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Para-occupational “take-home” exposure risks among forestry workers and their families in low-and middle-income countries (LMICs) have not been well characterized. This is a concern because research shows an association between chronic low-dose herbicide exposure and adverse health effects. This study explored take-home herbicide residue exposure risks among forestry workers in the Western Cape, South Africa, through the community-based participatory research approach of photovoice. A key finding of the study was the absence of provisions related to take-home exposure in the national legislation and workplace policies, which largely contributed to poor adherence to risk reduction practices at worksites, in addition to workers transporting residues to their homes. This study demonstrated evidence of the key omissions regarding take-home exposure at the policy level (e.g., recommendations for employers to reduce take-home risks among employees, and training of workers and their families on take-home exposure) and take-home herbicide residue exposure among worker’s families, including children.

Introduction: The intersection of health and climate change is often absent or under-represented in sub-national government strategies. This analysis of the literature, using a new methodological framework, highlights priority focus areas for a sub-national government response to health and climate change, using the Western Cape (WC) province of South Africa as a case study. Methods: A methodological framework was created to conduct a review of priority focus areas relevant for sub-national governments. The framework encompassed the establishment of a Project Steering Group consisting of relevant, sub-national stakeholders (e.g. provincial officials, public and environmental health specialists and academics); an analysis of local climatic projections as well as an analysis of global, national and sub-national health risk factors and impacts. Results: Globally, the discussion of health and climate change adaptation strategies in sub-national, or provincial government is often limited. For the case study presented, multiple health risk factors were identified. WC climatic projections include a warmer and potentially drier future with an increased frequency and intensity of extreme weather events. WC government priority focus areas requiring further research on health risk factors include: population migration and environmental refugees, land use change, violence and human conflict and vulnerable groups. WC government priority focus areas for further research on health impacts include: mental ill-health, non-communicable diseases, injuries, poisonings (e.g. pesticides), food and nutrition insecurity-related diseases, water- and food-borne diseases and reproductive health. These areas are currently under-addressed, or not addressed at all, in the current provincial climate change strategy. Conclusions: Sub-national government adaptation strategies often display limited discussion on the health and climate change intersect. The methodological framework presented in this case study can be globally utilized by other sub-national governments for decision-making and development of climate change and health adaptation strategies. Additionally, due to the broad range of sectoral issues identified, a primary recommendation from this study is that sub-national governments internationally should consider a “health and climate change in all policies” approach when developing adaptation and mitigation strategies to address climate change. Keywords: Climate change, Environmental health, Low- and middle-income countries, Adaptation, Sub-national, Climate health impacts

Background Chemical hazard communication (e.g., label) is intended to alert users of the potential hazards of chemicals. Apart from the fact that hazard information needs to be understood, it is also important that it is recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required. Methods A cross-sectional study investigating associations between the recall of chemical safety information on labels and safety data sheets among 402 participants including 315 workers (industry, transport and agriculture sectors) and 87 consumers in two provinces of South Africa was conducted. The recall of label information by participants was tested using two modules from a Hazard Communication Comprehensibility Testing (CT) Tool developed by the Centre for Environmental and Occupational Health Research at the University of Cape Town for the UN Institute for Training and Research (UNITAR). Results Respondents were predominantly male (67.7%), the median age was 37 years (IQR: 30–46 years) and less than half of the participants completed high school (47.5%). The skull and crossbones symbol was the label element most recalled, both freely without prompting (79.6%) and recognition after prompting (94.8%). Whereas, the first aid and treatment measures were the least frequently freely recalled (least frequent item 6.0%; most frequent item 29.9%). Multivariate analysis identified the following positive associations with the recall of all the label elements listing the strongest association: call appropriate services and industrial vs. consumer sector (OR = 2.4; 95% CI: 1.2; 4.6); call appropriate services and transport vs. consumer sector (OR = 4.4; 95% CI: 1.2; 16.0); flammable symbol and male vs. female gender (OR = 2.3; 95% CI: 1.0; 5.3); flammable symbol and home language English vs. African languages (OR = 6.6; 95% CI: 2.1; 21.2); any hazard statement and home language Afrikaans vs. African languages (OR = 14.0; 95% CI: 3.6; 54.2), any first aid statement and further education vs. none (OR = 3.3; 95% CI: 1.3; 8.0), correct chemical name and industry blue collar workers vs. non-industry blue collar workers (OR = 2.6; 95% CI: 1.1; 6.1), correct chemical name and non-industry white collar occupations vs. non-industry blue collar workers (OR = 2.7; 95% CI: 1.0; 7.1). Conclusion The study found a number of potential positive associations that influence recall of label elements of which some (e.g., sector, gender, occupation) suggest further research. Relevant policies in South Africa should ensure that the safety information on chemical labels is clearly visible to read and understandable which aids recall and the reduction in harmful chemical exposures.

