The copyright of this thesis vests in the author. No quotation from it or information derived from it is to be published without full acknowledgement of the source. The thesis is to be used for private study or non- commercial research purposes only. Published by the University of Cape Town (UCT) in terms of the non-exclusive license granted to UCT by the author. University of Cape Town i ESTABLISHMENT OF A COMPREHENSIVE SURVEILLANCE SYSTEM FOR ACUTE PESTICIDE POISONING IN TANZANIA Elikana Eliona Lekei LKXELI001 SUBMITTED TO THE UNIVERSITY OF CAPE TOWN In fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY Faculty Health Sciences UNIVERSITY OF CAPE TOWN Date of submission: 27th August 2012 Supervisor: Prof. Leslie London School ofy Public of Health Cape & Family Medicine Town Faculty of Health Sciences Anzio Road, Observatory 7925 South Africa E mail: [email protected] Tel: 27 21 4066524 Universit Co Supervisor: Dr Aiwerasia V Ngowi Muhimbili University of Health and Allied Sciences (MUHAS) School of Public Health and Social Sciences Department of Environmental and Occupational Health P O Box 65015 Dar es Salaam, Tanzania Tel: 255 2150302-6 Ext. 236; Fax: 255 22 2150465 i ii DECLARATION I, Elikana Eliona Lekei, hereby declare that the work on which this dissertation/thesis is based is my original work (except where acknowledgements indicate otherwise) and that neither the whole work nor any part of it has been, is being, or is to be submitted for another degree in this or any other university. I empower the university to reproduce for the purpose of research either the whole or any portion of the contents in any manner whatsoever. Signature: Signature removed Date: 28th August 2012 y of Cape Town Universit ii iii TABLE OF CONTENTS DECLARATION ii TABLE OF CONTENTS ....................................................................................................................... iii LIST OF TABLES ................................................................................................................................. x LIST OF FIGURES ............................................................................................................................ xiv LIST OF ABBREVIATIONS ................................................................................................................. xv GLOSSARY OF TERMS ................................................................................................................... xvii ACKNOWLEDGEMENTS ................................................................................................................. xix ABSTRACT (350 words) .................................................................................................................... 1 EXTENDED SUMMARY ..................................................................................................................... 2 CHAPTER 1.0: INTRODUCTION ....................................................................................................... 5 1.1 Pesticide use in Tanzania .............................................................................................................. 5 1.2 Pesticide exposure and health effects: Overview.......................................................................... 6 1.3 Occupational health risks associated with pesticide use in Tanzania........................................... 8 1.4 The need for surveillance of Acute Pesticide Poisoning (APP)....................................................... 9 1.5 Routine data from the Health Information Management System in Tanzania........................... 11 1.6 Statement of the Problem........................................................................................................... 12 1.7 Significance ................................................................................................................................. 12 CHAPTER 2.0 LITERATURE REVIEW.............................................................................................y of Cape Town 14 2.1. Pesticide definitions, classification and categorization............................................................... 14 2.1.1. Pesticide definitions and classification............................................................................... 14 2.1.2. Pesticide Classification by Chemical Group........................................................................ 14 2.1.3. WHO Classification by Toxicity........................................................................................... 16 2.1.4. Classification by Globally Harmonized System for Chemical Hazard and Labeling............ 16 2.1.5. Classification by other approaches .................................................................................... 17 2.2. Pesticide RegistrationUniversit Categories in Tanzania ................................................................................. 19 In 2008, there were 226 products in the Full registration category. These are the products which have fulfilled all requirements for registration and have dossiers requiring no further amendments or actions. The category has products which include 104 insecticides, 48 fungicides, 54 herbicides, 2 plant growth regulators, 2 rodenticides ,1 avicide and 15 acaricides (United Republic of Tanzania, 2008). ............... 19 The list of all pesticides registered in Tanzania can directly accessed at the URL: www.kilimo.go.tz/regulations.................................................................................................................. 19 2.3. Pesticide Use in Developing Countries ........................................................................................ 19 2.4. Pesticides in Africa............................................................................................................................. 20 iii iv 2.5. Acute Pesticide Poisoning ........................................................................................................... 21 2.6. Surveillance of Acute Pesticide Poisoning. .................................................................................. 24 2.6.1. Surveillance of pesticide poisoning in Central America ..................................................... 24 2.6.2. Surveillance of pesticide poisoning in the United States ................................................... 25 2.6.3. Surveillance of pesticide poisoning in China ...................................................................... 27 2.6.4. Surveillance of pesticide poisoning in Malaysia ................................................................. 27 2.6.5. Surveillance of pesticide poisoning in South Africa............................................................ 28 2.6.6. Surveillance of pesticide poisoning in Italy ....................................................................... 28 2.6.7. Surveillance of pesticide poisoning by the International Program on Chemical Safety (IPCS) 28 2.6.8. Surveillance of pesticide poisoning in terms of the Rotterdam Convention Reporting System 29 2.7. Implications of health worker practice on APP surveillance .............................................................. 31 2.8. Sources of data on poisoning information .................................................................................. 31 2.8.1. Poison control Centers ............................................................................................................... 32 2.8.2. Workers’ compensation claims .......................................................................................... 32 2.8.3. Health care professionals .................................................................................................. 34 2.8.4. Affected person or relatives ............................................................................................... 34 2.8.5. Laboratories ....................................................................................................................... 34 Medical laboratories may collect specimens and conduct analysis for pesticide and metabolites in a variety of human or animal biological media. The most common laboratory tests for pesticide exposure are measurement of plasma pseudo-cholinesterase or red blood cell acetyl cholinesterase levels, which measure cholinesterase inhibition and can indicate poisoning with OP or carbamate pesticides. Other methods measure pesticides and/or their metabolites in blood or urine. Having laboratories report to a central authority is a potential source for surveillance for pesticide poisoning. The US is an example of a country which has included laboratories asy one ofof its surveillance Cape data sources Town (Ballard et al, 2001; Calvert et al, 2004). States of California and Washington both require ChE monitoring of applicators who frequently handle cholinesterase inhibitors. The state of Washington has more detailed reporting of monitoring information because results of testing are centralized and reported by the state. .......... 34 2.9. Challenges for surveillance systems ............................................................................................ 35 2.10. Conclusion ................................................................................................................................... 35 CHAPTER 3.0: OVERVIEWUniversit : RATIONALE, OBJECTIVES, STUDY SITE AND DESIGN. ...................... 36 3.1. Rationale of the Study ................................................................................................................