Lead Poisoning in South African Children: The Hazard is at Horne

Association of low-level blood lead with plasma homocysteine in US children and adolescents

Although research in adults has revealed a positive relationship between blood lead levels (BLLs) and homocysteine (Hcy) levels in adults, few studies have investigated this relationship in children and adolescents. We evaluated the relationship between lowlevel blood lead and Hcy levels in US children and adolescents. A total of 8,313 children and adolescents aged 8-19 participated in this study via the National Health and Nutrition Examination Survey 1999-2006. Multivariable linear regression analyses were performed to examine the association between continuous BLLs and Hcy levels. The dose-dependent relationship between continuous BLLs and Hcy levels was analyzed using smooth curve fitting. The average age of participants was 14.1 ± 3.3 years (50.3% male). The mean values of BLLs and Hcy levels were 1.45 μg/dL and 5.77 μmol/L, respectively. In a multivariable adjusted model, an increase in 1.0 μg/dL of BLLs was associated with an elevation of 0.06 μmol/L in Hcy levels (β = 0.06, 95%CI:0.02-0.10, P = 0.001). A linear relationship between BLLs and Hcy levels was discovered using smooth curve fitting (P non-linearity = 0.464). The relationship between low-level blood lead and Hcy levels was stronger on participants with lower serum folate levels (P for interaction = 0.002). Low BLLs were positively associated with plasma Hcy levels in children and adolescents, which varies depending on the levels of folate, vitamin B, and dietary supplements involved in Hcy metabolism.

Lead levels of new solvent-based household paints in Zimbabwe and Botswana: A preliminary study

Background

Lead paint remains a major potential source of lead poisoning globally, but there has been no documentation on lead content in solvent paints available on the markets in Zimbabwe and Botswana.

Aim

To determine the lead content of solvent-based paints available on the market in Zimbabwe and Botswana and identify a need for a larger study to inform policy.

Methods

This pilot study was conducted in Harare, Zimbabwe, and Gaborone, Botswana. Popular brands of solvent-based household paints were bought from hardware shops in Harare (10 samples) and Gaborone (19 samples). Samples were analysed for lead content using inductively coupled plasma-atomic emission spectrometry.

Results

Seventy percent of samples from Zimbabwe were found to contain lead above 90 parts per million (ppm), the recommended regulatory limit, with ranges from less than 60 ppm to 12 000 ppm. Twenty percent of Zimbabwean samples had lead levels above 10 000 ppm. No samples from Botswana had lead concentration above the detection limit, with all levels below 100 ppm.

Lesson Learnt

Data strongly suggest very high lead content in popular brands of solvent paints in Zimbabwe, indicating a need for a larger, well-designed study for policy direction.

Association between Bone Lead Concentration and Aggression in Youth from a Sub-Cohort of the Birth to Twenty Cohort

BACKGROUND

An association between blood-lead levels and aggression has been demonstrated in children and adolescent youth in South Africa. However, there are limited studies that have assessed aggression as an outcome for cumulative lead exposure using bone lead concentration. This study aims to assess the association between bone lead concentration and aggressive behaviour among a sample of youth in South Africa.

METHODS

Bone lead in 100 participants (53 males and 47 females) recruited and followed in the Birth to Twenty (BT20) Cohort were measured using 109 Cd-based, K-shell X-ray fluorescence (KXRF). The Buss-Perry Aggression questionnaire was used to measure aggressive behaviour. Linear regression models were fitted to determine the association between aggression score for physical, verbal, anger and hostility and bone lead, adjusting for known confounders.

RESULTS

A one-microgram-per-gram increase in bone lead was found to increase the score for all four scales of aggression, but significantly only for anger (β = 0.2 [95% CI 0.04-0.370]). Psychosocial factors such as a history of family violence and exposure to neighbourhood crime were significant predictors for aggression.

CONCLUSIONS

The study provides a preliminary overview of the relationship between cumulative lead exposure and behavioural problems such as aggression. A larger sample, across exposed communities, may prove more definitive in further investigating the association between these two important public health factors and to maximize generalizability.