Occupational exposure to heat and solar ultraviolet radiation (UVR) threatens the health and wellbeing of outdoor workers. These threats are likely to increase as a result of climate change. This study examined the perceptions of occupational heat and sun exposure and health risk prevention among forestry workers removing alien invasive vegetation in the Western Cape, South Africa. The linkages between workers&rsquo, perceptions of heat, solar UVR, and herbicide exposure and impacts under the current climate were investigated to better understand potential adaptation needs under a changing climate. Using focus group discussions and participatory risk mapping, heat stresses identified by workers were either environmental (e.g., lack of shade) or work-related (e.g., wearing required personal protective equipment). Several heat and solar UVR health impacts were reportedly experienced by workers, local indigenous knowledge and coping mechanisms, such as wearing ochre for sun protection, were used to prevent these impacts. Despite workers&rsquo, current efforts to protect their health, existing gaps and opportunities to improve working conditions were identified. Institutional structures for improved reporting of adverse events are imperative, together with awareness and education campaigns about the risks associated with working in hot and sunny environments.

In low-income townships, pests are rife, a nuisance and are vectors of disease. Although alternatives are available, chemical means of pest control is often the first resort due to lack of knowledge of other methods, convenience and presumed efficacy. The demand for chemical pest control has created a unique business opportunity for informal vendors in South Africa servicing predominately low socio-economic communities. That is the selling of 'street pesticides', which are either containing agricultural pesticides too toxic for domestic use or illegally imported products. Poisonings from street pesticide exposures, particularly in children, are increasingly common and, along with pest-related diseases, creates a double burden of disease. Solutions are needed to decrease these incidences and to develop pest control strategies that are low- or non-toxic. It is imperative that, for sustainable problem-solving, all stakeholders, including vendors, be part of the solution in tackling this public health issue. This manuscript outlines an engaged scholarship approach for developing a sustainable resolution for reducing street pesticide use. This cyclical and iterative approach encompasses: the establishment of relationships, co-creation of solutions, co-implementation, co-monitoring, co-evaluation, co-reflection and co-re-design. The significance of the research and proposed engagement are discussed, as are anticipated challenges.

How do migrant women navigate their food environment during pregnancy? Foods are imbued with new meanings in a new place, and in low-and-middle-income countries including South Africa, a changing food environment leaves the poor, including many migrants, vulnerable to malnutrition. Thus, one of the ways economic and social vulnerability may be experienced and reproduced is via the foods one consumes. Examining food perceptions in the context of pregnancy offers a potentially powerful lens on wellbeing. Methods Nine focus group discussions (N = 48) with Somali, Congolese, and Zimbabwean men and women, and 23 in-depth interviews with Congolese, Somali and Zimbabwean women living in Cape Town were conducted, exploring maternal and infant nutrition. We used thematic analysis to guide analysis. Results (1) Participants described longing for self-categorised “traditional” foods, yet had limited access and little time and space to prepare these foods in the manner they had back home. (2) Sought-after foods available—and even celebratory—for migrants in Cape Town during pregnancy tended to be calorie-dense, nutrient poor fast foods and junk foods. (3) The fulfilment of cravings was presented as the embodiment of health during pregnancy. (4) Iron-folic acid supplementation was perceived as curative rather than preventive. (5) While participants did not describe hunger during pregnancy, food scarcity seemed possible. Discussion Food perceptions during pregnancy reflected migrants’ orientation towards home. Fast foods were widely acceptable and available during pregnancy. These foods were not perceived to have negative health consequences. Nutrition interventions targeting migrants should consider the symbolic nature of food, the increasingly globalised food environment in urban LMIC settings, as well as the contexts in which health perceptions evolve.

