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Licensed Unlicensed Requires Authentication Published by De Gruyter August 21, 2020

A scoping review of sources of mercury and its health effects among Pakistan’s most vulnerable population

  • Ejaz Ahmad Khan EMAIL logo and Zaigham Abbas


Mercury and methyl mercury are poisonous to human body. In the recent times, exposure to mercury has been anthropogenic in nature. Within the past several decades, many incidences of mercury poisoning have been documented in several countries including Pakistan. Mercury has been ingested where it has been used to preserve crops, through the point and non-point source discharge into the surface water, and consequently entering the food chain. We conducted this scoping review of mercury and its health effects in Pakistan in order to raise the flag to a silent ongoing Minamata disease in the country. We conducted a systematic search of the available literature in Google Scholar, PubMed, and grey literature of unpublished theses and reports of various universities across the country. We found that in the northern Pakistan, suspended sediments were the major pathway of the riverine mercury transport. Sediments of Hunza and Gilgit River were found high in mercury concentrations. Gold mining leads to an increase in mercury concentration in soil and river waters flowing in this region. High concentrations up to 108 ng/L were found in Shimsal River. It is suspected that that high level of mercury transport may be leading to accumulation of mercury in major water bodies and lakes downstream. Occupational exposure to mercury and other heavy metals is common in an unregulated private sector of the country. Goldsmiths burn the amalgamated gold without personal protective measures. Direct exposure to the fumes of mercury leads to respiratory, dermatological, systemic and neurological ailments specific to mercury poisoning. We found good evidence of bioaccumulation of mercury in fish and fish products in Pakistan. The untreated waste water discharge is responsible to not only afflicted the fish but also the birds which feed on this fish. Further, the same untreated waste water from factories and agriculture runoffs affect vegetables grown in it. Studies looking at the biomarkers for mercury in humans have shown increased and even toxic levels of mercury among the most vulnerable populations of the country. Other sources of mercury exposure included mercury in traditional medicines and cigarette products. Though no evidence was found for its presence in drinking water, its existence in the food chain and occupational exposure pose great threat to the humans as well as animals.

Corresponding author: Ejaz Ahmad Khan, Associate Professor, Health Services Academy, Islamabad, Pakistan, E-mail:

  1. Research funding: This activity was conducted as part of UNDP supported work on mercury for Ministry of Climate Change Pakistan. No funding was involved for writing this review for publication. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: We declare that we do not have any conflicts of interests whatsoever in conducting this study.

  4. Informed consent: Informed consent is not applicable.

  5. Ethical approval: The conducted research is not related to either human or animal use.


1. Neukum, G, Oberst, J, Hoffmann, H, Wagner, R, Ivanov, BA. Geologic evolution and cratering history of Mercury. Planet Space Sci 2001. in Google Scholar

2. Elhassani, SB. The many faces of methylmercury poisoning. Clin Toxicol 1982. in Google Scholar

3. Azizullah, A, Khattak, MNK, Richter, P, Häder, D-P. Water pollution in Pakistan and its impact on public health — a review. Environ Int 2011. in Google Scholar

4. Clifton, JC. Mercury exposure and public health. Pediatr Clin North Am 2007;49. in Google Scholar

5. Boening, DW. Ecological effects, transport, and fate of mercury: a general review. Chemosphere 2000. in Google Scholar

6. Selin, NE. Global biogeochemical cycling of mercury: a review. Annu Rev Env Resour; 2010;49.10.1146/annurev.environ.051308.084314Search in Google Scholar

7. Rice, KM, Walker, EM, Wu, M, Gillette, C, Blough, ER. Environmental mercury and its toxic effects. J Preventive Med Public Health 2014. in Google Scholar

8. Futsaeter, G, Wilson, S. The UNEP global mercury assessment: sources, emissions and transport. E3S Web of Conferences 2013. in Google Scholar

9. Xue, F, Holzman, C, Rahbar, MH, Trosko, K, Fischer, L. Maternal fish consumption, mercury levels, and risk of preterm delivery. Environ Health Perspect 2007. in Google Scholar

