Concentration and public health risk of DDT metabolites in different food items in Africa:Systematic review and metal analysis

Concentration and public health risk of DDT metabolites in different food items in Africa:Systematic review and metal analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Concentration and public health risk of DDT metabolites in different food items in Africa:Systematic review and metal analysis Dechasa Adare, Abraham Geremew, Roba Argaw, Tara Wolfing This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4187675/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract DDT is banned in many countries due to its persistency and negative impact on humans and the environment. However, it is continued to be used in many low-income countries, notably those in Africa, therefore exposing people in the region to various health threats. The current paper attempts to provide evidence regarding the concentration of DDT metabolites (pp DDT, pp DDD, and pp DDE) in a variety of food items in Africa. The preferred reporting item for systematic reviews and meta-analysis protocols was used to conduct this work. SCOPUS, PubMed, Web of Science, and other databases were used to retrieve articles using key words, Boolean logic operators, and MeSH terms. A total of 2002 studies were retrieved, of which 18 articles were included in the final analysis. The mean residue of pp DDT in vegetables, fruit, meat, fish, milk, cereals and khat was 0.195, 0.174, 0.028, 0.165, 0.056 and 0.043 mg/kg, respectively. The mean residue of pp DDD in vegetables, fruit, meat and fish, milk, and khat was 0.198, 0.011, 0.224, 0.068, and 0.021 mg/kg, respectively. The mean pp DDE residue in cereals, meat and fish, milk, vegetables, fruit, and khat was 0.57, 0.1259, 0.089, 0.1184, 0.029, and 0.0385 mg/kg, respectively. The metabolites in most food categories were higher than the recommended level, therefore posing major health risks to the public. Designing appropriate and effective pesticide management and safety measures, including tighter governmental regulation, is essential in the region. Africa DDT Pesticides Metabolites risk Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction In 2020, 2.7 million tons of insecticides were used worldwide, a 30% increase from 2000 to 2020 (FAO. 2022). Organochlorines (OCP) pesticides are a synthetic group of chlorinated hydrocarbon derivatives used worldwide in agriculture and chemical industries. However, some specific pesticides in this group (DDT) have been banned in industrialized countries due to their known toxicity, slow degradation, and environmental persistence. In the last ten years, pesticide use has increased by 20% in developing countries, particularly Africa (Jepson et al. 2020 ; FAO. 2022). Occupational exposure and accidental or deliberate poisoning due to the widespread use of pesticides have resulted in health issues and fatalities(WHO 2019 ). The health effects associated with pesticides include cancer, reproductive harm, immunosuppression, and endocrine disruption (WHO 2019 ), as well as acute neurological damage (Buah-Kwofie et al. 2018 ; Gerber et al. 2021 ). A global review from 2006 to 2015 revealed that pesticides accounted for approximately 14 to 20% of global suicides and about 110,000 to 168,000 fatalities annually from 2010–2014 (Mew et al. 2017 ). DDT and its metabolites are potentially hazardous to health and the environment due to their ability to have delayed effects at low concentrations (Tadevosyan et al. 2021 ) and have been classified as endocrine-disrupting chemicals (Frye et al. 2012 ; Bergman et al. 2013 ), as well as affecting the immune system, reproductive and endocrine function, and increase susceptibility to various diseases (Freire et al. 2014 ; Wahlang 2018 ). DDT is persistent in living and non-living environments, and its residue can be detected in almost every human body (Vall et al. 2018 ). Human exposure to DDT is in utero, during breastfeeding, and through the consumption of contaminated food (Jusko et al. 2012 ). Because of these characteristics, DDT was banned by the Stockholm Convention on Persistent Organic Pollutants in May 2001 by the majority of countries worldwide (Jusko et al. 2012 ). Nonetheless, it is still widely used in developing countries, including Africa, where there is inadequate knowledge and poor government regulation; all issues need immediate attention(Afata et al. 2022 ; Berni et al. 2021 ), as they can ultimately lead to serious consequences (Alebachew et al. 2023 ; Olisah et al. 2020 ; Berni et al. 2021 ; Sheahan et al. 2017 ). Prior systematic reviews and meta-analysis across the globe revealed the health risks of pesticide use (Stanganelli et al. 2020 ; Chiu et al. 2019 ; Karalexi et al. 2021 ; Evangelou et al. 2016 ; Kermani et al. 2021 ). However, evidence on the pooled mean concentration of DDT and its metabolites in various food items in Africa is lacking. Therefore, the current systematic review and meta-analysis aimed to provide the concentration of DDT metabolites ( pp DDT, pp DDD, and pp DDE) in various food items and the health risk implications in the African region. The findings can be used to develop intervention strategies for properly handling and controlling pesticides to reduce the health risks posed to human, animal, and environmental health. Materials and Methods Eligibility Criteria Inclusion Criteria Population In this study, the authors included DDT metabolites in various food items, including vegetables and fruits, fish and meat, khat, milk, and cereals. There was no limitation to the types of food items. Outcome The studies that reported pesticide residue or concentration of DDT metabolites, particularly pp DDT, pp DDE, and pp DDD were included in this report. Types of articles Full text and published articles written in English were included. Publication year Articles published between January 2010 - January 2024 were considered. Regions Studies conducted in the African Regions (North, West, East, Central, and Southern Africa) were included in the current study. Exclusion Criteria Editorial papers, short communication, review articles, report, preprint, and articles with a high risk of bias and those not written in English were excluded from the current study. 2.1 Information Sources and Search Strategy The articles were retrieved from SCOPUS/Science Direct, PubMed/MEDLINE, Web of Science, Google Scholar, DOAJ, National Repository and MedNar, from October 1, 2023, to January 20, 2024. A combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH) and main keywords were used to retrieve the articles from the included electronic databases. References within eligible studies were further screened for additional articles. The initial search for PubMed articles is provided as a supplementary file (supplementary file I). Study Selection Process The study selection process was performed using the PRISMA flow chart, indicating the number of articles included and excluded from the study, depicting the major reasons for exclusion. Duplicate articles were removed using the ENDNOTE software version X5 (Thomson Reuters, USA). The authors (DAM, AG, and RAT) independently screened the articles according to their titles and abstracts to determine their eligibility. Next, each author (DAM, AG, and RAT) independently evaluated the full text of all included articles. Disagreements with respect to the inclusion and exclusion of articles were resolved by consensus. Finally, the studies that met the inclusion criteria were included in the study. Data Extraction Process All authors (DAM, AG, RAT, and TW) independently extracted the relevant data required from eligible articles. To extract the data, a predetermined Microsoft Excel format (developed by the authors) was used. The extracted data included the following: survey and publication year, the region where the study was conducted, sample size, primary outcomes, residue or concentration of DDT metabolites ( pp DDT, pp DDE and pp DDD) in different food items, and the African region. Any disagreement with respect to data extraction was resolved through discussion. Quality Assessment The included articles were subjected to quality evaluation by the authors (DAM, AG, RAT, and TW) using the Joanna Briggs Institute Critical Assessment Tool (JBI) for the prevalence studies (JBI 2019 ). The authors (DAM, AG, and RAT) evaluated the articles to determine their eligibility. JBI critical appraisal tools have nine evaluation criteria (supplementary file II). Each parameter was assigned a one if 'Yes' and 0 if 'No'. Based on the total score, each article was classified as low risk of bias (85% and above), moderate (60–85% score), or high risk of bias (60% and blow score). Finally, articles with moderate and low risk of bias were included in the study. Disagreements between the authors (DAM, AG, and RAT) regarding quality assessment were resolved by discussion after repeating the same procedures. Statistical Procedures and Data Analysis The pooled mean concentration or residue of DDT metabolites ( pp DDT, pp DDE, and pp DDD) among various food items was determined using the Comprehensive Meta-Analysis version 3.0 statistical software. The results were also visualized using a forest plot and a random-effects model. The I-squared test (I 2 statistics) was used to evaluate the heterogeneity between articles. The level of heterogeneity was classified as without heterogeneity (0.0%-25%), low heterogeneity (25–50%), moderate heterogeneity (50–75%), and high heterogeneity (> 75%) (Ades). A random-effects model was used to analyze and report the data. Subgroup analysis was performed based on food items/categories and publication year. A sensitivity analysis was performed to determine differences in pooled effects by dropping studies that were found to influence the summary estimates. Results Study Selection A total of 2002 studies were retrieved from the databases and manual searches through Google. After retrieval, 562 duplicate articles were excluded. Furthermore, 169 non-eligible studies were excluded, and 732 were excluded due to their title and abstract. Next, 495 were omitted during the full-text screening, and 26 articles were excluded due to a high risk of bias. Finally, 18 articles were included in the final analysis (Fig. 1). Figure 1: Study selection process of included articles for systematic review and meta-analysis, 2024. General characteristics of the included articles. This study included 18 articles from various African regions that met the eligibility criteria. The included articles addressed the concentration of dichlorodiphenyltrichloroethane (DDT) metabolites ( pp DDT, pp DDD, and pp DDE) in various types of food items and khat consumed in the African region. Among the studies included in the analysis, 8 (44.4%), 5 (27.8%), 1 (5.5%), 1 (5.5%), 1 (5.5%), 1 (5.5%), 2 (11.1%) of them were conducted in Ethiopia (Terfe et al. 2023 ; Mekonnen et al. 2021 ; Mitiku and Mitiku 2022 ; Regassa et al. 2020 ; Gebremichael et al. 2013 ; Deti et al. 2014 ; Yohannes et al. 2014 ; Mekonen et al. 2017 ), Nigeria (Odewale et al. 2021 ; Olutona and Aderemi 2019 ; Sosan et al. 2015 ; Tongo and Ezemonye 2015 ; Unyimadu et al. 2018 ), DRC (Nuapia et al. 2016 ), South Africa (Nuapia et al. 2016 ), Togo (Kolani et al. 2016 ), Benin (Agnandji et al. 2018 ) and Ghana (Okoffo et al. 2016 ; Bempah et al. 2016 ), respectively. Among the studies that met the eligibility criteria, 9 (50.0%), 5 (27.78%), 2 (11.1%), 2 (11.1%), 2 (11.1%), and 1 (5.5%) reported the concentration of DDT metabolites in vegetables (Nuapia et al. 2016 ; Kolani et al. 2016 ; Okoffo et al. 2016 ; Bempah et al. 2016 ; Odewale et al. 2021 ; Agnandji et al. 2018 ; Olutona and Aderemi 2019 ; Terfe et al. 2023 ; Regassa et al. 2020 ), meat and fish (Nuapia et al. 2016 ; Tongo and Ezemonye 2015 ; Mitiku and Mitiku 2022 ; Unyimadu et al. 2018 ; Yohannes et al. 2014 ), fruit samples (Bempah et al. 2016 ; Odewale et al. 2021 ), milk (Deti et al. 2014 ; Gebremichael et al. 2013 ), khat (Mekonen et al. 2017 ) and cereals (Mekonnen et al. 2021 ), respectively (Table 1 ). Table 1 General characteristics of the studies included in the systematic review and meta-analysis, 2024 Food category Types of food items Sample size Publication year Types of pesticides and its concentration in mg/kg Country Reference pp DDT ± SD pp DDD ± SD pp DDE ± SD Total DDT Vegetable Bean 20 2016 0.0967 ± 0.00234 0.0495 ± 0.00351 0.0566 ± 0.0089 0.2028 ± 0.01475 DRC (Nuapia et al. 2016 ) Bean 20 2016 0.1097 ± 0.00692 0.0758 ± 0.00374 0.0997 ± 0.00741 0.2852 ± 0.0180 South Africa (Nuapia et al. 2016 ) Bean 32 2016 0.04 ± 0 0.03 ± 0.01 0.02 ± 0 0.09 ± 0.01 Ghana (Okoffo et al. 2016 ) Cabbage 4 2020 0.01 ± 0 0.01 ± 0 0.004 ± 0 0.024 ± 0 Ethiopia (Regassa et al. 2020 ) Cabbage 20 2016 0.1069 ± 0.0029 0.0611 ± 0.0021 0.0811 ± 7.23 0.2491 ± 0.2350 DRC (Nuapia et al. 2016 ) Cabbage 20 2016 0.1259 ± 0.0059 0.0957 ± 0.0021 0.1067 ± 0.0056 0.3283 ± 0.0136 South Africa (Nuapia et al. 2016 ) Cabbage 50 2016 0.016 ± 0.012 0.023 ± 0.015 0.014 ± 0.008 0.053 ± 0.035 Ghana (Bempah et al. 2016 ) Cabbage 55 2016 0.190 ± 0.000 -- 0.215 ± 0.021 0.405 ± 0.021 Togo (Kolani et al. 2016 ) Tomato 50 2016 0.027 ± 0.013 0.029 ± 0.017 0.022 ± 0.018 0.078 ± 0.048 Ghana (Bempah et al. 2016 ) Tomato 12 2021 1.24 ± 0.53 0.68 ± 0.52 0.08 ± 0.05 2 ± 0.58 Nigeria (Odewale et al. 2021 ) Tomato 55 2016 0.165 ± 0.021 -- 0.080 ± 0.010 0.245 ± 0.031 Togo (Kolani et al. 2016 ) Carrot 12 2021 0.75 ± 0.20 0.82 ± 0.26 0.38 ± 0.17 1.95 ± 0.63 Nigeria (Odewale et al. 2021 ) Lettuce 50 2016 0.032 ± 0.015 0.028 ± 0.012 0.031 ± 0.027 0.091 ± 0.054 Ghana (Bempah et al. 2016 ) Lettuce 40 2016 0.232 ± 0.1 -- 0.081 ± 0.047 0.313 ± 0.147 Togo (Kolani et al. 2016 ) Cowpea 6 2019 0.957 ± 0.353 0.81 ± 0.043 0.57 ± 0.1067 2.337 ± 0.5027 Nigeria (Olutona and Aderemi 2019 ) Bean 6 2019 0.24 ± 0.0633 0.33 ± 0 0.22 ± 0.0.047 0.79 ± 0.0633 Nigeria (Olutona and Aderemi 2019 ) Yam chips 10 2015 0.042 ± 0.014 0.086 ± 0.026 0.054 ± 0.012 0.182 ± 0.04 Nigeria (Sosan et al. 2015 ) Onion 12 2023 0.6085 ± 0.00011 0.0955 ± 0.001 0.1498 ± 0.0007 0.00213 Ethiopia (Terfe et al. 2023 ) Cowpea 10 2015 0.053 + 0.012 0.159 + 0.024 0.073 + 0.014 0.285 ± 0.05 Nigeria (Sosan et al. 2015 ) Fruit Mango 40 2016 0.020 ± 0.002 0.010 ± 0.004 0.011 ± 0.010 0.041 ± 0.016 Ghana (Bempah et al. 2016 ) Cucumber 12 2021 0.14 ± 0.06 0.41 ± 0.16 0.20 ± 0.08 0.75 ± 0.3 Nigeria (Odewale et al. 2021 ) Pineapple 40 2016 0.011 ± 0.007 0.009 _ 0.003 0.006 ± 0.002 0.026 ± 0.012 Ghana (Bempah et al. 2016 ) Apple 50 2016 LOD LOD LOD Ghana (Bempah et al. 2016 ) Green pepper 60 2016 0.024 ± 0.012 0.010 ± 0.005 0.011 ± 0.010 0.045 ± 0.027 Ghana (Bempah et al. 2016 ) Watermelon 12 2021 0.68 ± 0.30 1.85 ± 0.91 0.20 ± 0.07 2.73 ± 0.98 Nigeria (Odewale et al. 2021 ) Milk Cow milk 30 2013 0.165 ± 0.0027 0.0683 ± 0.00233 0.156 ± 0.00167 0.3893 ± 0.0067 Ethiopia (Gebremichael et al. 2013 ) Cow and goat milk 30 2014 0.155 ± 0 -- 0.02164 ± 0 0.17664 ± 0 Ethiopia (Deti et al. 2014 ) Cereals Corn 30 2021 0.046 ± 0.023 -- 0.045 ± 0.0217 0.091 ± 0.0447 Ethiopia (Mekonnen et al. 2021 ) Rice 30 2021 0.047 ± 0.098 -- 0.05 ± 0.021 0.097 ± 0.021 Ethiopia (Mekonnen et al. 2021 ) Sorghum 30 2021 0.0513 ± 0.0133 -- 0.0587 ± 0.009 0.11 ± 0.0223 Ethiopia (Mekonnen et al. 2021 ) Common millet 30 2021 0.078 ± 0.037 -- 0.0727 ± 0.0117 0.1507 ± 0.0487 Ethiopia (Mekonnen et al. 2021 ) Meat and fish Meat 20 2016 0.14512 ± 0.00671 0.09765 ± 0.0017 0.1542 ± 0.00434 0.39697 ± 0.00841 DRC (Nuapia et al. 2016 ) Fish 20 2016 0.06372 ± 0.00782 0.07352 ± 0.0057 0.0901 ± 0.00382 0.22734 ± 0.01734 DRC (Nuapia et al. 2016 ) Fish 137 2022 0.00158 ± 0.0003 0.00565 ± 0.003 0.06401 ± 0.0091 0.07124 ± 0.0124 Ethiopia (Mitiku and Mitiku 2022 ) Fish 100 2014 0.568 ± 0 0.655 ± 0 3.138 ± 0 4.361 ± 0 Ethiopia (Yohannes et al. 2014 ) Fish 60 2018 0.1352 ± 0.12 0.521 ± 0.385 0.0671 ± 0.0613 0.7233 ± 0.5663 Nigeria (Unyimadu et al. 2018 ) Meat 20 2016 0.1679 ± 0.0015 0.1136 ± 0.0029 0.2536 ± 0.0048 0.5351 ± 0.0092 South Africa (Nuapia et al. 2016 ) Fish 20 2016 0.1346 ± 0.0052 0.106 ± 0.0042 0.1258 ± 0.0072 0.3664 ± 0.0166 South Africa (Nuapia et al. 2016 ) Khat Khat 4 2020 0.07 ± 0 0.03 ± 0 0.01 ± 0 0.11 ± 0 Ethiopia (Regassa et al. 2020 ) Khat 58 2017 0.0159 ± 0 0.0122 ± 0 0.0669 ± 0 0.095 ± 0 Ethiopia (Mekonen et al. 2017 ) Keys : DRC: Democratic Republic of the Congo, SD: Standard deviation, pp DDT: p,p' dichlorodiphenyltrichloroethane, pp DDD: p,p'-Dichlorodiphenyl dichloroethane, pp DDE: Dichlorodiphenyldichloroethylene Pesticide residues in different food items Concentration of pp DDT residue in different food items The overall mean residue of pp DDT ± SD, regardless of the types of food items, accounted for 0.188 mg/kg ± 0.047 with a 95% CI of 9.7 to 28.0% and p -value < 0.001 (Fig. 2). Figure 2: Overall mean concentration of pp DDT residue, regardless of the types of food items, in Africa Based on the subgroup analysis of pp DDT according to the types of food or food category, the mean concentration of pp DDT (mg/kg ) in vegetables, fruit, meat and fish, milk, cereals, and khat accounted for 0.195 ± 0.025, 0.028 ± 0.005, 0.174 ± 0.151, 0.165 ± 0, 0.056 ± 0.006 and 0.043 ± 0.027 mg/kg, respectively (Table 3). Figure 3: Mean concentration of pp DDT residue based on types of food items in Africa Concentration of pp DDD residue in different food items Regardless of the types of food and the countries in which the studies were conducted, the concentration of pp DDD residue in the various food items was 0.22 ± 0.076 mg/kg [95% CI 7.2, 36.8%], p- value < 0.004 (Fig. 4). Figure 4: Overall mean concentration of pp DDD residue, regardless of the types of food items in Africa The subgroup analysis based on the types of food shows that the concentration of pp DDD (mg/kg) was 0.011 ± 0.0026, 0.021 ± 0.0089, 0.2246 ± 0.163, 0.0683 ± 0.0004, and 0.1981 ± 0.0573 in fruit, khat, meat and fish, milk, and vegetable, respectively (Fig. 5). Figure 5: Pooled mean concentration of pp DDD residue based on types of foods in Africa Concentration of pp DDE residue in different food items Regardless of the types of food and countries where the studies were conducted, the concentration of pp DDE residue in different food items was 0.0878 ± 0.0051 mg/Kg [95% CI 7.78, 9.78%], p -value < 0.0001 (Fig. 6). Figure 6: Overall mean concentration of pp DDE residue, regardless of the types of food items in Africa. Based on the types of food, the pp DDE residue was 0.57 ± 0.0056, 0.029 ± 0.0054, 0.0385 ± 0.0285, 0.1259 ± 0.0307, 0.089 ± 0.067 and 0.1184 ± 0.0233 mg/kg in cereals, fruit, khat, meat and fish, milk, and vegetable, respectively (Fig. 7). Figure 7: Mean concentration of pp DDE residue based on the types of food in Africa Discussion In the current study, 2002 studies were retrieved from different electronic databases to determine the concentration of DDT metabolites ( pp DDT, pp DDD, and pp DDE) in various food items in the African regions. The residue of the metabolites was detected in various food items. The review revealed that the residue of pp DDT in milk was 0.16 mg/kg, which is higher than the FAO/WHO MRL of 0.02 mg/kg ( FAO/WHO 2024 ) and also higher than the EU MRL (0.04mg/kg) set for food items ( EU 2023 ) . Similarly, the pp DDT residue in cereals was 0.056 mg/kg, higher than the EU MRL set for cereals (0.05mg/kg) ( EU 2023 ) . This suggests that consumers have a high risk of exposure through consuming food contaminated with pp DDT. The residue of pp DDT in meat (0.028 mg/kg) and khat (0.043 mg/kg) was relatively lower than the MRL indicated by FAO/WHO (1-5mg/kg for meat and 0.5mg/kg for leaves and herbs) ( FAO/WHO 2024 ) . However, the concentration of pp DDT might be underrepresented since only a few studies provided the data on these food categories. The concentration of other DDT metabolites, the pp DDD residue in milk and vegetables accounted for 0.0683 mg/kg and 0.198 mg/kg, respectively, which is higher than the maximum recommended level by FAO/WHO (0.02 mg/kg for milk) ( FAO/WHO 2024 ) and EU (0.04 mg/kg for milk and 0.05mg/kg for vegetable) ( EU 2023 ) . Since these foods are among Africa’s most commonly consumed foods, there is a high risk of exposure to the pp DDD residue. The overall mean concentration of pp DDE residue of in cereals, which accounted for 0.57 ± 0.0056 mg/kg, is higher than the FAO/WHO (0.1mg/kg) ( FAO/WHO 2024 ) and EU MRL 0.05mg/kg) ( EU 2023 ) . Moreover, the overall pp DDE residue in milk (0.089 ± 0.067 mg/kg) and vegetables (0.1184 ± 0.0233 mg/kg) is higher than the MRL of both FAO/WHO (0.02 mg/kg for milk) ( FAO/WHO 2024 ) and EU (0.04 mg/kg for milk and 0.05 for vegetable) ( EU 2023 ) . However, the residue of pp DDE in fruit (0.029mg/kg) and khat (0.0385 mg/kg) is lower than the MRL of 0.05 for fruit and 0.5mg/kg for khat ( EU 2023 ) . The current study revealed that in most food categories, the residues of DDT metabolites, pp DDT, pp DDD, or pp DDE, are higher than the maximum residue limits set by FAO and WHO ( FAO/WHO 2024 ) and the EU ( EU 2023 ) . This indicates that the populations in the region are at serious health risks associated with these chemicals. Therefore, developing effective intervention program strategies, including increasing awareness of the health risks, food safety, and appropriate uses of DDT for different purposes is fundamental. Strength and Limitations This study used multiple electronic databases with their applicable search strategies. Moreover, the quality of the articles was evaluated using standard tools for quality assessment. Additionally, this work was done based on the PRISMA guidelines or protocols. However, there was an unequal distribution of articles across African countries because a limited number of studies met eligible criteria. The DDT residue in different foods in many countries in the Region was not included due to the limited number of studies that meet the eligibility criteria. Furthermore, due to a limited number of studies, systematic reviews, and meta-analyses conducted on DDT residues in Africa and other regions, we cannot adequately compare the current study’s findings with the findings of other studies. However, we have compared the pooled mean residue of DDT in different food types with a recommended maximum limit of FAO, WHO, and the European Union to determine the health risk. Conclusions In general, vegetables, cereals, and milk had a residue of one DDT metabolite higher than the maximum recommended limit indicated by FAO, WHO ( FAO/WHO 2024 ) and EU ( EU 2023 ). The current study indicates the need for more effective pesticide management programs and government regulation, particularly in Africa. Pesticides, such as DDT, that have been deemed harmful to human, animals and the environment and been banned in most countries are being used throughout Africa; this poses a health risk unless appropriate measures are taken. Abbreviations CMA Comprehensive Meta-Analysis DDT Dichlorodiphenyltrichloroethane DRC Democratic republic of the Congo JBI Joanna Briggs Institute MeSH Medical Subject Heading OCPs organochlorines pp DDE Dichlorodiphenyldichloroethylene pp DDD p,p' -Dichlorodiphenyl dichloroethane pp DDT p,p ' dichlorodiphenyltrichloroethane preferred reporting items for systematic review and Meta-Analysis SD Standard Deviation WHO World Health Organization. Declarations Competing Interests The authors declare that there is no competing interest in this work. Funding The authors did not receive funds for this work. Authors’ Contributions In this study AG, DMA, RAT and TW conceived the idea for this research and played a major role in the review, extraction, cleaning, and analyzing of the data, writing, drafting, and editing the manuscript. All authors read and approved the final version of this manuscript and agreed on all aspects of this work. 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Int J Hyg Environ Health 217(2–3):370–378 Frye C, Bo E, Calamandrei G, Calza L, Dessì-Fulgheri F, Fernández M, Fusani L, Kah O, Kajta M (2012) Endocrine disrupters: a review of some sources, effects, and mechanisms of actions on behaviour and neuroendocrine systems. J Neuroendocrinol 24(1):144–159Le Gebremichael S, Birhanu T, Tessema DA (2013) Analysis of organochlorine pesticide residues in human and cow’s milk in the towns of Asendabo, Serbo and Jimma in South-Western Ethiopia. Chemosphere 90(5):1652–1657 Gerber R, Bouwman H, Govender D, Ishizuka M, Ikenaka Y, Yohannes YB, Smit NJ, Wepener V (2021) Levels of DDTs and other organochlorine pesticides in healthy wild Nile crocodiles (Crocodylus niloticus) from a flagship conservation area. Chemosphere 264:128368 JBI (2019) The Joanna Briggs Institute. Critical appraisal tools for use in the JBI systematic reviews checklist for prevalence studies: The University of Adelaide. https://joannabriggs.org/sites/default/files/2019-05/JBI_Critical_Appraisal Checklist_for_ Prevalence_Studies2017_0.pdf Jepson PC, Murray K, Bach O, Bonilla MA, Neumeister L (2020) Selection of pesticides to reduce human and environmental health risks: a global guideline and minimum pesticides list. Lancet Planet Health 4(2):e56–e63 Jusko TA, Klebanoff MA, Brock JW, Longnecker MP (2012) In-utero exposure to DDT and cognitive development among infants and school-aged children. Epidemiol (Cambridge Mass) 23(5):689 Karalexi MA, Tagkas CF, Markozannes G, Tseretopoulou X, Hernández AF, Schüz J, Halldorsson TI, Psaltopoulou T, Petridou ET, Tzoulaki I (2021) Exposure to pesticides and childhood leukemia risk: A systematic review and meta-analysis. Environ Pollut 285:117376 Kermani M, Dowlati M, Gholami M, Sobhi HR, Azari A, Esrafili A, Yeganeh M, Ghaffari HR (2021) A global systematic review, meta-analysis and health risk assessment on the quantity of Malathion, Diazinon and Chlorpyrifos in Vegetables. Chemosphere 270:129382 Kolani L, Mawussi G, Sanda K (2016) Assessment of organochlorine pesticide residues in vegetable samples from some agricultural areas in Togo. Am J Anal Chem 7(4):332–341 Mekonen S, Ambelu A, Negassa B, Spanoghe P (2017) Exposure to DDT and its metabolites from khat (Catha edulis) chewing: Consumers risk assessment from southwestern Ethiopia. Regul Toxicol Pharmacol 87:64–70 Mekonnen B, Siraj J, Negash S (2021) Determination of pesticide residues in food premises using QuECHERS method in Bench-Sheko Zone, Southwest Ethiopia. Biomed Res Int 2021:1–13 Mew EJ, Padmanathan P, Konradsen F, Eddleston M, Chang S-S, Phillips MR, Gunnell D (2017) The global burden of fatal self-poisoning with pesticides 2006-15: systematic review. J Affect Disord 219:93–104 Mitiku BA, Mitiku MA (2022) Organochlorine pesticides residue affinity in fish muscle and their public health risks in North West Ethiopia. Food Sci Nutr 10(12):4331–4338 Nuapia Y, Chimuka L, Cukrowska E (2016) Assessment of organochlorine pesticide residues in raw food samples from open markets in two African cities. Chemosphere 164:480–487 Odewale GO, Sosan MB, Oyekunle JAO, Adeleye AO (2021) Human health risk assessment of dichlorodiphenyltrichloroethane (DDT) and hexachlorocyclohexane (HCH) pesticide residues in fruits and vegetables in Nigeria. Environ Sci Pollut Res 28:33133–33145 Okoffo ED, Fosu-Mensah BY, Gordon C (2016) Persistent organochlorine pesticide residues in cocoa beans from Ghana, a concern for public health. Int J Food Contam 3(1):1–11 Olisah C, Okoh OO, Okoh AI (2020) Occurrence of organochlorine pesticide residues in biological and environmental matrices in Africa: A two-decade review. Heliyon 6 (3) Olutona G, Aderemi M (2019) Organochlorine pesticide residue and heavy metals in leguminous food crops from selected markets in Ibadan, Nigeria. Legume Science. 2019; 1–9 Regassa C, Tolcha T, Gomoro K, Megersa N (2020) Determination of residue levels of DDT and its metabolites in khat and cabbage samples using QuEChERS sample preparation method combined with GC-MS detection. Ethiop J Sci Sustainable Dev 7(1):44–53 Sheahan M, Barrett CB, Goldvale C (2017) Human health and pesticide use in sub-Saharan Africa. Agric Econ 48(S1):27–41 Sosan M, Oyekunle J, Olufade Y (2015) Dichloro-diphenyl-trichloro-ethane (DDT) and hexachlorohexane (HCH) pesticide residues in foodstuffs from markets in Ile-Ife, Nigeria. Int J Biol Chem Sci 9(1):442–453 Stanganelli I, De Felici MB, Mandel VD, Caini S, Raimondi S, Corso F, Bellerba F, Quaglino P, Sanlorenzo M, Ribero S (2020) The association between pesticide use and cutaneous melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 34(4):691–708 Tadevosyan NS, Kirakosyan GV, Muradyan SA, Poghosyan SB, Khachatryan BG (2021) Relationship between Respiratory Morbidity and Environmental Exposure to Organochlorine Pesticides in Armenia. J Health Pollution 11(31):210904 Terfe A, Mekonen S, Jemal T (2023) Pesticide residues and effect of household processing in commonly consumed vegetables in jimma zone, southwest ethiopia. Journal of Environmental and Public Health 2023 Tongo I, Ezemonye L (2015) Human health risks associated with residual pesticide levels in edible tissues of slaughtered cattle in Benin City, Southern Nigeria. Toxicol Rep 2:1117–1135 Unyimadu JP, Osibanjo O, Babayemi JO (2018) Levels of organochlorine pesticides in brackish water fish from Niger River, Nigeria. Journal of Environmental and Public Health 2018 Vall O, Gomez-Culebras M, Puig C, Rodriguez-Carrasco E, Baltazar AG, Canchucaja L, Joya X, Garcia-Algar O (2018) Correction: Prenatal and Postnatal Exposure to DDT by Breast Milk Analysis in Canary Islands. PLoS ONE 13(6):e0199904 Wahlang B (2018) Exposure to persistent organic pollutants: Impact on women’s health. Rev Environ Health 33(4):331–348 WHO (2019) Preventing disease through healthy environments: exposure to highly hazardous pesticides: a major public health concern. World Health Organization (WHO) Yohannes YB, Ikenaka Y, Nakayama SM, Ishizuka M (2014) Organochlorine pesticides in bird species and their prey (fish) from the Ethiopian Rift Valley region, Ethiopia. Environ Pollut 192:121–128 Supplementary Files Supplementary Files not available with this version. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4187675","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285468078,"identity":"e842290a-209d-4c02-8daa-ef379197cee0","order_by":0,"name":"Dechasa Adare","email":"","orcid":"","institution":"Haramaya University College of Health Sciences: Haramaya University College of Health and Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Dechasa","middleName":"","lastName":"Adare","suffix":""},{"id":285468079,"identity":"8a0f74ca-b67b-4185-9b7b-3ca2e6daeb25","order_by":1,"name":"Abraham 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College of Health and Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Roba","middleName":"","lastName":"Argaw","suffix":""},{"id":285468081,"identity":"583c406f-75d1-4df2-a2c5-b9ccf8eccc44","order_by":3,"name":"Tara Wolfing","email":"","orcid":"","institution":"Haramaya University College of Health Sciences: Haramaya University College of Health and Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Tara","middleName":"","lastName":"Wolfing","suffix":""}],"badges":[],"createdAt":"2024-03-29 11:41:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4187675/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4187675/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54043396,"identity":"fb214f76-d729-4750-bb81-6206dabcb41e","added_by":"auto","created_at":"2024-04-03 18:29:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183204,"visible":true,"origin":"","legend":"\u003cp\u003eStudy selection process of included articles for systematic review and meta-analysis, 2024.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/19643b6746e7fbe3de8a900b.png"},{"id":54043399,"identity":"a8dd1b29-e093-43bd-ad09-8601216acce2","added_by":"auto","created_at":"2024-04-03 18:29:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":184861,"visible":true,"origin":"","legend":"\u003cp\u003eOverall mean concentration of pp DDT residue, regardless of the types of food items, in Africa\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/4bef8d9a5f48da859cc9233f.png"},{"id":54043394,"identity":"dbe50abe-122d-4132-9b7e-93c0d45ab428","added_by":"auto","created_at":"2024-04-03 18:29:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":218809,"visible":true,"origin":"","legend":"\u003cp\u003eMean concentration of pp DDT residue based on types of food items in Africa\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/d6347b74c8032dbd31a69e0a.png"},{"id":54043402,"identity":"1030f1ce-cba8-4d86-8f44-78cf89dbd905","added_by":"auto","created_at":"2024-04-03 18:29:37","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":160428,"visible":true,"origin":"","legend":"\u003cp\u003eOverall mean concentration of pp DDD residue, regardless of the types of food items in Africa\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/253322917e552cfbabb5d224.png"},{"id":54043344,"identity":"d823deb6-e91e-45b3-abea-35e99c1f152f","added_by":"auto","created_at":"2024-04-03 18:29:34","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":157392,"visible":true,"origin":"","legend":"\u003cp\u003ePooled mean concentration of pp DDD residue based on types of foods in Africa\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/3da775dc7f9f44e342453e4d.png"},{"id":54043395,"identity":"897906f1-f025-449b-aab9-908f5b346abe","added_by":"auto","created_at":"2024-04-03 18:29:34","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":168700,"visible":true,"origin":"","legend":"\u003cp\u003eOverall mean concentration of pp DDE residue, regardless of the types of food items in Africa.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/6f10bfe8cd3cb462e148d47b.png"},{"id":54043397,"identity":"63ddf5bc-9404-41d5-a550-0bc2e3934d50","added_by":"auto","created_at":"2024-04-03 18:29:35","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":214136,"visible":true,"origin":"","legend":"\u003cp\u003eMean concentration of pp DDE residue based on the types of food in Africa\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/0c5bd96be1348b2e21a2ceec.png"},{"id":54048327,"identity":"11fdf97a-3efb-43fa-9bd3-2b92f19ce8c7","added_by":"auto","created_at":"2024-04-03 20:23:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2090923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4187675/v1/dcdcdd22-3a7e-4351-a188-609d346e0370.pdf"}],"financialInterests":"","formattedTitle":"Concentration and public health risk of DDT metabolites in different food items in Africa:Systematic review and metal analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn 2020, 2.7\u0026nbsp;million tons of insecticides were used worldwide, a 30% increase from 2000 to 2020 (FAO. 2022). Organochlorines (OCP) pesticides are a synthetic group of chlorinated hydrocarbon derivatives used worldwide in agriculture and chemical industries. However, some specific pesticides in this group (DDT) have been banned in industrialized countries due to their known toxicity, slow degradation, and environmental persistence. In the last ten years, pesticide use has increased by 20% in developing countries, particularly Africa (Jepson et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; FAO. 2022).\u003c/p\u003e \u003cp\u003eOccupational exposure and accidental or deliberate poisoning due to the widespread use of pesticides have resulted in health issues and fatalities(WHO \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The health effects associated with pesticides include cancer, reproductive harm, immunosuppression, and endocrine disruption (WHO \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), as well as acute neurological damage (Buah-Kwofie et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Gerber et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). A global review from 2006 to 2015 revealed that pesticides accounted for approximately 14 to 20% of global suicides and about 110,000 to 168,000 fatalities annually from 2010\u0026ndash;2014 (Mew et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDDT and its metabolites are potentially hazardous to health and the environment due to their ability to have delayed effects at low concentrations (Tadevosyan et al. \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and have been classified as endocrine-disrupting chemicals (Frye et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Bergman et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), as well as affecting the immune system, reproductive and endocrine function, and increase susceptibility to various diseases (Freire et al. \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Wahlang \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). DDT is persistent in living and non-living environments, and its residue can be detected in almost every human body (Vall et al. \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Human exposure to DDT is in utero, during breastfeeding, and through the consumption of contaminated food (Jusko et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Because of these characteristics, DDT was banned by the Stockholm Convention on Persistent Organic Pollutants in May 2001 by the majority of countries worldwide (Jusko et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Nonetheless, it is still widely used in developing countries, including Africa, where there is inadequate knowledge and poor government regulation; all issues need immediate attention(Afata et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Berni et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), as they can ultimately lead to serious consequences (Alebachew et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Olisah et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Berni et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Sheahan et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrior systematic reviews and meta-analysis across the globe revealed the health risks of pesticide use (Stanganelli et al. \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Chiu et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Karalexi et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Evangelou et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Kermani et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, evidence on the pooled mean concentration of DDT and its metabolites in various food items in Africa is lacking. Therefore, the current systematic review and meta-analysis aimed to provide the concentration of DDT metabolites (\u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDD, and \u003cem\u003epp\u003c/em\u003e DDE) in various food items and the health risk implications in the African region. The findings can be used to develop intervention strategies for properly handling and controlling pesticides to reduce the health risks posed to human, animal, and environmental health.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEligibility Criteria\u003c/h2\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePopulation\u003c/strong\u003e \u003cp\u003eIn this study, the authors included DDT metabolites in various food items, including vegetables and fruits, fish and meat, khat, milk, and cereals. There was no limitation to the types of food items.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOutcome\u003c/strong\u003e \u003cp\u003eThe studies that reported pesticide residue or concentration of DDT metabolites, particularly \u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDE, and \u003cem\u003epp\u003c/em\u003e DDD were included in this report.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTypes of articles\u003c/strong\u003e \u003cp\u003eFull text and published articles written in English were included.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePublication year\u003c/strong\u003e \u003cp\u003eArticles published between January 2010 - January 2024 were considered.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRegions\u003c/strong\u003e \u003cp\u003eStudies conducted in the African Regions (North, West, East, Central, and Southern Africa) were included in the current study.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003eEditorial papers, short communication, review articles, report, preprint, and articles with a high risk of bias and those not written in English were excluded from the current study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Information Sources and Search Strategy\u003c/h2\u003e \u003cp\u003eThe articles were retrieved from SCOPUS/Science Direct, PubMed/MEDLINE, Web of Science, Google Scholar, DOAJ, National Repository and MedNar, from October 1, 2023, to January 20, 2024. A combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH) and main keywords were used to retrieve the articles from the included electronic databases. References within eligible studies were further screened for additional articles. The initial search for PubMed articles is provided as a supplementary file (supplementary file I).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection Process\u003c/h2\u003e \u003cp\u003eThe study selection process was performed using the PRISMA flow chart, indicating the number of articles included and excluded from the study, depicting the major reasons for exclusion. Duplicate articles were removed using the ENDNOTE software version X5 (Thomson Reuters, USA). The authors (DAM, AG, and RAT) independently screened the articles according to their titles and abstracts to determine their eligibility. Next, each author (DAM, AG, and RAT) independently evaluated the full text of all included articles. Disagreements with respect to the inclusion and exclusion of articles were resolved by consensus. Finally, the studies that met the inclusion criteria were included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eData Extraction Process\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAll authors (DAM, AG, RAT, and TW) independently extracted the relevant data required from eligible articles. To extract the data, a predetermined Microsoft Excel format (developed by the authors) was used. The extracted data included the following: survey and publication year, the region where the study was conducted, sample size, primary outcomes, residue or concentration of DDT metabolites (\u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDE and \u003cem\u003epp\u003c/em\u003e DDD) in different food items, and the African region. Any disagreement with respect to data extraction was resolved through discussion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuality Assessment\u003c/h2\u003e \u003cp\u003eThe included articles were subjected to quality evaluation by the authors (DAM, AG, RAT, and TW) using the Joanna Briggs Institute Critical Assessment Tool (JBI) for the prevalence studies (JBI \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The authors (DAM, AG, and RAT) evaluated the articles to determine their eligibility.\u003c/p\u003e \u003cp\u003eJBI critical appraisal tools have nine evaluation criteria (supplementary file II). Each parameter was assigned a one if 'Yes' and 0 if 'No'. Based on the total score, each article was classified as low risk of bias (85% and above), moderate (60\u0026ndash;85% score), or high risk of bias (60% and blow score). Finally, articles with moderate and low risk of bias were included in the study. Disagreements between the authors (DAM, AG, and RAT) regarding quality assessment were resolved by discussion after repeating the same procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Procedures and Data Analysis\u003c/h2\u003e \u003cp\u003eThe pooled mean concentration or residue of DDT metabolites (\u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDE, and \u003cem\u003epp\u003c/em\u003e DDD) among various food items was determined using the Comprehensive Meta-Analysis version 3.0 statistical software. The results were also visualized using a forest plot and a random-effects model. The I-squared test (I\u003csup\u003e2\u003c/sup\u003e statistics) was used to evaluate the heterogeneity between articles. The level of heterogeneity was classified as without heterogeneity (0.0%-25%), low heterogeneity (25\u0026ndash;50%), moderate heterogeneity (50\u0026ndash;75%), and high heterogeneity (\u0026gt;\u0026thinsp;75%) (Ades). A random-effects model was used to analyze and report the data. Subgroup analysis was performed based on food items/categories and publication year. A sensitivity analysis was performed to determine differences in pooled effects by dropping studies that were found to influence the summary estimates.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection\u003c/h2\u003e \u003cp\u003eA total of 2002 studies were retrieved from the databases and manual searches through Google. After retrieval, 562 duplicate articles were excluded. Furthermore, 169 non-eligible studies were excluded, and 732 were excluded due to their title and abstract. Next, 495 were omitted during the full-text screening, and 26 articles were excluded due to a high risk of bias. Finally, 18 articles were included in the final analysis (Fig.\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eFigure 1: Study selection process of included articles for systematic review and meta-analysis, 2024.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGeneral characteristics of the included articles.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study included 18 articles from various African regions that met the eligibility criteria. The included articles addressed the concentration of dichlorodiphenyltrichloroethane (DDT) metabolites (\u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDD, and \u003cem\u003epp\u003c/em\u003e DDE) in various types of food items and khat consumed in the African region.\u003c/p\u003e \u003cp\u003eAmong the studies included in the analysis, 8 (44.4%), 5 (27.8%), 1 (5.5%), 1 (5.5%), 1 (5.5%), 1 (5.5%), 2 (11.1%) of them were conducted in Ethiopia (Terfe et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mitiku and Mitiku \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Regassa et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Gebremichael et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Deti et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Yohannes et al. \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Mekonen et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), Nigeria (Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Olutona and Aderemi \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sosan et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Tongo and Ezemonye \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Unyimadu et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), DRC (Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), South Africa (Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), Togo (Kolani et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), Benin (Agnandji et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) and Ghana (Okoffo et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), respectively. Among the studies that met the eligibility criteria, 9 (50.0%), 5 (27.78%), 2 (11.1%), 2 (11.1%), 2 (11.1%), and 1 (5.5%) reported the concentration of DDT metabolites in vegetables (Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Kolani et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Okoffo et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Agnandji et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Olutona and Aderemi \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Terfe et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Regassa et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), meat and fish (Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Tongo and Ezemonye \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mitiku and Mitiku \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Unyimadu et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Yohannes et al. \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), fruit samples (Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), milk (Deti et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Gebremichael et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), khat (Mekonen et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and cereals (Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the studies included in the systematic review and meta-analysis, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFood category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTypes of food items\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePublication year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003eTypes of pesticides and its concentration in mg/kg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eReference\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003epp\u003c/em\u003e DDT\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003epp\u003c/em\u003e DDD\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003epp\u003c/em\u003e DDE\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal DDT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"18\" rowspan=\"19\"\u003e \u003cp\u003eVegetable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0967\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0495\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0566\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2028\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1097\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0758\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0997\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00741\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2852\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Okoffo et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.004\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.024\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Regassa et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1069\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0611\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0811\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2491\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1259\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0957\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1067\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.3283\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.016\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.014\u0026thinsp;\u0026plusmn;\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.053\u0026thinsp;\u0026plusmn;\u0026thinsp;0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCabbage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.190\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.215\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.405\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Kolani et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTomato\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.027\u0026thinsp;\u0026plusmn;\u0026thinsp;0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.029\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.022\u0026thinsp;\u0026plusmn;\u0026thinsp;0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.078\u0026thinsp;\u0026plusmn;\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTomato\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTomato\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.165\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.080\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.245\u0026thinsp;\u0026plusmn;\u0026thinsp;0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Kolani et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarrot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLettuce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.028\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.031\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.091\u0026thinsp;\u0026plusmn;\u0026thinsp;0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLettuce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.232\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.081\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.313\u0026thinsp;\u0026plusmn;\u0026thinsp;0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Kolani et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCowpea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.957\u0026thinsp;\u0026plusmn;\u0026thinsp;0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.337\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Olutona and Aderemi \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Olutona and Aderemi \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYam chips\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u0026thinsp;\u0026plusmn;\u0026thinsp;0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.086\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.054 \u0026plusmn; 0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.182\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Sosan et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6085\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0955\u0026thinsp;\u0026plusmn;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1498\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.00213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Terfe et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCowpea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.053\u0026thinsp;+\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.159\u0026thinsp;+\u0026thinsp;0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.073\u0026thinsp;+\u0026thinsp;0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.285\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Sosan et al. \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eFruit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMango\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.020\u0026thinsp;\u0026plusmn;\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.010\u0026thinsp;\u0026plusmn;\u0026thinsp;0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.041\u0026thinsp;\u0026plusmn;\u0026thinsp;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCucumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePineapple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u0026thinsp;\u0026plusmn;\u0026thinsp;0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.009 _ 0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u0026thinsp;\u0026plusmn;\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.026\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreen pepper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.024\u0026thinsp;\u0026plusmn;\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.010\u0026thinsp;\u0026plusmn;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.011\u0026thinsp;\u0026plusmn;\u0026thinsp;0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.045\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Bempah et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWatermelon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Odewale et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCow milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.165\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0683\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.156\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.3893\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Gebremichael et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCow and goat milk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.155\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.02164\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.17664\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Deti et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCereals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.046\u0026thinsp;\u0026plusmn;\u0026thinsp;0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.045\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.091\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.047\u0026thinsp;\u0026plusmn;\u0026thinsp;0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.097\u0026thinsp;\u0026plusmn;\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSorghum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0513\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0587\u0026thinsp;\u0026plusmn;\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommon millet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.078\u0026thinsp;\u0026plusmn;\u0026thinsp;0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0727\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.1507\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mekonnen et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eMeat and fish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14512\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1542\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00434\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.39697\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06372\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.07352\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0901\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.22734\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDRC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e137\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.00158\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00565\u0026thinsp;\u0026plusmn;\u0026thinsp;0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06401\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07124\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mitiku and Mitiku \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.568\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.655\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.138\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.361\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Yohannes et al. \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2014\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1352 \u0026plusmn; 0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.521\u0026thinsp;\u0026plusmn;\u0026thinsp;0.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0671\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.7233\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Unyimadu et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1679\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1136\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2536\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.5351\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1346\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.106\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1258\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.3664\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Nuapia et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Regassa et al. \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0159\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0122\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0669\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.095\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(Mekonen et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cb\u003eKeys\u003c/b\u003e: \u003cem\u003eDRC: Democratic Republic of the Congo, SD: Standard deviation, pp DDT: p,p' dichlorodiphenyltrichloroethane, pp DDD: p,p'-Dichlorodiphenyl dichloroethane, pp DDE: Dichlorodiphenyldichloroethylene\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePesticide residues in different food items\u003c/h2\u003e \u003cp\u003e \u003cb\u003eConcentration of\u003c/b\u003e \u003cb\u003epp\u003c/b\u003e \u003cb\u003eDDT residue in different food items\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe overall mean residue of \u003cem\u003epp\u003c/em\u003e DDT\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, regardless of the types of food items, accounted for 0.188 mg/kg\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047 with a 95% CI of 9.7 to 28.0% and \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (Fig.\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eFigure 2: Overall mean concentration of \u003cem\u003epp\u003c/em\u003e DDT residue, regardless of the types of food items, in Africa\u003c/p\u003e \u003cp\u003eBased on the subgroup analysis of \u003cem\u003epp\u003c/em\u003e DDT according to the types of food or food category, the mean concentration of \u003cem\u003epp\u003c/em\u003e DDT (mg/kg ) in vegetables, fruit, meat and fish, milk, cereals, and khat accounted for 0.195\u0026thinsp;\u0026plusmn;\u0026thinsp;0.025, 0.028\u0026thinsp;\u0026plusmn;\u0026thinsp;0.005, 0.174\u0026thinsp;\u0026plusmn;\u0026thinsp;0.151, 0.165\u0026thinsp;\u0026plusmn;\u0026thinsp;0, 0.056\u0026thinsp;\u0026plusmn;\u0026thinsp;0.006 and 0.043\u0026thinsp;\u0026plusmn;\u0026thinsp;0.027 mg/kg, respectively (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eFigure 3: Mean concentration of \u003cem\u003epp\u003c/em\u003e DDT residue based on types of food items in Africa\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConcentration of pp DDD residue in different food items\u003c/h2\u003e \u003cp\u003eRegardless of the types of food and the countries in which the studies were conducted, the concentration of \u003cem\u003epp\u003c/em\u003e DDD residue in the various food items was 0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.076 mg/kg [95% CI 7.2, 36.8%], \u003cem\u003ep-\u003c/em\u003evalue\u0026thinsp;\u0026lt;\u0026thinsp;0.004 (Fig.\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eFigure 4: Overall mean concentration of \u003cem\u003epp\u003c/em\u003e DDD residue, regardless of the types of food items in Africa\u003c/p\u003e \u003cp\u003eThe subgroup analysis based on the types of food shows that the concentration of \u003cem\u003epp\u003c/em\u003e DDD (mg/kg) was 0.011\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0026, 0.021\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0089, 0.2246\u0026thinsp;\u0026plusmn;\u0026thinsp;0.163, 0.0683\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0004, and 0.1981\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0573 in fruit, khat, meat and fish, milk, and vegetable, respectively (Fig.\u0026nbsp;5).\u003c/p\u003e \u003cp\u003eFigure 5: Pooled mean concentration of \u003cem\u003epp\u003c/em\u003e DDD residue based on types of foods in Africa\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConcentration of pp DDE residue in different food items\u003c/h2\u003e \u003cp\u003eRegardless of the types of food and countries where the studies were conducted, the concentration of \u003cem\u003epp\u003c/em\u003e DDE residue in different food items was 0.0878\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0051 mg/Kg [95% CI 7.78, 9.78%], \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 (Fig.\u0026nbsp;6).\u003c/p\u003e \u003cp\u003eFigure 6: Overall mean concentration of \u003cem\u003epp\u003c/em\u003e DDE residue, regardless of the types of food items in Africa.\u003c/p\u003e \u003cp\u003eBased on the types of food, the \u003cem\u003epp\u003c/em\u003e DDE residue was 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0056, 0.029\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0054, 0.0385\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0285, 0.1259\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0307, 0.089\u0026thinsp;\u0026plusmn;\u0026thinsp;0.067 and 0.1184\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0233 mg/kg in cereals, fruit, khat, meat and fish, milk, and vegetable, respectively (Fig.\u0026nbsp;7).\u003c/p\u003e \u003cp\u003eFigure 7: Mean concentration of \u003cem\u003epp\u003c/em\u003e DDE residue based on the types of food in Africa\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the current study, 2002 studies were retrieved from different electronic databases to determine the concentration of DDT metabolites (\u003cem\u003epp\u003c/em\u003e DDT, \u003cem\u003epp\u003c/em\u003e DDD, and \u003cem\u003epp\u003c/em\u003e DDE) in various food items in the African regions. The residue of the metabolites was detected in various food items. The review revealed that the residue of \u003cem\u003epp\u003c/em\u003e DDT in milk was 0.16 mg/kg, which is higher than the FAO/WHO MRL of 0.02 mg/kg \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e and also higher than the EU MRL (0.04mg/kg) set for food items \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. Similarly, the \u003cem\u003epp\u003c/em\u003e DDT residue in cereals was 0.056 mg/kg, higher than the EU MRL set for cereals (0.05mg/kg) \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. This suggests that consumers have a high risk of exposure through consuming food contaminated with \u003cem\u003epp\u003c/em\u003e DDT.\u003c/p\u003e \u003cp\u003eThe residue of \u003cem\u003epp\u003c/em\u003e DDT in meat (0.028 mg/kg) and khat (0.043 mg/kg) was relatively lower than the MRL indicated by FAO/WHO (1-5mg/kg for meat and 0.5mg/kg for leaves and herbs) \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. However, the concentration of pp DDT might be underrepresented since only a few studies provided the data on these food categories.\u003c/p\u003e \u003cp\u003eThe concentration of other DDT metabolites, the pp DDD residue in milk and vegetables accounted for 0.0683 mg/kg and 0.198 mg/kg, respectively, which is higher than the maximum recommended level by FAO/WHO (0.02 mg/kg for milk) \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e and EU (0.04 mg/kg for milk and 0.05mg/kg for vegetable) \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. Since these foods are among Africa\u0026rsquo;s most commonly consumed foods, there is a high risk of exposure to the pp DDD residue.\u003c/p\u003e \u003cp\u003eThe overall mean concentration of pp DDE residue of in cereals, which accounted for 0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0056 mg/kg, is higher than the FAO/WHO (0.1mg/kg) \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e and EU MRL 0.05mg/kg) \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. Moreover, the overall pp DDE residue in milk (0.089\u0026thinsp;\u0026plusmn;\u0026thinsp;0.067 mg/kg) and vegetables (0.1184\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0233 mg/kg) is higher than the MRL of both FAO/WHO (0.02 mg/kg for milk) \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003eand EU (0.04 mg/kg for milk and 0.05 for vegetable) \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. However, the residue of pp DDE in fruit (0.029mg/kg) and khat (0.0385 mg/kg) is lower than the MRL of 0.05 for fruit and 0.5mg/kg for khat \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThe current study revealed that in most food categories, the residues of DDT metabolites, pp DDT, pp DDD, or pp DDE, are higher than the maximum residue limits set by FAO and WHO \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e and the EU \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. This indicates that the populations in the region are at serious health risks associated with these chemicals. Therefore, developing effective intervention program strategies, including increasing awareness of the health risks, food safety, and appropriate uses of DDT for different purposes is fundamental.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitations\u003c/h2\u003e \u003cp\u003eThis study used multiple electronic databases with their applicable search strategies. Moreover, the quality of the articles was evaluated using standard tools for quality assessment. Additionally, this work was done based on the PRISMA guidelines or protocols. However, there was an unequal distribution of articles across African countries because a limited number of studies met eligible criteria. The DDT residue in different foods in many countries in the Region was not included due to the limited number of studies that meet the eligibility criteria. Furthermore, due to a limited number of studies, systematic reviews, and meta-analyses conducted on DDT residues in Africa and other regions, we cannot adequately compare the current study\u0026rsquo;s findings with the findings of other studies. However, we have compared the pooled mean residue of DDT in different food types with a recommended maximum limit of FAO, WHO, and the European Union to determine the health risk.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn general, vegetables, cereals, and milk had a residue of one DDT metabolite higher than the maximum recommended limit indicated by FAO, WHO \u003cem\u003e(\u003c/em\u003eFAO/WHO \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e and EU \u003cem\u003e(\u003c/em\u003eEU \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e The current study indicates the need for more effective pesticide management programs and government regulation, particularly in Africa. Pesticides, such as DDT, that have been deemed harmful to human, animals and the environment and been banned in most countries are being used throughout Africa; this poses a health risk unless appropriate measures are taken.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComprehensive Meta-Analysis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDichlorodiphenyltrichloroethane\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDemocratic republic of the Congo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoanna Briggs Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMeSH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Subject Heading\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOCPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eorganochlorines\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003epp DDE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cem\u003eDichlorodiphenyldichloroethylene\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003epp\u003c/em\u003e DDD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cem\u003ep,p'\u003c/em\u003e-Dichlorodiphenyl dichloroethane\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cem\u003epp\u003c/em\u003e DDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cem\u003ep,p\u003c/em\u003e' dichlorodiphenyltrichloroethane\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003epreferred reporting items for systematic review and Meta-Analysis\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that there is no competing interest in this work.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors did not receive funds for this work.\u003c/p\u003e\u003ch2\u003eAuthors\u0026rsquo; Contributions\u003c/h2\u003e \u003cp\u003eIn this study AG, DMA, RAT and TW conceived the idea for this research and played a major role in the review, extraction, cleaning, and analyzing of the data, writing, drafting, and editing the manuscript. All authors read and approved the final version of this manuscript and agreed on all aspects of this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eAlmost all data are included in this study. However, some data may be available from the corresponding authors on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdes AE, Lu G, Higgins JP (2005) The interpretation of random-effects meta-analysis in decision models. Med Decis Making 25(6):646\u0026ndash;654\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfata TN, Mekonen S, Shekelifa M, Tucho GT (2022) Prevalence of pesticide use and occupational exposure among small-scale farmers in Western Ethiopia. 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Environ Pollut 192:121\u0026ndash;128\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Supplementary Files","content":"\u003cp\u003eSupplementary Files not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Africa, DDT, Pesticides, Metabolites, risk","lastPublishedDoi":"10.21203/rs.3.rs-4187675/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4187675/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDDT is banned in many countries due to its persistency and negative impact on humans and the environment. However, it is continued to be used in many low-income countries, notably those in Africa, therefore exposing people in the region to various health threats. The current paper attempts to provide evidence regarding the concentration of DDT metabolites (pp DDT, pp DDD, and pp DDE) in a variety of food items in Africa. The preferred reporting item for systematic reviews and meta-analysis protocols was used to conduct this work. SCOPUS, PubMed, Web of Science, and other databases were used to retrieve articles using key words, Boolean logic operators, and MeSH terms. A total of 2002 studies were retrieved, of which 18 articles were included in the final analysis. The mean residue of pp DDT in vegetables, fruit, meat, fish, milk, cereals and khat was 0.195, 0.174, 0.028, 0.165, 0.056 and 0.043 mg/kg, respectively. The mean residue of pp DDD in vegetables, fruit, meat and fish, milk, and khat was 0.198, 0.011, 0.224, 0.068, and 0.021 mg/kg, respectively. The mean pp DDE residue in cereals, meat and fish, milk, vegetables, fruit, and khat was 0.57, 0.1259, 0.089, 0.1184, 0.029, and 0.0385 mg/kg, respectively. The metabolites in most food categories were higher than the recommended level, therefore posing major health risks to the public. Designing appropriate and effective pesticide management and safety measures, including tighter governmental regulation, is essential in the region.\u003c/p\u003e","manuscriptTitle":"Concentration and public health risk of DDT metabolites in different food items in Africa:Systematic review and metal analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 18:29:16","doi":"10.21203/rs.3.rs-4187675/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c021369-9465-4108-bd34-70f1f3aeb1ca","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-03T20:15:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 18:29:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4187675","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4187675","identity":"rs-4187675","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}