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Research Detail

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Amal K. Mitra*
Department of Community Health Sciences, The University of Southern Mississippi, Hattiesburg, Mississippi, US

Akhlaque Haque
Department of Government, University of Alabama at Birmingham

Manirul Islam
North South University, Dhaka, Bangladesh

S.A.M. K. Bashar
North South University, Dhaka, Bangladesh

To assess the risk of lead poisoning among preschool and school-aged children in Bangladesh, 345 children were screened for blood lead levels (BLLs) from one rural and two urban areas in Bangladesh from September 2007 through January 2008. An urban industrial area at Tongi was identified as a disaster area, where 99% (104/105) of those tested had BLLs ≥10 µg/dL. Industrial emissions and use of leaded gasoline by two-stroke engine vehicles were identified as possible sources of lead in that area. A rural nonindustrial area at Chirirbandar, Dinajpur was identified as another high-risk area, where 14% of the children screened had BLLs ≥10 µg/dL. BLLs at the urban industrial area were significantly higher than those at the rural and urban nonindustrial areas (24.58 ± 10.32, 7.24 ± 6.31, and 2.47 ± 3.32 µg/dL, respectively; p <0.001). Weight-for-age z-scores of the urban children were significantly lower than that of the rural children (-1.41 ± 1.88 vs. 0.20 ± 1.16, p <0.001). Children with elevated BLLs had poorer nutritional status (p = 0.05) than those with normal BLLs. Over 90% of the parents did not know that lead causes health problems. In conclusion, the problem of lead poisoning in children was found to be high in both urban and rural Bangladesh. A universal lead screening for preschool and school-aged children and a lead education program for parents are recommended for implementation in Bangladesh. 

  Lead poisoning; Children; Bangladesh; GIS; Universal screening.
  Bangladesh
  00-09-2007
  00-01-2008
  Risk Management in Agriculture
  Health hazard

This study aimed to 1) assess the extent of the problem of elevated BLLs among young children in both urban and rural Bangladesh; 2) identify children at risk of elevated BLLs in terms of sociodemographic and anthropometric parameters (weight and height); and, 3) locate cases with elevated BLLs and possible sources by using Geographic Information Systems (GIS). 

The study was conducted from September 2007 through January 2008 in Bangladesh. A team of epidemiologists, two public health students, one laboratory technician, one GIS specialist, social workers from two non-governmental organizations, local political leaders, and school teachers participated in the selection of sites, lead education campaigns, and data collection for the project. The study was approved by the Human Subjects Protection Review Committee at The University of Southern Mississippi. Informed consent was obtained from parents of small children and assent was obtained from older children before enrollment. 

The study was conducted from September 2007 through January 2008 in Bangladesh. A team of epidemiologists, two public health students, one laboratory technician, one GIS specialist, social workers from two non-governmental organizations, local political leaders, and school teachers participated in the selection of sites, lead education campaigns, and data collection for the project. The study was approved by the Human Subjects Protection Review Committee at The University of Southern Mississippi. Informed consent was obtained from parents of small children and assent was obtained from older children before enrollment. 

The study was conducted from September 2007 through January 2008 in Bangladesh. A team of epidemiologists, two public health students, one laboratory technician, one GIS specialist, social workers from two non-governmental organizations, local political leaders, and school teachers participated in the selection of sites, lead education campaigns, and data collection for the project. The study was approved by the Human Subjects Protection Review Committee at The University of Southern Mississippi. Informed consent was obtained from parents of small children and assent was obtained from older children before enrollment. 

2.1. GIS Mapping Parameters such as location of homes, schools, industries, major roads, highways and intersections, and the location of person with elevated BLLs were geocoded, and GIS maps were constructed. 

2.2. Statistical Methods Data was analyzed using SPSS for Windows, version 15.0 (SPSS Inc., Chicago, IL, USA). BLLs of children were categorized into: <10 µg/dL; 10-14 µg/dL; 15-19 µg/dL; 20-44 µg/dL; 45-69 µg/dL; and ≥70 µg/dL. Mean BLLs were compared among the three study areas by one-way ANOVA and Tukey’s HSD tests. Children with normal and elevated BLLs were compared by Student’s t-test for continuous variables and by Chi-square test for categorical variables. A Mann Whitney Test was used for continuous variables with nonnormal distribution. A logistic regression analysis was conducted to identify which of the explanatory variables predicted elevated BLLs. Pearson’s correlation was used to assess correlation between BLLs and other variables. Distance between locations was measured by using the latitudes and longitudes of the points. A probability level of 0.05 or less was considered to be statistically significant.  

  Int. J. Environ. Res. Public Health 2009, 6, 84-95;
  doi:10.3390/ijerph6010084
Funding Source:
1.   Budget:  
  

In this study, children exhibited no specific clinical features that would identify them at risk of having elevated BLLs. That emphasizes importance of having a blood lead test done for the vulnerable population. However, an in-depth interview of parents revealed that children with elevated BLLs were less likely to eat properly and their growth was much slower. They were also reluctant to go to school and fell behind in academic performance. One child with a BLL level of 43.7µg/L had several seizures. However, the parents did not understand that this health issue was directly related to elevated BLLs in their child, nor did they think that lead poisoning is a big health problem. It should be noted  that adverse outcomes, such as reduced intelligence quotient and academic deficits occur even with very low lead exposure [23]. No level of lead exposure appears to be safe and even the current recommended levels of lead <10 µg/dL in children are associated with neurodevelopmental deficits. 

This study had several limitations. One of the limitations was that this study did not establish any causal pathway between suspected sources and cases of elevated BLLs. The nature of non-random sampling design has its potential weakness of bias. The samples were drawn from three areas, which may not sufficiently represent the total extent of the problem in the country. However, this study reinforced the severity of the problem of lead poisoning in young children in Bangladesh. Further studies are needed to identify the problem of lead poisoning in several other areas of Bangladesh and among people of different economic status. Based on this study, a universal lead screening program for preschool and school children in Bangladesh, as well as a mass lead education program to increase parents’ awareness of lead poisoning is recommended. 

  Journal
  


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