Midwife Razia's journey to combat lead poisoning in Mirzapur

“Children are extremely vulnerable to the effects of lead poisoning. However, if parents have the knowledge early on of how to mitigate its effects – their children will live a better life,” says Razia Sultana Tania resolutely.

Razia is a young midwife who is the lifeline of the Upazila Health Complex in Zamurki, Mirzapur. With specialized training supported by UNICEF, she is not only delivering newborn children but also delivering a healthier future for her community by helping combat lead poisoning.

Razia is part of UNICEF's intensive training programme supporting the Ministry of Health and Family Welfare and Directorate General of Health Services which aims to improve health system capacity and readiness to address lead poisoning prevention, as well as equipping healthcare providers with the knowledge and skills needed to tackle the issue in rural Bangladesh.

An invisible threat

Lead poisoning is a silent and pervasive problem, especially in Bangladesh, with devastating effects on children's development and overall health. It is particularly destructive to babies and children under the age of five, because it can cause irreparable harm to children’s brains and hamper their ability to develop fully. Moderate to high levels of exposure can cause children to suffer from headaches, abdominal pain, dullness, loss of memory, poor attention, loss of appetite, or constipation. Lead poisoning can also affect neurological processes and the central nervous system, which may result in violent behaviour later in life. Pregnant women are equally at risk, with high lead exposure levels resulting in miscarriage, stillbirth, premature birth, and low birth weight

Illegal recycling of used lead acid batteries close to homestead areas is a major source of lead exposure. High concentrations of lead have also been found in spices, for example in lead chromate, which is used to enhance the colour and weight of turmeric. Alarming levels of lead have also been reported in toys, paints, aluminum and ceramic cookware and some food items.

In Bangladesh alone, it is estimated that 35 million children have blood lead levels that are too high. According to the Institute of Health Metrics Evaluation, Bangladesh has the world's fourth-highest rate of death due to lead exposure.

Empowering the frontlines

In March 2023, a total of 35 health and education staff were trained as resource persons to support subnational capacity building activities using the recently developed national clinical management guideline on lead poisoning. Then, between May and August 2023, a total of 379 health care providers received training in four selected districts, Patuakhali, Sylhet, Tangail and Khulna. Participants included medical doctors, senior staff nurses, sub assistant community medical officers, medical technologists, health assistants and community health care workers – 46% of these attendees were women. 

The training covered the background and situation of lead poisoning in Bangladesh, principal sources, and routes of exposure to lead, understanding the toxicity of lead, diagnosis and management of lead poisoning and preventive measures. The objective of the training was to increase the knowledge of health care providers in lead poisoning management and prevention and empower them as facilitators and trainers in their respective districts. A variety of learning methods were used such as interactive presentations, case scenarios, small group discussions, video presentations and pre and post knowledge check/test.

In addition to healthcare providers, a wide-ranging network of individuals have been equipped with essential knowledge to combat lead poisoning. Through dedicated efforts, 199 high school teachers, 75 local government representatives, 23 business owners, 33 journalists, and 63 motivated youths have received training until August 31, 2023. These diverse groups have become essential partners in spreading awareness and mobilizing communities, amplifying the collective impact in the fight against lead poisoning.

A voice of prevention

The training transformed Razia's approach to her work. She emerged from the program not only as a healthcare provider but as a beacon of knowledge and empowerment. With a deep understanding of lead poisoning and how it could affect the communities around her, Razia has become a trusted resource person in the health complex. Her newfound expertise empowers her to educate not only her patients but also her fellow healthcare professionals, fostering a ripple effect of knowledge and awareness.

Amid her busy schedule, Razia took a moment to reflect on the impact of this training on her community. "Previously, lead poisoning was an invisible threat," she shared. "Now, I can counsel and educate pregnant and new mothers, parents and caregivers, on appropriate treatment and prevention."

A transformative partnership

Razia's dedication extends beyond the clinic walls. She has become a passionate advocate for lead poisoning prevention, spreading awareness about the principal sources of lead exposure, such as contaminated water, paint, and household items to pregnant and new mothers, making a significant difference in the lives of the families she serves.

UNICEF's support to the Government of Bangladesh has been instrumental in enabling healthcare providers like Razia to become the driving force behind lead poisoning prevention in rural Bangladesh. The combined investment in awareness raising and capacity-building initiatives has transformed healthcare professionals into knowledgeable advocates, ensuring that children and communities are safeguarded from this silent but deadly threat and paving the way for a healthier and safer Bangladesh.