1. Our Children are at Risk Lead Poisoning Presented by: Marcia Thelwell-Reid MPH, B.Sc. Walden University

2. Purpose of Presentation To increase knowledge of the risks from lead poisoning and to decrease childhood blood lead levels in your community.

3. Learning Outcomes At the end of the session, participants should be able to: Define lead poisoning Identify signs, symptoms and adverse effects of lead poisoning, especially in children Identify sources of lead in the environment Take steps to decrease childhood blood lead levels in your community

4. Stakeholders Parents Health care providers Cottage industry operators Scrap metal dealers Battery repairers

5. Headline News Jamaica Gleaner – June 22, 2008 “Lead poisoning linked to crime” (Professor Lalor) Jamaica Gleaner – April 2004 “Lead poisoning in Jamaican children is not a new phenomenon”(Dr. Evans-Gilbert) Could there be a possible link between our unexplainable high crime rate and lead poisoning of our children? (Source: http:www.jamaica-gleaner.com/gleaner/20080622/lead/lead6.html http:www.jamaica-gleaner.com/gleaner/20040414/news/news5.html

6. What is lead poisoning? A medical condition that occurs when lead builds up in the body over a period of time. It is also referred to as saturnism, plumbism or painters colic. Children under the age of 6 are very vulnerable to lead poisoning. Affects mental and physical development and can be fatal at high levels.

7. History Lead poisoning is not new, recognized as early as 2000 BC Gout, anemia and colic were prevalent in early Rome as a result of ingesting lead from food containers Famous individuals such as Beethoven and Handel suffered from lead poisoning.

8. Standards A 'high' blood level is now defined as more than 10 micrograms (a microgram is one millionth of a gram) of lead per deciliter (1/2 cup) of blood, i.e. (10 mcg/dL). Studies show that blood lead levels as low as 2 mcg/dL have been linked to deaths from heart attack and stroke. Conclusion – no level is safe! (Source: Lead in blood: Safe levels too high? Retrieved 17/07/09 from http://www.webmd.com/news/20060918/lead-in-blood-safe-levels-too-high

9. Jamaican Situation IN 2004, the National Safety Council reported that approximately 400,000 children under age six had significant levels of lead in their blood (Lalor, 2008). A Kingston study reveal that 43% of children had blood lead level greater than 70 mcg/dL, and 84% of yards had soil lead levels above 500 ppm (Matte, et al, 1989)

10. Sources of lead poisoning Most common source - battery repair shops Matte,et al (1989) concluded that battery repair shops create a high risk of lead poisoning for nearby residents. A previous study concluded that cottage lead smelters are a hazard for nearby residents. Increasing demand for lead on the world market has resulted in a 120% increase in backyard smelters for used batteries (Lalor, 2008).

11. Other Sources of Lead Soil – from gasoline or paint; can last for years, e.g., Red Pond and Kintyre communities Water – lead pipes, brass plumbing fixtures, copper pipes soldered with lead Lead paint – discontinued but older houses still have lead-based paints Household dust – from paint chips or soil brought in from outside Imported canned foods – lead solder still used in some countries Cosmetics Toys and crayons – tested regularly for lead Lead-glazed food containers

12. Symptoms of lead poisoning - children Lead poisoning is difficult to detect early as poisoned individuals may appear healthy. Signs may include: Decreased attention span Decreased hearing Speech delays Behavioral problems Loss of appetite Weight loss Abdominal pain Sluggishness and fatigue Vomiting Constipation anemia

13. Symptoms in adults Lead poisoning is also dangerous for adults Signs and symptoms include: Pain, numbness or tingling of the extremities Muscular weakness Headache Abdominal pain Memory loss Mood disorders Reduced sperm count, abnormal sperm Miscarriage or premature birth fatigue

14. Adverse effects - children The greatest risk to children is brain damage Even low levels can result in irreversible damage Decreased muscle and bone growth Hearing damage Learning disabilities Nervous system and kidney damage Poor muscle coordination Speech, language and behavior problems Anemia Source: Mayo Clinic, http://www.mayoclinic.com

15. Adverse effects - adults Cataracts Damage to reproductive organs in men Digestive problems High blood pressure Memory and concentration problems Muscle and joint pain Nerve disorders Pregnancy complications Schizophrenia Source: Mayo clinic

16. Factors Influencing Lead Toxicity in Developing Countries Risk factors are related to exposure, health and prevention efforts (Falk, 2003). Exposure Multiple sources Industrial sites located in residential areas Hot climates: more exposure to outdoor environments Child labour Inadequate tracking of lead use and consumption Poor environmental monitoring capacity

17. Factors Influencing Lead Toxicity in Developing Countries (Cont) Health Poor nutrition enhances lead toxicity (iron and calcium intake reduces lead accumulation) Limited knowledge of toxic chemicals among parents/caregivers Lack of equipment and trained personnel for laboratory monitoring Lack of or incomplete lead poisoning surveillance Unavailability of drugs for treatment

