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The Lead Poisoning Control in Zamfara and Niger States, Nigeria: A 2010-2018 Review

Nasir Tsafe Umar-Tsafe1, 2*, Adebola T Olayinka3, 4, Saad Ahmed4, Muhammad S Shehu4, Gaby Poggensi2, Abdulrazaq Habib5, Kabir Sabitu2, 4, Patrick M Nguku2, Abubakar Jafiya2, Mairo Kachalla2, Aishatu Binu Gubio2, Hawwa Inna Muhammad2, Sagir Aliyu6, Bashir Idris1, Bara’atu Shehu1, Abdulrahman Isah1, Halilu Ahmad1, Yusuf Madaro1, Rabi Usman1, Ibrahim Halilu1, Habibu Yalwa1, Hauwa Kolo7, Endie Waziri2, Saheed Gidado2, Mahmud Dalhat2, Benjamin J Mwangombe8, Ruth Olabiyo8, Gbemisola Oloruntuyi8, Abdullahi Zakariyya Yauri8, Balkisu A Shinkafi9, Nasir Sani-Gwarzo7, Zubairu Iliyasu5, Aisha Indo Mamman4, Hassan S Isah4, Shehu Akuyam4, John I. Anetor10 and Mary Jean Brown11
  • 1 Ministry of Health, Zamfara State, Nigeria
  • 2 Nigeria Field Epidemiology and Laboratory Training Program (NFELTP), Nigeria
  • 3 Nigerian Centre for Disease Control (NCDC), Nigeria
  • 4 Faculty of Medicine, College of Health Sciences, Ahmadu Bello University, Nigeria
  • 5 Bayero University Kano, Nigeria
  • 6 Zamfara Environmental Sanitation Agency, Nigeria
  • 7 Federal Ministry of Health (Nigeria), Nigeria
  • 8 Medicines Sans Frontiers (Nigeria), Nigeria
  • 9 School of Science, Federal University of Technology, Nigeria
  • 10 College of Medicine, University of Ibadan, Nigeria
  • 11 National Center for Environmental Health (CDC), United States

Background The lead poisoning (LP) disasters in Zamfara (2010) and Niger States (2015), Nigeria, were described as largest in modern times by scope and magnitude. LP due to artisanal gold-ore processing activities, affected children less than five years old (U5) with acute-severe outbreaks. This review provides an update on magnitude, scope, environmental, clinical, safety and other interventions applied to control and prevent further menace. Methods Secondary data reviewed on reports, publications from LP outbreaks and related studies (2010-2018): house-to-house cross-sectional, scoping-chain-referral and cluster sampling surveys. These covered 14 and 1 local government areas of Zamfara and Niger States, respectively. Standard interventions were applied by stakeholders based on Lead contamination (LC) values: >400 ppm defined elevated soil lead levels (ESLL), ≥5 and ≥10 µg/dL defined elevated blood lead levels (EBLL), confirming LP in U5 and animals, respectively. LCs were analysed in blood samples from U5s/animals, soil, water, food-items/crops, air, gold-ore materials and other environmental samples, using lead care II, X-ray fluorescence, atomic absorption and inductively-coupled-mass spectrometers. Data were analysed using SPSS, OpenEpi 2.3 and Epi-Info 7. Results The highest ESLL, EBLL were >150,000ppm, >700µg/dL (2010) and >550,000ppm, 300µg/dL (2015), in Zamfara and Niger States, respectively. These reduced to 10,000ppm, 30µg/dL and 1,000ppm, 29.7µg/dL (2018). Highest animal-EBLL were >300µg/dL (Zamfara,2010) and >270µg/dL (Niger,2015). LC Levels in other samples were significantly above their respective US-EPA standards. The strongest risk-factor associations between U5s requiring chelation therapy and environmental LCs were significant (OR: 5.8, 95% CI: 1.7, 19.1, P<0.01, Zamfara) and (OR: 32.8, 95% CI: 7.6, 141.9, P<0.001, Niger). Over 10,200 and 281 U5s were screened, with >7,200 and 180 successfully treated of LP, in Zamfara and Niger States, respectively (2010-2018). Conclusion LP-based U5 mortality (734-Zamfara and 28-Niger) has ceased. Zamfara LP morbidity-prevalence effectively reduced from >97%(2010) to <3%(2018), Niger’s reduced from 98%(2015) to <1%(2018). LP control program in Niger was so successful, handing-over by December 2018, whereas in Zamfara, >3,000 LP U5s are continuously exposed to LCs. Zamfara disaster remains an emergency, due to ineffective re-contamination control, access to low-cost intervention mechanisms, inadequate Government responses. Recommendations: environmental remediation, chelation therapy, safer mining practices/health education, continuous surveillance, other control and prevention measures.

Keywords: Lead Poisoning, Chelation Therapy, Soil remediation, Zamfara, Niger, Nigeria, EBLL, Safer mining

Conference: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”, Putrajaya, Malaysia, 3 Dec - 5 Feb, 2019.

Presentation Type: Poster Presentation

Topic: Miscellaneous

Citation: Umar-Tsafe N, T Olayinka A, Ahmed S, S Shehu M, Poggensi G, Habib A, Sabitu K, M Nguku P, Jafiya A, Kachalla M, Binu Gubio A, Inna Muhammad H, Aliyu S, Idris B, Shehu B, Isah A, Ahmad H, Madaro Y, Usman R, Halilu I, Yalwa H, Kolo H, Waziri E, Gidado S, Dalhat M, J Mwangombe B, Olabiyo R, Oloruntuyi G, Zakariyya Yauri A, A Shinkafi B, Sani-Gwarzo N, Iliyasu Z, Indo Mamman A, S Isah H, Akuyam S, Anetor JI and Jean Brown M (2019). The Lead Poisoning Control in Zamfara and Niger States, Nigeria: A 2010-2018 Review. Front. Pharmacol. Conference Abstract: International Conference on Drug Discovery and Translational Medicine 2018 (ICDDTM '18) “Seizing Opportunities and Addressing Challenges of Precision Medicine”. doi: 10.3389/conf.fphar.2019.63.00028

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Received: 05 Nov 2018; Published Online: 17 Jan 2019.

* Correspondence: Dr. Nasir Tsafe Umar-Tsafe, Ministry of Health, Zamfara State, Zamfara, Nigeria, untsafe@gmail.com