Assessing exposure to metals using biomonitoring: Achievements and challenges experienced through surveys in low- and middle-income countries

Hypoxaemia and risk of asphyxia during underground work in artisanal cobalt mines

BACKGROUND

More than half the cobalt needed for vehicle electrification originates from the southern part of the Democratic Republic of the Congo (DRC), with a substantial part being extracted by artisanal miners.

AIMS

To investigate oxygen saturation during underground work among cobalt artisanal miners.

METHODS

In a field survey, we measured oxygen saturation (SpO2) and heart rate by pulse oximetry in 86 miners from two underground mines and 24 miners from a surface mine at four different time points: before descent into the mine (T1), at 50 minutes in the mine (T2), upon leaving the shaft (T3), and 10 minutes after having left the mine (T4).

RESULTS

Miners working underground (-36 to -112 meters) were somewhat older (34.8 ± 6.7 years) than those working in the surface mine (32.0 ± 6.5 years), and they worked more hours daily (12.6 ± 1.2 hours) than controls (9.0 ± 0.0 hours). All participants had SpO2 >95% at T1 and T4. At T2, SpO2 dropped below 93% and 80% in 35% and 10% underground miners, respectively; SpO2 was still <93% at T3 in 13%. SpO2 remained stable among surface miners. Later, we showed that underground ambient oxygen levels decreased well below 21% in several pits.

CONCLUSIONS

Pulse oximetry revealed relevant hypoxaemia during underground work in a substantial proportion of artisanal miners. Such hypoxaemia without evidence of underlying cardiovascular disease is indicative of low ambient oxygen, due to insufficient mine ventilation. This may cause deaths from asphyxia. The hazards of low ambient oxygen in artisanal mines must be prevented by appropriate technical measures ensuring the supply of sufficient fresh air.

Transplacental transfer of cobalt: Evidence from a study of mothers and their neonates in the African Copperbelt

BACKGROUND

Transfer of the trace metal cobalt (Co) from mother to foetus has not been documented in populations with high environmental exposure to Co, as is the case in the African Copperbelt mining region. We analysed data obtained from 246 mother-infant pairs included (at delivery) in a previously published case-control study on birth defects, done in Lubumbashi (Democratic Republic of Congo) between March 1, 2013, and Feb 28, 2015.

METHODS

Co was measured by Inductively Coupled Plasma Mass Spectrometry in maternal blood, maternal urine, umbilical cord blood and placental tissue, as available.

RESULTS

The Co concentrations [geometric mean (GM) with interquartile range (IQR)] in maternal blood (GM 1.77 µg/L, IQR 1.07-2.93) and urine (GM 7.42 µg/g creatinine, IQR 4.41-11.0) were highly correlated (Spearman r = 0.71, n = 166; p < 0.001) and considerably higher than reference values determined for general populations elsewhere in the world. The concentrations of Co in umbilical cord blood (GM 2.41 µg/L) were higher (Wilcoxon test, p < 0.001) than in maternal blood (GM 1.37 µg/L), with a correlation between both values (Spearman r = 0.34; n = 127, p < 0.001). Co concentrations in placental tissue (geometric mean 0.02 µg/g wet weight) correlated with concentrations in maternal blood (Spearman r = 0.50, n = 86, p < 0.001) and in neonatal blood (Spearman r = 0.23, n = 83, p = 0.039).

CONCLUSION

This first study of maternal and neonatal Co concentrations in the African Copperbelt provides strong evidence of a high transfer of Co from mother to foetus.

Using native fish in eco-genotoxic assessment of heavy metal contamination pollution arising from nearby large Brazilian rivers

Worldwide water quality has declined progressively due to continuous pollution of aquatic resources by agrochemicals in particular heavy metals. Fish genotoxicity biomarkers are vital to identify and complement chemical parameters for determining environmental risk of adverse effects. Therefore, it was of interest to examine the eco-genotoxicity attributed to water pollution over different stream sections of Brazilian rivers by using Cichlasoma paranaense (Teleostei: Cichlidae), a neotropical freshwater cichlid fish, as a biological model. Chemical analysis of water and sediments collected from different Brazilian rivers sites demonstrated contamination by metals. Cichlasoma paranaense were collected at a reference location (a permanent water preservation area), maintained in the lab under standard conditions (controlled temperature, lighting, daily feeding, and constant aeration) and exposed to environmental samples of water and sediments. Subsequently, micronucleus (MN) and nuclear abnormalities (NA) frequencies were assessed in erythrocytes obtained from the caudal and gill regions. The highest concentrations of Cu were found in samples from river sites with forest fragmentation attributed to intensive agriculture practices. Similarly, exposure of fish to samples from agricultural areas induced significantly higher number of genotoxic effects. There was no marked difference between the tissues (tail and gill) regarding the observed frequencies of MN and NA. Thus C. paranaense fish served as a reliable model for detecting genotoxic effects, especially when water samples were collected near the discharge of agrochemicals. Evidence indicates that this method be considered for other global river sites which are also exposed to agrochemicals discharges containing Cu.

