Childhood Pesticide Poisoningpesticide poisoning [1, 2], and adolescents are often the victims.[3,...

Information

for Advocacy

and Action

Childhood Pesticide Poisoning

Childhood Pesticide Poisoning

WHO

Printed in SwitzerlandGE.04-00690-May 2004-2000

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Childhood Pesticide PoisoningInformation for Advocacy and Action

Prepared for the United Nations Environment Programme (UNEP)

The main text was prepared for the Food and Agriculture Organization (FAO), the UnitedNations Environment Programme (UNEP), and the World Health Organization (WHO) byDr. Lynn Goldmann, Professor, Environmental Health Sciences, John Hopkins School ofHygiene and Public Health, Baltimore, USA. These organizations wish to acknowledgethe contributions to the report from Mr. Bill Murray, FAO, Dr. Bo Wahlström, UNEP and

Dr. Jenny Pronczuk, WHO.

Published in May 2004 bythe 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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Pesticide poisoning is a serious healthproblem that disproportionately affectsinfants and children. Pesticides aredesigned to kill, reduce or repel insects,weeds, rodents, fungi, and other organ-isms that can threaten public health andnational economies. However, whenimproperly used or stored, these chemicalagents can also harm humans. Key risksare cancer, birth defects, and damage tothe nervous system and the functioning ofthe endocrine system.

People can be exposed to excessive pes-ticide levels while working; via food, soil,water or air; or by directly ingesting pesti-cide products. Pesticides are known tocause millions of acute poisoning casesper year, of which at least one millionrequire hospitalization. The number ofchildren involved in such incidents isunknown but, based on the experience ofmany countries, likely to be large. Betweenone and three agricultural workers perevery 100 worldwide suffer from acutepesticide poisoning [1, 2], and adolescentsare often the victims.[3, 4] The contributionof pesticides to chronic diseases, on theother hand, is unknown.

I. Introduction

Tackling the risks to children of pesticideexposure and poisoning requires compre-hensive strategies. These strategiesshould be designed for the local level andsupported nationally, regionally and inter-nationally. They should include researchactivities on how to develop effective eco-nomic and legal instruments. In addition,they should ensure that the public isinformed, health conditions are monitoredand, where necessary, treatment pro-grams are established.

The need for such strategies is confirmedby a number of international agreementsthat call for actions to protect childrenand the environment from the negativeeffects of human activities. These includethe United Nations Convention on theRights of the Child as well as Agenda 21,which was adopted by the United NationsConference on Environment andDevelopment.

The purpose of this document is to provideyou with information for advocacy andaction directed at reducing pesticide poisoning and addressing its effects onchildren and women.

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Selected extracts from Agenda 21, adoptedin 1992 by the United Nations Conferenceon Environment and Development, that dealwith children are:

Chapter 6: Protecting andpromoting human health

6.1 Action items under Agenda 21 mustaddress the primary health needs of theworld's population, since they are integralto the achievement of the goals of sus-tainable development and primary envi-ronmental care…

6.19 The health of children is affectedmore severely than other populationgroups by malnutrition and adverse envi-ronmental factors…

6.24. Specific major goals for child sur-vival, development and protection wereagreed upon at the World Summit forChildren and remain valid also for Agenda21. Supporting and sectoral goals coverwomen's health and education, nutrition,child health, water and sanitation, basiceducation and children in difficult circum-stances.

6.27. National Governments, in coopera-tion with local and non-governmentalorganizations, should initiate or enhanceprogrammes in the following areas:

a. Infants and children:

i. Strengthen basic health-care servicesfor children in the context of primaryhealth-care delivery, including prenatalcare, breast-feeding, immunization andnutrition programmes;

iv. Protect children from the effects ofenvironmental and occupational toxiccompounds;

Chapter 25: Children and youth insustainable development

25.12. Children not only will inherit theresponsibility of looking after the Earth,but in many developing countries theycomprise nearly half the population.Furthermore, children in both developingand industrialized countries are highly vulnerable to the effects of environmentaldegradation. They are also highly awaresupporters of environmental thinking. Thespecific interests of children need to betaken fully into account in the participatoryprocess on environment and developmentin order to safeguard the future sustain-ability of any actions taken to improve theenvironment.

25.13. National governments, accordingto their policies, should take measures to:

a. Ensure the survival, protection anddevelopment of children, in accordancewith the goals endorsed by the 1990 WorldSummit for Children.

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Selected extracts from the 1989Convention on the Rights of the Childdealing with the environment

Preamble The States Parties to the presentConvention,

…Convinced that the family, as the funda-mental group of society and the naturalenvironment for the growth and well-being of all its members and particularlychildren, should be afforded the neces-sary protection and assistance so that itcan fully assume its responsibilities within the community …

Article 241. States Parties recognize the right of thechild to the enjoyment of the highestattainable standard of health and to facil-ities for the treatment of illness and reha-bilitation of health. States Parties shallstrive to ensure that no child is deprivedof his or her right of access to such healthcare services.

2. States Parties shall pursue full imple-mentation of this right and, in particular,shall take appropriate measures:

(c) To combat disease and malnutrition,including within the framework of primaryhealth care, through, inter alia, the appli-cation of readily available technology andthrough the provision of adequate nutri-tious foods and clean drinking-water, taking into consideration the dangers andrisks of environmental pollution; …

(e) To ensure that all segments of society,in particular parents and children, areinformed, have access to education andare supported in the use of basic know-

ledge of child health and nutrition, theadvantages of breastfeeding, hygiene andenvironmental sanitation and the preven-tion of accidents;

Article 291. States Parties agree that the educationof the child shall be directed to:

(e) The development of respect for thenatural environment.

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Unintended – but harmful – effectsThe unintended but harmful effects ofpesticides have become clearer in recentdecades, which has increased theurgency for taking action. For example, if used on a broad scale, pesticides candisrupt the ecological balance of agricul-tural areas by killing natural biologicalcontrols; this can lead to outbreaks ofpests that were previously of minor impor-tance and consequently to lower cropyields. Once used, pesticides may accu-mulate in the air or water or on land,where they can harm non-target speciesand diminish biodiversity. By contaminat-ing groundwater, lakes, rivers, and otherbodies of water, they can pollute drinkingsupplies, fish and other resources thatcan be vital for human well-being. By polluting soil, they can endanger childrenat play or at work and make it difficult touse the land later for other purposes.

