MATERIALS AND METHODS

The study area: The survey for this study was conducted in Amman, the Capital of the Hashemite Kingdom of Jordan during the year 2009, the largest city with a population of two million people. The questionnaire was distributed among 205 women with disabled children. Based on the information provided by the 2004 population census, the total number of Jordanians with physical disabilities reached 32,793, amounting to 0.64% of the national population (DOS, 2004). According to the values provided by the DOS, persons with other disabilities represent 1.18% of the Jordanian population. Amman occupies the highest percentages of persons with disabilities across all major governorates in Jordan as it reached 32.3% of the total disabled persons in Jordan (DOS, 2004).

Survey design and implementation: In order to evaluate pregnant women who were using hair dye and gave birth to disabled children in the area of Amman, Jordan a survey in questionnaire form was conducted in the spring of 2009. The aim of this study was to investigate any correlation between using hair dye during pregnancy, type of hair dye, concentrations, application periods, number of hair dye applications during pregnancy and disabled children being born in the family. The survey was distributed among two hundred and thirty women who were using hair dye during their nine month pregnancy and disabled children within the family. Two hundred and five completed surveys were evaluated in this study.

The target population encompassed women in the area of Amman, Jordan who have disabled children within the family. Women with different backgrounds answered the questionnaire which consisted of fifteen questions concerning major issues of applying hair dye during the pregnancy such as: occupation, age when became pregnant with the disabled child, number of times the hair dye was applied during pregnancy, type of hair dye used, number of times the hair was washed during one week period, type and the degree of the child’s disability. The questions were in the form of limited multiple choice answers. The questionnaire was evaluated by professionals for its content, clarity of language and appropriateness of length prior conducting the study survey using an initial draft form. Fifty individuals with a variety of backgrounds, education levels and age from the same regional area were chosen for the draft evaluation. The pre-tested sample was excluded from the actual survey. The questionnaire was subsequently evaluated based on the pre-test and revised to its final format. The test-retest reliability coefficient Cronpanch Alpha (α) was used to test the reliability of the scale and the internal consistency of the questionnaire, which was calculated to be (0.86).

Table 1:	Results of Chi-square test correlation of the type of hair dye used by pregnant women and the level of disability in children born

From the statistical perspective this is a reliable result as it exceeds 0.60 (George and Mallery, 2003).

Raw data from the survey was entered into spreadsheets using Excel. Special records were arranged presenting the progress of work in all surveyed categories. The editing process focused on the completeness and consistency of data in order to minimize any data entry errors.

Chi-square analysis regarding colorations among different parameters were conducted on the means of the sample sets indicating if the apparent differences in the means of the data sets were statistically significant at a level of α = 0.05. The frequencies values from analysis are shown in Table 1. The Statistical Package for Social Sciences (SPSS) was also applied to the 205 completed questionnaires. Analysis were conducted on different parameters. The SPSS program was used to link the disabled children to the use of hair dye during the pregnancy of their mothers.

RESULTS AND DISCUSSION

According to the results of the survey analysis it is clear that the type of hair dye used during pregnancy has a direct impact on the number of disabled children born. From Table 1, it is evident that women who gave birth to children with disabilities were using high rates of organic and mineral hair dyes in comparison with mothers who were using natural hair dye during their pregnancy. This indicates that the usage of mineral and organic hair dye have serious health effects on mothers and their fetus, since the ingredients of such types of hair dye contain concentrated minerals such as lead, mercury and paraphenylene as it penetrates through the blood stream. On the other hand, using natural dyes is safer since these dyes originate from natural sources, however, mineral and industrial agents are added to natural hair dye for the purpose of improving quality and increasing quantities which can lead to kidney failure, body itching, or allergic reaction to humans which is in a complete agreement with studies made by Deepak et al. (2006), who indicated that chemical based dyes can harm health in general.

Table 2:	Results of Chi-square test correlation between the types of hair dye used and the type of disability

Table 3:	Results of Chi-Square test correlation to the degree of disability and repeated hair washing during pregnancy

Gill et al. (2002) indicated that the mercury agent in hair dye ingredients is able to reach the fetus umbilical cord and penetrates to the nerve system. From Table 1 it is clear that the value of Chi-square reached an indicator level less than (0.05) which amounted to (13.69) with probability value of (0.008). The results in Table 1 is in full agreement with Gill et al. (2002) indicating that the usage of mineral hair dye during pregnancy leads to higher frequencies of severe disabilities in children born.

The increase rate of mobility and mental disability is referred to mothers using mineral and organic hair dye as it directly affects the mother’s blood and kidney function. This reflects on the blood cells of the fetus as well as the nerve and sense systems, as the organisms of the fetus are still in the developing stages. For example, impurities in the blood system of the fetus cannot be filtered completely by the fetus’s kidneys due to the small size especially in the first three months of pregnancy. Different types of disabilities such as mobility, deafness, mental, slow learning and others which might occur is shown in Table 2 with the percentages of disabilities from the obtained survey regarding the types of hair dye. In general, high concentrations of heavy metals in hair dye could cause mental disability (Cook et al., 2004) this is in complete agreement with the outcome of the survey as shown in Table 2.

