الفهرس 
INTRODUCTION .Only 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
Mother`s breast milk is considered the most important nutrient for infants, that keep our children`s bodies more healthy. Breast milk increases the overall well-being of the infant, decreases the risk of chronic diseases, and enhances infant immunological status through supporting the immune system to fight infections, however, it still contaminated with chemical pollutants such as pesticides that bio-accumulate in fat such as OCP residues.
OCPs are lipophilic compounds that tend to bio-accumulate in the fatty tissues of the human bodies, and bio-magnificate in food chain. Breast milk is considered very suitable biotic medium for monitoring and evaluating these lipophilic POPs. Because breast milk contains higher amount of fat content, so these compounds are collected in breast milk fat, and transferred from mothers to fetus through lactation that cause serious negative health effects.
To assess the risk of these pesticides in breast milk for infants, in addition to show the difference between the level of such OCP residues in breast milk collected from mothers of rural and urban areas, a cross sectional study was designed to determine the level of these OCP residues in mother`s breast milk.
Two hundred mother`s breast milk samples were collected from the lactating mothers of two tested areas (100 samples from Arab ELmahdr Village in Kafr Elshekh Governorate as rural area, and 100 samples from Sidi Bishr family health unit in El-Montazah District, Alexandria Governorate as urban area). Only 151 of breast milk samples were successively analyzed (82 samples from the rural area, and 69 samples from the urban area). The breast milk samples were collected from the Lactating mothers who were selected randomly from both areas.
An interview questionnaire was designed about socio demographic profile, health status of the mothers, obstetric history, exposure to pesticides, data about their infants, and anthropometric measurements for mothers and infants were obtained. Mother`s breast milk samples were collected from October 2017 till February 2018 by manual expression at the end of breast feeding by the assistance of the nurse in the breast feeding clinic.
Breast milk samples were daily transferred to the laboratory in ice box, and freezed at -18oc. These samples were extracted with solid – phase dispersion technique with celite and sonication, then were identified and quantified using GC-ECD and confirmation with GC-MS compared with multi-standard solution of OCP residues. Residues of twenty OCPs (α-HCH, β-HCH, γ-HCH, δ-HCH, p,p`-DDT, o,p`-DDT, p,p`-DDE, p,p`-DDD, m,p`-DDD, Aldrin, dieldrin, heptachlor, heptachlor epoxide, endosulfan I, endosulfan II, endosulfan sulfate, endrin, endrin aldehyde, endrin ketone, o,p`-methoxychlor) were extracted from human breast milk.
Summary, Conclusions and Recommendations
90
The results of the present study showed that, one or more of these OCPs residues were detected in 100% of rural samples, and in 89.86% of urban samples with higher mean level in rural than urban samples. There were statistically significant difference in the level of ΣOCPs between rural and urban samples.
Also, the highest mean level of all OCPs in breast milk collected from rural and urban area were cyclodiene insecticides. The main contributor to increase the level of cyclodiene compounds was Σ aldrin & dieldrin.
Σ aldrin & dieldrin were represented the highest mean level from all cyclodiene compounds followed by Σ endosulfan, then Σ heptachlor and the least level was for Σ endrin.
In addition, Σ HCH and Σ DDT were detected in rural and urban samples with higher concentrations in rural than urban samples. The mean level of Σ HCH was higher than Σ DDT in both rural and urban samples. Meanwhile, o,p`-methoxychlor insecticide was detected in 25.6% of rural and 4.35% of urban breast milk samples.
By studying the effect of several factors such as age of the mother, education, occupation, order of the baby, BMI, and exposure to pesticides on level of OCPs in breast milk samples collected from both rural and urban area, it was found that all these factors have statistically significant effect on the level of some OCP residues in mother`s breast milk. Also, it was found that, there were significant weak negative correlation between age or BMI of the participant mothers and OCP level in mother`s breast milk. There were significant moderate negative correlation between occupation of the participant mothers and level of OCPs in breast milk. In addition, high educated mothers in urban area had the lowest level of OCPs in their breast milk. Primiparous mothers from rural or urban area had higher mean levels of OCPs in breast milk than multiparous mothers (had third and fourth baby).
The effect of OCP residues on infant`s health, infant birth weight, infant weight at time of samples collection, and infant height was statistically analyzed. It was found that there wasn`t a significant correlation between them, this was attributed this to the small size of the sample.
By studying the daily intake of OCPs in mother`s breast milk for infants, it was able to assess and predict risk of these pesticides on infant`s heath. EDI of OCP residues in breast milk for infants was calculated. It was found that the highest EDI for infants was recorded for Σ cyclodienes followed by Σ HCH, then Σ DDT then o,p`-methoxychlor.
