On the occasion of International Lead-Poisoning Prevention Week, Pure Earth Bangladesh, ESDO, UNICEF and Prothom Alo on 25 October organised a roundtable on ‘Lead Poisoning and Child Health in Bangladesh: The Way Ahead’. Selected parts of the discussions have been included in the following supplement.
Participants
Munshi Md Sadullah, Line Director, PMR, Directorate General of Health Services
Razinara Begum, Director, Chemical and Waste Management Unit, Department of Environment
Robed Amin, Line Director, NCDC, Directorate General of Health Services
Mahfuzur Rahman, Country Director, Pure Earth Bangladesh
Sanjana Bhadrwaj, Head of Heath Section, UNICEF
Mahbubur Rahman, Project Coordinator, icddr,b
Arun Mitra, General Secretary, Bangladesh Paint Manufacturers Association
Hasanul Banna, Lawyer, Bangladesh Environmental Lawyers Association (BELA)
Siddika Sultana, ESDO
Minjoon Kim, Health Specialist, UNICEF Bangladesh
Didarul Alam, Consultant, UNICEF Bangladesh
Opening statement, Abdul Quayum, Associate Editor, Prothom Alo
Moderator, Firoz Choudhury, Assistant Editor, Prothom Alo
Abdul Quayum: Many of us are not aware of lead poisoning. The matter is being discussed globally and many of us are not even aware of that either. The World Health Organisation (WHO) is vocal about the issue. However, many countries are not all that active about this. Lead is a poisonous substance that enters the body through food and water and also through respiration. It mixes with the blood to affect the liver, kidneys, bones and other organs. It attacks the soft tissue of the human body. If lead enters the bones, it remains there for up till 25 to 30 years.
Children are the most affected by lead. Lead poisoning stunts physical and mental growth of children. The authorities have drawn up laws in this regard and these laws must be made effective. We must be free of the toxic effect of lead. Certain steps can reduce the harmful level of lead in the body. Intake of Vitamin C, iron and calcium enriched foods can protect us. Public awareness can play a significant role in this regard.
Didarul Alam: Lead is a heavy toxic metal that is extremely harmful to our health. Lead melts at low heat and evaporates. It can easily be molded and shaped. That is why it is used to easily mix with various substances to form alloys. Lead can enters into the body through three routes – food and drink, breathing and through the skin.
Lead was used less in the past, but presently the use of lead has been increasing in the country and globally because of increasing demand for energy-efficient vehicles.It stays in the blood for six to seven weeks. Lead basically accumulates in our bones and teeth where it can remain for 20 to 30 years. Lead poisoning is harmful for children. This was first reported in 1967. In 1978 discussion began about halting the use of lead paint. Diesel and petrol contain lead. This year the use of leaded petrol had been stopped globally.
Globally, around 800 million children have 5 micrograms/deciliters of lead in their blood. In Bangladesh, approximately 35 million children have high levels of lead in their blood. Lead poisoning may have relationship with stunting of children in our country as highlighted in a Daily Star Report.
A new global report highlights that Bangladesh ranks fourth in the world in terms of number of children affected by lead poisoning. That is why it is important to pay attention to the matter. What is the source of lead? Lead poisoning can occurs from leaded fuel, paint and water pipes. Traces of lead have been found in powdered spices like turmeric, coriander, chili and such. It has also been detected in cheap jewelry, kohl kajal, sindoor (vermillion) and so on. Lead is extracted from used batteries and used to manufacture new ones. So battery recycling is also a significant source of lead contamination in the country.
Lead affects almost every organ and system of a human body. It damages the brain, lever, kidney, blood etc. Among children, lead first attacks the brain and nervous system. This affects the child’s body, hearing and cognitive abilities, behavioral abnormalities and learning outcomes. The elderly are affected in a similar manner. In the long run, this has an impact on the heart, liver as well as the digestive and reproductive system. This results in dizziness, painful glands and so on. High levels of lead in the body can even result in death.
Children, pregnant women and people handle lead contain materials are at higher risk of lead poisoning. A child can even be affected during pregnancy, if mothers are exposed to lead earlier. Children of poor families do not get adequate nutrition and don’t practice proper hygiene - are more at risk from lead poisoning. Proper monitoring of the implementation of the relevant laws are required to stop the use of lead in spices and other food as well as in the making of jewelry. In addition, a national strategy and action plan is utmost important to prevent and manage lead poisoning in Bangladesh.
Minjoon Kim: UNICEF and Pure Earth have been implementing PECP (Protecting Every Child’s Potential) project, a three-year programme in Bangladesh from late 2020 with support from DGHS. The aim of the programs is to mobilize national action and prevent children’s exposures to lead from substandard lead acid battery smelting and other products. We are regularly sharing our experiences with these four countries. Three years is a very short duration to deal with such a large problem. Even so, this effort will yield good results. We facilitated DGHS in formation of a Technical Implementation Committee, jointly conducted several consultative meetings and workshops on programs and research design and communication issues. We are in the second year of the programme and this is a very important time. There are targets to achieve many of the objectives in the second year. We are on process of conducting a study on Health Sector Situation Assessment with support of DGHS and icddr,b.
Also, with the support of the Institute of Epidemiology, Disease Control and Research, we are also conducting a study on Blood lead level monitoring. In the last year of the programme, we will emphasize mainstreaming Environmental Health with focus on lead poisoning. There will be nationwide campaigns to mobilize public awareness in this regard. Initiative will also be taken to build the capacity of the health service providers. We will support the DGHS in developing training and communication materials and preparing a national plan of action.
Every year 31,000 people die of lead poisoning, which is 3.6 per cent of the deaths in the country. We have identified many sources of lead contamination including the unsafe battery recycling sites. There are over a thousand used lead acid battery recycling factories/sites in the country.
There are several other sources that are responsible for lead pollution. These include sectors pertaining to pesticides, ship-breaking, cosmetics, paint, aluminum, turmeric, etc. We are taking help from Pure Earth and Dhaka University to prepare a list of all the toxic areas of lead contamination.
We face some challenges, too. There is a need for a system to regularly monitor levels of lead in the bloodstream. We want to carry out campaigns to create public awareness and positive behavioural changes.
The first international lead poisoning prevention week was held in 2013. This is now observed every year in the last week of October. This round table discussion is a part of the international lead poisoning prevention week that aims to raise awareness, share current programs, policies, and recommendations for lead poisoning prevention in Bangladesh. A multisectoral response is vital to prevent and effectively respond lead poisoning in Bangladesh.
Siddika Sultana: We have been endeavouring to create awareness about lead poisoning since 2008. We have also been researching in this regard. At the time, seven countries including Bangladesh began to work on this issue through the International Pollutants Elimination Network (IPEN). It began with the campaign against the use of lead in paint. From back then we tried to involve the department of environment, BSTI and the industries ministry in this effort.
Our work in this regard began in 2008 and we carried out research in this regard. Bangladesh Paint Manufacturers Association extended a lot of cooperation in this matter. So far 44 paint manufacturing companies have applied to BSTI for certification of their safe use of lead. They have received the certification. They will not be able to manufacture or market paint without BSTI approval. These paint manufacturing companies are monitored by BSTI every year. This now needs to be implemented in the industrial sector where the paint is used for roads, in the shopping industry and in sports areas. At an industrial level too, the WHO standards must be maintained. All types of paint must be free of lead. There is need for appropriate regulations and detailed laws for the use of safe paint.
There is lead content in pesticides, herbicides and fungicides which are directly linked to our food chain. Bangladesh Persistent Organic Pollutants mentions 12 pesticides, but globally now 24 pesticides are listed. The government must pay attention to this. There is a lack of inter-ministerial coordination in this regard. It is not possible for single ministries or departments to do all the work.
Hasanul Banna: We can identify other pollution in our environment easily. Water pollution can be detected by taste, smell and change in colour. In air pollution, sight is hampered and it is difficult to breathe. But lead poisoning is totally silent. It cannot be seen by the naked eye. Lead is a catalyst to all sorts of pollution. Lead is found in water, air and soil contamination too.
In order to bring lead poisoning under control, a notification was first issued under the environmental protection act. But not everything is under the law. In the US, there is a law that prohibits the use of lead in paint.
Lead has a link with all pollution. That is why this needs to be included in all related laws. The WHO regulations mention clinical management for lead control. It is difficult to implement all these in our country. A recent news report said that the department of environment had shut down two lead factories.
The department of environment is responsible for controlling all environment-related problems in the country. It is difficult for them to deal with all this single-handedly. The department of environment also has a shortage in workforce and required structural changes too. This urgently calls for inter-ministerial coordination. All concerned need to work together to find a solution to lead poisoning. Discussions have begun in this regard. These efforts will continue and more solutions will emerge.
Arun Mitra: We worked together with ESDO. We joined hands with BSTI in determining the permissible level of lead use in paints. According to this standard, the permissible level of lead in paint is 90 ppm. This is much less than other countries. In Nepal and Sri Lanka this standard is set at 1000ppm. We have been able to successfully implement this standard. There are 45 paint manufacturing companies and these are certified by BSTI. So we can say that we have been 100 per cent successful in freeing paint of lead. Two types of lead are used in paint.
There is still no law to free aluminum of lead. Nowadays plastic pipes are used instead of galvanized iron pipes. The use of galvanized iron pipes must be banned. If you rub a shiny aluminum utensil with your hand, it leaves a black mark. That basically is lead.
There is a lot of lead in red and yellow colouring pencils used by children. From our side we have managed to prevent the use of lead in paint. It is essential to pay attention to other areas where lead poisoning must be halted. High taxation can be an answer. Raw material for lead-free paints entails five times the expenditure. So duty on lead-free paint materials can be reduced. If high duty is imposed on any leaded items, this will discourage import and use.
Efforts are required on a priority basis to keep food additives free of lead. This goes straight into the respiratory system. We now use alternatives to lead.
Mahbubur Rahman: Lead has a harmful impact on a child’s intellectual development. Research shows that Tk 1.28 trillion is spent per year in the country due to lead-induced intelligence deficiency which causes a drop in productivity. This amounts to 6 per cent of Bangladesh’s GDP.
Lead can lead high blood pressure, strokes and hormonal imbalance.
Researchers say there is no such thing as a safe level of lead in the human body and bloodstream. In the US, the normal level of lead is 5 micrograms per decilitre. A study was carried out in Chandpur in 2010 where it was found that the urine of one-and-a-half-year-old infants contained over 6micrograms/decilitre. In 2009 a study in Dinajpur revealed that 14 per cent of the schoolchildren had over 10 micrograms/decilitre of lead in their blood. Research carried out by icddr,b in Gazipur, Mymensingh, Tangail and Kishoreganj (2016-2018) found the presence of lead in the bodies of expectant mothers. In the research, 31 per cent of the expectant mothers had 5 microgram/decilitre of lead in their bloodstream. In the area of the study, there was no lead recycling or leaded gasoline or paint. So where did the lead come from? The food, medications and utensils of the affected families were examined. The presence of lead was detected in three items – tin welded with lead, burnt clay which some pregnant women have the habit to nibble on, and turmeric used in cooking. We carried out isotopic tests which can determine the duration and source of lead. We found similarity between the lead in the women’s bloodstream and the lead in the turmeric, confirming that turmeric was the source of lead in their blood.
The question is, how did lead get into turmeric? Turmeric is produced the most in nine districts of Bangladesh. The tests indicated that in 7 of the 9 districts, the lead content in turmeric was high. The lead content in 20 per cent of these samples was much higher than permitted by BSTI.
According to information gathered from the wholesalers, over the past 30 years yellow food colour has been used to colour dry turmeric and this practice continues. The bright colour attracts customers. Bangladesh Safe Food Authority, the media and concerned department together worked to bring down the level of lead poisoning in turmeric. Lead is hardly detected in the reliable brands of turmeric available in the market. What is required now is regular monitoring and identifying the areas of lead poisoning. Everyone’s awareness must be raised about lead poisoning.
Mahfuzur Rahman: We used to say, all that glitters is not gold. Now we say, all the glitters is not good turmeric. Many disabled children and children with attention disorders were brought to Professor Naila Khan’s clinic. She tested the blood of these children and found high levels of lead. She collected such data and published it. Leaded petrol would be used in Bangladesh at the time. She mobilised awareness to stop the use of this leaded petrol. As a result, in 1999 the government stopped the use of leaded petrol. Immediately the air quality improved in the country.
There is a lack of coordination in many good things in Bangladesh. In order to prevent lead poisoning in Bangladesh, multisectoral efforts are needed and coordination between the ministries must be ensured. Some research has been carried out by iccdr,b. This research must be expanded further and scientists must place recommendations to the government for regulations to be based in such research. The areas of lead poisoning must be identified. Just shutting down those areas is not a solution, work must be done for a proper solution.
Globally, 800 million children has excess levels of lead in their bloodstream. In Bangladesh, lead was detected in the blood of 30 million to 35 million children. Unless attention is paid to this sector now, there will be no Einsteins emerging from our country in 20 years time. We must work together in this regard.
The informal battery recycling sector must be formalised and at the same time, the workers involved must be given alternative employment. Data regarding the blood lead level must be entered into the government information centre DHIS2 and monitored.
We do not know much about lead poisoning and so persons involved in the health sector must be trained in this regard so they can identify the symptoms. Work must be done in collusion with the media in order to increase awareness. Alongside world leaders, local leaders must also work to this end.
Sanjana Bhardwaj: This roundtable inspires hope. Attention must be paid to lead poisoning immediately. A lot of work has started in this regard in Bangladesh and other countries. There is a lot to be done. Bangladesh ranks at number four among countries most harmed by lead poisoning. Every second somewhere or the other a child, woman, family or community is being afflicted by lead poisoning. That is why programmes in this regard must be strengthened further.
This issue is linked with the Sustainable Development Goals (SDG). Bangladesh is in a leading position regarding the decrease in the rate of preventable infant mortality. Now the other reasons of infant mortality must also be identified. Lead does irreparable harm to the mental, physical and intellectual growth of children under five. Yet this is completely preventable.
UNICEF has created a global framework for healthy environment and healthy children. This is related to lead, air and water pollution as well as climate change. We are also working to mobilise public awareness. These tasks must be taken to the district, upazila and community level. People of all strata must know about this. Alongside awareness, it is also important to take up innovative plans of action. We talk about integrated initiatives. But this is easier said than done. Integrated efforts of all, government and non-government, is extremely important to ensure a lead-free future for our children. UNICEF will work with all to ensure that every child can reach its potential.
Robed Amin: We must start thinking about lead poisoning. We do not know much about this problem. No one has been able to say as yet, scientifically speaking, whether lead has any organic function in the human body. So the ideal level of lead content in the body should be zero. There is no end to the source of lead. There is lead in almost everything connected to our daily lives. That is why children are being affected the most. There are many mentally challenged children in the country. Have there been any tests to assess whether this has any connection to lead in the bloodstream?
There has been no focused study in Bangladesh on lead poisoning in the human body. There have been a lot of studies on this in China. Is there lead in rice? We all use pesticides. Do these contain lead? All sources responsible for lead poisoning must be identified. This is important in achieving the SDG. One of the targets of SDG is to reduce chemical waste by 2030. Lead poisoning is a serious problem. Battery recycling is a big source of lead poisoning.
In the case of school and pre-school children, we can identify lead poisoning extensively. Creating awareness is vital. We need to go to the schools and explain these matters to the children. It is also essential to inform the parents of these matters.
