Elevated blood lead levels and associated risk factors among school children in a non-industrialized city in Indonesia

Getting the lead out: Can iron help?

Tobacco smoke is an important source of lead exposure. Maternal smoking during pregnancy likely transfers lead from the mother to the child, contributing to increased lead exposure in developing children. The present study aims to examine the association between maternal smoking during pregnancy and blood lead levels (BLL) in children. A total of 18,946 US children aged 1-15 years in the 1999-2016 National Health and Nutrition Examination Survey were included. We defined children with elevated BLL if BLL ≥ 3.5 µg/dL. We estimated odds ratios (ORs) of elevated BLL in children born to mothers who smoked versus nonsmoking mothers. A decreasing trend in the prevalence of elevated BLL occurred between 1999 and 2016. After adjustment for the trend and other covariates, children whose mothers smoked during pregnancy had significantly increased odds of having elevated BLL (OR = 1.60; 95% confidence interval [CI] 1.25-2.06) compared to children of nonsmoking mothers. The stratified analyses revealed a significant association existed in children aged 1-5 years (OR = 1.88 [95% CI 1.32-2.68]) and aged 6-10 years (OR = 1.79 [1.07-2.98]), but not in youths (11-15 years, OR = 0.72 [0.37-1.40]). Being born to smoking mothers was found to be associated with high odds of elevated BLL in White (1.93 [1.35-2.77]) and Black children (2.03 [1.43-2.87]), but with low odds in Hispanic children (0.46 [0.23-0.92]). The study demonstrates age- and race-specific associations between maternal smoking during pregnancy and BLL among US children. Maternal smoking contributes to lead exposure in early life. Culturally appropriate interventions are needed to further reduce BLL in the pediatric population.

Lead affects the developing nervous system of children, and no safe blood lead level (BLL) in children has been identified. Elevated BLLs in childhood are associated with hyperactivity, attention problems, conduct problems, and impairment in cognition. Young children are at higher risk for environmental lead exposure from putting their hands or contaminated objects in their mouth. Although deteriorating lead paint in pre-1979 housing is the most common source of lead exposure in children, data indicate that ≥30% of children with elevated BLLs were exposed through a source other than paint. Take-home contamination occurs when lead dust is transferred from the workplace on employees' skin, clothing, shoes, and other personal items to their car and home. Recycling of used electronics (e-scrap) is a relatively recent source of exposure to developmental neurotoxicants, including lead. In 2010, the Cincinnati Health Department and Cincinnati Children's Hospital Pediatric Environmental Health Specialty Unit (PEHSU) investigated two cases of childhood lead poisoning in a single family. In 2012, CDC's National Institute for Occupational Safety and Health (NIOSH) learned about the lead poisonings during an evaluation of the e-scrap recycling facility where the father of the two children with lead poisoning worked. This report summarizes the case investigation. Pediatricians should ask about parents' occupations and hobbies that might involve lead when evaluating elevated BLLs in children, in routine lead screening questionnaires, and in evaluating children with signs or symptoms of lead exposure.

Blood lead levels and risk factors for lead poisoning in children and caregivers in Chuuk State, Micronesia

The objective of this study was to determine blood lead levels (BLLs) and the possible sources of exposure in the population of Kinshasa, the capital of the Democratic Republic of Congo. A cross-sectional survey was carried out from January to May 2008 in a representative sample of the Kinshasan population. BLL was measured in 275 individuals (53.4% women) aged 1-70 years in the urban area of Kinshasa and from 60 additional subjects in the rural area. Pb was also determined in environmental specimens (air and soil, indoor and outdoor). BLL in the study population ranged from 2.9 to 49.3 μg/dl (median, 9.9 μg/dl). The median BLL among children aged <6 years was 11.5 μg/dl (range: 3.0-37.8 μg/dl). Of these children, 71% had elevated BLL (≥10 μg/dl) and 22% had BLL ≥20 μg/dl. The proportion of elevated BLL (≥10 μg/dl) was higher for children aged <3 years than for children aged 3 to 5 years (97% vs 56%). A higher prevalence of elevated BLL was observed in urban compared with rural children (71% vs 20%). Significantly higher BLLs were also found in children whose mother consumed fired clay during pregnancy. Residential informal activities in the recycling of car batteries also contributed to elevated BLL in children. The elevated background of Pb exposure in the Kinshasan population indicates a public health issue that requires corrective actions. Pb-contaminated dust and air in children's home is an issue of public health concern. The use of leaded gasoline and the activities of car battery recycling in certain residences appear to constitute the main sources of exposure in the city of Kinshasa. The traditional use of fired clay for the treatment of gastritis by pregnant women is another significant contributor for elevated BLL in children.

