Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out.

BACKGROUND: We describe trends in childhood mortality in Kenya, paying attention to the urban-rural and intra-urban differentials. METHODS: We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). RESULTS: Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban-rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. CONCLUSIONS: The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums.

Dietary exposure to chlorpyrifos and levels of 3,5,6-trichloro-2-pyridinol in urine.

Information on associations between chlorpyrifos residues in food and personal exposure to chlorpyrifos would be valuable for evaluating the relationship between personal exposure and possible health effects. We used food consumption records, chlorpyrifos levels in duplicate plates, and measures of 3,5,6-trichloro-2-pyridinol (TCPy) in urine obtained from human volunteers in the National Human Exposure Assessment Survey in Maryland (NHEXAS-MD) to evaluate a food consumption-chemical residue model for estimating dietary intake of chlorpyrifos. Model inputs were the NHEXAS-MD food consumption records and chlorpyrifos residues in specific foods measured in the U.S. Food and Drug Administration Total Diet Study (TDS) market baskets from 1993 to 1997. The estimated mean and standard deviation of chlorpyrifos concentration (microg/kg) in duplicate plates (n=203) were within 20% and 50%, respectively, of the corresponding parameters of measured chlorpyrifos levels. However, predicted and measured concentrations in the 78 duplicate plates with detectable levels of chlorpyrifos were not significantly associated according to Spearman correlation analysis (r=0.04, p=0.7667) and linear regression (p=0.2726). Measured and estimated chlorpyrifos intakes for observations with non-zero values for each intake measure (n=71) were moderately associated on a rank (Spearman's r=0.24, p=0.0462) and linear basis (regression r(2)=0.07, p=0.0242). Measured intakes of chlorpyrifos from food and urinary TCPy were significantly correlated in rank order (n=87, Spearman's r=0.30, p=0.0041) and linear (n=87, Pearson's r=0.22, p=0.0409) analyses. Correlation coefficients between estimated intake of chlorpyrifos from food and TCPy were significantly different from zero (n=87; Spearman's r=0.22, p=0.0393; Pearson's r=0.21, p=0.0479). Comparing mean measured chlorpyrifos intake from food (0.46 microg/day) to mean estimated TCPy excretion via urine (6.3 microg/day), dietary intake of chlorpyrifos accounted for approximately 7% of TCPy in this population. These findings suggest the food consumption-chemical residue model can yield reasonably accurate estimates of the population distribution of dietary chlorpyrifos intake, but has little ability to predict dietary exposure for individuals; and that intake of chlorpyrifos from food is a minor contributor to TCPy in urine.

Longitudinal investigation of dietary exposure to selected pesticides.

Between September 1995 and September 1996, 4-day composite duplicate plate samples (379 solid food samples and 303 beverage samples) were obtained from a stratified random sample of 75 individuals in Maryland and analyzed for the presence of 10 pesticides. Samples were collected in each of six approximately equally spaced cycles as part of a larger pilot investigation of longitudinal exposure to pesticides and other elements. Chlorpyrifos was detected in 38.3% of the solid food samples, malathion in 75.2%, and p,p'-DDE in 21.4%. Other pesticides were detected in less than 10% of the solid food samples. Pesticide residues were not detected in duplicate beverage samples. In solid food samples, the mean concentration of chlorpyrifos was 0.7 (SD 1.7) microg/kg, 1.8 (2.1) for malathion, and 0.2 (0.6) for p,p'-DDE. The detection rate and mean concentration of chlorpyrifos, malathion, and p,p'-DDE varied by a factor of 2-3 among sampling cycles and significantly according to results from several statistical analyses. Co-occurrence of chlorpyrifos and malathion in solid food samples was found relatively frequently and also varied with time. Pesticides were detected in food samples with greatest frequency in spring and summer months and with lowest frequency in winter months. These results support the hypothesis that 4-day average exposure to chlorpyrifos and malathion varies over time for this population mean and for individual members of the population and that correlation between exposures to these two organophosphate pesticides can occur. The measurements of pesticide levels in duplicate plate samples presented here can be used to evaluate and set parameters for dietary exposure models.

Longitudinal investigation of exposure to arsenic, cadmium, chromium and lead via beverage consumption.

Semi-quantitative food checklists and duplicate beverage samples were collected from up to 80 individuals in Maryland in 1995-1996 in as many as six approximately equally spaced sampling cycles as part of a pilot longitudinal exposure investigation. The duplicate beverage samples were homogenized and analyzed for arsenic (As), cadmium (Cd), chromium (Cr) and lead (Pb) using inductively coupled plasma mass spectrometry (ICP-MS). Metal concentrations (microg/kg) and weights of the duplicate beverage samples (kg/day) were used to derive average daily exposure (microg/day) for each metal. Mixed models and generalized linear models were used to evaluate temporal and population variability of the beverage consumption rates, the log-transformed metal concentrations in the beverage samples, and the associated exposures. The mean number of beverage servings consumed per day was 3.4 (SD 1.9). The temporal variability of the total beverage consumption rates was found to be significant (p = 0.0476). As, Cd, Cr, and Pb were present at quantifiable levels in 93.5, 76.0, 93.5, and 96.7% of the beverage samples, respectively. The mean concentration in the samples was 2.0 (SD 4.4) microg/kg for As, 0.9 (1.6) for Cd, 29.2 (138.5) for Cr, and 2.0 (2.4) for Pb. The mean log-transformed concentrations for As, Cr and Pb and exposure for As varied by as much as a factor of 3 across sampling cycles and were statistically significantly different (p<0.05). Concentrations and exposures of all four metals varied significantly among participants. These findings are discussed with respect to the data collection methods, results from comparable studies, and implications for exposure and risk assessment.