The comparison between EDI of OCP residues for infants and ADI that recommended by FAO/WHO was made. There were samples from rural and urban areas exceeded ADI of OCP residues in breast milk. The exposure to these OCP residues at level higher than ADI may lead to serious health negative effects for infants such as risk of hepatic, renal, neurodevelopmental, immunological, genotoxic, several types of cancers (lung, cervix, prostate), endometriosis, and other serious negative effects.
Summary, Conclusions and Recommendations
91
6.2. Conclusions
from the results of the study, it can be concluded that:
1. The present study showed, the presence of one or more of OCP residues in 100%, and 89.86% of breast milk samples from mothers in rural and urban area, respectively.
2. Higher level of OCP residues were detected in breast milk samples from mothers in rural area than in urban one, with statistically significant difference in the level of OCPs between rural and urban samples (P = 0.000).
3. The highest mean level from all OCPs in breast milk collected from rural and urban area were cyclodiene insecticides. One or more of cyclodiene insecticides were detected in 100%, and 85.5% of rural and urban samples, respectively.
4. Σ aldrin & dieldrin were represented the highest mean level from all cyclodiene insecticides in breast milk samples from rural and urban areas followed by Σ endosulfan then, Σ heptachlor, and the least mean level was for Σ endrin.
5. The mean level of Σ cyclodiene insecticides was higher in breast milk samples collected from mothers in rural area than in urban one, with statistically significant difference between the levels of these insecticides in the two areas.
6. Mean levels Σ HCH were higher than Σ DDT either in rural or urban breast milk samples, which may attributed to recent exposure through recent use in agriculture or presence of residues that not metabolized due to long half-life.
7. The predominant isomer of HCH in breast milk samples was δ-HCH, and the least mean level of HCH isomers detected was α-HCH.
8. There were rural and urban breast milk samples that exceeded ADI of Σ cyclodienes, Σ HCH, Σ DDT, and o,p`-methoxychlor. These make infants at risk of serious complications and serious health effects, as breast milk of the mother is considered the main source of exposure due to transfer of these compounds to newborn through lactation.
9. More than half of mothers from rural area were work in agriculture, and had higher exposure to insecticides than mothers from urban area. BMI of mothers from urban area was higher than from rural one, this may be due to more than half of rural mothers that work in agriculture comparable to 81.2% of urban mothers that are housewives.
10. There were statistically significant effect of several factors such as, age of the mother, education, BMI, occupation, order of the baby, and exposure to pesticides on level of some OCP residues in mother`s breast milk collected from rural and urban areas, and not have statistically significant effect on the others compounds.
11. Primiparous mothers from both rural and urban areas had higher mean levels of Σ OCP in breast milk than multiparous mothers. There was significant weak negative correlation between age and BMI of the participant mothers and OCP level in mother`s breast milk. There was significant moderate negative correlation between occupation of the participant mothers and level of OCPs in breast milk.
Summary, Conclusions and Recommendations
92
12. The highest EDI for infants was recorded for Σ cyclodienes followed by Σ HCH, then Σ DDT, and o,p`-methoxychlor.
13. There was no significant correlation between level of OCPs and infant`s health status tested. Also, there was no significant correlation between OCP levels and infant`s birth weight, infant`s weight, infant`s height.
14. Through the estimation of EDI of OCPs in breast milk for infants, this enabled us to assess risk of these compounds on infant`s health. Breast milk is considered a good indicator and very suitable biotic medium for determination and monitoring environmental pollution with these fat soluble POPs.
6.3. Recommendations:
Based on the results and conclusion of the present study, it is recommended that:
1. Body burden of OCPs showed be reduced through changing food life style by encouraging future mothers on consuming vegetables, fruits, beans, instead of consuming fat rich food, this may reduce OCP intake and minimize fat bioaccumulation.
2. More restrictions on the importation and illegal entrance of unregistered pesticides.
3. Government must impose strict laws and regulations to Prevent smuggling, and commercial fraud of these OCPs and other unregistered compounds.
4. Government must regularly inspect pesticide – produce/ package companies that may adulterate their products with unregistered compounds.
5. Farmers and spray workers should use properly personal protective equipment (PPE) to reduce exposure to these pesticides.
6. Regulatory agencies, all social media and advertising must co-operate with the government to increase public awareness about the risks and dangerous effects of these pesticides. This may lead to decrease the improper use and consequently decrease harmful effects on human.
7. Government and other agencies must keep for rural mothers that work in agriculture without using any safety equipment, as they have higher exposure level either through direct exposure (through using pesticides in agriculture or at home) or indirect exposure through food intake and surrounding environment.
8. Increasing awareness of rural mothers that work in agriculture about good agricultural practice (GAP).
9. Further studies of these POPs in human breast milk of mothers on national scale including all types of governorates should be involved i.e. coastal, agricultural, industrial, touristic, bedouin governorates, with larger sample size all over Egypt, and follow up their children for further monitoring and assessment health effects must be performed.