Background: Lead (Pb) is a proven environmental toxicant throughout the world. Elevated blood lead level (BLL) adversely affects the neuro-cognitive and behavioral development of children. Considering the worst source of lead pollution, the government of Bangladesh banned leaded petrol and phased out two-stroked vehicles from Dhaka citya€”the capital of Bangladesha€”in late 1999. In 2000, on the verge of introducing unleaded gasoline, a baseline survey showed high mean value of BLLs (15 µg/dL) in school children of Dhakaa€”much higher than the CDC's permissible level of 10 µgm/dL. Methods: This cross sectional, follow-up study was conducted to see the current status of BLLs in school children of Dhaka city. Total 100 students from two schools, 50 girls and 50 boys from grade six through ten, were randomly selected and their finger-pricked bloods were analyzed for Pb levels. Results: The mean (±SD) BLLs was 15.31±5.81 µgm/dL; and the majority (84%) of the students tested had BLLs higher than 10µg/dL. The BLLs was found significantly higher among the students who used to play outside house premises in a dusty environment (p=0.03) and among the frequent users of a traditional eye cosmetics a€A“surmaa€ (p= 0.032). No significant associations were noted between BLLs and the gender of the study subjects, their housing status, and the distance of the houses from the school. Conclusion: The mean BLL is still alarmingly high in the studied school children that have not declined significantly despite taking several visibly effective measures. Recommendation: The possible causes and source(s) of such persistently higher BLLs in children need priority exploration, since this important environmental health issue is of crucial importance so far the health and wellbeing of the future generations of the country are concern.

BackgroundTraditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 µg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied.MethodsWe assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer.ResultsThe study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 µg/dL (SD = 3.5; range, 3.5–20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 µg/dL and 8.5 µg/dL, respectively (P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 µg/dL vs 5.3 µg/dL, P = .03).ConclusionsIt is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.

Assessment of lead exposure and associated risk factors in urban children in Silesia, Poland

“Toxicohistrionics”: Flint, Michigan and the Lead Crisis

ImportanceElevated blood lead levels in children are associated with neurologic effects such as behavioral and learning problems, lower IQ, hyperactivity, hearing problems, and impaired growth. In pregnant women, lead exposure can impair organ systems such as the hematopoietic, hepatic, renal, and nervous systems, and increase the risk of preeclampsia and adverse perinatal outcomes. Many of the adverse health effects of lead exposure are irreversible.ObjectiveTo update the 2006 US Preventive Services Task Force (USPSTF) recommendation on screening for elevated blood lead levels in children and pregnant women.Evidence ReviewThe USPSTF reviewed the evidence on the benefits and harms of screening for and treatment of elevated blood lead levels. In this update, an elevated blood lead level was defined according to the Centers for Disease Control and Prevention reference level of 5 μg/dL.FindingsThe USPSTF found adequate evidence that questionnaires and other clinical prediction tools to identify asymptomatic children with elevated blood lead levels are inaccurate. The USPSTF found adequate evidence that capillary blood testing accurately identifies children with elevated blood lead levels. The USPSTF found inadequate evidence on the effectiveness of treatment of elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women. The USPSTF found inadequate evidence regarding the accuracy of questionnaires and other clinical prediction tools to identify asymptomatic pregnant women with elevated blood lead levels. The USPSTF found inadequate evidence on the harms of screening for or treatment of elevated blood lead levels in asymptomatic children and pregnant women. The USPSTF concluded that the current evidence is insufficient, and that the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children 5 years and younger and in pregnant women cannot be determined.Conclusions and RecommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons. (I statement)

After implementing measures to control lead pollution in many countries, blood lead levels (BLLs) in children have been declined. The phase-out of leaded petrol began in Lucknow, the capital of most populated state, Uttar Pradesh in India on April 1, 2000. We evaluated the mean BLL and associated risk factors for lead exposure in Lucknow children (3-12 years) after petrol lead phase-out activity. The mean BLL of the 200 children was 9.3 microg/dL (range: 1.0-27.9 microg/dL). Seventy-four children (37%) had BLL above the Centre for Disease Control and Prevention's (CDC) level of concern (10 microg/dL). When these data were compared with BLLs determined by the George Foundation among the children of Mumbai, Bangalore, Kolkata, Chennai, Hyderabad, and Delhi during the year 1997 when leaded petrol was in use, where 62%, 62%, 87%, 96%, 43%, and 95%, respectively, then exceeded the CDC intervention level. Further, BLL of present study was very close to Mumbai children (age < or =12 years) estimated following the introduction of unleaded petrol, and 33% children had BLL above the CDC concern level with an average 8.4 microg/dL. Low socioeconomic status, proximity of home to traffic density, and mother's illiteracy were the factors associated with elevated BLLs in Lucknow children (P < 0.05). Overall, results indicate a declining trend of BLL in Lucknow children when compared with those reported from other cities of India when leaded petrol was in practice. A national population-based study is recommended to determine the prevalence of elevated BLLs after the phase-out of leaded-petrol. In addition, future studies on other sources of lead exposure in Lucknow are warranted for public health purposes.

