Mass lead intoxication from informal used lead-acid battery recycling in dakar, senegal

Pollution and Perceptions of Lead in Automobile Repair Shops in Dhaka, Bangladesh

BACKGROUND

Lead acid batteries are widely used, dependable, and inexpensive. Lead from these batteries can contaminate the surrounding ecosystem due to improper disposal and contribute to lead poisoning. Lead poisoning is an important public health issue that can cause adverse human health impacts.

OBJECTIVES

The present study aimed to assess exposure to lead released from automobile repair shops handling lead acid batteries in the city of Dhaka, Bangladesh, as well as shop owner and worker perceptions of lead pollution.

METHODS

Ten dust samples were collected for atomic absorption spectrophotometer analysis to determine the concentration of lead. In addition, a questionnaire survey (N=75) was conducted to determine the level of knowledge of lead exposure and associated risks.

RESULTS

Lead contamination was found in all dust samples, with lead concentrations ranging from 11.40 ppm to greater than 1000 ppm. In addition, 80% of respondents did not have any knowledge about the harmful effects of lead pollution.

CONCLUSIONS

The present study suggests the importance of defining permissible air lead levels and improving worker education on lead pollution.

ETHICS APPROVAL

The study was approved by the Ethics Committee of the Department of Environmental Science, Stamford University, Bangladesh.

COMPETING INTERESTS

The authors declare no competing financial interests.

Potential ecological risk of metal pollution in lead smelter-contaminated agricultural soils in Khulna, Bangladesh

Lead smelters are important source of metal pollution. This study assessed ecological risks of three heavy metals (Pb, As, and Zn) in agricultural soils surrounding five Pb smelters from Khulna district in Bangladesh. A total of 81 surface soil samples collected within 500-m radius of the smelters were analyzed using an atomic absorption spectrophotometer (AAS). Concentrations of Pb, As, and Zn ranged within 6-3902, 1.8-9.6, and 45.4-563 mg/kg, respectively. About half of the Pb samples (~ 51%) exceeded soil quality standard target value (85 mg/kg), and the concentrations gradually decreased with horizontal distance from the smelter. The value of pollution index (PI) measured for Pb, As, and Zn varied respectively in the range of 0-195, 0.6-3.2, and 0.67-8.28, with mean values of 11.7, 1.9, and 3.92. The value of integrated pollution index (IPI) calculated for these metals remained between 0.58 and 66.2 with a mean of 5.7, and that designates ~ 96% of the sampled soils as moderately or highly contaminated. Potential ecological risk (PER) calculated for the metals indicate that all the samples were within low to moderate risk, and the descending order of PER of the metals was Pb > As > Zn.

Prevalence of Blood Lead among Children Living in Battery Recycling Communities in Greater Jakarta, Indonesia

This study aimed to assess the prevalence of blood lead levels (BLLs) among children 1 to 5 years old who reside near and distant to informally used lead-acid battery (ULAB) recycling locations and examine risk factors for elevated BLLs. A cross-sectional study was conducted in three greater Jakarta neighborhoods where informal ULAB recycling occurs. Venous BLLs among 279 children were analyzed using portable blood lead testing machines. Demographic, child activities, and sources of lead exposure inside and outside homes were assessed. Multivariate analysis was performed to evaluate factors associated with the prevalence of BLLs. Forty-seven percent of children had BLLs ≥ 5 µg/dL and 9% had BLLs ≥ 10 µg/dL. No differences in geometric mean BLLs were observed between children who lived near and distant to ULAB locations. Older child age groups [Prevalence Ratio (PR) 2.14, 95% Confidence Interval (CI) 1.16, 4.18) and low household income (PR 1.58, 95% CI 1.03, 2.40) were associated with BLLs 5-9 µg/dL. Low educational attainment of the child's father (PR 3.17, 95% CI 1.23, 8.16) and frequent outdoor child activity (PR 4.93, 95% CI 1.09, 22.21) were predictors of BLLs ≥ 10 µg/dL. This study shows the association between lead exposure among children and environmental sources. Public health officials can consider expanded surveillance, health care provider education, and development of strategies to reduce lead exposure.

Fort J, Taylor MP. Assessment of the Presence of Soil Lead Contamination Near a Former Lead Smelter in Mombasa, Kenya

BACKGROUND

The informal settlement of Owino Uhuru near an abandoned lead smelter attracted international attention due to an apparent lead poisoning event. Despite this attention, the environmental data collected to date do not indicate high levels of residual contamination.

OBJECTIVES

To further confirm previous findings and determine any necessary risk mitigation measures, an assessment of surface soil lead concentrations was conducted in the community.

METHODS

Investigators carried out an assessment of the soil in a ~12,000 m2 section of the Owino Uhuru neighborhood over the course of a single day in June 2017 with the assistance of community leaders. Fifty-nine in situ soil measurements were taken using an Innov-X tube-based (40 kV) alpha X-ray fluorescence instrument (pXRF).

RESULTS

The assessment found that mean surface soil lead concentrations in areas conducive to exposure were 110 mg/kg (95% CI: 54-168); below United States Environmental Protection Agency and the Environment Canada screening levels of 400 mg/kg and 140 mg/kg, respectively.

CONCLUSIONS

There is likely no current need for risk mitigation activities in the community. These results could inform discussions on the allocation of public health spending.

COMPETING INTERESTS

The authors declare no competing financial interests. BE, VOO, CN and JSF are employees of Pure Earth. MPT sits on the Editorial Board of the Journal of Health and Pollution.

