Unprecedented lead poisoning strikes Nigerian villages

Published by MAC on 2010-06-19
Source: AFP, Reuters, Médecin Sans Frontières

Nearly two hundred infants confirmed dead, many still suffering

Nigeria's lead poison outbreak unprecedented: CDC

AFP

9 June 2010

LAGOS - An outbreak of lead poisoning linked to illegal gold mining that left more 160 people dead in Nigeria is unprecedented, the US Centers for Disease Control and Prevention (CDC) said on Tuesday.

More than 100 of those killed in the poisoning in recent weeks are children aged five years or under.

Nigerian health authorities last month roped in the CDC, along with the World Health Organisation (WHO) and Medecins Sans Frontieres (MSF), to help control the epidemic which the government said started in January.

"The scope of the poisoning is unprecedented in CDC's work with lead poisoning worldwide," CDC said in a statement received here from Atlanta.

"This is because of the severity of the poisoning, the number of fatalities, the large number of children and adults with symptomatic poisoning, and the extent of the environmental contamination," it said.

Nigerian health epidemiologists last week reported 111 toddler deaths out of the 163 lives lost.

The epidemic has hit five villages in Nigeria's northwest Zamfara State in recent weeks, affecting more than 300 people.

The poisonings were caused by the illegal extraction of ore by villagers, who would transport crushed rock home from the mines.

They would then extract the gold and haphazardly dispose of the soil containing lead deposits which children would play with.

Junior health minister Suleiman Bello on Monday said the outbreak had been brought under control.

CDC said "some children are still coming into healthcare facilities with severe symptomatic lead poisoning, and there continue to be some deaths."

CDC assisted with "surveying the population about the deaths of children," as well as collection and analysis of blood and soil samples.

It also helped with the environmental cleanup.

"Initial results have found extremely high levels of lead in blood of children and adults and in the soil," it said.

---

Nigeria tries to end "gold rush" after child deaths

By Sahabi Yahaya

Reuters

9 June 2010

DARETA, Nigeria - Scores of infants in northern Nigeria could be left with long-term neurological damage from lead poisoning caused by illegal gold mining which has already killed at least 170, most of them under five.

Authorities in the state of Zamfara, aided by international agencies including Medecins Sans Frontieres (MSF), the World Health Organisation and the U.S. Centers for Disease Control and Prevention (CDC), are helping treat the sick and bury mines to try to contain the pollution before heavy rains due next month.

The discovery of a gold deposit triggered a "gold rush" among impoverished farmers who dug up rocks by hand, unaware the ore contained dangerously high concentrations of lead.

At least six villages have been contaminated with high concentrations of lead spread by dust from the open mines, and by women processing the ore in compounds where children play barefoot.

The Blacksmith Institute, a New York-based anti-pollution consultancy which has sent experts to help in the clean-up, said at least 170 children had died in the past month. All but three of 133 children tested had lead levels so high it was off the scale of the detection equipment.

"We expect several hundred children will require treatment over the next few months," said Richard Fuller, president of the Blacksmith Institute.

"Unless the homes are fully decontaminated and the lead removed from the environment, the risk for continued poisoning and death remains," he said.

The Dutch arm of MSF (Doctors Without Borders) has set up an emergency centre in Bukkuyum village, where around 50 children are being treated. It plans to expand to double that number by the end of the week and hopes to open a second facility soon.

"For the more severe cases, we see neurological symptoms that have been as severe as to affect the level of consciousness and cause convulsions, sadly followed by death for some of the smaller children," MSF co-ordinator Lauren Cooney told Reuters.

"The deaths we know of, nearly all of them were children under 5 as far as we are aware," she said, adding one village had lost a third of its children under 5 in a matter of weeks.

"Act of God"

Cooney said some of the children who had been receiving treatment for the past week were starting to show signs of improvement. Breast-feeding mothers were also being treated as contamination could be passed through their milk.

"One child who had a lot of convulsions and hadn't really spoken for more than a week ... spoke to his mother for the first time. Another little girl who had some muscle weakness is walking again," Cooney said.

"But I don't want to exaggerate, we still have some children that are seriously unwell and it remains to be seen how they will do with treatment. Sadly it seems likely some will be left with permanent damage."

The Blacksmith Institute has brought in two X-ray fluoroscopes -- machines that look like giant hairdryers -- to detect concentrations of metals in the ground. Toxic earth is dug up and removed before the pits are filled with sand.

Few of the residents in Sunke, Dareta, Tungar Magaji and other mud-brick villages in the poor, arid Sahel region on the southern fringe of the Sahara, have received much formal education. They are sceptical that mining killed their children.

"This problem has not begun with Dareta or the surrounding villages, it must be from elsewhere," said Yakubu Ibrahim, a 43-year-old Dareta resident.

"This is the only way I live. If this mining is no longer possible, what will I do?" he said.

Behind him, villagers warned their youths would turn to stealing cattle if they could no longer mine, saying there had been a rare robbery outside the village just the night before.

On the edge of the village, a plot is encircled with bamboo.

"This is where we bury the children we lost. It is an act of God," said Idriss Yahaya, 55.

It is a common response among the Muslim villagers trying to cope with the sudden death of so many children.

The high infant mortality rate was initially thought to have been caused by cerebral malaria, which can trigger some similar symptoms such as convulsions in small children.

It was only when an MSF team testing for meningitis in the region found high levels of heavy metal in the villagers' blood that the authorities were alerted.

For now, the emergency response is focused on containing the pollution and treating the sick. But educational materials are being prepared in the local Hausa language and aid workers say that in the longer term, only changing the villagers' behaviour will prevent more children from being poisoned.

"This is a great source of livelihood for them and it's not uncommon in these sort of circumstances that people will deny that their activities are an issue," said Blacksmith's Fuller.

"There has to be a campaign of education and it has to include training so they don't lose the livelihood but can do it in a way that is safe for their children." (For more Reuters Africa coverage and to have your say on the top issues, visit: af.reuters.com/ ) (Writing and additional reporting by Nick Tattersall, editing by Paul Taylor)

---

Lead poisoned children in Nigeria requiring immediate treatment

Médecins Sans Frontières (MSF) News Release

16 June 2010

In north western Nigeria, Médecins Sans Frontières and the Nigerian health authorities have started treating 50 children who are sick with lead poisoning. The poisoning, caused by local mining practices has been confirmed in two villages, while four other villages are also suspected to be contaminated, affecting as many as 10,000 people.

"This is an unprecedented and tragic situation - in one village, 30% of the children under five have died in the past year. A continued coordinated, large scale emergency response is needed, to ensure that the contaminated villages are cleaned up, that the most vulnerable receive urgent treatment and that effective health education messages are passed to prevent re-contamination of living areas," explains Lauren Cooney, emergency coordinator for MSF in Nigeria.

The lead poisoning is a consequence of local villagers practicing small-scale gold extraction from lead-containing ore. The processing of the ore involves crushing and drying. The crushing causes dust which contains large amounts of lead. Drying often takes place inside the huts of villagers, which increased the risk of lead poisoning of children.

The poisoning affects all of the population exposed to the dust caused by the crushing of the rocks, and its subsequent leaching into water wells and the soil. However, the most vulnerable are children younger than five years old, due to their low body weight, and because they are at crucial stage of growth and brain development. Lead poisoning can cause a loss of appetite, anaemia, weakness and renal damage. More serious consequences are the loss of consciousness and convulsions, and eventually death.

MSF has, in collaboration with local health authorities, set up a treatment centre at a safe distance from the contaminated zone. As of early June, 50 children have been admitted. Another 15 to 20 children are expected to be admitted every second day, aiming for at least 100 children in the facility. Breast feeding mothers are also receiving treatment as lead can be passed to the child through breast milk. Treatment is provided with an oral drug that binds the heavy metal in the patient's blood, which is then excreted in the urine. The treatment takes 28 days but in extreme cases two or more rounds may be necessary.

MSF is working on setting up a second treatment centre to be able to care for children from other affected villages. Furthermore, our teams are working on an information campaign to inform the population of the dangers of gold extraction and the treatment program that MSF offers. The information campaign is especially important to prevent people from being poisoned again.

INTERVIEW with Lauren Cooney: Lead poisoning in Nigeria

16 June 2010

Could you introduce yourself? Where are you? And what are you doing at the moment?

My name is Lauren Cooney. I'm an emergency manager with MSF. And I'm currently in the north of Nigeria supporting MSF's response to acute lead poisoning in Zamfara state.

Can you tell me a bit about the situation in Nigeria?

We heard about an unusual number of deaths and a strange illness in a remote village in the northwest of Nigeria some weeks ago and went to investigate the situation with a Ministry of Health team.

The village reported that several children had died in the last 2 to 3 months. When the team investigated further, they found 39 fresh graves in the village and the community reported that all of those deaths were children less than 5 years old. In the community, there were very sick children, with fevers, convulsions and they were incredibly unwell. Further investigation was carried out, including surveys and sending blood and urine samples to a laboratory in Europe.

We found incredibly high levels of lead in the blood of the children that were tested, and as a final indication, the symptoms matched what you would expect to see with lead poisoning. We were notified there were other villages that had a similar problem, and when we investigated further, we identified over 350 probable cases and possible linked deaths of over 160 in the previous 6 month period.

What is the scale of the problem? What sort of high levels do you mean?

A Centre for Disease Control (CDC) team has come to work with us and the Ministry of Health. There's some screening in one of the villages. All of the children that were tested registered over 65ug/dL and that's actually the highest that machine would read. We've since done some other confirmation testing that shows results between 100 and 400ug/dL for these children.

Now, anything over 10ug/dL is dangerous and will probably need a response. Anyone with levels over 45ug/dL needs specific treatment, which we call chellation treatment, to treat the lead poisoning in their system. So basically, so far everyone who has been tested really needs treatment. So it's an extremely urgent situation.

When did MSF start treating patients, and how are they being treated?

MSF started treating patients approximately 8 days ago (June 1, 2010), using a chellation agent, an oral drug called DMSA (Dimercaptosuccinic Acid). This treatment works by binding the heavy metal, in this case lead, in the patient's blood which can be excreted harmlessly in the urine. It's quite a long treatment: we're doing a 28-day protocol at the moment. That means that the children or adults, need to take one tablet twice a day, for 28 days. And then two weeks after the treatment is finished, we need to recheck the lead levels again and see if they've stayed low enough, or if they require a second round of treatment.

And what are the long-term consequences of the poisoning?

There's quite a lot of potential long-term consequences. Most significant of course is death. Other problems include delayed neurological development. Because children's brains are still developing and they are still growing, it very easy for the lead poisoning to cause severe damage. Some of that may be resolved with treatment, but some may be permanent. Other long term consequences include high blood pressure, kidney damage, anaemia, neurobehavioral changes such as irritability, poor attention span, loss of memory, muscle weakness. Additionally, it can lead to infertility for men and associated with very high rates of still births for women.

How are the families coping? What is the situation in the villages?

I have spent a bit of time in the villages, talking to women, some of whom have already lost children but who still have sick children with very high levels of lead poisoning. I don't think we can begin to really understand what is going through peoples' minds and how they're coping with a tragedy like this. In one village where every household was screened, they found that 30% of their children under 5 have died in the past year, most in the past few months. I don't think we really know what unimaginable effects this has had on the community and the families.

In the last week we have seen some improvements in the children we are treating. One little girl, about 3 years old, wasn't walking properly, as I said muscle weakness can be a consequence of the lead poisoning, so after her first week of treatment, she's now walking properly. Another little boy, 2 years old, had convulsions on and off for the past week and hadn't spoken to his mother for more than a week. He has stopped having convulsions and also started talking to his mum again. These are some of the positive sides of what is happening, but it's only a small start, there's an incredibly long way to go.

What is MSF's main concern over the coming months?

The treatment is actually only one small factor of what needs to happen. Treatment is important and needs to be scaled up significantly, as well as by other actors so that the most vulnerable population can receive treatment in a timely way.

But I guess more importantly really, is that this is an environmental contamination. Contamination was caused by mining done at local village level by people mining for gold. The ore that the gold is found in has a very high percentage of lead.

That lead is what has caused this poisoning. It has contaminated the soil in the village, and inside the households. So the only solution is that this contamination is cleaned up.

International environmental actors are working on that now with the appropriate government authorities and obviously the communities themselves. It really needs to happen quite quickly but it's not easy - that means removing all the contaminated soil from these areas and then eventually replacing it with clean soil or possibly cement on the floors of the houses.

Then there needs to be a concerted health education programme aimed at behavioural change to also prevent recontamination at these sites. As one of the experts in lead poisoning said, if you have to put all your resources somewhere, put 80% into cleanup and prevention of recontamination and 20% into treatment because that cleanup and stopping people from being contaminated is the only way to ensure that people get better and to ensure that no more people get sick or die.

Why are we only treating children, aren't the adults sick as well?

At the moment, this is an emergency action. We're treating the most vulnerable first. Because children are small, they are much more vulnerable to the effects of lead in their bodies. Also because of the stage of development, children less than 5 years old, especially those around 2 years old, are still developing their brains, they're learning to walk, they're learning to talk, so when you have a poison that is attacking those systems, of course the impact is much higher than in adults.

We're treating some adults, breast-feeding mothers as there is some risk of lead passing through the breast milk. We have to prioritise the most vulnerable at the moment to try to ensure that we see a decrease in mortality and a decrease in any permanent morbidity.