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Home , Pesticide, Pesticide poisoning

childhood couverture 28/06/04 14:42 Page 1

ChildhoodChildhood PesticidePesticide PoisoningPoisoning

Information for Advocacy and Action

Printed in Switzerland GE.04-00690-May 2004-2000

WHO maquette childhood last 28/06/04 14:46 Page 1

Childhood Information for Advocacy and Action

Prepared for the United Nations Environment Programme (UNEP)

The main text was prepared for the and Organization (FAO), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO) by Dr. Lynn Goldmann, Professor, Environmental Health Sciences, John Hopkins School of and Public Health, Baltimore, USA. These organizations wish to acknowledge the contributions to the report from Mr. Bill Murray, FAO, Dr. Bo Wahlström, UNEP and Dr. Jenny Pronczuk, WHO.

Published in May 2004 by the Chemicals Programme of the United Nations Environment Programme (UNEP Chemicals) with the assistance of UNEP’s Information Unit for Conventions. For more information please contact UNEP Chemicals, International Environment House, 11-13 Chemin des Anémones, CH-1219 Châtelaine, Switzerland, or [email protected].

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I. Introduction

Pesticide poisoning is a serious health Tackling the risks to children of pesticide problem that disproportionately affects exposure and poisoning requires compre- infants and children. are hensive strategies. These strategies designed to kill, reduce or repel , should be designed for the local level and , , fungi, and other organ- supported nationally, regionally and inter- isms that can threaten public health and nationally. They should include research

national economies. However, when activities on how to develop effective eco- Introduction improperly used or stored, these chemical nomic and legal instruments. In addition, agents can also harm humans. Key risks they should ensure that the public is are cancer, birth defects, and damage to informed, health conditions are monitored the and the functioning of and, where necessary, treatment pro- the endocrine system. grams are established. People can be exposed to excessive pes- The need for such strategies is confirmed ticide levels while working; via food, , by a number of international agreements water or air; or by directly ingesting pesti- that call for actions to protect children cide products. Pesticides are known to and the environment from the negative cause millions of acute poisoning cases effects of human activities. These include per year, of which at least one million the United Nations Convention on the require hospitalization. The number of Rights of the Child as as Agenda 21, which was adopted by the United Nations children involved in such incidents is Conference on Environment and unknown but, based on the experience of Development. many countries, likely to be large. Between one and three agricultural workers per The purpose of this document is to provide every 100 worldwide suffer from acute you with information for advocacy and [1, 2], and adolescents action directed at reducing pesticide are often the victims.[3, 4] The contribution poisoning and addressing its effects on of pesticides to chronic diseases, on the children and women. other hand, is unknown. 2 3 maquette childhood last 28/06/04 14:46 Page 4

Selected extracts from the 1989 Selected extracts from Agenda 21, adopted Convention on the Rights of the Child in 1992 by the United Nations Conference dealing with the environment on Environment and Development, that deal with children are: Preamble Chapter 25: Children and youth in ledge of child health and nutrition, the Chapter 6: Protecting and The States Parties to the present sustainable development Convention, advantages of breastfeeding, hygiene and promoting human health environmental sanitation and the preven- 25.12. Children not only will inherit the …Convinced that the family, as the funda- 6.1 Action items under Agenda 21 must tion of accidents; responsibility of looking after the Earth, mental group of society and the natural address the primary health needs of the but in many developing countries they environment for the growth and well- world's population, since they are integral comprise nearly half the population. being of all its members and particularly Article 29 to the achievement of the goals of sus- Furthermore, children in both developing children, should be afforded the neces- 1. States Parties agree that the education tainable development and primary envi- and industrialized countries are highly sary protection and assistance so that it of the child shall be directed to: ronmental care… vulnerable to the effects of environmental can fully assume its responsibilities 6.19 The health of children is affected (e) The development of respect for the degradation. They are also highly aware within the community … more severely than other population natural environment. supporters of environmental thinking. The Introduction groups by malnutrition and adverse envi- specific interests of children need to be Article 24 ronmental factors… taken fully into account in the participatory 1. States Parties recognize the right of the 6.24. Specific major goals for child sur- process on environment and development child to the enjoyment of the highest vival, development and protection were in order to safeguard the future sustain- attainable standard of health and to facil- agreed upon at the World Summit for ability of any actions taken to improve the ities for the treatment of illness and reha- Children and remain valid also for Agenda environment. bilitation of health. States Parties shall 21. Supporting and sectoral goals cover 25.13. National governments, according strive to ensure that no child is deprived women's health and education, nutrition, to their policies, should take measures to: of his or her right of access to such health child health, water and sanitation, basic care services. education and children in difficult circum- a. Ensure the survival, protection and development of children, in accordance 2. States Parties shall pursue full imple- stances. with the goals endorsed by the 1990 World mentation of this right and, in particular, 6.27. National Governments, in coopera- Summit for Children. shall take appropriate measures: tion with local and non-governmental (c) To combat disease and malnutrition, organizations, should initiate or enhance including within the framework of primary programmes in the following areas: health care, through, inter alia, the appli- a. Infants and children: cation of readily available and i. Strengthen basic health-care services through the provision of adequate nutri- for children in the context of primary tious and clean drinking-water, health-care delivery, including prenatal taking into consideration the dangers and care, breast-feeding, immunization and risks of environmental ; … nutrition programmes; (e) To ensure that all segments of society, iv. Protect children from the effects of in particular parents and children, are environmental and occupational toxic informed, have access to education and compounds; are supported in the use of basic know- 4 5 maquette childhood last 28/06/04 14:46 Page 6

II. What do we know about pesticide poisoning and why are children at greater risk?

Summary Hazardous by design Unintended – but harmful – effects countries, where safeguards typically are inadequate or lacking altogether.[6][1] The unintended but harmful effects of Children are often more vulnerable Pesticides are toxic substances designed Although developing countries use pesticides have become clearer in recent than adults to the effects of pesticides to kill, repel or inhibit the growth of living 25% of the world’s production of decades, which has increased the as a result of several risk factors. . They are used against insects, pesticides, they experience 99% of the urgency for taking action. For example, These include their smaller size; , , fungi, and deaths.[1] greater rates of exposure to food, other creatures that can pose problems if used on a broad scale, pesticides can soil, water, and air; differing for agriculture, public health, or homes, disrupt the ecological balance of agricul- The total health impact of pesticide expo- ; and rapidly growing schools, buildings and communities.[6] tural areas by killing natural biological sure is probably much greater than these figures suggest. The symptoms of pesti- and developing organ Pesticides impair the functioning of controls; this can to outbreaks of cide poisoning, which may involve a skin systems. They tend to explore their biological processes essential for life, pests that were previously of minor impor- rash or mild gastroenteritis, are frequently immediate environment more than such as the nervous and reproductive tance and consequently to lower similar to other health problems, so the adults do and to put things in their systems. Very often, these processes are yields. Once used, pesticides may accu- link to pesticides may go undetected. mouths. Inexperience, lack of similar among different organisms, mulate in the air or water or on land, maturity, illiteracy and an inability whether insects or humans, adults or chil- where they can harm non-target species People suffering from acute poisoning to assess risk make children more dren. and diminish . By contaminat- may lack access to medical care and may likely to accidentally ingest ing groundwater, lakes, rivers, and other not even report the illness to the medical Many pesticides have similar chemical pesticides. Children who work bodies of water, they can pollute drinking system. Health personnel may lack the structures and thus may act in the same around pesticides face additional supplies, and other resources that training for recognizing pesticide - way. For example, the opportunities to be severely poisoned. can be vital for human well-being. By ing or the means to report it to national and poison [3, 4] Because children are at polluting soil, they can endanger children authorities, which may themselves lack insects by inhibiting the enzyme acetyl greater risk, they need greater at play or at work and make it difficult to reporting systems. Moreover, it is difficult . This mode of action can protection.[5] More awareness-raising use the land later for other purposes. to associate chronic health effects with also be toxic to people. By regulating is needed about risks, especially pesticides for several reasons. Chronic pesticides one at a time we may be under- Pesticides are harmful to human health. It from the most acutely toxic has been reported that an estimated 1 million disease tends to result from lower expo- estimating the cumulative impact of What do we know about pesticide poisoning? pesticides, since adverse effects sure levels than do acute illnesses. There pesticides of similar .[5] to 5 million cases of pesticide on children are completely occur every year, resulting in 20,000 fatal- is a time lag between the exposure and preventable. ities among agricultural workers. Most of the disease, and in individual cases it is these poisonings take place in developing usually impossible to make a firm link. 6 7 maquette childhood last 28/06/04 14:46 Page 8

Acute poisoning research, and reported incidents involving abnormalities in laboratory animals.[11] human exposure to different doses of Certain organophosphorus compounds herefore we know very little about the Acute poisoning can cause a range of pesticides all support the following points: have caused long-term neurological chronic health impacts of pesticides and symptoms in adults and children, depend- Developmental and reproductive effects. disabilities in farm workers who have must rely on animal tests and epidemio- ing on the type of pesticide. For example, Certain pesticides are believed to cause suffered acute poisoning.[12] logical studies to understand what the commonly used organophosphorus and reproductive problems, such as sponta- Carcinogenic effects. A number of pesti- magnitude of those effects might be. carbamate compounds can produce neu- robehavioral effects, such as fatigue, neous abortions, stillbirths, lower birth cides cause cancer in laboratory animals, The impact of an exposure to pesticides dizziness, and blurred vision; intestinal weights, birth defects and early neonatal and several have been associated on human health depends on a number of effects, such as nausea; respiratory deaths.[8, 9] with cancer in humans. The concern for factors, including the class of pesticide effects, such as dry throat and difficulty Endocrine disruption. Many pesticides children is twofold. First, cancers in involved, the specific chemical and for- with breathing; effects involving skin and have been shown to disrupt natural children, including , sarcomas, mulation, and the amount, route, mucous membranes, such as stinging endocrine systems in pests, wildlife and , and brain cancer, have been timing and duration of the dose. The route eyes, itchy skin, and a burning nose; and laboratory animals. In small doses these associated with parents or homes that of exposure can be via breathing, drinking muscular symptoms, such as stiffness pesticides are able to mimic or block hor- have been exposed to pesticides.[13] or eating, or through the skin or mucous and weakness.[7] mones or trigger inappropriate hormonal Second, people may face an increased membranes. Other factors include activity. At high enough doses during crit- risk of developing cancer during their the health of the person poisoned. Acute pesticide poisoning can result in ical times of development such exposures lifetime if they have been exposed to Malnutrition and dehydration, for example, death, either rapidly or over the course of have the potential to interfere with impor- in their childhood. increase the sensitivity to pesticides. weeks, depending on the characteristics tant developmental and reproductive Immunological effects. In animal exper- Children who are malnourished and dehy- of the product and type of exposure. functions and may cause sterility, lowered iments, certain pesticides have been drated are at greater risk, and the risk for sperm counts, cancer of the reproductive proven to compromise the immune such children working in agriculture is Long-term health effects organs and other effects.[10] system. A weakened immune system, still higher. Furthermore, where access to Some health effects caused by pesticides particularly in growing children, exacer- quality medical care is lacking, poisoning only become apparent over a longer period Neurobehavioral effects. Impaired devel- opment of the nervous system can cause bates the risk of infectious disease and cases may go undiagnosed or untreated. What do we know about pesticide poisoning? of time. Controversy continues over the cancer, thus increasing mortality rates. Treatments such as antidotes and lowered intelligence and behavioral nature and severity of the health impacts This would be especially menacing in removal from the source of exposure may abnormalities. Although these impacts from long-term exposure to pesticides. developing countries, where children not be available. have not been studied in humans, However, studies of laboratory animals, face greater exposures to infectious a growing body of epidemiological exposure to certain pesticides in utero 8 causes developmental and neurological agents and may already have compro- 9 maquette childhood last 28/06/04 14:46 Page 10

