Blood Lead Levels in children 2 through 59 months old in Bhutan
Introduction: Pediatric lead exposure has long-term health, public health, and economic consequences; however, it is an underrecognized problem in low and middle-income countries. Our objective was to determine the prevalence of elevated blood lead levels (EBLLs) (≥5μg/dL) and evaluate risk factors for EBLLs in infants and children in two cities in Bhutan. Methods: A crosssectional study of children 2 through 59 months old was conducted in Thimphu and Phuentsholing, Bhutan during 2018. Blood was obtained by finger-stick and tested using a LeadCare II analyzer (Meridian Bioscience). Data were double entered in EpiData 3.1 and validated. Excel, Prism8, and STATA/IC 15.1 were used for analysis. Results: Among 531 participants, the prevalence of EBLLs was 43.88%. The prevalence of EBLLs in girls and boys was 37.40% (n=262) and 50.19% (n=269), respectively (p= 0.004). The prevalence in Thimphu was 52.35% (n=361), compared to 25.88% (n=170) in Phuentsholing (p< 0.001). In Thimphu, 70.47% (n=149) of 1 - 4 year old children tested in spring had EBLLs, compared to 51.45% (n=138) in autumn (p=0.001). Of the risk factors assessed, only regularly eating with fingers or hands was significantly associated with EBLLs (p < 0.001). Conclusion: Nearly half of participants in two cities in Bhutan had elevated blood lead levels. Seasonal exposure to lead appears to be present. The high prevalence in this study is alarming. Further studies are urgently needed to both characterize the sources of lead and validate these findings on a larger scale.
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