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The National Referral Centre for Lead Poisoning in India

The National Referral Centre for Lead Poisoning Prevention in India (NRCLPI) established by The George Foundation with St.John's National Institute of Health Sciences, Bangalore has now become the nodal referral centre in India. Several sub centres are being setup in Andhra pradesh, Kerala and other states. NRCLPI conducts blood lead tests, awareness creation efforts and communication with lead-based industries to reduce lead contamination.

Lead ranks as one of the most serious environmental poisons amongst the heavy metals on earth. It poses serious health hazards to humans, especially to young children.1 The sources of exposure to lead include gasoline, leaded pipes, lead solders in water supply systems, and lead based paint, cosmetics, medicines, etc. 2,3,4 Studies conducted in various countries have uncovered the fact that lead poisoning and iron deficiency anemia are problems of major proportions in large cities throughout the world and more so in developing countries where environmental regulations are not effectively enforced, and where public awareness is extremely low.

Though lead poisoning is one of the major urban environmental hazards, most developed nations have been successful in reducing its danger in their respective countries during the past three decades, through aggressive implementation of preventive measures. Until recently, only isolated incidents of lead poisoning were detected in India, and population studies to determine blood lead levels were hardly conducted. Even today, no reliable statistics are available on the incidence of lead poisoning and its impact on the Indian population, and hence, the problem remains poorly understood.

Between 1997-1999, a major screening program called "Project Lead Free" was carried out by The George Foundation (TGF), a non-governmental organization, to determine the blood lead levels among the population in seven major Indian cities (Bangalore, Calcutta, Chennai, Vellore, Hyderabad, Delhi and Mumbai). This study of over 15,000 children and 5,000 adults clearly indicated an environmental health crisis; it concluded that over 50% of the children below the age of 12 years living in urban environments have unacceptable blood lead levels of 10ug/dl or more. Further 14% of the children in these cities have seriously elevated levels of lead of 20ug/dl or more. The results of Project Lead-Free brought about greater awareness of the problem among the public, and more importantly, among policy makers in government.

In order to reduce lead poisoning in India, efforts have to be made to create public awareness through community involvement, comprehensive programmes and coordination at all levels. Raising public awareness about the dangers of lead poisoning from occupational and environmental sources is a crying need in Indian cities today. The International Conference on Lead poisoning: Prevention and Treatment, organized by The George Foundation, and sponsored by the Centers for Disease Control (CDC), World Bank, and US Environmental Protection Agency (EPA) in 1999 at Bangalore, elevated national awareness to this problem and resulted in the initiation of several policy measures by the government. The executive committee of the conference prepared a document entitled: A call for action on the prevention and treatment of lead poisoning in developing countries, and submitted it to the Government of India. The recommendations contained in this document included twelve priority items for the prevention and treatment of lead poisoning, most of which "if instituted without delay" could be "realistically accomplished within five years." Following the conference, the three State-run oil companies introduced unleaded patrol throughout India in April 2000, a major first step in reducing lead poisoning.

Since the problem of lead poisoning in India still persists, continuous efforts are needed to deal with the problem. A developing country like India can tackle this preventable environmental health hazard only through proper public awareness, communication and education. Hence, following the international conference, The National Referral Center for Lead Poisoning in India (NRCLPI) was established as a joint project of St. John's National Academy of Health Sciences (SJNAHS) and The George Foundation, both from Bangalore. NRCLPI is a non-profit undertaking that carries out the following activities.

Mission and goal of NRCLPI is to:

• Provide updated information on all aspects of lead poisoning and its prevention through a designated website www.leadpoison.net.
• Offer a referral and confirmatory lead testing service for blood samples received at the Centre from anywhere in India.
• Disseminate relevant information on lead poisoning to Government authorities, NGO's, clinicians treating lead poisoned cases and other institutions concerned, and create awareness among the general public through education, documentation and media communication.

In carrying out the above functions, NRCLPI concentrates on the following:

1. Provide adequate information to clinicians treating cases of lead poisoning.
2. Organize training programs to pre and para-medical representatives on the laboratory assessment and evaluation of lead poisoning.
3. Recommend to the government on the implementation of various policies to protect lead based industries and its employees.
4. Create awareness among the public through the media, publications and out reach programs.
5. Assist researchers and academicians involved in research activities in the field of toxicology with special reference to lead.
6. Screen for lead poisoning by evaluating blood lead levels using established international standards and protocols.
7. Provide consultancy services to employees of lead based industries in evaluating, monitoring and eliminating workplace and lead poisoning.
8. Make policy recommendations on reduction and prevention of lead poisoning to the government for national implementation.

Currently, NRCLPI lab receives over 200 blood samples each week from all over India for confirmation of lead levels. However, much of its efforts are focused on prevention and assistance in dealing with lead contamination. Industries that use or process lead are contacted by NRCLPI to conduct testing for their employees, and also to advise them on prevention. It is hoped that governments at both central and state levels will work through and with NRCLPI and other similar organizations to bring about policy changes, and implement the necessary measurers to deal with the serious problem of lead poisoning in India.

NRCLPI is chaired jointly by Dr. Abraham George from The George Foundation, and Dr. (Fr.) Thomas Kalam from SJNAHS, and directed by Dr. T. Venkatesh from the Department of Biochemistry, St. Johns Medical College, Bangalore. Contact: Tel: 080-2065058; Fax: 080-5520777;
Email: nrclpi@leadpoison.net. Website: www.leadpoison.net

References:

1.Bellinger D, Leviton A, Waternauz C et al: "Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development in early infancy". Paediatrics (1987); 80: 721-730.

2. Gogte ST, Nandita Basu, Seeta Sinclair et al: "Blood lead levels of children with pica and surma use". Indian J pediatrics (1991); 58:513-519

3. Smitherman J and Harber P: "A case of mistaken identity: herbal medicine as a cause of lead toxicity". American Journal of Industrial Medicine (1991); 20(6): 795-8.

4. Shenoi RP, Khandekar RN, Jayakar AV et al: " Sources of lead exposure in urban slum school children". Indian Paediatrics (1991); 28: 1021-1027.