The Blood Lead Levels of Children and the Loss of Ca2+ from Neurons Owing to Lead

In order to understand current blood lead levels (BLLs), we investigated the BLLs of children in Sichuan Province from 2011 to 2020. We then monitored the treatment effects of calcium in children with high BLLs to assess their treatment status. Finally, we explored the effects of lead on Ca²⁺ through in-situ experiments. Whole blood samples were used for BLL tests. The BLLs of 76,362 children aged 0-7 years were measured using atomic absorption spectrometry. The median BLL was 35 μg/L (interquartile range: 28-47). The BLLs were significantly higher in boys than in girls (p < 0.001). The BLLs generally decreased annually and increased with age. The overall prevalence of BLLs ≥ 100 μg/L was 1.20%. The children with high BLLs received subsequent check-ups, and the median time required for effective treatment was 18 months. We observed that lead exposure led to a gradual and persistent loss of Ca²⁺ levels in neurons of mice brain slices, and the effect did not subside immediately even after the lead was removed. China has made rapid progress in pediatric healthcare, but the treatment status remains unsatisfactory. Because lead causes an irreversible loss of Ca²⁺, there is an urgent need to develop new standardized treatments to reduce the treatment duration.

Fifty years of articles in JEQ on trace elements in the environment and future outlook

Fifty years ago, the Journal of Environmental Quality (JEQ) was launched to provide an outlet for publication of research on the impacts of agriculture on the environment, and vice versa. A core concept of JEQ is advancement of environmental science, with emphasis on understanding factors that affect the fate, risks, and quality of soil, water, and atmospheric systems, and how these system processes affect plants, microbes, and animals. Trace elements are a focus area of JEQ because when present at higher than natural concentrations, they may pose risks to environmental quality and ecosystem health, depending on their bioavailability. Trace element biogeochemical cycling is affected by anthropogenic influences on land, air, and water, including land management practices such as agriculture and mining. The Journal of Environmental Quality has published a prolific catalog of scientific research publications on trace elements and their risks to humans, soil health, water quality, and the environment. In this review, research on trace elements and their impacts on environmental quality is presented, with a special focus on work published in JEQ.

Study protocol to examine the relationship between environmental exposure to lead and blood lead levels among children from day-care centres in Ekurhuleni Metropolitan Municipality

INTRODUCTION

Lead exposure is toxic to all humans and is very harmful to young children, especially 5-year-olds. Elevated blood lead levels (BLLs) in children have been associated with their daily surrounding environment. This protocol seeks to evaluate the association between environmental lead exposure and BLLs among children in day-care centres, including household and other risk factors.

METHODS AND ANALYSIS

To achieve the objectives of the study, we adopted a cross-sectional analytical design. A portable X-ray fluorescence analyser was used for environmental sampling, and BLLs were determined using the LeadCare II machine among preschool children. Household and other risk factors were assessed using a questionnaire. Random sampling was employed to select day-care centres in the municipality and children in each day-care centre. Data will be analysed using SPSS V. 26.

ETHICS AND DISSEMINATION

Ethical approval and permission were obtained prior to commencement of the study. The researcher intends to publish the results in peer-reviewed journals and also to present a paper at a scientific conference. The study will generate information on environmental lead exposure among vulnerable children (2-5 years), and it will promote public health action to prevent long-term exposure in day-care centres.

Lead-based paints and children's PVC toys are potential sources of domestic lead poisoning - A review

Lead (Pb) both in paints and children's Polyvinyl chloride (PVC) toys is a major public health concern which has attracted attention of the international community. Concentrations of Pb both in lead-based paints and children's PVC toys have been assessed through various studies across the globe. Therefore, the purpose of this article was to summarize the results reported in these studies and provide some comprehension on their implications to human health for law enforcement as well as for awareness raising to the general public. Highlights on identified gaps have been provided to pave ways for further research interventions in order to establish comprehensive information on the subject. Regardless of regulatory limits on the content of lead, both in paints and children's PVC toys existing in different countries in the world, some of the reviewed articles have revealed significant levels of lead in these two items far above the permissible limits. High lead levels in paints have been recorded in China (116,200 ppm), Cameroon (500,000 ppm), South Africa (189,000 ppm), Tanzania (120,862.1 ppm), Uganda (150,000 ppm), Thailand (505,716 ppm) and Brazil (170,258.4 ppm) just to mention a few. Lead poisoning cases in children have been reported in several countries including France, Morocco, South Africa and United States. Countries where high levels of lead in children's PVC toys have been recounted include; China (860,000 ppm), South Africa (145,000 ppm), United States (22,550 ppm), Thailand (4,486.11 ppm), Palestine (6,036 ppm) and India (2,104 ppm). Awareness raising among parents is vital to impart them with knowledge on the matter so that they can take strenuous measures to protect their children from lead poisoning emanating from playing with toys and paint dust. Law enforcement on phasing out lead-based paints and control of lead content in children's PVC toys worldwide is also highly recommended.