Phytoremediation assisted by mycorrhizal fungi of a Mexican defunct lead-acid battery recycling site

A field experiment was conducted during 15 months to study the effects of four arbuscular mycorrhizal fungi (AMF) on the growth of Ricinus communis accession SF7. Plants were established on amended soil (vermicompost:sawdust:soil 1:1:1) severely polluted by lead-acid batteries (LAB) located at Mexico State, Mexico. Plants inoculated with Acaulospora sp., Funneliformis mosseae and Gigaspora gigantea had 100% survival in comparison to non-inoculated plants (57%). These same AMF enhanced palmitic and linoleic acids content in seeds of R. communis. Acaulospora sp. modified rhizosphere soil pH and decreased 3.5 folds Pb foliar concentrations while F. mosseae BEG25 decreased three times Pb soil availability in comparison to non-inoculated plants. Spatial changes in Pb soil availability were observed at the end of this research. No fungal effect on P, Ca, Cu foliar concentrations, soluble sugars, proline, chlorophyll or on the activity of two oxidative stress enzymes was observed. Mycorrhizal colonization from the inoculated fungi was between 40% and 60%, while colonization by native fungi was between 16% and 22%. A similar percentage of foliar total phenolic compounds was observed in non-mycorrhizal plants and those inoculated with G. gigantea and Acaulospora sp. This is the first research reporting effects of AMF on R. communis (castor bean) shrubs when grown on a LAB recycling site suggesting the use of Acaulospora sp. and F. mosseae BEG25 in phytostabilization to ameliorate Pb pollution and decreasing its ecological risk.

Forecasting model to assess the potential of secondary lead production from lead acid battery scrap

Lead acid battery (LAB) scrap management is an important issue both environmentally and economically. The recovery of lead from battery scrap leads to a reduction in negative impacts of lead mining, as well as making the battery production cycle environmentally friendly. This work aims to propose a forecasting model for lead generation from LAB scrap based on time series modeling that uses data regarding after-market of batteries and new batteries produced for new cars. In order to illustrate the applicability of the new proposal, the model was applied to the Brazilian case. The main results show that at least 1% of LAB scrap from light vehicles have unknown or improper destinations; the efficiency of the recycling process in Brazil is still low, resulting in lead losses close to 4.5%; the lack of a sectorial agreement between the official battery market and the government concerning the reverse logistics of LAB scrap leads to a lack of precise data on the amount of LAB scrap generated and its final destination. Moreover, the economic importance of lead recycling and logistics of the secondary market are also discussed, with a focus on the dangers of illegal recycling.

Blood Lead Levels in Women of Child-Bearing Age in Sub-Saharan Africa: A Systematic Review

This paper reported available studies on blood lead level of childbearing age in Sub-Saharan African women. PubMed and Google scholar databases were searched for original articles reporting blood lead levels of women of childbearing age in Sub-Saharan Africa. Searches were not limited to year of study but limited to studies published in English Language. Data were extracted and synthesized by estimating the weighted mean of the reported blood lead levels. Fifteen papers fulfilled the inclusion criteria. Mean blood lead levels of women in the studies ranged from 0.83 to 99 μg/dl. The overall weighted mean of blood lead levels was 24.73 μg/dl. The weighted mean from analyses of data on blood lead levels of pregnant women alone was 26.24 μg/dl. Identified sources of lead exposure included lead mine, informal lead-acid battery recycling, leaded gasoline and piped water. Elevated BLLs were associated with incidence of preeclampsia, hypertension, and malaria. Important contributing factors for elevated blood lead levels (BLL) in these women include poverty, high environmental lead burden, low awareness on lead exposure hazards and lack of regulation for lead in consumer products. BLLs of women of childbearing age in SSA are unacceptably high. There is need therefore, for aggressive programs to address lead exposure in this population.

A meta-analysis of blood lead levels in India and the attributable burden of disease

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38-9.35) in children and 7.52 μg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Source analysis of municipal solid waste in a mega-city (Guangzhou): Challenges or opportunities?

Rapid economic development accelerates the generation of municipal solid waste (MSW), and thereby calls for an effective and reliable waste management strategy. In the present work, we systematically investigated the status of MSW management in a mega-city of China (Guangzhou). The data were collected from literatures, government statistics and field sampling work. It can be found that a combination of waste sorting by individual residents and a necessary quantity of sanitation workers is one of the most feasible strategies to achieve a sustainable waste management. With implementation of that integrated strategy, approximately 0.03 million tons of metal, 0.24 million tons of paper, as well as 0.46 million tons of plastics can be recycled/recovered for further processing. A cost reduction of 70 million US$ is achieved in comparison with the un-optimized system due to the sale revenue of recyclable materials and the saving from waste disposal fees. The values of environmental assessment were expressed as environmental load units. The developed scenarios could decrease the environmental cost, namely, 0.66 million US$. Based on the studies, waste sorting is urgently needed in Guangzhou. However, to make the proposed strategy to be more economically feasible, the sorting should be performed individually as well as with public participation. The establishment of a win-win situation for all stakeholders is an effective path for the improvement of the integrated waste management system.

Elevated Blood Lead Levels in Infants and Children in Haiti, 2015

OBJECTIVE

Few studies have reported blood lead levels (BLLs) in Haitian children, despite the known presence of lead from environmental factors such as soil, water, leaded paint and gasoline, improperly discarded batteries, and earthquakes. We sought to determine the prevalence of elevated blood lead levels (EBLLs) among healthy Haitian children.

METHODS

We enrolled children aged 9 months to 6 years from 3 geographic areas in Haiti (coastal, urban, and mountain) from March 1 through June 30, 2015. We obtained anthropometric measurements, household income, potential sources of lead exposure, and fingerstick BLLs from 273 children at 6 churches in Haiti. We considered a BLL ≥5 μg/dL to be elevated.

