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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
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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
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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
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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
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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
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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
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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
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Emissions Along The Household Fuel Ladder Smith et al.38
Indoor Air Pollution: Cooking MethodIndoor Air Pollution: Cooking Method
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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
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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
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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
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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
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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).
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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
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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
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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
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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
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Occupational
Carpet weaversCarpet weavers Factory workersFactory workers Vehicle workersVehicle workers Street childrenStreet children Sex workersSex workers
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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
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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 warChildren at war
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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.
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www.prsharma.org.np