INTRODUCTION:

Lead is a toxic heavy metal, and widely distributed throughout environment (air, soil, surface water and even in food) as well as in biological systems. The chronic exposure to lead cause a wide range of effects on children as well as in adult’s health condition, however children (under five years) are commonly affected and face health related threats due to lead exposure.

Elevated levels of lead in the blood of under five year children usually affects their central nervous system which exhibits reduced IQ level, learning disabilities, attention deficit disorders, behavioral problems, stunted growth, impaired hearing and renal failure etc. The high levels of exposure may lead to mental retardation, coma, hyperactivity and even death¹.

World Health Organization statistics highlights that around 6, 00,000 new cases of intellectual disability every year and 70 types of neurological problems are caused mainly due to the lead exposure, wherein only 10 micrograms per deciliter of lead can cause behavioral and learning disabilities in children².

The Quality Council of India investigation reported that 33% of over 370 samples of water from top 26 cities of India have tested positive for harmful content of lead, while 2% of the samples failed to meet even the lenient Indian norms of 50 part per billion (ppb) and 31% samples failed to adhere to the WHO standards of lead content of less than 10 ppb³. These facts are a cause of great concern, lead is a slow poison and the country needs to wake up before it is too late.

Parents do not have much knowledge of domestic sources of lead exposure, its health effects and ways to prevent childhood lead poisoning. The information and education from health care providers can improve the parental knowledge and prevention behaviors^{4, 5.}The education cum training programme was found to be effective not only in upgrading the participants knowledge on lead poisoning but was also effective in modifying their perceptions and enhancing their level of confidence in designing the prevention of lead poisoning related activities⁶.

Similarly a randomized control study on parental education on lead poisoning revealed that study group parents had significantly improved awareness in relation to health effect, lead sources and prevention of childhood lead poisoning. Alongside the children and parent’s behavior were also improved accordingly and significantly. It emphasized that the parental education is proved to be an effective approach for children with mild and moderate lead poisoning⁷.

Lead poisoning is a major public health concern, and there is a need for increasing awareness about the same. Along with awareness, prevention remains the best possible choice for reducing childhood exposure to lead. Information and education is imperative in preventing the occurrence of lead poison related diseases and protection of children from hazardous exposure. The available evidence envisages that there is an inadequate awareness among the parents in relation to lead poisoning and its prevention. Health care professionals are the educated resources available within the community, where the awareness generation acknowledged as a best public health option. Thus present study was carried out to evaluate the impact of an education intervention on knowledge of lead poison among parents.

MATERIAL AND METHODS:

It’s an experimental study where pre test and post test design was used. A total of 50 parents of Loni (Bk) village of Ahmednagar Dist, Maharashtra (the size was calculated scientifically by openepi, version 3 open source calculator – SS mean), and aged above 21 years were included in the study after taking the written informed consent; parents of children undergoing treatment for lead poison was excluded. Study was approved by Institutional Ethics Committee/Institutional Research Committee of PIMS (DU), Loni (Bk). Probability method, simple random sampling technique was used to select the participants. The Chicago Lead Knowledge Test questionnaire (Marathi version) (consist of 24 items with four sections a) general information b) exposure c) nutrition and d) prevention) was used to collect data related to lead poison.

After pre test, education intervention was implemented individually in their home with help of lecture cum discussion method of teaching in Marathi language (regional) for four sessions of 45 minutes each, along with educative materials like leaflets and pamphlets were supplemented for reinforcement and compliance. Education intervention comprised of following aspects such as: a) sources of lead poison b) health effects c) measures to reduce lead exposure d) nutritional suggestions e) safer toy ideas f) dust clean up practices and g) behavioral changes that can reduce lead exposure. After 30 days of education intervention post test was carried out by using same tool. Collected data was coded, tabulated and analyzed with help of descriptive and inferential statistics wherever required.

RESULTS:

Findings related to socio demographic data of mothers and under five year children:

All the parents under study was mothers, while majority (76%) of mothers was belong to 20 – 25 years of age, higher percent (64%) had higher secondary education as highest educational qualification, nearly half (48%) had monthly income of Rs. 5001 – 10000 and most of them (92%) were homemakers. Majority (62%) of mothers did not have previous knowledge on lead poisoning. Almost all (98%) consumes Gram Panchayat water (pipe water), more than half (54%) of their home was repaired/renovated in the past 6 months, majority (64%) used dry broom for cleaning the home. Majority of participants (70%) of children were 1 – 3 years of age, (56%) had female children, and (64%) of them had first birth order.

