Statement of Problem

Lead exposure remains a critical public health challenge in Nepal due to its widespread presence in the environment. Major sources include -

1. Traditional Medicine- Ayurvedic Medicine (1)

2. Industrial Emissions- Factories and industries that use lead in their processes can release lead into the environment.(2)

3. Household Items- Lead-based paints and plumbing systems can contribute to lead exposure.(3)

4. Improper disposal and handling of electronic waste (4)

5. Environmental Contamination- Leaded gasoline, although phased out, has left a lasting legacy of lead in soil and dust.

6. Toys - Regardless of regulatory limits on the content of lead, children's toys existing in Nepal has high lead content.(5)

7. Cosmetics: Nepal does not have any standards, guidelines, or legislation regarding the limits of heavy metals in cosmetic products. Neither government agencies nor private sectors monitor the heavy metal impurities in cosmetics imported, produced, marketed, distributed, and used in Nepal. (7)

The pervasive nature of lead in the environment poses a serious threat to public health, particularly affecting children, who are more susceptible to lead poisoning. A recent study has shown that 64% of children between 6-36 months in Nepal have detectable blood lead level.(7) Lead exposure in children can lead to developmental delays, cognitive impairments, and various health issues, creating an urgent need for comprehensive strategies to reduce and manage lead contamination in Nepal.

Diagnostic Challenges

Diagnosing lead poisoning is fraught with challenges, including:

1. Nonspecific Symptoms: Lead poisoning symptoms often mimic other illnesses, making it difficult to diagnose based on clinical presentation alone. Symptoms such as abdominal pain, irritability, fatigue, and developmental delays in children can be easily attributed to other conditions.

2. Lack of Awareness: Many healthcare providers in Nepal may not consider lead poisoning in their differential diagnoses due to a lack of awareness and training on the issue.

3. Limited Access to Testing: Even when lead poisoning is suspected, access to reliable diagnostic testing is limited. This is exacerbated by the scarcity of laboratories equipped to measure blood lead levels accurately.

4. Overlooking by healthcare providers: In resource-limited settings, clinicians may prioritize more immediate health concerns over lead poisoning, especially if it is perceived as less common or less urgent.

Call to Action

1. Inclusion in Essential Diagnostics List: The World health organization (WHO) should consider including lead testing in the essential list of diagnostic tools. This would ensure global recognition of the importance of lead testing and encourage its adoption in national health systems.

2. Increase awareness and educational events: Concerned authorities should support initiatives aimed at raising awareness about lead poisoning among healthcare providers and the general public. Continuous professional development programs for medical professionals on the diagnosis and management of lead poisoning are essential.

3. Support for Laboratory Infrastructure: International organizations should assist Nepal and the region in building and equipping laboratories capable of performing accurate lead testing. This includes providing technical support, funding, and resources.

4. Policy Advocacy: Advocating for policies that reduce lead exposure, such as regulations on industrial emissions, paints and cosmetics, safer practices in traditional medicine, and public health campaigns, is critical.

Role of APFCB - Establishing an APFCB Working Group for blood lead level to enhance early detection and prevention in developing nations:

The APFCB should consider establishing a dedicated working group focused on blood lead level testing in developing nations within the region. This group could play a crucial role in advocating for comprehensive screening models, promoting the adoption of point-of-care testing (POCT) devices, and pushing for the inclusion of BLL tests on the World Health Organization's essential list of in vitro diagnostics.
 

By promoting these initiatives, the working group can help improve early detection and management of lead poisoning, a significant public health issue in many developing countries. Furthermore, the group could foster scientific research aimed at better understanding the sources, epidemiology, and preventive strategies for lead exposure, ultimately contributing to the reduction of lead poisoning incidents. This coordinated effort would not only enhance diagnostic capabilities but also support policy development and implementation, ensuring that effective lead poisoning prevention and intervention measures are in place across the Asia-Pacific region.

Conclusion

Lead poisoning remains a significant but often overlooked public health issue in Nepal and the region. Addressing this challenge requires a multifaceted approach, including better diagnostic capabilities, increased clinician awareness, and stronger laboratory infrastructure.

1. Pant V, Gautam K, Pyakurel D, Shrestha A, Pradhan S, Joshi N. Broadening the list of differential diagnosis for acute abdomen–a case report from Nepal. EJIFCC. 2020 Nov;31(4):347.

2. Gautam K, Pradhan S, Thuppil V, Pyakurel D, Shrestha A. Blood lead level among school children in an industrial city of Nepal. Journal of Pathology of Nepal. 2017 Mar 30;7(1):1091-4.

3. Gottesfeld P, Pokhrel D, Pokhrel AK. Lead in new paints in Nepal. Environmental research. 2014 Jul 1; 132:70-5.

4. Gautam K, Pant V, Pradhan S, Pyakurel D, Bhandari B, Shrestha A. Blood lead levels in rag-pickers of Kathmandu and its association with hematological and biochemical parameters. EJIFCC. 2020 Jun; 31(2):125.

5. Suwal A, Prajapati M, Shah RC. Assessment of Toxic Heavy Metal Content in Children Toys. Khwopa Journal. 2023 Dec 29; 5(2):147-62.

6. Dangi NB, Maharjan S, Shrestha A, Rokaya RK, Joshi KR. Determination of heavy metals in selected cosmetic products sold in Nepal. Journal of Health and Allied Sciences. 2022; 12(2):23-7.

7. Dhimal M, Karki KB, Aryal KK, Dhimal B, Joshi HD, Puri S et al.High blood levels of lead in children aged 6-36 months in Kathmandu Valley, Nepal: A cross-sectional study of associated factors. PLoS One. 2017 Jun 12;12(6):e0179233.