Landscape Analysis of Cobalt Mining Activities from 2009 to 2021 Using Very High Resolution Satellite Data (Democratic Republic of the Congo)

The cobalt mining sector is well positioned to be a key contributor in determining the success of the Democratic Republic of the Congo (DRC) in meeting the Sustainable Development Goals (SDGs) by 2030. Despite the important contribution to the DRC’s economy, the rapid expansion of mining operations has resulted in major social, health, and environmental impacts. The objective of this study was to quantitatively assess the cumulative impact of mining activities on the landscape of a prominent cobalt mining area in the DRC. To achieve this, an object-based method, employing a support vector machine (SVM) classifier, was used to map land cover across the city of Kolwezi and the surrounding mining areas, where long-term mining activity has dramatically altered the landscape. The research used very high resolution (VHR) satellite imagery (2009, 2014, 2019, 2021) to map the spatial distribution of land cover and land cover change, as well as analyse the spatial relationship between land cover classes and visually identified mine features, from 2009 to 2021. Results from the object-based SVM land cover classification produced an overall accuracy of 85.2–90.4% across the time series. Between 2009 and 2021, land cover change accounted to: rooftops increasing by 147.2% (+7.7 km2); impervious surface increasing by 104.7% (+3.35 km2); bare land increasing by 85.4% (+33.81 km2); exposed rock increasing by 56.2% (+27.46 km2); trees decreasing by 4.5% (−0.34 km2); shrub decreasing by 38.4% (−26.04 km2); grass and cultivated land decreasing by 27.1% (−45.65 km2); and water decreasing by 34.6% (−3.28 km2). The co-location of key land cover classes and visually identified mine features exposed areas of potential environmental pollution, with 91.6% of identified water situated within a 1 km radius of a mine feature, and vulnerable populations, with 71.6% of built-up areas (rooftop and impervious surface class combined) situated within a 1 km radius of a mine feature. Assessing land cover patterns over time and the interplay between mine features and the landscape structure allowed the study to amplify the findings of localised on-the-ground research, presenting an alternative viewpoint to quantify the true scale and impact of cobalt mining in the DRC. Filling geospatial data gaps and examining the present and past trends in cobalt mining is critical for informing and managing the sustainable growth and development of the DRC’s mining sector.

Impacts of Trace Metals Pollution of Water, Food Crops, and Ambient Air on Population Health in Zambia and the DR Congo

Zambia and the DR Congo are situated in the central African Copperbelt, which is part of the Lufilian geological structure arc stretching over from Kolwezi in Katanga Province in the DRC to Luanshya in Copperbelt Province in Zambia. The area has large copper-cobalt deposits of which the extraction causes severe ecosystem damage due to pollution of water, food crops, and the ambient air negatively impacting population health. Contamination of drinking water for domestic use and foods (cereals, roots and tubers, vegetables, and fruits) was determined by assessing the contents of trace metals including Mn, Ni, Pb, Zn, Co, As, U, Cd, and Cu and through a questionnaire for environmental damage. Food samples were analyzed by inductively coupled argon plasma/optical emission spectroscopy (ICP-OES), while water and urine samples were analyzed by inductively coupled argon plasma mass spectrometry (ICP-MS). Concentrations of Ni, Pb, and Cd were higher in almost all food crops, although Cu was more in samples of Cucurbita maxima and Amaranthus hybridus. Mean contents (μg/L) of Mn, Zn, Cd, Pb, and U were, respectively, 5,454.6, 2552.2, 138.7, 39.7, 2361.1, and 21.4 in the DRC and 108.9, 543.3, 0.3, 0.2, 1.5, and 0.5 in Zambia, being significantly higher and always far above World Health Organization maximum limits in the DRC. Urine samples taken only from the DRC contained trace metals with children's samples being more contaminated than adult ones. Our results conclusively echo the most critical challenges of toxic pollutants causing numerous health issues among the population. Given an outcry among households adjacent to mines about land degradation and food spoilage, and health problems over years, joint efforts are needed from public and private sectors for stringent mining exploitation monitoring for sustainable governance to protect the environment and ensure food and nutrition safety, and population well-being in Zambia and the DR Congo.

