Assessment of Knowledge on Lead Poisoning among the Residents of Kabwe, Zambia

Master's Thesis, 2019

66 Pages

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1.1 Background.
1.2 Problem Statement
1.3 Research Questions
1.4 General Objective
1.4.1 Specific Objectives
1.5. The scope of the study
1.6 The significance of the study

2.1 Introduction
2.2. lead poisoning
2.3 Heath Effects of lead poisoning
2.4 Sources and pollution pathways of lead poisoning
2.5 knowledge studies on lead poisoning

3.2 The individual:
3.3 Social environment:
3.4 Physical Environment:
3.5 Policy:
3.6 Developmental Effects of Lead on an individual:
3.7 Delinquency and Society:
3.8 Exposure and Social Status:

4.1 Research design:
4.2 Study population
4.3 Inclusion/Exclusion Criteria
4.4 Sample size
4.5 Sampling Procedure.
4.6 Data collection tool
4.7 Data analysis
4.8 Ethical considerations












Kabwe is one of the most affected towns with lead poisoning due to its earlier mining activities. Research conducted by Zambia Consolidated Copper Mine Investment Holding show that 35 per cent of Kabwe’s population in Chowa, Kasanda and Katondo is exposed to high levels of lead. This prompted ZCCM-IH to conduct sensitizations and encourage formation of lead treatment support groups. However, data has continued to show a high number of children being diagnosed with lead poisoning. Therefore, the research attempted to assess the levels of knowledge on lead poisoning among the residents of kabwe District.

The general objective of the research was to assess knowledge on lead poisoning among the Adult population of Chowa, Kasanda and Katondo in Kabwe District in order to identify areas where knowledge is lacking and help effectively direct public health and environmental related programs in Kabwe District Data was collected using Questionnaires that were given to each of the participants who were recruited in the research. The questionnaires were a Likert-type scale in section A and open ended in section B.

Eight six (86) participants that included adult male and female participants were recruited.

Quantitative data was analyzed using Excel and Statistical Package for Social Science(SPSS) The results revealed that knowledge levels of the residents were low despite staying in high lead poisoning exposure areas. This explains why the number of children being diagnosed with lead poisoning is high and people are still constructing houses even in highly lead contaminated areas. It is recommended that the government through Zambia Environmental Management Agency and other stakeholders come up with new strategies to combat lead poisoning exposure and also ways of increasing the knowledge of the people on health effects of lead poisoning. The local authority should stop giving out plots in high lead exposure areas along the heavily polluted canal.



This chapter covers: The background, statement describing the problem, research questions and objectives, scope of the study and significance.

1.1 Background.

Lead mining in Kabwe started around 1904 and continued until 30 June 1994 when the mine was temporally shut down. Over the years, the mine has changed ownership several times. Soon after Independence in 1964, the Government of Zambia adopted a nationalization policy. It became the major shareholder in the mining company in 1973 and took full ownership around 1982 through Zambia Consolidated Copper Mines Limited (Terre des hommes ,2016). In 2000, all-state owned mining companies were privatized as a requirement under the Structural Adjustment Program agreed with International Monetary Fund and World Bank.

The Kabwe Mine was sold in 2012 to Berkeley Mineral Resources, which, through its subsidiary Enviro Processing Limited resuscitated mining operations. Rising commodity prices and advances in ore processing technology meant that lead mining had become profitable again. The Zambian Government, through Zambia Consolidated Copper Mines - Investment Holding Limited retained the responsibility to address the environmental liabilities that were a result of the many decades of unregulated mining. This included rehabilitating and restoring the environment affected by Kabwe mine.

The genesis of this project stems from a 2007 Time Magazine article that referenced a Black Smith Institute report on Kabwe’s lead pollution. This article listed Kabwe as one of the most polluted places on the planet (Blacksmith,2003). In order to understand the seriousness of this claim, context is needed and to provide this context, this report has compared lead poisoning blood levels and effects in the western countries, to those found in Kabwe. The natural blood-lead levels in humans, is approximately 0.0016 μg/dl, but the acceptable normal levels are currently pegged at 10 micrograms per deciliter. People in the United states have been found to generally have normal lead-blood concentrations of less than 10 μg/dl, where as in Kabwe, levels as high as 300 μg/dl were found. “Symptoms of acute lead poisoning occur at concentrations of 20 μg/dl and above, hence resulting in vomiting and diarrhea which further causes muscle spasms and kidney damage. Levels over 10 μg/dl are considered unhealthy and levels in excess of 120 μg/dl can often lead to death. In Kabwe, concentrations of 300 μg/dl have been recorded in children even though records show that the average lead concentrations in the blood of children ranges between 60 μg/dl and 120 μg/dl.” Lead is a cumulative toxicant that affects multiple body systems and is particularly harmful to young children, and when it enters the body, it is distributed to the brain, liver, kidney, nervous system and bones.

In the human body, lead commonly accumulates and stores in the teeth and bones, however, the contamination of the human body to lead is commonly determined and assessed through the testing of blood. Lead is unquestionably one of the most potent neurotoxins, and because of its negligent mining in Kabwe, the town has found its human and environmental health contaminated.

1.2 Problem Statement

Studies done in children under the age of 7 years in townships around the mine, where blood samples were collected and analyzed using an Inductively Coupled Plasma -Mass Spectroscopy (ICP-MS) showed that all of the sampled children had blood lead levels exceeding 5microgramme per deciliter. Children in these areas could be at serious risk of lead toxicity as 18% of the sampled children in Chowa, 57% in Kasanda and 25% in Makululu had blood lead levels exceeding 65 μg/dl. Eight children had blood lead levels exceeding 150 μg/dl with the maximum being 427.8 μg/dl. A recommendation was made that medical intervention be commenced in the children with blood levels exceeding 45 micrograms per deciliter (Yabe et al,2012).

The natural blood-lead level in humans is about 0.0016 μg/dl. In developed countries like the United States, strict enforcement has resulted into lead levels averaging figures below 10 micrograms per deciliter but in Kabwe averages lie between 60 μg/dl and 120 μg/ dl. Levels over 10 μg/dl are unhealthy, while levels above 20 μg/ dl can cause acute poisoning. whereas levels over 120 μg/dl often result into death (Chilongo,2014).

It appears that knowledge level of preventive measures among women of child-bearing age was low at 40.9% despite staying in high lead poisoning exposure residential areas and 89.1% of the respondents having heard of lead poisoning. One mother said that ‘when she is pregnant she likes eating soils.’ It was also revealed that many people in the area where not aware about lead poisoning preventive measures except those who had someone who is suffering from lead poisoning or had joined a Lead Poisoning Treatment Support Group. From the evidence of this research, the residents in the lead poisoning endemic areas are not knowledgeable about the lead precautionary measures(Mpokota,2014).

1.3 Research Questions

1. What information do the adult population of Kabwe District have on lead poisoning?
2. What are the views of the adult population of Kabwe concerning their role on lead poisoning?
3.How could Environmental Education be used to improve lead poisoning management in Kabwe?

1.4 General Objective

The general objective of the study was to assess knowledge on lead poisoning among the Adult population of Chowa, Kasanda and Katondo in Kabwe District in order to identify areas where knowledge is lacking and help effectively direct public health and environmental related programs in Kabwe District.

1.4.1 Specific Objectives

1.To determine facts and information on lead poisoning among the adult population of Kabwe District.
2.To assess the views of the adult population concerning their role on lead poisoning, and
3.To investigate how Environmental Education could be used to improve lead poisoning management in Kabwe.

1.5. The scope of the study

This dissertation is composed of eight chapters. Chapter one provides the background, statement of the problem and the objectives. It also outlines the scope of the study, research questions and significance of the study. Chapter two provides the literature review and Chapter three outlines the theoretical frame work used in the study. Chapter four provide the methodology which was used in the study in terms of the research design, population, sample, sampling procedure and instruments used to collect data among other things. Chapter five presents data analysis of the study. Chapter six provides discussion of the findings. Chapter seven outlines the Conclusions and recommendations are given in chapter eight that is followed by the Reference. The study concentrated on Knowledge assessments and did not cover much on the concentration of lead in plants and other organisms such as lizards and rats.

1.6 The significance of the study

The study findings add insight on the relevance of knowledge on lead poisoning. The findings also highlight ways of how Knowledge on lead poisoning could be used to facilitate preventive measures on lead poisoning. This might help in providing information that is of practical value to policy makers and planners such as Zambia Environmental Management Agency which is beyond Kabwe local authority. The findings may also be of help to the local community as it may highlight the need for the local community to get involved in the management of lead poisoning and reduce the effects of lead on man and the Environment. The findings of the research might also contribute information to existing literature on proper ways of managing lead poisoning.

The study will make available to the District Medical Office material on lead poisoning that could be used to educate the health personnel especially those operating from the study areas.



2.1 Introduction

The background, problem statement, research questions and objectives, scope of the study and significance were covered in chapter one. In this chapter, the literatures relevant to the study are described in more detail in terms of: Lead poisoning, Health effects, Sources of lead poisoning and knowledge studies on lead poisoning in Developed and developing countries.

