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Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh
Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261827/ https://www.ncbi.nlm.nih.gov/pubmed/33971132 http://dx.doi.org/10.1016/j.envres.2021.111292 |
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author | Jahir, Tania Pitchik, Helen O. Rahman, Mahbubur Sultana, Jesmin Shoab, A.K.M. Nurul Huda, Tarique Md Byrd, Kendra A. Islam, Md Saiful Yeasmin, Farzana Baker, Musa Yeasmin, Dalia Nurunnahar, Syeda Luby, Stephen P. Winch, Peter J. Forsyth, Jenna E. |
author_facet | Jahir, Tania Pitchik, Helen O. Rahman, Mahbubur Sultana, Jesmin Shoab, A.K.M. Nurul Huda, Tarique Md Byrd, Kendra A. Islam, Md Saiful Yeasmin, Farzana Baker, Musa Yeasmin, Dalia Nurunnahar, Syeda Luby, Stephen P. Winch, Peter J. Forsyth, Jenna E. |
author_sort | Jahir, Tania |
collection | PubMed |
description | Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans. We developed and evaluated an intervention to reduce lead exposure among children and their caregivers in rural Bangladesh. We conducted formative research to inform theory-based behavioral recommendations. Lead exposure was one of several topics covered in the multi-component intervention focused on early child development. Community health workers (CHWs) delivered the lead component of the intervention during group sessions with pregnant women and mother-child dyads (<15 months old) in a cluster-randomized trial. We administered household surveys at baseline (control n = 301; intervention n = 320) and 9 months later at endline (control n = 279; intervention n = 239) and calculated adjusted risk and mean differences for primary outcomes. We conducted two qualitative assessments, one after 3 months and a second after 9 months, to examine the feasibility and benefits of the intervention. At endline, the prevalence of lead awareness was 52 percentage points higher in the intervention arm compared to the control (adjusted risk difference: 0.52 [95% CI 0.46 to 0.61]). Safe turmeric consumption and food storage practices were more common in the intervention versus control arm at endline, with adjusted risk differences of 0.22 [0.10 to 0.32] and 0.13 [0.00 to 0.19], respectively. Semi-structured interviews conducted with a subset of participants after the intervention revealed that the perceived benefit of reducing lead exposure was high because of the long-term negative impacts that lead can have on child cognitive development. The study demonstrates that a group-based CHW-led intervention can effectively raise awareness about and motivate lead exposure prevention behaviors in rural Bangladesh. Future efforts should combine similar awareness-raising efforts with longer-term regulatory and structural changes to systematically and sustainably reduce lead exposure. |
format | Online Article Text |
id | pubmed-8261827 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-82618272021-08-01 Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh Jahir, Tania Pitchik, Helen O. Rahman, Mahbubur Sultana, Jesmin Shoab, A.K.M. Nurul Huda, Tarique Md Byrd, Kendra A. Islam, Md Saiful Yeasmin, Farzana Baker, Musa Yeasmin, Dalia Nurunnahar, Syeda Luby, Stephen P. Winch, Peter J. Forsyth, Jenna E. Environ Res Article Lead exposure is harmful at any time in life, but pre-natal and early childhood exposures are particularly detrimental to cognitive development. In Bangladesh, multiple household-level lead exposures pose risks, including turmeric adulterated with lead chromate and food storage in lead-soldered cans. We developed and evaluated an intervention to reduce lead exposure among children and their caregivers in rural Bangladesh. We conducted formative research to inform theory-based behavioral recommendations. Lead exposure was one of several topics covered in the multi-component intervention focused on early child development. Community health workers (CHWs) delivered the lead component of the intervention during group sessions with pregnant women and mother-child dyads (<15 months old) in a cluster-randomized trial. We administered household surveys at baseline (control n = 301; intervention n = 320) and 9 months later at endline (control n = 279; intervention n = 239) and calculated adjusted risk and mean differences for primary outcomes. We conducted two qualitative assessments, one after 3 months and a second after 9 months, to examine the feasibility and benefits of the intervention. At endline, the prevalence of lead awareness was 52 percentage points higher in the intervention arm compared to the control (adjusted risk difference: 0.52 [95% CI 0.46 to 0.61]). Safe turmeric consumption and food storage practices were more common in the intervention versus control arm at endline, with adjusted risk differences of 0.22 [0.10 to 0.32] and 0.13 [0.00 to 0.19], respectively. Semi-structured interviews conducted with a subset of participants after the intervention revealed that the perceived benefit of reducing lead exposure was high because of the long-term negative impacts that lead can have on child cognitive development. The study demonstrates that a group-based CHW-led intervention can effectively raise awareness about and motivate lead exposure prevention behaviors in rural Bangladesh. Future efforts should combine similar awareness-raising efforts with longer-term regulatory and structural changes to systematically and sustainably reduce lead exposure. Elsevier 2021-08 /pmc/articles/PMC8261827/ /pubmed/33971132 http://dx.doi.org/10.1016/j.envres.2021.111292 Text en © 2021 The Authors. Published by Elsevier Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Jahir, Tania Pitchik, Helen O. Rahman, Mahbubur Sultana, Jesmin Shoab, A.K.M. Nurul Huda, Tarique Md Byrd, Kendra A. Islam, Md Saiful Yeasmin, Farzana Baker, Musa Yeasmin, Dalia Nurunnahar, Syeda Luby, Stephen P. Winch, Peter J. Forsyth, Jenna E. Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title | Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title_full | Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title_fullStr | Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title_full_unstemmed | Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title_short | Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh |
title_sort | making the invisible visible: developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural bangladesh |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261827/ https://www.ncbi.nlm.nih.gov/pubmed/33971132 http://dx.doi.org/10.1016/j.envres.2021.111292 |
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