Infants Methemoglobinemia: The Drinking Water Quality in Al-Jabal Al-Akhdar Province, Libya with Particular reference to Nitrate

The use of nitrate-contaminated drinking water to prepare infant formula is a well-known risk factor for infant Methemoglobinemia. Effected infants develop a peculiar blue-gray skin color and may become irritable or lethargic, depending on the severity of their condition. The condition can progress rapidly to cause coma and death if it is not recognized and treated appropriately. In the study area (Al-Jabal Al-Akhdar, Libya) reinforce the need for testing of the water for nitrate concentration levels. So, we have performed the following steps as a mechanism to work: First: The Drinking Water study was conducted between Summer August 2011 and Winter January 2012, in Al-Jabal Al-Akhdar Province, Libya; we have taken the water samples from all the Province regions that were 22 regions (study area), the results shown increased of the nitrates concentration year by year comparing with the previous studies, especially in the winter. There is a significant difference between areas in the nitrate concentration level, where the highest value obtained in the winter was (52.33 mg/l) in the Al Haniya region Well, this value highest than the acceptable standards of Libyan and WHO, the lower value was (10.2 mg/l) in the Samalos region Well. Second: we have searched and investigated in the patients' files during 3 years (2009- 2010- 2011) to know the infant’s Methemoglobinemia prevalence in the study area. Where, we have reviewed the hospitalization records of Al-Bayda Hospital ( the main Hospital in the Province), the results shown that there are not any diagnosed Methemoglobinemia (Confirmed Cases) vs that the results shown that there are 165 (Possible Cases) cyanotic infants undiagnosed (the main symptom of the infants Methemoglobinemia) included 13 death of infants under 5 months . We've noticed that there is a rise in the number of cases of undiagnosed cyanosis among infants year by year. Third: About the Infants Methemoglobinemia disease, we have conducted survey study (Questionnaire) and personal interviews with 53 Pediatricians that have at least 10 years experience, in the study area, the participation rate to all questions was 90.42%, where their opinions were 96.22% reported that they did not diagnosing any case throughout the period of their work, and 84.90% of them answered about the reason, that the disease is rare, 62.26 % reported that there is no any consideration or importance for this disease (at medical conferences, scientific research, etc.) between the local Libyans doctors vs 22.64% rarely that there is importance. 73.58 % of them reported that they have faced a cases of within its symptoms the Cyanosis and the situation developed to death before diagnosed, 79.24 % reported that diagnostic services are unavailable like (Lab investigations) in workplace vs 7.55% available. 3 83.02 % of them have transferred a cases of within its symptoms the cyanosis to the an advanced hospitals. Fourth: We tried finding a link in the study area between the Methemoglobinemia and the nitrates contaminated drinking water, by used the GIS program (Arc Map 10.1 software packages). Until otherwise proven, we can conclude that: 1- There is a slight correlation by using GIS between the disease and nitrates the reason of the data lack because this is the first study on this topic in the country of study (Libya). 2- The disease is rare in the study area. 3- There is undiagnosed Infants cyanosis and there are many of them are transferred to advanced hospitals without we know what happened to these cases, due to poor of the health system. 4- Lack of possibilities diagnostic devices such as laboratory. So, we can assume that the undiagnosed infant’s cyanosis cases (Possible cases) can be Infants Methemoglobinemia disease. We Recommend that: 1- Repair and revive the health system in Libya, using the means of the modern management and application experiences of developed countries in the provision of health services. 2- The need to urge the responsible authorities in the study area to work to provide a database to facing of the problems related to public health as the following: a. Assess the current status of the public water network and reservoirs collecting and the situation of existing wells in the study area. b. Study and evaluate the sewerage network and its status in the study area. c. Identify the characteristics of social and economic activities carried out by the study area residents. d. Census and distribution of populations of different locations in the study area. e. Inventory of the previous studies in the study area, include (geological, hydrogeological and environmental, etc). 3- Conducting prospective studies on the Infants Methemoglobinemia in the study area as the first stage, then study the situation for all Libyan provinces. 4- Provide the diagnostic lab devices such as Methemoglobin blood level measuring devices that not found in all Libyan hospitals. 5- The need to provide electronic systems for medical record-keeping in the hospitals to facilitate the process of researching and documentation. 6- Need to cooperation with scientifically advanced countries such as Italy (it is close to Libya) to develop methods of providing medical services in Libya.