Pesticides are harmful to human health. Ithas been reported that an estimated 1 millionto 5 million cases of pesticide poisoningsoccur every year, resulting in 20,000 fatal-ities among agricultural workers. Most ofthese poisonings take place in developing

countries, where safeguards typically areinadequate or lacking altogether.[6][1]Although developing countries use 25% of the world’s production of pesticides, they experience 99% of thedeaths.[1]

The total health impact of pesticide expo-sure is probably much greater than thesefigures suggest. The symptoms of pesti-cide poisoning, which may involve a skinrash or mild gastroenteritis, are frequentlysimilar to other health problems, so thelink to pesticides may go undetected.People suffering from acute poisoningmay lack access to medical care and maynot even report the illness to the medicalsystem. Health personnel may lack thetraining for recognizing pesticide poison-ing or the means to report it to nationalauthorities, which may themselves lackreporting systems. Moreover, it is difficultto associate chronic health effects withpesticides for several reasons. Chronicdisease tends to result from lower expo-sure levels than do acute illnesses. Thereis a time lag between the exposure andthe disease, and in individual cases it isusually impossible to make a firm link.

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g?SummaryChildren are often more vulnerablethan adults to the effects of pesticidesas a result of several risk factors.

These include their smaller size; greater rates of exposure to food,soil, water, and air; differing metabolism; and rapidly growing and developing organ systems. They tend to explore their immediate environment more than adults do and to put things in theirmouths. Inexperience, lack of maturity, illiteracy and an inability to assess risk make children more likely to accidentally ingest pesticides. Children who work around pesticides face additional opportunities to be severely poisoned.[3, 4] Because children are at greater risk, they need greater protection.[5] More awareness-raising is needed about risks, especially from the most acutely toxic pesticides, since adverse effects on children are completely preventable.

Hazardous by designPesticides are toxic substances designedto kill, repel or inhibit the growth of livingorganisms. They are used against insects,mammals, plants, fungi, nematodes andother creatures that can pose problemsfor agriculture, public health, or homes,schools, buildings and communities.[6]

Pesticides impair the functioning of biological processes essential for life,such as the nervous and reproductivesystems. Very often, these processes aresimilar among different organisms,whether insects or humans, adults or chil-dren.

Many pesticides have similar chemicalstructures and thus may act in the sameway. For example, the organophosphateand carbamate insecticides poisoninsects by inhibiting the enzyme acetylcholinesterase. This mode of action canalso be toxic to people. By regulating pesticides one at a time we may be under-estimating the cumulative impact of pesticides of similar toxicity.[5]

II. What do we knowabout pesticidepoisoning and why are children at greater risk?


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research, and reported incidents involvinghuman exposure to different doses of pesticides all support the following points:

Developmental and reproductive effects.Certain pesticides are believed to causereproductive problems, such as sponta-neous abortions, stillbirths, lower birthweights, birth defects and early neonataldeaths.[8, 9]

Endocrine disruption. Many pesticideshave been shown to disrupt naturalendocrine systems in pests, wildlife andlaboratory animals. In small doses thesepesticides are able to mimic or block hor-mones or trigger inappropriate hormonalactivity. At high enough doses during crit-ical times of development such exposureshave the potential to interfere with impor-tant developmental and reproductivefunctions and may cause sterility, loweredsperm counts, cancer of the reproductiveorgans and other effects.[10]

Neurobehavioral effects. Impaired devel-opment of the nervous system can causelowered intelligence and behavioralabnormalities. Although these impactshave not been studied in humans, exposure to certain pesticides in uterocauses developmental and neurological

abnormalities in laboratory animals.[11]Certain organophosphorus compoundshave caused long-term neurological disabilities in farm workers who havesuffered acute poisoning.[12]

Carcinogenic effects. A number of pesti-cides cause cancer in laboratory animals,and several have been associated with cancer in humans. The concern forchildren is twofold. First, cancers in children, including leukemia, sarcomas,lymphoma, and brain cancer, have beenassociated with parents or homes thathave been exposed to pesticides.[13]Second, people may face an increasedrisk of developing cancer during theirlifetime if they have been exposed tocarcinogens in their childhood.

Immunological effects. In animal exper-iments, certain pesticides have beenproven to compromise the immune system. A weakened immune system,particularly in growing children, exacer-bates the risk of infectious disease andcancer, thus increasing mortality rates.This would be especially menacing indeveloping countries, where childrenface greater exposures to infectiousagents and may already have compro-

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herefore we know very little about thechronic health impacts of pesticides andmust rely on animal tests and epidemio-logical studies to understand what themagnitude of those effects might be.

The impact of an exposure to pesticideson human health depends on a number offactors, including the class of pesticideinvolved, the specific chemical and for-mulation, and the amount, route, timing and duration of the dose. The routeof exposure can be via breathing, drinking or eating, or through the skin or mucousmembranes. Other factors include the health of the person poisoned.Malnutrition and dehydration, for example,increase the sensitivity to pesticides.Children who are malnourished and dehy-drated are at greater risk, and the risk forsuch children working in agriculture isstill higher. Furthermore, where access toquality medical care is lacking, poisoningcases may go undiagnosed or untreated.Treatments such as antidotes andremoval from the source of exposure maynot be available.

Acute poisoningAcute poisoning can cause a range ofsymptoms in adults and children, depend-ing on the type of pesticide. For example,commonly used organophosphorus andcarbamate compounds can produce neu-robehavioral effects, such as fatigue,dizziness, and blurred vision; intestinaleffects, such as nausea; respiratoryeffects, such as dry throat and difficultywith breathing; effects involving skin andmucous membranes, such as stingingeyes, itchy skin, and a burning nose; andmuscular symptoms, such as stiffnessand weakness.[7]

Acute pesticide poisoning can result indeath, either rapidly or over the course ofweeks, depending on the characteristicsof the product and type of exposure.

Long-term health effectsSome health effects caused by pesticidesonly become apparent over a longer periodof time. Controversy continues over thenature and severity of the health impactsfrom long-term exposure to pesticides.However, studies of laboratory animals, a growing body of epidemiological


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mised immune systems due to poor nutri-tion and other factors. [14] At present,there are no standardized tests fordevelopmental immunotoxicity.

In many countries pesticides must under-go comprehensive toxicity testing. Evenso, most pesticides have not beenassessed for one or more hazards rele-vant to the health of children, especiallydevelopmental neurotoxicity and immuno-logical effects. While unnecessary testingshould be minimized, it is important toassure that risks to children are includedin safety assessments of pesticides.[5]

General exposure – frequent andoften unknowing

Pesticides are readily available and widelyapplied. They are used by farmers tospray crops and treat livestock. They areused in public health programmes, whichcan include indoor spraying of houses orpublic places. They are applied in alltypes of buildings, including schools.They are also used by trained applicators,maintenance workers, building residents,farmers and farm workers. The most haz-ardous pesticides should be applied onlyby professional applicators, but this may

not always be the case in developingcountries. For indoor applications, ade-quate ventilation is essential, but notalways practiced.

The use of pesticides can expose people torisks at different stages of the applicationprocess, from the purchase of productsand the preparation and mixing of solutionsto spraying, handling of pesticide-treateditems and disposal.[1, 2] Protective equip-ment is often impractical in hot tropicalclimates and not affordable for manyfarmers.[15, 16]

Not only workers but nearby residentsand children can be exposed to pesticidessprayed on fields. Field workers enteringan area treated by pesticides often face ahigher risk of harm, particularly if the timebetween application and entry is shortand if they lack protective clothing. Olderchildren and adolescents may be directlyexposed as field workers, while youngerchildren may be brought into treated fieldsto accompany their parents[3, 4, 17-22]

Work clothes often carry pesticideresidues, exposing both workers and fami-ly members. Workers can be exposed fora prolonged time if they do not removeand wash clothes after each application

or spill. Clothing can occlude the skin,which enhances its ability to absorb pesti-cides. When clothes are brought home forlaundering, those doing the washing arealso exposed to the pesticides. Residuesfrom laundering contaminate water andsoil, further extending the chain of risk.[15]Clothing may also be purposely treatedwith pesticides; recently lindane wasidentified in shipments of leather fromAfrica.[23]

Pesticide spills are common and canoccur at different stages and places,including manufacturing, processing,packaging, transport, storage, mixing,field application and disposal.

Once used or spilled, pesticides may contaminate water used for drinking orbathing. They can also pollute soil, eitherfrom agricultural use or as a result of spillsduring manufacturing and processing.Sediments in rivers, lakes and bays can becontaminated by runoff from pesticideproduction and use. Cleaning up contami-nated water, soils, and sediments can bedifficult and expensive and require yearsof treatment.

One of the most important sources ofexposure is food residues. Growing food

on or near contaminated soil and usingcontaminated water on crops or for washing puts people – and children inparticular – at risk.

Farmers and others may store pesticidesin or around their homes where householdmembers can accidentally gain access tothem, or where these toxic substancescan contaminate food or water that isstored nearby. Used pesticide containersare often reused to store water and food.

The greater vulnerability ofchildren

Although exposure to pesticides maypresent a risk to all people, children generally face higher risks than adults.Children may be more susceptible thanadults to certain pesticides, and they maybe more greatly exposed than adults. They thus bear a disproportionate burdenof risk and need additional protection.[5]

Children are often more exposed to pesti-cides. For example, when a mother isexposed to pesticides, the child oftenbecomes exposed as well. Children mayeven be exposed to pesticides beforebirth, while still in the womb. This occurswhen pesticides are transferred to the


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During early infancy, children also come into contact with persistent and bio-accumulative pesticides that arepassed on to them through breastfeeding.This can be a major source of exposure.Because breast milk is the best source ofnutrition for infants and recommended bythe World Health Organization, protectingmothers from exposure to toxic contami-nants is crucial.[24]

As they grow, children drink more water,kilo for kilo, than do adults. Figure 1shows the consumption of drinking waterfor several different age groups. As canbe seen, infants under one year of agewho are fed reconstituted infant formulaconsume more than twice as much wateras adults. This means that, if the watercontains residues of pesticides, infantswill receive more than double the dose ofpesticide as an adult drinking the samewater.[25]

Children consume more food, per bodyweight, than do adults. Figure 2 shows USdata on the consumption of various foodsin which persistent and bio-accumulativepesticides may be present at high levels,

such as meat, milk, eggs and fish. Similarly,pesticides in fruits and vegetables are alsopassed on to children at high levels,including in processed foods.

Children may have completely differenteating patterns than adults, making their potential exposure to pesticideseven more disproportionate. Their diet ismuch less diversified, resulting in a largerrelative consumption of certain foods. For example, in the US infants consumemuch more of certain fruits like apples per body weight than adults do. As a consequence, diet can be a major sourceof pesticide exposure for children, andgreater relative to their size than foradults.[5]

Figure 3 compares daily breathing ratesfrom several different age groups.[25] It shows that when pesticide residues arepresent in the air or in airborne dust,infants can receive higher doses thanolder children and adults. In addition, children play closer to the ground, where many pesticides may be present at higher concentrations.

Children behave and play differently thanadults, resulting in greater potential expo-

sure to pesticides. In addition to playingcloser to the ground, children may beexposed to more pesticides in dusts andsoils due to normal hand-to-mouth activity;figure 4 compares the amount of soil eateneach day by children and adults.[25]Children frequently put toys or other objectsinto their mouths as well, and as a conse-quence may receive significant doses ofpesticides from contaminated objects, suchas those found in agricultural areas, homesor gardens.

Because children have different metabo-lisms than adults, they may have differentcapacities for breaking down or metaboliz-ing, excreting, activating or deactivatingpesticides. Such processes change dramat-ically from birth until adulthood. These factors can cause pesticides to have morepronounced toxic effects in children, or possibly lead to somewhat different poisoning symptoms than those seen inadults.

Poverty can put children in a number ofpotentially high-risk situations. Childrenmay help out on family-owned farmswhere pesticides are used. They maywork for local concerns, carrying goods

treated with pesticides. The result can beeven higher exposure to pesticides.Pesticide-related illnesses in childrenemployed in farm work have been documented in many countries.[3, 4]

High-risk exposure scenarios forchildren

The fact that children will receive higherdoses of pesticides compared to adultsmay be of particular concern in certainsituations. These include the consumptionof fish and other food that is highly con-taminated with pesticides, subsistencefarms that use large quantities of pesti-cides, and pesticide-spraying pro-grammes. For example:

• Indoor pesticide sprays, fogs or dustscan be misapplied, creating hazardouslevels of pesticides in the air and thebuild-up of pesticides in foam articlessuch as bedding and children’s toys.[26]

• Mispackaged pesticides can lead tochildren accidentally ingesting pesti-cides.[27] The most hazardous pesticidepackages are bottles that look like thosecontaining soft drinks or other bever-ages.

figure 1 figure 2 figure 3 figure 4


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Exposure in urban settingsIn developing countries, the marketing ofpesticides is sometimes uncontrolled orillicit. Misbranded or unlabelled formula-tions, including ready-made solutions insoft drink bottles and other unlabelled liquid containers, are sold at open stands.Industrialized countries have also experi-enced the fraudulent marketing of agricul-tural pesticides for indoor use, whichcauses children to face further expo-sures.[31]

Exposure in rural settingsSoil is contaminated by pesticidessprayed on neighboring fields or spillednear living quarters while equipment isbeing filled.

Contaminated equipment is left afterworking hours near areas used by children for playing.

Family members working with sprayingequipment do not wash and change theirclothes after work or they leave their contaminated clothes lying around.[32]

Spraying of field pesticides occurs closeto living quarters or drifts into neighboringfields, homes, or schools.[4, 33]

Spraying of pesticides for vector control ininterior spaces, including living quarters,takes place regularly, and reentry timesare not observed. Some pesticides breakdown slowly, and exposure continuesdespite the observance of re-entry times.

Infants who are still being breastfed arecarried by their mothers in the fields during spraying operations. Older childrenare allowed to play around treated fields.

Pesticides or ready-to-use solutions arekept in the home in unlabelled containersor are labelled in a language other thanthe local one. Illiteracy compounds therisk of exposure.

Exposure and developing coun-triesMany situations involving pesticide expo-sure are linked to education and certainsocio-economic conditions. These condi-tions tend to occur more often in develop-ing countries, thus resulting in increasedrisk to children.[34]

Stockpiles of unwanted or obsolete pesti-cides, which are unprotected and uncon-trolled and often lack legible labeling,

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g?• Highly toxic pesticides may be viewedby older children as a convenient meansof attempting suicide.[28]

• Highly concentrated and acutely toxicpesticides can cause severe illness ordeath even if ingested in very small quan-tities – for example, a single swallow.[29]Concentrates are also hazardous aroundthe home because they must be reconsti-tuted in another container, one that maybe easily confused as being safe by ayoung child.

• Household pesticide contamination(caused by insecticides that are used forsanitation or vector control, carried intothe home by parents or tracked into the house through contaminated soil)can be especially hazardous to childrenwho display “pica” behavior. Suchyoung children have a propensity forpeeling off and eating paint chips, wallpaper, and other materials; it is most common among children with anutritional deficiency – the same chil-dren who are likely to be more vulnera-ble to the effects of toxic pesticides.Such children would thus be moreexposed to DDT and other pesticidessprayed on the walls.

• Pesticides can contaminate nearbygroundwater and surface-water. Conta-minated water is more likely to be con-sumed by small children, who tend todrink water from any source.

• Locally grown food may not be properlymonitoring or controlled for residues ofpesticides. Because food sold at thefarm gate often has higher residue levelsthan food distributed later, families whoeat directly from fields may have higherpesticide exposures.

• Containers for pesticides in low-income countries and areas are oftenused and re-used for other purposes,including storing and transporting foodand water.

• Grain storehouses are continuallytreated with rodenticides to limit croplosses. Bait can easily be mistaken fornormal grain, which is particularly dan-gerous for children because they have lit-tle protection against most rodenticides.Looting of baited grain by children fromfamilies with low incomes can lead tosevere poisonings.

• Pesticides are too often stored in house-holds where they are in easy reach ofchildren.[16, 30]


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g?may be found close to living quarters or to areas where children play or work.

Seeds coated with pesticide for planting,or pesticide-treated grains for use as bait,are often stored without proper labelingand protective measures. In times of eco-nomic stress or food shortage, people maybe tempted to eat such seeds.

Any spraying equipment used by subsis-tence farmers tends to be low-end technology. Manual equipment used byan individual results in imprecise sprayingand substantial drift of pesticides to nearby living quarters.

Pesticide users, including teenagers, maylack access to protective equipment suchas gloves and masks, which is required to assure the safety of the pesticide product.[16]

Pesticide users, particularly on subsis-tence farms, often lack access to training.This can lead to pesticides being usedcarelessly, including in the presence ofchildren.[15]

The lack of education for girls has particularly significant consequences.When girls grow up they go on to shoulderresponsibilities for household chores,water provision, education of family mem-bers, and work in agriculture and otherareas where pesticides play a role.

Excerpt from Final Report of FourthSession of Intergovernmental Forum onChemical Safety,

Bangkok, Thailand, 1-7 November 2003

Children and chemical safety1. When assessing the protection of children, consideration should be given tochemical exposures that can occur duringpreconception, throughout gestation,infancy, childhood and adolescence.

2. Governments should prepare, throughmulti-stakeholder consultation, initialnational assessments of children’s envi-ronmental health and chemical safety.These assessments should identify thepriority concerns and provide a basis fordeveloping action plans to address thoseconcerns. Governments should provide aprogress report to Forum V.

WHO is requested to develop, throughmulti-stakeholder consultation, guidancetools, and to assist at least three countriesin different stages of economic develop-ment in each region to prepare theassessment and action plans by 2006.

3. Governments, with support from stake-holders, particularly WHO and UNICEF,should promote education and training onchildren’s chemical safety, and whererisks are identified, governments andstakeholders should commit to takingaction to prevent or reduce exposure.Governments should also promote harmo-nized data collection, research, legislationand regulations, and consider the use ofindicators of children’s environmentalhealth, and report back to Forum V in 2006.

Governments should, when settingacceptable levels or criteria related tochemicals, take into consideration thepotential enhanced exposures and/or vulnerabilities of children.

4. WHO is requested to support, collabo-rate with, and coordinate among researchorganizations and those supportingresearch (such as the EuropeanCommission, Science NGOs, the GlobalHealth Research Forum, governments andothers) to develop mechanisms to facili-tate collaborative national and interna-tional research and share technology.

5. Governments and stakeholders shouldcommit to sharing information on optionsfor taking effective action to protect children from established chemicalthreats and from chemical risks wherethere is a degree of uncertainty. WHO isrequested to convene a multi-stakeholdermeeting to explore the mechanisms for collecting data and disseminatinginformation that could be used to reduceuncertainty in risk assessment.

6. In addition, Forum IV requests the IFCSPresident to convey these recommenda-tions to other meetings and fora.

In carrying out the recommendations set out in this priority, the stakeholdersconcerned should be guided by the fulldecision document and companion infor-mation paper that were developed by theForum Working Group.


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• Ensure hygienic conditions, especiallywhen storing food and water, and wash foodprior to eating it.

• Minimize the unnecessary use of pesti-cides around children by practicing inte-grated pest management in homes andschools. Where pesticides are used, strictlyfollow instructions about application ratesand re-entry intervals.[35]

• Health care providers need to know how torecognize and treat cases of pesticidepoisoning. They can also help to educatefarmers and others about the adverseeffects of pesticides and how to preventpesticide exposures, and they should docu-ment and report any cases of pesticide poisoning.

• Pesticide users and their families need tobe better educated about how to recognize,prevent and treat pesticide poisoning, in particular mothers with small children wholive in areas where pesticide exposures maybe high. Such information could be includedin school curricula.

• Where hazardous pesticides are used,communities need a cadre of trained pesti-cide applicators so that the pesticides will

be used in the safest manner possible.Pesticides that have restrictions for use,such as requirements for special protectivegear, should only be applied by such trainedprofessionals.

