Environmental Issues
and
Child Health in Nepal
Dr. Pushpa Raj Sharma
Professor of Paediatrics, Institute of Medicine
President: Nepal Paediatric Society
Ex President of Paediatric Associations of
SAARC countries
Environmental 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
Nepal’s Environmental
Issues

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Pervasive Poverty
Water Pollution
Air Pollution
Food Pollution
Vector Born
Diseases
 School Health
 Child Labor
 Political Problems
It is dangerous in children
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.
Children eat & drink more
(ml/kg body weight)
200
180
160
140
120
100
80
60
40
20
0
<.5
.5-.9
1-3.
4-6.
7-14.
15-19.
20-44.
>44
Behavioral factors
 Soil consumption
(mainly hand to mouth
transfer)
 Spend more time in
contact with floor.
 May eat paint chips and
other non-food items.
 Small breathing zone
near floor.
 Infants cant move from
noxious stimulus.
60
50
40
30
Soil
consumptin
mg/kg/day
20
10
0
Child
10
Kg
Adult
65
Kg
Fetus and infant are at risk
Rapid development of
brain and reproductive organs
Brain and reproductive
organs are to suffer most.
Children have more
future years
21 weeks
6 months
Indoor Air Pollution: Cooking Method
Emissions Along The Household Fuel Ladder
Smith et al.38
Nepal
Indoor air pollution from biofuel
combustion
1986 2 villages
4 2000
9
Reid et al
1990 1 village before
2 8200
0 (RSP)
Pandey et
- after
1986 Cooking - wood
(geometric mean)
al
2 3000
0 (RSP)
1
7 4700
Davidson et
al
Benzene from Petrol
Measurements by the Ministry of
Population and Environment (MoPE)
show benzene concentrations of nearly
80 micrograms per cubic metre along
Kathmandu’s main streets.
Diesel Exhaust Particulate
 Enhanced IgE and IgG response to aero
allergens
 Potentiation of histamine release
 Implications for exacerbating allergic airway
disease
 DEP enhances development of new allergy
 Produces behavioral changes
Air Pollution
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.
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).
Lead poisoning in relation to lead
BSL
Death
150ug/DL
Encephalopathy
100ug/DL
Abdominal colic
60ug/DL
Anaemia
40ug/DL
Sensory abnormality
20ug/DL
Low IQ
10ug/DL
Water Pollution
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%
Arsenic Poisoning: The largest mass
poisoning of a population in history.
7% of Tube Wells in Tarai Region is unsafe for drinking.
UNICEF/DWSS
Chemicals
Mustard oil, which was used
for cooking, was found to be
contaminated with oil of
Argemone mexicana seeds.
Trop Pediatr 1999 Feb;45(1):8-13
Epidemic dropsy in the eastern region
of Nepal.
Singh R, Faridi MM, Singh K, Siddiqui R, Bhatt N, Karna S.
.
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Occupational
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Carpet weavers
Factory workers
Vehicle workers
Street children
Sex workers
Occupational
The Carpet Syndrome*
Tuberculosis
Asthma
Scabies
Lichenification of dorsum of hands
Deformity of fingers
*Sharma PR, Adhikari RK; Journal of IOM, 1992
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.
Children at war
What is needed now ?
 Collect more data to increase the power of
evidence.
 Sensitization of policy makers.
 Increase public awareness using mass
media
 Formulation of policy to protect children
from environmental hazards.
www.prsharma.org.np