Assessment of Mothers' Knowledge and Their Health Habits Regarding Lead Pollution at Bani-Khaled Village in Minia Governorate

Introduction

Lead is stated often in early biblical accounts. The Babylonians used the metal as plates on which to record inscriptions. The Romans consumed it for tablets, water pipes, coins, and even cooking utensils; indeed, as a result of the last use, lead poisoning was recognized in the time of Augustus Caesar. Modern developments date to the exploitation in the late 1700s of deposits in the Missouri-Kansas-Oklahoma area in the United States (Amstock, 2017).

Healthy People 2020 recognize lead poisoning as a public health concern because it is not an element necessary for the human body. The Center for Disease Control and Prevention (CDC, 2019) defines elevated blood lead level (EBLL) as greater than or equal to 5 mcg/dl, as determined by a blood test. Exposure to lead has had devastating consequences for health, especially for children. Exposure to lead in high levels could affect the brain, academic performance, the central nervous system and cause seizures, coma, and even death (Majumder et al., 2021).

The major source of children's exposure to lead are, lead added to petrol, lead solder in food cans, ceramic glazes drinking water system, lead pipes, lead in products such as indigenous medicines, home remedies, cosmetics and toys, lead released by burning of lead-containing waste. Lead poisoning can be detected by simple blood test. Chelating therapy is used for children with 45 μg/dl of lead in the body (Yang et al., 2018).

Lead exposure remains a major public health problem, especially in Egypt and developing countries, whereas regulations and policies are missing, children, especially those living in the vicinity of industrial areas, are exposed to the highest levels of lead from different sources, such as petrol, lead released by burning of paper products, discarded rubber, battery casings, and painted wood for cooking and heating. Children are more at risk than adults to the toxic effects of lead. This correlates with their ability to walk, their hand-mouth behavior, and spending more time on dusty floors. Also, physiological functions of their blood–brain barrier and liver detoxification systems are biologically immature (Moawad et al., 2016).

Lead poisoning can be prevented by simple measures which include, washing hands and toys, cleaning dusty surfaces, removing shoes before entering the house, running cold water in old plumbing containing lead pipes for at least a minute before use, preventing children from playing in the soil, regular healthy nutrition, which include adequate calcium, Vitamin C and Iron. When lead is swallowed /inhaled, some poison remains in the body which causes serious health effect. Awareness of the public health influence of exposure to lead is growing but relatively few of these countries have introduced policies and regulations for significantly fighting the problem (Smith, 2019).

Also Alhammad et al., (2019), stated that 39.5% of mothers thought lead can be prevented by cleaning children hands and toys and surface cleaning, while 26% of mothers had no idea about how to avoid lead poisoning, and 16.25% of mothers  thought it can be avoided by cleaning hands and toys and eating healthy food, and 8.75% of mothers believe it could be avoided by cleaning hands and toys and house cleaning.          

The role of community health nurse to control lead pollutions approved primary health care that should include health assessment of individuals and communities of health problems and assessing knowledge about methods to prevent and control these health problems. also community health nurse should provide important activities including health promotion activities and ensuring adequate amounts of food and proper adequate nutrition; adequate safe water and safe basic sanitation; proper maternal and child health care, which should include family planning, immunization; adequate and appropriate treatment of common diseases and different injuries (WHO., 2019).

Significance of the study

In United States of America poisoning with lead caused a financial heavy burden for health care financial costs especially for children, in addition it may cause several health problems later in life which may include neurological problems, adult hypertension, blood pressure disorders, and osteoporosis (Wright et al., 2020). 

Environmental monitoring of Egyptian Ministry of Health, reported that, arithmetic mean at year (2017) from points of air monitoring about measuring lead in Egypt. Minia was arranged as the third governorate in lead pollution. Also they observe that pollutions in Minia are increasing each year than previous years.Bani-khaled scored the highest level in lead pollution (Environmental monitoring center, 2017).

Egyptian children, like children from any other country, are at great risk for blood lead poisoning because of exposure to lead, although sources of exposure are different, in Egypt poisoning with lead forms a great health challenge, but there is no simple solutions are found to solve this problem. May be one of the few real solutions to be used in the short term is to assess mothers' knowledge about lead pollution and its sources (Safi et al., 2019).

Aim of the study

The aim of this study is to assess mothers' knowledge and their health habits regarding lead pollution at Bani-Khalid Village in Minia Governorate.

Research Questions:                                                                                 

The study will answer the following questions:

1-       What is the mothers' knowledge about lead pollution?

2-       Is there a relationship between mothers' socio-demographic characteristics and their knowledge?

3-       Is there a relationship between mothers' knowledge?

Subjects and Methods

Research design:

Descriptive research design was used.