Biomonitoring of arsenic, cadmium and lead in two artisanal and small-scale gold mining areas in Zimbabwe

People living and working in artisanal and small-scale gold mining (ASGM) areas are frequently exposed to elemental mercury (Hg), which is used for gold extraction. However, additional exposure to other toxic metals such as arsenic (As), cadmium (Cd) and lead (Pb) may result from mining-related activities and could be ingested via dust, water or food. In these areas, only limited biomonitoring data is available for toxic metals other than Hg. In particular, data about the exposure to As, Cd and Pb is unavailable for the Zimbabwean population. Therefore, we conducted a cross-sectional study in two ASGM areas in Zimbabwe to evaluate the internal exposure to these metals. In total, urine and blood samples from 207 people that identified themselves as miners were collected and analysed for As and Cd in urine as well as Pb in blood by GF-AAS. Median levels (interquartile ranges in μg/l) of As and Pb were 9.7 μg/l (4.0, 18.5) and 19.7 μg/l (12.5, 34.5), respectively. The 25th percentile and the median for Cd were below the limit of detection (0.5 μg/l); the 75th percentile was at 0.9 μg/l. The results were compared to reference values found for the general population in the USA and Germany, and a significant number of participants exceeded these values (As, 33 %; Cd, 27 %; Pb, 32 %), indicating a relevant exposure to toxic metals. Although not representative for the Zimbabwean population, our results demonstrate that the exposure to toxic metals is relevant for the public health in Zimbabwe and requires further investigation.

Risk Analysis Approaches to Evaluating Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries

Risk analysis offers a useful framework for evaluating and managing environmental health risks across different settings. In this Perspective, we question whether the principles and practice of risk analysis could be beneficial in the context of land-based pollution in low- and middle-income countries (LMICs) to better support risk-based decision making. Specifically, potential health and economic impacts from land-based pollution in LMICs has become an increasing issue of concern due to widespread environmental contamination from active and legacy operations, particularly informal activities that are becoming increasingly dispersed throughout communities, such as used lead acid battery recycling, artisanal and small-scale gold mining, and small-scale tanneries. However, the overall magnitude and scale of the public health problem arising from these sources remains highly uncertain and poorly characterized and cannot be compared to land-based pollution in high-income countries due to unique factors. This lack of knowledge has negatively affected the political priority and level of funding for risk mitigation actions targeting land-based pollution in these countries. Our primary objective is to raise further awareness of this emerging issue among risk analysts and decisionmakers and to advocate for more robust and focused research. Here, we highlight the types of industries and activities contributing to land-based pollution in LMICs and describe key findings and knowledge and data gaps that have hindered a fuller understanding of this issue. We also discuss how several risk assessment and risk management approaches might be useful in this resource-constrained context. We conclude that a combination of risk analysis approaches may be worthwhile, but more work is needed to determine which methods or tools will be most informative, technically feasible, and cost-effective for identifying, prioritizing, and mitigating land-based pollution in LMICs. Affected researchers, funding agencies, and local or national governments will need to work together to develop improved study designs and risk mitigation strategies.

Protective Effects of Sodium Para-aminosalicylic Acid on Manganese-Induced Damage in Rat Pancreas

Sodium p-aminosalicylic acid (PAS-Na) has been previously shown to protect the brain from manganese (Mn)-induced toxicity. However, the efficacy of PAS-Na in protecting other organs from Mn toxicity and the mechanisms associated with this protection have yet to be addressed. Therefore, here, we assessed pancreatic damage in response to Mn treatment and the efficacy of PAS-Na in limiting this effect, along with specific mechanisms that mediate PAS-Na's protection. Mn exposure led to increased blood Mn content in dose- and time-dependent manner. Furthermore, subchronic Mn exposure (20 mg/kg for 8 weeks) led to pancreatic damage in a dose-dependent manner. In addition, the elevated Mn levels increased iron and decreased zinc and magnesium content in the pancreas. These effects were noted even 8 weeks after Mn exposure cessation. Mn exposure also affected the levels of amylase, lipase, and inflammatory factors such as tumor necrosis factor (TNF-α) and interleukin-1 β (IL-1β). PAS-Na significantly inhibited the increase in Mn concentration in both blood and pancreas, restored Mn-induced pancreatic damage, reversed the Mn-induced alterations in metal levels, and restored amylase and lipase concentrations. Taken together, we conclude that in rats, PAS-Na shows pharmacological efficacy in protecting the pancreas from Mn-induced damage.

