MedDocs Publishers ISSN: 2639-4391 Annals of Epidemiology & Public Health Open Access | Research Article Pesticides contamination and nervous disorders in an agricultural area in Akkar, Lebanon. A cross-sectional study Chaza Chbib1,2; Fouad Ziade2; Moomen Baroudi2; Sopheak Net1; Baghdad Ouddane1* 1Université de Lille, Equipe Physico-Chimie de l’Environnement, LASIR UMR CNRS 8516, Bâtiment C8, 59655 Villeneuve d’Ascq Cedex, France 2Lebanese University, Faculty of Public Health III, Water and Environment Science Laboratory, Tripoli, Lebanon *Corresponding Author(s): Baghdad Ouddane Abstract Université de Lille, Equipe Physico-Chimie de Objective: Published studies in the second largest ag- l’Environnement, LASIR UMR CNRS 8516, Bâtiment ricultural zone in Lebanon showed that the well’s water is C8, 59655 Villeneuve d’Ascq Cedex, France highly contaminated by pesticides that can affect the hu- man system, especially the nervous system. The aim of this Email: [email protected] study is to assess the human exposure to pesticides, and to estimate the prevalence of two chronic neurodegenerative diseases including Alzheimer (AD) and Parkinson Disease Received: Dec 24, 2019 (PD) in this region. Accepted: Feb 11, 2020 Methods: Cross-sectional study was performed from July Published Online: Feb 13, 2020 2015 to November 2017 in the region of Akkar-Lebanon to investigate the presence of AD and PD. A questionnaire was Journal: Annals of Epidemiology and Public health filled face to face with a random sample of 2833 inhabitants Publisher: MedDocs Publishers LLC aged from 25 to 91 years obtained from 1264 surveys. Online edition: http://meddocsonline.org/ Results: In Akkar, the prevalence of AD and PD of people Copyright: © Ouddane B (2020). This Article is aged ≥65 years was respectively 10.30% and 10.91%, which distributed under the terms of Creative Commons exceed international percentages. The prevalence rate of Attribution 4.0 International License both diseases increased as age group increases and their presence in females were higher than males. In addition, symptoms and signs to AD and PD were detected with high prevalence in inhabitants consuming well’s water comparing Keywords: Alzheimer; Parkinson; Prevalence; Pesticides con- to those that did not consume this water (p-values<0.0001), tamination; Groundwater and a significant relationship has been associated between well’s water consumption and PD appearance. Conclusion: Future studies could be taken to identify the levels of pesticides in human blood, serum or urine. Cite this article:Ouddane B, Chbib C, Ziade F, Baroudi M, Net S. Pesticides contamination and nervous disorders in an agricultural area in Akkar, Lebanon. A cross-sectional Study. A Epidemiol Public Health. 2020; 3(1): 1012. 1 MedDocs Publishers Introduction The cultivated area represents one-third of the total area of Akkar. The governorate can be divided into two agricultural Pesticides regrouped a large number of organic compounds regions: (i) the mountainous region, where olive trees and all belonging to different chemical families that are used for re- kinds of fruit trees are cultivated, and (ii) the plain of Akkar moving weeds, fungi and insects and increasing agricultural where is concentrated the main crop production regions such productivity [1]. However, these products are environmental as Tobacco, citrus trees, cereals, potatoes, grapes and vegeta- hazards due to their stability, persistence, and toxicity [2]. The bles. The plain was considered as one of the poorest segment severity of their effects is related to the individual chemical cat- of the population in the country that has the lowest average egory of each pesticide, its toxicity, the way, the dose, the dura- individual income level and highest illiteracy rate in Lebanon. It tion of exposure and the exposure route [3]. In order to reduce suffers from a lack of services of all kinds, as well as the absence their risk, several directives regulated the levels of pesticides in of governmental and non-governmental organizations in most the environment by setting maximum values. The most popular villages. Furthermore, due to the absence of a public network regulations are WHO, European directives, United States stan- for water distribution in this region, groundwater constitutes dards [4-6]. the principal source of drinking water for local inhabitants. Humans became into contact with the residues of pesticides, In addition, there is no control for the extensive use of pes- through multiple pathways and routes either orally, inhalation, ticides, and a lack of awareness in farmers amongst the toxicity or skin absorption [3]. Living close to pesticides in agricultural of these chemicals. Numerous pesticides such as OCs, OPs, and areas like Akkar-north Lebanon is considered as sustainable ONs has been detected at a high level in 15 groundwater sam- long-term exposure to different toxic chemicals and increase ples collected from different villages on the Akkar plain [13]. the incidence of adverse