By W.A. Zeleke
01/03/2017
CONCERNS ABOUT LEAD EXPOSURE TOXICITY in ETHIOPIA
During the US presidential campaign just ended with the election of Donald Trump, a relatively less known city in Michigan called Flint attracted the attention of the candidates and many others around the world because of unexpected poisoning of its residents with lead from drinking water. Lead is a confirmed toxic metal that primarily affects young children, in most cases with long-term irreversible consequences. As expected, whereas each candidate promised voters the resolving of the lead problem during his/her administration in the future, continued investigation of the issue led to the resignation and criminal charging of a number of city officials, and the changing of the source of the water supply. Being alarmed by what happened in Flint, investigators also found nearly 3000 other communities in other states with recoded lead poisoning rates close to double of that recorded in Flint.
These findings in present-day America are surprising to many, given that the country is in use of one of the strictest environmental regulations in the world and the fact that it has long abandoned (at least in principle) the unsafe use of lead. Although efforts are being made to implement the lead policies as intended, occasionally, however, failures are encountered for a number of unintentioned reasons, as exemplified by the unfortunate cases noted above. Nonetheless, since the system established is self-correcting in most cases, it is hoped that these experiences with lead will only remain as isolated incidents.
Being aware of the devastating health effects associated with lead exposure, the story that surfaced in Flint instigated me to ask some key questions regarding the situation of lead in Ethiopia. Is lead used in Ethiopia for any purpose? Are there reports of lead contamination and poisoning/toxicity in the country? Is there any regulatory mechanism related to the availability/use of the metal. Is there anything that can be done if lead-related problem exists and so on? In an attempt to answer these questions, I looked at the available information in different reliable sources at my disposal, including scientific articles, conference presentations, books and other sources in the Internet.
Lead Availability and Exposure in Ethiopia It is generally known that lead exposure mostly arise from consumption of contaminated foods and drinking water, occupation linked to lead, hobbies, and atmospheric contamination. The literature search results specific to the current Ethiopian condition regarding the availability of lead, control mechanisms, and exposure issue are summarized below, along with other related pieces of information. Lead in gasoline: A study conducted about four years ago determined that the contents of lead in fourteen different roadside soils of Addis Abeba were more than four times higher than the maximum limit recommended by the WHO. The main cause for the increased contamination was believed to be the inclusion of lead additives in the gasoline used in Ethiopia.
This fact also holds true today, despite recent claims by governmental/TPLF authorities of the importation/distribution of gasoline with lower lead contents. Relative to comparable cities in many other countries, the levels of lead determined in the soils of Addis Abeba were higher- with the likelihood of still remaining higher at this very moment. Besides surface soil contamination, the presence of excessive lead in gasoline is also associated with lead contamination of the air, water, vegetation, dust and airborne particles, particularly in urban areas through emissions from ever-crowded motor vehicles. It is predictable that people inevitability can come in contact with the lead so widely spread in environment. Lead in contraction industries: Lead exposure is considered an occupational hazard in Ethiopia, mainly as a result of its used/misuse in the construction industry. This industry employs a huge number of unskilled laborers, both men and women, who are involved in jobs like demolishing, manual scraping, concreting, plastering and painting. All of these jobs involve the handling of materials containing or contaminated with excessive amounts of lead.
As the well-being of laborers is not a priority in Ethiopia under TPLF, workers they are not aware of the potential dangers of lead contamination, nor are they given the required protection by their immediate employers. Consequently, they are grossly exposed to the metal in this exploitative and unsafe working environment. This highly hazardous condition may not only be limited to the workers themselves, but it can also be extended to others that they come in contact with, for example, in their homes and the neighborhoods.
In support of the role of occupations, a recent study carried out in Jimma has documented markedly elevated blood lead level of construction workers, both males and females. The participation of female workers in this hazardous job is more concerning because exposure of these workers lead can be an added risk factor for the health of their future offspring.
Lead in battery/auto-garage industry: It is common knowledge that almost in every city in Ethiopia- small or large- there are auto workers heavily engaged in lead-acid battery repair/recycling and auto-garage service jobs. These workers are among the most exposed to high levels of lead in Ethiopia. As a result, in adding to endangering themselves, they have the potential to spread the toxic substance to other places including their homes, with the high probability affecting others that they may directly interact with. Furthermore, unwanted lead-acid batteries are disposed in open fields without any consideration of negative effects, creating fertile conditions for land and water contaminations with lead.
At times, batteries are burnt with other garbage collections in open air further causing widespread dangerous environmental pollution. Lead in paints: While paints free from harmful levels of lead are commonly used in most countries of the world, this is not the case in Ethiopia. There are a number of companies in Ethiopia that manufacture/develop, import, export and/or distribute paints locally. It appears that the majority of these companies are owned by individuals who are well connected to the TPLF ‘ruling’ organization. It has been reported that out of 36 paints currently available in Ethiopia, nearly 30 (83%) contain lead levels far above the internationally accepted maximum limit (in some cases, by more than 500 folds).
These paints are widely used in the country for a number of purposes, but more commonly for painting house walls, fences, doors, furniture, and perhaps toys. Such a wide and ‘nearby’ application of lead obviously further increased the risk of exposure to its toxic effects. Somewhat puzzled by this reality in Ethiopia and elsewhere, a spoke-person of the UNEP in a 2013 international meeting on lead expressed: ‘In this day and age, it is quite frankly breathtaking that parents painting their child’s nursery a cheerful red, or handing their child a colorful toy may, through no fault of their own, be exposing that child to a pernicious and damaging toxin– lead.’ This statement emphasizes the lack of concern of the authorities in these countries for the well-being of their own people.
Lead in drinking water- the root cause of the story: As to lead contents in drinking water in Ethiopia, there are no reports of evaluation, except for a few cases in large urban centers. Granted the rampant incompetency and corruption in the so called Ethiopian government, it is no surprise that citizens are not getting what they deserve from their leaders. As expected, the few studies conducted in Addis Abeba have demonstrated higher amounts of lead in piped household water supplied from different reservoir sources, beyond that recommended by the WHO (that is, greater than 10 gram of lead per liter). Since lead rarely occurs naturally in water, most of the lead contamination takes place at some point in the water delivery system.
It has been found that in a situation like the one existing in present-day Ethiopia, the source of the lead in drinking water is due primarily to the pipe itself (made from lead), the service connections, and the solder/brass fixtures. Bound by circumstances of continued consumption, lead in drinking water in Ethiopia plays a prominent role in increasing the total lead exposure and the risks associated with it. Other lead sources:
There are also many other sources of lead for increased exposure that need to be aware of for protection. These include lead in agriculturally applicable products, such as some fertilizers and pesticides, some cosmetic and dyeing products, and food items stored in lead-soldered cans. Lead and adoption of children: It is interesting and instructional to note that the CDC has issued a warning concerning lead for American families planning to adopt children from certain developing countries with recorded high levels of lead. Unfortunately, one of the countries identified as a possible location for excessive lead exposure is Ethiopia.
The sources of lead discussed earlier are believed to be contributory to the problem raised in relation to the adoption of children from other countries. To be objective, the primary purpose of the CDC communication was to inform perspective parents interested in adopting children from overseas about the problems of lead exposure and to help them prepare to safeguard the health of the children. Overall, the information presented above provides ample evidence that the risks for excessive lead exposure are generally much higher in Ethiopia than what is expected relative to the recommended WHO value. Sadly, this situation has put the Ethiopian people in a position with increased probability of experiencing the damaging consequences of lead exposure. What Are the Health Effects of Lead? Because lead is neither essential nor beneficial, it not supposed to be in the human body. Once it gets access, it can, however, cause health hazards of various types and intensities, depending on multiple factors.
As a heavy metal, its basic mechanism of action involves inactivation cellular enzymes. It has also the ability to displace useful endogenous chemicals from their normal sites of action. These and other effects of lead then result in impairment of cell/organ functions that normally depend on the processes affected. Effects during pregnancy and on the newborn: In pregnant woman, lead can pass the placenta barrier and reach the fetus.