Globally a number of studies have been conducted to determine absorption, distribution, metabolism elimination and health effects of lead to the body. Lead may enter the human body through ingestion, inhalation or dermal exposure to be absorbed into and transported by the bloodstream, where over 95% of lead is found in red blood cells (RBC), and about 1% in the plasma and serum (Dorman, 2012). Although only a small proportion of lead exist in the plasma, it is considered significant because it acts as a means of distribution to target organs such as kidney, lungs, brain, spleen, teeth, and bones. As lead can readily substitute calcium, the skeletal system serves as a long-term storage of lead (75% in children and between 90 and 95% in adults). This stored lead can be mobilized from bone to blood and other tissues, especially during periods of altered mineral metabolism such as during pregnancy and lactation (Gulson et al, 1998). Since inorganic lead, the most predominant form of lead in the environment, is not metabolized, the rate of excretion of lead is low, mostly through urine. Lead may also be excreted with bile through the gastrointestinal tract. An assessment of the rate of decline of lead in the blood indicated that periods of 24.0, 20.9, 14.3, and 9.2 months are required for lead in the ranges of 25–29, 20–24, 15–19, and 10–14 μg/dl respectively are required to decline to less than 10 μg/dl (Roberts et al, 2001). On the other hand, lead in soft tissues has a mean life-time of 40 days whereas lead in bones has a lifetime of close to 30 years (Anon). The use of chelating agents can enhance lead excretion in urine. This is the basis of lead chelation therapy. The toxikinetic of lead is affected by a number of metabolic and nutritional factors. For example, strong negative correlations have been observed between calcium and iron. These two elements affect absorption of lead probably because they share common transport mechanisms in the gut. Since Calcium and Iron affect absorption of lead, they are sometimes referred to as ‘effect modifiers’ of lead.

In the United States of America blood lead levels were observed to decline as atmospheric lead declined (Hayes, nd). There are also many numerous sources of lead that can be termed as ‘miscellaneous sources’ because they are not well documented or characterized. These include crayons, finger paints, jewels (CDC, 2015), cosmetics and fishing sinkers. Occupational sources of lead are not within the scope of the present study except in the cases where parents may bring lead from work through clothes and equipment.

Lead contamination of food can also result from use of contaminated utensils/apparatus for food preparation or storage. As an example, lead-glazed ceramics are an important source of lead contamination in some countries, where a correlation could be found between use of lead-glazed ceramics and Blood lead among women in Mexico (Avila et al., 1991).

In South Africa, 48% of paint in public playgrounds in the municipalities of Johannesburg exceeded the reference level of 1 mg/cm3 (Mathee et al., 2009). Hazardous levels of lead were also found in domestic paint in Nigeria (Clark et al., 2009), and Cameroon (Gottesfeld et al., 2013). The presence of lead was also found in medicines in Nigeria, where the use of herbal medicines is reported to result in “lead intakes ranging from 250 μg/day to 27,000 μg/day, which were higher than the Provisional Tolerable Weekly Intake of 25 μg/week of lead that was being used at the time” (Obi et al., 2006).

In Nigeria lead was not only found in herbal medicines but also in imported western medicinal syrups (Orisakwe et al, 2009), indicating that both herbal and ‘western’ medicines may be a potential source of lead. Studies have also been conducted on lead in air where, lead concentrations of 1 µg/m3 in air and 3620 mg/kg in dust were found in air in industrial, commercial, park/beach and residential areas of South Africa (Nriagu et al., 1996) and in Ghana, where the air in areas surrounding a battery, an electronic repair, a welding and e-waste recycling workshops, and a waste disposal site exceeded the contemporary World Health Organization standard of 50 μg/m3 (Caravanos et al., 2011).

Studies on lead in food in Uganda indicated that vegetables grown along heavily trafficked streets were heavily contaminated with lead (Nabulo et al, 2006), this was possibly due to lead in petrol while in Kenya, fish and vegetables were also found to be contaminated with high levels of lead (Makokha et al, 2008).

In Zimbabwe, high levels of lead were found in vegetables that were irrigated using mixtures of wastewater and sewage sludge containing high levels of lead (Muchuweti et al., 2006). Lead was also found in processed foods. For example, in Nigeria, lead was found in canned and non-canned beverages (Maduabuchi et al, 2006). There were also studies on lead in other commodities such as toys, crayons and cosmetics. For example, in Nigeria, lead was shown to be present in toys (Osibanjo et al, 2011), and in South Africa, lead was present in crayons (Okonkwo et al, 2004). In South Africa, levels of lead in lipsticks, lip gloss, and foundation ranged from below detection limit to 73.1 ± 5.2 mg/g, 4.7 to 11.7 ± 2.8 mg/g, and 7.8 to 32.9 ± 1.4 mg/g, respectively, with the majority exceeding the United States Food and Drug Administration (USFDA) maximum permissible concentration of 0.10 mg/g for lead in cosmetics (Brandao et al, 2012). High levels of lead were also present in cosmetics in Nigeria (Orisakwe et al, 2013).

These and other studies in Africa confirm the possibility of exposure to lead from these sources among children in Africa. They also confirm that although banning the use of leaded petrol had a significant impact on Blood lead in children, other sources of lead may still remain, and therefore they may warrant further investigation.

Children are exposed to lead from a number of sources, including food (47%), dust and soil (45%), water (6%) and air (1%) (Prüss-Üstün et al, 2006). Concentrations of lead in tap water have been shown to be associated blood lead level in many countries (Fertmann et al, 2004). As most sources of water have naturally very low lead levels, drinking water from the source is usually free of lead. Use of lead for soldering pipes and plumbing has in the past been a major source of high lead levels in water. Therefore, water may be contaminated as it is distributed from the water treatment plant through lead water pipes and across lead-soldered joints into homes (Renner, 2009). As soft, acidic water has the greatest tendency to dissolve lead (plumbosolvency), plumbosolvency is decreased when the pH and water hardness are increased through the addition of lime (Fergusson, 1986). Indeed, when lead pipes were still in use it was shown in England that towns that had soft water supplies had the highest water lead concentrations and consequently the highest mean blood lead concentrations (Pocock et al, 1983). Lead pipes are no longer used for water distribution throughout the world. Food can be a significant contributor to blood lead, contributing as much as 72% of the total daily lead intake (Wilhelm et al, 2003). Lead in food can come from environmental contamination of crops through atmospheric deposition, soil or water. Since there are spatial variations in environmental contamination of lead, there can be variations in lead concentrations in foods from different regions of the same country (Cuadrado et al, 2000). The variations can also result from the methodological challenges in sampling and dietary exposure assessment.

In addition, food and drink cans soldered with lead-based solder can also be an important source of lead (Sherlock, 1987). Lead exposure can also result from paint since lead pigments are often used in domestic and industrial paints. Paint is essentially composed of a binder, pigment and solvent. Binders are usually polymeric substances that are added to the paint to hold the pigment to the surface of the wall. Pigments are used primarily to give the paint its colour and finish, as well as protecting the surface underneath from corrosion and weathering (Clark, 2000). Common lead-based pigments include white lead, vivid yellow lead chromate, basic lead chromate, lead molybdate, lead carbonate, red lead, leaded zinc oxide, basic lead sulphate, litharge and basic lead silicate (Sturges et al, 1985). Lead pigments are often preferred to other paint pigments because of their durability and bright colors (Filippelli et al, 2010). Lead compounds may also be added to enamel (oil-based) paints to act as driers (sometimes called drying agents or catalysts). The driers serve as catalysts that speed up the polymerization, and thus make paints dry faster and more evenly (UNEP, 2013). Lead compounds that are commonly used as driers include lead octoate, lead acetate and lead naphthenate. Lead compounds are also sometimes added to paints used on metal surfaces to inhibit rust or corrosion, where the most common of these is lead tetroxide. Children can be exposed to lead when lead-based paints are applied in their environments, where they can be exposed when they play with walls, through dust when they play on the floor and through direct eating of paint chips in a habit known as pica. In this regard, paint flakes make significant contributions to lead in house dust and street dust (Gulson et al, 1995). Consequently, house dust has been found to be a significant source of blood lead (Kumar et al, 2009, Lanphear et al, 1998). Lead-based paint is also often applied to children’s toys through which children can be exposed to lead via mouthing behavior. Children’s toys made of Polyvinyl chloride(PVC) can also contain lead through the use of lead as a stabilizer in PVC. For these reasons, studies on lead in toys in many countries have shown lead levels above permissible limits (Greenway and Gerstenberger, 2010, Kumar and Pastore, 2007, Omolaoye et al, 2010), which is currently 100 mg/kg in the United States of America. Heavy metals, including lead, are found to be bio accessible from PVC toys (Zagury et al,2014). Lead can also be found in air. Sources of lead emissions include traffic (Monna et al, 2006), industries and waste combustion (Sun et al, 2006), thermal power stations (Liang et al, 2010), lead smelters (Roels et al, 1980), lead-zinc smelters (Gulson et al, 2004), copper smelters (Carrizales et al., 2006) and mining (Zheng et al, 2013). Atmospheric concentrations of lead were high in areas where there was use of leaded petrol or industries that dealt with lead, especially mining. However, the most important source of lead in air appears to have been leaded petrol, which is now banned in almost all countries of the world, leading to a significant reduction in atmospheric lead. Internationally, after the introduction of regulations on lead in gasoline, concentrations of lead air have been reported to be reduced to about 0.2 µg/m3 (Thomas et al, 1999).

2.2. lead poisoning

Lead ranks as one of the most serious environmental poisons amongst the toxic heavy metals all over the world. Lead poisoning is a serious problem! Lead poisoning whether it is of occupational or environmental origin in human, poses serious, health hazards, especially to young children and may alter virtually all biochemical process and organ system. As early as the second century B.C the symptom of lead poisoning was described by the Greek physician ‘Nikander’ (George,2010) Lead poisoning in Zambia.

Heavy metal pollution is one of the most important problems in Zambia and causes serious effects to humans and animals. In a study done by Ikenaka et al in 2010, river and lake sediments and soil samples were collected from a large area of Zambia and analyzed for ten heavy metals (Cr, Co, Ni, Cu, Zn, As, Cd, Pb, Sr and Hg). The results indicated that heavy metal pollution in Zambia has strong regional differences. Using cluster analysis, the patterns of heavy metal pollution were divided into three major clusters: Kabwe, Copper belt and Lusaka and other areas. Heavy metals on the Copper belt area are transported to downstream areas by the Kafue River. Pollution was also detected in national parks, and Lake Itezhi-tezhi has been polluted with high concentrations of Cu, possibly from mining activities in the upper reaches of the river. However, areas geographically distant from mining beds had only moderate or low heavy metal concentrations, although the concentrations of Pb and Zn were highly correlated with the populations of each town. Findings of the study indicated that heavy metal pollution in Zambia is still increasing, due to human activities, especially mining.

Lead poisoning in kabwe: pollution pathways

According to Blacksmith Institute (2003), Kabwe’s lead deposits were discovered in 1902 and were mined up until 1994 without any meaningful government oversight that addressed the dangers of lead pollution. Even though the mine is no longer operational, it has still left some parts of the city contaminated with lead concentrations that have become harmful to human health. “The dense fumes which came from the smelter, were rich in metallic pollutants such as cadmium, copper, lead, and zinc. These pollutants that were emitted into the air eventually precipitated on the ground surface. Since these metals are non-biodegradable, their pollution is long lasting and would entail pollution remediation strategies in the future (Tembo et al,2006). Lead pollutants are significantly toxic because of their non-biodegradability, cumulative nature, and nonphysiologically use in the human body.

Knowledge of this lead pollution in Kabwe and its harmful effects on the local population was previously known, but not publicly disclosed by the government. In 1975 for example, a research study conducted by A.R.L. Clark from the London School of Hygiene and Tropical Medicine, indicated that the primary pollution pathways causing lead contamination from the mine included, atmospheric, soil, vegetation, and water pollution, and had predominantly affected the Kasanda, Chowa, Makululu, and Mine Municipality residential areas. (Clark ,1975).

Clark’s research was conducted between 1971 and 1974, and at the time of his study the mining industry had just been nationalized in 1973. This study could potentially have provided the Kaunda Administration a timely opportunity to enact environmental laws that would mitigate the lead pollution that was happening in Kabwe. Kasanda Township, whose population was about 11,000 residents, was the most affected area by the lead pollution; in some part, this was because of its leeward or downwind geographical position relative to the mine and the prevailing winds that first pass through the mine before reaching this neighborhood; the township’s central area is only about one kilometer from the mine’s smelter stack, hence making it easier to contaminate the air quality over this area. During this same period, Chowa Township was a much smaller residential area with only about 3,000 residents, and because of its eastern location relative to the mine, this puts it in the windward or upwind side of the prevailing winds that blow first through Chowa and then onto the mine, hence not being subject to significant wind-blown lead pollution from the mine; and as for Makululu, this is a large squatter area which at the time of the research only had about 3,000 residents; this neighborhood is however located much further to the west of the mine and Kasanda Township. It is therefore evident that a township’s location in reference to the mine and the prevailing winds played a key part in determining the levels of lead pollution and contamination.

2.3 Heath Effects of lead poisoning

Lead is an environmental poison that affects almost every system in the body. It can damage the kidney, the nervous system, the reproductive system and high blood pressure. It is harmful to the developing brain of fetuses and young children.

Neurobehavioral effects of lead poisoning

Similar to children, neurotoxic effects have also been observed in adults, although in adults they appear to be initiated at blood lead levels of about 18 µg/dL, whereas in children they are observed at blood lead levels below 10 µg/dL (Murata et al, 2009). The main neurotoxic effect in adults is the decline in cognitive functions, which has been reported following both environmental and occupational exposures (Schwartz et al, 2005, Shih et al., 2006, Dorsey et al, 2006). Neurological effects can also be detected in adults 20 years after childhood environmental exposure (Stokes et al, 1998). Effects of lead on the Central Nervous System(CNS) also result on adverse effects on sensory faculties such as eye sight and hearing. In this regard, lead has been shown to cause impairment of scotopic vision (night blindness) in monkeys (Bushnell et al., 1977, Lilienthal et al, 1994).

Similarly, in humans, an association was established between chronic lead exposure and the agerelated risk of cataract in men (Schaumberg et al, 2004). In addition, occupational and environmental lead exposure also causes impairment in hearing (Forst et al, 1997, Choi et al., 2012). Since it is now recognized that parameters of fetal, infant, and childhood growth may be predictors of disease in later life, there have been speculations on the possible role of lead in neurodegenerative disease such as Alzheimer’s disease and Parkinson disease (Prince, 1998, Landrigan et al, 2005). Indeed, it has been reported that exposure to lead in early life can reprogram gene expressions that can result in both upregulation and down-regulation of genes that may contribute to neurodegeneration in old age, leading to Alzheimer’s disease (Bihaqi et al, 2011, Wu et al, 2008). However, a meta-analysis on retrospective occupational exposures to lead found no association between lead and the disease (Graves et al, 1991). These conflicting results are expected as studies on early exposures to lead and the onset of Alzheimer’s disease are beset by long latency periods and lack of validated circulating epigenetics biomarkers and retrospective biomarkers of lead exposure (Bakulski et al, 2012). Associations have also been found between exposure to lead and the development of Parkinson’s disease, where more than 20 years of coexposures to lead, copper and iron were found to be risk factors for Parkinson’s disease, with odd ratios 5.24 and 2.83 respectively (Gorell et al, 1997). Divalent metals such as Pb2+ accelerates the rate of formation of α-synuclein fibril, which is involved in Parkinson's disease (Uversky et al, 2001).

Reproductive and developmental effects of lead poisoning

In male mice lead was shown to inhibit spermatogenesis and sperm development (Wang et al, 2013). Similarly, in men, lead can impair the production of sperms and reduce concentrations of androgens, and consequently “decreased sperm count, volume, and density, impaired sperm motility and morphology in male workers” have been reported among workers exposed to lead at blood lead levels higher than 40 µg/dl (Landrigan et al, 2000). Reproductive effects of lead have also been observed among the general population at average blood lead concentrations of about 5 µg/dl (Telišman et al, 2007). Lead also significantly suppressed circulating levels of luteinizing hormone (LH), follicle stimulating hormone, estradiol in monkeys, without inducing overt signs of menstrual irregularity (Foster, 1992). Similarly, in women, lead can cause spontaneous abortions and low birth weight in infants. For example, odds ratios of spontaneous abortions of 2.3, 5.4, and 12.2, for blood lead levels of 5-9, 10-14 and ≥ 15 ug/dL, respectively, in comparison to < 5 ug/dL, have been reported in Mexico (Borja-Aburto et al, 1999). Increased frequency of spontaneous abortions and decreased birth weights in children have also been reported in Sweden (Nordstrom, 1979).

Effects of lead poisoning on the immune system

Lead affects the immune system, where it suppresses the T helper (Th1)-dependent delayed type hypersensitivity (DTH) response, increases production of immunoglobulin E (IgE), and increases production of the proinflammatory cytokines tumor necrosis factor (TNF) α and IL-6 (Dietert and Piepenbrink, 2006, Dietert et al., 2004).

Effects of lead poisoning on the Blood.

Lead interferes with heme synthesis and production of RBC, where reduction of RBC production has been observed at concentrations above 7.0 µg/dl (Iavicoli et al., 2003). In addition, lead shortens the life spans of RBC (Hernberg et al., 1967). For these reasons anemia is often observed with lead poisoning. A strong non-linear dose-response relationship between blood lead level and hematocrit was observed in a cross-sectional study involving children (Schwartz et al., 1990). In India, children with blood lead levels above 10 µg/dl were 1.3 times as likely to have moderate anemia as children with blood lead levels below 10 µg/dl. Furthermore, children with Blood lead level (BPb) above 10 µg/dl were at least 1.7 times more likely to develop severe anemia than children with blood lead below 10 µg/dl (Jain et al, 2005).

Renal effects of lead poisoning

Nephrotoxic effects can result from both acute and chronic exposure to lead. Acute lead nephrotoxic effects include a deficit of tubular transport mechanisms and degenerative changes in the tubular epithelium, manifested in children by glycosuria and aminoaciduria and changes in specific ion transport. These changes appear to result from effect of lead on mitochondrial respiration and phosphorylation (Goyer, 1989). On the other hand, chronic lead nephrotoxic effects include renal dysfunction, characterized by glomerular and tubule interstitial changes, and culminating in chronic renal failure, hypertension and hyperuricemia (Rastogi, 2008). While acute nephrotoxic effects are reversible upon reduction of lead exposure or treatment with chelating agent, chronic nephrotoxic effects are irreversible (Goyer, 1989). Nephrotoxic effects have been associated with lead exposure in children in some epidemiological studies. For example, environmental exposure to lead in the vicinity of a lead smelter caused slight effects on the proximal tubule function in children in Prague (Bernard et al, 1995). The pattern of nephrotoxic effects in children appear to be similar to that observed in adults, although they occur at lower blood lead levels than in adults (Fels, et al, 1998).

