Question NW4629 to the Minister of Health
23 December 2022 - NW4629
Ismail, Ms H to ask the Minister of Health
(1) With reference to the high level of lead poisoning in the Republic (details furnished) since 2006, what total number of cases of lead poisoning have been reported to the National Institute for Communicable Diseases nationally and provincially; (2) (a) how will his department ensure that doctors, nurses and medical staff are sufficiently trained to identify lead poisoning and (b) what total number of (i) health facilities, such as clinics and hospitals, and (ii) laboratories in the Republic can identify lead poisoning nationally and provincially; (3) (a) how does his department monitor and enforce adherence to legislation of only 0.009% lead particles allowed in paint and (b) what are the consequences of contravening the Hazardous Substances Act, Act 15 of 1973; (4) how does his department intend to remove lead in buildings that were painted before 2006; (5) (a) on what date did the SA Medical Research Council launch its education campaign and (b) what does the specified campaign entail? NW5751E
Reply:
(1) Since 2006, there has been 4 lead poisoning cases that were notified to the National Institute for Communicable Diseases (NICD) nationally. Two (2) cases were reported in 2017, one from Free State Province and the other one from Mpumalanga province. The other two (2) cases were reported in 2022, one from Eastern Cape province and the second one from Western Cape province.
According to the World Health Organization (WHO), clinical diagnosis of lead poisoning is difficult, as a result, it can be misdiagnosed. The reason being most lead poisoned individuals are often asymptomatic and even when signs and symptoms are present, they are difficult to differentiate and relatively non-specific poisoning symptoms such as anorexia, nausea, vomiting, abdominal pain, constipation, poor concentration, headache, fatigue, language and speech delay, behavioral problems, etc. Lack of clear history of exposure, also contributes to difficulty in making a clinical diagnosis. Laboratory investigation which can only happen based on the clinician/medical practitioner`s perception of the need for it, is the only reliable way to diagnose leadexposed individuals (WHO. 2011.Brief Guide to Analytical Methods for Measuring Lead in Blood; WHO.2010. Childhood Lead Poisoning).
(2) (a) Education and training on lead poisoning is part of doctors and nurses undergraduate education and training and there are continual in service initiatives that are ongoing to raise awareness and improve the knowledge on lead poisoning and other related matters.
(b) The fact that nurses and doctors receive under-graduate training plus the continuous awareness programmes that are currently underway, means that all health facilities should be able to act (get patients tested/refer for tests) on suspicion. Tests from health facilities are done at the National Health laboratory Services.
(3) (a) The 0.009% lead content limit in paint is not yet in force. The relevant government Gazette Notice where this 0.009% lead content limit was legislated was published for public comments and comments are in the process of being incorporated. Therefore, the current lead in paint declaration as a hazardous substance law, Gazette Notice No. 801 of July 2009, is still applicable until repealed by the new law. The lead paint law is monitored by Environmental Health Practitioners (EHPs) at national, provincial and at municipal level. Chemical safety and hazardous substances control functions fall within the work scope of EHPs in terms of the Scope of Profession for Environmental Health, R888 of 26 June 1991. Monitoring is done through inspections, sampling, seizure and detaining paint products and subjecting suspected or randomly selected sampled paint product to laboratory analysis and taking any further necessary legal action.
(b) The consequences of contravening the Hazardous Substances Act, Act 15 of 1973; range from a fine to imprisonment for a period between 6 months and 10 years depending on the offence or to both a fine and such imprisonment.
(4) The Department does not remove lead from buildings. According to WHO, as long as the paint on painted wall surfaces remains intact, the lead content is not a hazard unless it deteriorates or ages showing peeling, chipping, chalking or cracking as it releases lead into dust (WHO. 2020. Global elimination of lead paint: Policy brief). It is the responsibility of each building owner to ensure that its building paint is in intact condition.
(5) (a) The South African Medical Research Council (SAMRC) started its education campaign on lead in 2004.
(b) The campaign has developed a number of lead hazards awareness raising materials, including training toolkit in collaboration with the Department of Health. The leaflets embraced various lead exposure sources and pathways such as paint, painted surfaces, toys, cookware, lead bullet ammunition, and melting fishing sinkers. It has also shared information on lead exposure, research findings and recommended intervention measures for government and communities in various government events and academic platforms through presentations, exhibitions, and lectures, targeting various health and education professionals and students.
END.