Assessment of prevalence of elevated blood lead levels and risk factors among children and pregnant women in Bihar, India

BACKGROUND

While modeled estimates and studies in contaminated areas indicate high lead exposure among children in Bihar, India, local data on lead exposure in the child population is limited.

OBJECTIVES

To characterize lead exposure, and assess potential sources of lead exposure among a state-representative sample of children and their pregnant mothers residing in Bihar.

METHODS

Blood samples were collected from 697 children under five and 55 pregnant women from eight districts in Bihar. Blood lead levels were determined using capillary blood and a portable lead analyzer. Household demographics, home environment, behavior, and nutrition information were collected through computer-assisted personal interviews with primary caregivers. Logistic regression was used to assess associations between potential risk factors and elevated blood lead levels.

RESULTS

More than 90% of children and 80% of pregnant women reported blood lead levels ≥5 μg/dL. Living near a lead-related industry and pica behavior of eating soil were significantly associated with increased odds of having elevated blood lead levels. Additional risk factors for having a blood level ≥5 μg/dL included the use of skin lightning cream (aOR = 5.11, 95%CI: 1.62, 16.16) and the use of eyeliners (aOR = 2.81, 95%CI: 1.14, 6.93). Having blood lead levels ≥10 μg/dL was also significantly associated with the household member who had an occupation or hobby involving the use of lead (aOR = 1.75, 95%CI: 1.13, 2.72).

DISCUSSION

Elevated blood lead levels were prevalent among children and pregnant women in Bihar, indicating the urgent need for a comprehensive lead poisoning prevention strategy.

Toxicity and bioremediation of the lead: a critical review

Lead is a naturally occurring, bluish-gray metal that is found in small quantities in the earth's crust. The existing literature demonstrates that non-biodegradable character and continuous use results in accumulation of lead concentration in the environment and causes various ill effects such as neurotoxicity, change in psychological and behavioral development of different organisms. Nowadays the most effective technique in the revival of the environment is bioremediation and it is environmentally friendly and cost-effective. Bacterial strains such as Oceanobacillus profundus and Lactobacillus acidophilus ATCC4356 have the ability to reduce lead 97% and 73.9%, respectively. Similarly some species of algae and fungal strains also showed lead removal efficiency as 74% (spirulina), 97.1% (Chlorella kessleri), 95.5% (Penicillium janthinillum) and 86% (Aspergillus flavus). Biodegradation of lead by various microbes would be the most efficient and sustainable approach. This review focuses on toxicity, fate of lead in the environment and its microbial degradation.

Assessment of Blood Lead Level of School Children in 10 Cities of India: A Cross-Sectional Study

OBJECTIVES

To assess the blood lead level (BLL) of school children in 10 cities of India.

METHODS

This multi-centric cross-sectional study enrolled participants from randomly selected schools. Data on demographic details, socioeconomic status (SES) and anthropometric indicators was collected. Samples were collected for assessment of lead level in blood. Inductively coupled plasma-optical emission spectrometry technique was used to assess BLL.

RESULTS

From April 2019 through February 2020, 2247 participants were recruited from sixty schools (62.6% government schools) with equal gender distribution. The overall median (interquartile range) BLL was 8.8 (4.8, 16.4) µg/dl. The highest median (interquartile range) BLL was in Manipal 30.6 (23.0, 46.7) and lowest in Dibrugarh 4.8 (3.2, 7.0). Overall, 82.5% of participants had BLL above ≤4 µg/dl. Significant negative correlation was observed between BLL and SES (correlation= -0.24, p <0.001), anthropometric indicators (correlation= -0.11, p <0.001), hemoglobin level (correlation= -0.045, p = 0.03) and multivariate regression model showed association with gender, SES and anthropometric indicators.

CONCLUSIONS

BLL are elevated in urban school going children and there is intercity variation. Hence, urgent focus is needed to reduce exposure to lead in India.