Immobilization of cadmium and lead by Lactobacillus rhamnosus GR-1 mitigates apical-to-basolateral heavy metal translocation in a Caco-2 model of the intestinal epithelium

Heavy metals are highly toxic elements that contaminate the global food supply and affect human and wildlife health. Purification technologies are often too expensive or not practically applicable for large-scale implementation, especially in impoverished nations where heavy metal contamination is widespread. Lactobacillus rhamnosus GR-1 (LGR-1) was shown in previous work to reduce heavy metal bioaccumulation in a Tanzanian cohort of women and children through indeterminant mechanisms. Here, it was hypothesized that LGR-1 could sequester the heavy metals lead (Pb) and cadmium (Cd), thereby reducing their absorption across intestinal epithelium. LGR-1 and other lactobacilli significantly reduced the amount of Pb and Cd in solution at all concentrations tested (0.5 mg/L - 50 mg/L) and exhibited sustained binding profiles over a 48-hour period. Relative binding efficiency of LGR-1 decreased as Pb concentration increased, with an absolute minimum binding threshold apparent at concentrations of 2 mg/L and above. Electron microscopy revealed that Pb formed irregular cell-surface clusters on LGR-1, while Cd appeared to form intracellular polymeric clusters. Additionally, LGR-1 was able to significantly reduce apical-to-basolateral translocation of Pb and Cd in a Caco-2 model of the intestinal epithelium. These findings demonstrate the absorbent properties of LGR-1 can immobilize Pb and Cd, effectively reducing their translocation across the intestinal epithelium in vitro. Oral administration of heavy metal-binding Lactobacillus spp. (many of which are known human symbionts and strains of established probiotics) may offer a simple and effective means to reduce the amount of heavy metals absorbed from foods in contaminated regions of the world.

Reduction of in utero lead exposures in South African populations: Positive impact of unleaded petrol

Background

Prenatal exposure to lead (Pb) has been shown to have negative and irreversible health impacts on foetal and early childhood development, affecting morbidity and mortality in adulthood. This study aimed to assess in utero Pb exposure, examine birth outcomes, and identify confounding factors in the large cohort of South African population, following the legislated removal of Pb from petrol.

Methods

Lead was measured in the maternal blood, urine and cord blood using Inductive Coupled Plasma Mass spectrometry (ICP-MS). The statistical analyses included Spearman’s correlation, Wilcoxon rank sum (Mann Whitney), Kruskal-Wallis rank tests and multivariate linear regression.

Results

Overall, the geometric mean (GM) of Pb in maternal blood (PbB) was 1.32 μg/dL (n = 640; 95% CI, 1.24–1.40). In the subset cohort, the GM of paired maternal PbB and cord blood (PbC) was 1.73 μg/dL (n = 350; 95% CI, 1.60–1.86) and 1.26 μg/dL (n = 317; 95% CI, 1.18–1.35), respectively with a positive correlation between the log PbB and the log PbC (rho = 0.65, p = <0.001). Birth outcomes showed geographical differences in the gestational age (p<0.001), birth length (p = 0.028) and head circumference (p<0.001), Apgar score at 5 min (p<0.001) and parity (p<0.002). In female neonates, a positive association was found between PbC and head circumference (rho = 0.243; p<0.016). The maternal PbB levels were positively correlated with race, educational status, water sources, cooking fuels and use of pesticides at home.

Conclusions

This study has demonstrated not only the positive impact that the introduction of unleaded petrol and lead-free paint has had on in utero exposure to Pb in South Africa, but has also contributed new data on the topic, in a region where such data and scientific investigations in this field are lacking. Future research should evaluate if similar effects can be detected in young children and the adult population.

Endocrine Disruptors and Health Effects in Africa: A Call for Action

BACKGROUND

Africa faces a number of unique environmental challenges. Unfortunately, it lacks the infrastructure needed to support the comprehensive environmental studies that could provide the scientific basis to inform environmental policies. There are a number of known sources of endocrine-disrupting chemicals (EDCs) and other hazardous chemicals in Africa. However, a coordinated approach to identify and monitor these contaminants and to develop strategies for public health interventions has not yet been made.

OBJECTIVES

This commentary summarizes the scientific evidence presented by experts at the First African Endocrine Disruptors meeting. We describe a "call to action" to utilize the available scientific knowledge to address the impact of EDCs on human and wildlife health in Africa.

DISCUSSION

We identify existing knowledge gaps about exposures to EDCs in Africa and describe how well-designed research strategies are needed to address these gaps. A lack of resources for research and a lag in policy implementation slows down intervention strategies and poses a challenge to advancing future health in Africa.