Setting

The study was conducted at Bani-Khaled Village at Samalout district affiliated to Minia governorate, east sea, the village is surrounded by four directions, from the west a river and from the east the cemeteries, and from the sea side a factory called Portlandi Helwan, from the tribal side, the Iron and Steel Factory, and most of the lands of the village are expropriated by the cement factory, it has the highest levels of lead pollution in Minia governorate in 2017 which exceeded allowed levels (Environmental monitoring center 2017), also Bani-khaled residents have a low socio-economic status, low level of education, have cement factory and iron and steel factory.  This produces a polluted environment both physically and visually.

Sample: A convenient sample of 251 mother were included in the study this number represents 20% of the total numbers of mothers in the village which is 1253 mothers according to the last national Egyptian census in 2017, because the people living near the factory always complain from their health problem and talk to the mass media and write complain about their suffering to the responsible people. The inclusion criteria of the study were mothers of males and females child and agreed to participate.

Tools:

Tool I: interviewing Questionnaire:-

Three tools were designed after reviewing related literature to assess the mothers' knowledge and their health habits about lead pollution.

Tool I:- A Semi structured interview questionnaire, this questionnaire assessed the following:

Part I: - From Q1 to Q 9 assessed the demographic data of the studied subjects:such as age, monthly income, educational level of father, their occupation, educational level of mother and their occupation.

Part II: - Mothers knowledge assessment questionnaire about lead pollution such as: define pollution, lead pollution and lead poisoning, things that cause lead pollution in homes (SIvrI & OzpuLat, 2015).

Scoring System:-

The scores of each item ranged from zero to 1 for yes answer, zero for no or don’t know answer. The total knowledge score was calculated by summation of all knowledge items with total score (38) was computed. Therefore the studied subjects considered have good level of knowledge if the total score was ≥50% (≥19/38), poor if the total score was less than 50% (<19/38) for knowledge assessment part (Abel Galil et al., 2018).

Tool II: - Mothers health habits questionnaire , It concerned with the assessment of the practices  of mother about lead pollution, it include sixteen (18) question, open-ended questions such as: (The mother puts on cosmetics, the mother uses hair dye …...etc.), with answer yes or no (Abel Galil et al., 2018).

Scoring System:-

The practices assessment part of the questionnaire, the scores of each item ranged from zero to 1. Yes answer take score (1), No answer take score (0). The total practices score was calculated by summation of all practices items with total score (18) was computed. Therefore the studied subjects considered have Satisfactory level of practices if the total score was ≥50% (≥9/18), unsatisfactory if the total score was less than 50% (<9/18) for practices assessment of mothers (Abel Galil et al., 2018).

Tool III:- An observational Checklist to assess homes environment such as  ways of cleaning house to decrease pollution with lead, drying food on newspaper… etc (Asunta et al., 2019).

Validity of Content:

The content validity of the data collection tools was determined through an extensive review of literature related to lead pollution. The tools were submitted to a panel of five experts in community health nursing and public health and preventive medicine to test their validity. Necessary modifications of the tools were done according to the panel judgment on appropriateness of the content, sequence of items and according to accuracy of items.

Pilot Study

A pilot study was carried out on 10% of cases; it tested the application and clarity of the questions of the study tool, and estimated that the time needed to complete the tool was 30-35 minutes according to the needed explanation. No modification was done in the study tool based on the pilot study. The pilot study was excluded from the total of the study sample.

Ethical Concern

  The mothers were informed that their participation in the study was completely voluntary and there was no harm if they not participated in the study. Oral consent was taken to be included in the study subject. Explanation about the study was done to the mothers included the aim of the study and the potential benefits. The participant was informed about the withdrawal procedures if they decided to leave the study at any time before and during the completion of data collection, confidentiality of data, privacy, identity, voluntary participation, and the right to refuse to participate in the study was emphasized to subjects.

Study Procedure

Before starting data collection, formal letters were issued from faculty of nursing to conduct the study. Following ethical committee approval at Minia University's Faculty of Nursing, an official letter from the city council president of Bani-Khaled Village at Samalout district was obtained for data collection. This letter included a brief description of the study's goals, as well as a request for permission.

  In 2021, the investigator created data collection methods after conducting an exhaustive analysis of applicable national and international literature. Five experts in the field of nursing from Minia University's faculty of nursing and faculty of medicine updated the study tools in order to assess their material validity and feasibility. The required modifications included rephrasing and rearrangements of some sentences. Prior to data collection, a pilot study of 25 mothers was performed, with those who were not included in the study being omitted.

From the first of july 2021 to December 2021, the investigator visited Bani-Khaled Village  twice a week (on Saturdays and Tuesdays) from 10 am to 12 p.m to recruit the study sample. According to inclusion criteria, all mothers having young children and agreed to participates (6:8 mother per week) were chosen. The average number of interview subjects per day was four, and the average time spent on each was about 25-30 minutes, depending on the individual's response.

After obtaining oral consent from each participant and describing the purpose and goals of the study to gain their cooperation, the mothers were interviewed. The investigator met the participants in at times that were convenient for them. The questionnaire was introduced for the mothers to fill it out, unless the participant was unable to read or write, in this case the investigator filled it out. The investigator read the questions to the participant and recorded their exact responses. Participants were given the opportunity to ask questions and receive explanations.