Plant-Based Dietary Practices and Socioeconomic Factors That Influence Anemia in India

While rates of malnutrition have declined over the last decade in India due to successful government interventions, the prevalence of anemia remains high. Staple foods provide almost 70% of the daily iron intake. As staple foods are a rich source of phytate, this ingested iron is poorly absorbed. Currently, 59% of children below 3 years of age, 50% of expectant mothers and 53% of women aged 15-19 years are anemic. The most common intervention strategy has been through the use of iron supplements. While the compliance has been low and supplies irregular, such high rates of anemia cannot be explained by iron deficiency alone. This review attempts to fit dietary and cooking practices, field-level diagnostics, cultural beliefs and constraints in implementation of management strategies into a larger picture scenario to offer insights as to why anemia continues to plague India. Since the rural Indian diet is predominantly vegetarian, we also review dietary factors that influence non-heme iron absorption. As a reference point, we also contrast anemia-related trends in India to the U.S.A. Thus, this review is an effort to convey a holistic evaluation while providing approaches to address this public health crisis.

Dose and duration-dependent toxicological evaluation of lead acetate in chicks

Lead is one of the utmost contaminated and dangerous heavy metals. This toxicant ultimately enters into the human body through the food chain and accumulated in the body because the animal/human body has not an appropriate mechanism to excrete it from the body. The main objective of the present research was to assess the toxicological effects of lead on body weights, biochemical, and hematological parameters of chickens and also to measure its bioaccumulation in the brain. Lead acetate was administrated orally at doses of 0, 71, 142, 213, and 284 mg/kg of body weight of chicken for groups A, B, C, D, and E, respectively. Along with determination of biometry of all experimental chicks, hematological [hemoglobin (Hb), packed cell volume (PCV), mean corpuscular hemoglobin concentration (MCHC), total erythrocyte count (TEC), white blood cells (WBCs), leukocyte differential count (LDC)] and biochemical [low density lipoprotein (LDL), total protein, high-density lipoprotein (HDL), and alanine aminotransferase (ALT)] parameters were measured. The present study showed that the bodyweight of chickens was not affected significantly by lead acetate exposure. The levels of MCHC, PCV, TEC, Hb, LDL, HDL, and total protein were found to be significantly decreased while WBC, LDC, and ALT profile were enhanced due to administration of lead acetate. Bioaccumulation of lead acetate was found to be higher in the brain. We conclude that the chronic administration of lead acetate affected the blood and biochemical profile of exposed chicken. These effects might be due to the accumulation of the chemical in certain vital organ(s). However, further studies in the future are suggested to refine such findings.

Blood Lead Levels in Children Living Near an Informal Lead Battery Recycling Workshop in Patna, Bihar

BACKGROUND

Lead can cause significant biological and neurologic damage, even at small concentrations, and young children are at higher risk. Informal recycling of lead batteries and lead-based workshops/industries have increased the burden of lead toxicity in developing countries, including India. Many informal recycling lead battery workshops have been established by the local people of Patna, Bihar as self-employment opportunities. However, most of the residents are not aware of the risk factors associated with lead poisoning.

OBJECTIVES

The present pilot study aimed to assess blood lead levels (BLLs) and hemoglobin levels among children aged between 3 to 12 years in the settlement of Karmalichak near Patna, India.

MATERIALS AND METHODS

Children residing near the informal lead battery manufacturing unit were selected for BLL assessment. A total of 41 children were enrolled in the questionnairebased survey.

RESULTS

All the children in the present study had detectable lead concentrations in their blood. Only 9% of the studied children had a BLL ≤5 μg/dl, while 91% children had a BLL above >5 μg/dl.

CONCLUSIONS

The present study carried out in children of Karmalichak region of Patna, India was an attempt to better understand the problem of lead toxicity, describe the epidemiology of its adverse effects, identify sources and routes of exposure, illustrate the clinical effects and develop strategies of prevention so that remedial measures may be taken by government agencies and regulatory bodies. In view of the high lead levels in children in the study area, attempts are being made to develop strategies for future prevention by relocating the informal battery recycling workshops from the area. Moreover, parents have been advised to increase nutritional supplementation of children by providing calcium-, iron- and zinc-rich foods, including milk and vegetables.