10. Choi, AL, Weihe, P, Budtz-Jørgensen, E, Jørgensen, PJ, Salonen, JT, Tuomainen, T-P, et al. Methylmercury exposure and adverse cardiovascular effects in Faroese Whaling men. Environ Health Perspect 2009. in Google Scholar

11. Agusa, T, Kunito, T, Iwata, H, Monirith, I, Tana, TS, Subramanian, A, et al. Mercury contamination in human hair and fish from Cambodia: levels, specific accumulation and risk assessment. Environ Pollut 2005. in Google Scholar

12. LIU, X, Cheng, J, Yuling, S, Honda, S, Wang, L, Liu, Z, Sakamoto, M, et al. Mercury concentration in hair samples from Chinese people in coastal cities. J Environ Sci 2008. in Google Scholar

13. Ng, DKK, Chan, CH, Soo, MT, Lee, RSY. Low-level chronic mercury exposure in children and adolescents: meta-analysis. Pediatr Int 2007. in Google Scholar

14. Lim, S, Chung, HU, Paek, D. Low dose mercury and heart rate variability among community residents nearby to an industrial complex in Korea. Neurotoxicology 2010. in Google Scholar

15. Biber, K, Khan, SD, Shah, MT. The source and fate of sediment and mercury in Hunza River basin, Northern Areas, Pakistan. Hydrol Process 2015. in Google Scholar

16. Waseem, A, Arshad, J, Iqbal, F, Sajjad, A, Mehmood, Z, Murtaza, G. Pollution status of Pakistan: a retrospective review on heavy metal contamination of water, soil, and vegetables. BioMed Res Int 2014. in Google Scholar

17. Jan, FA, Ishaq, M Ihsanullah, I, Asim, SM. Multivariate statistical analysis of heavy metals pollution in industrial area and its comparison with relatively less polluted area: a case study from the City of Peshawar and district Dir Lower. J Hazard Mater 2010. in Google Scholar

18. Rehman, K, Fatima, F, Waheed, I, Akash, MSH. Prevalence of exposure of heavy metals and their impact on health consequences. J Cell Biochem 2018. in Google Scholar

19. Gul, N, Khan, S, Khan, A, Ahmad, SS. Mercury health effects among the workers extracting gold from carpets and dusted clays through amalgamation and roasting processes. Environ Sci Pollut Res 2015. in Google Scholar

20. Shaq, M, Khan, MA, Jan, FA, Ahmad, I. Heavy metals in brick kiln located area using atomic absorption spectrophotometer: a case study from the city of Peshawar, Pakistan. Environ Monit Assess 2010;166:409–20. in Google Scholar

21. Gul, N, Khan, S, Khan, A, Nawab, J, Shamshad, I, Yu, X. Quantification of Hg excretion and distribution in biological samples of mercury-dental-amalgam users and its correlation with biological variables. Environ Sci Pollut Res 2016. in Google Scholar

22. Khwaja, MA, Nawaz, S, Ali, SW. Mercury exposure in the work place and human health: dental amalgam use in dentistry at dental teaching institutions and private dental clinics in selected cities of Pakistan. Rev Environ Health 2016. in Google Scholar

23. Gul, N, Shah, MT, Khan, S, Khattak, NU, Muhammad, S. Arsenic and heavy metals contamination, risk assessment and their source in drinking water of the Mardan District, Khyber Pakhtunkhwa, Pakistan. J Water Health 2015. in Google Scholar

24. Rahman, MA, Rahman, MM, Rahman, IMM, Hasegawa, H. Dietary intake of potentially toxic elements from vegetables. In: Fruit and vegetable consumption and health. New York: Nova Science Publishers; 2009.Search in Google Scholar

25. Khan, A, Khan, S, Khan, MA, Qamar, Z, Waqas, M. The uptake and bioaccumulation of heavy metals by food plants, their effects on plants nutrients, and associated health risk: a review. Environ Sci Pollut Res 2015. in Google Scholar