Findings related to knowledge on lead poison: Findings of study shows that in pretest overall awareness mean score was (12.1±2.96) indicating parents had ‘average’ level awareness on lead poison wherein during posttest participants had higher mean score (20.4±2.61) indicating ‘good’ awareness which was found statistically significant at p<0.05 level (table1). Alongside, the effectiveness of intervention on various items on lead poisoning was depicted in (table 2). A statistically significant association was found between awareness and demographic characteristics of parents such as age (x²=4.71) and education (x²=3.94) at p<0.05 level.

Table 1: Mean scores of awareness on lead poisoning among parents

SN	Areas	Pretest		Post test		t value
SN	Areas	Mean	SD	Mean	SD	t value
1	General information	14.6	3.02	21.1	2.79	3.9*
2	Exposure	13.9	2.51	20.5	2.65	4.7*
3	Nutrition	15.3	2.83	22.7	3.14	3.8*
4	Prevention	11.4	1.95	19.8	2.36	3.5*
Overall		12.1	2.96	20.4	2.61	4.3*

df – 49 *Significant p<0.05

Table 2: Effectiveness of educative intervention on lead poisoning

S.No	Items	Pre test (%)	Post test (%)
1	Lead paint chips can be poisonous when eaten	74	96
2	High lead in the body can affect a child ability to learn	78	89
3	Most children have symptoms right away if they have an elevated blood lead level	60	79
4	House owners are required to renders about known lead containing paint in home when a lease is signed	64	86
5	A child highest blood lead level generally occurs around five years of age	51	93
6	Lead paint is more likely to be found in newer homes than in older homes	64	94
7	Living in a building during innovation / remodeling increase child’s exposure to lead	57	96
8	Lead dust on their hands and then putting their hands in their mouth will get lead poisoning	66	99
9	A child can become lead poisoned during exposure to lead containing dust	62	99
10	Some imported ceramic is not safe to use for cooking or for eating because it contains lead	56	78
11	Parents who work with lead at their jobs can bring lead on their clothes	66	97
12	The lead a pregnant woman takes in to her body can be transferred to the unborn baby	42	98
13	Lead in soil cannot harm children	68	86
14	Most cases of childhood lead poisoning are caused by drinking water that contains lead	58	96
15	Most children get lead poisoning by breathing in lead, rather than by eating or swallowing lead	50	92
16	Some herbal or traditional home remedies contain lead	58	94
17	Washing a child’s hand often helps prevent lead poison	66	95
18	Warm tap water usually contains less lead than cold tap water	70	91
19	Lead in water can be removed by boiling	54	90
20	Cleaning a home with soap and water decreases lead in the home more than dusting or sweeping	68	89
21	The human body needs a small amount of lead for good nutrition	47	80
22	Less lead is taken up by the body if a child eats a balanced diet, without too many fatty food	68	89
23	A diet with a iron rich foods will help decrease a child’s chance of becoming lead poisoned	36	87
24	A diet with enough calcium helps prevent lead poisoning	33	84

DISCUSSION:

The study results revealed that all parents participated under study was mothers and greater proposition of mothers were up to 25 years of age. This finding was consistent with the study carried out by Kegler MC and Malcoe LH who also noticed that most of caregivers (participants) were mothers⁸. Exposure to lead from environment, contaminated foods and water impose a major concern to human species. Majority of participants under study used pipe water as source of drinking water. This finding is consistent with a fact that the most common reason for lead poisoning is through potable water, where pipes are used for supplying water to homes for drinking and agricultural field for irrigation are the most common source of lead entering the human system⁹.

Improved house cleaning practice proven to be cost effective strategy for prevention of potential lead poisoning in the environment. In line with it was observed that majority of participants under study were used dry broom for cleaning home. This is similar to the study of Haman T, Mathee A and Swart A also found most of participants reported cleaning their floors on daily basis with help of dry broom¹⁰. Half of participants under study had renovated their homes in the past 6 months of period, it is in congruence with fact that older homes contain lead components and have chipping and peeling paint on interior and exterior surfaces are at higher risk of lead exposure, wherein the renovation of homes i.e. healthy home prevents the lead exposure¹¹.