PARTICIPANT CONSENT

Obtained.

ETHICAL APPROVAL

The study was approved by the ethical committee of Era's Lucknow Medical College & Hospital, Era University, Lucknow (India).

COMPETING INTERESTS

The authors declare no competing financial interests.

Lead as a Risk Factor for Osteoporosis in Post-menopausal Women

Lead exposure is increasingly becoming an important risk factor for osteoporosis. In adults, approximately 80-90 % of absorbed lead is stored in the bones. These bone lead deposits are released into the blood during periods of enhanced bone resorption like menopause, forming a potential endogenous source of lead exposure. Postmenopausal women are at a higher risk for bone lead release because of hormonal and age related changes in bone metabolism. Estrogen deficiency is associated with increase in osteoclasts number and activity leading to both the early and late form of osteoporosis. Hence, high blood lead level coupled with concomitant environmental exposure exposes women in this age group to lead related adverse outcomes like hypertension, reduced kidney and neurocognitive functions as well as increased risk of atherosclerosis and cardiovascular mortality. A few studies have also identified coexisting variates like ethnicity, occupation, residence, education, smoking, alcohol medications, water etc. as significant determinants of bone and blood lead in women, thus increasing the magnitude of postmenopausal bone changes. Hence, interventions focused on reducing the intensity of bone resorption during menopause will help decrease exposure to endogenous lead. This would play a significant role in decreasing the morbidity and mortality associated with menopause. Also, identification of modifiable factors that prevent bone lead release will reduce the risk of chronic lead exposure and improve the health outcomes of post-menopausal women.

Cord blood levels of toxic and essential trace elements and their determinants in the Terai region of Nepal: a birth cohort study

The purpose of this study is to evaluate the cord blood level of toxic and trace elements and to identify their determinants in Terai, Nepal. One hundred pregnant women were recruited from one hospital in Chitwan, Nepal in 2008. The cord blood levels of toxic [lead (Pb), arsenic (As), and cadmium (Cd)], essential trace elements [zinc (Zn), selenium (Se), and copper (Cu)], demographic, socioeconomic, and behavioral variables were measured. The mean values of Pb, As, Cd, Zn, Se, and Cu in cord blood level were found as 31.7, 1.46, 0.39, 2,286, 175, and 667 μg/L, respectively. In the multivariate regression model, cord blood As levels from less educated mothers were higher than those from educated mothers (coefficient = -0.01, 95% confidence interval [CI] = -0.02-0.00). The maternal age was positively associated with the cord blood Cd level (coefficient = 0.02, 95% CI = 0.01-0.03), while it was negatively associated with the cord blood As level (coefficient = -0.01, 95% CI = -0.03--0.01). Cord blood levels of Pb, Zn, Se, and Cu were not associated with maternal age, socioeconomic status, living environment, and smoking status. As and Cd levels were relatively lower than those reported in previous studies in Asia, while the levels of Pb and the trace elements were similar. Less educated mothers are more likely to become a higher in utero As source to their fetus, and fetuses of older mothers were more likely to have higher in utero Cd exposure in Terai, Nepal.

Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial

BACKGROUND

Umbilical cord infection (omphalitis) is a risk factor for neonatal sepsis and mortality in low-resource settings where home deliveries are common. We aimed to assess the effect of umbilical-cord cleansing with 4% chlorhexidine (CHX) solution, with or without handwashing with antiseptic soap, on the incidence of omphalitis and neonatal mortality.

METHODS

We did a two-by-two factorial, cluster-randomised trial in Dadu, a rural area of Sindh province, Pakistan. Clusters were defined as the population covered by a functional traditional birth attendant (TBA), and were randomly allocated to one of four groups (groups A to D) with a computer-generated random number sequence. Implementation and data collection teams were masked to allocation. Liveborn infants delivered by participating TBAs who received birth kits were eligible for enrolment in the study. One intervention comprised birth kits containing 4% CHX solution for application to the cord at birth by TBAs and once daily by family members for up to 14 days along with soap and educational messages promoting handwashing. One intervention was CHX solution only and another was handwashing only. Standard dry cord care was promoted in the control group. The primary outcomes were incidence of neonatal omphalitis and neonatal mortality. The trial is registered with ClinicalTrials.gov, number NCT00682006.

