An assessment of health outcomes and methylmercury exposure in munduruku indigenous women of childbearing age and their children under 2 years old

This research was funded by the Vice-Presidency of Environment, Care and Health Promotion (VPPAS) of Fundação Oswaldo Cruz through (Fiocruz) Decentralized Execution of Resources Document No. 175/2018, Process: 25000.209221/2018-18, signed between the Fiocruz and the Special Department for Indigenous Health, both under the Ministry of Health. The non-governmental organization WWF-Brazil offered financial support to disseminate the results of the research.Imperial College. Faculty of Medicine. St Mary’s Hospital. London, UK.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Endemias Samuel Pessoa. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto de Pediatria e Puericultura Martagão Gesteira. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Laboratório de Educação Profissional em Vigilância em Saúde. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Centro de Referência Professor Hélio Fraga. Rio de Janeiro, RJ, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto de Pediatria e Puericultura Martagão Gesteira. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto de Pediatria e Puericultura Martagão Gesteira. Rio de Janeiro, RJ, Brazil.In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12–49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus effort

Mercury exposure in Munduruku indigenous communities from Brazilian Amazon: methodological background and an overview of the principal results

This research was funded by the Vice-Presidency of Environment, Care and Health Promotion (VPPAS) of Fundação Oswaldo Cruz (Fiocruz) through Decentralized Execution of Resources Document No. 175/2018, Process: 25000.209221/2018-18, signed between the Fiocruz and the Special Department for Indigenous Health, both under the Ministry of Health. The non-governmental organization WWF-Brazil offered financial support to disseminate the results of the research.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Endemias Samuel Pessoa. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Centro de Referência Professor Hélio Fraga. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Laboratório de Educação Profissional em Vigilância em Saúde. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Endemias Samuel Pessoa. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto de Pediatria e Puericultura Martagão Gesteira. Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brazil.Imperial College London. Faculty of Medicine. Medical School Building. St Mary’s Hospital. Norfolk Place, London, UK.Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Centro de Dor, Departamento de Neurologia. São Paulo, SP, Brazil.Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Centro de Dor, Departamento de Neurologia. São Paulo, SP, Brazil.Universidade de São Paulo. Instituto de Psicologia. Programa de Pós-Graduação em Psicologia Clínica. São Paulo, SP, Brazil.Centro Universitário Estadual da Zona Oeste. Laboratório de Pesquisa de Ciências Farmacêuticas. Rio de Janeiro, RJ, Brazil.Universidade Federal do Oeste do Pará - Unidade Tapajós. Programa de Pós-Graduação em Ciências da Saúde. Santarém, PA, Brazil.Universidade Federal do Oeste do Pará. Programa de Pós-Graduação em Biociências. Santarém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Secretaria Especial de Saúde Indígena Tapajós. Distrito Sanitário Especial Indígena Rio Tapajós. Itaituba, PA, Brazil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Endemias Samuel Pessoa. Rio de Janeiro, RJ, Brazil.The Amazonian indigenous peoples depend on natural resources to live, but human activities’ growing impacts threaten their health and livelihoods. Our objectives were to present the principal results of an integrated and multidisciplinary analysis of the health parameters and assess the mercury (Hg) exposure levels in indigenous populations in the Brazilian Amazon. We carried out a cross-sectional study based on a census of three Munduruku indigenous villages (Sawré Muybu, Poxo Muybu, and Sawré Aboy), located in the Sawré Muybu Indigenous Land, between 29 October and 9 November 2019. The investigation included: (i) sociodemographic characterization of the participants; (ii) health assessment; (iii) genetic polymorphism analysis; (iv) hair mercury determination; and (v) fish mercury determination. We used the logistic regression model with conditional Prevalence Ratio (PR), with the respective 95% confidence intervals (CI95%) to explore factors associated with mercury exposure levels ≥6.0 µg/g. A total of 200 participants were interviewed. Mercury levels (197 hair samples) ranged from 1.4 to 23.9 μg/g, with significant differences between the villages (Kruskal–Wallis test: 19.9; p-value < 0.001). On average, the general prevalence of Hg exposure ≥ 6.0 µg/g was 57.9%. For participants ≥12 years old, the Hg exposure ≥6.0 µg/g showed associated with no regular income (PR: 1.3; CI95%: 1.0–1.8), high blood pressure (PR: 1.6; CI95%: 1.3–2.1) and was more prominent in Sawré Aboy village (PR: 1.8; CI95%: 1.3–2.3). For women of childbearing age, the Hg exposure ≥6.0 µg/g was associated with high blood pressure (PR: 1.9; CI95%: 1.2–2.3), with pregnancy (PR: 1.5; CI95%: 1.0–2.1) and was more prominent among residents in Poxo Muybu (PR: 1.9; CI95%: 1.0–3.4) and Sawré Aboy (PR: 2.5; CI95%: 1.4–4.4) villages. Our findings suggest that chronic mercury exposure causes harmful effects to the studied indigenous communities, especially considering vulnerable groups of the population, such as women of childbearing age. Lastly, we propose to stop the illegal mining in these areas and develop a risk management plan that aims to ensure the health, livelihoods, and human rights of the indigenous people from Amazon Basin