CONCLUSION

To address the many challenges posed by EDCs, we argue that Africans should take the lead in prioritization and evaluation of environmental hazards, including EDCs. We recommend the institution of education and training programs for chemical users, adoption of the precautionary principle, establishment of biomonitoring programs, and funding of community-based epidemiology and wildlife research programs led and funded by African institutes and private companies. https://doi.org/10.1289/EHP1774.

Using behavior change to reduce child lead exposure in resource-poor settings: a formative study

The objective of this formative research was to explore the acceptability and feasibility of changing housekeeping behaviors as a low-cost approach that may reduce childhood lead exposure in Johannesburg, South Africa. Using the Trials of Improved Practices (TIPs) methodology, modified housekeeping behaviors were negotiated with participants who chose the behaviors they wanted to try and then performed them in their homes over 4 weeks. Researchers interviewed them at the end of the month to understand their experience of trying out the behaviors. The modified behaviors offered to each participant were as follows: cleaning window sills with detergent and water, cleaning window sills more frequently, mopping floors with two buckets (one with soapy water for washing and one with clean water for rinsing), mopping floors more frequently, dusting surfaces with detergent and water and dusting surfaces more frequently. Participants found cleaning window sills with soap and water and cleaning them more often the most acceptable and feasible of behavior modifications. Environmental samples showed a significant reduction in lead dust on window sills. These findings can assist in the development of acceptable and feasible medium-term interventions to reduce childhood lead exposure in resource-poor settings until more robust health policies are implemented.

Lead exposure in adult males in urban Transvaal Province, South Africa during the apartheid era

Human exposure to lead is a substantial public health hazard worldwide and is particularly problematic in the Republic of South Africa given the country’s late cessation of leaded petrol. Lead exposure is associated with a number of serious health issues and diseases including developmental and cognitive deficiency, hypertension and heart disease. Understanding the distribution of lifetime lead burden within a given population is critical for reducing exposure rates. Femoral bone from 101 deceased adult males living in urban Transvaal Province (now Gauteng Province), South Africa between 1960 and 1998 were analyzed for lead concentration by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Of the 72 black and 29 white individuals sampled, chronic lead exposure was apparent in nearly all individuals. White males showed significantly higher median bone lead concentration (ME = 10.04 µg·g⁻¹), than black males (ME = 3.80 µg·g⁻¹) despite higher socioeconomic status. Bone lead concentration covaries significantly, though weakly, with individual age. There was no significant temporal trend in bone lead concentration. These results indicate that long-term low to moderate lead exposure is the historical norm among South African males. Unexpectedly, this research indicates that white males in the sample population were more highly exposed to lead.

Environmental lead exposure and socio-behavioural adjustment in the early teens: the birth to twenty cohort

Lead exposure remains high in South Africa. Environmental lead exposure has been associated with behaviour problems in childhood and adolescence. The objective of this study was to determine the relationship between blood lead levels and socio-behavioural problems among young adolescents in the Birth to Twenty cohort (Bt20). The uniquely South African Bt20 cohort started in 1989 and is a long-term prospective follow-up study of the health and well-being of children born in the Greater Johannesburg area. The total analytical sample size consisted of 1041 adolescents (487 males and 554 females). Blood lead levels were obtained from whole venous blood that was collected. Thirty two items representing Rule-breaking and Aggressive behavioural characteristics from the Youth Self Report (YSR) were assessed. Bivariate and multiple regression analyses were conducted to assess for associations between blood lead levels and socio-behavioural problems at 13 years of age. The geometric mean blood lead level was significantly (P value < 0.001) higher in boys (6.0 μg/dl) compared to girls (4.5 μg/dl). In the total analytical sample four behavioural items were significantly associated with the geometric mean blood lead levels. When stratifying the sample by sex, the bivariate analyses showed that boys' blood lead levels were significantly associated with four types of aggressive behaviour. There were no significant associations found in girls. The multivariate analysis was conducted in the boys sample and after adjusting for socio-economic factors "Attacking People" remained significantly associated with blood lead levels. High blood lead levels are associated with anti-social and destructive behaviour amongst boys in their early teens. However, the relationships are complex and confounded by other aspects of adversity.

Prenatal and adolescent blood lead levels in South Africa: child, maternal and household risk factors in the Birth to Twenty cohort

INTRODUCTION

The risk factors for lead exposure in developing countries have not been fully described. This study looks at child, maternal and household factors associated with increased risk of lead exposure at birth and at 13 years of age in the Birth to Twenty cohort.