RESULTS

Of 273 children enrolled in the study, 95 were from the coastal area, 78 from the urban area, and 100 from the mountain area. The median BLL was 5.8 μg/dL, with higher levels in the mountain area than in the other areas ( P < .001). BLLs were elevated in 180 (65.9%) children. The prevalence of EBLL was significantly higher in the mountain area (82 of 100, 82.0%; P < .001) than in the urban area (42 of 78, 53.8%) and the coastal area (56 of 95, 58.9%; P < .001). Twenty-eight (10.3%) children had EBLLs ≥10 μg/dL and 3 (1.1%) children had EBLLs ≥20 μg/dL. Exposure to improperly discarded batteries ( P = .006) and living in the mountain area ( P < .001) were significant risk factors for EBLLs.

CONCLUSIONS

More than half of Haitian children in our study had EBLLs. Public health interventions are warranted to protect children in Haiti against lead poisoning.

Metals and metalloids in PM10 in Nandan County, Guangxi, China, and the health risks posed

Intense mining, smelting, and tailing activities of polymetallic ore deposits have affected the environment in Nandan County, Guangxi, China. Samples of particulates with aerodynamic diameters low or equal 10 μm (PM₁₀) were collected in Nandan County to investigate the concentrations of and health risks posed by 17 metals and metalloids in the PM₁₀. The metal and metalloid concentrations were lower than those found in other industrial cities. The mean Cr concentration was 7.48 ng/m³. Significant higher metal and metalloid concentrations were found in PM₁₀ from mining areas (Dachang and Chehe) than from the control area (Liuzhai) (p < 0.05). Principal component analysis indicated that the main sources of Ba, Co, Cr, Fe, K, Mg, Mo, Na, and Sr were resuspension of the soil produced through mineral erosion, the main sources of As, Cd, Cu, Pb, Sb, and Zn were smelting and mining activities, and the main source of Ni was fossil fuel combustion. Higher non-carcinogenic and carcinogenic risks were posed in Dachang and Chehe than in Liuzhai. The non-carcinogenic risks posed to adults and children by individual metals and metalloids in PM₁₀ at all the sites were low, but the non-carcinogenic risks posed to children by all the metals and metalloids together exceeded the safe level (i.e., risk value > 1). The carcinogenic risks posed by Cd, Ni, and Pb were negligible at all sites, while As, Co, and Cr posed potential carcinogenic risks to the residents.

A systemic ecological risk assessment based on spatial distribution and source apportionment in the abandoned lead acid battery plant zone, China

In China, potential heavy metal hazard around abandoned lead-acid battery plant (ALBP) area has been a great concern but without detailed report. The distribution and sources of heavy metals in soils and so by risk assessment associated with ALBP are conducted in this contribution, based on geographies and statistics. Pb and Zn are quantitively identified to be still emitted from ALBP soil, and Cd as well As are from agricultural activity. We investigate vertical metal distribution, and fortunately find that metals migrate within limit of 40 cm below topsoil, which is higher than groundwater table. The visualized stable depths are Zn 40 cm, Pb, As 20 cm, and Cd 40 cm. The mapped pollution load index (PLI) suggests a high pollution level exists in ALBP soil. The estimation of potential ecological risk index (PERI) indicates a light ecological risk in studied area, while As and Cd mainly from agricultural activity possess 54% of total E_ri. Health risk index (THI) is 0.178 for children, indicating non-cancer risks may be ignored in observed area. Though calculated risk is temporarily affordable, soil remediation and reduction of agricultural chemical reagents are recommended for preventing potential cumulative risk from further bioconcentration of heavy metals.

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

In this narrative account based on a keynote presentation on exposure biomonitoring of metals in low- and middle-income countries (LMIC), we first briefly address practical issues that have arisen from our experience during the conduct of various surveys in LMIC. These have included the statistical handling of multiple pollutants in the same subject, the problem of correctly adjusting for urinary flow in spot samples of urine, and the possible external contamination of samples when doing field surveys in challenging environments. We then review and present selected results from surveys conducted in the mining area of Katanga in the Democratic Republic of Congo (DR Congo), where we documented high urinary levels of cobalt and other trace metals (arsenic, uranium) in people living close (<3 km) to mining or smelting operations (Banza et al., 2009). Consumption of contaminated foodstuffs (maize, legumes, fish) and, especially among children, dust ingestion proved to be the main sources of exposure to cobalt (Cheyns et al., 2014). Urinary biomonitoring studies among artisanal workers involved in mining cobalt, craftsmen working malachite, and workers processing gold ore revealed high to extremely high values of cobalt (largely exceeding the Biological Exposure Index of 15 μg/L), as well as other trace metals such as uranium, manganese, lead or mercury, depending on the type of jobs. This abundant biomonitoring data has been valuable to argue for improved enforcement of legislation to protect workers and citizens against the hazards posed by the mining activities in the area. Epidemiological studies have been undertaken and are ongoing to assess the human health impact of this pollution.

Environmental Assessment and Blood Lead Levels of Children in Owino Uhuru and Bangladesh Settlements in Kenya

BACKGROUND

Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL.

OBJECTIVES

This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya.

METHODS

The present study is a population-based, cross-sectional study of children aged 12-59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1-3 ml venous blood drawn from each child was tested for lead using a LeadCare ® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy.

RESULTS

We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30-52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (p<0.05). The geometric mean lead concentration of soil samples from Owino Uhuru was 146.5 mg/Kg (GSD: 5.2) and 11.5 mg/Kg (GSD: 3.9) (p<0.001) in Bangladesh settlement. Children who resided <200 m from the lead smelter were more likely to have a BLL ≥5 μg/dL than children residing ≥200 m from the lead smelter (adjusted odds ratio (aOR): 33.6 (95% confidence interval (CI): 7.4-153.3). Males were also more likely than females to have a BLL ≥5 μg/dL (39, 62%) compared to a BLL<5 μg/dL [aOR: 2.4 (95% CI: 1.0-5.5)].

CONCLUSIONS

Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC.

COMPETING INTERESTS

The authors declare no competing financial interests.

Estimating the Prevalence of Toxic Waste Sites in Low- and Middle-Income Countries

BACKGROUND

Exposure to heavy metals at contaminated industrial and mining sites, known also as hot spots, is a significant source of toxic exposure and adverse health outcomes in countries around the world. The Toxic Sites Identification Program (TSIP) developed by Pure Earth, a New York-based nongovernmental organization, is the only systematic effort to catalogue contaminated sites globally. To date, TSIP has identified and catalogued 3282 sites in low- and middle-income countries. The TSIP methodology is not designed to survey all contaminated sites in a country. Rather sites are prioritized based on their perceived impact on human health, and only a limited number of the most highly hazardous sites are surveyed. The total number of contaminated sites globally and the fraction of contaminated sites captured by TSIP is not known.

OBJECTIVE

To determine the TSIP site capture rate, the fraction of contaminated sites in a country catalogued by TSIP.

METHODS

Ghana was selected for this analysis because it is a rapidly industrializing lower middle income country with a heterogeneous industrial base, a highly urban population (51%), and good public records systems. To develop an estimate of the fraction of sites in Ghana captured by TSIP, assessors targeted randomly selected geographic quadrats for comprehensive assessment using area and population statistics from the Ghana Statistical Service. Investigators physically walked all accessible streets in each quadrat to visually identify all sites. Visual identification was supplemented by field-based confirmation with portable x-ray fluorescence instruments to test soils for metals. To extrapolate from survey findings to develop a range of estimates for the entire country, the investigators used 2 methodologies: a "bottom-up" approach that first estimated the number of waste sites in each region and then summed these regional subtotals to develop a total national estimate; and a "top-down" method that estimated the total number of sites in Ghana and then allocated these sites to each region. Both methods used cluster random sampling principles.

FINDINGS

The investigators identified 72 sites in the sampled quadrats. Extrapolating from these findings to the entire country, the first methodology estimated that there are 1561 sites contaminated by heavy metals in Ghana (confidence interval [CI]: 1134-1987), whereas the second estimated 1944 sites (CI: 812-3075). The estimated total number of contaminated sites in Ghana is thus 7-9 times the number of sites captured through TSIP. On a population basis, it was estimated that there are between 31 and 115 contaminated sites per million inhabitants in Ghana.

CONCLUSIONS

The findings of this study indicate that the TSIP methodology provides a sound statistical basis for policy formulation. The statistical approaches used in this study can be replicated in other countries to improve estimates of the prevalence of contaminated sites. This information provides important input to calculations of the global burden of disease attributable to hazardous exposures at contaminated sites.

Lead acid battery recycling for the twenty-first century

There is a growing need to develop novel processes to recover lead from end-of-life lead-acid batteries, due to increasing energy costs of pyrometallurgical lead recovery, the resulting CO2 emissions and the catastrophic health implications of lead exposure from lead-to-air emissions. To address these issues, we are developing an iono-metallurgical process, aiming to displace the pyrometallurgical process that has dominated lead production for millennia. The proposed process involves the dissolution of Pb salts into the deep eutectic solvent (DES) Ethaline 200, a liquid formed when a 1 : 2 molar ratio of choline chloride and ethylene glycol are mixed together. Once dissolved, the Pb can be recovered through electrodeposition and the liquid can then be recycled for further Pb recycling. Firstly, DESs are being used to dissolve the lead compounds (PbCO3, PbO, PbO2 and PbSO4) involved and their solubilities measured by inductively coupled plasma optical emission spectrometry (ICP-OES). The resulting Pb2+ species are then reduced and electrodeposited as elemental lead at the cathode of an electrochemical cell; cyclic voltammetry and chronoamperometry are being used to determine the electrodeposition behaviour and mechanism. The electrodeposited films were characterized by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). We discuss the implications and opportunities of such processes.

Bioactive profiling and therapeutic potential of mushroom (Pleurotus tuberregium) extract on Wistar albino rats (Ratus norvegicus) exposed to arsenic and chromium toxicity

Mushroom species are valued in gourmet traditions around the world for their unique taste, aroma, nutritional value and medicinal potentials. The bioactive profiling of P. tuberregium mushroom was evaluated to determine it therapeutic effect on Wistar albino rats exposed to arsenic (As) and chromium (Cr) toxicity. Proximate analysis of P. tuberregium showed high composition of carbohydrate (80.24) followed by moisture (21.16), protein (11.46), ash (3.03) and fibre (0.25) content. Phytochemical analysis revealed the presence of polyphenols (2.58), alkaloid (2.46), oxalate (4.25), flavonoid (1.68), tannin (0.38) and Saponin (trace) in trace amount. Mineral analysis yielded variable amounts of Na, Mg, K and Ca. Therapeutics assessment of P. tuberregium to Wistar albino rats exposed to As-Cr toxicity showed improved feed and water intake during the exposure duration. Haematological indices revealed significant increase in platelet (PLT), granulocytes and monocytes while lymphocyte (LY) and red cell distribution width (RDW) were low. Biochemical and redox marker of liver and kidney profiles showed decrease in alkaline phosphatase (ALP), alanine transaminase (ALT) and aspartate transaminase (AST) in the liver. Creatinine and urea in the kidney also decrease while total protein increased significantly. Malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), glutathione S-transferase (GST) decrease in the liver and kidney of the therapeutic group when compared with As-Cr treated rats. The presence of alkaloids and flavonoids in significant amount may have contributed in the therapeutic changes observed in all the parameters. Therefore, our findings conclude that P. tuberregium possessed remarkable effect against As-Cr induced toxicity in albino rats and may be useful in metal toxicity treatment in man and may be concluded that they are therapeutically effective.

Cost Effectiveness of Environmental Lead Risk Mitigation in Low- and Middle-Income Countries

Environmental remediation efforts in low- and middle-income countries have yet to be evaluated for their cost effectiveness. To address this gap we calculate a cost per Disability Adjusted Life Year (DALY) averted following the environmental remediation of the former lead smelter and adjoining residential areas in Paraiso de Dios, Haina, the Dominican Republic, executed from 2009 to 2010. The remediation had the effect of lowering surface soil lead concentrations to below 100 mg/kg and measured geometric mean blood lead levels (BLLs) from 20.6 μg/dL to 5.34 ug/dL. Because BLLs for the entire impacted population were not available, we use environmental data to calculate the resulting disease burden. We find that before the intervention 176 people were exposed to elevated environmental lead levels at Paraiso de Dios resulting in mean BLLs of 24.97 (95% CI: 24.45-25.5) in children (0-7 years old) and 13.98 μg/dL (95% CI: 13.03-15) in adults. We calculate that without the intervention these exposures would have resulted in 133 to 1,096 DALYs and that all of these were averted at a cost of USD 392 to 3,238, depending on assumptions made. We use a societal perspective, meaning that we include all costs regardless of by whom they were incurred and estimate costs in 2009 USD. Lead remediation in low- and middle-income countries is cost effective according to World Health Organization thresholds. Further research is required to compare the approach detailed here with other public health interventions.

Soil contamination from lead battery manufacturing and recycling in seven African countries

Lead battery recycling is a growing hazardous industry throughout Africa. We investigated potential soil contamination inside and outside formal sector recycling plants in seven countries. We collected 118 soil samples at 15 recycling plants and one battery manufacturing site and analyzed them for total lead. Lead levels in soils ranged from < 40-140,000mg/kg. Overall mean lead concentrations were ~23,200mg/kg but, average lead levels were 22-fold greater for soil samples from inside plant sites than from those collected outside these facilities. Arithmetic mean lead concentrations in soil samples from communities surrounding these plants were ~2600mg/kg. As the lead battery industry in Africa continues to expand, it is expected that the number and size of lead battery recycling plants will grow to meet the forecasted demand. There is an immediate need to address ongoing exposures in surrounding communities, emissions from this industry and to regulate site closure financing procedures to ensure that we do not leave behind a legacy of lead contamination that will impact millions in communities throughout Africa.

Improving human health outcomes with a low-cost intervention to reduce exposures from lead acid battery recycling: Dong Mai, Vietnam

This study details the first comprehensive evaluation of the efficacy of a soil lead mitigation project in Dong Mai village, Vietnam. The village's population had been subject to severe lead poisoning for at least a decade as a result of informal Used Lead Acid Battery (ULAB) recycling. Between July 2013 to February 2015, Pure Earth and the Centre for Environment and Community Development (Hanoi, Vietnam) implemented a multi-faceted environmental and human health intervention. The intervention consisted of a series of institutional and low-cost engineering controls including the capping of lead contaminated surface soils, cleaning of home interiors, an education campaign and the construction of a work-clothes changing and bathing facility. The mitigation project resulted in substantial declines in human and environmental lead levels. Remediated home yard and garden areas decreased from an average surface soil concentration of 3940mg/kg to <100mg/kg. One year after the intervention, blood lead levels in children (<6 years old) were reduced by an average of 67%-from a median of 40.4μg/dL to 13.3μg/dL. The Dong Mai project resulted in significantly decreased environmental and biological lead levels demonstrating that low-cost, rapid and well-coordinated interventions could be readily applied elsewhere to significantly reduce preventable human health harm.

Reusable resistive aptasensor for Pb(II) based on the Pb(II)-induced despiralization of a DNA duplex and formation of a G-quadruplex

The article describes a reusable biosensor for Pb(II) ions. A duplex DNA with a terminal amino group and containing a G-quadruplex (G4) aptamer was covalently conjugated to single walled carbon nanotubes on a field effect transistor (FET). The detection scheme is based on the despiralization of the DNA duplex because Pb(II) can induce the G4 aptamer to form a stabilizing G4/Pb(II) complex. This structural change affects the electrical conductivity of SWNTs which serves as the analytical signal. The biosensor was characterized via scanning electron microscopy, Raman, UV-vis, and voltage-current profiles. Under optimized conditions, the relative resistance at 0.02 V increases linearly with the logarithm of the Pb(II) concentration in the range from 1 ng·L^-1 to 100 μg·L^-1, and the limit of detection is 0.39 ng·L^-1. Compared to other sensors, this oner demonstrates superior simplicity, sensitivity, and selectivity even in mixtures of heavy metal ions. It was applied to the determination of Pb(II) in (spiked) water and soil samples and gave good results. Graphical abstract Schematic of the fabrication a biosensor for Pb(II). It is making use of an SWNT-based FET, G4-DNA and complementary DNA with an amino group. Pb(II) can despiralize the DNA duplex to form a G-quadruplex which affects the electrical conductivity of SWNTs. After each detection, the single complementary strand DNA can rebind the G4-DNA, which makes the biosensor reusable.

The effect of soil on human health: an overview

Soil has a considerable effect on human health, whether those effects are positive or negative, direct or indirect. Soil is an important source of nutrients in our food supply and medicines such as antibiotics. However, nutrient imbalances and the presence of human pathogens in the soil biological community can cause negative effects on health. There are also many locations where various elements or chemical compounds are found in soil at toxic levels, because of either natural conditions or anthropogenic activities. The soil of urban environments has received increased attention in the last few years, and they too pose a number of human health questions and challenges. Concepts such as soil security may provide a framework within which issues on soil and human health can be investigated using interdisciplinary and transdisciplinary approaches. It will take the contributions of experts in several different scientific, medical and social science fields to address fully soil and human health issues. Although much progress was made in understanding links between soil and human health over the last century, there is still much that we do not know about the complex interactions between them. Therefore, there is still a considerable need for research in this important area.

Systematic Review: Occupational illness in the waste and recycling sector

BACKGROUND

The waste and recycling sector is a growing part of industry. Whether health surveillance is indicated and how it should be undertaken is unclear.

AIMS

To undertake a review of the literature to identify hazards to health, biological effects and occupational illnesses for workers in the sector.

METHODS

A systematic review of the published literature and two UK databases.

RESULTS

Rates of fatal, non-fatal injuries and self-reported work-related illness were found to be higher in the waste and recycling sector than in UK industry as a whole. There was an increased prevalence of respiratory, gastro-intestinal and skin complaints in workers exposed to compost relative to controls. They may also be at increased risk of extrinsic allergic alveolitis, allergic bronchopulmonary aspergillosis, occupational asthma and abnormalities of lung function. Workers involved with the recycling of batteries and cables may be at risk of lead poisoning and exposure to other heavy metals. There were case reports of mercury poisoning from the recycling of fluorescent lights. Cases of occupational asthma have been reported in association with wood and paper recycling. The recycling of e-waste may cause exposure to heavy metals and organic pollutants, such as polybrominated diphenyl ethers, dioxins and polyaromatic hydrocarbons, which have been associated with damage to DNA and adverse neonatal outcomes.

CONCLUSIONS

Ill-health and adverse biological effects have been described in waste and recycling workers, but their true prevalence has probably not been captured. Targeted health surveillance may be required to assess exposure and to identify occupational illness.

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.

Metal Exposure and Associated Health Risk to Human Beings by Street Dust in a Heavily Industrialized City of Hunan Province, Central China

Fifty-five urban street dust samples were collected from Zhuzhou, an industrial city in central China and analyzed for a range of toxic elements. Potential carcinogenic and non-carcinogenic health effects on children and adults due to exposure to street dust were assessed. Concerning the two subgroups, the child cohort is confronted with considerably greater health risks than adults. According to the Hazard Quotient (HQ) method, ingestion of dust particles poses primary risk to children and adults, followed by dermal contact and inhalation for all of the metals investigated except Hg, for which inhalation of its elemental vapor constitute a slightly higher risk than ingestion. For children, Pb, As, Cd, Cr, Hg and Sb exposure were deemed as the highest contributors to non-cancer health risks, while As and Cr represent an enhanced cancer risk for children. For adults, risk indicator values for both cancer and non-cancer effects obtained were within the safety threshold. In a comparison with other locations within and outside mainland China, exposure to arsenic is prominent for the population of Zhuzhou, indicating more attention and preventive actions should been taken.

Exposure to lead in South African shooting ranges

INTRODUCTION

Lead exposure in shooting ranges has been under scrutiny for decades, but no information in this regard is available in respect of African settings, and in South Africa specifically. The aim of this study was to determine the blood lead levels in the users of randomly selected private shooting ranges in South Africa's Gauteng province.

METHODS

An analytical cross sectional study was conducted, with participants recruited from four randomly selected shooting ranges and three archery ranges as a comparator group.

RESULTS

A total of 118 (87 shooters and 31 archers) were included in the analysis. Shooters had significantly higher blood lead levels (BLL) compared to archers with 36/85 (42.4%) of shooters versus 2/34 (5.9%) of archers found to have a BLL ≥10μg/dl (p<0.001).

CONCLUSION

Shooting ranges may constitute an import site of elevated exposure to lead. Improved ventilation, low levels of awareness of lead hazards, poor housekeeping, and inadequate personal hygiene facilities and practices at South African shooting ranges need urgent attention.

Child Exposure to Lead in the Vicinities of Informal Used Lead-Acid Battery Recycling Operations in Nairobi Slums, Kenya

BACKGROUND

Child exposure to lead from informal used lead-acid battery (ULAB) recycling operations is a serious environmental health problem, particularly in developing countries.

OBJECTIVES

We investigated child exposure to lead in the vicinities of ULAB recycling operations in the Dandora, Kariobangi and Mukuru slums in Nairobi between January and August 2015.

METHODS

Top soil (n = 232) and floor dust (n = 322) samples were collected from dwelling units (n = 120) and preparatory schools (n = 44) and analyzed using an inductively coupled plasma-optical emission spectrometer at the Mines and Geological Department Laboratory in the Ministry of Mining, Nairobi. From the obtained lead levels in soil and house dust, child blood lead levels were subsequently predicted using the Integrated Exposure Uptake Biokinetic Model for Lead in Children (IEUBK), Windows version.

