• Burial of the contaminated top soil at the dump site near Dareta Village, Anka LGA. Photo by Sola Ogundipe

* High treatment cost, staff constraint, community apathy challenge response initiative

By Sola Ogundipe

Infants and children affected by the lead poisoning saga in Zamfara State are at risk of suffering permanent brain damage as a result of  prolonged exposure to the toxic effects of lead, that has killed more than 200 children in five communities of two Local Govenment Areas of the State.

Already,  high cost of treatment coupled with shortage of hospital staff, reluctance by  parents in the affected communities to surrender their  children for treatment and  inaccessibility of some affected  villages continue to be major factors militating against the response drive spearheaded by the Zamfara State government.

Increasing activities of illegal miners and improper processing of lead-contaminated gold ore within households in the community, were largely responsible for the high death toll.

Offloading sacks of the contaminated topsoil at the dump site. Photo by Sola Ogundipe

Dr. Alhassan Hamisu Dama, a medical personnel supervising the treatment  of victims in Dareta village in Anka  Local Government Area of the State, confirmed that most of those who died were children aged five years and below.

“I cannot say precisely, but more than 200 children died and that is why we are concentrationg on treating victims of that age group,” he told Good Health Weekly during a visit to the affected community.

Dama who urged for financial and technical assistance  from the Federal Government and other humanitarian agencies said: “We came here and tested blood samples of the people, we also took samples of the soil and water for testing  and found that levels of soil that were between 28,000-100,000 times above the normal levels of 400 microgrammes per decilitre.

According to the medic, in the blood, the normal level is of less than 10 microgrammes per decilitre. “But when we tested them, all the victims had more than 65,000 microgrammes per decilitre lead blood levels. The implication of this is that many of them might have suffered permanent brain damage and the damage is likely to affect their intelligence and they might show other manifestations of damage to the central nervous system.”

As part  of the palliative measures put in place under the response initiative, it is compulsory for all children with lead levels above 65 microgrammes per decilitre in their blood  to be placed on a special therapy that would protect them from advancement of the complications.

However, the permanent brain damage is already there. We are also limiting the exposure to the lead, as all the contaminated soil in the households and the immediate environment has been cleaned up and replaced by clean topsoil.

High cost of treatment

Among other challenges, the high cost of treatment is paramount. Dama, who remarked that the treatment for children is fund demanding, said to place just one child on the complete dose of drug  treatment requires about N400,000.

“Right now, we are estimating that each child on admission is consuming to the tune of N480,000 in the hospital. Then there is the lack of cooperation from some of the villagers, some of who do not want to take their children to the hospital. This is another big challenge we are having.”

During the visit, Good Health Weekly observed that many of the affected villages have the challenge of response. At the Anka General Hospital, Dr. Orimode of the Medicins Sans Fracias (MSF) said the treatment regimen would continue to be focused on children under five years as well as pregnant women and nursing mothers because of their vulnerability.

“We are focusing on under fives. For the very, very young and nursing mothers, lead poisoning is very dangerous. At the last count, today (July 6) we have on admission 60 patients from Bukkuyum and Dareta LGAs, but we are expecting at least 30 more pateients later today from Dareta.”

He explained that 37 patients had been discharged earlier following four weeks of radiation therapy designed to enable the blood lead level to drop below the 65 micro grammes per decilitre limit.

Infants and children affected by the lead poisoning saga in Zamfara State are at risk of suffering permanent brain damage as a result of  prolonged exposure to the toxic effects of lead, that has killed more than 200 children in five communities of two Local Govenment Areas of the State.

Already,  high cost of treatment coupled with shortage of hospital staff, reluctance by  parents in the affected communities to surrender their  children for treatment and  inaccessibility of some affected  villages continue to be major factors militating against the response drive spearheaded by the Zamfara State government.

Increasing activities of illegal miners and improper processing of lead-contaminated gold ore within households in the community, were largely responsible for the high death toll.

Dr. Alhassan Hamisu Dama, a medical personnel supervising the treatment  of victims in Dareta village in Anka  Local Government Area of the State, confirmed that most of those who died were children aged five years and below.

“I cannot say precisely, but more than 200 children died and that is why we are concentrationg on treating victims of that age group,” he told Good Health Weekly during a visit to the affected community.

