**1. Introduction**

Breastfeeding is admitted to present numerous beneficial health e ffects and it is vastly considered as the best suitable food for the baby [1]. The World Health Organization recommends to exclusively breastfeed for six months after birth [2]. However, the European recommendation varies among countries between four and six of exclusive breastfeeding [3].

In Lebanon and Syria, two Middle Eastern Arab countries sharing almost the same socio-demographic characteristics including religion and language, a percentage of 10% was shown for an exclusive breastfeeding rate at six months [4]. According to the United Nations Children Fund [5], the average of breastfed Syrian infants under six months of age was found to be 43%. The absence of support for breastfeeding by social workers and health care providers were considered the main reasons for low prevalence of exclusive breastfeeding. It could be also due to psychological reasons such as mother's emotional stress and the perceived breast-milk inadequacy [6].

Breast milk is an important source of energy and nutrients for children's health [7]. However, many studies have been conducted to assess the chemical contaminants in breast milk associated with its health e ffects on the infant and the mother. This contamination could occur due the exposure of the nursing mother on a daily basis to chemical pollution of the environment. These environmental chemicals are released from several basic activities and di fferent sources such as water, air, food and manufactured products [8].

Few research studies have reported the presence of antibiotic and pesticide residues in breast milk. It is worth mentioning that studies screening antibiotic residues are rare on the international scale. The latest study conducted in Turkey [9], detected quinolone and beta-lactam residues in human milk samples, with an occurrence of 8/34 (23.5%) and 29/34 (85.2%), respectively. It is to be noted that the lactating mothers enrolled in this study do not have antibiotic history. Antibiotic residues in human milk were thought to derive from the mothers' food such as chicken, meat and dairy products [10].

Additionally, some studies have screened the presence of pesticide residues in breast milk especially organochlorine pesticides [11–15]. The most important study was carried out in China where a wide range of concentrations for 23 organochlorine pesticide (OCP) compounds were detected in 24 pooled samples of breast milk. The dichlorodiphenyltrichloroethane (DDT) contamination in breast milk was the highest with a mean value 582.8 ± 362.7 ng/g. The explanation for such high contamination was mainly from the mother's dietary intake since positive correlation was observed between concentration of DDT in human milk and consumption of animal origin food in the Chinese population [16].

However, to our knowledge no studies have been conducted on Syrian refugee lactating mothers residing in camps especially where the living and environmental conditions are very poor. Moreover, our study is the first conduced in Lebanon, screening antibiotics and pesticide residues in breast milk. Thus, the aim of this study was to assess the occurrence of antibiotic and pesticide residues in the breast milk of Syrian refugee lactating women residing in Lebanon camps. It investigated as well the socio-demographic and nutritional factors associated with milk contamination.

#### **2. Materials and Methods**

#### *2.1. Study Population and Area*

This cross-sectional study was conducted in Syrian refugee camps located in Lebanon, North Lebanon city—Akkar camps. The participants in this study were lactating Syrian refugee mothers residing in camps. In total, 40 women were randomly recruited and invited to participate in the study by providing mature breast milk samples.

### *2.2. Ethical Approval*

The study protocol and ethics of this study were approved by the institutional review board (IRB) code: 2019H-0087-HS-M-0325 (17 January 2019), of Beirut Arab University prior to approaching the participants and a written, signed informed consent was obtained from all participants. All women who volunteered to participate in this study were informed about the purpose of the study and agreed to be part of it.