mised immune systems due to poor nutri- not always be the case in developing or spill. Clothing can occlude the skin, on or near contaminated soil and using tion and other factors. [14] At present, countries. For indoor applications, ade- which enhances its ability to absorb pesti- contaminated water on or for there are no standardized tests for quate ventilation is essential, but not cides. When clothes are brought home for washing puts people – and children in developmental immunotoxicity. always practiced. laundering, those doing the washing are particular – at risk. also exposed to the pesticides. Residues In many countries pesticides must under- The use of pesticides can expose people to Farmers and others may store pesticides from laundering contaminate water and go comprehensive toxicity testing. Even risks at different stages of the application in or around their homes where household soil, further extending the chain of risk.[15] so, most pesticides have not been process, from the purchase of products members can accidentally gain access to Clothing may also be purposely treated assessed for one or more rele- and the preparation and mixing of solutions them, or where these toxic substances with pesticides; recently was vant to the health of children, especially to spraying, handling of pesticide-treated can contaminate food or water that is identified in shipments of leather from developmental and immuno- items and disposal.[1, 2] Protective equip- stored nearby. Used pesticide containers Africa.[23] logical effects. While unnecessary testing ment is often impractical in hot tropical are often reused to store water and food. should be minimized, it is important to climates and not affordable for many Pesticide spills are common and can assure that risks to children are included farmers.[15, 16] occur at different stages and places, The greater vulnerability of including manufacturing, processing, in safety assessments of pesticides.[5] Not only workers but nearby residents children packaging, , storage, mixing, and children can be exposed to pesticides Although exposure to pesticides may field application and disposal. General exposure – frequent and sprayed on fields. Field workers entering present a risk to all people, children often unknowing an area treated by pesticides often face a Once used or spilled, pesticides may generally face higher risks than adults. contaminate water used for drinking or Pesticides are readily available and widely higher risk of harm, particularly if the time Children may be more susceptible than bathing. They can also pollute soil, either applied. They are used by farmers to between application and entry is short adults to certain pesticides, and they may from agricultural use or as a result of spills spray crops and treat livestock. They are and if they lack protective clothing. Older be more greatly exposed than adults. during manufacturing and processing. used in public health programmes, which children and adolescents may be directly They thus bear a disproportionate burden Sediments in rivers, lakes and bays can be can include indoor spraying of houses or exposed as field workers, while younger of risk and need additional protection.[5] contaminated by runoff from pesticide public places. They are applied in all children may be brought into treated fields Children are often more exposed to pesti- production and use. Cleaning up contami- types of buildings, including schools. to accompany their parents[3, 4, 17-22] cides. For example, when a mother is nated water, , and sediments can be They are also used by trained applicators, Work clothes often carry pesticide exposed to pesticides, the child often What do we know about pesticide poisoning? difficult and expensive and require years maintenance workers, building residents, residues, exposing both workers and fami- becomes exposed as well. Children may of treatment. farmers and farm workers. The most haz- ly members. Workers can be exposed for even be exposed to pesticides before ardous pesticides should be applied only a prolonged time if they do not remove One of the most important sources of birth, while still in the womb. This occurs 10 by professional applicators, but this may and wash clothes after each application exposure is food residues. Growing food when pesticides are transferred to the 11 maquette childhood last 28/06/04 14:46 Page 12

figure 1 figure 2 figure 3 figure 4

fetus via the placenta. such as , milk, eggs and fish. Similarly, sure to pesticides. In addition to playing treated with pesticides. The result can be During early infancy, children also pesticides in fruits and are also closer to the ground, children may be even higher exposure to pesticides. come into contact with persistent and passed on to children at high levels, exposed to more pesticides in dusts and Pesticide-related illnesses in children bio-accumulative pesticides that are including in processed foods. soils due to normal hand-to-mouth activity; employed in farm work have been passed on to them through breastfeeding. Children may have completely different figure 4 compares the amount of soil eaten documented in many countries.[3, 4] This can be a major source of exposure. eating patterns than adults, making each day by children and adults.[25] Because breast milk is the best source of their potential exposure to pesticides Children frequently put toys or other objects High-risk exposure scenarios for nutrition for infants and recommended by even more disproportionate. Their diet is into their mouths as well, and as a conse- children quence may receive significant doses of the World Health Organization, protecting much less diversified, resulting in a larger The fact that children will receive higher pesticides from contaminated objects, such mothers from exposure to toxic contami- relative consumption of certain foods. doses of pesticides compared to adults as those found in agricultural areas, homes nants is crucial.[24] For example, in the US infants consume may be of particular concern in certain or . As they grow, children drink more water, much more of certain fruits like apples situations. These include the consumption kilo for kilo, than do adults. Figure 1 per body weight than adults do. As a Because children have different metabo- of fish and other food that is highly con- shows the consumption of drinking water consequence, diet can be a major source lisms than adults, they may have different taminated with pesticides, subsistence for several different age groups. As can of pesticide exposure for children, and capacities for breaking down or metaboliz- farms that use large quantities of pesti- be seen, infants under one year of age greater relative to their size than for ing, excreting, activating or deactivating cides, and pesticide-spraying pro- who are fed reconstituted infant formula adults.[5] pesticides. Such processes change dramat- grammes. For example: ically from birth until adulthood. These consume more than twice as much water Figure 3 compares daily breathing rates • Indoor pesticide sprays, or dusts factors can cause pesticides to have more as adults. This means that, if the water from several different age groups.[25] can be misapplied, creating hazardous pronounced toxic effects in children, or contains residues of pesticides, infants It shows that when pesticide residues are levels of pesticides in the air and the possibly lead to somewhat different will receive more than double the dose of present in the air or in airborne dust, build-up of pesticides in foam articles poisoning symptoms than those seen in pesticide as an adult drinking the same infants can receive higher doses than such as bedding and children’s toys.[26] water.[25] older children and adults. In addition, adults. • Mispackaged pesticides can lead to Children consume more food, per body children play closer to the ground, Poverty can put children in a number of children accidentally ingesting pesti- What do we know about pesticide poisoning? where many pesticides may be present potentially high-risk situations. Children weight, than do adults. Figure 2 shows US cides.[27] The most hazardous pesticide at higher concentrations. may help out on family-owned farms data on the consumption of various foods packages are bottles that look like those where pesticides are used. They may in which persistent and bio-accumulative Children behave and play differently than containing soft drinks or other bever- pesticides may be present at high levels, adults, resulting in greater potential expo- work for local concerns, carrying goods 12 ages. 13 maquette childhood last 28/06/04 14:46 Page 14