METHODS

Mothers were recruited from antenatal clinics in the Johannesburg-Soweto metropolitan area in 1990 (n=3273). Lead levels were analysed in cord blood collected at birth (n=618) and at 13 years (n=1546). Data on selected child, maternal and household factors were collected using a structured questionnaire in the third trimester and at 13 years of age. Statistical analyses were conducted to determine the associated risk factors.

RESULTS

The mean blood lead level at birth was 5.85 microg/dl, and at 13 years of age it was 5.66 microg/dl. The majority of children had blood lead levels above 5 microg/dl (52% at birth and 56% at 13 years). At birth, being a teenage mother and having low educational status were strong predictors for elevated cord blood lead levels. Being a male child, having an elevated cord blood level, and lack of household ownership of a phone were significant risk factors for high blood lead levels at 13 years.

CONCLUSION

Significant associations found in the study point to the low socio-economic status of lead-affected mothers and children. These poor circumstances frequently persist into later childhood, resulting in continued high lead levels. Thus broader measures of poverty alleviation and provision of better education may help decrease the risk of exposure.

Estimating the burden of disease attributable to four selected environmental risk factors in South Africa

INTRODUCTION

The first South African National Burden of Disease study quantified the underlying causes of premature mortality and morbidity experienced in South Africa in the year 2000. This was followed by a Comparative Risk Assessment to estimate the contributions of 17 selected risk factors to burden of disease in South Africa. This paper describes the health impact of exposure to four selected environmental risk factors: unsafe water, sanitation and hygiene; indoor air pollution from household use of solid fuels; urban outdoor air pollution and lead exposure.

METHODS

The study followed World Health Organization comparative risk assessment methodology. Population-attributable fractions were calculated and applied to revised burden of disease estimates (deaths and disability adjusted life years, [DALYs]) from the South African Burden of Disease study to obtain the attributable burden for each selected risk factor. The burden attributable to the joint effect of the four environmental risk factors was also estimated taking into account competing risks and common pathways. Monte Carlo simulation-modeling techniques were used to quantify sampling, uncertainty.

RESULTS

Almost 24 000 deaths were attributable to the joint effect of these four environmental risk factors, accounting for 4.6% (95% uncertainty interval 3.8-5.3%) of all deaths in South Africa in 2000. Overall the burden due to these environmental risks was equivalent to 3.7% (95% uncertainty interval 3.4-4.0%) of the total disease burden for South Africa, with unsafe water sanitation and hygiene the main contributor to joint burden. The joint attributable burden was especially high in children under 5 years of age, accounting for 10.8% of total deaths in this age group and 9.7% of burden of disease.

CONCLUSION

This study highlights the public health impact of exposure to environmental risks and the significant burden of preventable disease attributable to exposure to these four major environmental risk factors in South Africa. Evidence-based policies and programs must be developed and implemented to address these risk factors at individual, household, and community levels.

The presence and impact of environmental lead in passerine birds along an urban to rural land use gradient

Contamination of wetlands by lead shot and lead fishing weights has generated a tremendous amount of research into the impact of lead poisoning on wildlife. Less well known are the potential threats to wildlife posed by lead contaminants still prevalent in urban environments. Despite a U.S. federal ban on lead-based paint and gasoline in 1978 and 1986, respectively, lead residue is still prevalent at hazardous levels in urban and suburban environments and may present a health concern for people and wildlife, particularly birds. We quantified soil lead content in residential properties across a rural-to-urban land-use gradient in the metropolitan Washington, D.C. area and then assessed the impact of lead contamination on body condition in adult and nestling passerine birds at the same sites. Soil lead concentration was significantly higher in urban sites compared to rural sites. Accordingly, adult and nestling birds captured in urban sites had significantly higher blood lead concentrations than their rural counterparts. However, only gray catbird nestlings exhibited lower body condition as a result of lead contamination. Birds continue to breed in urban habitats despite numerous negative attributes to these environments including light, noise, pedestrian and toxic contaminants, such as lead. These sites often contain habitat that appears suitable for roosting, nesting, and foraging and thus may act as an ecological trap for breeding birds because breeding success is often negatively associated with increasing urbanization. Lead contamination is one more feature of urbanization that birds and other wildlife must face in an increasingly developed world.

Poor school performance

Education is one of the most important aspects of human resource development. Poor school performance not only results in the child having a low self-esteem, but also causes significant stress to the parents. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, attention deficit hyperactivity disorder, emotional problems, poor socio-cultural home environment, psychiatric disorders and even environmental causes. The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis. However, a multidisciplinary evaluation by an ophthalmologist, otolaryngologist, counselor, clinical psychologist, special educator, and child psychiatrist is usually necessary before making the final diagnosis. It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential.