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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

There were 39 participants overall, with one person failing to keep his appointment at the venue of the focus group discussions. The age of the participants ranged from 23 to 72 years with mean (SD) of 44.5 (12.8) years. There were 19 (49%) women and 20 (51%) men; 6 Muslims (15%) and 33 Christians (85%) and their occupations were students (9, 23%), teachers (6, 15%), drivers (6, 15%) and clerks (6, 15%). The rest belonged to a wide variety of occupations.


What is lead and where can it be found?

Most participants believed that lead is a metal which is used in soldering materials and it can be found in cooking pots, domestic and automobile batteries, pencils, cosmetics, fuel, local herbs and medications. Discussants thought that lead is poisonous. It can cause asthma, cancer, eye and chest diseases and can shorten lifespan. Many participants mentioned some of the commonly used canned foods and condiments in Nigerian markets, such as canned tomato puree, canned fish, tinned milk, cutlery and cooking utensils as potential sources of lead.

Participant: My own understanding of lead is both abstract and physical. The physical is in form of gold, silvery in color, and usually heavy in substance. It is used for soldering flexible wires, radio and television (...) used by blacksmith, tinkers, and other likes (sic). The other one which is abstract so to speak is within the mineral sector and my own overall understanding of the thing is that it is poisonous because it is usually incubated through liquid water or sucking lead pencil or eating any kind of tinned food that has expired thereby secreting lead into the container which is made of tin as a component (sic). There is another one that can be absorbed through water, depending on the kind of soil the water flows through (sic).

Participant: In all this small small batteries we use for torch light, there is lead in it, it is like a rod (inside) the battery(sic)...People also use it those selling herbs (alternative medicine practitioners). If you have itches, scratches or any infection in the body, you go to buy soap for it; they will mix it with (the) soap and sell it to you. I even used it for my own grand daughter when she had rashes on her head.

Participant: ...lead is in this pencil that we use to write.

Participant: It is a heavy metal and we can find it in traces of fumes of vehicle (sic). It affects the health of children, that is why if you see some children in the park ... they don't behave like normal children ... when they inhale it in large quantity it can affect health (sic).

What risks are associated with exposure to lead?

Most of the discussants stated that they believe that lead is poisonous and dangerous to health but there was no unanimity about which of the body's systems is vulnerable. Many of the participants thought exposure to lead can cause cancer.

Participant: It can affect the eyes, that is why they (workers who use lead products) cover the eyes with face mask (goggles) (sic).

Facilitator: Many of you mentioned pencil as a source of lead, has anyone noticed anything peculiar about children using pencil?

Participants: I see children playing with pencil. I have never paid attention and I have never met a mother in my life (who) complained about pencil apart from the sharpness (sic). When I was a child I used to play with pencil and put (it) in my mouth, nothing has ever happened to me (sic).

Participant: Yes, I have 2 experiences, one was with a child sucking lead pencil and it resulted in upset stomach (sic). She was hale and hearty before sucking the substance. The other one also resulted in stomach upset by playing with battery and licking the head, thereby absorbing the water from the battery (sic). So in the two instances, it ultimately led to stomach pain.

Participant: It can shorten life because it can affect any organ. We know it is bad, we don't know the exact thing it can cause in the body (sic).

Participant: I noticed this welder (who) uses lead ... it makes them lean (sic). It affects their health.

Participant: (Children) tend to be dull if they are exposed to lead.

Participant: It affects intelligence.

Where can we get information about lead and additional comments?

Discussants felt that they can obtain information about lead exposure from welders, automobile battery repairers and manufacturers. There was general agreement on the need for the government to do more to increase awareness of lead exposure while putting effective remediation measures in place (Table 2).


What do you think of when you hear "lead poisoning"?

The use of the term poison engaged the attention of the discussants, though they did not know specifically about lead poisoning. They were sure that the metal is poisonous. Overall, they felt that apart from specialists in the field, most people do not know what "lead poisoning" is about.

How do you think we are exposed to lead and how can we reduce it?

Most of the discussants believed that one can be exposed to lead through petrol, pipe-borne water and pencils. Less commonly, they also mentioned soil, cooking utensils, soap and industrial pollution as sources of lead exposure. There was general agreement that there is a need to increase awareness of lead exposure and increase the role of regulatory agencies in ensuring that products sold on the market do not contain lead. Some participants suggested that people should return to the use of earthenware pots for cooking, out of concern that modern cooking utensils may be associated with lead exposure, though they acknowledged that such a move is not likely to be popular. Other participants thought that recent government efforts to reduce importation of old vehicles (used vehicles are commonly imported into Nigeria and constitute the majority of new vehicle purchases) will reduce the amount of lead pollution from exhaust of old cars with inefficient engines.

Practices Have you tested the amount of lead in your environment? Would you accept to have your environment tested for lead?

None of the participants has ever tested their environment for lead. A participant, who works in the state government's department in charge of housing and civil engineering works, was aware that the department has the capacity to test lead level in soil and does it for corporate bodies and large organizations before they are given building permits.

Participant: supposing what you are going to use to test the level is going to have a negative impact. (Secondly) what use will the test be to (an individual). ...a man whose daily income depends on constant exposure to lead will have been exposed for too long and (he will say) I am now used to it. ... it needs ... education, letting them know why, is there going to be harm (sic).

Participant: Nowadays you can never know the purpose of research because we have read in some papers that some people will just bring something in their environment because they want to make money or name out of it (sic).

Participant: I think the first and best solution is awareness. I think the first solution is awareness for people to know that they have a lot of lead in their environment and they have to reduce it (sic).

Participant: The reason I am opposing awareness is that ... we have a lot of poverty (sic). If you are saying there should be awareness, are you saying that the pot (we use for cooking) we have should be thrown away (if it is found to contain lead)?

Participant: I think awareness should be done. Like in the primary and secondary school level, this kind of study should be included in the school curriculum so that the generation coming will be able to have proper knowledge of what is going on in their environment (sic).

Participant: paints in homes, because we are even advised that when you paint a house, if possible, let people not be there for a few days (sic).

Participant: ... thorough research (we) will be able to bring out certain results which I believe will be passed to the government and invariably ... legislation will result. There are some soap(s) that contain heavy metal, if we know such ones so as to avoid them (sic).

Some participants think that since lead is used for welding, pencils, paints, etc, it is needed and beneficial. (Table 3)

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