Concurrent Heavy Metal Exposures and Idiopathic Dilated Cardiomyopathy: A Case-Control Study from the Katanga Mining Area of the Democratic Republic of Congo

Blood and/or urine levels of 27 heavy metals were determined by ICPMS in 41 patients with dilated cardiomyopathy (DCM) and 29 presumably healthy subjects from the Katanga Copperbelt (KC), in the Democratic Republic of Congo (DRC). After adjusting for age, gender, education level, and renal function, DCM probability was almost maximal for blood concentrations above 0.75 and 150 µg/dL for arsenic and copper, respectively. Urinary concentrations above 1 for chromium, 20 for copper, 600 for zinc, 30 for selenium, 2 for cadmium, 0.2 for antimony, 0.5 for thallium, and 0.05 for uranium, all in μg/g of creatinine, were also associated with increased DCM probability. Concurrent and multiple exposures to heavy metals, well beyond permissible levels, are associated with increased probability for DCM. Study findings warrant screening for metal toxicity in case of DCM and prompt public health measures to reduce exposures in the KC, DRC.

A Systematic Framework for Collecting Site-Specific Sampling and Survey Data to Support Analyses of Health Impacts from Land-Based Pollution in Low- and Middle-Income Countries

The rise of small-scale and localized economic activities in low- and middle-income countries (LMICs) has led to increased exposures to contaminants associated with these processes and the potential for resulting adverse health effects in exposed communities. Risk assessment is the process of building models to predict the probability of adverse outcomes based on concentration-response functions and exposure scenarios for individual contaminants, while epidemiology uses statistical methods to explore associations between potential exposures and observed health outcomes. Neither approach by itself is practical or sufficient for evaluating the magnitude of exposures and health impacts associated with land-based pollution in LMICs. Here we propose a more pragmatic framework for designing representative studies, including uniform sampling guidelines and household surveys, that draws from both methodologies to better support community health impact analyses associated with land-based pollution sources in LMICs. Our primary goal is to explicitly link environmental contamination from land-based pollution associated with specific localized economic activities to community exposures and health outcomes at the household level. The proposed framework was applied to the following three types of industries that are now widespread in many LMICs: artisanal scale gold mining (ASGM), used lead-acid battery recycling (ULAB), and small tanning facilities. For each activity, we develop a generalized conceptual site model (CSM) that describes qualitative linkages from chemical releases or discharges, environmental fate and transport mechanisms, exposure pathways and routes, populations at risk, and health outcomes. This upfront information, which is often overlooked, is essential for delineating the contaminant zone of influence in a community and identifying relevant households for study. We also recommend cost-effective methods for use in LMICs related to environmental sampling, biological monitoring, survey questionnaires, and health outcome measurements at contaminated and unexposed reference sites. Future study designs based on this framework will facilitate consistent, comparable, and standardized community exposure, risk, and health impact assessments for land-based pollution in LMICs. The results of these studies can also support economic burden analyses and risk management decision-making around site cleanup, risk mitigation, and public health education.

Occupational rhinitis and asthma in bakers: a cross-sectional study in the former Katanga province of DR Congo

OBJECTIVE

Bakers are at high risk of rhinitis and asthma, but the prevalence of these occupational diseases is not well known in Sub-Saharan Africa. We investigated the prevalence of occupational rhinitis and asthma among industrial bakers in the former province of Katanga.

METHODS

In a cross-sectional study conducted in eight towns from October 2018 to September 2019, we included 276 male workers from 18 industrial bakeries and 113 male controls (35 butchers and 78 bread sellers), all nonsmokers. Participants replied to a validated questionnaire (European Community of Respiratory Health Survey II), administered face to face, and performed spirometry at the work place. In 15 bakers with symptoms of work-related asthma, records of self-measured peak expiratory flow (PEF) 4 times per day during 4 weeks were analyzed by the OASYS (Occupational Asthma System) protocol.

RESULTS

The bakers and controls did not differ by age (32.2 ± 7.3 y vs 32.8 ± 10.3 y). According to the questionnaire, work-related rhinitis and asthma were significantly more prevalent among bakers (31% and 5%, respectively) than among controls (2% and 0%, respectively). However, the groups did not differ significantly with regard to spirometric parameters. Based on PEF records, 10 out of 15 were positive for occupational asthma (OASYS score > 2.5), so the rate of occupational asthma was 3.6% in this study.

CONCLUSION

This first study in DR Congo demonstrates the existence of occupational rhinitis and asthma among industrial bakers in Katanga. Further epidemiological studies are needed to clarify the extent and risk factors of baker's asthma in the area. In the meantime, advocacy and implementation of appropriate occupational hygiene measures are warranted to protect bakery workers in DR Congo.

Respiratory Health and Urinary Trace Metals among Artisanal Stone-Crushers: A Cross-Sectional Study in Lubumbashi, DR Congo

Background: Thousands of artisanal workers are exposed to mineral dusts from various origins in the African Copperbelt. We determined the prevalence of respiratory symptoms, pulmonary function, and urinary metals among artisanal stone-crushers in Lubumbashi. Methods: We conducted a cross-sectional study of 48 male artisanal stone-crushers and 50 male taxi-drivers using a standardized questionnaire and spirometry. Concentrations of trace metals were measured by Inductively Coupled - Plasma Mass Spectrometry (ICP-MS) in urine spot samples. Results: Urinary Co, Ni, As, and Se were higher in stone-crushers than in control participants. Wheezing was more prevalent (p = 0.021) among stone-crushers (23%) than among taxi-drivers (6%). In multiple logistic regression analysis, the job of a stone-crusher was associated to wheezing (adjusted Odds Ratio 4.45, 95% Confidence Interval 1.09–18.24). Stone-crushers had higher values (% predicted) than taxi-drivers for Forced Vital Capacity (105.4 ± 15.9 vs. 92.2 ± 17.8, p = 0.048), Forced Expiratory Volume in 1 Second (104.4 ± 13.7 vs. 88.0 ± 19.6, p = 0.052), and Maximum Expiratory Flow at 25% of the Forced Vital Capacity (79.0.1 ± 20.7 vs. 55.7 ± 30.1, p = 0.078). Conclusion: Stone-crushers were more heavily exposed to mineral dust and various trace elements than taxi-drivers, and they had a fourfold increased risk of reporting wheezing, but they did not have evidence of more respiratory impairment than taxi-drivers.

Agnathia otocephaly: A case from the Katanga Copperbelt

BACKGROUND

Agnathia otocephaly is a rare craniofacial malformation complex characterised by absent/hypoplastic mandible, abnormally positioned ears meeting at level of neck. Besides mutations in two genes, PRRX1 and OTX2, a teratogenic cause has been suggested. A higher risk of congenital malformations has been associated with paternal work in mining in the Democratic Republic of the Congo's part of the Copperbelt.

CASE

We studied a female neonate with a clinical diagnosis of agnathia otocephaly, stillborn in Lubumbashi in 2019. The child's father had been working as an artisanal mineworker at the time of conception.

RESULTS

Genetic analysis did not reveal a causal mutation. The concentrations of cobalt, arsenic cadmium, and uranium in cord blood of the infant were much higher than those of normal neonates from a previous study.

CONCLUSION

In the absence of identified genetic causes, we hypothesize this case of agnathia otocephaly was related to an exogenous cause, possibly the father's mining-related job.

Artisanal and small-scale gold mining: A cross-sectional assessment of occupational mercury exposure and exposure risk factors in Kadoma and Shurugwi, Zimbabwe

In artisanal and small-scale gold mining (ASGM) the toxic metal mercury is used for gold extraction. The objective of this cross-sectional study was to assess mercury concentrations in urine and blood and mercury-related symptoms of participants identifying themselves as miners from Kadoma and Shurugwi, Zimbabwe. Moreover, we aimed to explore possible risk factors influencing mercury body burden. In 2019, urine and blood samples of 207 participants were collected and analyzed for mercury using atomic absorption spectroscopy. All participants answered questions regarding their exposure risks. The median urine mercury value was 4.75 μg/L with a maximum of 612 μg/L. Median mercury concentration in creatinine corrected urine values was 3.98 μg/g with a maximum value of 478 μg/g. The median blood mercury value was 2.70 μg/L with a maximum of 167 μg/L. Correlations between exposure risks factors such as the lack of retort use and elevated mercury values were demonstrated. ASGM is very common in Zimbabwe. Thus, mercury exposure is a major occupational health risk for miners. Moreover, this study emphasizes the impact of exposure risk factors on the mercury body burden.

Mining is bad for health: a voyage of discovery

Mining continues to be a dangerous activity, whether large-scale industrial mining or small-scale artisanal mining. Not only are there accidents, but exposure to dust and toxins, along with stress from the working environment or managerial pressures, give rise to a range of diseases that affect miners. I look at mining and health from various personal perspectives: that of the ordinary man (much of life depends on mined elements in the house, car and phone); as a member of the Society for Environmental Geochemistry and Health (environmental contamination and degradation leads to ill health in nearby communities); as a public health doctor (mining health is affected by many factors, usually acting in a mix, ranging from individual inheritance-genetic makeup, sex, age; personal choices-diet, lifestyle; living conditions-employment, war; social support-family, local community; environmental conditions-education, work; to national and international constraints-trade, economy, natural world); as a volunteer (mining health costs are not restricted to miners or industry but borne by everyone who partakes of mining benefits-all of us); and as a lay preacher (the current global economy concentrates on profit at the expense of the health of miners). Partnership working by academics with communities, government and industry should develop evidence-based solutions. Employment, health, economic stability and environmental protection need not be mutually exclusive. We all need to act.

Erectile dysfunction and mining-related jobs: an explorative study in Lubumbashi, Democratic Republic of Congo

Introduction

The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Anecdotal reports of erectile dysfunction (ED) among mineworkers in the area led us to conduct an explorative study to investigate the possible association between ED and working in mining-related jobs.

Methods

We included 42 consecutive men (18–40 years) buying sildenafil (the active substance of Viagra) from a pharmacy located in a popular neighbourhood in Lubumbashi, and 42 age-matched (±2 years) men buying painkillers. All participants replied to questionnaires administered face-to-face to obtain sociodemographic data, including information on occupation, and a score of erectile function using the International Index of Erectile Function (IIEF6).

Results

The IIEF6 score (maximum 30) was lower among sildenafil-buyers (median 17, range 8–30) than among painkiller-buyers (median 30, range 17–30). The proportion of mining-related jobs was higher among sildenafil-buyers (19/42, 45%) than among painkiller-buyers (7/42, 17%), yielding an OR of 4.1 (95% CI 1.5 to 11.3; p=0.009). The proportion of mining-related jobs was higher among men with ED (defined as IIEF6 <26) (24/45, 54%) than among men without ED (2/39, 5%) (OR 21.1; 95% CI 4.5 to 98.4; p<0.001). Using a more stringent definition of ED (IIEF6 <22) gave similar results: 55% (20/36) of men with ED had a mining-related job versus 13% (6/48) of men without ED (OR 8.7; 95% CI 2.9 to 25.7; p=0.001).

Discussion

The findings of this preliminary study justify further epidemiological studies of the possible role of occupational exposures in the pathogenesis of male sexual dysfunction among miners and workers in the copper and cobalt industry.

Analysis of urinary trace element levels in general population of Wuhan in central China

Trace element distribution in the human body varies across regions and countries due to their different living environment and lifestyle. Thus, it is of great significance to investigate the reference level of trace element in a specific population. Wuhan is the largest metropolitan area in central China with highly developed heavy industries. This study aimed at determining the reference urinary distribution in general populations of Wuhan for nine trace elements (Cr, Mn, Cu, As, Se, Cd, Hg, Tl, Pb), and analyzed their associations with age, sex, and the kidney function. In total, 226 healthy adults not exposed to these trace elements were recruited, and the first-morning urine specimens were analyzed by using ICP-MS-based method. Our results showed higher urinary levels for As and Cd in Wuhan population when compared with other countries, while other element levels were almost equivalent. Sex difference existed for urinary Cu, Mn, As, Tl, and Pb. And urinary Cd, Tl, and Pb levels were associated with the glomerular filtration rate. Almost all these urinary elements showed significant inter-correlations, especially for Cu but except for Mn. This study provides systematic information regarding urinary trace element levels in residents of Wuhan in central China, and shall be of importance for future environmental and occupational biomonitoring.

Lead Exposure in Low and Middle-Income Countries: Perspectives and Lessons on Patterns, Injustices, Economics, and Politics

Lead exposure is a legacy issue that continues to affect vulnerable population groups globally, but particularly in low and middle-income countries (LMICS). We take a multi-disciplinary approach to examine the patterns of lead exposure in these countries, discuss the underlying injustices and socio-political causes, and the economic costs that are associated with exposure. We conclude with some lessons we drew from our discussion of lead across the disciplines and advocate for a number of approaches to solving this ongoing issue. These include (i) biomonitoring that could be integrated into existing health surveys or public health programs targeting young children; (ii) greater civic engagement to push for solutions; and, (iii) environmental control policies that represent a continuum of local, context-specific to broad, national-level, and even global approaches.