Environmental Issues and Child Health in Nepal

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Environmental Issues and Child Health in Nepal
Dr. Pushpa Raj Sharma Professor of Paediatrics,
Institute of Medicine President Nepal Paediatric
Society Ex President of Paediatric Associations
of SAARC countries
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Environmental health
Environmental health comprises those aspects of
human health, including quality of life, that
are determined by physical, chemical,
biological, social, and psychosocial factors in
the environment.
-WHO
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Nepals Environmental Issues

• Pervasive Poverty
• Water Pollution
• Air Pollution
• Food Pollution
• Vector Born Diseases

• School Health
• Child Labor
• Political Problems

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It is dangerous in children
The elegance and delicacy of the development of a
human being from conception through adolescence
affords particular windows of vulnerability to
environmental hazards. Exposure at those moments
of vulnerability can lead to permanent and
irreversible damage.
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Children eat drink more(ml/kg body weight)
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Behavioral factors

• Soil consumption (mainly hand to mouth transfer)
• Spend more time in contact with floor.
• May eat paint chips and other non-food items.
• Small breathing zone near floor.
• Infants cant move from noxious stimulus.

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Fetus and infant are at risk
Rapid development of brain and reproductive organs
Brain and reproductive organs are to suffer most.
Children have more future years
6 months
21 weeks
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Indoor Air Pollution Cooking Method
Emissions Along The Household Fuel Ladder Smith
et al.38
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Indoor air pollution from biofuel combustion
Nepal Nepal Nepal Nepal Nepal Nepal Nepal Nepal Nepal Nepal Nepal
1986 1986 2 villages 2 villages 49 49 2000 2000 2000 Reid et al Reid et al
1990 1990 1 village - before 1 village - before 20 20 8200 (RSP) 8200 (RSP) 8200 (RSP) Pandey et al Pandey et al
- after 20 20 3000 (RSP) 3000 (RSP) 3000 (RSP)

1986 Cooking - wood (geometric mean) Cooking - wood (geometric mean) Cooking - wood (geometric mean) Cooking - wood (geometric mean) 17 4700 4700 Davidson et al

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Benzene from Petrol
Measurements by the Ministry of Population and
Environment (MoPE) show benzene concentrations
of nearly 80 micrograms per cubic metre along
Kathmandus main streets.
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Diesel Exhaust Particulate

• Enhanced IgE and IgG response to aero allergens
• Potentiation of histamine release
• Implications for exacerbating allergic airway
  disease
• DEP enhances development of new allergy
• Produces behavioral changes

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Air Pollution
A study conducted by the World Bank found that
the share of brick kilns in the valley's air
pollution was 28 per cent while that of domestic
fuel burning was 25 per cent, cement factory 17
per cent, vehicle emission 12 per cent and road
dust 9 per cent. The study estimated that dust
particles in the air cause 18,863 cases of
asthma and 4,847 cases of bronchitis in
Kathmandu every year.
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Percentage of Indian Children With Average Blood
Lead Levels Above 10 ?g/dl (n 1,477)
Source The Alliance to End Childhood Lead
Poisoning and Environmental Defense, The Global
Dimensions of Lead Poisoning (1994).
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Lead poisoning in relation to lead BSL
Death 150ug/DL
Encephalopathy 100ug/DL
Abdominal colic 60ug/DL
Anaemia 40ug/DL
Sensory abnormality 20ug/DL
Low IQ 10ug/DL
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Water Pollution
UN report The report adds that the quality of
drinking water in the Kathmandu Valley is very
poor as it is polluted with coliform
bacteria,iron, ammonia and other contaminants.
Safe Drinking Water Safe Drinking Water Adequate Excreta Disposal Adequate Excreta Disposal
Urban Rural Urban Rural
61 59 74 18
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Arsenic Poisoning The largest mass poisoning of
a population in history.
7 of Tube Wells in Tarai Region is unsafe for
drinking. UNICEF/DWSS
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• Mustard oil, which was used for cooking, was
  found to be contaminated with oil of Argemone
  mexicana seeds.
• Trop Pediatr 1999 Feb45(1)8-13
• Epidemic dropsy in the eastern region of
  Nepal.Singh R, Faridi MM, Singh K, Siddiqui R,
  Bhatt N, Karna S..

Chemicals
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Occupational

• Carpet weavers
• Factory workers
• Vehicle workers
• Street children
• Sex workers

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Occupational
The Carpet Syndrome
Tuberculosis Asthma Scabies Lichenification of
dorsum of hands Deformity of fingers
Sharma PR, Adhikari RK Journal of IOM, 1992
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Girls are trafficked for different purposes
including domestic work, forced beggary, carpet
weaving and for sex trade. About 20 (i.e.
40,000) of the total trafficked women for sex
trade are girls below 16 years.
Most of the household chores and child rearing
activities are the responsibility of girls.
Girls aged between 10-14 work double as
compared to boys in the same age-group.
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Children at war
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What is needed now ?

• Collect more data to increase the power of
  evidence.
• Sensitization of policy makers.
• Increase public awareness using mass media
• Formulation of policy to protect children from
  environmental hazards.

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