human health effects including neu- Moreover, OCs were found in the agricultural soil of six villages rodegenerative diseases. Furthermore, many studies demon- at high levels ranged from 14.36 to 47.56 ng/g. The concentra- strated that people exposed to pesticides had an elevated risk tion level of heavy metals such as As, Zn, Cu, Pb, and Ni was not of Alzheimer’s (AD) and Parkinson’s Disease (PD) [7-9]. Approxi- significant for this area except for cadmium, its concentration mately 90 % of the total contaminants are from oral exposure, was detected at a moderate level [18]. including food and well’s water [10]. Direct contamination of drinking well’s water by pesticides has been documented in the Sampling technique and data collection literature [11,12]. In Akkar valley- northern Lebanon, many studies had shown an intensive use of pesticides and high contamination of ana- lyzed groundwater samples by numerous herbicides and insec- ticides like Organochlorine (OCs), Organonitrogen (ONs) and Organophosphate pesticides (OPs). This area is vulnerable to long-term pesticides exposure with many publications report- ing that the concentrations of OPs, OCs, and ONs exceeded the limits fixed by the European Union Drinking Water Directive [13,14]. Exposure to pesticides was associated with chronic re- spiratory symptoms and disease among Lebanese children [15]. However, little is known about the prevalence of nervous disor- ders and no modeling efforts exist in estimating the potential human health from exposure to pesticides posed by water or food consumption. Figure 1: Location of survey area (Akkar and the 15 studied villages) Based on this background, the present study has been aimed to assess the exposure to pesticides using the human health risk The present cross-sectional study was a part of a joint thesis assessments approach, and to estimate the prevalence of two project and was approved by Lille University – France and Leba- nervous disorders Alzheimer (AD) and Parkinson Disease (PD) in nese University-Lebanon. It was carried out from July 2015 to the north area of Lebanon namely Akkar valley. November 2017 in a square of 100 Km2. Fifteen most remote Methods villages namely: 1-Kobbet Al Choumra; 2-Mqaitaa; 3-Qaabar- ine; 4-Qlaiaa; 5-Tall Mehyen; 6-Ballaneh Al Hissa; 7-Hissa; Study area and population 8-Massoudieh, 9-Tal Andi; 10-Al Chaykh Ayach; 11-Tal Biri; 12- Tal Abbas El Gharbi; 13-Kouikhat; 14-Tal Abbas El Charqi; 15-Al Akkar is considered the most deprived rural regions in Leba- Mhamra non (80,000 hectares of agricultural land), with a rural popula- were studied. These villages are located in the valley tion of 80%. It is located in the North Governorate of Lebanon of Akkar and they represent around 50% of the plain area. The and limited by the Lebanese Syrian border from the north, and studied area was divided into three zones as shown in figure the Mediterranean seashore from the west (Figure 1). It covered 1. The study population consisted of adult Lebanese popula- 798 km2 of territory with a high density of population. In 2015, tion aged ≥ 25 years old and resident in the targeted area (15 the population of the governorate was estimated at 389,899 villages) for at least 10 years before the study. Non-Lebanese including 126,339 Syrian and Palestinian refugees [16]. Akkar inhabitants (Syrians and Palestinians) were excluded from this is consists of 121 municipalities that present six main areas: Al- study. Subjects were also excluded if there was no consent for Sahel (Plain of Akkar), Middle and Higher Dreib, Joume, Shaffat participation in the study, history of AD and PD around the fam- and Qaita. Its capital “Halba”, lies 30 km away from Tripoli [17]. ily, and a history of other concomitant diseases potentially as- sociated with these nervous disorders. Annals of Epidemiology and Public health 2 MedDocs Publishers Face to face interviews was conducted by 35 students of the as the hazard quotient (HQ) (Eq. 2) by dividing the average dose Faculty of Public Health III of Lebanese University. The students (ADD) to a specific reference dose (RfD) (mg/kg-day) (21- 23). were familiar with the health issue problems related to the study and were trained in the house how to conduct the face to Table 1 shows the oral RfD and the calculated HQ. face interview, and all protocol procedures related to the study Equation 2. HQ= ADD/RfD were discussed with them. An informed verbal consent form has been obtained from all participants. In total 2833 resident If the value of HQ exceeds one, there is an unacceptable risk were included in the present study. of adverse non-carcinogenic effects on human health, while if the HQ is less than one, it is at an acceptable level (24). For Questionnaire the risk assessment of mixture chemicals, the individual HQ are Based on literature reviews, a detailed questionnaire includ- combined to form the hazard index (HI< 1: an acceptable level ing basic demographic and socioeconomic characteristics such of risk; HI> 1 unacceptable level) [23].