Bhutan National Blood Lead Level Survey

Bhutan's National Blood Lead Level Survey 2024 report represents a crucial step forward in assessing and addressing lead exposure among the country's youngest citizens, specifically children aged 1 to 6 years. It provides essential insights that will guide future, national strategies, policies, and interventions focused on protecting and promoting children’s health. 

The survey was conducted as a component of the 2023 National Health Survey, employing both structured interviews to identify lead-related risk factors and blood sampling to measure levels of lead (Pb) and hemoglobin (Hgb). This survey also tested blood lead levels (BLLs) in pregnant or breastfeeding women and children from monastic institutions under 13 years of age. 

Key Survey Findings

• More than 3 out of 4 (75.9%) children tested had a BLL of 3.5 micrograms per deciliter or higher. 
• Around 3 out of 5 (58.9%) of the pregnant and breastfeeding mothers tested had a BLL of 3.5 micrograms per deciliter or higher. 
• More than 4 out of 5 (86.0%) children tested in monastic institutions had a BLL of 3.5 micrograms per deciliter or higher. 
• Male children exhibited a higher prevalence of BLLs at or above 3.5 micrograms per deciliter (79.9%) compared to females (71.7%). 
• Lead poisoning was extensive in all dzongkhags, in both rural and urban areas, and among households of all income levels. 
• Anemia & developmental delays were found to be associated with BLLs. 
• Among the source samples tested, lead exceeding the reference threshold was found in 44.2% of Jinlab, 20.0% of spices and foods, 21.5% of kitchen items, 9.1% of toys, 3.3% of soil, and 0.8% of paints tested. 
• Children ever taking Jinlab and the recency of taking Jinlab were both associated with having a BLL ≥3.5 µg/dL. 
• While 75.2% of religious and traditional Bhutanese objects and 47.2% of household hardware contained lead, the risk of exposure is currently unknown for these items.

There is a high prevalence of lead poisoning in Bhutan, with multiple sources of exposure, posing a significant public health and economic threat in the country. A whole-of-government and whole-of-society approach is critical to address lead poisoning.