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Background: With increasing control of lead (Pb) in gasoline, food has emerged as an important secondary pathway for Pb exposure globally. This study assessed Pb levels in food duplicates and blood. Furthermore, it assessed the correlation of Pb in food duplicates and blood Pb levels with common food items taken by pregnant women of Sindh, Pakistan. Methods: A cross-sectional study was conducted from August 2014 to November 2015, in urban (Karachi) and rural (Gambat, Khairpur) area of Sindh-Pakistan. A total of 103 venous blood samples (Karachi = 63 and Gambat = 40) of pregnant women were measured for blood Pb levels at the time of delivery. One month post-delivery, food frequency questionnaire (FFQ) was administered and three-day food duplicates (same number of cooked portions of food eaten by women) were collected. Food duplicates were analysed for Pb levels. Multivariable linear regression was conducted to identify the frequency of food items which contribute to blood and food Pb levels of pregnant women, separately. Results: With 90% confidence interval, chapati (local flat bread) (β=0.20, pO.001), boiled rice (β=0.35, pO.001), cooked root vegetables (β= 0.16, p=0.03), fried savory items (β=0.15, p=0.03), sweet snacks (β=0.13, p=0.08) were positively associated with elevated mother blood Pb levels. While cream biscuits (β =-0.14, p=0.04), lassi (blend of yogurt, water and spices) (β= -0.31,p<0.01), market milk desserts (β=-0.22, pO.001), fish (β= -0.16, p=0.02), soft drinks (β= -0.19, p=0.01) and supari/gutka (betel-nut) (β=-0.13, p= 0.06) were negatively associated with mother Pb levels. Tetra-pak market juices (β= 0.30, p<0.001) and cooked root vegetables (β=0.19, p=0.05) were positively associated with mother food Pb levels, at 90% CI. Conclusion: Bread, boiled rice, fried savoury items, sweet snacks and cooked root vegetables were contributing to blood Pb levels of pregnant women in Pakistan. These food items may be contaminated with Pb during processing, packaging and storage. Inverse relation of Supari/gutka and soft drinks with blood Pb levels may be due its overall reduction in absorption capacity of the gut for nutrients. Objective individual food item analysis for Pb is warranted for further intervention. [ABSTRACT FROM AUTHOR]

Aim: Exposure assessment of lead (Pb) and Arsenic (As) from food, water, and house dust intake were assessed among pregnant women, their children and fetuses in Pakistan and Japan, as well as their body burden of the metals in their blood.Method: Fifty families which included a pregnant woman, a fetus and the 1-3-year-old siblings were recruited in Karachi and Khairpur in Pakistan, and Shimotsuke and Asahikawa in Japan, respectively. Their dietary exposure to Pb and As was measured in 3-day food duplicates and drinking water by ICP-MP. Pb in house dust and respirable dust was evaluated with an energy dispersive X-ray fluorescence spectrometry. Non-radioactive isotope Pb profiles of blood specimens will be compared with those of the exposure origins, such as food duplicates, respirable house dust, the soils nearby, and gasoline.Results: Judging from the data collected and analyzed so far, contribution from dietary intake is highly correlated to higher body burden of Pb among Pakistani mothers. Additional data analyses will reveal the status of Pb and As body burden in Pakistani mothers, fetuses and their siblings, and causal sources of high body burden is delineated by Pb isotope profile analysis of different sources of Pb exposure. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Lead is a toxic metal. Cosmetic products have been implicated as potential source of exposure to lead, particularly in South Asia and Middle East. We analyzed the lead concentration in 'surma' and related cosmetic products used in Pakistan and Saudi Arabia. METHODS: 33 cosmetic samples were bought from the market of Pakistan and Saudi Arabia. The cosmetic products which make the large respective market share were purposely chosen. The products originated from Pakistan, India, Saudi Arabia, Germany, France, Italy and England. The samples were analyzed by metallic composition analysis by energy dispersive X-ray fluorescence spectrometry. RESULTS: Of the total 33 samples 6 had lead content in them. Four (4) samples had extremely high lead levels ranging from 96-99%. Samples with high lead levels were popular brands originated from Pakistan and Saudi Arabia. CONCLUSION: Lead containing cosmetics has potential to increase the risk for women, her newborn and young child in South Asia. A policy need to be devised to put a ban on cosmetics containing lead. A market survey of all cosmetic products should be conducted and regularly monitoring is required to curb this menace. [ABSTRACT FROM AUTHOR]

BACKGROUND: Antenatal Care (ANC) utilization is associated with better maternal, newborn and child health. There is strong evidence that ANC utilization influences maternal behavior and increases skill birth attendance, postnatal care and improves newborn care. Around 74% of maternal deaths can be averted if all women have access to maternal health care services. OBJECTIVES: To determine the factors affecting ANC utilization in Pakistan. METHODS: Pakistan Demographic and Health Survey (PDHS 2012-13) is a representative population based random cluster survey. Using PDHS a total of 7443 ever married women of reproductive age (15-49 years) with a live birth in five years preceding the survey were included in the analysis. Andersen's conceptual framework was adapted to examine predisposing and enabling factors affecting ANC utilization at individual and systems level by using multivariate logistic regression analysis. RESULTS: Only 37% women had 4 ANC visits during pregnancy. Most important predisposing factors for ANC utilization were women's education (aOR: 3.62, 95% CI: 2.86-4.59), husband's education (aOR: 1.25, 95% CI: 1.03-1.52), having first child (aOR: 5.87, 95% CI: 4.47-7.69). Living in urban areas (aOR: 3.20, 95% CI: 2.90-3.52), and wealthiest health quintile (aOR: 1.25, 95% CI: 1.03-1.52) enabled females for ANC utilization. Women in Balochistan province were less likely to utilize ANC (aOR: 0.14, 95% CI: 0.10-0.19). CONCLUSION: This is the first study focusing on factors affecting ANC utilization on a nationally representative data. ANC utilization is low in Pakistan. Significant improvement can be achieved through addressing education and providing access to services across all provinces. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exposure to lead (Pb) and arsenic (As) during pregnancy and early life adversely affect the neuropsychological development of the children. The exposure levels and the dose at which adverse health effects occur are not known for Pb and As in developing countries to set population based standards and policies. OBJECTIVES: Health risk assessment for Pb and As among lactating mothers, newborns and young children (1-3 year old) by estimating provisional tolerable daily intake (PTDI) and provisional tolerable weekly intake (PTWI). METHODS: Total of 100 triplets comprising of mother, newborn and young child are being enrolled, 50 from Karachi (urban) and 50 from Gambat (rural) sites in Sindh. Exposure assessment will be the the level of Pb and As from mother's blood, hair and nails, placenta and cord blood for the newborn, and child's blood. In addition, environmental samples of air, house dust and water, and food duplicate samples for 3 days is being collected. Outcome assessment will be the maternal and newborn DNA (CD 34 cells) will be extracted to assess changes in epigenes. Bayley's III assessment will be done for assessing child development. CONCLUSION: Provisional Tolerable Weekly Intakes (PTWIs) and Provisional Tolerable Daily Intakes (PTDIs) recommended by the FAO/WHO Joint Expert Committee on Food Additives (JECFA) will be compared and standards and policies will be devised based on available information. [ABSTRACT FROM AUTHOR]

Facility-based, age- and residential area-matched case-control study was conducted in Sindh, Pakistan to determine association between biomass fuel use for cooking and pulmonary tuberculosis (TB). Cases were women with pulmonary TB, and controls were those suffering from other diseases. Current users of biomass fuel were at higher risk of pulmonary TB (adjusted matched odds ratio [mOR] = 3.0; 95% CI = 1.1-4.9) compared with nonusers. In comparison with former biomass users (women not using biomass for >10 years), recent biomass users (women who switched from biomass to nonbiomass ≤10 years ago), and current (lifetime) users were at a higher risk in a dose-response manner (adjusted mOR = 2.8, 95% CI = 0.9-8.2 and adjusted mOR = 3.9, 95% CI = 1.4-10.7, respectively). Population attributable fraction for TB related to biomass fuel use was 40.6% (95% CI = 35.5%-45.7%). This study strengthens the evidence that biomass fuel use for cooking is associated with pulmonary TB and risk increases with duration of exposure.