There is evidence indicating that it can cause miscarriage/abortion or harm to the unborn. Therefore, pregnant women or women likely to become pregnant should be especially careful and avoid exposure to lead. In the past, since female workers dealing with lead were found to suffer from high rates of miscarriage and stillbirth, many countries had restricted their employment in lead industries. Children born from women with high blood levels of lead are reported to encounter neonatal death, reduced gestational ages, minor congenital/chromosomal anomalies, reproductive disorders, decreased placental functioning, reduced birth weights, slow growth, and learning difficulties. During lactation, there is also increased and sustained mobilization of maternal skeletal lead to breast milk, posing a potential hazard to the infant. Effects on children: Lead is a major health threat to children, inducing adverse effects in different organ systems that can last life-long. However, the greatest risk is to brain/nervous system development where irreversible damage can occur.
In this regard, children under six years of age are most vulnerable to lead exposure because their brains/nervous system are still developing. Those between the ages of one and three are at greater risk since they are walking, playing, crawling and have more frequent eating activities on floors where lead dust can accumulate.
The damage inflicted on the brain/nervous system can affect the intellect (IQ) to result in learning disabilities and other behavioral changes. It should also be noted that although the brain/nervous system effect of lead in the young is more prominent and serious, there are many other related as well as unrelated effects caused by high lead exposure. These actions include general developmental delay, loss of appetite, weight loss, irritability, gastrointestinal effects, and hearing loss. It is likely that higher levels of lead can also damage the kidneys and even cause seizures, unconsciousness and possibly death in both children and adults.
Effects on adults: Although children are more at risk, poisoning with lead can also be dangerous for adults. In male adults, depending on the concentration level, lead cause testicular dysfunction, sperm abnormalities, erectility dysfunction, reduced serum testosterone, decreased sex drive, and sterility. In females, varying with its concentration, lead can induce ovarian dysfunction, reduced sex drive, and sterility/ infertility. Also, in both male and female adults, lead poisoning is characterized by at least the following additional signs and symptoms: high blood pressure, gastrointestinal disorders, muscle and joint pain, headache, mood disorders, neuralgia, and declining mental functioning. How Is Lead Poisoning Treated? • The initial step of treatment is to identify and remove (or seal) the source of the lead. • Children should be kept away from the source. • Contact experts or authorities for information on how to remove lead and to help you avoid the likelihood of exposure. • With the recommendation and help of health professionals, a procedure known as chelation therapy can be used in more severe cases. The agent used in this treatment binds to lead that has accumulated in the body. The complex formed is then excreted out of the body in the form of urine. • In other cases (or additionally), activated charcoal can be used to bind the lead while in the gastrointestinal tract to facilitate its elimination via defecation. For this, a chelating agent (EDTA) may also be used. •
It is important to realize that even with treatment, it may be hard to reverse the effects of chronic lead exposure, and this is considered to be the worst outcome of exposure to the metal, which starts to develop early in life. How Can Lead Poisoning Be Prevented? Simple steps can help prevent lead poisoning and these include: • Educating yourself and others about the dangers of lead poisoning • Avoiding or minimizing exposure to lead by considering the following practical measures, among some others: –
Get your household water tested for lead and if the lead levels are high, take appropriate action to change the water source or remove the lead – Use cold tap water to prepare foods and drinks – Avoid or throw away suspected painted toys and canned foods – Keep your home and furniture free from dust – Wash hands before eating – Wash regularly toys and bottles used by children – Instruct children to wash their hands after playing and at bedtime. – Use lead-free paints or paints within the recommended lead limitation – Have young children’s blood lead level screened as recommended – Use appropriate protective workplace measures if lead is involved – Avoid places where lead-based paint may have been used •
Asking help from potential providers or professionals in case of lead-related problem(s) that cannot be addressed properly. Dietary Recommendations for Lead Toxicity The above recommendations regarding the prevention and treatment of lead toxicity are more or less universally accepted and considered standards. However, in many countries, particularly in the ‘Third world’, their implementation largely remains questionable for a number of reasons, mostly related to administrative failures and neglect. In addition to these recommendations, diet-based supplemental therapy is found to be important for reducing the amount of lead in the body and to lessen its harmful effects.