Table 3 shows that women who fail to wash their hair after the use of hair dye frequently and on regular bases delivered children with severe disabilities, while women who repeatedly wash their hair after the use of hair dye gave birth to children with moderate disabilities. This is in a full agreement with Zhang et al. (2008), who indicated that mothers who washed their hair frequently after dyeing reduced the effects of toxic chemicals and the effects on the fetus. The statistical results shown in Table 3 indicate a Chi-square at the level of statistical significances which reached the indicator level of (0.05) and less which amounted to (15.62) with probability value of (0.048). On the other hand, frequencies of the survey showed that women who were washing their hair at the minimum level (1-2 times) resulted in giving birth to children with disability due to the direct impact of hair dye chemicals, this accounted for 42 children out of 202 of individual mothers who participated in the study. Women who washed their hair repeatedly (8 times and more) with total disability occurrences after one year or more were 12 children born with disability; this indicates that less harmful effects of toxic chemicals if hair is washed frequently. Such action leads to reducing the rate of those chemicals in the mother and the blood of her fetus and thus the emergence of subsequent period of disability after child birth. The value of Chi-square at the level of statistical significances reached an indicator level of (0.05) and less which amounted to (35.27) with probability value of (0.000) as shown in Table 4.

Usually, a specialist, or hairdresser at beauty salons would choose the suitable hair dye and perform the process in more professional and timely manner than the use of at-home hair color dye conducted by the woman herself (Hueber-Becker et al., 2007). The results of this study, Table 5 indicates that pregnant women who were dyeing their hair using at-home hair color dye had higher statistical frequencies of disabled children who have more than one disability, this is in comparison to the mothers who have been dyeing their hair at hair salons by hair specialists.

Table 4:	Results of Chi-square test correlation between the number of times of repeated hair wash and when the disabilities occurred

Table 5:	Chi-square test correlation of the places pregnant women dyed their hair and the occurrences of more than one disability in children born

Table 6:	Results of Chi-square test correlations of the time of disability occurrence and the place where the hair was dyed

The statistical significances for these results reached an indicator level of (4.87) with probability value of (0.027) as shown in Table 5.

Mothers who have being dyeing their hair at home gave birth to disable children directly after delivery in comparison with mothers who have been dyeing their hair at hair saloons. This can be attributed to the severity and direct negative results of mislead usage of hair dye at home. Mothers experienced in making the best use of hair dye chemicals are limited in comparison with a hair salon specialist. Mothers tend to care more about the color of their hair resulting from dye materials, the negative impacts of non-compliance in the quantities or the time the dye should remain on the hair while pregnant could have a direct influence on the type and severity of disabled children born. The results shown in Table 6 is in full agreement with the above statement as the value of Chi square at the level of statistical significances reached the indicator level of (0.05) and less which amounted to (20.42) with probability value of (0.000).

Table 7:	Results of Chi-square test in relation between the occurrence of disabilities and the type of hair dye used

The severity of disabilities occurs during pregnancy due to the direct impact of input chemicals on the fetus as the mother is the main and only source of nutrition for complete growth of the child. Table 7 shows that mothers who used mineral hair dye gave birth to disabled children, while others who used organic or natural hair dye gave birth to children whose disabled symptoms occurred after the first year of birth or beyond. This indicates the direct impact and harmful effect of chemicals in hair dye on pregnant women and their fetus. It is clear from Table 7 that the value of Chi square is at a level of statistical significance reaching the indicator level of (0.05) and less which amounted to (13.47) with probability value of (0.009).

Hair dye is usually absorbed through the scalp and into the body identified through urine tests. Some medical experts are hesitant to give carte blanche to hair coloring during all stages of pregnancy. Often, many physicians advise holding off coloring hair with permanent dyes during the first trimester when pregnant woman and the fetus is undergoing important neurological developments. Coloring can then be resumed in the second or third trimester. The results of the statistical analysis in this research is in full agreement with the above statements as shown in Fig. 1, the earlier the application of hair dye during pregnancy the more harm and more risk on the fetus development with disabilities. The value of Chi-square is at level of statistical significances reaching the indicator level of (0.05) and less which amounted to (22.13) and a probability value of (0.014), indicating a direct relationship between the period of hair dye used during pregnancy and the severity of the disability.

Fig. 1:	The degree of disability of born children and the time mothers used hair dye during pregnancy

DISCUSSION

The results of the survey analysis indicated that women who gave birth to children with disabilities were using high rates of organic and mineral hair dyes in comparison with mothers who were using natural hair dye during pregnancy. The type of hair dye used during pregnancy (organic, mineral, or natural) has a direct impact on the number and severity of disabled children born. The statistical analysis of the study revealed that the earlier the application of hair dye during pregnancy (first trimester, second trimester, etc.) the more harm and more risk on the fetus development with disabilities. Women who fail to wash their hair after the use of hair dye frequently and on regular bases delivered children with severe disability, while women who repeatedly washed their hair after the use of hair dye gave birth to children with moderate disability. Mothers who have being dyeing their hair at home gave birth to disable children directly after delivery in comparison with mothers who have been dyeing their hair at hair salons. The results of this study indicates that pregnant women who were dyeing their hair using at-home hair color dye had higher statistical frequencies of disabled children who have more than one disability, this is in comparison to the mothers who have been dyeing their hair at hair salons by hair specialists.

As a result of this research and in order to prevent the possibilities of disabled children born due to the mother’s usage of hair dye during pregnancy the following recommendations are provided: