Case Report

Acute Atrazine Food Poisoning In Shaibupe: A Farming Community in Northern Ghana.

Edmund Der, Juventus B Ziem, Ken Sagoe, Richard K Gyasi and Jehoran T Anim

Department of Pathology, University for development studies School of medicine and health sciences P.O Box 1350 Tamale, Ghana

Abstract

 

Introduction

    Atrazine belongs to a class of selective herbicides called triazine (4,6-dichloro-N-(2-chlorophenyl)-1,3,5-triazin-2-amine). It is  restricted in most countries due to its potential for groundwater contamination [1]. In the United States of America it is registered for the control of broadleaf weeds and some grassy weeds. It is currently used on corn, sorghum, sugarcane, wheat, guava, and macadamia nuts [2]. In animals, atrazine can be absorbed into the bloodstream through the oral route, skin and inhalation exposure. When ingested in lower doses it causes symptoms such as abdominal pain, diarrhea and vomiting, irritation of the eyes and mucous membranes[3]. In larger doses, animals such as rats showed excitation followed by depression, slowed breathing, incoordination, muscle spasms, hypothermia, hypoactivity, breathing difficulty, prostration, convulsion and death[4]. The mechanism of atrazine action in human is not clear, but lethal doses in test animals have caused severe damage, in the form of congestion and/or hemorrhaging, to the lungs, kidneys, liver, spleen, brain and heart[5].  
      Deaths due to pesticide poisoning have been reported around the world particularly in the developing countries[6]. Published autopsy data on pesticide-related deaths in Ghana are scanty. Emerging evidence from northern Ghana indicates that agrochemical related deaths from the farming communities are on the increase [7,8].  Adetola et al., in their paper; "Pesticide poisoning: A nine year study (1989-1987)", found the main pesticides-related causes of deaths to be; carbamate (126 cases), organophosphorus (66 cases) and organochlorines (74 cases)[9].  We present a case report of acute atrazine food poisoning in Shaibupe, a farming community in Buipe Traditional Area of northern Ghana, 100 Kilometers  south of Tamale, the regional capital.

Case Report

According to information provided by the Police investigator, on the day in question( 31/10/11), the brother-in-law of the deceased, received a call from the man calling for a help, because he and his family of nine were dying after they had consumed cooked beans for lunch. The brother-in-law arrived at the village (Shaibupe) about 3 hours later and found that seven members of the family were already dead and two were unconscious. The two were rushed to Buipe health center and later to the Tamale Teaching hospital (TTH). Unfortunately, one of the two victims, an adult male (34 years), later died bringing the total dead to eight.The bodies were deposited in the Tamale Teaching hospital awaiting autopsy. The only survivor was a child. Cooked and uncooked beans were retrieved from the scene by the police investigator.
    Autopsy was performed on seven of the victims 3 days after death. These were; two girls (aged 2 and 7 years), 3 boys (aged 2,5 and 6 years), and two adults, a man and  a woman(aged 34 and 45 years respectively). The bodies were at various stages of decomposition probably partly due to poor preservation. The bodies of the children (3 boys and 2 girls), were reasonably preserved, especially those without clothing. Those of the adults in clothing showed advanced decomposition (crepitation, blebs, peeling of the skin, dark-black fluid from the mouth and nostrils, grossly distended abdomen).
    All the internal organs showed varying degrees of autolysis. The stomachs were filled with partly digested beans. The intestines were distended with gas. No tissue was submitted for histological examination on account of autolysis. Using the information provided, and the scanty autopsy findings, a preliminary diagnosis was made of deaths due to food poisoning.
    For further investigations, the following were sent to the Ghana Standards Authority for toxicological analysis:105g of uncooked beans and 295g of cooked beans from victims home; 151-586g of stomach content from the victims, submitted individually; 44-146g of liver of the  victims submitted individually and 3 ml of venous blood taken from each victim.
    Reports were received one week later. Significant quantities of atrazine were detected in both the uncooked and cooked beans from the victims’ house and also from the stomach contents, blood and liver specimens.
    In light of the above findings, a final cause of death was reported as acute atrazine poisoning

Discussion

Although the time interval was not stated, judging from the time the brother-in-law received the call and the time the victims were found dead, it is estimated to be less than 6 hours. Atrazine, a restricted herbicide, was detected in significant quantities from the uncooked and cooked beans, as well as stomach contents, blood and liver specimens of the victims. These findings potentially suggested that, the deaths of the seven persons were atrazine related. According to the police investigator, the cooked and uncooked beans were retrieved from the victim’s home, but it was not possible to tell if it was from their farm, from the market or, a gift from someone. This was further complicated by the fact that the only survivor is a child(less than two years old, who could offer no information about the beans). Interestingly during that same period, there were other reports of pesticide-related deaths in northern Ghana. Two months earlier, it was reported that five persons had died after eating a meal of maize and beans, at Nayoko 4 kilometers from Walewale in the Northern Region of Ghana [8]. Similarly, in the same month of October 2011, 17 out of 28 persons from various farming communities in the East Mamprusi District of Northern Region died of suspected food poisoning. Also, five other cases of suspected food poisoning in Gbintiri and 12 in Nanori also in northern region were successfully treated and discharged [7]. Chemicals potentially implicated in these cases were; DDT, Endosulfan, Lindane, Dieldrin, Aldrin and Endrin. Unfortunately, in all these cases, autopsies were not performed and the exact pesticides were not identified.
    For the Shaibupe victims, autopsies were performed and Atrazine detected. Statistics from the Forensics Science Department of the Ghana Standards Authority indicate that in 2011, a total of 10 positive cases of atrazine-related poisoning were reported, of which 7(70%), are the subjects of this report, thus making it the first documented positive cases of atrazine poisoning in Ghana. This finding together with those cited above, support the view that higher proportions of pesticide poisoning and illnesses occur in remote agricultural areas where there are inadequate occupational safety standards, insufficient enforcement of pesticide-related legislation, poor labeling of pesticide containers, illiteracy, inadequate protective clothing and washing facilities as well as user’s lack of knowledge of pesticide hazards [10-11].

Public Health importance:

1.    Our finding may just be the tip of the ‘’iceberg’’, judging from the fact that the Northern Region of Ghana is predominantly a farming community, and that during that same period there were other reports of pesticide- related deaths in that part of the country.
2.     Food security. The incident took place in the immediate post harvest period. This means that the atrazine was used during the farming or storage period to control pests, but because of poverty and food insecurity, the time required for the residue of the chemical to disappear was not observed.
3.    In general, this could also point to the fact that laws regulating the importation, sale, distribution and use of agrochemical in Ghana are not strictly enforced.

Conclusion

Atrazine is a restricted selective herbicide in most developed countries, but still finds its way into northern Ghana. Our findings may just be the tip of a revelation and does not tell the magnitude of the problem of pesticide-related deaths in farming communities of Ghana. There is the need for the appropriate institution to enforce laws regulating the importation and use of agrochemicals in Ghana. There is also the need for continuous education of farmers about the safe handling, hazards and effects of agrochemicals. All such pesticide-related deaths must be reported to the appropriate authority to enable a more comprehensive assessment of the problem and lasting solutions to be found.

Recommendations

1. National and international action restricting access to the most toxic pesticides is of paramount importance to reduce the number of self-poisoning
2. As a long term measure, cost-effective alternatives have to be made available to farmers to reduce the overall use of toxic pesticides
3. Further investments are needed to promote the safe storage of pesticides at the community level
4. Education on handling of pesticides by farmers should be intensified.
5. It is essential to improve quality, affordability and accessibility of health care facilities close to the farming communities, to provide immediate assistance to victims

Conflict of Interests

The authors declare that there are no conflict of interests

Acknowledgement

Our thanks go to Mr Rabiu Mikdad, Vitus Bio and the rest of the mortuary staff of the Tamale Teaching Hospital. We also wish to express our sincere gratitude to the police investigator for sending the samples to the Ghana Standard Authority. Finally, we thank Mr Atakpi and the staff of the forensic science unit of the Ghana Standard Authority for their assistance in making the results available to us.

Authors' Contributions

ED: Concept and design, literature review and preparation of manuscript.
JBZ: Concept and design, literature review and preparation of manuscript.
KS: Concept and design, literature review and preparation of manuscript.
RKG: Concept and design, literature review and preparation of manuscript.
JTA: Concept and design, literature review and preparation of manuscript.

Ethical Considerations

The study was approved by the Institutional IRB

Funding

None declared

References

1. Food Chemical News, Inc. 1990 (Jan. 31). Atrazine use restricted; other label changes imposed by EPA. Pesticide and Toxic Chemical News. Washington, DC.
2. Kellogg RL, Nehring R, Grube A, et al. Environmental indicators of pesticide leaching and runoff from farm fields. United States Department of Agriculture Natural Resources Conservation Service; February 2000.
3.  Hallenbeck WH, Cunningham-Burns KM. 1985. Pesticides and human health. New York: Springer-Verlag.
4.  Hayes WJ, Laws ER (ed.). Handbook of Pesticide Toxicology, Vol. 3, Classes of Pesticides. Academic Press, Inc., New York.1990
5. US EPA. 1988 (August). Atrazine: Health Advisory. Office of Drinking Water, US EPA, Washington, DC.
6. Tariq MI, Hussain S Sultana N “Pesticide Exposure in Pakistan: A review”, Environment International,2007;33:1107-1122. (Doi:101016/j.envint200707012)
7. Daniel Abugah. 17 persons died of food poisoning from farming communities in the East Mamprusi District of the northern region. Source: Daily Guide News paper. October 3rd 2011.
8. Food poisoning; 5 family members die in Nayoko, West Mamprusi District of the Northern Region. Source: The Ghanaian Times,  August 19,2011: Pages 1 and 32
9. Adetola E, Ataki JK, Atidepe E, et al. Pesticide Poisoning – A Nine Year Study(1989-1997), Department of Pathology, University of Ghana Medical School and Ghana Standards Board, Accra, 1999.(Unpublished)
10. Tchounwou BP, Ashour BA, Raghed DA et al. Health Risk Assessment of Pesticide Usage in Menia El-Kamh Province of Sharkia Governorate in Egypt. International journal of Molecular Science. 2002. 10:1082-1094. (doi:10,33,90/i3101082)
11. Snelder DJ, Maasipiquena MD, de Snoo GR. Risk Assessment of Pesticide Usage by Smallholder Farmers in the Cagayan Valley. Crop production;2008.3-5:747-762 (doi.10.1016/j.cropro2007.10.011)