Combined Neurodevelopmental and Neurodegenerative Burden: Lifetime DALYs from Pesticide Exposure in MENA Agricultural Communities

Pesticide exposure in agricultural populations poses well-documented neurotoxic risks, yet comprehensive burden of disease assessments remain absent for the Middle East and North Africa (MENA) region—home to 450 million people with intensive agricultural practices. We quantified lifetime disability-adjusted life years (DALYs) attributable to pesticide-induced neurological disorders across 18 MENA countries from 2010–2023, focusing on prenatal neurodevelopmental impacts (intellectual disability from IQ decrements) and adult neurodegenerative disease (Parkinson's disease). Country-specific exposure prevalence was estimated from agricultural employment patterns (occupational pathway) and rural population distributions (environmental pathway), with pesticide application intensity derived from FAO statistics. We applied exposure-response coefficients from prospective birth cohort studies for neurodevelopment and meta-analytic relative risks for Parkinson's disease, calculating population attributable fractions and age-specific burden using Global Burden of Disease methodology. Regional burden reached 568,329 DALYs annually, with Egypt, Yemen, and Algeria accounting for 61% of total impact despite representing 32% of population. Neurodevelopmental burden dominated (90% of DALYs), challenging conventional adult-focused occupational health paradigms. Per-capita burden rates (229–235 DALYs per 100,000 in highest-burden countries) reached magnitudes comparable to lead exposure in contaminated populations, yet receive substantially less policy attention. An apparent inverse relationship between pesticide intensity and Parkinson's disease burden (ρ=-0.35, p = 0.14) was explained by agricultural mechanization confounding rather than causal dose-response: Gulf countries have high pesticide intensity (capital-intensive greenhouse systems) but minimal PD burden (young, urbanized populations with low baseline PD rates). Excluding these outlier countries eliminated the inverse relationship (ρ=+0.28, p = 0.36), though the positive association remained non-significant. These findings establish pesticide neurotoxicity as a major environmental health determinant in MENA, with prenatal and early-life exposure representing critical intervention windows requiring hazard-based chemical restrictions, spatial buffer zones, and occupational health programs targeting aging farmworker populations.