Studies conducted around the world have established beyond doubt that elevated childhood blood lead levels may lead to detrimental health effects. Research has shown that certain groups of South African children are at particular risk of elevated blood lead levels. Johannesburg is the largest urban complex in southern Africa, with a population of around 3 million and extensive industrial and manufacturing activity. Among the challenges posed in the city are rapid urbanization, extensive poverty, and inequity. Little information on the blood lead distribution of Johannesburg children is available. This study was undertaken to determine blood lead levels among children living in three areas of Johannesburg: inner city suburbs and the low-income townships of Alexandra and Westbury to the north and west of the city center, respectively. The results indicated that blood lead levels ranged from 6 to 26 μg/dL, with a mean level of 11.9 μg/dL. The blood lead levels of 78% of children equaled or exceeded 10 μg/dL, the current international action level. Maternal educational status, the presence of smokers in the home, and living in an informal dwelling were among the factors associated with elevated blood lead levels.