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      The association between children’s exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis

      systematic-review

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          Abstract

          Background

          Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children.

          Methods

          A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique.

          Result

          A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14–1.35) with extreme heterogeneity ( I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14–1.57), with high heterogeneity ( I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45–2.21) with nonsignificant low heterogeneity ( I 2 = 30%, p-value = 0.18).

          Conclusion

          This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.

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          Most cited references70

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          Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data.

          There currently does not exist guidance for authors aiming to undertake systematic reviews of observational epidemiological studies, such as those reporting prevalence and incidence information. These reviews are particularly useful to measure global disease burden and changes in disease over time. The aim of this article is to provide guidance for conducting these types of reviews.
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            Exposure to pesticides and the associated human health effects.

            Pesticides are used widely to control weeds and insect infestation in agricultural fields and various pests and disease carriers (e.g., mosquitoes, ticks, rats, and mice) in houses, offices, malls, and streets. As the modes of action for pesticides are not species-specific, concerns have been raised about environmental risks associated with their exposure through various routes (e.g., residues in food and drinking water). Although such hazards range from short-term (e.g., skin and eye irritation, headaches, dizziness, and nausea) to chronic impacts (e.g., cancer, asthma, and diabetes), their risks are difficult to elucidate due to the involvement of various factors (e.g., period and level of exposure, type of pesticide (regarding toxicity and persistence), and the environmental characteristics of the affected areas). There are no groups in the human population that are completely unexposed to pesticides while most diseases are multi-causal to add considerable complexity to public health assessments. Hence, development of eco-friendly pesticide alternatives (e.g., EcoSMART) and Integrated Pest Management (IPM) techniques is desirable to reduce the impacts of pesticides. This paper was hence organized to present a comprehensive review on pesticides with respect to their types, environmental distribution, routes of exposure, and health impacts.
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              Pesticides and human chronic diseases: evidences, mechanisms, and perspectives.

              Along with the wide use of pesticides in the world, the concerns over their health impacts are rapidly growing. There is a huge body of evidence on the relation between exposure to pesticides and elevated rate of chronic diseases such as different types of cancers, diabetes, neurodegenerative disorders like Parkinson, Alzheimer, and amyotrophic lateral sclerosis (ALS), birth defects, and reproductive disorders. There is also circumstantial evidence on the association of exposure to pesticides with some other chronic diseases like respiratory problems, particularly asthma and chronic obstructive pulmonary disease (COPD), cardiovascular disease such as atherosclerosis and coronary artery disease, chronic nephropathies, autoimmune diseases like systemic lupus erythematous and rheumatoid arthritis, chronic fatigue syndrome, and aging. The common feature of chronic disorders is a disturbance in cellular homeostasis, which can be induced via pesticides' primary action like perturbation of ion channels, enzymes, receptors, etc., or can as well be mediated via pathways other than the main mechanism. In this review, we present the highlighted evidence on the association of pesticide's exposure with the incidence of chronic diseases and introduce genetic damages, epigenetic modifications, endocrine disruption, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum stress and unfolded protein response (UPR), impairment of ubiquitin proteasome system, and defective autophagy as the effective mechanisms of action. Copyright © 2013 Elsevier Inc. All rights reserved.
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                Author and article information

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                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                24 May 2024
                2024
                : 12
                : 1402908
                Affiliations
                [1] 1Department of Environmental Health, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                [2] 2Department of Epidemiology and Biostatistics School of Public Health, College of Medicine and Health Science Wollo University , Dessie, Ethiopia
                [3] 3Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                [4] 4Amref Health in Africa, COVID-19 Vaccine/EPI Technical Assistant at West Gondar Zonal Health Department , Gondar, Ethiopia
                [5] 5Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                [6] 6Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                [7] 7Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University , Dessie, Ethiopia
                Author notes

                Edited by: Petra Zimmermann, Université de Fribourg, Switzerland

                Reviewed by: Guilherme Liberato Da Silva, University of Vale do Taquari, Brazil

                Yu Sun, South China Agricultural University, China

                *Correspondence: Awoke Keleb, kalebawoke@ 123456gmail.com
                Article
                10.3389/fpubh.2024.1402908
                11167956
                38868160
                93b6a811-c9d4-4f62-81bb-9f17c0540d40
                Copyright © 2024 Keleb, Daba, Asmare, Bayou, Arefaynie, Mohammed, Tareke, Kebede, Tsega, Endawkie, Kebede, Abera, Abeje and Enyew.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 18 March 2024
                : 22 April 2024
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 74, Pages: 17, Words: 9463
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Public Health
                Systematic Review
                Custom metadata
                Children and Health

                pesticide exposure,chronic respiratory diseases,asthma,respiratory tract infection,children,systematic review,meta-analysis

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