Statistical analysis

Data were scored, tabulated, and analyzed by computer using “the statistical package for social science” (SPSS) version 20 .Descriptive  data were expressed as number and percentage. Quantitative data were presented by mean and standard deviation. Chi square test was used to see if there was a connection between two qualitative variables or if there was a difference between two or more proportions.  Correlation was calculated between knowledge and practices using Pearson correlation test.  Probability (p-value) less than 0.05 was considered significant in tests of relationships.

Results

Table (1): Distribution of the Study Subjects According to Their Demographic Characteristicsat Bani-Khaled Village in Minia Governorate 2021 (n=251)

Table (1) illustrates that, 62.5% of subjects their age ranged from 22 years to 32 years, 5.5% their age more than 43 yrs. with mean age 32±6.5 years. Regarding their monthly income 21.5% of study subject reports have enough income but 78.5% reports have not enough monthly income. The educational level of mother reveals that, 46.2 % are illiteracy, 21.9 % had basic education, 9.6% have university degree and 82.1% of mother are house wife. Regarding father education 37.1% of father has basic education, 28.3% have secondary school, 20.3% are illiteracy, and 68.1% of father works in coloring and decorating glass and 12% of fathers are plumber.

Table (2): Distribution of the Mothers According to Their Knowledge about Lead Pollution at Bani-Khaled Village in Minia Governorate 2021 (n=251)

Table (2) shows that, 86.1% of mothers  says smoking, 13.9 % says no smoke, 81.3% reports throwing dead animals into the river, but 18.7% reports no,   85.7% reports the smoke coming out of burning rubbish and 86.5% don't  heard about lead contamination but 13.5% hear about lead pollution.

Table (3): Distribution of the Mothers According to Their knowledge about Lead home pollution at Bani-Khaled Village in Minia Governorate 2021 (n=251)

Table (3) clears that, 55.8% of mothers donot have knowledge about lead pollution, says smoking, 15.9 % says Water pipes and some painted toys, 10.4% reports TV remote control and decorative spoons. 43.0% of mothers says the elderly are the most suscpitable to lead contamination, 25.5% donot know the most vulnerable group. Regarding the area where lead dust accumulate in the house, 52.2% donot know, 2% says the doors and their frames, the internal and external walls of the house and 6.4% of mothers reports wire the net and under the beds.

Figur (1):  Distribution of Mothers regarding Overall Knowledge scores about Lead Pollution at Bani-Khaled Village in Minia Governorate 2021 (n=251)

Figure (1), illustrates 44.3% of mothers have good knowledge scores, but 55.7% of mothers have poor knowledge scores.

Table (4): Distribution of  Mothers Practice Practices about lead Pollution at Bani-Khaled Village in Minia Governorate 2021(n=251)

Table (4) illustrates that, 59.8% of mothers buys eye powder or stone from Al-Attar, 40.2% don't buy eye powder, 60.2% of mothers apply eye powder to their child but 39.8% don't, 68.1% of mothers don't puts on cosmetics and 31.9% of mothers use cosmetic. In addition 57.8% of mothers don't use hair dye.

Table (5): Distribution of the Mothers practices According to Their Child about lead Pollution at Bani-Khaled Village in Minia Governorate 2021 (n=251)

Table (5) depicts that, 80.1% of mothers their children baby crawling on the ground and their child sucks on one of his fingers but 19.9% of mothers reports no. Also72.1% of mothers their children don't bits of wall paint in his mouth, 52.6% of mothers their child licks the beds and the sofa, 50.6% of mothers their child puts colored ornaments in his mouth, 51.8% of mothers their child  don't chews newspapers and magazines, 59.8% of mothers their child eats without washing hands, 85.7% of mothers  their children play with materials available in the environment, 72.1% of mothers clean kids toys, 88.0% of mothers their babies puts toys in his mouth, 66.1% of mothers  their child playing in the street, 86.1% of mothers  their child has toys with battery stones, 70.1% of mothers their child puts the battery in his mouth, 75.7 % of mothers their child puts the pencil in his mouth and 39.0% of mothers their  child draws his face on occasions and holidays.

Figur (2):  Distribution of Mothers Practices scores regarding Lead Pollution at Bani-Khaled in Minia Governorate 2021 (n=251)

Figur (2), illustrates 78.1% of mothers have satisfactory practices scores, but 21.9 of mothers have unsatisfactory practices scores.

Table (6): Relation between practices of Mothers and Their Some Demographic characteristics at Bani-Khaled Village in Minia Governorate 2021(n=251)

               Significant at (p-value <0.01)

Table (6): points a positive statistically significant relationship between practices score , age and education p value  0.001.

Table (7) : Relation between knowledge of Mothers and Their Some Demographic characteristics at Bani-Khaled Village in Minia Governorate 2021 (n=251)

               Significant at (p-value <0.01)

Table (7): points a positive statistically significant relationship between total knowledge scores scores, age and education p value 0.001, 0.002 respectively.