WHO has drawn up regulations for the overall management of lead poisoning. We can draw up such regulations in our country. There is also need for a strong monitoring system.
Razinara Begum: Our entire body can be affected by the impact of lead poisoning. Children are even more vulnerable in this regard. Children are five times more vulnerable to lead poisoning than adults. Various studies highlight the health risks caused by lead poisoning. The government is conscious about this.
It has been learnt that 80 per cent of the global lead poisoning comes from leaded batteries. The government has imposed new regulations in this regard from 18 February. Many of these matters have been discussed here today. Battery recycling plants require clearance from the department of environment. The battery recycling process in the informal sector will be regularised. Measures have been taken to absorb those involved in the informal sector of battery recycling, into the formal sector. In the case of battery import, the importer must sign an agreement with the recycling company before import. When the battery life expires after import, it will be given to the recycling company. This contact will be a precondition to import.
For the first time in Bangladesh, there is provision in the environment protection act for punishment of anyone who violates the clauses in the circular. If the persons connected to the battery recycling sector can be brought into the formal sector, a large part of lead poisoning can be reduced. If proper processes are followed in recycling, the level of contamination will be reduced.
Bangladesh still has many child workers. Many of these child workers are involved in battery recycling. These children face severe health risk. Last June the e-waste regulations were enforced. This also mentioned leaded batteries and such. The department of environment will work further on all this. Many establishments have been fined and closed for battery recycling which is harming the environment. These actions continue. Our objective is not to close down these establishments, but to bring them under regulations. We seek everyone’s cooperation. With everyone’s cooperation we will achieve a lead-free Bangladesh.
Munshi Md Sadullah: The manner in which lead poisoning comes about has been discussed. Expectant mothers and children under six are more vulnerable to lead poisoning. There is fear of expectant mother aborting as a result of lead poisoning. Attention must be paid to these matters. Many people were not aware about lead poisoning before. There has been work in this regard over the past few years. Petrol and paint have been declared lead-free. More monitoring is required.
We have certain informal industries which have not been registered. We need to create awareness about this at first. The health department is working to this end. We must keep in contact with other ministries about this too. The frontline media must also come forward to create public awareness.
We must identify things that contain lead and also the percentage of expectant mothers and infants that have high lead content in their bodies. There is no such thing as an acceptable level of lead. We cannot have lead in our bloodstream. Of the death in Bangladesh, 3.6 per cent are caused by lead poisoning. Every year about 31,000 people die of lead poisoning. This is higher than the number of deaths caused by Covid. Yet no public awareness has been created about lead poisoning as it has been about Covid. That is why awareness is required at first. Inter-ministerial discussions will be required to create a law in this regard.
We involve our health workers in raising awareness about this matter. They can hold yard discussions about this. Detection on a wide scale is a big challenge. We have planned with UNICEF. Work will commence shortly.
Firoz Choudhury: The matter of awareness has been highlighted in today’s discussion. Alongside laws, it is vital to increase awareness. Many have mentioned public-private initiatives. It is also essential to increase coordination among the various ministries. We express our sincerest thanks and gratitude to you all for participating in the discussion.
Recommendations
· All sources of lead poisoning must be identified
· WHO standards must be followed in preventing lead poisoning in paint at an industrial level
· Higher duty can be imposed on leaded items to discourage the import and use of such items
· Regulations need to be drawn up to control the use of lead and prevent lead contamination
· Lead poisoning must be prevented in order to achieve the SDG
· The leaded battery recycling factories must be regularly monitored
· Extensive public awareness must be mobilised about the harmful effect of lead poisoning
· It is urgently required to take up multisectoral programmes to prevent lead poisoning
· The proper application of the law must be ensured to halt the use of lead in spices, food products, jewellry, toys and cooking utensils
· A national programme must be taken up to detect lead in the bloodstream.
· There is need for coordination among the concerned government, non-government and development partners in this regard