26. Movalli, PA. Heavy metal and other residues in feathers of laggar falcon Falco biarmicus jugger from six districts of Pakistan. Environ Pollut 2000. in Google Scholar

27. Siraj, M, Shaheen, M, Alam Sthanadar, A, Khan, A, Muhammad Yousafzai, A. A comparative study of bioaccumulation of heavy metals in two fresh water species, Aorichthys seenghala and Ompok bimaculatous at River Kabul, Khyber Pakhtunkhwa, Pakistan. J Biodivers Environ Sci J Bio Env Sci 2014.Search in Google Scholar

28. Shah, AQ, Kazi, TG, Baig, JA, Afridi, HI, Kandhro, GA, Arain, MB, et al. Total mercury determination in different tissues of broiler chicken by using cloud point extraction and cold vapor atomic absorption spectrometry. Food Chem Toxicol 2010. in Google Scholar

29. Iftikhar, B, Arif, S, Siddiqui, S, Khattak, R. Assessment of toxic metals in dairy milk and animal feed in Peshawar, Pakistan. Br Biotechnol J 2014. in Google Scholar

30. Waheed, S, Siddique, N. Evaluation of dietary status with respect to trace element intake from dry fruits consumed in Pakistan: a study using instrumental neutron activation analysis. Int J Food Sci Nutr 2009. in Google Scholar

31. Jaleel. MA, Noreen R, Baseer A. Concentration of heavy metals in drinking water of different localities in district east Karachi. JAMC J Ayub Med Coll Abbottabad 2001.Search in Google Scholar

32. Ishaq, M, Jan, FA, Khan, MA, Ihsanullah, I, Ahmad, I, Shakirullah, M, et al. Effect of mercury and arsenic from industrial effluents on the drinking water and comparison of the water quality of polluted and non-polluted areas: a case study of Peshawar and Lower Dir. Environ Monit Assess 2013. in Google Scholar

33. Hajra, B, Qayum, I, Orakzai, S, Hussain, F, Faryal, U. Evaluation of toxic heavy metals in ayurvedic syrups sold in local markets of hazara, Pakistan. J Ayub Med Coll Abbottabad 2015.Search in Google Scholar

34. Afridi, HI, Talpur, FN, Kazi, TG, Brabazon, D. Assessment of toxic elements in the samples of different cigarettes and their effect on the essential elemental status in the biological samples of Irish hypertensive consumers. J Hum Hypertens 2015. in Google Scholar

35. Kampalath, RA, Jay, A. Sources of mercury exposure to children in low- and middle-income countries. J Heal Pollut 2015. in Google Scholar

36. Landrigan, PJ, Lucchini, RG, Kotelchuck, D, Grandjean, P. Chapter 24 – Principles for prevention of the toxic effects of metals. In: handbook on the toxicology of metals. Cambridge: Academic Press; 2015.10.1016/B978-0-444-59453-2.00024-XSearch in Google Scholar

37. Gilmour, CC, Henry, EA, Ralph, M. Sulfate stimulation of mercury methylation in freshwater sediments. Environ Sci Technol 1992. in Google Scholar

38. Kehrig, HA, Pinto, FN, Moreira, I, Malm, O. Heavy metals and methylmercury in a tropical coastal estuary and a mangrove in Brazil. Org Geochem 2003. in Google Scholar

39. Gehrke, GE, Blum, JD, Marvin-DiPasquale, M. Sources of mercury to San Francisco Bay surface sediment as revealed by mercury stable isotopes. Geochim Cosmochim Acta 2011. in Google Scholar

40. Lambertsson, L, Nilssons, M. Organic material: the primary control on mercury methylation and ambient methyl mercury concentrations in estuarine sediments. Environ Sci Technol 2006. in Google Scholar

41. Feng, X, Foucher, D, Hintelmann, H, Yan, H, He, T, Qiu, G. Tracing mercury contamination sources in sediments using mercury isotope compositions. Environ Sci Technol 2010. in Google Scholar

