Fabián Muñoz

Background: The Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture (SEMILLA) is a community-based birth cohort study carried out in the Cayambe, Pedro Moncayo region, Ecuador, with intensive industrial floricultural activity. Maternal occupational and environmental pesticide exposure was assessed among three groups of pregnant women stratified according to "maternal occupational activity" at the time of recruitment. This article describes the recruitment process and strategies used, determines their effectiveness in targeting pregnant women with different levels of exposure, and discusses reasons that influenced recruitment rates. Methods: The projected sample was stratified into three occupational activity groups: floricultural/agricultural workers, non-agricultural workers, and non-workers (women not working outside the home for pay). Recruitment strategies include community activities, collaboration with health care providers, information from obstetric records (“Obstetric Census”), and non-monetary recognition. Analyses were conducted by occupational activity at the time of recruitment. Recruitment rates were calculated by occupational group. Monitoring indicators included the number and percentage of participants recruited by strategy. Wilcoxon rank-sum test and Fisher's exact test were used to compare characteristics between eligible and participating pregnant women; the Kruskal–Wallis test was used to compare among participant groups. Results: A total of 409 participants were recruited, 74% of floricultural/agricultural workers, 81% of non-agricultural workers, and 64.5% of non-workers. The strategy that referred the highest number of participants was the “non-monetary recognition” (60.9%), proving its effectiveness for recruiting floricultural/agricultural and non-agricultural workers (74.5% and 67.7%, respectively). The “Obstetric Census” was the second most important strategy (30.6%), especially effective in recruiting non-workers (49.6%). Compared to floricultural/agricultural and non-agricultural workers, non-workers were younger ( p < 0.001) and had a significantly higher average number of prenatal check-ups ( p = 0.0006). Floricultural/agricultural workers had a significantly higher average number of pregnancies and living children than the other two groups ( p > 0.01). Time restrictions among women working outside the home for pay, and lack of autonomy among non-workers, were crucial factors that limited participation in the study. Conclusions: Stratifying recruitment by comparability groups requires differentiated strategies. Understanding living conditions and the social context of the study region are critical to effectively targeting recruitment efforts.

Background: Ethylenebisdithiocarbamates, widely used in floriculture, degrade into ethylenethiourea (ETU), a teratogen. The SEMILLA study investigates prenatal ETU exposure and infant health in Ecuador’s flower-growing region. This analysis examines whether prenatal ETU metabolite levels differ by work sector and whether maternal urinary ETU increases with longer work hours. Methods: Participants (agricultural workers, non-agricultural workers, and non-workers) provided baseline urine samples, which were processed and stored for ETU analysis. Surveys captured ETU exposure predictors. Regression models assessed associations between work sector, weekly work hours, and urinary ETU levels (specific gravity-corrected), controlling for key covariates. Results: The sample includes 111 agricultural workers (92% floriculture), 149 non-agricultural workers, and 149 non-workers. At baseline, maternal age averaged 27 years (SD = 5.8) and gestational age 15 weeks (SD = 3.2). Urinary ETU_SG levels were elevated across the sample (geometric mean: 3.38 µg/L). Agricultural workers had significantly higher ETU_SG levels than others (5.61 vs. 3.07 and 2.57 µg/L; p < 0.001). Among agricultural workers, ETU_SG levels increased with weekly hours (B = 0.288, p = 0.001). Conclusions: Agricultural work strongly predicts higher prenatal ETU exposure, with evidence of a dose–response relationship. Research on prenatal fungicide exposure and infant health among pregnant workers is limited. Findings highlight the need for targeted interventions to protect pregnant workers and infant health.

