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  • Title: Drinking water nitrate and prevalence of methemoglobinemia among infants and children aged 1-7 years in Moroccan areas.
    Author: Sadeq M, Moe CL, Attarassi B, Cherkaoui I, Elaouad R, Idrissi L.
    Journal: Int J Hyg Environ Health; 2008 Oct; 211(5-6):546-54. PubMed ID: 18155958.
    Abstract:
    CONTEXT: Nitrate is ubiquitous in environmental media (air, water and soil) and other sources (some medicines, inorganic fertilizers and household's chemicals). It is a hemoglobin-oxidizing agent that can cause methemoglobinemia. The effect of nitrate on infants is well known but less is known about nitrate-induced methemoglobinemia in young children. METHOD: Two cross-sectional studies were carried out in Salé, Morocco to determine the prevalence of methemoglobinemia among 411 infants and children aged 1-7 years in two adjacent areas that were similar in terms of the air quality, available vegetables and medicines but different in terms of the drinking water quality (nitrate-contaminated well water versus municipal water). RESULTS: In the exposed area, nitrate concentration was measured in 78 wells and ranged from 15.39 to 246.90mg/l as NO3-. Nitrate levels were higher than 50mg/l in 69.2% of the surveyed wells, and 64.2% of the participants were drinking nitrate contaminated well waters. The prevalence of methemoglobinemia among study children was 36.2% in the exposed area, and 27.4% in the non-exposed area. Study children drinking well water with a nitrate concentration >50mg/l were significantly more likely to have methemoglobinemia than those drinking well water with a nitrate concentration <50mg/l (p=0.001 at 95% CI=[1.22-2.64]) or than those drinking municipal water (p<0.01 at 95% CI=[1.16-2.21]). In the exposed area, the mean methemoglobin (MetHb) level increased with age (R2= 0.79, p=0.04), whereas in the unexposed area, the mean MetHb level remained relatively stable in the first 6 years of life (R2=0.21, p=0.44). Mean MetHb was normal when the nitrate concentration in water was below 50mg/l as NO3-, and reached an abnormal level, when the nitrate concentration in water ranged between 50 and 90mg/l as NO3-. This last level was statistically similar to mean MetHb at nitrate level above 90mg/l as NO3- (up to 246.9mg/l as NO3-). No association was observed between methemoglobinemia prevalence and gender. This is the first study about methemoglobinemia conducted in Morocco.
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