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In this study, the authors conducted several focus group discussions with adult …

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- An examination of knowledge, attitudes and practices related to lead exposure in South Western Nigeria

In this study, we found some awareness of lead exposure among our participants. Many of them were aware of the presence of lead in petrol but had little knowledge of domestic sources of lead exposure such as paint, water and soil. Many of the participants confused the popular appellation for pencils, which is "lead pencil", to imply that the writing element in pencils were made of lead. Several of our FGD participants were aware of lead exposure arising from car battery manufacture and repairs. There used to be a motor car battery manufacturing plant in Ibadan and many residents were aware of the environmental degradation associated with its operations. Participants were also aware of the presence of lead in some alternative medicines and in association with occupations such as welding. Some of our participants were aware of the health implications of lead exposure in children, suggesting that it may be responsible for "abnormal behavior" and "dullness". Nevertheless, none of the participants has ever tested their environments for lead.

At least one participant who works with the government department in charge of civil engineering was aware that facilities for testing lead level in the environment exists but added that this was usually done by large organizations and not individuals. Participants believed that there is need to increase awareness of lead exposure in the community. Many however agreed when another participant suggested that people are likely to be pragmatic in their response to any campaign to reduce exposure to lead, suggesting that alternative sources of income should be found for those whose occupation is likely to be affected by lead remediation activities, otherwise such campaigns will fail. Furthermore, it was suggested that alternatives should be provided for lead contaminated products. While some of the participants were hopeful that research results will lead to government intervention, others were not as optimistic, suggesting that previous experience does not support any expectation that the government will respond positively to such research. Most of the participants felt that they can obtain information about lead from those who are occupationally exposed to it.

There is increasing awareness of the risks posed by domestic exposure to lead, particularly to children. Children can be exposed to lead through dust inhalation and ingestion [10,11]. In a survey of households in the United Kingdom, the total estimated lead intake of young children was 36 μg/day, of which 1 μg/day was by inhalation and the rest by ingestion [12]. Recent prevalence studies show that over 90% of children in urban and rural communities of Cape Province, South Africa have blood lead levels ≥ 10 mg/dl. Studies in other countries likewise suggest that childhood lead poisoning is a widespread urban health problem throughout the continent of Africa [13,14]. Reduction of childhood lead exposure will result in substantial economic gains, possibly to a greater degree than has been reported from developed countries [10,15].

This study has outlined the current knowledge, attitudes and practices of a cross section of Ibadan residents about lead exposure. To our knowledge, there is no previous report on the use of FGD to ascertain knowledge of health hazard posed by lead exposure in Nigeria or any other parts of Africa. Our participants were similar to the general Nigerian population in terms of age, sex and occupation [16]; however the presence of a battery manufacturing company in Ibadan in the recent past may have increased the baseline knowledge of residents in this city to lead exposure compared to other parts of Nigeria. There is little or no enforcement of minimum standard for lead content of domestic environment in Nigeria. This is partly because of low awareness of the health implications of these exposures and competing attention from infectious diseases like HIV/AIDS and malaria. There has never been domestic lead abatement in Nigeria and none is planned.

Focus group discussions provide an opportunity to interview a group of individuals in a directed conversation about a specific topic and it can be used to generate new insights about attitudes and beliefs [17,18]. The interaction among participants leads to the promotion of rich discussion and opportunity to present contrary opinions that are not limited by the constraints imposed by the limited choices in a quantitative study [17,19]. In situations where little previous documentation exists, such as this topic, focus group discussions help to generate new ideas and hypothesis for further research. They can also be used in conjunction with other methodological techniques for triangulation purposes thus helping to validate research findings [20]. However like other qualitative research methods, their results and conclusions must be treated with caution [21].

We conducted four focus group discussions and it may be considered that bigger groups or more groups would lead to more valid conclusions. This is however not necessarily so [22,23]. In addition, it is possible that having such a heterogeneous group may dilute the information obtained and may be unrepresentative of the population's knowledge and attitudes to lead exposure. The facilitators' prompts and interventions may also be misunderstood and in the few instances where the participants spoke in Yoruba, the sense of the contribution may have been lost in the translation.

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