Abstract
Lead is a major environmental toxin that presents numerous health consequences for children. Refugee children are at a risk of lead poisoning post-resettlement due to urban housing and environmental inequalities stemming from lack of funding, legislation, and advocacy. This article addresses lead exposure upon arrival and post-resettlement in 705 refugee children (age 0–16 years) attending a university clinic in Syracuse, NY, a city with a large refugee population. 17% of the newly arrived children had elevated blood lead levels (BLLs) (≥ 5 µg/dL); 10% had elevated BLL upon follow-up; 8.3% of the children’s follow-up elevated BLL were new exposures. 30% were found to have increased BLL at follow-up regardless of arrival status. An analysis of new exposures found a significant proportion of children would have been missed on routine screening that targets children < 2 years old. Primary prevention efforts are needed to prevent exposure and address risks to improve the health of all children locally, including newly resettled refugees.
Highlights
By the end of 2016, the United Nations High Commission for Refugees (UNHCR) estimated that 65.6 million people were forcibly displaced from their homes; 22.5 million requested refugee status, with over half of them being children [1]
New York State was ranked 5th highest in the United States (US) for refugee resettlement in 2017 [2], with Onondaga county ranked 2rd highest per capita for refugees resettled in the state [3]
A total of 892 refugee children established as new refugee patients during the study period; 705 children from 278 families met inclusion criteria
Summary
By the end of 2016, the United Nations High Commission for Refugees (UNHCR) estimated that 65.6 million people were forcibly displaced from their homes; 22.5 million requested refugee status, with over half of them being children [1]. New York State regulations require testing at ages 1 and 2 years with regular assessment of risk factors for lead exposure (e.g. peeling paint exposure, parental employment involving lead exposure, sibling with lead exposure, pica-like behavior) until the age of 6 [6]. Both New York State and CDC guidelines recommend routine blood lead level (BLL) screening and nutritional evaluations for refugee children from birth to 16 years upon arrival to the US; a second BLL is recommended 3–6 months after they establish permanent residence regardless of initial screening results [7, 8]. BLL’s < 5 μg/dL are considered acceptable or below reference level; results of 5 μg/dL and higher
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