P-684 Introduction: Lead exposure has previously been associated with intellectual impairment in children in a number of international studies. In India, it has been reported that nearly half of the children have elevated blood lead levels (BLLs). However, little is known about risk factors for these elevated BLLs. Methods: We conducted a retrospective cross-sectional analysis of data from the Indian National Family Health Survey, a population-based study conducted in 1998–99. We assessed potential correlates of BLLs in 1,081 children who were <3 years of age and living in Mumbai or Delhi. We examined factors such as age, sex, religion, caste, mother's education, standard of living, breast feeding, and weight/height percentile. Results: Most children (76%) had BLLs between 5 and 20 μg/dL. Age, standard of living, weight/height percentile and total number of children ever born to mother were significantly associated with BLLs (log transformed) in multivariate regression models. As compared with children ≤3 months of age, 4–11 and 12–23 month olds had 84% and 146% higher BLLs, respectively (p<0.001). A low standard of living correlated with a 32.3% increase in BLLs (p=0.02). Children >95 percentile for their weight/height had 31% (p=0.03) higher BLLs as compared with those who were <5 percentile for their weight/height. Children from the same immediate family had highly correlated BLLs (correlation coefficient=0.48). Discussion and Conclusions: Our study found that increasing age, a lower standard of living index, >95 weight/height percentile, and higher total number of children ever born to mother were correlated with elevated BLLs in children <3 years of age in Mumbai and Delhi. The correlation between >95 percentile weight/height and higher BLL may reflect an impact of lead exposure on body habitus. Since, lead pollution is a public health issue of concern, the demonstration of factors correlated with BLLs in Indian children may aid in prioritization of children for lead screening and also in studying correctable factors. Although, progress has recently been made by phasing out leaded gasoline in India, exposure from many other sources (including the entrainment of lead oxide from combusted leaded gasoline into dust, water, and the food system) is likely to continue for many years to come. Further efforts to control lead pollution, especially in populations at high risk, should be considered.

Environmental and take-home lead exposure in children living in the vicinity of a lead battery smelter in Serbia

Background.Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL.Objectives.This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya.Methods.The present study is a population-based, cross-sectional study of children aged 12–59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1–3 ml venous blood drawn from each child was tested for lead using a LeadCare ® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy.Results:We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30–52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (p<0.05). The geometric mean lead concentration of soil samples from Owino Uhuru was 146.5 mg/Kg (GSD: 5.2) and 11.5 mg/Kg (GSD: 3.9) (p<0.001) in Bangladesh settlement. Children who resided <200 m from the lead smelter were more likely to have a BLL ≥5 μg/dL than children residing ≥200 m from the lead smelter (adjusted odds ratio (aOR): 33.6 (95% confidence interval (CI): 7.4–153.3). Males were also more likely than females to have a BLL ≥5 μg/dL (39, 62%) compared to a BLL<5 μg/dL [aOR: 2.4 (95% CI: 1.0–5.5)].Conclusions.Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective.Participant Consent.ObtainedEthics Approval.Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC.Competing Interests.The authors declare no competing financial interests.

No safe level of exposure to lead has been identified. To evaluate individual- and community-level factors associated with detectable and elevated blood lead levels (BLLs) in children. This cross-sectional, retrospective study analyzed deidentified results from blood lead tests performed at a large clinical laboratory from October 1, 2018, to February 29, 2020. Participants were 1 141 441 children younger than 6 years living in all 50 US states and the District of Columbia who underwent blood lead testing during the study period. Children who underwent lead testing of unknown source and those with elevated BLLs who received capillary blood lead testing without confirmatory venous testing were excluded. Individual demographic categories included sex, age, and insurance type; community-level demographic categories included pre-1950s housing, poverty, predominant race and ethnicity, and geographical regions. Proportions of children with detectable (≥1.0 μg/dL) and elevated (≥5.0 μg/dL) BLLs, by exposure category. Of the 1 141 441 children (586 703 boys [51.4%]; mean [SD] age, 2.3 [1.4] years) in the study, more than half of the children tested (576 092 [50.5%; 95% CI, 50.4%-50.6%]) had detectable BLLs, and 21 172 children (1.9% [95% CI, 1.8%-1.9%]) had BLLs of 5.0 μg/dL or more. In multivariable analyses, children with public insurance had greater odds of having detectable BLLs (adjusted odds ratio [AOR], 2.01 [95% CI, 1.99-2.04]) and elevated BLLs (AOR, 1.08 [95% CI, 1.04-1.12]). The proportion of children with detectable and elevated BLLs increased significantly for progressive pre-1950s housing and poverty quintiles (P < .001). The odds of detectable BLLs were significantly higher among children in the highest vs lowest quintile of pre-1950s housing (AOR, 1.65 [95% CI, 1.62-1.68]) and of poverty (AOR, 1.89 [95% CI, 1.86-1.93]). A similar association was found for those with elevated BLLs, with an AOR of 3.06 (95% CI, 2.86-3.27) for the highest vs lowest quintile of pre-1950 housing and 1.99 (95% CI, 1.88-2.11) for the highest quintile of poverty. Children residing in zip codes with predominantly Black non-Hispanic and non-Latinx populations had higher odds of detectable BLLs (AOR, 1.13 [95% CI, 1.11-1.15]) but lower odds for elevated BLL (AOR, 0.83 [95% CI, 0.80-0.88]). This study suggests that, despite progress in reducing pediatric lead exposure, substantial individual- and community-level disparities persist.