This article focuses on the devastating hidden perils of agricultural pesticides repurposed by informal sellers in urban South African townships to kill rats and other unwanted pests. Drawing on collaborative research techniques, we investigate the causal relationship between child poisoning episodes and the household use of illegal street pesticides. Such pesticides are used to safeguard homes from pests in an attempt to protect children from the harmful consequences of rodent bites and vectorborne diseases. Here, we consider the social injustice and economic inequality of episodes of child pesticide poisoning in the Western Cape from three disciplinary perspectives: public health, medical anthropology and fine art. We ultimately seek to demonstrate the complex relationship between the political economy of sanitation, waste removal and insecure housing, and the proliferation of rodents and other pests in urban townships. As a contribution to the medical humanities, the paper leans into different disciplines to highlight the toxic layering at play in a child pesticide poisoning event. The public health perspective focuses on the circulation of illegal street pesticides, the anthropologists focus on the experiences of the children and caregivers who are victims of poisoning, and the fine artist centres the rat within a broader environmental context. While non-toxic methods to eliminate rats and household pests are critical, longer term structural changes, through environmental and human rights activism, are necessary to ameliorate the suffering caused by poisoning. The medical and health humanities is well poised to highlight creative ways to draw public attention to these challenges, as well as to bridge the divide between science and the humanities through collaborative research efforts. With this paper we set the stage for discussing and balancing perspectives when addressing pest control in poor urban communities.

Background: Mobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs). Methods A descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher’s exact test was applied to determine associations. Results A significant association was found between participants’ knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes. Conclusions Mobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.

Background Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. Methods As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Results Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Conclusion Although there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation.

The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audience's varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.

Background Infant feeding recommendations are of health importance, yet the extent to which migrant communities in low- and middle-income countries know or implement these recommendations is poorly understood. This study explores the perspectives of infant feeding amongst cross-border migrants in Cape Town, South Africa. Methods Between February and October 2013, semi-structured in-depth interviews (n = 23) were conducted face-to-face with Congolese, Somali and Zimbabwean mothers living in Cape Town. To assess commonly identified narratives of infant feeding, nine focus group discussions (three with men and six with women) were conducted with migrant Somalis, Congolese, and Zimbabweans. Results Three dominant themes framed infant feeding. 1) Pragmatism in feeding choices drove responses to baby’s cues, including cries, sleeping patterns, and weight gain (2). Formula feeding was normative in the South African context, whereas lack of commercial infant milk back home was described in terms of expense (3). Low rates of breastfeeding were explained in terms of work responsibilities including household work and lack of breastmilk supply resulting from stress and poor diet. However, women participants typically did not consider their feeding choices to negatively affect their baby’s health. Conclusions The reasons for early introduction of both commercial infant milk and solid foods were complex. Breastfeeding was not prioritized despite an awareness of medical recommendations. Rather than emphasizing specific breastfeeding intentions, participants favoured an approach that reacted to their baby’s perceived changing needs. The practical challenges of breastfeeding described by cross-border migrant women reflect one way in which socio-economic and health inequalities may currently be perpetuated for marginalised populations.

Pesticide companies and regulators in developing countries use the United Nations Food and Agricultural Organization (FAO) recommended pictograms on pesticide labels to communicate risk information based on toxicological and environmental risk assessment data. The pesticide label not only is often the only access people have to pesticide risk information, but also in many countries is a legally binding document. As a result of the crucial role pesticide labels play in protecting health and the environment and as a legal instrument, pictograms are used to overcome literacy challenges in transmitting pesticide risk information. Yet, this risk communication tool is often prone to misinterpretations of the risk information which results in hazardous exposures to pesticides for farm workers and end-users generally. In this paper, results are presented from a study with 115 farm workers on commercial vineyards in the Western Cape, South Africa, assessing their interpretations of 10 commonly used pictograms. A standardized questionnaire based on four commonly used pesticide labels was administered. Overall, 50% or more of the study farm workers had misleading, incorrect and critically confused interpretations of the label pictograms. Interpretations often reflected farm workers' social and cultural frames of reference rather than the technically intended risk information. For example, the pictogram indicating a pesticide's toxicity requires boots must be worn, evoked interpretations of "dangerous to pedestrians" and "don't walk through pesticides". Furthermore, there was a gender variation in pictogram comprehension whereby males generally had more correct interpretations than females. This is a result both of a lack of training for women who are assumed to not work with pesticides, as well as a lack of pictograms relevant for female exposures. These findings challenge the viability of the United Nations current initiative to globally harmonize pictograms used on all chemical labels under the new Globally Harmonized System for the Classification and Labelling of Chemicals (GHS). Particularly as the GHS pictograms were not piloted prior to adoption of the system and represent complex risk assessment data such as chronic hazards. Public health and pesticide policy, backed by relevant research, need to address developing applicable and effective pesticide risk communication tools, particularly for developing country populations. Merely providing risk assessment derived information in a pictogram does not ensure that an end-user will interpret the message as intended and be able to make risk decisions which mitigate risks from exposures to pesticides or chemicals in general.