It is documented that the educative intervention (comprised of health sequelae of lead, lead exposure reduction strategies, household cleaning and nutrition) was effective in improving awareness on lead poisoning, and also found statistically significant. This finding is consistent with study conducted by Campbell C, Tran M, Gracely E, Starkey N, Kersten H, Palermo and Rothman N et al also documented that lead education significantly increased knowledge during the baseline visit from a pretest mean of 6 to a posttest mean of 12 (p<0.001), while the subsequent comparisons indicated retention of most of the material on lead poisoning¹².

The demographic variables of participants such as age and educational status had a statistically significant association with the awareness on lead poisoning. These findings were contradictory with the findings of Karunwi AO and Oshiname F that sex and educational qualification were not determinants of the level of knowledge regarding lead and lead poisoning at pre and post test. Educational qualification did not play any role in improving the baseline knowledge on lead poisoning¹³. However the community education is a recommended mechanism for comprehensive childhood lead poisoning prevention activity.

CONCLUSION:

Though there are various interventions available to reduce the risk of childhood lead exposure which may be costly and challenging one. However the lead awareness programs such as educative interventions are relatively cost effective and shown impact in improving the awareness and enhancing the prevention behaviors of lead poisoning. The awareness generation leads to comprehensive understanding on childhood exposure of lead poisoning. It is imperative that the public awareness drive i.e. community education on lead poisoning and its hazardous effects on health is a stepping stone of lead poisoning prevention in the country which needs to be practiced regularly.

SOURCE OF FUNDING:

Self.

CONFLICT OF INTEREST:

Nil .

REFERENCE:

1. Centers for Disease Control and Prevention. Preventing lead exposure in young children: a housing based approach to primary prevention of lead poisoning, Atlanta: CDC; 2004.

2. World Health Organization. Lead poisoning and health, Fact Sheet, 2017.

3. Vikas Ecotech Limited. White Paper, Lead poisoning India’s food and water supply chain. 2016: 1 – 5

4. Sridhar KC and Adebamowo AC, An examination of knowledge, attitudes and practices related to lead exposure in South Western Nigeria. BMC Public Health, 2006; 6: 82.

5. Metha S and Binns HJ. What do parents know about lead poisoning? Arch Pediatric Adolesc, 1998; 152: 1213 – 1218

6. Karunwi AO and Oshiname F. Outcome of training intervention on teacher’s knowledge, perception and self efficacy for prevention of childhood poisoning. Afr J Biomed, 2015; 18 (2): 147 – 60

7. Shen XM, Yan CH, Wu SH and Shi R, Parental education to reduce blood lead levels in children with mild and moderate lead poisoning: a randomized controlled study. Zhonghua Er Ke Za Zhi, 2004; 42(12): 892 – 97.

8. Kegler MC and Malcoe LH. Results from a lay health advisor intervention to prevent lead poisoning among rural Native American children. American Journal of Public Health, 2004; 94 (10): 1730 – 35

9. Vikas Ecotech Ltd. White Paper, Lead poisoning India’s food and water supply chain, 2016: 1 – 5

10. Haman T, Mathee A and Swart A. Low levels of awareness of lead hazards among pregnant women in a high risk Johannesburg neighborhood. Int J Environ Res, 2015; 12: 15022 – 27

11. Mississippi State Department of Health. Mississippi Lead poisoning prevention and healthy homes, 2012 – 2016: 1 – 59

12. Campbell C, Tran M, Gracely E, Starkey N, Kersten H, Palermo and Rothman N et al. Primary prevention of lead exposure: The Philadelphia lead safe homes study. Public Health Reports, 2011; 126 (1): 76 – 88

13. Karunwi AO and Oshiname F. Outcome of training intervention on teacher’s knowledge, perception and self efficacy for preventing childhood lead poisoning. Afr J Biomed Res, 2015; 18 (2): 147 – 160

Received on 27.03.2018 Modified on 20.05.2018

Asian J. Nursing Education and Research. 2018; 8(4):511-514.

DOI: 10.5958/2349-2996.2018.00104.0