Carcinogenic and genotoxic effects of lead poisoning

Substitution of Zn2+ and Ca2+ by lead in enzymes that are involved in deoxyribonucleic acid (DNA) processing and repair can inhibit DNA repair. Lead may also produce reactive oxygen species which can cause oxidative damage to DNA (Silbergeld et al, 2000). The inhibition of DNA repair or oxidative damage to DNA may result in genotoxic effects. Therefore, lead is likely to be mutagenic or it is a mutagen (Ariza and Williams, 1996, Zelikoff et al, 1988). The direct damage of DNA or inhibition of DNA synthesis or repair may also cause lead to be carcinogenic. lead has been reported to cause kidney and brain tumors in rats and mice (Mulware, 2013). However, “because of the limited and inadequate evidence in humans and sufficient evidence in experimental animals”, the International Agency for Research on Cancer (IARC) classifies inorganic lead compounds as probably carcinogenic to humans (IARC, 2004). DNA damage has been detected in children exposed to lead around a mining site (Yáñez et al, 2003), and lead exposure was found to cause an increase in micronuclei in children (Kapka et al., 2007), which is an indication of DNA damage. This notwithstanding, there appears to be no literature on the prevalence or incidence of cancer resulting from lead exposure in children.

Cardiovascular effects of lead poisoning

Exposure to lead has been shown to be “associated with blood pressure, hypertension and increased incidence of cardiovascular complications such as coronary heart disease, stroke and peripheral arterial disease, left ventricular hypertrophy and alterations in cardiac rhythm” (NavasAcien et al, 2007). The mechanism for cardiovascular dysfunctions is reported to occur through “impairing nitric oxide signaling, augmentation of adrenergic activity, increasing endothelin production, alteration of the renin-angiotensin system, raising of vasoconstrictor prostaglandins, lowering of vasodilator prostaglandins, disturbance in vascular smooth muscle calcium ion signaling, reduction in endothelium-dependent vaso relaxation, and modification of the vascular response to vasoactive agonists”. An association between prenatal lead exposure and blood pressure has been established in children (Zhang et al, 2012).

2.4 Sources and pollution pathways of lead poisoning

The sources of lead exposures vary among countries depending on historic and current issue at hand, In India the main source of lead pollution is automobile exhaust, mining activities, base metal smelting and refining, coal powdered power stations, cement manufacture, fertilizer production ferroalloys (Shilu et al,2000)

Breast milk feeding with high lead concentration is one of the first source of lead exposure in neonates. A comparative study was conducted in Riyadh reported that lead in breast milk from 81% (47 of nursing mothers) varied from low concentration of 0.31 mg/dl to a high concentration of 2.5 mg/dl. Living condition, cooking utensils and eating habits were the major source of lead in these mothers.

In Sub-Saharan Africa, there have been relatively few studies on exposure to lead in blood and/or sources of lead including food, air, water, soil, toys, paint, crayons, medicines (herbal and western) and cosmetics. Most studies have been conducted in South Africa and Nigeria, where most of these studies were on the identification of the sources of lead and levels of exposure, often with no accompanying risk assessment resulting from the exposures in Nigeria, prior to the banning of leaded petrol the mean Blood lead level in children aged 1-6 years was found to be 10.6 µg/dL (Nriagu et al., 1997b). There appear to be no other studies on Blood lead levels in Nigeria that may indicate the impact of introduction of regulations on lead. However, as a confirmation of the importance of other sources of lead, investigations into the fatal lead poisoning outbreaks in Nigeria showed that 97% of children had Blood lead ≥ 45 μg/dL, resulting from gold ore processing (Dooyema et al., 2012, Lo et al., 2012). Studies on lead in blood were also conducted in other countries, such as Botswana, where at the time regulations on leaded petrol were introduced, 31% of children were shown to have BPb ≥ 10 µg/dL (Mbongwe et al, 2005), and in Uganda, where the mean Blood lead after the introduction of regulations on leaded petrol was 7.15 µg/dL, with 20.5% of the children having Blood lead above10 µg/dL (Graber et al, 2010). In addition to studying lead in blood, there are many studies in sub-Saharan Africa on sources of lead.

For example, there were a number of studies on levels of lead in paint.

Sources and Pollution Pathways of Lead Poisoning in Kabwe

Atmospheric Source and Pathway

The prevailing westerly winds that blow through the mine and onto Kasanda go unimpeded neither by trees nor buildings; these winds take up the lead particles from the effluent coming from the smelter furnace and plant stacks, and in a fumigating plume, blows them over most of Kasanda Township. The wind also tends to pick up particles from the waste ore deposited on the ground, hence contributing to the high levels of lead concentration in the air over Kasanda. Chowa Township on the other hand recorded levels within normal limits; these normal atmospheric lead levels in Chowa are attributed to its windward location relative to the mine and westerly winds that blow over Chowa prior to passing over the mine. The atmospheric lead levels in Kasanda averaged 0.0968 mg/m3 per month, which was above the U.S. standard requirement of 0.005 mg/m3 for a 30-day period. On the other hand, pollution decay due to distance travelled explains why the Makululu area, which lies further west of Kasanda and on the leeward side of the mine, experiences relatively less atmospheric lead pollution from the westerly winds passing over the mine and towards the Makululu area. (Ibid, 2006).

Soil source and pathway

Even though soil as a lead pollution pathway already occurs naturally through the lead-baring ore, much of the lead in the soil found in the three residential areas being focused on, mainly originated from the smelter stack the mine uses to emit its pollutants into the atmosphere. Kasanda Township on the other hand was an exception because it not only experienced soil contamination from the emissions settling on the ground, but more worryingly from the foundation on which the township was built. The lead concentrations found in its soils remained relatively high compared to the other residential areas because Kasanda township was built on what used to be the mine’s waste rock.

Water source and Pathway

Water as a lead pollution pathway is very minimal because of Kabwe’s predominantly carbonate geology. Since lead is not soluble in hard alkaline water, Kabwe’s carbonate geology acts as a buffer by making water hard and insoluble, hence minimizing the water contamination. Water samples collected from five operating boreholes as well as from domestic taps in the supplied areas, showed lead concentrations of about 10 μg/dl; this figure is well within the current official safety limits. According to Komex (2002) Even though these levels are considered normal and acceptable, the recent discovery of the low dose impact of lead poisoning should have caused a policy review in official levels of lead contamination by lowering the acceptable lead concentrations levels. In the United States for example, the goal of United States Environmental Protection Agency (EPA) for acceptable lead levels in drinking water is zero; this policy was motivated by studies that showed the association of low dose blood-lead levels in children to their health and intelligence impairment. The town of Kabwe should also consider emulating this policy even though its hard water prevents the problem of lead solubility.

In addition, right before the mine was closed, an Environmental Impact Assessment (EIA) was carried out to help facilitate the privatization process by assessing how much environmental damage had been done by ZCCM. Different samples that were taken from the Kabwe Mine site and its surrounding areas revealed high levels of lead contamination through the drainage canal from the plant site. This proved to be a key pollution pathway to off-site lead contamination, especially in times the canal got flooded during the rainy season. Surface run-off water from the mine plant that drained into the perimeter ditch and then directed into the drainage canal was highly contaminated; from the mine site, the canal runs along the periphery of Chowa, Railways and Katondo residential areas, and during the rainy season, the canal often over flows into parts of these neighborhoods and hence spilling its pollutants over the land and possibly into the water wells that have been dug in these neighborhoods.

Vegetation Source and pathway

Certain types of plant species are capable of acting as lead pollution pathways. Depending on the type of plant and specie, the quantity of lead uptake and different root systems. This lead uptake also depends on the amount of soluble lead available to a plant root system. “Through plant uptake, Pb (Lead) enters the food chain which then ends up being ingested by humans through contaminated food crops. It is argued that once lead ion is ingested, it accumulates in the bones of its host’s skeleton and is subsequently remobilized along with the phosphates from the bones which exert a toxic effect (Nachiyunde,2013).

In the case of Kabwe, the amount of soluble lead available to a plant root system is relatively small and insufficient and since root crops tend to generally contain more lead than leaf or fruit crops, there were very few crops that were found to be contaminated with lead; the maize cob on the other hand, a popular staple food crop consumed by Kabwe residents was found to be easily contaminated, but not from the soluble lead going through root system but instead from atmospheric pollution. Once it was discovered that the maize cobs were being contaminated due to atmospheric lead pollution, it gave a better understanding as to why ingested locally grown maize in certain areas recorded higher levels of lead poisoning than in other areas. It is a common practice among most households in Kabwe to grow a maize garden in their backyards so as to supplement their food basket and because of this, any backyard garden exposed to atmospheric lead pollution was likely to get contaminated, (Chilongo,2014).

Mother and infant Pathway

Cultural practices have also contributed to lead exposure and poisoning; for example, in Nigeria lead based material known as otanjere in the local Igbo language is used for its supposed “magical” properties and also for the treatment of ophthalmologic (eye) infections. (Nnoron,2005). In Kabwe on the other hand, a cultural practice that exposes pregnant women to lead poisoning is geophagia. This is a common practice in Zambia among pregnant women experiencing cravings that cause them to deliberately ingest soil. These craving are generally known as pica and tend to have a secondary impact on infants, (Castiglia,2007). Pica is considered to be a compulsive eating habit that can be identified in most cultures; many substances including dirt, clay, laundry starch, mothballs, ice, coffee grounds, antacids, and ashes have been identified as common pica cravings. Picas therefore have different name variations depending on the substance being craved, for example, geophagia is a clay pica, whereas laundry starch pica is called amylophagia, and lead pica is called plumbophagia . Unfortunately for some of the women in Kabwe who practice geophagia , there is also a chance that the soil being ingested is contaminated with lead, hence classifying this type of pica as plumbophagia. This practice therefore plays a key role in partly explaining the lead poisoning in Kabwe among newly born babies. Once lead enters the body it accumulates in the teeth and bones of an adults, but in pregnant women the lead remobilizes in the blood, hence exposing the fetus to contamination, Pica is thus a sign of nutritional deficiency (WHO,2013).

Between 1973 and 1974, blood samples were taken from children below the age of sixteen in Kasanda, Mine Municipality, Chowa, and Makululu, to determine the extent of lead poisoning in their blood. In the 1960s and early 1970s, the acceptable normal upper limits of lead concentrations in the blood of children in most countries including the United States and Zambia was 60 μg/dl.

(Needleman,2004). Today however the acceptable normal levels stand at 10 μg/dl and will probably get lower due to the recent discovery of how low dose lead exposure is just as harmful. Lowering the acceptable levels for safe body lead burdens may also be based on the fact that the natural blood-lead levels in humans is approximately 0.0016 μg/dl. This fact maybe attributed to another fact that lead has no physiologic function to the human body and when ingested it tends to accumulate in the body. (chukwuma, nd). Due to these factors, one can make a convincing case for the lowering of the current acceptable blood-lead concentrations of 10 μg/dl. When a comparison of lead concentration in the blood from the children living in Kasanda, Mine Municipality, Chowa and Makululu was done, there were certain commonalities and differences that were observed in the data.

2.5 knowledge studies on lead poisoning

Another descriptive study was conducted in Gujarat on 119 pregnant women assessing the knowledge, perceptions, of behaviour pregnant women in relation to child health hazards, by using a structured questionnaire. The result showed that only 13 participants had heard of lead poisoning before and the majority of participants [89% n-107] had not heard of lead before. The study concluded that mothers had the low level of knowledge, lacked perception and high risk behaviour and practices in relation to child health hazards (Trepka,2005).

Collen (2007) reports that a cross sectional study was conducted in Haitian regarding assessing the caregiver’s knowledge and attitudes regarding childhood lead poisoning. The structured questionnaire was administered for assessing the knowledge of lead poisoning. Of the 110 participants, 61% were Haitian, 24% were 18-24yr old’s, 50% were mothers, 33% had below high school level education, 12% had un insured children, and 65% were non- home owners. The result of the study shows that Haitian caregivers had a lower overall knowledge on lead poisoning.

Fernandes (2014) Conducted a research on knowledge regarding lead poisoning among mothers from selected rural community at karkalla in which pretest results showed that 30% of mothers had poor knowledge regarding lead poisoning ,30% of them had average knowledge and 40% of them had good knowledge on lead poisoning.

Mpokota (2014) conducted a research in kabwe to establish whether the knowledge level of lead poisoning precautionary measures influences the residence of child-bearing age women in high lead poisoning exposure residential area. The survey revealed that knowledge level of precautionary measures among women of child-bearing age was low at 40.9% despite staying in high lead poisoning exposure residential areas and 89.1% of the respondents having heard of lead poisoning. A similar study was conducted in Germany by Fertmann et al. that showed that the Germans in Hamburg were not aware of the lead exposure in drinking water despite having high levels of blood lead concentrations (Fertmann et al, 2004). One mother said that ‘when she is pregnant she likes eating soils.’ It was also revealed that many people in the area where not aware about lead poisoning precautionary measures except those who had someone who was suffering from lead poisoning or had joined a Lead Poisoning Treatment Support Group. From the evidence of this research, the residents in the lead endemic areas are not knowledgeable about the lead precautionary measures.

Another Study conducted by Nair in Bangalore in India showed that 190 (63.3%) of the students had inadequate knowledge, 110 (36.7%) of the students had the moderate knowledge and none possessed adequate knowledge regarding the various characteristics of lead poisoning. Data revealed that there was an association between the knowledge score and the stream of education based on the knowledge score categorization (χ2 = 20.727, p < 0.001) and also based on the various content area (t = 4.83, p<0.001), but there was no association between the knowledge score and other baseline variables like age and gender (Nair,2018) In Zambia, not much studies have been done on assessment of knowledge on lead poisoning among the residents of kabwe.




This chapter outlines the theoretical framework relevant to this study and its component that include: Individual, social environment, physical environment and policy.

Theoretical framework plays an important role in guiding the entire process of the research study. This research uses socio-ecological theory that uses components namely: Individual, Interpersonal, Organizational, Community and Policy.

The term Ecology originates in the Biological Sciences and refers to the interrelationships between Organisms and their Environments. Ecological and social-ecological theory of human behavior have evolved over a number of decades in the fields of sociology, psychology, education and health and focus on the nature of people’s interactions with their environments.

Environmental health behaviors, including lead poisoning, are thought to be improved when environments and policies support healthy choices, and individuals are motivated and educated to make those choices (WHO, 2000). Educating people to make environmentally healthy choices when environments are not supportive will not be effective in making behavioral change. The social-ecological theory acknowledges that it takes a combination of both individual level and environmental or policy level interventions to achieve substantial changes in health behaviors, including behavior on the prevention of lead poisoning.

Human behavior is difficult to change especially in an environment that does not support change.

In order to increase residents’ participation in prevention of lead poisoning, efforts need to focus not only on the behavior choices of each individual but also on factors that influence those choices. The social-ecological theory helps to identify opportunities to promote participation of individuals in prevention of lead poisoning by recognizing the multiple factors that influence an individual’s behavior. Efforts to change behavior are more likely to be successful when multiple levels of influence are addressed at the same time(Anon)

3.1 Components of the Social-Ecological Model

There are four major components of the socio-ecological model as discussed below:

3.2 The individual:

This is at Centre of the social-ecological model. This level includes personal factors that increase or decrease the likelihood of an individual being physically active. Individual factors which influence people’s participation include: knowledge, attitudes, behaviors, beliefs, perceived barriers, motivation, level of education, socioeconomic status. Strategies which bring change at the individual level tend to focus on changing an individual’s knowledge, attitudes and behaviors.

They include education and awareness programs.

3.3 Social environment:

Surrounding the individual in the social-ecological model is the social environment. The social environment comprises the relationships, the culture and the society with whom the individual interacts. The social environment has a significant influence on knowledge of lead poisoning behavior. The social environment includes cultural background, socioeconomic status of the community, institutions and organizations, such as schools, workplaces and community organizations, access to social support networks versus social isolation and so on. Strategies which bring change at the social environment level include community education, support groups, awareness programs, workplace incentives and social marketing campaigns. These are used to promote positive community attitudes and awareness to participation in activities to prevent lead poisoning.

3.4 Physical Environment:

Environmental activities take place in physical environments. Physical environment includes the natural environment and the built (man-made) environment. The built environment provides opportunities for intervention, such as provision of lead pollution prevention services. Strategies focusing on the physical environment usually should be put in place before educational or community awareness initiatives are attempted. Sometimes educational initiatives encourage impossible or unrealistic behavior. For example, media campaigns that encourage people to plant grass in their yards to prevent lead dust will be ineffective in communities where there is no proper water reticulation system. In this case, education and awareness programs are more likely to be effective when preceded by programs for the development of community facilities (Sallis et al, 2000).

3.5 Policy:

This refers to legislation, regulatory or policy making actions that have the potential to affect lead poisoning activities. These are often formal legal actions taken by local or state governments but also can be informal local policies or rules in settings such as communities or workplaces. Policy includes education policies such as mandating time for environmental education classes, health policies, environmental policies and funding policies.

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3.6 Developmental Effects of Lead on an individual:

Once it enters the body, lead causes problems in behavioral and cognitive development by disrupting various brain mechanisms. Calcium is an element that aids proteins and presynaptic cells in healthy brain functioning. Lead particles are able to mimic calcium, allowing lead to attach to brain structures and inhibit healthy functioning (Needleman, 2004). Lead is able to interfere with the central nervous system’s ability to relay information throughout the brain through processes such as synaptic firing by attaching to these various structures. Lead can also have deleterious health effects outside of the brain, affecting other bodily functions such as the kidneys and blood pressure (Needleman, 2004).

3.7 Delinquency and Society:

Individual effects of lead are problematic and the outcome of such effects can be detrimental to society as a whole. Multiple studies have found a positive association between lead concentrations in the body and criminal behavior, which is a societal issue in addition to the individual’s concern. Needleman et al (2001) found that boys aged 7 and 11 who had higher bone lead levels were more likely to self-report antisocial and other delinquent behaviors.

3.8 Exposure and Social Status:

The health hazards of lead exposure while real to everyone, disproportionally affect those individuals living in areas concentrated with lead (Levin, et al., 2008). Low social economic status for example, is a consistent predictor of Environmental blood lead levels (EBLLs). Mahaffey et al. (2001) demonstrate through an investigation of the National Health and Nutrition Examination Survey (NHANES) that EBLLs are more common in children from families whose annual income is less than 6,000 dollars.

The social-ecological theory needs to be tailored to suit particular behaviors and population groups. While the components of the social-ecological model will remain, the same and can be used in a range of populations, the specific examples within each component will vary depending on the population group (Elder, 2007, p. 156).

This theory was deemed relevant to this study in that it outlines a number of factors that are at play in the way people perceive lead poisoning. It also highlights the importance of education in behavioral change. In this study the specific aspects of the social ecological theory used include the individual factors, policy and the physical environment. The study sought to assess knowledge on lead poisoning among the residents of selected places in kabwe. The policy and environment is said to influence the behavior of individuals. This study also sought to establish how the physical environment provided opportunity for intervention in the prevention of lead poisoning.



This chapter gives an overview of the methods used in the study in terms of research design, study population, inclusion and exclusion criteria, sample size, Sampling procedure, data collection tool, data analysis and ethical consideration.

4.1 Research design:

The design was primarily Qualitative and secondarily Quantitative in that it aimed at in depth assessment of the phenomenon under study.

4.2 Study population

The research was conducted in residential areas of Chowa, Kasanda and katondo in kabwe District.

The study population included all male and female adults living in the selected study sites.

4.3 Inclusion/Exclusion Criteria

Inclusion criteria

Male and Female adults living in the study area

Exclusion Criteria

Male and Female adults who refused to give informed consent

4.4 Sample size

The survey targeted male and female adults to make a total of 86 which was the required sample size. The choice of this number agrees with Creswell (1978:122) and Marrow and Smith (1995) who argued that for studies following Qualitative design, sample sizes ranging between 11 and 30 participants are adequate.

4.5 Sampling Procedure.

The respondents were sampled using probability simple random sampling. The respondents were talked to by research assistants and those who agreed were told the nature of the study. Informed consent was then obtained.

4.6 Data collection tool

Questionnaires were given to each of the participants who were recruited in the study. The questionnaires were a Likert-type scale in section A and open ended in section B. The Likert type scale is an intact scale created by Likert, an American educator and organizational psychologist in 1932 (Johns, 2010). Researchers use Likert-type scales to compile items on a 5-point scale that expresses a large range of attitudes including strongly agree, agree, uncertain, disagree, and strongly disagree.

4.7 Data analysis

Data from the field was verified for completeness and consistence at the end of that day’s field work. The data was analyzed using Descriptive statistics in Excel and Statistical package for social sciences(SPSS).

4.8 Ethical considerations

Ethical approval was sought. The purpose of the study was explained to respondents and informed consent was sought. Efforts were made to ensure that the participants understood that, there would be no consequences for anyone who would refrain from participating. Confidentiality and anonymity was maintained. This was done by ensuring that participants did not indicate their names on the questionnaires.



This chapter presents the findings of the research in terms of Assessment of knowledge on lead poisoning among the residents of Chowa, Kasanda and Katondo in Kabwe District. The aim of the research was to assess knowledge on lead poisoning among the Adult population of Chowa, Kasanda and Katondo in Kabwe District in order to identify areas where knowledge is lacking and help effectively direct public health and environmental related programs in Kabwe District.

The specific research questions that were used to achieve this aim were;

1. What facts and information do the adult population of Kabwe District have on lead poisoning?
2. What are the views of the adult population of Kabwe concerning their role on lead poisoning? 3. How could Environmental Education be used to improve lead poisoning management in Kabwe?

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Figure 5.1: Knowledge on Lead Levels in Children Requiring Medical Attention.

Source: Field data, 2018

Out of the 86 respondents 27 strongly agree and another 27 agreed to the fact that children in kabwe have high levels of lead that require medical attention.20 respondents were uncertain and Only 4 respondents strongly disagreed to this fact.

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Figure 5.2: Knowledge on Lead Causing Kidney Failure and Hypertension

Source: Field data, 2018

31% of the respondents were uncertain, the other 28% disagreed to the fact that lead poisoning cause kidney failure and Hypertension.5% Strongly disagreed to this fact.

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Figure 5.3: Knowledge On Lead Causing Infertility in Both Male and Female

Source: field data ,2018

Out of 86 respondents 38 were uncertain and 4 strongly disagreed to the fact that lead causes infertility in both males and females exposed to it and brings about miscarriage in pregnant mothers.

Table5.1: Knowledge on Lead Reducing Intelligence Quotient of Children

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Source: Field data,2018

42.2%of the respondents strongly agreed to the statement that lead reduces the intelligence quotient of children and affects their performance at school. Only 2.3% strongly disagreed to this fact.

Table5.2: Receiving Education About Lead Poisoning at the Clinic

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Source: Field data, 2018

44.2% of the respondents disagreed to the statement that when they go to the clinic they educate them about lead poisoning. Only 5.8% of the respondents strongly agreed.

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Figure5.4: Knowledge on Chowa, Kasanda and Katondo having high levels of Lead.

Source: Field data, 2018

31% of the respondents agreed to the fact that Chowa, Kasanda and Katondo Townships have high levels of lead.5% of the respondents strongly disagreed to this fact.

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Figure 5.5: Knowledge on effects of lead Resulting into Psychosis

Source: Field data, 2018

Out of the 86 respondents 38 were uncertain about the fact that acute and chronic effects of lead results into psychosis. Only 2 respondents strongly agreed to this fact.

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Figure5.6: Knowledge on Lead Being Carcinogenic

Source: Field data, 2018

Of the 86 respondents 35 were uncertain about the fact that lead may be carcinogenic, mutagenic or teratogenic,24 disagreed and Only 2 strongly agreed to this fact.

Projects taking place in the area that relate to lead poisoning?

When participants were asked about projects taking place in their area that relate to lead poisoning, they gave their views as below.

Participant 10. There are no projects in this area to do with lead poisoning.

Participant. 40. There is nothing in this area that concern lead.

Participant 39. I saw them putting soil in the houses

Participant 80.I have not seen anything I can cheat

Participant 86. The council is not doing anything.

Most of the participant said there are no projects taking place in their area that relate to lead poisoning.

Having heard any program on the local radio stations that relate to lead poisoning and the contents of the program.

Participant 11. No I have not heard anything on KNC.

Participant 2. I did not hear anything

Participant 66. NO

Participant 79.NO

Participant 82 Nothing

Participant 20. No they just talk about Roads

Most of the participants said they did not hear any program related to lead from the local radio stations that exist.

Having read any leaflet or brochure containing information on lead poisoning .

Participant 9. No I did not read

Participant 8. Yes, they were giving but I did not read.

Participant 3. I did not read

Participant 34. NO

Participant 18.I did not read that thing.

Participant 27. NO

Most of the responses were ‘I did not read ‘It appears leaflets containing information about lead were distributed but people did not read so that they could know the contents

Children learning about lead poisoning in school?

Participant 44. They don’t

Participant 20. They don’t Participant 38. NO

Participant 16. They don’t

Participant 14.NO

Most of the participants said their children do not learn about lead poisoning in the schools they go to.

Views of the people on environmental education concerning lead poisoning?

Participant 5. They should be educating us so that we know about lead.

Participant 44. Education is important to us.

Participant 6. They have never educated us.

Participant 81. we do not know who should teach us

Participant 1. Nothing

Most of the answers were “they should be educating us” ‘They have never educated us” ‘Nothing”. This shows that the participants did not know and role that environmental education could play in preventing lead poisoning



This chapter presents the discussion of the findings on respondents’ knowledge on lead poisoning in the study area.

The sample size of the study was 86 and out of this number 27 (31.4%) participant strongly agreed to the fact that children in Kabwe have high levels of lead that require medical attention, while another 27 (31.4%) participants agreed to this fact as shown in figure 5.1. The study reveals that the residents of Kabwe had knowledge about the levels of lead in the children that require medical treatment. This coincides with the research that was conducted by Schultz in 2014 that revealed that out of 246 children tested for blood lead levels of toxicity eight children demonstrated levels of 150 to 427 μg/dl well above the guidance level of 5 μg/dl (Yabe et al,2015).

However, what was surprising was the number of participants that were uncertain about this fact, in which uncertain mean lacking clear knowledge or definite opinion when this problem has been going on for almost 100 years now from about 1902 when the mining of lead started to date.

When the respondents were asked about whether lead poisoning could cause kidney failure and Hypertension diseases as per figure 5.2, 31% of the participants were uncertain and the 28% disagreed to this fact. This Research reveals that the majority of residents of Kabwe who were surveyed have inadequate knowledge about lead causing kidney failure and Hypertension disease. By today it is expected that the people know some of the health implications of lead poisoning more especially that they know that the children have high levels of lead that require medical attention. The people who live in Chowa and part of Katondo live near a canal that used to carry waste water from the mine where lead treatment plant used to be and this canal is still a hot spot of lead, during rainy season the canal floods taking lead contaminated water into the nearby homes and during dry season people work up in the morning and start sweeping without protective clothing inhaling a lot of dust that contain lead particles there by taking lead into their bodies. These are some of the people who go to the clinic and are found with hypertension and are prescribed with anti-hypertension. When the people have knowledge about this health implication of lead, the problem could be avoided. Lead however, is a likely cause of hypertension and the residents of Kabwe should know so that they put up measures to prevent lead entering their bodies as prevention should start with the people themselves.

If this is known by the residents it could be used to change their mind set and social behavior where some have even built houses just one meter away from the canal and use the waste water for watering gardens and allow their children to swim in this water that is contaminated with lead.

Moreover, WHO (2010) reports that in kidneys, lead causes proximal tubular injury with a characteristic pathology of proximal tubule nuclear inclusion bodies that progress to tubuleinterstitial disease and fibrosis. Lead accumulation in the proximal tubule reads to hyperuricemia and gout presumably by inhibiting uric acid secretion and also diminished renal clearance, tubular reabsorption and glomerular filtrate rates (Gonick,2008).

When participants were asked about what they know concerning lead causing infertility in both males and females 38 participants representing 44.2% out of the total of 86 were uncertain and 4 representing 4.7% strongly disagreed to this fact, this is shown in figure 5.3. This indicates that the majority of the surveyed population have inadequate knowledge about lead causing such a problem. The community may have some of the family members having problems with infertility and some may even think they have been bewitched and yet the highly cause may be lead poisoning. If the people are made to know about problem such as this one would be prevented and certain costs may be prevented such as frequent visits to the hospital to undertake infertility tests at a cost.

Knowledge on the health effects of lead is however supported by Blacksmith Institute (2017) in their newsletter that reports that high levels of exposure to lead can severely damage the brain and kidneys in adults or children and ultimately cause death. In pregnant women, high levels of exposure to lead may cause miscarriage and high levels in males damage the organ responsible for sperm production.

Prior to the sale of the mine in 1994 the baseline data in the environmental impact assessment that was conducted revealed high levels of lead in Kabwe but the information was never disclosed to the residents so that they could have the knowledge about the state of the environment they live in. Lack of this knowledge even made the residents to be going to the slag dump and undertake illegal mining of lead without proper safety measures there by increasing exposure to lead and enhancing the effects that lead has on human beings .There is need to step up efforts on increasing the level of knowledge of the residents of Kabwe on health implications of lead so that proper preventive measures are put in place by the residents themselves rather than waiting for intervention by the government at curative level that may cost the economy of Kabwe District and the country.

On assessing the level of knowledge on the fact that lead reduces Intelligence Quotient, 44.2% of the participants strongly agreed to the fact, 22.1% agreed and only 2.3% strongly disagreed to this fact, this is indicated in table 5.1. This study reveals that the residents of Kabwe Surveyed in this study have knowledge about lead reducing Intelligence Quotient in children and could have detrimental effect on their performance at School. This knowledge may be attributed to the works done by Blacksmith Institute where they facilitated the formation of Kabwe Environmental Rehabilitation Foundation a Non-Governmental Organization that helped to spread the information on how lead poisoning could be prevented. Because of this fact some parents have concentrated on reducing the exposure of lead to their children and yet even them they are at risk. On this fact, Schwartz (1994) estimates a 2.6-point decrease in Intelligence Quotient for every 10 Pico gram per deciliter. Even low levels of 3 to 8 can cause mild IQ decrease and or attention deficit disorders(Schultz,2014).

Environmental Education enables the acquisition of Knowledge and makes people change their mind sets and behavior. It helps people to understand their roles regarding an environmental problem such as lead poisoning in Kabwe. Mwinga (2014) reports that environmental education among the people would generate environmental awareness which could result in to the formation of groups concerned with how to protect the environment and avoid or minimize the hazards of environmental pollution and degradation. When the respondents were asked whether they receive education on lead poisoning when they go to the clinic,44.2% of them disagreed 16.3% were uncertain and only 5.8% strongly agreed. This is indicated in table 5.2. This study reveals that when the majority of the sampled population go to the health facilities they are never educated about lead poisoning; this could be the reason why most people do not even know some health implications of lead poisoning. Health facilities should endeavor by all means to provide education on lead poisoning so that the people are made to know about them. The provision of this education should be done by the Nurses, Public health workers, Environmental health personnel, the neighborhood health committees and Clinicians who come into contact with the people almost on daily basis. The non-provision of environmental education in particular concerning lead poisoning may be attributed to among other things, lack of knowledge about health implications of lead in human beings among the health personnel. Some of the participants in the study who are residents of Chowa and Kasanda are health workers and most them expressed ignorance about the implications of lead poisoning.

If the people get the know on health implications of lead poisoning and become willing to solve the environmental problem that come with lead, Chowa, Kasanda and Katondo in Kabwe could be better places to live in.

Kamara (2006) argues that if understanding of the connection between environmental awareness and education and the people’s health are well internalized, people’s perception and attitudes towards environmental protection are likely to improve. For the problem that has been affecting people for many years and is still affecting them it is important that they are provided with education about the health implications of lead poisoning so that their knowledge is enhanced. If the residents are made to know that lead poisoning brings about: Hypertension, Infertility, Anemia, kidney failure, Psychosis and reduce Intelligence quotient in children they will be able to intensify on the efforts of prevention and change their life style.

Moreover, this could result into the relocation of some of the residents who are building in very close proximity just one meter away from the mine canal that is heavily polluted with lead. Those who would want to rent houses may not even think of such places. It is surprising to note that some people allow their children to swim in the water found this canal which is a hotspot of lead and some women work up in the morning and start sweeping and raising dust particles of lead in the soil that is around their yards. Some of the residents of these places are likely victims of infertility and hypertension that lead brings about but they do not know. It is therefore important that environmental education is put into good use at the local health centers of Katondo, Kasanda and Chowa.

On assessing if the residents knew that Chowa, Kasanda and Katondo townships having high levels of lead, 31% of the participants agreed,30% strongly agree and 5% strongly disagreed, figure 5.4 indicates this. This study reveals that the majority of the sampled population were aware of the presence of lead in the townships. Because they were aware, they should then be made to know the adverse effects that come with the introduction of lead into the body because people may just know that lead is there but if the health implications are not known they will continue with social behavior that are not good in terms of prevention of lead poisoning. Fear is a very important factor in regulation of social behavior and if the people are told that lead causes death at certain levels they will put up preventive measures that will help them reduce the health implications that come with lead. Mpokota (2014) reports that people know about the presence of lead in the environment but the knowledge is not translated into good social behavior.

Despite knowing lead is present in Kabwe people have continued to get sick and die of it. Blacksmith (2017) reports that for almost a century, Kabwe, a city of 300,000 in Zambia, has been highly contaminated with lead from a government owned lead mine and smelter, Zambia Consolidated Copper Mines (ZCCM). Although the mine has been closed since 1994, residents continue to get sick and die from the contamination due to lack of clean-up efforts on the part of the company and the government. The deaths could however, be minimized by increasing the levels of knowledge of the residents on health implications and preventive measures.

Because lead poisoning has been there for almost a century, by today almost every home in the hotspot areas is expected to have information about lead its toxic effects. This study reveals that the number of people who have heard about lead in Kabwe is still low. Out of the 86 participants 32(37.2%) agreed that they have heard about lead poisoning 22 (25.5%) were uncertain and 3(3.5%) strongly disagreed.

The majority of people who indicated that they were uncertain resided in Katondo. This means that there is need to step up efforts to increase awareness through groups, Radio programs, print media, leaflets, health talks at the local health centers.

On assessing the knowledge of people about whether they know lead causes psychosis which means loss of contact with reality: a psychiatric disorder such as schizophrenia or mania that is marked by delusions, hallucinations, incoherence, and distorted perceptions of reality (Encarta ,2008) .38(44.2%) participants were uncertain 2 (2.3%) strongly agreed to this fact, as indicated in figure 5.5. This study reveals that the sampled residents of Kabwe have low level of knowledge about lead causing psychosis. On the package for the environmental education it is imperative this is included so that people may intensify on preventive measures. When the residents suffer from conditions that bring delusions, hallucinations and withdraw from reality many of the people think it is cannabis or witchcraft and yet lead poisoning may be the cause. Public health workers, Environmental health workers, nurses and clinicians are supposed to educate the people and include it in their screening procedures. Some of the conditions clinicians deal with are as a result of lead poisoning but they end up giving antibiotics which is a waste of resources and time.

The problem of cancer is one that is developing at a very fast rate. Kabwe is one of the towns which has recorded a number of cervical cancer patients. Genetic disorders and birth defects and some of these problems the people do not the route cause but lead poisoning is one of the contributing factor to such problems. This study reveals that the sampled residents of Kabwe have inadequate knowledge about lead causing these problems. Figure 5.6 indicates that out of 86 participants 35 (40.7%) were uncertain and 24 (27.9%) disagreed to the fact that lead may cause Cancer, Genetic Disorders and birth defects. This lack of knowledge could be attributed to lack of environmental education from the Neighborhood Health Committee, Public health workers, Environmental Health personnel most of whom express ignorance about most of the health effects of lead in Kabwe. There is need however, to incorporate knowledge on lead poisoning in the training programs so that their knowledge is enhanced.

In relation to the projects taking place in the area that relate to lead poisoning , most of the participants expressed ignorance about the efforts that the government through Zambia environmental management agency and other stake holders such as the blacksmith institute are doing in the area such as putting of black soil in some houses in order to prevent lead dust, formation of lead treatment support groups and formation of Kabwe environmental rehabilitation foundation that was formed to help educate the local population about lead poisoning. This could be attributed to the lack of the use of proper channels of communication that could help disseminate information quickly such as the radio, newspapers, posters, flyers and door to door campaigns.

Radio is one of the communication too that play a role in increasing the level of knowledge of the people but when the participants were asked if they head anything on radio about lead poisoning most of them said that there are no programs on the local radio stations concerning lead poisoning. However, Anifowose (2013) asserted that communication involves the process by which information and understanding are transferred from one person to another. It is the basis for all human interaction for all group functioning. Radio remains a medium in development communication usually employed by the development officers or experts for the dissemination of relevant development messages, especially for rural audience. He further argued that radio can be multi-faceted as among other things, it can serve to pass messages, improve the capability of calling upon and organizing groups and organizations, enlarge the forum for social dialogue, provide effective capability building of the community to raise awareness and knowledge of community issues, bring the people’s voice to the higher level of their political structure and mobilize community to tackle issues. This means that radio could be effective in increasing knowledge about lead poisoning.

Omenesa (1997) observed that radio programs are usually timely and capable of extending messages to the audience no matter where they may be as long as they have a receiver with adequate supply of power. The absence of such facilities as road, light and water are no hindrance to radio. Similarly, such obstacles as difficult topography, distance, time and socio-political exigencies do not hinder the performance of radio. He further observed, that illiteracy is no barrier to radio messages since such messages can be passed in the audience own language.

When participants were asked if they had ready any leaflet containing read most of them refused having read any and some responded like ‘I did not read it’ a fact that means that they were given but did not just read the leaflets but Jenni (2014) reports that Leaflets and other small media fulfil a larger purpose to ensure that a comprehensive source of information on a specific topic was achieved. For instance, as a part of an HIV prevention campaign, different types of small media have the ability to draw service users from initial interest or campaigns, to picking up a leaflet. This enables them to gain more detailed information, to making a decision to seek further interventions, or perhaps to alter their behavior. Written interventions cannot be expected to meet complex social needs or address interpersonal problems. Instead, they are best used to convey information, and to raise awareness. This could be vital in increasing knowledge on lead poisoning among the residents of Kabwe.

Environmental education facilitates the acquisition of knowledge and skills and enables people to change their attitudes towards lead poisoning. It helps people understand the harmful effects of their behaviors and highlight their roles and responsibilities in regard to lead poisoning. This research reveals that the majority of the participants had no idea on how environmental education could be used to improve preventive measures of lead poisoning in the area. The few participants who had ideas stated the following;

1. The Kabwe Municipal Council should engage and educate community leaders by making them understand the problem of lead poisoning and what needs to be done before rolling out to the people.
2.The Kabwe Municipal Council should use community leaders to form neighborhood committees in their localities and to help them disseminate information on deleterious effects of lead poisoning.
3.The Kabwe Municipal Council should provide waste receptacles and support these community committees as they enforce the bylaws. They must also motivate them if possible.
4.The Health Department could be used to disseminate the information in compounds, by using mega phone announcements through community meetings to fliers.
5.They should be educating us so that we know about lead.
6. Education is important to us.
7.They have never educated us.
8.we do not know who should teach us

Kamara (2006) argues that if understanding of the connection between environmental awareness and education and people’s health are well internalized, people’s perception and attitude towards environmental protection are likely to improve.

Larijani (2010) goes on to state that it cannot be thought of achieving a sustainable way of life without an appropriate educational system designed to internalize the principles of sustainability in the life and work of the people.

Knowledge on lead poisoning could be gained through environmental education (EE) and when people have the knowledge and become willing to solve the environmental problem that come with lead poisoning in their locality, then health effects of lead would be reduced. Unfortunately, the Kabwe Municipal Council, the Kabwe Medical Office and other stake holders may not have done enough in educating the people of Chowa, Katondo and Kasanda about lead poisoning, how it could be prevented and some health effects of lead.



This chapter provides the Conclusion of the analysis discussed in the previous chapter.

The study was conducted in Chowa, Kasanda and Katondo townships in Kabwe District in order to assess knowledge on lead poisoning among the residents Using both quantitative and qualitative methods, this study revealed a number of issues that should be addressed in the sensitization of the communities that live-in areas containing high levels of lead.

Most of these people live in lead poisoned areas of Chowa, Katondo, Kasanda, Mines and Makululu. Therefore, most of these residents needed knowledge on the health effects of lead and how lead poisoning could be prevented. However, the residents’ knowledge was inadequate. By today the knowledge of the people is expected to be high. This study revealed that there is a significance percentage of the Kabwe’s population who do not know about the: primary sources of lead, the exposures pathways of lead, some health implications of lead (that include reducing intelligence quotient, effects on the reproduction, effects on the kidneys) and some knowledge on prevention of lead poisoning when the problem has been there for almost a century now. The low levels of knowledge explain why there is high number of children and adults with high blood lead levels in the population that is well above the recommended range of 5 μg/dl to 10 μg/dl of blood lead level. It may also explain why people are building houses in highly lead contaminated areas some of which are one meter away from the canal that is heavily polluted with lead.

Some residents in Katondo, Chowa and Kasanda are involved in the selling of contaminated soil, vegetables, crushed stones and sand.

The reduced levels of knowledge on lead poisoning could be because of not giving the residents enough knowledge on health implications of lead poisoning, sources, how lead enters the body and how it can be prevented.

Even if there was not enough information about prevention of lead poisoning by the residents,32 out of 86 participants reported having heard about lead poisoning and another 30% believed Chowa, Kasanda and Katondo have high levels of lead.

There is need to intensify on increasing the knowledge of the residents of kabwe about lead poisoning, its health implications, sources and preventive measures if Kabwe District is to be a better place.


This chapter gives the recommendations in relation to the findings. Future research study to be conducted is also presented. The following are the major recommendations.


1.It is recommended that the government through Zambia Environmental Management Agency and other stakeholders come up with new policies to combat lead poisoning exposure and come up with ways of creating awareness that will take on board health implications of lead poisoning in endemic areas.
2.Ministry of Mines should come up with policies to depress people from foraging old mine site for scrap metal and mineral ores.
3.Kabwe Municipal Council should stop giving out plots in high lead exposure areas without putting in place measures that will prevent exposure to lead.
4.The Health Facilities through public health workers and environmental health workers should carry out monthly health promotion sessions on health implications of lead in antenatal Care to capture women of child-bearing age.
5.The Office of the District Health Director’s Office should support community health in lead poisoning prevention and implications.
6.The District Health Office and the Kabwe Municipal Council should take their personnel for specialized training on lead and its effects so that their knowledge is enhanced
7.The Medical Office and Local Authority should partner in Airing programs on lead poisoning prevention and implications on local radio stations, on Zambia National Broadcasting Corporation (ZNBC) Print media weekly or monthly
8. The Local Authority in Kabwe through the health department and medical office should start conducting door to door Environmental Educations that include health implications and prevention of lead.
9. Those Health workers who live in Chowa, Kasanda and Katondo should share their knowledge about lead poisoning with their neighbors.
10.The people of Kabwe should take lead poisoning and its health implications seriously and come up with preventive measures that could make the town a better place.
11. The Local Education Authority should see how they could incorporate lessons on the health effects of lead and how lead poisoning could be prevented at household levels.
12. The Local Authority should consider banning the growing of maize in the backyards of the hotspot areas.
13. Zambia Environmental Management Agency should consider coming up with the acceptable blood lead level for the residents of Kabwe and Zambia.


1.Further research needs to be done to determine the education levels of health personnel on lead poisoning
2.Research on how to effectively educate the residents on recognition of lead hazards needs to be done.
3.Research on the Role of the Local Radio Stations, Musicians, Posters and Mass Media in increasing the knowledge of the residents on lead poisoning needs to be done.


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Appendix A: Informed Consent Form

Informed Consent Form

You are invited to take part in a research study of Assessment of knowledge on lead poisoning among the Residents of Chowa, Kasanda and Katondo in kabwe District. This procedure is part of a process called “informed consent” to allow you understand the study before deciding to take part. The study is being conducted by Enock Mutepuka a Master of Science student at the University of Lusaka.


Once you agree to be in this study you will be asked to complete the questionnaire.

Voluntariness of the Study:

The study is voluntary. Everyone will respect your decision of whether or not you choose to be in the study. No one will treat you differently if you decide not to be in the study. If you decide to join the study now, you can still change your mind during the study.


Any information provided will be kept confidential. The researcher will not use your personal information for any purposes outside the research project. I will not include your name or anything else that could identify you in the project reports.

Statement of Consent:

Completing the questionnaires indicates that you have chosen to participate



Appendix B: Questionnaires

Complete the questionnaires. This information is significant for Assessment of knowledge on lead poisoning among the residents of Chowa, Kasanda and Katondo in kabwe district.


Tick the appropriate response and further provide information on other questions.


1. I believe that children in kabwe have high levels of lead that require medical attention.
- Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain

2. I believe that lead can cause kidney failure and hypertension diseases.
- Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain

3. lead causes infertility in both males and females exposed to it and brings about miscarriage in pregnant mothers. o Strongly Agree o Disagree o Agree o Strongly disagree o Uncertain

4. lead reduces the intelligence quotient(IQ) of children and affects their performance at school.
- Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain

5. When we go to the clinic they Educate us about lead poisoning.
- Strongly Agree
- Disagree
- Agree
- Strongly disagree Uncertain

6. Chowa, Kasanda and Katondo townships in kabwe have high levels of lead.
- Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain

7.Acute and Chronic effects of lead results into Psychosis o Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain

8. Effects of Lead may be Carcinogenic, Mutagenic or Teratogenic o Strongly Agree
- Disagree
- Agree
- Strongly disagree
- Uncertain


9. What projects are taking place in your area that relate to lead poisoning?

10.Have you heard any programs on the local radio stations that relate to lead poisoning? if yes, What were the contents of these programs?

11. Have you read any leaflet or brochure containing information on lead poisoning? If yes, what were the contents?

12.Do your children learn about lead poisoning in school?

13.What is your view on environmental education concerning lead poisoning?

14.Have you talked about lead poisoning in your area with your neighbor? If yes, what were the contents of your discussion?

15.How do you utilize the sources of information regarding lead poisoning in your area?

Thank you.


66 of 66 pages


Assessment of Knowledge on Lead Poisoning among the Residents of Kabwe, Zambia
University of Lusaka  (Postgraduate studies)
Environmental management
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ISBN (Book)
assessment, knowledge, lead, poisoning, residents, kabwe, zambia
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Enock Mutepuka (Author), 2019, Assessment of Knowledge on Lead Poisoning among the Residents of Kabwe, Zambia, Munich, GRIN Verlag,


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