Dama who urged for financial and technical assistance  from the Federal Government and other humanitarian agencies said: “We came here and tested blood samples of the people, we also took samples of the soil and water for testing  and found that levels of soil that were between 28,000-100,000 times above the normal levels of 400 microgrammes per decilitre.

According to the medic, in the blood, the normal level is of less than 10 microgrammes per decilitre. “But when we tested them, all the victims had more than 65,000 microgrammes per decilitre lead blood levels. The implication of this is that many of them might have suffered permanent brain damage and the damage is likely to affect their intelligence and they might show other manifestations of damage to the central nervous system.”

As part  of the palliative measures put in place under the response initiative, it is compulsory for all children with lead levels above 65 microgrammes per decilitre in their blood  to be placed on a special therapy that would protect them from advancement of the complications.

However, the permanent brain damage is already there. We are also limiting the exposure to the lead, as all the contaminated soil in the households and the immediate environment has been cleaned up and replaced by clean topsoil.

High cost of treatment

Among other challenges, the high cost of treatment is paramount. Dama, who remarked that the treatment for children is fund demanding, said to place just one child on the complete dose of drug  treatment requires about N400,000.

“Right now, we are estimating that each child on admission is consuming to the tune of N480,000 in the hospital. Then there is the lack of cooperation from some of the villagers, some of who do not want to take their children to the hospital. This is another big challenge we are having.”

During the visit, Good Health Weekly observed that many of the affected villages have the challenge of response. At the Anka General Hospital, Dr. Orimode of the Medicins Sans Fracias (MSF) said the treatment regimen would continue to be focused on children under five years as well as pregnant women and nursing mothers because of their vulnerability.

“We are focusing on under fives. For the very, very young and nursing mothers, lead poisoning is very dangerous. At the last count, today (July 6) we have on admission 60 patients from Bukkuyum and Dareta LGAs, but we are expecting at least 30 more pateients later today from Dareta.”

He explained that 37 patients had been discharged earlier following four weeks of radiation therapy designed to enable the blood lead level to drop below the 65 micro grammes per decilitre limit.

Other constraints

Orimode however lamented that there were major challenges militating against the smooth running of the reponse. “There is serious staff shortage. At the momemt in this hospital, there is a total of 14 medical staff made up of 11 Community Health Extension Workers (CHEWS) and three doctors.

“There are also logistics issues as well as with the community members some of who are not readily willing to bring their children to the hospital for treatment.
“We are trying to get more people to come forward and access the available treatment facilities, but we cannot force them. We are only appealling to them through emlightenment programmes and reach-out campaigns.”     

No plan to evacuate communities

Meanwhile there are no immediate plans to evacuate people from their homes in Dareta or other villages moreso because  the soil contamination is superficial. A source from the State Ministry of Health noted that the threat of spread of the contamination had been effectively checked, hence there was no immediate danger to residents within the affected communities. Already, excavation of the topsoil from 3 to 6 centimetres deep and replacement with fresh soil has been completed in 102 compounds in the town.
The Zamfara State Ministry of Health was first informed of deaths occurring among children in Yargalma village, Bukkuyum LGA and in Dareta, Abare and Tunga Daji villages in Anka LGA presenting with symptoms such as abdominal pain, vomiting and convulsions. 

In-depth investigation in the two villages  confirmed  the large outbreak of childhood death and illness caused by acute lead poisoning. Blood surveys in the two villages later indicated a 100 percent prevalence of high blood lead levels (>10 ug/dL) among children under the age of 5 years in both villages with 95 per cent of the children need chelation therapy.

A report by the Centers for Diseases Control (CDC) confirmed that the  environmental contamination and timing of the outbreak were related to  recent  increase in illegal mining activities and the greater involvement of women and children in processing lead contaminated gold ore in their homes.

From the CDC report, two thirds of the compounds surveyed reported having at least one mining activity inside the compound involviing breaking down ore rocks or grinding of ore gravel.
Other activities include washing of ground ore gravel, drying of the ground materials, separating mercury from gold, and melting / burning the mercury off.  

Between March 30, 2010 and July 6, 2010 when Good Health Weekly visited the community,  over 250 cases meeting the case definition had been reported from Dareta, Kasumke, Abare, Tunga Daji and Duza towns, all in Anka LGA.