FINDINGS

187 clusters were randomly allocated to one of the four study groups. Of 9741 newborn babies delivered by participating TBAs, factorial analysis indicated a reduction in risk of omphalitis with CHX application (risk ratio [RR]=0·58, 95% CI 0·41-0·82; p=0·002) but no evidence of an effect of handwashing (RR=0·83, 0·61-1·13; p=0·24). We recorded strong evidence of a reduction in neonatal mortality in neonates who received CHX cleansing (RR=0·62, 95 % CI 0·45-0·85; p=0·003) but no evidence of an effect of handwashing promotion on neonatal mortality (RR=1·08, 0·79-1·48; p=0·62). We recorded no serious adverse events.

INTERPRETATION

Application of 4% CHX to the umbilical cord was effective in reducing the risk of omphalitis and neonatal mortality in rural Pakistan. Provision of CHX in birth kits might be a useful strategy for the prevention of neonatal mortality in high-mortality settings.

FUNDING

The United States Agency for International Development.

Relation between anemia and blood levels of lead, copper, zinc and iron among children

BACKGROUND

Anemia is a health problem among infants and children. It is often associated with a decrease in some trace elements (iron, zinc, copper) and an increase in heavy metals as lead. This study was done to determine the association of blood lead level > 10 mug/dl, with the increased risk to anemia, also, to investigate the relationship between anemia and changes in blood iron, zinc and copper levels, and measure lead level in drinking water.The study is a cross-sectional performed on 60 children. Venous blood samples were taken from the studied population for estimating hematological parameters as well as iron and ferritin levels. The concentrations of zinc, copper, and lead were measured. The studied population was divided into anemic and non-anemic (control) groups. The anemic group was further classified into mild, moderate and severe anemia. The study subjects were also categorized into low and high blood lead level groups.

FINDINGS

Approximately 63.33% of children had blood lead levels >/= 10 mug/dl. At the blood lead level range of 10-20 mug/dl, a significant association was found for mild and severe anemia. The blood level of iron and ferritin was found to be significantly lower in high blood lead level and anemic groups than those of the low blood lead level and control groups. Lead level in drinking water was higher than the permissible limit.

CONCLUSION

Lead level >/= 10 mug/dl was significantly associated with anemia, decreased iron absorption and hematological parameters affection. High blood lead levels were associated with low serum iron and ferritin. Lead level in drinking water was found to be higher than the permissible limits.

Global pediatric environmental health

Children are uniquely vulnerable to environmental health problems. Developed countries report as the most common problems ambient (outdoor) air pollution and lead. Developing countries have a wider range of common problems, including childhood injuries, indoor air pollution, infectious disease, and poor sanitation with unsafe water. Globally, the agencies of the United Nations act to protect children and perform essential reporting and standards-setting functions. Conditions vary greatly among countries and are not always better in developing countries. Protecting the health of children requires strengthening the public health and medical systems in every country, rather than a single global agenda.

Childhood correlates of blood lead levels in Mumbai and Delhi

BACKGROUND

Lead exposure has previously been associated with intellectual impairment in children in a number of international studies. In India, it has been reported that nearly half of the children have elevated blood lead levels (BLLs). However, little is known about risk factors for these elevated BLLs.

METHODS

We conducted a retrospective cross-sectional analysis of data from the Indian National Family Health Survey, a population-based study conducted in 1998-1999. We assessed potential correlates of BLLs in 1,081 children who were < 3 years of age and living in Mumbai or Delhi, India. We examined factors such as age, sex, religion, caste, mother's education, standard of living, breast-feeding, and weight/height percentile.

RESULTS

Most children (76%) had BLLs between 5 and 20 microg/dL. Age, standard of living, weight/height percentile, and total number of children ever born to the mother were significantly associated with BLLs (log transformed) in multivariate regression models. Compared with children < or = 3 months of age, children 4-11 and 12-23 month of age had 84 and 146% higher BLLs, respectively (p < 0.001). A low standard of living correlated with a 32.3% increase in BLLs (p = 0.02). Children greater than the 95th percentile for their weight/height had 31% (p = 0.03) higher BLLs compared with those who were below the 5th percentile for their weight/height.

CONCLUSIONS

Our study found various factors correlated with elevated BLLs in children. The correlation between greater than the 95th percentile weight/height and higher BLL may reflect an impact of lead exposure on body habitus. Our study may help in targeting susceptible populations and identifying correctable factors for elevated BLLs in Mumbai and Delhi.

Intoxicação por chumbo e saúde infantil: ações intersetoriais para o enfrentamento da questão

Inquérito epidemiológico realizado pela Secretaria de Estado da Saúde de São Paulo e Secretaria Municipal de Saúde de Bauru visou à realização de exames de plumbemia em 853 crianças de 0 a 12 anos, em Bauru, São Paulo, Brasil (2002), a partir de indícios de chumbo oriundo de resíduos industriais nas proximidades de uma fábrica de baterias. Os níveis sangüíneos de chumbo no grupo controle foram inferiores aos apresentados pelo grupo exposto (p < 0,05). Mediante a existência de 314 crianças com taxas de plumbemia superiores àquelas aceitáveis pelo Centers for Disease Control and Prevention (10µgPb/dl sangue), foi desencadeado um conjunto de ações com participação dos serviços públicos, universidades e voluntariado, para promover o diagnóstico e a assistência à saúde da população atingida. Ações emergenciais, visando a reduzir riscos de recontaminação, incluíram a raspagem de camada superficial das vias públicas, resultando em 1.392m³ de terra contendo material tóxico, que permanece depositada nas dependências da fábrica. Foi promovida a aspiração de poeira do interior das residências e a lavagem e vedamento das caixas d'água. O Grupo de Estudo e Pesquisa da Intoxicação por Chumbo em Crianças de Bauru, por meio deste trabalho, faz o compartilhamento de uma experiência intersetorial, multidisciplinar e interinstitucional.

Relation between blood lead levels and childhood anemia in India

Lead pollution is a substantial problem in developing countries such as India. The US Centers for Disease Control and Prevention has defined an elevated blood lead level in children as > or = 10 microg/dl, on the basis of neurologic toxicity. The US Environmental Protection Agency suggests a threshold lead level of 20-40 microg/dl for risk of childhood anemia, but there is little information relating lead levels <40 microg/dl to anemia. Therefore, the authors examined the association between lead levels as low as 10 mug/dl and anemia in Indian children under 3 years of age. Anemia was divided into categories of mild (hemoglobin level 10-10.9 g/dl), moderate (hemoglobin level 8-9.9 g/dl), and severe (hemoglobin level <8 g/dl). Lead levels <10 mug/dl were detected in 568 children (53%), whereas 413 (38%) had lead levels > or = 10-19.9 microg/dl and 97 (9%) had levels > or = 20 microg/dl. After adjustment for child's age, duration of breastfeeding, standard of living, parent's education, father's occupation, maternal anemia, and number of children in the immediate family, children with lead levels > or = 10 microg/dl were 1.3 (95% confidence interval: 1.0, 1.7) times as likely to have moderate anemia as children with lead levels <10 microg/dl. Similarly, the odds ratio for severe anemia was 1.7 (95% confidence interval: 1.1, 2.6). Health agencies in India should note the association of elevated blood lead levels with anemia and make further efforts to curb lead pollution and childhood anemia.

Prevalence of blood lead levels >or= 5 micro g/dL among US children 1 to 5 years of age and socioeconomic and demographic factors associated with blood of lead levels 5 to 10 micro g/dL, Third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVES

As part of an investigation into the impact of a potential revision in federal childhood lead poisoning prevention policy that would result in screening children for blood lead levels (BLLs) >or=5 micro g/dL rather than the current 10 micro g/dL, we analyzed the most recent available, nationally representative data to identify prevalence of BLLs >or=5 micro g/dL and socioeconomic and demographic characteristics of 1- to 5-year-old children with BLLs >or=5 but <10 micro g/dL.