The high exposure risks of workers to herbicides in low- and middle-income countries is an important public health concern because of the potential resulting negative impacts on workers' health. This study investigated workers' personal protective equipment (PPE) compliance as a risk mitigation measure; particularly workers who apply herbicides for Working for Water (WfW) – a South African invasive alien vegetation control programme. The study aim was to understand workers' low PPE compliance by analysing their risk perceptions of herbicide use, working conditions and socio-cultural context. Research methods included ethnographic observations, informal interviews, visual media, questionnaires and a focus group. Study results indicated that low PPE compliance persists despite workers' awareness of herbicide exposure risks and as a result of the influence from workers' socio-cultural context (i.e. gender dynamics and social status), herbicide risk perceptions and working conditions (i.e. environmental and logistical). Interestingly, teams comprised of mostly women had the highest compliance rate. These findings highlighted that given the complexity of PPE compliance, especially in countries with several economic and social constraints, exposure reduction interventions should not rely solely on PPE use promotion. Instead, other control strategies requiring less worker input for effectiveness should be implemented, such as elimination and substitution of highly hazardous pesticides, and altering application methods.

An effective surveillance system is required to reduce pesticide exposures and poisonings, especially from street pesticides (illegal, unlabelled, and decanted agricultural pesticides used predominately for urban household purposes). Poisoning from any pesticide class, not only organophosphates, constitutes a medically notifiable condition in South Africa. Current practice, however, is to report only organophosphate cases, resulting in severe under-reporting. The lack of data concerning the link between poisonings and street pesticides has led to the mistaken assumption that urban populations are not at risk from significant pesticide exposures and poisonings. Without accurate statistics, healthcare professionals and policy makers are unaware of the contribution of street pesticide poisonings to the overall health burden. Accurate diagnosis is a prerequisite for notification and subsequent surveillance. An algorithm has been developed to enable healthcare professionals to improve the diagnosis and notification of pesticide poisonings.

Background Rodent infestations are a public health problem in poor urban communities. The use of illegal street pesticides to control rodent infestations with resulting poisonings is an additional public health concern receiving limited attention in many developing countries, including South Africa. Methods Participants in a household intervention in two poor urban areas of Cape Town, South Africa, received two high quality rat traps. Reported in this article are the results of a follow-up survey conducted six months after distribution to assess community perceived acceptability of using rat traps instead of toxic pesticides (N = 175). Results Of the 175 respondents that were followed up, 88% used the traps and only 35% continued using pesticides after the intervention. The analysis identified perceived effectiveness of the traps (prevalence odds ratio 18.00, 95% confidence interval 4.62 to 70.14), being male (prevalence odds ratio 8.86, 95% confidence interval 1.73 to 45.19), and the willingness to buy traps from an informal market (prevalence odds ratio 17.75, 95% confidence interval 4.22 to 74.57) as significantly associated with the acceptance of trap use. Conclusions Rat traps, when introduced to poor urban communities, are acceptable as an alternative to toxic pesticides for rodent control. Sustainability of trap use, however, needs to be researched, especially cost and cost-benefit.

Context. Exposure of children to pesticides and overt poisoning are an increasingly important problem in South Africa. Objective. This study describes the profile of acute paediatric pesticide exposures and poisonings presenting to Red Cross War Memorial Children’s Hospital (RCWMCH) in Cape Town South Africa from 2003 to 2008, identifies those poisonings due to illicit pesticides sold on the streets (‘‘street pesticides’’) and assesses the number of incidents in which the statutory requirement of notification to the local health authority is met. Methods. Cases were identified by review of the RCWMCH case and notification records and the local health authority notification records. Results. There were 306 patients with 311 incidents of acute pesticide exposure or poisoning. This represents 11% of all paediatric exposures and poisonings (N ¼2868) seen over the 6-year period. The number of pesticide incidents increased annually. Two hundred seventy-eight (91%) children were under 6 years old and 164 (54%) were males. Two hundred seventeen (70%) patients came from six socio economically diverse suburbs in the Cape Town Metropole, each of which ranges from informal settlements with extreme poverty to formal housing with lower to middle class populations. There was a summer predominance of acute pesticide exposures and poisonings. The commonest group of pesticides were 203 cholinergics (includes organophosphates and carbamates), 35 anticoagulants and 45 unknowns. One hundred incidents were classified as exposures as they were asymptomatic. Two hundred eleven symptomatic incidents, termed pesticide poisonings, required admission; 121 to High Care or Intensive Care Unit (ICU). The median length of stay in hospital was 3 days (range 0–52). There were 6 (2%) deaths. The large group of cholinergic exposures and poisonings (203) required 195 (96%) admissions; 120 (59%) to High Care or ICU. Of the 44 ‘‘street pesticide’’ exposures and poisonings, 33 were cholinergic poisonings and 21 required High Care or ICU. Eighty-seven (41%) of 211 poisonings requiring notification were recorded at the local health authority; all were instances of cholinergic poisoning. Conclusion .T he increasing number and the morbidity and mortality of acute paediatric pesticide exposure and poisoning is of great concern. Furthermore, the magnitude of the problem is masked by inadequate notification with the relevant health authorities.

As part of a larger dermatological investigation undertaken in 1999 - 2001 involving the Department of Dermatology, Groote Schuur Hospital (Cape Town, South Africa) and Nottingham University (UK), household pesticide use was investigated among Xhosa-speaking families living in three areas in South Africa (a rural area, an urban township and an informal settlement).The aim was to characterise pesticide use patterns and potential exposures through skin absorption, ingestion and inhalation for this group of South African children.A standardised questionnaire, which included a section investigating household pesticide use, was administered by four trained fieldworkers to the parents/guardians of the 740 children (25%) aged between 3 and 11 years identified as having atopic dermatitis either by clinical examination or according to the UK criteria (rural N=387, urban N=292, informal N=61).Of the children with atopic dermatitis, 539 (73%) had been exposed to household pesticides. Most childhood exposure (89%) occurred in the informal settlements, followed by 78% in the urban area and 63% in the rural area.This research highlighted considerable home environment pesticide exposure of South African children in lower socio-economic groups in rural, urban and informal areas. As children are particularly vulnerable to the short- and long-term health effects of pesticide exposure, further in-depth investigation is needed to ascertain and document the health effects associated with such exposure in the home.

Objective To determine whether caregivers are able to make informed decisions about their families’ use of over-the-counter (OTC) painkillers through access to and use of three mechanisms of information provision. Methods A cross sectional, face-to-face questionnaire was administered to 60 caregivers and seven pharmacists in Cape Town, South Africa. Caregivers answered questions related to paracetamol (acetaminophen) labels, inserts and Patient Information Leaflets (PIL). Results Most study caregivers received labels with the painkillers they purchased. Many pharmacists (43%) felt that the information provided was ineffective in preventing overdosing. Study caregivers found it difficult to understand the scientific terms in all three mechanisms of information provision. Most respondents (80%) found the PIL easiest to understand, yet few had received PILs with their purchase. Ten percent of literate respondents were unable to understand the dosage requirements for children. Conclusion Most caregivers are not able to make informed decisions from the information provided with OTC painkillers. This is mostly attributable to limited provision of information and low health literacy. Practice implications Written information with OTC medications in simple language and verbal counselling at dispensaries would play a significant role in increasing the health literacy of especially at risk populations of over-dosing their children.

In South Africa, as in much of the developing world, youth participation in the informal, unregulated street pesticide market results in exposures and risks of acute and chronic effects, yet has gone largely undocumented. A conceptual framework for understanding youth involvement in street pesticide sales and use includes contextual factors, health outcomes, and externalities (unintended negative consequences). An exploratory study based on this framework shows that highly-toxic pesticides, such as aldicarb, methamidophos, and chlorpyrifos, are easily available in informal markets in Cape Town's urban periphery. Youth are involved in the sale, distribution, and use of street pesticides, and are exposed during handling, transportation, spillage, storage, use and other activities, with little safety information available. Demand and supply for street pesticides is driven by joblessness, poverty, and inadequate pest management strategies. National and international efforts addressing underlying contextual determinants are required to protect children from exposures to street pesticides.