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Anita Hunter's Research Site College of Nursing

Uganda: Assessing the Health of Women of Child-Bearing Age and the Children for Developmental Health – The Impact of Heavy Metals


Purpose: Clinical and research work in Uganda over the past 8 years has found a high incidence of malnutrition and developmental concerns in children as well as malnutrition and poor child-bearing health of the women. Arsenic was found in multiple water sources in 2013 by water quality and chemistry colleagues from University of San Diego. Assessing the impact consumption of such contaminated water has had on the population was critical. This research study, conducted in January 2016, expanded on a small pilot project in 2013 to answer the following research question: Is there a relationship between the consumption of water contaminated by heavy metals, malnutrition, and malaria on the child-bearing health of women and the physical and developmental health of their children?

Background: Between 2010 and 2012, 300 children in Mbarara (birth – age 12) were assessed for their physical and developmental achievements, nutrition status, and the incidence of severe malaria they had encountered. The results were that 50% of the children were cognitively and developmentally delayed, and 80% were malnourished. However, only 22.7% of the variance for developmental delays could be explained by malnutrition and malaria. In 2012 – 2015, when arsenic was found in the water sources in and around the Mbarara District and many other areas of Uganda, it became apparent that such a heavy metal could be a contributor to the developmental concerns in the children. Science has found that heavy metal/arsenic poisoning has the greatest health consequences to the fetus as these toxins cross the placenta barrier and the blood-brain barrier to cause fetal anomalies, spontaneous abortions, prematurity, neurological disorders, developmental and cognitive delays.

Methods: A triangulated research design was used, comprised of a detailed health history and questions related to access to water, water sources, nutrition, symptomatology; physical exams on both women and their children; a developmental exam on the children using the Malawi Developmental Assessment tool; urine testing for evidence of kidney damage, infection, and excretion of heavy metals including arsenic. A teaching intervention was given to the community as well as to the education and health professionals in the Mbarara District addressing optimum nutrition, how to create clean and safe water for drinking and cooking, and healthy pregnancies. A full IRB review was approved by Washington State University for this project.

Results: Average age of the women was 28 years; average age of the children was 2.5 years; villages with access to clean water (n=180 people) tested negative to heavy metals/arsenic in the urine; had minimal child-bearing health problems; and minimal child developmental problems. The villages with no access to clean water (n=90) had 70% of the population testing positive for high levels of heavy metal/arsenic in their urine; 52% of the women had neurological problems in gait, memory, headaches paresthesias; 30% of the women had poor child-bearing health; 18% of the children were malnourished; and 21% of the children failed the Malawi developmental exams.

T-Test for heavy metal on adult neuro, headaches, cardiac; and child cognitive, speech and language development were:

Neuro: t 5.043; df 89; Sig .000; mean diff. 0.222 95% interval .13 – .31
Headaches t 5,851; df 89; Sig .000; mean diff 0.278; 95% interval .18 – .37
Cardiac t 3.700; df 89; Sig .000; mean diff 0.133; 95% interval .06 – .20
Cognitive t 18.235; df 38; sig .000; mean diff 0.897; 95% interval .80 – 1.00
Speech/lang. t 18.235; df 38; sig .000; mean diff 0.897; 95% interval .80 – 1.00

Women in these communities had twice the incidence of neurological problems and three times the incidence of fetal loss; children were ten times more likely to have developmental delays.

Eighty-five percent of the population live in rural areas of Uganda and most of these areas do not have access to clean water. The potential long-term effects on the development of children and the healthy child-bearing status of women in this population exposed to heavy metal contaminated water is significant. Further research on this subject is scheduled for July 2016 to accrue enough data to present to the Ministries of Health and Environment in Uganda so appropriate action can be taken.