42. Delongchamp, TM, Lean, DRS, Ridal, JJ, Blais, JM. Sediment mercury dynamics and historical trends of mercury deposition in the St. Lawrence River area of concern near Cornwall, Ontario, Canada. Sci Total Environ 2009. in Google Scholar

43. Bose-O’Reilly, S, McCarty, KM, Steckling, N, Lettmeier, B. Mercury exposure and children’s health. Curr Prob Pediatr Adolesc Health Care 2010. in Google Scholar

44. Crespo-López, ME, Macêdo, GL, Pereira, SID, Arrifano, GPF, Picanço-Diniz, DLW, doNascimento, JLM, et al. Mercury and human genotoxicity: critical considerations and possible molecular mechanisms. Pharmacol Res 2009. in Google Scholar

45. Park, J-D, Zheng, W. Human exposure and health effects of inorganic and elemental mercury. J Prev Med Public Health 2012. in Google Scholar

46. Paruchuri, Y, Siuniak, A, Johnson, N, Levin, E, Mitchell, K, Goodrich, JM, et al. Occupational and environmental mercury exposure among small-scale gold miners in the Talensi-Nabdam District of Ghana’s Upper East region. Sci Total Environ 2010. in Google Scholar

47. Wickre, JB, Folt, CL, Sturup, S, Karagas, MR. Environmental exposure and fingernail analysis of arsenic and mercury in children and adults in a Nicaraguan gold mining community. Arch Environ Health 2004. in Google Scholar

48. Malm, O. Gold mining as a source of mercury exposure in the Brazilian Amazon. Environ Res 1998. in Google Scholar

49. Ohlander, J, Huber, SM, Schomaker, M, Heumann, C, Schierl, R, Michalke B, et al. Risk factors for mercury exposure of children in a rural mining town in Northern Chile. PLoS One 2013. in Google Scholar

50. Dsikowitzky, L, Mengesha, M, Dadebo, E, De Carvalho, CEV, Sindern, S. Assessment of heavy metals in water samples and tissues of edible fish species from Awassa and Koka Rift Valley Lakes, Ethiopia. Environ Monit Assess 2013. in Google Scholar

51. EFSA. Opinion of the scientific panel on contaminants in the food chain on a request from the commission related to mercury and methylmercury in food. EFSA J 2004. in Google Scholar

52. Costa, M, Barbosa, SCT, Barletta, M, Dantas, DV, Kehrig, HA, Seixas, TG, et al. Seasonal differences in mercury accumulation in Trichiurus lepturus (Cutlassfish) in relation to length and weight in a Northeast Brazilian estuary. Environ Sci Pollut Res 2009. in Google Scholar

53. Arroyo, HA, Fernandez, MC. Environmental toxic and its effect on neurodevelopment. Medicina. 2013(Suppl 1):93–102.Search in Google Scholar

54. Tian, W, Egeland, GM, Sobol, I, Chan, HM. Mercury hair concentrations and dietary exposure among Inuit preschool children in Nunavut, Canada. Environ Int 2011. in Google Scholar

55. Castaño, A, et al. Fish consumption patterns and hair mercury levels in children and their mothers in 17 EU countries. Environ Res 2015. in Google Scholar

56. Liu, J, Shi, J-Z, Yu, L-M, Goyer, RA, Waalkes, MP. Mercury in traditional medicines: is cinnabar toxicologically similar to common mercurials?. Exp Biol Med 2008. in Google Scholar

57. Ang, HH, Lee, KL. Contamination of mercury in tongkat Ali hitam herbal preparations. Food Chem Toxicol 2006. in Google Scholar

58. Saper, RB, Phillips, RS, Sehgal, A, Khouri, N, Davis, RB, Paquin, J, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the internet. JAMA – J Am Med Assoc 2008. in Google Scholar

59. Caldas, ED, Machado, LL. Cadmium, mercury and lead in medicinal herbs in Brazil. Food Chem Toxicol 2004. in Google Scholar

Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-12-09
Accepted: 2020-06-11
Published Online: 2020-08-21
Published in Print: 2021-03-26

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