Yatin Pimple, Technical Advisor, Vital Strategies and Ambrish Kumar Chandan, Technical Advisor, Vital Strategies in an interaction with Express Healthcare talk about lead exposure among children in India and highlight that Vital Strategies collaborate with government agencies to implement blood lead surveillance programs
What are the health and economic impacts associated with lead exposure among children in India?
Lead is an environmental toxicant, and its exposure can cause anaemia, hypertension, renal impairment, immunotoxicity, and toxicity to the reproductive organs. Young children are particularly susceptible to lead poisoning because they absorb far more lead from their environments than adults and because their central nervous systems are still developing (Schwartz, 1994). Lead exposure can affect children’s brain development even at a low level. It can result in reduced intelligence quotient (IQ), behavioural changes, and reduced educational attainment and lifetime earnings.
What is the current modelled prevalence of elevated blood lead levels in Indian children? Why is blood lead surveillance urgently needed in India?
As per the NITI Aayog-CSIR Report 2022, 23 states in India are estimated to have an average BLL above 5 μg/dL, which according to WHO is an actionable threshold. India contributes to 26 per cent of global annual deaths due to exposure to lead and 1 out of 2 Indian children is estimated to have an unsafe blood lead level (IHME, 2019). Since 1990, India has seen a 21 percent increase in deaths due to lead exposure (IHME, 2018). Lead exposure in India is responsible for a loss of 236 billion of US dollars per year, equivalent to 5 per cent of India’s gross domestic product (GDP) (Attina, 2013).
Most of what we know related to lead prevalence is based on modelled estimates or previous studies on lead exposure around hotspots. There is no population level data on lead exposure and blood lead levels available in India. NITI Aayog and CSIR highlighted the need for primary data to estimate the local burden of childhood lead exposure.
How does Vital Strategies collaborate with government agencies to implement blood lead surveillance programs, ensuring tailored initiatives for diverse communities and addressing challenges in low-resource settings?
Vital Strategies, in partnership with Pure Earth, has collaborated with local governments and reputed institutions to design and implement blood lead surveillance.
In Bihar, Vital Strategies engaged with the State Health Society and Mahavir Cancer Sansthan and Research Centre to conduct a statewide representative childhood lead poisoning surveillance in 8 districts. The surveillance findings were shared with government officials and civil society representatives. The research findings asks for immediate action to control and remove lead contamination to safeguard children’s future. The research recommends strengthening the health system by integrating blood lead surveillance of children into routine paediatric care and efforts to increase awareness, monitoring lead content in consumer products and edible items, and focusing on minimizing risk from occupational exposures.
In Tamil Nadu, Vital Strategies is collaborating with the Directorate of Public Health (DPH), Government of Tamil Nadu and Sri Ramachandra Institute of Higher Education and Research (SRIHER) to conduct childhood lead poisoning surveillance in 7 districts. Department of Environmental Health Engineering at SRIHER, the key implementer, is a WHO collaborating centre and an ICMR Advanced research centre. DPH is supporting in identification of eligible households, mobilising them for blood lead testing and setting up blood sample collection centres.
In Maharashtra, Vital Strategies has signed a Memorandum of Understanding (MoU) with the Commissionerate of Health Services, Maharashtra, the key local implementing partner. Some of the project activities involve working with State Health Systems Resource Centre, State Famil Welfare Bureau, State Surveillance Unit and State Public Health Laboratory. The work will involve evaluating and building laboratory and operational capacity, designing and establishing representative blood lead surveillance, identifying important sources of lead exposure, and strengthening health professionals’ ability to identify and treat lead poisoning. Vital Strategies will lead the design and implementation of the surveillance system as well as health worker training. This project will enable the Maharashtra government to pilot and establish statewide blood lead surveillance and strengthen the health system to allow early prevention and timely treatment of childhood lead poisoning cases.
We have undertaken blood lead surveillance in Bihar and submitted the findings and recommendations to the government. The surveillance is under progress in Tamil Nadu.
In Maharashtra, we are currently discussing the surveillance strategy by providing a set of surveillance options to the health department for them to consider. The surveillance options are drafted considering the needs of the local government, available resources, and diverse demographic and geographical characteristics.
In addition to blood lead surveillance to understand exposures and health impacts, Vital Strategies has partnered with Pure Earth for the identification of leading sources of exposure by analysing lead contamination in environmental samples.
Vital Strategies is engaging with the High-Level Roundtable led by the Centre for Global Development to discuss the measures to ameliorate the burden of lead poisoning in the country. We are also working to create mass awareness in society for the lead poisoning problem. We train media champions to bring forward stories about lead poisoning, its causes, disease burden, and possible solutions to generate awareness.
What are the organisation’s future plans for collaborating with governments to expand blood lead surveillance and build a comprehensive lead poisoning prevention program in India?
Vital Strategies plans to successfully implement a government-led blood lead surveillance in one of the states. State Government-led surveillance will be promoted as a model that can be customised and replicated in other locations/ states. In our surveillance options document for governments, we recommend integrating blood lead testing with routine health care diagnostics, national surveys like the National Family Health Survey, health surveillance screening programs like Rashtriya Bal Swasthya Karayakram, Integrated Disease Surveillance Program, and National Programme on Non-Communicable Diseases. Vital Strategies is working to strengthen the health system to effectively respond to and focus on lead poisoning.