Graduate School in Biomedical, Clinical and Experimental Sciences Exposure Assessment of Persistent Organic Poll
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Graduate School in Biomedical, Clinical and Experimental Sciences UNIVERSITÀ DEGLI STUDI DI MILANO FACOLTÀ DI MEDICINA E CHIRUGIA Exposure Assessment of Persistent Organic Pollutants and Associated Health Risks among Italian Population EZRA JONATHAN MREMA 2011/2012 Exposure Assessment of Persistent Organic Pollutants and Associated Health Risks among Italian Population by Ezra Jonathan Mrema A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy (PhD) in Occupational Medicine and Industrial Hygiene XXV Cycle Graduate School in Biomedical, Clinical and Experimental Sciences, Department of Health Sciences Università degli Studi di Milano, Supervisor: Prof. Claudio Colosio Co-Supervisor: Dr. Federico M. Rubino Coordinator: Prof. Giovanni Costa Milan December, 2012 ACKNOWLEDGEMENTS Prays, glory and honour is to Almighty God for his mercy, grace and blessings to me throughout the whole period of my study. I have been encouraged and motivated so much with these verses: “I can do ALL things through him who gives me strength (Phillipians 4:13)” and “Rise up this matter is in your hands. We will support you, so take courage and do it (Ezra 10:4).” These motivated me to undertake this big commitment which I have finally managed to accomplish. A number of individuals have contributed a lot towards my postgraduate training and make this work a great success and thus they deserve to be acknowledged. First, I feel greatly indebted to all members of my family including my parents, my father the late Jonathan Nakisa Mrema and my mother Salome Ndesanjo Macha for the foundation of education laid on me despite of their poor economic situation; my wife Candida Flavian Materu, my sons Evan and Joel who accepted and afforded to have me away, even during the times when they needed me the most; my brother and sisters (Frank, Ainess, Happiness, Luza and Violet); grandfathers (the late Nakisa Nguruko Mrema & Ndesanjo Mtuche Macha) and grandmothers (the late Magdalena Mrema and Awishana Ndelaiyona Maliha), uncles and aunts whose encouragement and moral supports are greatly honoured. Asanteni sana!! I acknowledge the mentorship of Prof. Claudio Colosio the Director of International Centre for Rural Health (ICRH), a WHO Collaborating Centre, for his significant contributions in developing my professional and academic career. He provided a considerable support at each and every stage of my work since conceiving to finalization of my PhD project. The conducive and amicable learning environment he created is a secret of all this success. He was not tired in providing support whenever needed. He assisted in translation of application package which made my life easier during the application process. Even where I was about to stuck in the embassy in processing my application his endless efforts were made to push and ensure my application went through. Grazie mille sei molto gentile!! Once he had this offer for non–EU fellow he did not hesitate to share it with his colleagues. Prof. Leslie London of University of Capetown, South Africa is acknowledged for availing this information to Dr. Aiwerasia Vera Ngowi the Head of Environmental and Occupational Health (DEOH) of Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania iii who in turn encouraged me to apply for the post. It is through this networking which enabled me to get this opportunity. Thank you very much madam!! Prof. Antonio Colombi the then Coordinator of the PhD and the Director of Department of Occupational and Environmental Health of Università degli Studi di Milano (UNIMI) for providing me with the invitation to participate in the proficiency test for admission to PhD programme in Occupational Health. I also extend my thanks to other member of academic staff including Prof. Pier Alberto Bertazzi, Prof. Giovanni Costa, Prof. Gabri Brambila, Prof. Angelo Moretto and Dr. Dario Consonni for providing academic support during the period of my training. Administration of Muhimbili University of Health and Allied Sciences (MUHAS) is acknowledged for giving me the 3 years study leave which allowed me to take part in this study. Thanks to other members of DEOH for their moral support and encouragement during the whole period of study. To mention them these are Dr. Larama Rongo, Dr. Simon Mamuya, Mr. Yahya Kishashu, Ms. Jane Mlimbila, Ms Gloria Sakwari, Mr. Mohamed Hussein, Mr. Hurbert Kaijage and Mr. Denis Ryemamu. Ms. Else an Italian lady working in Tanzania is acknowledged for her wonderful day and night work of translating my academic certificates and other documents required for registration to the course. Grazie mille signorina!! Dr. Federico Maria Rubino was quiet instrumental