• Highly toxic pesticides may be viewed • Pesticides can contaminate nearby Exposure in urban settings Spraying of pesticides for control in by older children as a convenient means groundwater and surface-water. Conta- interior spaces, including living quarters, In developing countries, the marketing of of attempting .[28] minated water is more likely to be con- takes place regularly, and reentry times pesticides is sometimes uncontrolled or sumed by small children, who tend to are not observed. Some pesticides break • Highly concentrated and acutely toxic illicit. Misbranded or unlabelled formula- drink water from any source. down slowly, and exposure continues pesticides can cause severe illness or tions, including ready-made solutions in despite the observance of re-entry times. death even if ingested in very small quan- • Locally grown food may not be properly soft drink bottles and other unlabelled tities – for example, a single swallow.[29] monitoring or controlled for residues of liquid containers, are sold at open stands. Infants who are still being breastfed are Concentrates are also hazardous around pesticides. Because food sold at the Industrialized countries have also experi- carried by their mothers in the fields the home because they must be reconsti- farm gate often has higher residue levels enced the fraudulent marketing of agricul- during spraying operations. Older children tuted in another container, one that may than food distributed later, families who tural pesticides for indoor use, which are allowed to play around treated fields. be easily confused as being safe by a eat directly from fields may have higher causes children to face further expo- Pesticides or ready-to-use solutions are young child. pesticide exposures. sures.[31] kept in the home in unlabelled containers • Household pesticide contamination • Containers for pesticides in low- or are labelled in a language other than (caused by insecticides that are used for income countries and areas are often Exposure in rural settings the local one. Illiteracy compounds the sanitation or vector control, carried into used and re-used for other purposes, Soil is contaminated by pesticides risk of exposure. the home by parents or tracked into including storing and transporting food sprayed on neighboring fields or spilled the house through contaminated soil) and water. near living quarters while equipment is Exposure and developing coun- can be especially hazardous to children • Grain storehouses are continually being filled. tries who display “pica” behavior. Such treated with to limit crop Contaminated equipment is left after Many situations involving pesticide expo- young children have a propensity for losses. Bait can easily be mistaken for working hours near areas used by sure are linked to education and certain peeling off and eating paint chips, normal grain, which is particularly dan- children for playing. socio-economic conditions. These condi- wallpaper, and other materials; it is gerous for children because they have lit- Family members working with spraying tions tend to occur more often in develop- most common among children with a tle protection against most rodenticides. nutritional deficiency – the same chil- equipment do not wash and change their ing countries, thus resulting in increased

Looting of baited grain by children from What do we know about pesticide poisoning? clothes after work or they leave their risk to children.[34] dren who are likely to be more vulnera- families with low incomes can lead to contaminated clothes lying around.[32] ble to the effects of toxic pesticides. severe poisonings. Stockpiles of unwanted or obsolete pesti- Such children would thus be more Spraying of field pesticides occurs close cides, which are unprotected and uncon- • Pesticides are too often stored in house- exposed to DDT and other pesticides to living quarters or drifts into neighboring trolled and often lack legible labeling, holds where they are in easy reach of 14 sprayed on the walls. fields, homes, or schools.[4, 33] 15 children.[16, 30] maquette childhood last 28/06/04 14:46 Page 16

Excerpt from Final Report of Fourth Session of Intergovernmental Forum on Chemical Safety,

Bangkok, Thailand, 1-7 November 2003

Children and chemical safety Governments should, when setting 1. When assessing the protection of acceptable levels or criteria related to children, consideration should be given to chemicals, take into consideration the chemical exposures that can occur during potential enhanced exposures and/or preconception, throughout gestation, vulnerabilities of children. infancy, childhood and adolescence. 4. WHO is requested to support, collabo- may be found close to living quarters or Pesticide users, particularly on subsis- 2. Governments should prepare, through rate with, and coordinate among research to areas where children play or work. tence farms, often lack access to training. multi-stakeholder consultation, initial organizations and those supporting research (such as the European Seeds coated with pesticide for planting, This can lead to pesticides being used national assessments of children’s envi- Commission, Science NGOs, the Global or pesticide-treated grains for use as bait, carelessly, including in the presence of ronmental health and chemical safety. Health Research Forum, governments and are often stored without proper labeling children.[15] These assessments should identify the others) to develop mechanisms to facili- and protective measures. In times of eco- The lack of education for girls has priority concerns and provide a basis for tate collaborative national and interna- nomic stress or food shortage, people may particularly significant consequences. developing action plans to address those tional research and share technology. be tempted to eat such seeds. When girls grow up they go on to shoulder concerns. Governments should provide a progress report to Forum V. 5. Governments and stakeholders should Any spraying equipment used by subsis- responsibilities for household chores, commit to sharing information on options tence farmers tends to be low-end water provision, education of family mem- WHO is requested to develop, through for taking effective action to protect technology. Manual equipment used by bers, and work in agriculture and other multi-stakeholder consultation, guidance children from established chemical an individual results in imprecise spraying areas where pesticides play a role. tools, and to assist at least three countries threats and from chemical risks where and substantial drift of pesticides to in different stages of economic develop- there is a degree of uncertainty. WHO is nearby living quarters. ment in each region to prepare the assessment and action plans by 2006. requested to convene a multi-stakeholder Pesticide users, including teenagers, may meeting to explore the mechanisms lack access to protective equipment such 3. Governments, with support from stake- for collecting data and disseminating as gloves and masks, which is required holders, particularly WHO and UNICEF, information that could be used to reduce to assure the safety of the pesticide should promote education and training on uncertainty in risk assessment. product.[16] children’s chemical safety, and where risks are identified, governments and 6. In addition, Forum IV requests the IFCS stakeholders should commit to taking President to convey these recommenda- action to prevent or reduce exposure. tions to other meetings and fora. Governments should also promote harmo- In carrying out the recommendations

nized data collection, research, legislation set out in this priority, the stakeholders What do we know about pesticide poisoning? and regulations, and consider the use of concerned should be guided by the full indicators of children’s environmental decision document and companion infor- health, and report back to Forum V in 2006. mation paper that were developed by the Forum Working Group. 16 17 maquette childhood last 28/06/04 14:46 Page 18

III. What can be done to prevent pesticide poisoning of children?

Strategies to prevent At the local level • Ensure hygienic conditions, especially be used in the safest manner possible. pesticide poisoning must be designed for when storing food and water, and wash food Pesticides that have restrictions for use, The risks posed by pesticides can be best local conditions while drawing support prior to eating it. such as requirements for special protective avoided by minimizing the use of pesticides, from the national and international levels. gear, should only be applied by such trained especially the most hazardous ones, and by • Minimize the unnecessary use of pesti- These strategies should be sensitive professionals. taking measures to reduce exposures cides around children by practicing inte- to differing cultural, political, economic, where it is not practical to eliminate use grated management in homes and • Pesticide manufacturers and governments technological and altogether. Everyone responsible for caring schools. Where pesticides are used, strictly should follow the voluntary FAO development circumstances. for children or who is involved with pesti- follow instructions about application rates International Code of Conduct on the cide use should be aware of the problems and re-entry intervals.[35] Distribution and Use of Pesticides. The Code caused by pesticides and be encouraged to: • Health care providers need to know how to outlines measures for ensuring the safety of recognize and treat cases of pesticide pesticides through the testing, manufactur- • Reduce and eliminate possible sources ing, advertising, labeling, and distribution of pesticide exposures to children (in food, poisoning. They can also help to educate farmers and others about the adverse phases.[36] It calls on manufacturers to sup- water, dust, and soil and in the home and ply information and instructions in a form the work environment). effects of pesticides and how to prevent pesticide exposures, and they should docu- and language adequate for ensuring safe • Reduce unnecessary uses of agricultural ment and report any cases of pesticide and effective use. It also asks them to retain pesticides by adopting strategies that can poisoning. an active interest in following their products reduce pesticide use, such as integrated to the ultimate consumer, keeping track of pest management and . • Pesticide users and their families need to major uses and any problems that may arise Where pesticides are needed, encourage be better educated about how to recognize, during the actual use of their products. the use of safer pesticides. prevent and treat pesticide poisoning, in This information can then be used for deter- particular mothers with small children who whether any changes are needed in • Keep pesticides out of children’s reach live in areas where pesticide exposures may and store them securely in containers that labeling, directions for use, packaging, be high. Such information could be included formulation or product availability. do not resemble those used for food or in school curricula. drinks, are properly labeled and use child- proof tops. Do not store any highly toxic • Where hazardous pesticides are used, communities need a cadre of trained pesti- pesticides or pesticide concentrates in the What can be done to prevent pesticide poisoning? home.[35] cide applicators so that the pesticides will 18 19 maquette childhood last 28/06/04 14:46 Page 20

FAO International Code of Conduct on the 3.4.2 in close cooperation with procurers Distribution and Use of Pesticides of pesticides, adhere closely to provisions of FAO guidelines on tender 3. Pesticide management procedures (4); 3.1 Governments have the overall responsibility to regulate the availability, 3.4.3 pay special attention to the choice distribution and use of pesticides in their of pesticide formulations and to presen- countries and should ensure the allocation tation, packaging and labelling in order of adequate resources for this mandate. to reduce risks to users and minimize adverse effects on the environment; 3.2 Pesticide industry should adhere to the provisions of this Code as a standard 3.4.4 provide, with each package of pes- for the manufacture, distribution and ticide, information and instructions in a At the national level The OECD has documented the fact that advertising of pesticides, particularly in the riskiest type of chemical products are form and language adequate to ensure Pesticides can pose risks anywhere in countries lacking appropriate legislation effective use and reduce risks during often exported from industrialized to and advisory services. the world. The problem is greatest, how- developing countries. Moreover, busi- handling; ever, in developing countries where low nesses that are involve in formulation retail prices promote pesticide use but of pesticides are more common in devel- 3.3 Governments of pesticide exporting 3.4.5 be capable of providing effective weak legislation and inadequate law oping countries than pesticide manufac- countries should, to the extent possible: enforcement fail to control risks. Such technical support, backed up by full turers; has serious product stewardship to field level, countries should establish systems for potential for risks to health and the 3.3.1provide technical assistance to including advice on disposal of pesti- collecting data on cases of pesticide environment, unless adequate safeguards other countries, especially those lacking cides and used pesticide containers, if exposure. A number of software systems are taken. are readily available for this purpose, technical expertise in the assessment of necessary; including the INTOX Programme pro- The following sections of the voluntary the relevant data on pesticides; FAO International Code of Conduct on the duced by the International Programme on 3.3.2 ensure that good trading practices 3.4.6 retain an active interest in follow- Distribution and Use of Pesticides are Chemical Safety (IPCS). are followed in the export of pesticides, ing their products to the end-user, keep- particularly applicable to actions on the especially to those countries with limited ing track of major uses and the occur- Awareness of pesticide risks and how to national level: manage them should be promoted or no regulatory schemes. rence of any problems arising from the through information and education use of their products, as a basis for campaigns, including via television and determining the need for changes in 3.4 Pesticide industry and traders radio programs. Risks related to pesticide labelling, directions for use, packaging, should observe the following practices in production may not be relevant in many formulation or product availability. pesticide management, especially in developing countries, but in those coun- countries without legislation or means of tries that do have manufacturers, weaker implementing regulations: 3.5 Pesticides whose handling and laws and enforcement may increase the application require the use of personal likelihood that workers and nearby protective equipment that is uncomfort- communities could be exposed. 3.4.1 supply only pesticides of adequate able, expensive or not readily available quality, packaged and labelled as appro-

should be avoided, especially in the case What can be done to prevent pesticide poisoning? priate for each specific market (3); of small-scale users in tropical climates. 20 Preference should be given to pesticides 21 maquette childhood last 28/06/04 14:46 Page 22

3.11 Governments, pesticide industry and 5.1.5 establish national or regional national and international organizations poisoning information and control should collaborate in developing and pro- centres at strategic locations to provide moting resistance management strategies immediate guidance on first aid and to prolong the useful life of valuable pesti- medical treatment, accessible at all cides and reduce the adverse effects times; resulting from the development of resist- 5.1.6 utilize all possible means for col- ance of pests to pesticides. lecting reliable data and maintaining sta- tistics on health aspects of pesticides 4. Testing of pesticides and pesticide poisoning incidents, with 4.2 Each country should possess or the objective of establishing the WHO have access to facilities to verify and harmonized system for identifying and that require inexpensive personal protec- extension agents, crop consultants, food exercise control over the quality of pesti- recording such data (25). Suitably tive and application equipment and to industry, manufacturers of biological and cides offered for sale or export, to estab- trained personnel and adequate procedures appropriate to the conditions chemical pesticides and application lish the quantity of the active ingredient or resources should be made available to under which the pesticides are to be equipment, environmentalists and repre- ingredients and the suitability of their for- ensure the accuracy of information handled and used. sentatives of consumer groups should mulation, according to FAO or WHO spec- collected; play a proactive role in the development ifications, when available. 3.6 National and international organiza- and promotion of IPM. 5.1.7provide extension and advisory tions, governments and pesticide industry services and farmers' organizations with 5. Reducing health hazards should take coordinated action to dissem- 3.9 Governments, with the support of adequate information about practical IPM inate educational materials of all types relevant international and regional organ- 5.1 Governments should: strategies and methods, as well as the to pesticide users, farmers, farmer organ- izations, should encourage and promote range of pesticide products available for izations, agricultural workers, unions and research on, and the development of, 5.1.1 implement a pesticide registration use; other interested parties. Similarly, users alternatives posing fewer risks: biological and control system along the lines set out 5.1.8 ensure, with the cooperation of should seek and understand educational control agents and techniques, non- in Article 6; pesticide industry, that where pesticides materials before applying pesticides and chemical pesticides and pesticides that are available through outlets which also 5.1.2 periodically review the pesticides should follow proper procedures. are, as far as possible or desirable, tar- deal in food, clothing, medicines or other marketed in their country, their accept- get-specific, that degrade into innocuous products for consumption or topical 3.7 Concerted efforts should be made able uses and their availability to each constituent parts or metabolites after use application, they are physically segre- by governments to develop and promote sector of the public, and conduct special and are of low risk to humans and the gated from other merchandise to the use of IPM. Furthermore, lending reviews when indicated by scientific environment. prevent contamination and/or mistaken institutions, donor agencies and govern- evidence; identity. Where appropriate, they should ments should support the development of 3.10 Governments and the application 5.1.3 carry out health surveillance pro- be clearly marked as hazardous materials. national IPM policies and improved IPM equipment industry should develop and grammes of those who are occupationally Every effort should be made to publicize concepts and practices. These should promote the use of exposed to pesticides and investigate, as the dangers of storing foodstuffs and be based on scientific and other strategies methods (6, 7) and equipment (8, 9, 10, 11) well as document, poisoning cases; pesticides together; that promote increased participation that pose low risks to human health and of farmers (including women's groups), the environment and that are more effi- 5.1.4 provide guidance and instructions 5.1.9 utilize all possible means for collect- extension agents and on-farm researchers. cient and cost-effective, and should con- to health workers, physicians and hospi- ing reliable data, maintaining statistics on duct ongoing practical training in such tal staff on the treatment of suspected environmental contamination and 3.8 All stakeholders, including farmers activities (12). pesticide poisoning; reporting specific incidents related to What can be done to prevent pesticide poisoning? and farmer associations, IPM researchers, pesticides; 22 23 maquette childhood last 28/06/04 14:46 Page 24

5.1.10 implement a programme to moni- prior to domestic use and ensure that 7.3 Two methods of restricting availability tor pesticide residues in food and the each pesticide product is registered can be exercised by the responsible environment. before it can be made available for use authority: not registering a product or, as a (29, 30, 31); condition of registration, restricting the 5.3 Government and industry should availability to certain groups of users in cooperate in further reducing risks by: 6.1.3 conduct risk evaluations and make risk management decisions based on all accordance with a national assessment of available data or information, as part of the hazards involved in the use of the 5.3.1 promoting the use of proper and the registration process; product. affordable personal protective equip- 6.1.8 collect and record data on the 7.4 Governments and industry should ment; import, export, manufacture, formula- ensure that all pesticides made available 5.3.2 making provisions for safe storage tion, quality, quantity and use of to the general public are packaged and of pesticides at both warehouse and pesticides in order to assess the extent labelled in a manner which is consistent farm level; of any possible effects on human health with the FAO guidelines on packaging and 5.3.3 establishing services to collect or the environment, and to follow trends labelling (3) and with appropriate national and safely dispose of used containers in pesticide use for economic and other regulations. and small quantities of left-over pesti- purposes; cides; 7.5 Prohibition of the importation, sale and purchase of highly toxic and haz- 5.3.4 protecting biodiversity and mini- 7. Availability and use ardous products, such as those included mizing adverse effects of pesticides on in WHO classes Ia and Ib (34), may be the environment (water, soil and air) and desirable if other control measures or on non-target organisms. 7.1 Responsible authorities should give special attention to drafting rules and regu- good marketing practices are insufficient to ensure that the product can be handled 6. Regulatory and technical requirements: lations on the availability of pesticides. These should be compatible with existing with acceptable risk to the user. 6.1 Governments should: levels of user training and expertise. 6.1.1 introduce the necessary legislation The parameters on which such decisions 8. Distribution and trade for the regulation of pesticides and on availability are based vary widely and make provisions for its effective enforce- must be left to the discretion of each ment, including the establishment of government. 8.1 Governments should: appropriate educational, advisory, exten- 8.1.1 develop regulations and implement 7.2 In addition, governments should take sion and health-care services, using licensing procedures relating to the sale note of and, where appropriate, use the FAO guidelines as far as possible (2, 29, of pesticides, so as to ensure that those WHO classification of pesticides by haz- 30). In so doing, they should take full involved are capable of providing buyers ard (34) as the basis for their regulatory account of local needs, social and eco- with sound advice on risk reduction and measures and associate the class nomic conditions, levels of literacy, cli- efficient use (26); matic conditions and availability of with well-recognized hazard symbols. When determining the risk and degree of 8.1.2 take the necessary regulatory appropriate pesticide application and measures to prohibit the repackaging or personal protective equipment; restriction appropriate to the product, the type of formulation and method of decanting of any pesticide into food or 6.1.2 strive to establish pesticide regis- application should be taken into account. beverage containers and rigidly enforce tration schemes and infrastructures punitive measures that effectively deter What can be done to prevent pesticide poisoning? under which products can be registered such practices; 24 25 maquette childhood last 28/06/04 14:46 Page 26

At the regional and international level

Although all pesticides Pesticides with high acute toxicity: Epidemiology of acute pesticide should be considered as being Ia, Ib, and II Chemicals poisonings potentially hazardous to human health, The World Health Organization (WHO) Adding to the risk is the fact that small- The unsafe use of pesticides represents a some groups of pesticides classifies most pesticides mainly on the scale farmers in developing countries problem for human health in both devel- are of particular basis of acute toxicity studies of animals. typically cannot afford protective clothing. oped and developing countries. Although concern internationally. Pesticides are classified as extremely Even if available, protective garb the adverse effects of pesticides on National governments hazardous (Ia), highly hazardous (Ib), mod- used under tropical conditions is hot and human and environmental health have and intergovernmental organizations erately hazardous (II), slightly hazardous uncomfortable at best, and can lead to been studied in almost every country, con- are carrying out a number of activities to (III) and unlikely to be hazardous under heat stress. Thus, it is unlikely to be used. troversy continues about the extent and reduce the adverse health normal use (no class number assigned). severity of poisonings. The primary reason and environmental impacts For some class Ia pesticides, just 5 ml (a for the controversy is the limited scope of of pesticides. teaspoon) taken into the mouth is suffi- past reports and studies. cient to kill an adult human being. The International Programme on Chemical Small-scale farmers in the tropics use Safety (IPCS) has initiated a project that will large amounts of pesticides belonging to provide reliable and updated information on classes Ia, Ib, and II. For example, in the extent of the problem and make it pos- in 1995, 44 percent of the 265 sible to compare epidemiological data registered pesticides were Class Ia, Ib, or among various study populations. Data II; one field study revealed that 50 percent from different health sources and study sites are being collected, and countries

of pesticides used by farmers belonged to At the regional and international level these classes. are being given guidance on how to strengthen their national data collection systems and promote prevention and education. These activities are designed to reduce the incidence and severity of poisonings and their adverse effects.

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Persistent Organic – Pesticides under the Rotterdam Pesticides Convention Another group of pesticides of particular The on the Prior substances are likely to be added in the concern is persistent organic pollutants Informed Consent Procedure for Certain future. All of the listed chemicals have (POPs). These pesticides are toxic; persist Hazardous Chemicals and Pesticides in been banned or severely restricted by for long periods in the environment; travel International Trade was adopted in countries to protect human health and the long distances via air, water and living September 1998. [38] The Convention has environment. The list includes severely creatures; and are found in areas where been signed by 73 countries, and its goals hazardous pesticide formulations that can they were never used or produced. They are being pursued on a voluntary basis cause problems under the conditions of store easily in fatty tissues and build up in through the interim PIC procedure until use in developing countries and countries food chains.[37] Children may be exposed the agreement enters into force. The with economies in transition. to these pesticides when still in the womb Convention entered into force on For further information, see the Rotterdam and during breastfeeding. (However, 24 February 2004. Convention website www.pic.int. breast milk is the preferred source of The Rotterdam Convention establishes a nutrition for young infants.) first line of defence against future Responding to mounting concern, govern- tragedies by giving importing countries ments adopted a legally binding treaty the power to decide which potentially in 2001 under the auspices of the United hazardous chemicals they want to receive Nations Environment Programme at and to exclude those they cannot manage reducing and eliminating a starting list of safely. When trade is permitted, require- 12 POPs. Nine are pesticides: ments for labelling and providing At the regional and international level , , DDT, , , importers with information on potential , , , and hexa- health and environmental effects will pro- (the later is also an indus- mote the safe use of the chemicals. trial chemical). The Convention starts with 22 pesticides and five other chemicals; many more

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Activities of International Organizations

United Nations Environment Programme (UNEP) Mr. Jim Willis, Director UNEP/Chemicals is the focus for all UNEP Chemicals activities on the sound management of hazardous chemicals. Its aim of International Environment House protecting human health and the 11-13 Chemin des Anémones environment from the negative impacts CH-1219 Châtelaine of toxic chemicals is pursued by: Switzerland - Jointly with FAO, providing the secre- tariat for the Rotterdam Convention on Tel. +41 22 917 81 83 the Prior Informed Consent Procedure Fax +41 22 797 34 60 for Certain Hazardous Chemicals and Email: [email protected] Pesticides in International Trade; - Providing the secretariat for the Stockholm Convention on Persistent Organic Pollutants (POPs); - Catalyzing actions to help governments address risks from toxic chemicals; - Promoting the world-wide exchange of information on toxic chemicals; and Activities of International Organizations - Providing training and capacity building to countries in the sound management of chemicals.

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Food and Agriculture Organization Dr. Niek Van Der Graaff, Chief World Health Organization of the United Nations (FAO) Protection Service (WHO). FAO assists member countries to Plant Production and Protection Division WHO's work in chemical safety is Dr. Timothy Meredith, Coordinator improve the sound management of Food and Agriculture Organization undertaken largely through the Programme on Chemical Safety International Programme on Chemical chemicals by: Via delle Terme de Caracalla World Health Organization Safety (IPCS), a joint programme of I-00100 Rome WHO, UNEP and the International Avenue Appia, 20 - Promoting the provisions of the Code Italy Labour Organization (ILO). At WHO CH-1211 Geneva 27 of Conduct on the Distribution and Use Tel. +39 6 5705 34 41 headquarters, the Programme for Switzerland of Pesticides and providing technical the Promotion of Chemical Safety is assistance on implementing rational Fax +39 6 5705 63 47 the Central Unit for IPCS, with dual Tel. +41 22 791 3761/3791 plant-protection programmes and pre- Email: [email protected] responsibilities for technical work and Fax +41 22 791 41 27 venting and disposing obsolete and coordination. WHO also coordinates Email: [email protected] unwanted pesticides; IPCS activities with other WHO - Jointly with IAEA, improving the use of programmes featuring chemical safety in food and agriculture; components, such as the International - Jointly with UNEP providing the Agency for Research in Cancer (IARC), Secretariat for the Rotterdam , occupational health, and Convention; control of tropical diseases. - Jointly with WHO, making recommen- Areas of activity include: dations for Acceptable Daily Intakes of - Evaluation of risks to human health food additives, pesticide and veterinary and the environment; Activities of International Organizations drug residues, and Maximum Residue - Methodologies for risk assessment; Limits in food for pesticides and veteri- nary drugs and tolerable intakes of - Prevention and management of toxic other food contaminants; and exposures and chemical emergencies; - Providing the Secretariat for the - Exchange of information on chemical Joint FAO/WHO safety and of related Commission, the executive organ of the hazards and risks; and 32 joint FAO/WHO Food Standards - Capacity building for sound manage- 33 Programme. ment of chemicals and risk reduction. maquette childhood last 28/06/04 14:46 Page 34