RESULTS

Lead loadings in all the floor dust samples from the Dandora, Kariobangi and Mukuru slums exceeded the United States Environmental Protection Agency (USEPA) guidance value for lead on floors with a range of 65.2 - 58,194 μg/ft2. Control floor dust samples recorded lower lead loadings compared to the Dandora, Kariobangi and Mukuru slums. Lead concentration in 70.7% of the soil samples collected from waste dumps, industrial sites, residential areas, playgrounds and preparatory schools in Dandora, Kariobangi and Mukuru exceeded the respective USEPA guidance values for lead in soils. Lead concentration in 100% of control soil samples were below the respective USEPA limits. The IEUBK model predicted that nearly 99.9% of children ≤ 7 years old living near informal ULAB recycling operations in Dandora, Kariobangi and Mukuru were at risk of being lead poisoned, with predicted blood lead levels (BLL) above the Centers for Disease Control (CDC) reference value for blood lead. A total of 99.9% of exposed children living in the Mukuru slums are likely to have BLL above 34 μg/dL.

CONCLUSIONS

There is a need for coordinated efforts to decrease lead emissions from informal battery recycling in Nairobi slums and to remediate existing soils, particularly around battery workplaces and dumpsites. The BLL of local children should be clinically tested and appropriate intervention measures taken.

Elevated Concentrations of Lead in Particulate Matter on the Neighborhood-Scale in Delhi, India As Determined by Single Particle Analysis

High mass concentrations of atmospheric lead particles are frequently observed in the Delhi, India metropolitan area, although the sources of lead particles are poorly understood. In this study, particles sampled across Delhi (August - December 2008) were analyzed by computer-controlled scanning electron microscopy with energy dispersive X-ray spectroscopy (CCSEM-EDX) to improve our understanding of the spatial and physicochemical variability of lead-rich particles (>90% lead). The mean mass concentration of lead-rich particles smaller than 10 μm (PM10) was 0.7 μg/m(3) (1.5 μg/m(3) std. dev.) with high variability (range: 0-6.2 μg/m(3)). Four samples (16% of 25 samples) with PM10 lead-rich particle concentrations >1.4 μg/m(3) were defined as lead events and studied further. The temporal characteristics, heterogeneous spatial distribution, and wind patterns of events, excluded regional monsoon conditions or common anthropogenic sources from being the major causes of the lead events. Individual particle composition, size, and morphology analysis indicate informal recycling operations of used lead-acid batteries as the likely source of the lead events. This source is not typically included in emission inventories, and the observed isolated hotspots with high lead concentrations could represent an elevated exposure risk in certain neighborhoods of Delhi.

Preeclampsia and toxic metals: a case-control study in Kinshasa, DR Congo

BACKGROUND

Preeclampsia is frequent in Kinshasa (Democratic Republic of Congo), especially during the dry season. We tested whether preeclampsia was associated with exposure to environmental metals.

METHODS

Using a case-control design, 88 women hospitalized with preeclampsia (cases) and 88 healthy pregnant women from the antenatal clinic (controls) were included in the study; 67 and 109 women were enrolled during the rainy and dry season, respectively. The concentrations of 24 elements were quantified by inductively coupled plasma mass spectrometry (ICP-MS) in 24-h urine collections. Differences in the urinary excretion of metals were investigated between cases and controls, and the interaction with season was assessed.

RESULTS

Cases and controls were well matched regarding age, parity and duration of pregnancy. In controls, the urinary concentrations of most elements were substantially higher than reference values for adults from industrially developed countries, e.g. for lead: geometric mean (GM) 8.0 μg/L [25(th)-75(th) percentile 3.1-13.8]. The daily urinary excretions of 14 metals were significantly higher in women with preeclampsia than in control women, e.g. for lead: GM 61 μg/day (25(th)-75(th) percentile 8-345) in women with preeclampsia vs 9 μg/day (25(th)-75(th) percentile 3-21) in controls (p < 0.001). A significant interaction was found between season and preeclampsia for several elements, with higher urinary excretions in preeclamptic women than controls during the dry season, but not during the rainy season.

CONCLUSIONS

This study revealed not only that women with preeclampsia excrete higher amounts of several toxic metals, especially lead, than control women, but also that this excretion exhibits seasonal variation, thus possibly explaining the high incidence and seasonal variation of preeclampsia in Kinshasa. Although the exact sources of this exposure are unknown, these findings underscore the need for preventing environmental exposures to lead and other toxic metals.

Health risks of children's cumulative and aggregative exposure to metals and metalloids in a typical urban environment in China

Rapid development of industrialization and urbanization results in serious environmental contamination by metal(loid)s, which would consequently cause deleterious health effects to the exposed people through multi-pathways. Therefore, total health risk assessment for the population in urban environment is very important. Unfortunately, few studies to date investigate the cumulative health risks of metal(loid)s through aggregative pathways in Children who are often susceptible population. 12 metal(loid)s including Lead(Pb), Cadmium(Cd), Arsenic(As), Chromium(Cr), Zinc(Zn), Copper(Cu), Nickel(Ni), Manganese(Mn), Cobalt(Co), Selenium(Se), Antimony(Se) and Vanadium(V), were analyzed in PM10, drinking water, food, soil and indoor dust in this study. The cumulative and aggregative risks of these metal(loid)s among the local children were then evaluated on a field sampling and questionnaire-survey basis. The results showed that the environments were heavily polluted by metal(loid)s. For most metal(loid)s, food ingestion accounted for more than 80% of the total daily exposure dose. The non-cancer risks were up to 30 times higher than the acceptable level due to the food ingestion via Pb, Cr, Cu, Zn, As, Se, Cd and Sb, and the PM10 inhalation via Cr and Mn. While, the cancer risks were mainly attributed to Cr via food ingestion and As via food and dust ingestion, and approximately 100 times of the maximum acceptable level of 1.0 × 10(-4). The study highlights the cumulative and aggregative exposure assessment, instead of pollutant investigation to evaluate the potential health risks and emphasizes concerns to improve indoor hygienic and environmental quality and to decrease the potential harmful health effects of children living in urban area.