• Pesticide manufacturers and governmentsshould follow the voluntary FAOInternational Code of Conduct on theDistribution and Use of Pesticides. The Codeoutlines measures for ensuring the safety ofpesticides through the testing, manufactur-ing, advertising, labeling, and distributionphases.[36] It calls on manufacturers to sup-ply information and instructions in a formand language adequate for ensuring safeand effective use. It also asks them to retainan active interest in following their productsto the ultimate consumer, keeping track ofmajor uses and any problems that may ariseduring the actual use of their products. This information can then be used for deter-mining whether any changes are needed inlabeling, directions for use, packaging, formulation or product availability.

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pesticide poisoning must be designed forlocal conditions while drawing supportfrom the national and international levels.These strategies should be sensitiveto differing cultural, political, economic,technological anddevelopment circumstances.

III. What can be doneto preventpesticidepoisoningof children?

At the local levelThe risks posed by pesticides can be bestavoided by minimizing the use of pesticides,especially the most hazardous ones, and bytaking measures to reduce exposureswhere it is not practical to eliminate usealtogether. Everyone responsible for caringfor children or who is involved with pesti-cide use should be aware of the problemscaused by pesticides and be encouraged to:

• Reduce and eliminate possible sourcesof pesticide exposures to children (in food,water, dust, and soil and in the home andthe work environment).

• Reduce unnecessary uses of agriculturalpesticides by adopting strategies that canreduce pesticide use, such as integratedpest management and crop rotation.Where pesticides are needed, encouragethe use of safer pesticides.

• Keep pesticides out of children’s reachand store them securely in containers thatdo not resemble those used for food ordrinks, are properly labeled and use child-proof tops. Do not store any highly toxicpesticides or pesticide concentrates in thehome.[35]


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FAO International Code of Conduct on theDistribution and Use of Pesticides

3. Pesticide management

3.1 Governments have the overallresponsibility to regulate the availability,distribution and use of pesticides in theircountries and should ensure the allocationof adequate resources for this mandate.

3.2 Pesticide industry should adhere tothe provisions of this Code as a standardfor the manufacture, distribution andadvertising of pesticides, particularly incountries lacking appropriate legislationand advisory services.

3.3 Governments of pesticide exportingcountries should, to the extent possible:

3.3.1 provide technical assistance toother countries, especially those lackingtechnical expertise in the assessment ofthe relevant data on pesticides;

3.3.2 ensure that good trading practicesare followed in the export of pesticides,especially to those countries with limitedor no regulatory schemes.

3.4 Pesticide industry and tradersshould observe the following practices inpesticide management, especially incountries without legislation or means ofimplementing regulations:

3.4.1 supply only pesticides of adequatequality, packaged and labelled as appro-priate for each specific market (3);

3.4.2 in close cooperation with procurersof pesticides, adhere closely to provisions of FAO guidelines on tenderprocedures (4);

3.4.3 pay special attention to the choiceof pesticide formulations and to presen-tation, packaging and labelling in orderto reduce risks to users and minimizeadverse effects on the environment;

3.4.4 provide, with each package of pes-ticide, information and instructions in aform and language adequate to ensureeffective use and reduce risks duringhandling;

3.4.5 be capable of providing effectivetechnical support, backed up by fullproduct stewardship to field level,including advice on disposal of pesti-cides and used pesticide containers, ifnecessary;

3.4.6 retain an active interest in follow-ing their products to the end-user, keep-ing track of major uses and the occur-rence of any problems arising from theuse of their products, as a basis fordetermining the need for changes inlabelling, directions for use, packaging,formulation or product availability.

3.5 Pesticides whose handling andapplication require the use of personalprotective equipment that is uncomfort-able, expensive or not readily availableshould be avoided, especially in the caseof small-scale users in tropical climates.Preference should be given to pesticides

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Pesticides can pose risks anywhere inthe world. The problem is greatest, how-ever, in developing countries where lowretail prices promote pesticide use butweak legislation and inadequate lawenforcement fail to control risks. Suchcountries should establish systems forcollecting data on cases of pesticideexposure. A number of software systemsare readily available for this purpose,including the INTOX Programme pro-duced by the International Programme onChemical Safety (IPCS).

Awareness of pesticide risks and how tomanage them should be promotedthrough information and education campaigns, including via television andradio programs. Risks related to pesticideproduction may not be relevant in manydeveloping countries, but in those coun-tries that do have manufacturers, weakerlaws and enforcement may increase thelikelihood that workers and nearby communities could be exposed.

The OECD has documented the fact thatthe riskiest type of chemical products areoften exported from industrialized todeveloping countries. Moreover, busi-nesses that are involve in formulation of pesticides are more common in devel-oping countries than pesticide manufac-turers; pesticide formulation has seriouspotential for risks to health and theenvironment, unless adequate safeguardsare taken.

The following sections of the voluntaryFAO International Code of Conduct on theDistribution and Use of Pesticides areparticularly applicable to actions on thenational level:


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3.11 Governments, pesticide industry andnational and international organizationsshould collaborate in developing and pro-moting resistance management strategiesto prolong the useful life of valuable pesti-cides and reduce the adverse effectsresulting from the development of resist-ance of pests to pesticides.

4. Testing of pesticides

4.2 Each country should possess orhave access to facilities to verify andexercise control over the quality of pesti-cides offered for sale or export, to estab-lish the quantity of the active ingredient oringredients and the suitability of their for-mulation, according to FAO or WHO spec-ifications, when available.

5. Reducing health hazards

5.1 Governments should:

5.1.1 implement a pesticide registrationand control system along the lines set outin Article 6;

5.1.2 periodically review the pesticidesmarketed in their country, their accept-able uses and their availability to eachsector of the public, and conduct specialreviews when indicated by scientific evidence;

5.1.3 carry out health surveillance pro-grammes of those who are occupationallyexposed to pesticides and investigate, aswell as document, poisoning cases;

5.1.4 provide guidance and instructionsto health workers, physicians and hospi-tal staff on the treatment of suspectedpesticide poisoning;

5.1.5 establish national or regional poisoning information and control centres at strategic locations to provideimmediate guidance on first aid andmedical treatment, accessible at alltimes;

5.1.6 utilize all possible means for col-lecting reliable data and maintaining sta-tistics on health aspects of pesticidesand pesticide poisoning incidents, withthe objective of establishing the WHOharmonized system for identifying andrecording such data (25). Suitablytrained personnel and adequateresources should be made available toensure the accuracy of information collected;

5.1.7 provide extension and advisoryservices and farmers' organizations withadequate information about practical IPMstrategies and methods, as well as therange of pesticide products available foruse;

5.1.8 ensure, with the cooperation ofpesticide industry, that where pesticidesare available through outlets which alsodeal in food, clothing, medicines or otherproducts for consumption or topicalapplication, they are physically segre-gated from other merchandise to prevent contamination and/or mistakenidentity. Where appropriate, they shouldbe clearly marked as hazardous materials.Every effort should be made to publicizethe dangers of storing foodstuffs andpesticides together;

5.1.9 utilize all possible means for collect-ing reliable data, maintaining statistics onenvironmental contamination andreporting specific incidents related topesticides;

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that require inexpensive personal protec-tive and application equipment and to procedures appropriate to the conditionsunder which the pesticides are to be handled and used.

3.6 National and international organiza-tions, governments and pesticide industryshould take coordinated action to dissem-inate educational materials of all types to pesticide users, farmers, farmer organ-izations, agricultural workers, unions andother interested parties. Similarly, usersshould seek and understand educationalmaterials before applying pesticides andshould follow proper procedures.

3.7 Concerted efforts should be madeby governments to develop and promotethe use of IPM. Furthermore, lending institutions, donor agencies and govern-ments should support the development ofnational IPM policies and improved IPMconcepts and practices. These should be based on scientific and other strategiesthat promote increased participation of farmers (including women's groups),extension agents and on-farm researchers.

3.8 All stakeholders, including farmersand farmer associations, IPM researchers,

extension agents, crop consultants, foodindustry, manufacturers of biological andchemical pesticides and applicationequipment, environmentalists and repre-sentatives of consumer groups shouldplay a proactive role in the developmentand promotion of IPM.

3.9 Governments, with the support ofrelevant international and regional organ-izations, should encourage and promoteresearch on, and the development of,alternatives posing fewer risks: biologicalcontrol agents and techniques, non-chemical pesticides and pesticides thatare, as far as possible or desirable, tar-get-specific, that degrade into innocuousconstituent parts or metabolites after useand are of low risk to humans and theenvironment.

3.10 Governments and the applicationequipment industry should develop andpromote the use of pesticide applicationmethods (6, 7) and equipment (8, 9, 10, 11)that pose low risks to human health andthe environment and that are more effi-cient and cost-effective, and should con-duct ongoing practical training in suchactivities (12).


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prior to domestic use and ensure thateach pesticide product is registeredbefore it can be made available for use(29, 30, 31);

6.1.3 conduct risk evaluations and makerisk management decisions based on allavailable data or information, as part ofthe registration process;

6.1.8 collect and record data on theimport, export, manufacture, formula-tion, quality, quantity and use of pesticides in order to assess the extentof any possible effects on human healthor the environment, and to follow trendsin pesticide use for economic and otherpurposes;

7. Availability and use

7.1 Responsible authorities should givespecial attention to drafting rules and regu-lations on the availability of pesticides.These should be compatible with existinglevels of user training and expertise. The parameters on which such decisionson availability are based vary widely andmust be left to the discretion of each government.

7.2 In addition, governments should takenote of and, where appropriate, use theWHO classification of pesticides by haz-ard (34) as the basis for their regulatorymeasures and associate the hazard classwith well-recognized hazard symbols.When determining the risk and degree ofrestriction appropriate to the product, the type of formulation and method ofapplication should be taken into account.

7.3 Two methods of restricting availabilitycan be exercised by the responsibleauthority: not registering a product or, as acondition of registration, restricting theavailability to certain groups of users inaccordance with a national assessment ofthe hazards involved in the use of theproduct.

7.4 Governments and industry shouldensure that all pesticides made availableto the general public are packaged andlabelled in a manner which is consistentwith the FAO guidelines on packaging andlabelling (3) and with appropriate nationalregulations.

7.5 Prohibition of the importation, saleand purchase of highly toxic and haz-ardous products, such as those includedin WHO classes Ia and Ib (34), may bedesirable if other control measures orgood marketing practices are insufficientto ensure that the product can be handledwith acceptable risk to the user.

8. Distribution and trade


8.1.1 develop regulations and implementlicensing procedures relating to the saleof pesticides, so as to ensure that thoseinvolved are capable of providing buyerswith sound advice on risk reduction andefficient use (26);

8.1.2 take the necessary regulatorymeasures to prohibit the repackaging ordecanting of any pesticide into food orbeverage containers and rigidly enforcepunitive measures that effectively detersuch practices;

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5.1.10 implement a programme to moni-tor pesticide residues in food and theenvironment.

5.3 Government and industry shouldcooperate in further reducing risks by:

5.3.1 promoting the use of proper andaffordable personal protective equip-ment;

5.3.2 making provisions for safe storageof pesticides at both warehouse andfarm level;

5.3.3 establishing services to collectand safely dispose of used containersand small quantities of left-over pesti-cides;

5.3.4 protecting biodiversity and mini-mizing adverse effects of pesticides onthe environment (water, soil and air) andon non-target organisms.

6. Regulatory and technical requirements:


6.1.1 introduce the necessary legislationfor the regulation of pesticides andmake provisions for its effective enforce-ment, including the establishment ofappropriate educational, advisory, exten-sion and health-care services, usingFAO guidelines as far as possible (2, 29,30). In so doing, they should take fullaccount of local needs, social and eco-nomic conditions, levels of literacy, cli-matic conditions and availability ofappropriate pesticide application andpersonal protective equipment;

6.1.2 strive to establish pesticide regis-tration schemes and infrastructuresunder which products can be registered

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The World Health Organization (WHO)classifies most pesticides mainly on thebasis of acute toxicity studies of animals.Pesticides are classified as extremelyhazardous (Ia), highly hazardous (Ib), mod-erately hazardous (II), slightly hazardous(III) and unlikely to be hazardous undernormal use (no class number assigned).For some class Ia pesticides, just 5 ml (ateaspoon) taken into the mouth is suffi-cient to kill an adult human being.

Small-scale farmers in the tropics uselarge amounts of pesticides belonging toclasses Ia, Ib, and II. For example, inIndonesia in 1995, 44 percent of the 265registered pesticides were Class Ia, Ib, orII; one field study revealed that 50 percentof pesticides used by farmers belonged tothese classes.

Although all pesticidesshould be considered as beingpotentially hazardous to human health,some groups of pesticidesare of particularconcern internationally.National governmentsand intergovernmental organizationsare carrying out a number of activities toreduce the adverse healthand environmental impactsof pesticides.

At the regional and international level

Adding to the risk is the fact that small-scale farmers in developing countries typically cannot afford protective clothing.Even if available, protective garb used under tropical conditions is hot anduncomfortable at best, and can lead toheat stress. Thus, it is unlikely to be used.

Epidemiology of acute pesticide poisonings

The unsafe use of pesticides represents aproblem for human health in both devel-oped and developing countries. Althoughthe adverse effects of pesticides onhuman and environmental health havebeen studied in almost every country, con-troversy continues about the extent andseverity of poisonings. The primary reasonfor the controversy is the limited scope ofpast reports and studies.

The International Programme on ChemicalSafety (IPCS) has initiated a project that willprovide reliable and updated information onthe extent of the problem and make it pos-sible to compare epidemiological dataamong various study populations. Datafrom different health sources and studysites are being collected, and countriesare being given guidance on how tostrengthen their national data collectionsystems and promote prevention and education. These activities are designedto reduce the incidence and severity ofpoisonings and their adverse effects.


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Another group of pesticides of particularconcern is persistent organic pollutants(POPs). These pesticides are toxic; persistfor long periods in the environment; travellong distances via air, water and livingcreatures; and are found in areas wherethey were never used or produced. Theystore easily in fatty tissues and build up infood chains.[37] Children may be exposedto these pesticides when still in the womband during breastfeeding. (However,breast milk is the preferred source ofnutrition for young infants.)

Responding to mounting concern, govern-ments adopted a legally binding treaty in 2001 under the auspices of the UnitedNations Environment Programme atreducing and eliminating a starting list of12 POPs. Nine are pesticides: aldrin, chlordane, DDT, dieldrin, endrin,heptachlor, mirex, toxaphene, and hexa-chlorobenzene (the later is also an indus-trial chemical).

Pesticides under the RotterdamConvention

The Rotterdam Convention on the PriorInformed Consent Procedure for CertainHazardous Chemicals and Pesticides inInternational Trade was adopted inSeptember 1998. [38] The Convention hasbeen signed by 73 countries, and its goalsare being pursued on a voluntary basisthrough the interim PIC procedure untilthe agreement enters into force. TheConvention entered into force on 24 February 2004.

The Rotterdam Convention establishes afirst line of defence against futuretragedies by giving importing countriesthe power to decide which potentiallyhazardous chemicals they want to receiveand to exclude those they cannot managesafely. When trade is permitted, require-ments for labelling and providingimporters with information on potentialhealth and environmental effects will pro-mote the safe use of the chemicals.

The Convention starts with 22 pesticidesand five other chemicals; many more

substances are likely to be added in thefuture. All of the listed chemicals havebeen banned or severely restricted bycountries to protect human health and theenvironment. The list includes severelyhazardous pesticide formulations that cancause problems under the conditions ofuse in developing countries and countrieswith economies in transition.

For further information, see the RotterdamConvention website www.pic.int.


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Activities ofInternationalOrganizations

United Nations EnvironmentProgramme (UNEP)

UNEP/Chemicals is the focus for allactivities on the sound management ofhazardous chemicals. Its aim of protecting human health and the environment from the negative impactsof toxic chemicals is pursued by:

- Jointly with FAO, providing the secre-tariat for the Rotterdam Convention onthe Prior Informed Consent Procedurefor Certain Hazardous Chemicals andPesticides in International Trade;

- Providing the secretariat for theStockholm Convention on PersistentOrganic Pollutants (POPs);

- Catalyzing actions to help governmentsaddress risks from toxic chemicals;

- Promoting the world-wide exchange ofinformation on toxic chemicals; and

- Providing training and capacity buildingto countries in the sound management ofchemicals.

Mr. Jim Willis, Director

UNEP Chemicals

International Environment House

11-13 Chemin des Anémones

CH-1219 Châtelaine

Switzerland

Tel. +41 22 917 81 83

Fax +41 22 797 34 60

Email: [email protected]


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World Health Organization(WHO).

WHO's work in chemical safety isundertaken largely through theInternational Programme on ChemicalSafety (IPCS), a joint programme ofWHO, UNEP and the InternationalLabour Organization (ILO). At WHOheadquarters, the Programme for the Promotion of Chemical Safety is the Central Unit for IPCS, with dualresponsibilities for technical work andcoordination. WHO also coordinatesIPCS activities with other WHO programmes featuring chemical safetycomponents, such as the InternationalAgency for Research in Cancer (IARC),food safety, occupational health, andcontrol of tropical diseases.

Areas of activity include:

- Evaluation of risks to human healthand the environment;

- Methodologies for risk assessment;

- Prevention and management of toxicexposures and chemical emergencies;

- Exchange of information on chemicalsafety and communication of relatedhazards and risks; and

- Capacity building for sound manage-ment of chemicals and risk reduction.

Dr. Timothy Meredith, Coordinator

Programme on Chemical Safety

World Health Organization

Avenue Appia, 20

CH-1211 Geneva 27

Switzerland

Tel. +41 22 791 3761/3791

Fax +41 22 791 41 27


Food and Agriculture Organizationof the United Nations (FAO)

FAO assists member countries toimprove the sound management ofchemicals by:

- Promoting the provisions of the Codeof Conduct on the Distribution and Useof Pesticides and providing technicalassistance on implementing rationalplant-protection programmes and pre-venting and disposing obsolete andunwanted pesticides;

- Jointly with IAEA, improving the use ofagrochemicals in food and agriculture;

- Jointly with UNEP providing theSecretariat for the RotterdamConvention;

- Jointly with WHO, making recommen-dations for Acceptable Daily Intakes offood additives, pesticide and veterinarydrug residues, and Maximum ResidueLimits in food for pesticides and veteri-nary drugs and tolerable intakes ofother food contaminants; and

- Providing the Secretariat for the Joint FAO/WHO Codex AlimentariusCommission, the executive organ of thejoint FAO/WHO Food StandardsProgramme.

Dr. Niek Van Der Graaff, Chief

Plant Protection Service

Plant Production and Protection Division

Food and Agriculture Organization

Via delle Terme de Caracalla

I-00100 Rome

Italy

Tel. +39 6 5705 34 41

Fax +39 6 5705 63 47



35

Endn

otes1. Jeyaratnam, J., Acute pesticide

poisoning: a major global health problem.World Health Stat Q, 1990. 43(3): p. 139-44.

2. Kahn, E., Pesticide related illness inCalifornia farm workers. J Occup Med, 1976.18(10): p. 693-6.

3. Wesseling, C., L. Castillo, and C.G. Elinder,Pesticide poisonings in Costa Rica. Scand JWork Environ Health, 1993. 19(4): p. 227-35.

4. McConnell, R. and A.J. Hruska, An epidemic of pesticide poisoning inNicaragua: implications for prevention indeveloping countries. Am J Public Health,1993. 83(11): p. 1559-62.

5. National Research Council, Pesticidesin the Diets of Infants and Children. 1993,Washington, DC: National Academy Press.

6. World Health Organization, PublicHealth Impact of Pesticides Used inAgriculture. 1990, WHO: Geneva.

7. Reigart, J.R. and J.R. Roberts,Recognition and Management of PesticidePoisonings. Fifth ed. 1999, Washington, DC:US Environmental Protection Agency.

8. Goldman, L.R., New approaches forassessing the etiology and risks ofdevelopmental abnormalities from chemicalexposure. Reprod Toxicol, 1997. 11(2-3):p. 443-51.

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Endnotes9. Munger, R., et al., Intrauterine growthretardation in Iowa communities withherbicide- contaminated drinking watersupplies [published erratum appears inEnviron Health Perspect 1997Jun;105(6):570]. Environ Health Perspect,1997. 105(3): p. 308-14.

10. U.S. Environmental Protection Agency,Endocrine Disruptor Screening and TestingAdvisory Committee. Final Report. 1998,EPA Office of Prevention, Pesticides andToxic Substances: Washington, DC.

11. Eskenazi, B., A. Bradman, and R.Castorina, Exposures of children toorganophosphate pesticides and theirpotential adverse health effects. EnvironHealth Perspect, 1999. 107 Suppl 3: p. 409-19.

12. Rosenstock, L., et al., Chronic centralnervous system effects of acuteorganophosphate pesticide intoxication.The Pesticide Health Effects Study Group.Lancet, 1991. 338(8761): p. 223-7.

13. Zahm, S.H. and M.H. Ward, Pesticidesand childhood cancer. Environ HealthPerspect, 1998. 106 Suppl 3: p. 893-908.

14. Repetto, R. and S. Baliga, Pesticidesand the immune system: the public healthrisks. 1996, World Resources Institute:Washington, DC.

15. Kishi, M., et al., Relationship ofpesticide spraying to signs and symptomsin Indonesian farmers. Scand J WorkEnviron Health, 1995. 21(2): p. 124-33.

16. Clarke, E.E., et al., The problemsassociated with pesticide use by irrigationworkers in Ghana. Occup Med (Lond), 1997.47(5): p. 301-8.

17. National Research Council, ProtectingYouth at Work: Health, Safety, andDevelopment of Working Children andAdolescents in the United States. 1998,National Academies Press: Washington, DC.

18. Keifer, M., et al., Symptoms andcholinesterase activity among ruralresidents living near cotton fields inNicaragua. Occup Environ Med, 1996.53(11): p. 726-9.

19. Kimani, V.N. and M.A. Mwanthi,Agrochemicals exposure and healthimplications in Githunguri location, Kenya.East Afr Med J, 1995. 72(8): p. 531-5.

20. McConnell, R., et al., Subclinical healtheffects of environmental pesticidecontamination in a developing country:cholinesterase depression in children.Environ Res, 1999. 81(2): p. 87-91.

21. Azaroff, L.S., Biomarkers of exposureto organophosphorous insecticides among


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farmers' families in rural El Salvador:factors associated with exposure. EnvironRes, 1999. 80(2 Pt 1): p. 138-47.

22. Azaroff, L.S. and L.M. Neas, Acutehealth effects associated withnonoccupational pesticide exposure inrural El Salvador. Environ Res, 1999. 80(2 Pt1): p. 158-64.

23. Font, J. and A. Marsal, Determinationof organochlorine pesticides in skins andleather by gas chromatography. JChromatogr A, 1998. 811(1-2): p. 256-60.

24. Brouwer, A., et al., Report of the WHOworking group on the assessment of healthrisks for human infants from exposure toPCDDs, PCDFs and PCBs. Chemosphere,1998. 37(9-12): p. 1627-43.

25. US Environmental Protection Agency,Exposure Factors Handbook. 1995, Office ofResearch and Development: Washington, DC.

26. Lioy, P.J., et al., House dust levels ofselected insecticides and a herbicidemeasured by the EL and LWW samplersand comparisons to hand rinses and urinemetabolites. J Expo Anal Environ Epidemiol,2000. 10(4): p. 327-40.

27. Litovitz, T. and A. Manoguerra,Comparison of pediatric poisoning hazards:

Endnotes

37

Endn

otesan analysis of 3.8 million exposure

incidents. A report from the AmericanAssociation of Poison Control Centers [seecomments]. Pediatrics, 1992. 89(6 Pt 1): p. 999-1006.

28. Saadeh, A.M., et al., Clinical andsociodemographic features of acutecarbamate and organophosphatepoisoning: a study of 70 adult patients innorth Jordan. J Toxicol Clin Toxicol, 1996.34(1): p. 45-51.

29. Wesseling, C., et al., Unintentionalfatal paraquat poisonings amongagricultural workers in Costa Rica: reportof 15 cases. Am J Ind Med, 1997. 32(5): p. 433-41.

30. Landrigan, P.J., et al., Pesticides andInner-City Children: Exposures, Risks, andPrevention. Environ Health Perspect, 1999.107 Suppl 3: p. 431-437.

31. Esteban, E., et al., Associationbetween indoor residential contaminationwith methyl parathion and urinary para-nitrophenol. J Expo Anal EnvironEpidemiol, 1996. 6(3): p. 375-87.

32. Bradman, M.A., et al., Pesticideexposures to children from California'sCentral Valley: results of a pilot study.

J Expo Anal Environ Epidemiol, 1997. 7(2): p. 217-34.

33. Fenske, R.A., et al., Biologically basedpesticide dose estimates for children in anagricultural community. Environ HealthPerspect, 2000. 108(6): p. 515-20.

34. Carpenter, D.O., et al., Environmentalthreats to the health of children: the Asianperspective. Environ Health Perspect, 2000.108(10): p. 989-92.

35. Spann, M.F., J.M. Blondell, and K.L. Hunting, Acute hazards to young chil-dren from residential pesticide exposures.Am J Public Health, 2000. 90 (6): p. 971-3.

36. Food and Agriculture Organization ofthe United Nations, International Code ofConduct on the Distribution and Use ofPesticides (Revised). 2003, FAO: Rome.

37. Kutz, F.W., P.H. Wood, and D.P.Bottimore, Organochlorine pesticides andpolychlorinated biphenyls in human adi-pose tissue. Rev Environ Contam Toxicol,1991. 120: p. 1-82.

38. Rotterdam Convention on the PriorInformed Consent Procedure for CertainHazardous Chemicals and Pesticides inInternational Trade. 1998, UNEP/FAO.


Childhood Pesticide Poisoningpesticide poisoning [1, 2], and adolescents are often the victims.[3,...

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Transcript of Childhood Pesticide Poisoningpesticide poisoning [1, 2], and adolescents are often the victims.[3,...