Endnotes

1. Jeyaratnam, J., Acute pesticide 9. Munger, R., et al., Intrauterine growth 15. Kishi, M., et al., Relationship of poisoning: a major global health problem. retardation in Iowa communities with pesticide spraying to signs and symptoms World Health Stat Q, 1990. 43(3): p. 139-44. - contaminated drinking water in Indonesian farmers. Scand J Work 2. Kahn, E., Pesticide related illness in supplies [published erratum appears in Environ Health, 1995. 21(2): p. 124-33. Environ Health Perspect 1997 California farm workers. J Occup Med, 1976. 16. Clarke, E.E., et al., The problems Endnotes 18(10): p. 693-6. Jun;105(6):570]. Environ Health Perspect, associated with pesticide use by irrigation 1997. 105(3): p. 308-14. 3. Wesseling, C., L. Castillo, and C.G. Elinder, workers in Ghana. Occup Med (Lond), 1997. Pesticide poisonings in Costa Rica. Scand J 10. U.S. Environmental Protection Agency, 47(5): p. 301-8. Work Environ Health, 1993. 19(4): p. 227-35. Screening and Testing 17. National Research Council, Protecting Advisory Committee. Final Report. 1998, 4. McConnell, R. and A.J. Hruska, Youth at Work: Health, Safety, and EPA Office of Prevention, Pesticides and An epidemic of pesticide poisoning in Development of Working Children and Toxic Substances: Washington, DC. Nicaragua: implications for prevention in Adolescents in the . 1998, developing countries. Am J Public Health, 11. Eskenazi, B., A. Bradman, and R. National Academies Press: Washington, DC. 1993. 83(11): p. 1559-62. Castorina, Exposures of children to 18. Keifer, M., et al., Symptoms and organophosphate pesticides and their 5. National Research Council, Pesticides cholinesterase activity among rural potential adverse health effects. Environ in the Diets of Infants and Children. 1993, residents living near fields in Health Perspect, 1999. 107 Suppl 3: p. 409-19. Washington, DC: National Academy Press. Nicaragua. Occup Environ Med, 1996. 12. Rosenstock, L., et al., Chronic central 53(11): p. 726-9. 6. World Health Organization, Public nervous system effects of acute Health Impact of Pesticides Used in 19. Kimani, V.N. and M.A. Mwanthi, organophosphate pesticide intoxication. Agriculture. 1990, WHO: Geneva. Agrochemicals exposure and health The Pesticide Health Effects Study Group. implications in Githunguri location, Kenya. 7. Reigart, J.R. and J.R. Roberts, Lancet, 1991. 338(8761): p. 223-7. East Afr Med J, 1995. 72(8): p. 531-5. Recognition and Management of Pesticide 13. Zahm, S.H. and M.H. Ward, Pesticides Poisonings. Fifth ed. 1999, Washington, DC: 20. McConnell, R., et al., Subclinical health and childhood cancer. Environ Health US Environmental Protection Agency. effects of environmental pesticide Perspect, 1998. 106 Suppl 3: p. 893-908. contamination in a developing country: 8. Goldman, L.R., New approaches for 14. Repetto, R. and S. Baliga, Pesticides cholinesterase depression in children. assessing the etiology and risks of and the immune system: the public health Environ Res, 1999. 81(2): p. 87-91. developmental abnormalities from chemical risks. 1996, World Resources Institute: 34 exposure. Reprod Toxicol, 1997. 11(2-3): 21. Azaroff, L.S., Biomarkers of exposure 35 Washington, DC. p. 443-51. to organophosphorous insecticides among maquette childhood last 28/06/04 14:46 Page 36

Endnotes

farmers' families in rural El Salvador: an analysis of 3.8 million exposure J Expo Anal Environ Epidemiol, 1997. 7(2): factors associated with exposure. Environ incidents. A report from the American p. 217-34. Res, 1999. 80(2 Pt 1): p. 138-47. Association of Poison Control Centers [see 33. Fenske, R.A., et al., Biologically based 22. Azaroff, L.S. and L.M. Neas, Acute comments]. Pediatrics, 1992. 89(6 Pt 1): pesticide dose estimates for children in an p. 999-1006. health effects associated with agricultural community. Environ Health Endnotes nonoccupational pesticide exposure in 28. Saadeh, A.M., et al., Clinical and Perspect, 2000. 108(6): p. 515-20. rural El Salvador. Environ Res, 1999. 80(2 Pt sociodemographic features of acute 34. Carpenter, D.O., et al., Environmental 1): p. 158-64. carbamate and organophosphate threats to the health of children: the Asian 23. Font, J. and A. Marsal, Determination poisoning: a study of 70 adult patients in perspective. Environ Health Perspect, 2000. of organochlorine pesticides in skins and north Jordan. J Toxicol Clin Toxicol, 1996. 108(10): p. 989-92. 34(1): p. 45-51. leather by gas chromatography. J 35. Spann, M.F., J.M. Blondell, and Chromatogr A, 1998. 811(1-2): p. 256-60. 29. Wesseling, C., et al., Unintentional K.L. Hunting, Acute hazards to young chil- 24. Brouwer, A., et al., Report of the WHO fatal poisonings among dren from residential pesticide exposures. working group on the assessment of health agricultural workers in Costa Rica: report Am J Public Health, 2000. 90 (6): p. 971-3. risks for human infants from exposure to of 15 cases. Am J Ind Med, 1997. 32(5): p. 433-41. 36. Food and Agriculture Organization of PCDDs, PCDFs and PCBs. Chemosphere, the United Nations, International Code of 1998. 37(9-12): p. 1627-43. 30. Landrigan, P.J., et al., Pesticides and Conduct on the Distribution and Use of 25. US Environmental Protection Agency, Inner-City Children: Exposures, Risks, and Pesticides (Revised). 2003, FAO: Rome. Prevention. Environ Health Perspect, 1999. Exposure Factors Handbook. 1995, Office of 37. Kutz, F.W., P.H. Wood, and D.P. 107 Suppl 3: p. 431-437. Research and Development: Washington, DC. Bottimore, Organochlorine pesticides and 26. Lioy, P.J., et al., House dust levels of 31. Esteban, E., et al., Association polychlorinated biphenyls in human adi- selected insecticides and a herbicide between indoor residential contamination pose tissue. Rev Environ Contam Toxicol, measured by the EL and LWW samplers with methyl and urinary 1991. 120: p. 1-82. para-nitrophenol. J Expo Anal Environ and comparisons to hand rinses and urine 38. Rotterdam Convention on the Prior Epidemiol, 1996. 6(3): p. 375-87. metabolites. J Expo Anal Environ Epidemiol, Informed Consent Procedure for Certain 2000. 10(4): p. 327-40. 32. Bradman, M.A., et al., Pesticide Hazardous Chemicals and Pesticides in 27. Litovitz, T. and A. Manoguerra, exposures to children from California's International Trade. 1998, UNEP/FAO. 36 Comparison of pediatric poisoning hazards: Central Valley: results of a pilot study. 37