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SAMJ: South African Medical Journal

versão On-line ISSN 2078-5135
versão impressa ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.107 no.10 Pretoria Out. 2017 



Bibliometric trends of South African environmental health articles between 1998 and 2015: Making local research visible and retrievable



C Y WrightI, II; F DominickIII; Z KuneneIV; T KapwataV; R A StreetI, VI

IPhD; Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
IIPhD; Department of Geography, Geoinformatics and Meteorology, Faculty of Natural and Agricultural Sciences, University of Pretoria, South Africa
IIIBSc; Ludwig Maximilian University of Munich, Germany
IVBCur Hons; Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
VMSc; Environment and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
VIPhD; Discipline of Occupational and Environmental Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa





BACKGROUND. South Africa (SA) has to grapple with multiple burdens of disease for which environmental factors have a role to play in both causation and prevention. This article describes a bibliometric review of environmental health indexed literature for SA over an 18-year period.
OBJECTIVES. To provide an overview of the nature of SA-based published environmental health indexed research and to identify search challenges, frequently researched topics, and gaps and opportunities for future research.
METHODS. The Web of Science, PubMed and Science Direct were used to search for original, peer-reviewed and review articles with the inclusion criteria 'environmental health' and 'South Africa' available online and published between 1998 and 2015, inclusively.
RESULTS. A total of 230 journal articles were included in the bibliometric analysis. The highest number of articles (n=54) was published in 2015. The majority of the first authors were affiliated with SA institutions (n=160, 69.5%). For the articles where funding was explicitly declared (n=148), the three most frequently occurring agencies that funded the published research were the National Research Foundation in SA (n=17), the South African Medical Research Council (n=13) and the Water Research Commission (n=9). There was little inter-annual/ environmental health category variation over time owing to the relatively small sample size. The largest number of retrieved journal articles was in the area of environmental pollution control (n=76), followed by environmental health lifestyle and behaviour-related topics (n=42) and then water monitoring (n=26).
CONCLUSIONS. Despite the research needed to solve large environmental health challenges in SA, environmental health was only used as a keyword in title, author keywords or abstract for 230 SA-based studies over an 18-year period. This makes it extremely difficult for environmental health research to be located and used to inform the profession as well as the research agenda. Several issues that environmental health practitioners are typically tasked to implement and monitor are not indexed as environmental health topics. The need for authors to use 'environmental health' as a keyword is emphasised, particularly if research is to inform decision-making and policy support, as well as guide future research in the country.



Worldwide, an estimated 12.6 million deaths each year are attributed to an unhealthy environment.[1] Environmental risk factors (unsafe water, inadequate sanitation and hygiene, indoor air pollution from solid fuel use, urban outdoor air pollution, and lead exposure) were associated with 5% of all deaths in South Africa (SA) in 2000. The joint attributable burden was high in children aged <5 years, with nearly 11% of total deaths in this age group.[2] Many of these deaths could be prevented by appropriate public health interventions.

Despite the pressing environmental health problems in SA, no research has assessed the bibliometric characteristics of environmental health research in the country. Such studies have been done for other sciences[3] and for a specific topic[4] or disease,[5] but not for environmental health research as a whole in SA. A bibliometric assessment provides patterns of publications within a field of study or body of literature. It can help decipher overall patterns in research, indicate where and how to find the articles, and provide direction for future research. The World Health Organization defines environmental health as those aspects of human health and disease that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.'61



To provide an overview of the nature of published SA environmental health indexed research over an 18-year period and to identify search challenges, frequently researched topics, and gaps and opportunities for future research.



Search procedures

We used an adapted version of the bibliometric analysis methodology applied by Pouris and Pouris[4] and Chuang et al.[3] The literature search was conducted in March 2016 in three electronic databases: the Institute for Scientific Information (ISI) Web of Science Citation Index Expanded (SCI-Expanded), the US National Library of Medicine/National Institutes of Health PubMed (, and Science Direct ( The search for published articles was limited to between the years 1998 and 2015, inclusively. Search terms were 'environmental health' (the Medical Subject Headings (MeSH)) exact thesaurus term match for environmental health[7]) AND 'South Africa'. In Web of Science, limits were set for the search in all databases for article, other and review, in Science Direct, restrictions were set in journals for article, review article, short survey and discussion, and in PubMed, limits were set for the time period and for all fields and types of articles.