Low Levels of Awareness of Lead Hazards among Pregnant Women in a High Risk--Johannesburg Neighbourhood

Background: The widespread use of lead and elevated risk of lead exposure in South African children justifies a need for high levels of awareness of the sources, exposure pathways, and measures to reduce this risk in children. This study aimed to determine the levels of knowledge of lead hazards among pregnant women in an area where children had already been established to be at a high risk of lead exposure and poisoning. Methods: Following informed consent, a structured questionnaire was administered to 119 pregnant women attending antenatal clinic services at Rahima Moosa Mother and Child Hospital, west of central Johannesburg. Questions were asked about social, demographic and residential characteristics, as well as knowledge, perceptions, behaviours and practices in relation to child lead hazards. Conclusion: Overall awareness of the dangers of lead in pregnancy was low (11%). Amongst those who had heard of it, only 15% thought that lead could cause detrimental health effects. A consequence of this low level of awareness of lead hazards is a high potential for the participants and their children to unwittingly be exposed to environmental lead from various sources, thereby undermining preventative approaches.

Childhood Lead Exposure from Battery Recycling in Vietnam

Background. Battery recycling facilities in developing countries can cause community lead exposure. Objective. To evaluate child lead exposure in a Vietnam battery recycling craft village after efforts to shift home-based recycling outside the village. Methods. This cross-sectional study evaluated 109 children in Dong Mai village, using blood lead level (BLL) measurement, parent interview, and household observation. Blood samples were analyzed with a LeadCare II field instrument; highest BLLs (≥45 μg/dL) were retested by laboratory analysis. Surface and soil lead were measured at 11 households and a school with X-ray fluorescence analyzer. Results. All children had high BLLs; 28% had BLL ≥45 μg/dL. Younger age, family recycling, and outside brick surfaces were associated with higher BLL. Surface and soil lead levels were high at all tested homes, even with no recycling history. Laboratory BLLs were lower than LeadCare BLLs, in 24 retested children. Discussion. In spite of improvements, lead exposure was still substantial and probably associated with continued home-based recycling, legacy contamination, and workplace take-home exposure pathways. There is a need for effective strategies to manage lead exposure from battery recycling in craft villages. These reported BLL values should be interpreted cautiously, although the observed field-laboratory discordance may reflect bias in laboratory results.

Health seeking behaviours among electronic waste workers in Ghana

BACKGROUND

Electronic waste workers are prone to various illnesses and injuries from numerous hazards thus the need for them to seek health care. The aim of this study was to describe health-seeking behavior, and social and other factors affecting this behavior, among electronic waste workers at Agbogbloshie, Accra, Ghana.

METHODS

In-depth interviews were conducted and analyzed qualitatively from a grounded theory perspective.

RESULTS

Workers experienced various kinds of ailments. These included physical injuries, chest and respiratory tract associated symptoms, malaria, headaches, body pains and stomach discomfort. They reported seeking health care from multiple sources, and the main determinants of health seeking behaviour were severity of illness, perceived benefit of treatment, accessibility of service, quality of service, ease of communication with service provider and cost of health care.

CONCLUSION

Multiple sources of health care were used by the e-waste workers. As cost was a major barrier to accessing formal health care, most of the workers did not subscribe to health insurance. Since enrollment in health insurance is low amongst the workers, education campaigns on the need to register with the National Health Insurance Scheme would facilitate access to formal health care and could result in improved health outcomes among e-waste workers.

[Gunshot wounds: should projectiles and fragments always be removed?]

BACKGROUND

Projectiles or metal fragments can remain lodged in the body of victims of gunshot injuries. This also applies to projectiles which do not tend to deform or fragment on impact. When a projectile fragments on penetration, jacket or lead core particles are likely to remain lodged in the affected region even if the projectile has exited the body.

AIM OF THE STUDY

A frequently asked question in the surgical management of such injuries is whether there are medical indications for the surgical removal of projectiles or fragments.

MATERIAL AND METHODS

This article presents some typical cases of patients who have received treatment at our institution and reviews the pertinent literature to show general recommendations in special cases concerning the removal of projectiles or fragments and when additional surgical trauma is justified. Parameters for decision making are presented in an algorithm.

RESULTS

From our own patients, 5 with remaining fragments in the soft tissue were invited for a clinical follow up. Serum probes and 24 h urine output was analysed for serum lead levels and urinary aminolevulinic acid levels. 74 months (max. 128 - min. 42 months) after injury we documented not elevated serum lead levels of 8.25 μg/ml and urinary aminolevulinic acid levels of 4.8 mg/24 h.

DISCUSSION

When lead-containing projectiles or fragments remain lodged in the body, monitoring is required and includes the measurement of serum lead levels and urinary aminolevulinic acid levels. The most important clinical symptoms of lead poisoning are gastrointestinal and neurological in nature. The treatment of choice for lead poisoning is the administration of chelating agents and removal of the lead source by surgical intervention.

Health risk assessment of various metal(loid)s via multiple exposure pathways on children living near a typical lead-acid battery plant, China

Manufacture of lead-acid batteries is of widespread interest because of its emissions of heavy metals and metalloids into environment, harming environmental quality and consequently causing detrimental effects on human health. In this study, exposure pathways and health risks of children to heavy metal(loid)s (Pb, