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Prevalence of lead poisoning and unique lead sources in Bhutan: Findings from a nationally representative survey 2024
Mongal Singh Gurung1, Phillip Erbele2,3, Kinley Dorjee1
1Ministry of Health, Thimphu, Bhutan.
Insights
Lead poisoning is a significant public health issue in Bhutan, with high blood lead levels (BLLs) found in children and other groups. Unique local sources, like Jinlab Mendrup, contribute to this pervasive problem, necessitating urgent intervention.
Area of Science:
- Environmental Health
- Pediatric Toxicology
- Public Health Policy
Background:
- Lead exposure poses severe health risks, particularly to children, with significant global prevalence.
- Low- and middle-income countries often lack essential data on blood lead levels (BLLs) and lead sources.
- Bhutan, a low-income country, faced a data gap regarding lead poisoning prevalence and sources.
Purpose of the Study:
- To assess the prevalence of elevated BLLs in children aged 1-6 years in Bhutan.
- To identify risk factors and environmental sources contributing to lead exposure.
- To provide data for targeted public health interventions in Bhutan.
Main Methods:
- A nationally representative cross-sectional survey of 2,959 children aged 1-6 years was conducted in 2024.
- Blood lead levels (BLLs) were measured using LeadCare II analyzers.
- Environmental lead sources were identified using portable X-ray fluorescence (XRF) analyzers, including analysis of unique Bhutanese items like Jinlab Mendrup.
Main Results:
- A high prevalence of elevated BLLs was observed: 75.9% of children had BLLs ≥ 3.5 µg/dL and 51.3% had BLLs ≥ 5 µg/dL.
- The mean BLL was 5.3 µg/dL, indicating widespread exposure.
- Lead was detected above thresholds in Jinlab Mendrup (44.2%), spices (22.4%), and kitchen items (21.5%).
- Consumption of Jinlab Mendrup was significantly associated with elevated BLLs (aOR=1.94).
Conclusions:
- Lead poisoning is pervasive among young children and other tested populations in Bhutan.
- Traditional practices and local products, such as Jinlab Mendrup, are significant sources of lead exposure.
- Urgent, targeted interventions are required to mitigate lead poisoning in Bhutan.
Abstract:
Lead is a toxic element causing devastating consequences in children and affecting health throughout life. One in three children globally are estimated to have a blood lead level (BLL) of 5 µg/dL or higher, and lead causes harm at even lower levels. Low-level lead poisoning is pervasive. However, few low- and middle-income countries have national BLL prevalence or local lead source data. A nationally representative cross-sectional BLL survey in children 1-6 years old was conducted in Bhutan in 2024. Risk factors were surveyed, and BLLs were tested with LeadCare II analyzers. Convenience sampling of children less than 13 years old in monastic institutions and purposive sampling of pregnant/breastfeeding women were conducted. Targeted environmental lead source testing was conducted using portable Evident/Olympus Vanta X-ray fluorescence (XRF) analyzers. Two BLL cutoffs were analyzed for comparison with global data. In nationally representative sampling of 1-6-year-old children, 2,246/2,959 (75.9% [95% CI 74.0-77.7]) had a BLL ≥ 3.5 µg/dL, and 1,518/2,959 (51.3% [95% CI 49.0-53.6]) had a BLL ≥ 5 µg/dL. The mean (SD) BLL was 5.3 (3.2) µg/dL. Among monastic children and pregnant/breastfeeding women, 178/207 (86.0%) and 73/124 (58.9%) respectively, had a BLL ≥ 3.5 µg/dL. These two populations were not nationally representative. Lead poisoning prevalence was high across all ages, rural/urban locations, and income quintiles. Taking Jinlab Mendrup (blessed religious substance) in the previous 15 days was associated with having a BLL ≥ 3.5 µg/dL, aOR=1.94 (1.34-2.70, p = 0.009). XRF source testing identified lead above reference thresholds in 44.2% (339/767) of Jinlab Mendrup samples, 22.4% (15/67) of spices, and 21.5% (143/665) of kitchen items. Lead poisoning prevalence was pervasive in young children in Bhutan and in other groups tested. Numerous potential lead sources were identified, including Jinlab Mendrup and items unique to Bhutan. Urgent action is needed to address the high prevalence of lead poisoning.
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