Inclusion criteria

Full-text articles that met inclusion criteria similar to those used by Chuang et al.,[3] available online through an open-access platform or via two of the authors' institutional libraries, were included in the dataset for review (Table 1). Both search terms needed to appear in the title or author keywords or abstract. First the article title, then the abstract of the article and the aim/hypothesis/objective(s) in the introduction were reviewed to determine relevance to the topic 'environmental health' and 'South Africa'. In addition, the article had to focus on an SA issue or an SA study site. The article was excluded if the study was only done by an SA institution and not at an SA study site. Review articles were included. For cross-checking purposes, an independent double check was made by two different researchers regarding whether or not to include an article in the study. Where the researchers did not agree, two additional researchers reviewed the article and a final decision was made whether to include or exclude the article based on the defined inclusion criteria.

Article processing and categorisation

Bibliometric characteristics of all retrieved articles were downloaded into a Microsoft Excel spreadsheet (Microsoft Office Professional Plus 2013, Microsoft, USA), and each article was given a unique identity number. Downloaded information, as suggested by Carpenter et al.,[8] included names of authors, title of article, year of publication, name of the journal in which the article was published, and, in accordance with the visibility metric applied by similar bibliometric studies in South Africa,[4,9] its 2016 ISI impact factor (extracted from the Journal Citation Reports Journal 2016 Impact Factor List), affiliation of first author, country of first author, and whether the article was a research article or a review. The articles were also allocated to one of the environmental health subcategories based on the scope of practice of environmental health practitioners in SA[10] (Table 2). A brief description of each subcategory is provided to illustrate the complexity of subcategories in this field of public health. We used these categories rather than the ISI Web of Science subject categories[3] because in SA environmental health research aims to serve the profession and the country, as well as contribute to international knowledge.

Four subcategories emerged during the article processing stage, namely lifestyle/behaviour, climate change, sustainable development and occupational health. The latter is probably an erroneous finding (occurring where occupational health and environmental health were mentioned), but we have included it for illustration purposes, and this will be explained in the discussion.

For completeness, an independent double allocation to the subcategories by two different researchers was conducted in April 2016. Again, when the two researchers did not agree on an article's topic allocation, the same two additional researchers who had already reviewed several articles for the final decision whether to include or exclude the article based on the defined inclusion criteria also reviewed the article for the appropriate category. Finally, a decision was made on the journal article's appropriate category.

Data processing and statistical analysis

After processing and categorisation, the articles spreadsheet was prepared for export into Stata 14 (StataCorp, USA) for further analysis. Descriptive statistics were explored regarding individual variables and relations between several variables. Variables included number of articles published per year, journal names and number of articles per journal, number of different main-author countries, number of articles per category of environmental health research, and number of review articles v. research articles. Comparisons of bibliometric characteristics are discussed and interpreted as numbers and percentages.



Bibliometric description of the sample

A total of 1 182 articles were retrieved. After removing all duplicates (n=99), there were 1 083 articles remaining for critical review. These articles were scrutinised and 853 were excluded after reading the title, abstract, aim, hypothesis and objectives in the introduction showed that the focus of the article was not in fact environmental health related to an SA-specific (in-country) issue or an SA study site. The total number of articles remaining was 230 (Appendix 1).

The number of published articles by year and cumulatively during the 10-year period is shown in Fig. 1. No more than 30 relevant articles were retrieved per year, except for 2015. The highest number of retrieved articles was published in 2015 (n=54), followed by 2014 with 28 articles published. Of the total, 79.0% of retrieved articles were original research articles and the remaining 49 were review articles.



Ninety-one different institutions, including national and international institutions, were represented in the sample of first authors' first reported affiliation. The majority of the retrieved articles' first authors were affiliated with SA institutions (n=160, 69.5%). The highest-numbering first author's first affiliation was the University of Cape Town (n=50), followed by the University of KwaZulu-Natal (n=31), the South African Medical Research Council (SAMRC) (n=14) and Tshwane University of Technology (n=15). Across all years, the province with the most articles was the Western Cape (n=51), followed by Gauteng (n=49).

The USA was the country with the greatest number of first authors after SA, followed by the UK. Only three other sub-Saharan African countries were represented by first authors, namely Tanzania, Zimbabwe and Egypt (Table 3). The London School of Hygiene and Tropical Medicine was the non-SA first author main affiliation with the highest number of retrieved articles (n=4) in the study.