METHODS

We performed statistical analyses on data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988-1994) to describe trends in BLLs >or=5 micro g/dL overall and among subpopulations of children <6 years old and to compare risk factors for falling within 1 of 3 groups of children (those with BLLs >or=5 but <10 micro g/dL; >or=10 but <20 micro g/dL; and >or=20 micro g/dL) using the group reported as 0.7 to <5 micro g/dL as the referent.

RESULTS

Overall prevalence of BLLs >or=5 micro g/dL among 1- to 5-year-old children was 25.6%, although most (76%) of these children had BLLs <10 micro g/dL. Children with BLLs >or=5 micro g/dL included 46.8% of non-Hispanic black children, 27.9% of Mexican American children, and 18.7% of non-Hispanic white children; 42.5% of children in housing built before 1946, 38.9% of children in housing built between 1946 and 1973, and 14.1% of children in housing built after 1973 had BLLs >or=5 micro g/dL. Compared with non-Hispanic white children, non-Hispanic black children were 3 times more likely to have a BLL >or=5 but <10 micro g/dL, 7 times more likely to have a BLL of 10-20 micro g/dL, and 13.5 times more likely to have a BLL >or=20 micro g/dL. Similar increases in the association between risk factor and BLL were seen with respect to other known risk factors including age of housing, region of the country, and poverty.

CONCLUSIONS

The high prevalence of BLLs >or=5 micro g/dL overall and within US subpopulations will be an important variable in any change in screening and intervention criteria. However, most children with BLLs >or=5 micro g/dL are below the current intervention level of 10 micro g/dL. Exposure to lead from multiple sources is suggested by the prevalence of BLLs >or=5 micro g/dL but <10 micro g/dL among children with uncertain risk factors. The probable presence of one or more known risk factors for childhood lead poisoning increases as BLL increases.

[Association between blood lead and sociodemographic parameters among children]

OBJECTIVE

To determine the relationship between blood lead concentration (Pb-S), and sociodemographic parameters among children.

METHODS

Blood lead concentration (Pb-S) was determined in 243 children (aged 5.94 +/- 2.78 years) in the district of Valencia. The required analysis was performed at the Center for Toxicological Investigations of University of Carabobo (CITUC), Venezuela, between January 1st, 1998 to December 31st, 2000. Geographical Information Systems (GIS) technology was used for data mapping.

RESULTS

Average Pb-S (11.62 ug/dl) was significantly higher than the allowed levels. One hundred and fifty (61.7%) children had Pb-S levels above the allowed concentration (VSLP) and this amount was significantly high in relation to the total number of subjects studied. The logistic regression analysis showed a significant association of sectors 12 (status A) and 16 and 28 (status C) with VSLP (R=0.1189; p<0,01; R=0.1202, p<0,01 and R=0.1189; p<0.01, respectively). Odds ratio showed that children from status C are 7,286 times more likely to have Pb-S VSLP than those from A or B.

CONCLUSIONS

This study confirms that SGI and epidemiological-statistical methods widen the possibilities of preventing contaminants' adverse health effects. It also shows that correlating geographical and health data has allowed to identifying "high risk" areas, leading to a pro-active public health action

Effects on brain development leading to cognitive impairment: a worldwide epidemic

This article reviews causes of cognitive impairment in children with a focus on those in developing countries. The number of children with cognitive limitations is increasing, and for the majority there is little access to professional expertise. Causes include malnutrition, genetic diseases, infectious diseases such as meningitis, parasites, and cerebral malaria, in utero drug and alcohol exposure, newborn asphyxia, low birth weight, head injuries, and endocrine disorders. Many of these are preventable; however, resources for prevention are limited in most developing areas of the world. The challenge for this century is to encourage community leaders and government officials to take on the prevention of cognitive impairment as the highest priority for society. This article proposes that specialists in child behavior and development work with United Nations agencies to develop a "world cognitive impairment watch" to assess and assist each country annually in terms of risk factors, prevention programs, and early intervention programs.