This is one of the recommendations presented by the Michigan Health Department for the residents of Flint affected by the recent lead crisis. This diet therapy consists of nutritional ingredients that can easily be obtained and adopted by other victims of lead toxicity almost anywhere, including even in Ethiopia. Following are dietary components commonly recommended as part of a healthy diet designed to reduce the effects of lead poisoning, along with the preferred method of application for better outcomes. •
Eat healthy food regularly to reduce absorption of lead from the stomach because empty stomach absorbs more lead. • When applicable, select ingredients from fresh and organic sources • Wash fruits and vegetables before eating • Choose to eat foods that contain high amounts of calcium, iron and vitamin C (ascorbic acid) – Calcium can reduce blood level of lead, in addition to directly reducing (at least partly) the capacity of lead to impair organ functions. – Iron is very similar and competitive to lead, and when there is more iron, less lead is absorbed in the gut and also taken-up by cells within the body, lessening its impact on organs. – It is relevant to note that In Ethiopia iron deficiency is a common problem, that can exacerbate the toxicity of lead, particularly in children. – Vitamin C can help the body absorb more iron and calcium, thus lowering blood lead levels. •
Foods rich in calcium: – Milk, milk products (yogurt, cheese) – Green leafy vegetables (spinach, kale, collard greens) – Fish (salmon) – Peanuts • Foods rich in iron: – Lean red meats, fish, chicken (skinless) – Nuts or sunflower seeds – Green leafy vegetables – Fish (tuna, salmon) – Dried fruits (raisins, prunes) – Dried beans and peas – Teff products (preferably brown or red teff) • Foods rich in vitamin C (ascorbic acid): – Oranges, tangerines, orange juice – Grapefruits, grapefruit juice – Lemons, limes – Strawberries – Kiwis – Cantaloupes – Broccoli – Potatoes, sweet potatoes – Tomatoes, tomato juice – Green/bell peppers Concluding Remarks Lead is a highly toxic metal which builds up in the body to cause serious and sometimes fetal conditions. As a neurotoxin, it is more harmful to children with developing brains than adults.
Adults with moderate exposure to lead usually recover without any complications, but in children recovery can take time, if irreversible damaged has not already occurred. Even low lead exposure starting at young age can result in permanent intellectual disability, if not properly treated in time. Demonstrating the gravity of the lead issue, Hanna-Attisha, one of the physicians treating the victims of toxicity in Flint stated: \”If you were to put something in a population to keep them down for generation and generations to come, it would be lead.\” There are a number of helpful prevention and treatment approaches for lead toxicity and these are outlined in the present article for consideration. Key References: Lead poisoning, Mayo Clinic Staff, http://www.mayoclinic.org/diseases-conditions/lead-poisoning/home/ovc-20275050 (accessed 12-30-2016) Children in developing countries exposed to toxic lead Paint, Environmental News Service, 12/ 23, 2013. Ethiopia lead paint data, 2014-2015,
IPEN, http://ipen.org/sites/default/files/documents/ Ethiopia%202015%20Lead%20Paint%20Data_EN.pdf Lead in Flint water, Flint Water
ResponseTeam, http://ehscc.umich.edu/multimedia/Lead_in_Water_Pamphlet_English.pdf Asse
ssment of Lead Toxicity Awareness among Battery Charging Garage and Workshop Workers and Levels of Lead in Piped Drinking Water of Addis Ababa, Ethiopia, Tamene Duressa, 2008, http://etd.aau.edu.et/bitstream/123456789/1146/2/PDF.pdf Note:
1.This article is primarily intended for fellow Ethiopians back home who live under the threat of lead toxicity and many other adversities. The author feels obliged to request readers to share the information with them by whatever means possible to provide the opportunity to take appropriate action(s).
2. The current Ethiopian government (TPLF) has a record of using drugs and poisons as a tool for ethnic cleansing (especially of the Amara and Oromo people) and to kill individuals that are perceived competitors or enemies. Learning from experience, it is imperative to be suspicious of the TPLF government that it may choose, at any time, to use lead as a weapon against the people of Ethiopia that it selectively picks to eliminate.
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