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Champion WM, Buerck AM, Nenninger C, Yusuf K, Barrett LJP, Rakotoarisoa L, Rakotondrazaka R, Alfredo K, Cunningham J, Khaliq M, Mihelcic JR. Childhood blood lead levels and environmental risk factors in Madagascar. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:68652-68665. [PMID: 35545747 DOI: 10.1007/s11356-022-20586-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
One-third of children globally have blood lead levels (BLLs) exceeding the (former) US CDC reference value of 5 µg/dL; this value may be as high as one-half for children in low- and middle-income countries (LMICs). Lead exposure occurs through a variety of routes (e.g., water, dust, air), and in LMICs specifically, informal economies (e.g., battery recycling) can drive lead exposures due, in part, to absent regulation. Previous work by our team identified a ubiquitous source of lead (Pb), in the form of Pb-containing components used in manually operated pumps, in Toamasina, Madagascar. Characterization of BLLs of children exposed to this drinking water, and identification of additional exposure routes were needed. BLLs were measured for 362 children (aged 6 months to 6 years) in parallel with surveying to assess 14 risk factors related to demographics/socioeconomics, diet, use of pitcher pumps, and parental occupations. BLL data were also compared against a recent meta-review of BLLs for LMICs. Median childhood BLL (7.1 µg/dL) was consistent with those of other Sub-Saharan African LMICs (6.8 µg/dL) and generally higher than LMICs in other continents. Risk factors significantly associated (p < 0.05, univariate logistic regression) with elevated BLL (at ≥ 5 µg/dL) included male gender, living near a railway or major roadway (owing potentially to legacy lead pollution), having lower-cost flooring, daily consumption of foods (beans, vegetables, rice) commonly cooked in recycled aluminum pots (a previously identified lead source for this community), and a maternal occupation (laundry-person) associated with lower socioeconomic status (SES). Findings were similar at the ≥ 10 µg/dL BLL status. Our methods and findings may be appropriate in identifying and reducing lead exposures for children in other urbanizing cities, particularly in Sub-Saharan Africa, where lead exposure routes are complex and varied owing to informal economics and substantial legacy pollution.
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Affiliation(s)
- Wyatt M Champion
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA.
| | - Adaline M Buerck
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Christopher Nenninger
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Korede Yusuf
- College of Nursing and Public Health, Adelphi University, One South Ave., Garden City, NY, 11530, USA
| | | | | | | | - Katherine Alfredo
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Jeffrey Cunningham
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
| | - Mahmooda Khaliq
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612, USA
| | - James R Mihelcic
- College of Engineering, Department of Civil and Environmental Engineering, University of South Florida, 4202 E. Fowler Ave., ENG 030, Tampa, FL, 33620, USA
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von Stackelberg K, Williams PR, Sánchez-Triana E. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094676. [PMID: 33924797 PMCID: PMC8125743 DOI: 10.3390/ijerph18094676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 10/28/2022]
Abstract
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.
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