The 230 retrieved articles included in the study were published in 130 different journal titles. The journal wi6t0h the most retrieved articles was Environmental Research (n=10), followed by NeuroToxicology (n=9), Environment International (n=7), The Lancet (n=6) and Science of the Total Environment (n=6). The Thomson Reuters 2016 impact factors of the journals ranged from 1.06 (Journal of Occupational and Environmental Hygiene) to 44.00 (The Lancet) (Fig. 2). The majority (n=185, 80.4%) of the journals had an impact factor of <4 and only 9 had impact factors of >10.



For the retrieved articles where funding was explicitly mentioned (n=148), the three most frequently mentioned agencies were the National Research Foundation in SA (n=17), the SAMRC (n=13) and the Water Research Commission (n=9).

Fig. 3 provides a description of the impact factors of the 230 articles by nationality. There was a smaller number of non-SA first authors (n=67) compared with SA first authors (n=163). However, the articles published by non-SA first authors were generally published in journals with higher impact factors.



Number of retrieved articles by environmental health sub-categories

The review and analysis of the retrieved articles were based on the subcategories for environmental health as defined in the Scope of Practice for Environmental Health Practitioners[10] practising in SA. Fig. 4 is a count of the total number of publications in each of the 20 categories. Table 2 (right-hand column) shows that the largest number of retrieved journal articles was in the area of environmental pollution control (n=76, 33.0%), followed by the newly defined subcategory of lifestyle and behaviour-related topics (n=42, 18.2%), and then water monitoring (n=26, 11.3%). There was no trend in the pattern of article frequency within these (or any of the other) environmental health subcategories by year, except perhaps for a slight step change between 2009 and 2010 for articles retrieved and categorised in the lifestyle and behaviour category. Environmental pollution control (category 7) and lifestyle/behaviour (category 15) had the highest number of publications for the period 1998 - 2010 (Fig. 5).





Statistical analysis

Linear regression was run to assess the relationship between time (1998 - 2015) and the number of publications over that period. There was a strong positive correlation that the relationship between time and impact factors; although r2was lower (0.5284), p was still <0.001, showing a statistically significant association (Table 4).




This bibliometric exercise aimed to identify published research articles on SA-related environmental health issues and to identify research gaps and opportunities for future research. We set out to determine which environmental health themes are most often published, in which institutions the work is being carried out and by whom, and the suite of journals in which environmental health science related to SA is being published. Our goal was to identify the research gaps in the light of the current environmental health challenges facing SA and to highlight opportunities for future research, especially through the use of existing and big data that we hope will help environmental health surveillance and disease tracking. However, as we progressed through the interpretation of the study findings, it became clear that a number of important, non-research-related issues that pertained to aligning accessibility of science to the profession of the science were as important.

From the retrieved studies in our dataset, the annual number of environmental health/SA-related articles has increased over the past 18 years. Several factors may have contributed to this increasing trend. For example, availability of research funding to support environmental health projects may have increased, and there may have been more postgraduate students at local universities completing projects and publishing their findings. Interestingly, despite the pressing concern of climate change effects on human health, and the key role of environmental health in this research domain, only two studies were retrieved that considered long-term climatic impacts on environmental health. The absolute number of articles retrieved and that met our inclusion criteria seemed low (n=230) for an 18-year period. We compared our findings with a similar 10-year European bibliometric study[11] in which 6 329 articles were included and found that their total represented articles published by 29 countries, so when this figure is averaged by number of countries, on average each country produced 218 articles over 10 years, which is comparable to our findings (despite the European study using a set of MeSH terms including 'environmental health', 'environmental exposure', 'environmental illness' or 'environmental epidemiology').

In our study, we used the MeSH exact thesaurus term match of 'environmental health'. There are nine phrase matches, and the MeSH tree for environmental health includes three terms, namely 'health physics', 'sanitation engineering' and 'sanitation'. Furthermore, the MeSH terms for 'environment and public health' closely follow the subtopics of environmental health, such as food inspection and environmental pollution, compared with those for environmental health. This poses a dilemma for researchers and others searching for the latest published environmental health topics, since the net of words one needs to apply in the search is large and complex. In bibliometric study of public health research in Africa, <5% of authors added the phrase 'public health' to the author keywords list, even though the subject or subcategory subject fell into public health. [3] Frequently authors referred to a specific disease in the keywords.

More than two-thirds of the retrieved articles were led by an author affiliated to an SA institution, with the University of Cape Town the most prolific. Similarly, the University of Cape Town was also the most prolific institution in Africa in terms of collaborating on article publication with other African countries between 2007 and 2011. The majority of retrieved articles were published in international journals with an impact factor of <4 (and ~45% had impact factors of <2). While the impact factor is only one publication metric expressing the impact of research (other metrics exist, but in the present SA academic climate the impact factor holds as much weight as Department of Higher Education accreditation with regard to subsidy for article publication), these low figures do pose the question whether SA environmental health science is visible and accessible nationally and internationally. If this is not currently the case, researchers should consider ways in which to make it so, to ensure that local research can also have an influence in other low- and middle-income countries where environmental health issues are paramount.

Categorisation of the retrieved articles into environmental health subcategories research revealed that one-third of articles were related to environmental pollution and its control. Environmental pollution, i.e. water, air and soil pollution, is a challenging environmental health problem, particularly in countries with high levels of inequality and poverty such as SA. Relatively small numbers of articles were retrieved in the other subcategories, but this does not necessarily mean that they are under-researched. They may be, but it is more likely that they are indexed using different keywords, such as meat science for 'food control', and therefore do not appear in a search for environmental health. The example for occupational health was that one study with environmental and occupational health focus was included in our dataset. Occupational health is not a true subcategory of environmental health; it is its own field. In several studies where occupational health issues are concerned with environmental parameters, such as air pollution in an open-cast mine, environmental health concerns exist, but they fall under the jurisdiction of the mine safety, environment and health officer, and not the environmental health practitioner (EHP), who is tasked with community environmental health services. Nevertheless, the research may be relevant to the EHP and it would therefore be helpful if such articles were accessible when searching for pollution control as a subcategory of environmental health. Noise pollution, although a part of environmental health, did not appear in our dataset of retrieved studies, probably owing to lack of the words 'environmental health'. Such studies do exist for SA, such as a study that considered the environmental footprint of aircraft noise exposure at Cape Town International Airport.[12] Of all the environmental health subcategories, it seems that 'disposal of the dead' is possibly the least researched topic.

Study limitations

Our searches were made in three indices, which may not include several local SA journals that also publish articles on environmental health and its subcategories for SA sites. These articles would not have been included here.

An important limitation is that the use of the keyword 'environmental health' is likely not to include all articles related to environmental health. For example, if studies used 'prevention', 'intervention' or a specific disease name such as schistosomiasis, without mentioning 'environmental health' anywhere in the title, abstract or author keywords, the article would not have been retrieved. Studies on malaria control or noise pollution, which are highly relevant to environmental health, are unlikely to be indexed as such. Either all environmental health-related articles should be indexed with 'environmental health', or when someone searches for environmental health topics, the search should be targeted to a subcategory topic of environmental health without that term. If this bibliometric review for SA were to be repeated, it is recommended that all environmental health MeSH terms should be explored.

A local limitation may also relate to a change in government terminology from 'municipal health services' to 'environmental health services' in the 2000s. This could have affected the search return for articles published in the 1990s, when 'municipal health services' may have been used. Future research may also consider using the Social Science Citation Index, since environmental health perceptions and psychologies may be described in studies published by the social sciences in addition to the natural and health sciences.



Environmental health research in SA and beyond spans a range of complex subjects and fields. With the emphasis on multi-and interdisciplinary research to solve multifaceted problems, it is paramount that the research be retrievable and visible. This bibliometric review highlights the importance of standardised keywords across the environmental health research sector. The steady growth in research output, particularly in the past 3 years, is promising. The most frequently published field from our findings was environmental pollution control, which remains high on the SA policy agenda. As evident by first author publishers, the interest of the USA and UK in SA environmental health issues should be encouraged further through research collaboration. However, this study also highlights environmental health research collaborations that need to be nurtured.

Acknowledgements. We thank Nokulunga Cele and Patricia Albers for their assistance with data collection and preparation.

Author contributions. CYW conceptualised the study; FD performed the data collection and analysis; CYW, ZK and TK and RAS assisted with data analysis and presentation; CYW wrote the manuscript; and all co-authors contributed to its finalisation.

Funding. CYW and RAS receive funding from the South African Medical Research Council and the National Research Foundation.

Conflicts of interest. None.



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C Y Wright

Accepted 25 April 2017



Appendix 1. Articles included in this review

Abalu G, Hassan R. Agricultural productivity and natural resource use in southern Africa. Food Policy 1998;23(6):477-490.        [ Links ]

Abbott J. The use of GIS in informal settlement upgrading: Its role and impact on the community and on local government. Habitat Int 2003;27(4):575-593.        [ Links ]

Agenbag MH, Lues L, Lues JF. Compliance of local government towards controlling the informal milk-producing sector in South Africa. Int J Environ Health Res 2009;19(5):379-388.        [ Links ]

Albers P, Voyi K, Wright CY, Mathee A. Household fuel use and child respiratory ill health in two South African towns, Mpumalanga. S Afr Med J 2015;205(7):573-577.        [ Links ]

Allison MC. Balancing responsibility for sanitation. Soc Sci Med 2002;55(9):1539-1551.        [ Links ]

Ammar MG. Evaluation of the Green Egyptian Pyramid. Alexandria Eng J 2012;51(4):293-304.        [ Links ]

Andersson E, Westberg H, Bryngelsson IL, Magnuson A, Persson B. Cancer incidence among Swedish pulp and paper mill workers: A cohort study of sulphate and sulphite mills. Int Arch Occup Environ Health 2013;86(5):529-540.        [ Links ]

Andrade-Rivas F, Rother HA. Chemical exposure reduction: Factors impacting on South African herbicide sprayers' personal protective equipment compliance and high risk work practices. Environ Res 2015;142:34-45.        [ Links ]

Andriessen R, Snetselaar J, Suer RA, et al. Electrostatic coating enhances bioavailability of insecticides and breaks pyrethroid resistance in mosquitoes. Proc Nat Acad Sci U S A 2015;112(39):12081-12086.        [ Links ]

Aneck-Hahn NH, Schulenburg GW, Bornman MS, Farias P, de Jager C. Impaired semen quality associated with environmental DDT exposure in young men living in a malaria area in the Limpopo Province, South Africa. J Androl 2007;28(3):423-434.        [ Links ]

Arjoon A, Olaniran AO, Pillay B. Enhanced 1,2-dichloroethane degradation in heavy metal co-contaminated wastewater undergoing biostimulation and bioaugmentation. Chemosphere 2013;93(9):1826-1834.        [ Links ]

Azimoh CL, Klintenberg P, Wallin F, Karlsson B. Illuminated but not electrified: An assessment of the impact of Solar Home System on rural households in South Africa. Appl Energy 2015;155:354-364.        [ Links ]

Baatjies R, Lopata AL, Sander I, et al. Determinants of asthma phenotypes in supermarket bakery workers. Eur Respir J 2009;34(4):825-833.        [ Links ]

Baatjies R, Meijster T, Heederik D, Sander I, Jeebhay MF. Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa. Occup Environ Med 2014;71(12):811-818.        [ Links ]

Bachmann MO, Makan B. Salary inequality and primary care integration in South Africa. Soc Sci Med 1997;45(5):723-729.        [ Links ]

Barkemeyer R, Comyns B, Figge F, Napolitano G. CEO statements in sustainability reports: Substantive information or background noise? Account Forum 2014;38(4):241-257.        [ Links ]

Barnes B, Mathee A, Moiloa K. Assessing child time - activity patterns in relation to indoor cooking fires in developing countries: A methodological comparison. Int J Hyg Environ Health 2005;208(3):219-225.        [ Links ]

Barnes BR. The politics of behavioural change for environmental health promotion in developing countries. J Health Psychol 2007;12(3):531-538.        [ Links ]

Barten F, Santana VS, Rongo L, Varillas W, Pakasi TA. Contextualising workers' health and safety in urban settings: The need for a global perspective and an integrated approach. Habitat Int 2008;32(2):223-236.        [ Links ]

Batterman S, Chernyak S, Gouden Y, Hayes J, Robins T, Chetty S. PCBs in air, soil and milk in industrialized and urban areas of KwaZulu-Natal, South Africa. Environ Pollut 2009;157(2):654-663.        [ Links ]

Batterman S, Su FC, Jia C, Naidoo RN, Robins T, Naik I. Manganese and lead in children's blood and airborne particulate matter in Durban, South Africa. Sci Total Environ 2011;409(6):1058-1068.        [ Links ]

Batterman SA, Chernyak SM, Gounden Y, Matooane M, Naidoo RN. Organochlorine pesticides in ambient air in Durban, South Africa. Sci Total Environ 2008;397(1-3):119-130.        [ Links ]

Bekker JL, Hoffman LC, Jooste PJ. Knowledge of stakeholders in the game meat industry and its effect on compliance with food safety standards. Int J Environ Health Res 2011;21(5):341-363.        [ Links ]

Bell ML, O'Neill MS, Cifuentes LA, et al. Challenges and recommendations for the study of socioeconomic factors and air pollution health effects. Environ Sci Policy 2005;8(5):525-533.        [ Links ]

Bischel HN, Özel Duygan BD, Strande L, McArdell CS, Udert KM, Kohn T. Pathogens and pharmaceuticals in source-separated urine in eThekwini, South Africa. Water Res 2015;85:57-65.        [ Links ]

Bond P. Basic infrastructure for socio-economic development, environmental protection and geographical desegregation: South Africa's unmet challenge. Geoforum 1999;30(1):43-59.        [ Links ]

Bornman M, Schlemmer L, van der Walt T, van Dyk C, Bouwman H. Implications for health education and intervention strategies arising from children's caregivers concerns following successful malaria control. Trans R Soc Trop Med Hyg 2012;106(7):408-414.        [ Links ]

Bornman R, de Jager C, Worku Z, Farias P, Reif S. DDT and urogenital malformations in newborn boys in a malarial area. BJU Int 2010;106(3):405-411.        [ Links ]

Bourne LT, Harmse B, Temple N. Water: A neglected nutrient in the young child? A South African perspective. Matern Child Nutr 2007;3(4):303-311.        [ Links ]

Cameron J, Jagals P, Hunter PR, Pedley S, Pond K. Economic assessments of small-scale drinking-water interventions in pursuit of MDG target 7C. Sci Total Environ 2011;410-411:8-15.        [ Links ]

Chanda RR, Fincham RJ, Venter P. A review of the South African food control system: Challenges of fragmentation. Food Control 2010;21(6):816-824.        [ Links ]

Channa K, Odland JO, Kootbodien T, et al. Differences in prenatal exposure to mercury in South African communities residing along the Indian Ocean. Sci Total Environ 2013;463-464:11-19.        [ Links ]

Chelule PK, Mbongwa HP, Carries S, Gqaleni N. Lactic acid fermentation improves the quality of amahewu, a traditional South African maize-based porridge. Food Chem 2010;122(3):656-661.        [ Links ]

Clark CS, Rampal KG, Thuppil V, et al Lead levels in new enamel household paints from Asia, Africa and South America. Environ Res 2009;109(7):930-936.        [ Links ]

Collins JF, Salmon AG, Brown JP, Marty MA, Alexeeff GV Development of a chronic inhalation reference level for respirable crystalline silica. Regul Toxicol Pharmacol 2005;43(3):292-300.        [ Links ]

Couth R, Trois C. Carbon emissions reduction strategies in Africa from improved waste management: A review. Waste Manag 2010;30(11):2336-2346.        [ Links ]

Cranston I, Potgieter N, Mathebula S, Ensink JHJ. Transmission of Enterobius vermicularis eggs through hands of school children in rural South Africa. Acta Trop 2015;150:94-96.        [ Links ]

Credé S, Sinanovic E, Adnams C, London L. The utilization of health care services by children with foetal alcohol syndrome in the Western Cape, South Africa. Drug Alcohol Depend 2011;115(3):175-182. https://doiorg/10.1016/j.drugalcdep.2010.10.019        [ Links ]

Criswell SR, Nelson G, Gonzalez-Cuyar LF, et al. Ex vivo magnetic resonance imaging in South African manganese mine workers. Neurotoxicology 2015;49(July):8-14.        [ Links ]

Dabrowski JM, Shadung JM, Wepener V. Prioritizing agricultural pesticides used in South Africa based on their environmental mobility and potential human health effects. Environ Int 2014;62:31-40. https://doiorg/10.1016/j.envint.2013.10.001        [ Links ]

Dalal S, Holmes MD, Laurence C, et al. Feasibility of a large cohort study in sub-Saharan Africa assessed through a four-country study. Global Health Action 2015;8(1):27422.        [ Links ]

Dalvie MA, Africa A, London L. Change in the quantity and acute toxicity of pesticides sold in South African crop sectors, 1994 - 1999. Environ Int 2009;35(4):683-687.        [ Links ]

Dalvie MA, Africa A, Naidoo S. Relationship between firewood usage and urinary Cr, Cu and As in informal areas of Cape Town. S Afr Med J 2014;104(1):61.        [ Links ]

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