18. Factors Influencing Lead Toxicity in Developing Countries (Cont) Prevention measures Limited safety or hygiene programs Lack of adequate regulations and standards Lack of enforcement where standards exist Lack of protective devices or safety equipment Absence of programmes to remove children from contaminated areas

19. Who are at risk? People who live in areas at high risk for lead poisoning (smelters and battery repair shops) Children who live with adults that are exposed to lead (furniture makers, battery workers, potters and those making stained glass and remodelling homes) Babies and children under six years (absorb lead more easily than adults) Children living in older homes with lead paints People with lead amalgam in their dental fillings

20. Treatment for lead poisoning First step is to remove the individual from the source of contamination For mild cases, avoiding exposure will reduce blood lead levels For severe cases: Chelation therapy EDTA therapy

21. Prevention Lead poisoning in children is preventable! Parents Keep children away from peeling paints (windows) Wash child's hands often, especially if he/she sucks thumb Avoid food storage in lead glazed pottery Fortify the diet with iron and calcium Know where your kids play Keep your home dust free If you have metal pipes, run tap for 1 minute before using Avoid using hot tap water for babies’ formula Keep children away from lead workers

22. Prevention Workers Wear protective clothing and equipment Change clothes and shower before leaving the job Avoid washing work clothes with other clothing Don’t eat or drink where lead may be present Don’t remove lead paint by sanding (creates more dust) Avoid backyard battery repairs and smelting

23. Prevention Health Care Providers Be aware of the signs and symptoms of lead poisoning Refer suspected children for testing Educate parents about lead poisoning and preventive measures

24. Prevention Governmental authorities Ensure adequate supply of treatment drugs Assess local situation and identify all sources of lead in the environment Develop policies aimed at reducing lead exposure from the identified sources Implement monitoring and surveillance system for lead poisoning in children

25. Efforts to reduce lead contamination in Jamaica Leaded gasoline banned in 2000 Lead in household paint discontinued Toy imports checked for toxic levels of lead Lead recovery plant closed Sources of poisoning in Kintyre and other areas isolated

26. Existing problem Greatest source of lead in the Jamaican environment is the improper disposal of lead acid batteries

27. A Success Story - USA In 1978 there were about 14.8 million lead poisoned children in the United States. By the early 1990s, that number had declined to 890,000 children, as a result of: Phase out of lead from gasoline, food and beverage containers and new house paints Reduction of lead in: industrial emissions drinking water Consumer goods Hazardous waste sites The CDC established a goal to eliminate BLL ≥ 10 µg/dL in children under six years by 2010. Blood lead levels continue to decline. Children with BLL ≥ 10 µg/dL have declined from 130,512 in 1997 to 74,887 in 2001 (Meyer, 2003).

28. Conclusion Lead poisoning is preventable Requires the efforts of all stakeholders in saving our children from lead poisoning. There is also the possibility of reducing our spiralling crime rate by preventing lead poisoning in our children. We can stop making “fools” of our chiildren.

29. Thank you for listening Questions ? ? ? ?

30. Reference Evans-Gilbert, T. (2004). Lead poisoning in Jamaican children. Retrieved 18/07/09 from http://www.jamaica-gleaner.com/gleaner/20040414/news/news5.html http://www.jamaica-gleaner.com/gleaner/20040414/news/news5.html Falk, H. (2003). International environmental health for the pediatrician: Case study of lead poisonong. Pediatrics, 112:259 - 264 Lalor, G. (2008). Lead poisoning linked to crime. Retrieved 18/07/09 from http://www.jamaica-gleaner.com/gleaner/20080622/lead/lead6.html http://www.jamaica-gleaner.com/gleaner/20080622/lead/lead6.html Lead poisoning. Retrieved 17/07/09 from http://kidshealth.org/parent/http://kidshealth.org/parent/ Matte, T.D., Figueroa, J.P., Ostrowiski, S., Burr, G., Jackson-Hunt, L., Keenlyside, R.A. & Baker, E.L. (1989). Lead poisoning among household members exposed to lead-acid battery repair shops in Kingston, Jamaica. International Journal of Epidemiology, 18:874 – 881. Matte, T.D., Figueroa, J.P., Ostrowiski, S., Burr, G., Jackson-Hunt, L., & Baker, E.L. (1991). Lead exposure from conventional and cottage lead smelting in Jamaica. Archives of Environmental Contamination and Toxicology, 21:65 – 67. Mayo Clinic (2009). Lead poisoning. Retrieved 17/07/09 from http://www.mayoclinic.com/health/lead-poisoning/ http://www.mayoclinic.com/health/lead-poisoning/ Meyer, et al (2003). Surveillance for Elevated Blood Lead Levels Among Children --- United States, 1997—2001. Retrieved 27/06/09 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5210a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5210a1.htm