying they don’t withhold funds and support the use of DDT in IRS, where appropriate:

    http://timpanogos.wordpress.com/2011/02/16/usaid-policy-statement-on-ddt-and-malaria-control/

    Here’s an excerpt from that statement:

    USAID activities for malaria control are based on a combination of internationally-accepted priority interventions and country-level assessments for achieving the greatest public health impact, most importantly, the reduction of child mortality (deaths).

    Contrary to popular belief, USAID does not “ban” the use of DDT in its malaria control programs.

    From a purely technical point of view in terms of effective methods of addressing malaria, USAID and others have not seen DDT as a high priority component of malaria programs for practical reasons. In many cases, indoor residual spraying of DDT, or any other insecticide, is not cost effective and is very difficult to maintain. In most countries in Africa where USAID provides support to malaria control programs, it has been judged more cost-effective and appropriate to put US government funds into preventing malaria through insecticide-treated nets, which are every bit as effective in preventing malaria and more feasible in countries that do not have existing, strong indoor spraying programs.

    USAID country missions provide support to national malaria control programs in about 21 countries in sub-Saharan Africa, where the burden of malaria deaths is the highest. This support covers a broad range of activities, according to local priorities, resource availability and complementary activities by other donors and multinational institutions in each country.

    International efforts to fight malaria are largely coordinated by Roll Back Malaria (RBM), a global partnership that includes leaders from across Africa, African health institutions, the World Health Organization (WHO), UNICEF, World Bank, UNDP, multi-lateral agencies, international, national and local NGOs, and the private sector. USAID is a key RBM partner. RBM has identified three priority interventions to reduce deaths and illness from malaria. These are consistent with USAID ’s priority areas for investment in malaria. These are:

  4. 1. Insecticide-Treated Nets (ITNs) for young children and pregnant women.
  5. 2. Prompt and Effective Treatment with an anti-malarial drug within 24 hours of onset of fever
  6. 3. Intermittent Preventive Therapy (IPT) for pregnant women as a part of the standard ante-natal services.
  7. Each of these interventions is backed by solid evidence of effectiveness under program conditions and effective in reducing the sickness and death from malaria, especially in Africa. For example, proper use of ITNs can reduce overall child deaths by up to 30% and significantly reduce sickness in children and pregnant women.

    DDT in Malaria Programs

    DDT is only used for malaria control through the spraying of interior house walls – Indoor Residual Spraying, or (IRS). A number of other insecticides can also be used for IRS, and are in many countries when those alternative insecticides are safer and equally effective. IRS, when efficiently conducted in appropriate settings, is considered to be as efficacious as ITNs in controlling malaria.

    In most countries in Africa where USAID provides support to malaria control programs, it has been judged more cost-effective and appropriate to put US government funds into other malaria control activities than IRS. USAID has funded non-IRS support to malaria control programs in countries in which DDT is being used, for example, Eritrea, Zambia, Ethiopia and Madagascar.

    USAID regulations (22 CFR 216) require an assessment of potential environmental impacts of supporting either the procurement or use of pesticides in any USAID assisted project, but if the evidence assembled in preparing such an environmental review indicates that DDT is the only effective alternative and it could be used safely such as interior wall spraying undertaken with WHO application protocols, then that option would be considered. The U.S. government is signatory to the Stockholm Convention on Persistent Organic Pollutants (the POPS treaty), which specifically allows an exemption for countries to use DDT for public health use in vector control programs, as long as WHO guidelines are followed and until a safer and equally effective alternative is found. The US voted in favor of this exemption.

    There are a few situations in which IRS with DDT is generally found to be appropriate. For example, in South Africa when certain mosquitoes developed resistance to the major alternative class of insecticides, the synthetic pyrethroids, DDT was used. Such situations are relatively rare, however, and demonstrate the value of the provisions of the POPs Treaty, which restrict and document use of DDT, but provide for its use when appropriate.

    The U.S. is committed to fighting malaria. If DDT is the best way to do that in some location, the U.S. is for it — the U.S. does not oppose the use of DDT in any case.

    Here’s the website for the President’s Malaria Initiative:

    http://www.pmi.gov/

    DDT simply is not the best way to fight the disease any more, if it ever was. DDT only works to hold down mosquito populations temporarily. It was used in an ambitious campaign to beef up medical care in the interim to cure malaria in the human carriers while the mosquito population was knocked down. Without that medical care improvement component, DDT is worse than worthless, it’s destructive and it aids malaria.

    So, the U.S. is putting money into bednets, improving medical care, and other effective treatments.

    You may want to note that the death toll from malaria, right now at the lowest total in human history, continues to fall. Since the heyday of DDT (1959-1960), when 4 million people died from malaria each year, the death toll has been reduced to under 900,000 — a more than 75% reduction in deaths while the target populations have skyrocketed and the range of malaria-carrying mosquitoes has increased.

    We’re reducing malaria without DDT, successfully. In most of the world, DDT would be a waste of money. Surely your debating opponents are not arguing to waste money instead of fighting malaria, would they?

    One other note: India still makes DDT (China and North Korea may still be making the stuff, too). India uses more DDT than all the rest of the world together. India has an increasing malaria problem. If DDT were magic against malaria, it should have been eradicated from India years ago. But DDT is not magic, and often is not even very effective.

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  8. ruidhidh says:

    I am hearing claims that the US threatens to withhold foreign aid from countries that do not also ban DDT. How do I answer this claim?

    Like

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