Limits...
Nonmalarial infant deaths and DDT use for malaria control.

Chen A, Rogan WJ - Emerging Infect. Dis. (2003)

Bottom Line: However, plausible if inconclusive studies associate DDT with more preterm births and shorter duration of lactation, which raise the possibility that DDT does indeed have such toxicity.Assuming that these associations are causal, we estimated the increase in infant deaths that might result from DDT spraying.Unintended consequences of DDT use need to be part of the discussion of modern vector control policy.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.

ABSTRACT
Although dichlorodiphenyl trichloroethane (DDT) is being banned worldwide, countries in sub-Saharan Africa have sought exemptions for malaria control. Few studies show illness in children from the use of DDT, and the possibility of risks to them from DDT use has been minimized. However, plausible if inconclusive studies associate DDT with more preterm births and shorter duration of lactation, which raise the possibility that DDT does indeed have such toxicity. Assuming that these associations are causal, we estimated the increase in infant deaths that might result from DDT spraying. The estimated increases are of the same order of magnitude as the decreases from effective malaria control. Unintended consequences of DDT use need to be part of the discussion of modern vector control policy.

Show MeSH

Related in: MedlinePlus

Protection of breast-feeding against infant death caused by infectious disease (not breast-feeding versus breast-feeding). CI, confidence intervals; OR, odds ratio. Source: World Health Organization study team.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3020610&req=5

Figure 2: Protection of breast-feeding against infant death caused by infectious disease (not breast-feeding versus breast-feeding). CI, confidence intervals; OR, odds ratio. Source: World Health Organization study team.

Mentions: Shorter duration of lactation increases the risk for infant and childhood deaths in both industrialized and developing countries (23–25). The World Health Organization (WHO) conducted a Mantel-Haenszel pooled analysis to review the effect of breast-feeding on infant and child death rates (11). The analysis identified breast-feeding as a strong protective factor against infant death, especially that caused by infectious illnesses such as diarrhea and acute lower respiratory tract infection. Breast-feeding was most protective in younger infants; nevertheless, it was still protective at 9 to 11 months after birth (Figure 2). If the median duration of lactation were shortened from 19 months to 11–12 months because of high concentrations of DDE, we would expect the proportion of children weaned before 12 months of life to increase from ~25% to 50%. In Africa, where prolonged breast-feeding is the norm, the risk of not being breast-fed continues into the second year of life, with ORs ranging from 8 in Ghana to 2 in Senegal (11). (Death after 1 year of age is no longer considered an infant death, but ORs should not change abruptly between 12 and 19 months of age). In the WHO analyses, the ORs for breast-feeding longer >1 year all were from Africa, and the ORs for breast-feeding <1 year were from Asia or South America. To estimate the effect of decreasing from a median duration of 19 months in Africa to 11 months, we used the most stable African estimate, from Senegal, which is 2.9 at 19 months, and compared it to the pooled estimate from Asia and South America at 11 months, which is 1.4. Thus, if we assume the overall RR of infant death from this degree of DDT-induced shortened lactation to be approximately 2.0, shortened lactation would result in a 20% (=((p2*RR+1-p2)-(p1*RR+1-p1))/(p1*RR+1-p1), p1=25%, p2=50%, RR=2) increase in infant mortality caused by infectious diseases.


Nonmalarial infant deaths and DDT use for malaria control.

Chen A, Rogan WJ - Emerging Infect. Dis. (2003)

Protection of breast-feeding against infant death caused by infectious disease (not breast-feeding versus breast-feeding). CI, confidence intervals; OR, odds ratio. Source: World Health Organization study team.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3020610&req=5

Figure 2: Protection of breast-feeding against infant death caused by infectious disease (not breast-feeding versus breast-feeding). CI, confidence intervals; OR, odds ratio. Source: World Health Organization study team.
Mentions: Shorter duration of lactation increases the risk for infant and childhood deaths in both industrialized and developing countries (23–25). The World Health Organization (WHO) conducted a Mantel-Haenszel pooled analysis to review the effect of breast-feeding on infant and child death rates (11). The analysis identified breast-feeding as a strong protective factor against infant death, especially that caused by infectious illnesses such as diarrhea and acute lower respiratory tract infection. Breast-feeding was most protective in younger infants; nevertheless, it was still protective at 9 to 11 months after birth (Figure 2). If the median duration of lactation were shortened from 19 months to 11–12 months because of high concentrations of DDE, we would expect the proportion of children weaned before 12 months of life to increase from ~25% to 50%. In Africa, where prolonged breast-feeding is the norm, the risk of not being breast-fed continues into the second year of life, with ORs ranging from 8 in Ghana to 2 in Senegal (11). (Death after 1 year of age is no longer considered an infant death, but ORs should not change abruptly between 12 and 19 months of age). In the WHO analyses, the ORs for breast-feeding longer >1 year all were from Africa, and the ORs for breast-feeding <1 year were from Asia or South America. To estimate the effect of decreasing from a median duration of 19 months in Africa to 11 months, we used the most stable African estimate, from Senegal, which is 2.9 at 19 months, and compared it to the pooled estimate from Asia and South America at 11 months, which is 1.4. Thus, if we assume the overall RR of infant death from this degree of DDT-induced shortened lactation to be approximately 2.0, shortened lactation would result in a 20% (=((p2*RR+1-p2)-(p1*RR+1-p1))/(p1*RR+1-p1), p1=25%, p2=50%, RR=2) increase in infant mortality caused by infectious diseases.

Bottom Line: However, plausible if inconclusive studies associate DDT with more preterm births and shorter duration of lactation, which raise the possibility that DDT does indeed have such toxicity.Assuming that these associations are causal, we estimated the increase in infant deaths that might result from DDT spraying.Unintended consequences of DDT use need to be part of the discussion of modern vector control policy.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.

ABSTRACT
Although dichlorodiphenyl trichloroethane (DDT) is being banned worldwide, countries in sub-Saharan Africa have sought exemptions for malaria control. Few studies show illness in children from the use of DDT, and the possibility of risks to them from DDT use has been minimized. However, plausible if inconclusive studies associate DDT with more preterm births and shorter duration of lactation, which raise the possibility that DDT does indeed have such toxicity. Assuming that these associations are causal, we estimated the increase in infant deaths that might result from DDT spraying. The estimated increases are of the same order of magnitude as the decreases from effective malaria control. Unintended consequences of DDT use need to be part of the discussion of modern vector control policy.

Show MeSH
Related in: MedlinePlus