and his time to time willingness to provide valuable technical and professional support to my work is highly appreciated and honoured. I thank Dr. Luca Neri for his initial assistance in various aspects of statistical analysis of my data. Dr. Raffaella Zanzottera a librarian at Clinica del Lavoro Luigi Devoto is acknowledged for her wonderful and tireless assistance in searching and availing references not available online whenever she was requested. I also extend my thanks to my fellow postgraduate students: Ramin Tabibi, Dr. Stefan Mandic- Rajcevic and Lorenzo Fugnoli who willingly contributed their experiences during the entirely period of my study. Thanks are also due to those whom we worked together especially at International Centre for Rural Health (ICRH) including Dr. Maryam Sokooti, Giulia Rabozzi, Maria Grazia Troja Martinazzoli, Lucia Zanini, Gaia Varischi, Giorgio Vienello and Marco Pitton. All have played a crucial role in one way or another towards the success of my study. iv Other ICHR team members especially Signora Giovanna Radaelli, Chiara Somaruga, Fracesca Velere and Illaria Bollina are highly appreciated for their tireless in providing commucations and organization of my traveling and stay at Milan (communication, hospitality, information on how to live in Region of Lombardy, flight and accommodation arrangements). Thanks are also extended to Prof. Claudio Minoia and Dr. Roberta Turci of the Laboratory for Environmental and Toxicological Testing, Salvatore Maugeri Foundation, Pavia Italy, for providing analytical facilities which enabled all analyses of investigated persistent organic pollutants reported in this Thesis. Many sincere thanks are also due to all study subjects who willingly consented to take part to the study. Definitely without them this work would not be possible. I also recognize and extend thanks to some International Scientists for accepting the invitations of my supervisor to revise our project anticipated to be run in Tanzania as a continuation of this work. Among them include Melissa Perry, The Professor of Epidemiology and Biostatistics based at The George Washington University, United States of America and Luigi Cocco, The Professor of Occupational Medicine and Epidemiology, University of Cagliari, Italy. Professor Mary Gulumian from School of Pathology, University of the Witwatersrand, South Africa is highly acknowledged for her generous invitation to Risk Assessment course which enriched my skills and knowledge in this area. I feel particularly indebted to The Ministry of Health of Italy for providing me with financial support for the first two years of my study through the then Department of Occupational and Environmental Health of Università degli Studi di Milano within REALEXPO project. Professor Paolo Carrer is highly thanked for soliciting funds which enable me to finalize my final year of my training. Last but not least, I acknowledge all administrative and technical staff of the Università degli Studi di Milano for their cooperation during the course of my studies. Specifically Ms. Raffaella Saurgnani, Samantha Astro, Rosemary Bentoglio, Teresa Costantiello and Antonella Astori are acknowledged for providing all administrative arrangements required prior and during the whole period of the study. v DEDICATION To my family especially my mother Salome Ndesanjo Macha, my wife Candida Flavian Materu and our children Evan and Joel vi ABSTRACT Persistent Organic Pollutants is a group of structurally diverse man-made chemicals characterized by a high bio-persistence and the ability to travel a long distance on the planetary scale. This class of chemicals includes polychlorinated biphenyls, organochlorinated pesticides such as DDT and its metabolites and other chemicals such as polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo furans. These chemicals are widely distributed in the environment as some of them have long been employed in agriculture and in public health as pesticides, others as industrial chemicals and others are unavoidable by-products of industrial processes. These chemicals can be a source of health risk to human. Despite extensive use of OCPs such DDT in Italy in the 1940s to 1970s especially for public health control of malaria mosquitoes and PCBs in industry, in energy production and in industrial commodities, information on their exposure levels among the general population is limited. This study aims at determining the levels of OCPs and of PCB congeners among the residents from Italians living in three different places: Novafeltria (a village in Central Italy), Pavia (a mid-sized town) and Milan (the second-largest city in Italy) and at exploring the relationship with places of residence, gender, age and individual body size of their accumulation in the population. To measure PCBs concentrations,