Environmental Issues and

Child Health in Nepal

Dr. Pushpa Raj SharmaDr. Pushpa Raj Sharma

Professor of Paediatrics, Institute of MedicinePresident: Nepal Paediatric Society

Ex President of Paediatric Associations of SAARC countries

Environmental healthEnvironmental 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

Nepal’s Environmental Nepal’s Environmental IssuesIssues

Pervasive PovertyPervasive Poverty Water PollutionWater Pollution Air PollutionAir Pollution Food PollutionFood Pollution Vector Born Vector Born

DiseasesDiseases

School HealthSchool Health Child LaborChild Labor Political ProblemsPolitical Problems

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.

It is dangerous in children

Children eat & drink moreChildren eat & drink more(ml/kg body weight)(ml/kg body weight)

0

20

40

60

80

100

120

140

160

180

200

<.5 .5-.9 1-3. 4-6. 7-14. 15-19. 20-44. >44

Behavioral factorsBehavioral factors

Soil consumption Soil consumption (mainly hand to mouth (mainly hand to mouth transfer)transfer)

Spend more time in Spend more time in contact with floor.contact with floor.

May eat paint chips and May eat paint chips and other non-food items.other non-food items.

Small breathing zone Small breathing zone near floor.near floor.

Infants cant move from Infants cant move from noxious stimulus.noxious stimulus.

0

10

20

30

40

50

60

Child10Kg

Adult65Kg

Soilconsumptinmg/kg/day

Fetus and infant are at riskFetus and infant are at risk

Brain and reproductive organs are to suffer most.

Rapid development ofbrain and reproductive organs

Children have more future years

6 months21 weeks

Emissions Along The Household Fuel Ladder Smith et al.38

Indoor Air Pollution: Cooking MethodIndoor Air Pollution: Cooking Method

Indoor air pollution from biofuel combustionNepal

1986

2 villages 4

9

200

0

Reid et al

1990

1 village - before

2

0

8200 (RSP)

Pandey et al

- after 2

0

3000 (RSP)

1986 Cooking - wood (geometric mean)

17

4700

Davidson et al

Measurements by the Ministry of Population and Environment (MoPE) show benzene concentrations of nearly 80 micrograms per cubic metre along Kathmandu’s main streets.

Benzene from Petrol

Diesel Exhaust ParticulateDiesel Exhaust Particulate

Enhanced IgE and IgG response to aero Enhanced IgE and IgG response to aero allergensallergens

Potentiation of histamine releasePotentiation of histamine release Implications for exacerbating allergic airway Implications for exacerbating allergic airway

diseasedisease DEP enhances development of new allergyDEP enhances development of new allergy Produces behavioral changesProduces behavioral changes

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.

Air PollutionAir Pollution

Percentage of Indian Children With Average Blood Lead Levels Above 10 ตg/dl (n = 1,477)

Source: The Alliance to End Childhood Lead Poisoning and Environmental Defense, The Global Dimensions of Lead Poisoning (1994).

Lead poisoning in relation to lead Lead poisoning in relation to lead BSLBSL

Death 150ug/DL

Encephalopathy 100ug/DL

Abdominal colic 60ug/DL

Anaemia 40ug/DL

Sensory abnormality 20ug/DL

Low IQ 10ug/DL

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 Adequate Excreta Disposal

Urban Rural Urban Rural

61% 59% 74% 18%

Water PollutionWater Pollution

Arsenic Poisoning: Arsenic Poisoning: The largestThe largest mass mass poisoning of a population in history.poisoning of a population in history.

7% of Tube Wells in Tarai Region is unsafe for drinking.UNICEF/DWSS

Mustard oil, which was used for Mustard oil, which was used for cooking, was found to be cooking, was found to be

contaminated with oil of Argemone contaminated with oil of Argemone mexicana seeds. mexicana seeds. Trop Pediatr 1999 Feb;45(1):8-13 Trop Pediatr 1999 Feb;45(1):8-13

Epidemic dropsy in the eastern region of NepalEpidemic dropsy in the eastern region of Nepal..Singh R, Faridi MM, Singh K, Siddiqui R, Bhatt N, Karna S.Singh R, Faridi MM, Singh K, Siddiqui R, Bhatt N, Karna S.

..

ChemicalsChemicals

Occupational

Carpet weaversCarpet weavers Factory workersFactory workers Vehicle workersVehicle workers Street childrenStreet children Sex workersSex workers

TuberculosisAsthmaScabies

Lichenification of dorsum of handsDeformity of fingers

The Carpet Syndrome*The Carpet Syndrome*

*Sharma PR, Adhikari RK; Journal of IOM, 1992*Sharma PR, Adhikari RK; Journal of IOM, 1992

Occupational

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.

Children at warChildren at war

What is needed now ?What is needed now ?

Collect more data to increase the power of Collect more data to increase the power of evidence.evidence.

Sensitization of policy makers.Sensitization of policy makers. Increase public awareness using mass Increase public awareness using mass

mediamedia Formulation of policy to protect children Formulation of policy to protect children

from environmental hazards.from environmental hazards.

www.prsharma.org.np