Background/Objectives: Women of childbearing age not only reside in agricultural communities but also form an integral part of the agricultural labor force. Limited research investigates the impact of prenatal fungicide exposure on infant health, specifically ethylenebisdithiocarbamates and their toxic by-product, ethylenethiourea (ETU), particularly in occupational settings. This paper describes the background, aims, protocol, and baseline sample characteristics for the SEMILLA study, which investigates prenatal ETU exposure, neonatal thyroid function, infant growth, and neurobehavioral development in an agricultural region of Ecuador. Methods: This cohort study follows pregnant women and their infants up to 18 months of age, incorporating urinary biomarkers and survey data on ETU exposure and infant growth and neurodevelopmental measures. Data collection includes detailed questionnaires, scales, and physical examinations on maternal and infant health and development, as well as environmental factors. Descriptive statistics on key characteristics of the study population at baseline are presented. Results: SEMILLA enrolled 409 participants (72% enrollment rate): 111 agricultural workers (mostly floricultural), 149 non-agricultural workers, and 149 non-workers. Baseline characteristics show comparability between work sector groups, with some economic differences. Conclusions: SEMILLA will provide key evidence on prenatal fungicide exposure and infant development and encompass comprehensive multistage data collection procedures in pregnancy and infancy, focusing on structural and social determinants of health as well as individual-level chemical exposures. The community-based approach has proven essential, even amid challenges like the COVID-19 pandemic. The medium-term objective is to inform sustainable interventions promoting maternal and child health, with a long-term goal to reduce community exposures and improve worker health policies, particularly for women and pregnant workers.

Modern food systems generate social inequalities in the access to healthy food, but some families maintain behaviors that provide an alternative to these systems. Agroecological consumers (ACs) and non-agroecological direct market consumers (DMCs) are key actors in alternative food systems. We assessed the characteristics of ACs and DMCs using data from a representative sample of households in Ibarra, Quito and Riobamba (n = 2914). We also deepened the exploration of motivations for adopting these practices through mini-ethnographies with families who were identified as ACs or DMCs (n = 15). We found motivations related to personal health problems, food quality (e.g., taste, freshness), and safety (e.g., avoiding pesticides) to be key. Other motivations were price and community solidarity with farmers. Barriers included inconvenience, lack of awareness, and insecurity of market location. Using Chi-square tests, we found differences between ACs and DMCs on place of residence, education, employment, health, and diet. Controlling for socioeconomic and health variables using logistic regressions, we found DMC dietary habits to be similar to the remainder of the study population, except that they were less likely to eat processed foods less frequently (adjusted odds ratio (AOR) 0.6, 95% confidence interval 0.4–0.9). In contrast, ACs were more likely than the remainder of the study population to control their salt intake (3.2, 1.9–5.2) and have greater knowledge of nutrition labels (2.8, 1.7–4.6). They were more likely to eat traditional foods frequently (1.9, 1.1–3.3), fruit and vegetables daily (1.6, 1.0–2.8), and processed foods less frequently (2.7, 1.5–4.8). Hence, these two types of alternative food provisioning practices (AC and DMC) were adopted by different types of consumers, with heterogenous motivations and food consumption practices. These findings have implications for public health initiatives aiming to scale up the nutrition and ecological potential of alternative food systems.

Some rural areas of Ecuador, including the Imbabura Province of the Andes Highlands, are experiencing a double burden of malnutrition where micronutrient deficiencies persist at the same time obesity is increasing as many traditional home-grown foods are being replaced with more commercially prepared convenience foods. Thus, the relationships among agricultural food production diversity (FPD), dietary diversity (DD), and household food insecurity (HFI) of the rural small holder farmers need further study. Therefore, we examined these associations in small holder farmers residing in this Province in the Andes Highlands (elevation > 2500 m). Non-pregnant maternal home managers (n = 558, x age = 44.1, SD = 16.5 y) were interviewed regarding the number of different agricultural food crops cultivated and domestic animals raised in their family farm plots. DD was determined using the Minimum Dietary Diversity for Women Score (MDD-W) based on the number of 10 different food groups consumed, and household food insecurity (HFI) was determined using the 8-item Household Food Insecurity Experience Scale. The women reported consuming an average of 53% of their total food from what they cultivated or raised. Women with higher DD [MMD-W score ≥ 5 food groups (79% of total sample)] were on farms that cultivated a greater variety of crops (x = 8.7 vs. 6.7), raised more animals (x = 17.9 vs. 12.7, p < 0.05), and reported lower HFI and significantly higher intakes of energy, protein, iron, zinc, and vitamin A (all p < 0.05). Multiple regression analyses demonstrated that FPD was only modestly related to DD, which together with years of education, per capita family income, and HFI accounted for 26% of DD variance. In rural areas of the Imbabura Province, small holder farmers still rely heavily on consumption of self-cultivated foods, but greater diversity of crops grown in family farm plots is only weakly associated with greater DD and lower HFI among the female caretakers.