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An increase in incidence and amplitude of extreme weather events (EWEs) linked to climate change, has resulted in greater human exposure and vulnerability to weather-related health effects. Increases in the occurrence of EWEs, including storms, flooding, extreme heat and wildfires, will impact health globally, with poor and vulnerable populations disproportionately affected. Vulnerability to EWEs, and the ability to adapt to these weather shocks, are influenced by existing physical, social and political limitations of a given region. As such, developing context-specific health vulnerability indices to inform planning and decision-making for policy makers and citizens alike, should be prioritized. The existence and development of health vulnerability indices in South Africa are limited, therefore, this study provides a foundation from which future indices can build. Mixed methods approaches including evidence and data analysis/synthesis and focus groups are used to understand the interconnections between extreme weather events and human health, including citizens’ understanding of emergent vulnerabilities linked to these events. The methods employed in this study include: • A rapid evidence review (RER) including data extraction identifying health impacts and indicators. • Development of a draft health vulnerability index (HVI) framework. • Focus groups and individual interviews testing the draft HVI for citizen input and framework refinement.

Dichlorodiphenyltrichloroethane (DDT) usage has been prohibited in developed nations since 1972 but is exempted for use in indoor residual spraying (IRS) in developing countries, including African countries, for malaria control. There have been no previous reviews on DDT residues in water resources in Africa. The study aimed to provide a review of available research investigating the levels of DDT residues in water sources in Africa and to assess the consequent human health risks. A scoping review of published studies in Africa was conducted through a systematic electronic search using PubMed, Web of Science, EBSCO HOST, and Scopus. A total of 24 articles were eligible and reviewed. Concentrations of DDT ranged from non-detectable levels to 81.2 μg/L. In 35% of the studies, DDT concentrations surpassed the World Health Organization (WHO) drinking water guideline of 1 μg/L in the sampled water sources. The highest DDT concentrations were found in South Africa (81.2 μg/L) and Egypt (5.62 μg/L). DDT residues were detected throughout the year in African water systems, but levels were found to be higher during the wet season. Moreover, water from taps, rivers, reservoirs, estuaries, wells, and boreholes containing DDT residues was used as drinking water. Seven studies conducted health risk assessments, with two studies identifying cancer risk values surpassing permissible thresholds in water sampled from sources designated for potable use. Non-carcinogenic health risks in the studies fell below a hazard quotient of 1. Consequently, discernible evidence of risks to human health surfaced, given that the concentration of DDT residues surpassed either the WHO drinking water guidelines or the permissible limits for cancer risk in sampled drinking sources within African water systems. Therefore, alternative methods for malaria vector control should be investigated and applied.

Objective: Children and adolescents living in agricultural areas are likely to be exposed to mixtures of pesticides during their daily activities, which may impair their neurodevelopment. We investigated various such activities in relation to headache severity and neurodevelopment of school-children living in rural agricultural areas in the Western Cape of South Africa. Method: We used baseline date from 1001 school-children of the Child Health Agricultural Pesticide Cohort Study in South Africa (CapSA) aged 9–16 from seven schools and three agriculture areas in the Western Cape. Questionnaires were administrated to assess activities related to pesticide exposure and health symptoms addressing four types of activities: 1) child farm activities related to pesticide handling, 2) eating crops directly from the field, 3) contact with surface water around the field, and 4) seen and smelt pesticide spraying activities. Neurocognitive performance across three domains of attention, memory and processing speed were assessed by means of an iPad-based cognitive assessment tool, Cambridge Automated NeuroPsychological Battery (CANTAB). Headache severity was enquired using a standard Headache Impact Test (HIT-6) tool. Cross-sectional regression analysis was performed. Results: About 50% of the cohort report to have ever been engaged in activities related to pesticide exposure including farm activities, eating crops directly from the field and leisure activities. Headache severity score was consistently increased in relation to pesticide-related farm activities (score increase of 1.99; 95% CI: 0.86, 3.12), eating crops (1.52; 0.41, 2.67) and leisure activities of playing, swimming or bathing in nearby water (1.25; 0.18, 2.33). For neurocognitive outcomes, an overall negative trend with pesticide exposure-related activities was observed. Among others, involvement in pesticide-related farm activities was associated with a lower multi-tasking accuracy score (−2.74; −5.19, −0.29), while lower strategy in spatial working memory (−0.29; −0.56; −0.03) and lower paired associated learning (−0.88; −1.60, −0.17) was observed for those who pick crops off the field compared to those who do not pick crops off the field. Eating fruits directly from the vineyard or orchard was associated with a lower motor screening speed (−0.06; −0.11, −0.01) and lower rapid visual processing accuracy score (−0.02; −0.03, 0.00). Conclusions: Children who indicate activities related to pesticide exposure may be at higher risk for developing headaches and lower cognitive performance in the domains of attention, memory and processing speed. However, self-reported data and cross-sectional design are a limitation. Future research in CapSA will consider pesticide exposure estimations via urinary biomarkers and longitudinal assessment of cognitive functions.

South Africa is the leading pesticide user in Sub-Saharan Africa. However, little is known about the occurrence of pesticide mixtures in surface water and potential environmental risks in Africa.This study investigated the occurrence of pesticides mixtures in three watersheds during a drought year in South Africa. The study was conducted in the Krom River, Berg River and Hex River watersheds within larger agriculture systems in the Western Cape. Pesticide spray records were collected from 38 farms. A total of 21 passive water samplers (styrenedivinylbenzene disks (SDB)) were deployed, each for two weeks per month, over seven sampling rounds during the main pesticide application period between July 2017 and January 2018. Samples were analyzed for 248 pesticide compounds using LC-HR-MS/MS. Pesticide occurrence was analyzed for temporal agreement with pesticide spraying events (Cohen’s κ) and correlation with rainfall patterns and river discharge (Pearson correlation (rp)). Pesticide time-weighted average concentrations were estimated and compared to environmental quality standards (EQS). According to the farm spray records, 96 different pesticides were sprayed during the sampling period and differed considerably between the three study areas, seasons and crops grown. In total, 53 compounds were detected in river water. We detected 39% of compounds from the spraying records and demonstrated close temporal correlations of seasonal patterns for 11 pesticide compounds between reported on spraying records and observations in the streams (κ = 0.90). However, 23 detected pesticides were not found on spray records, many of them being herbicides. Most of the estimated two-week average pesticide concentrations were below 40 ng/L. The insecticides imidacloprid, thiacloprid, chlorpyrifos and acetamiprid and the herbicide terbuthylazine exceeded at least once their EQS 58-fold (EQS 13 ng/L), 12-fold (EQS 10 ng/L), 9-fold (EQS 0.46 ng/L), 5-fold (EQS 24 ng/L) and 3-fold (EQS 220 ng/L), respectively. Our study substantially widens the view on pesticide pollution in surface water compared to previous studies in Sub-Saharan Africa by targeting more than 200 pesticides using passive sampling systems. This broad assessment revealed the presence of 53 compounds, some of them in high concentrations, indicating possible adverse effects on biota and the quality of the ecosystem. Whether the observed concentration levels in the year 2017 were exceptional due to the lowest ever recorded rainfall and river discharge needs to be tested with additional data to better understand how pesticide pollution levels manifest under average rainfall and river discharge conditions. Keywords: Climate change, Drought, Passive water sampling, Pesticide, Surface water, Sustainable development goal 6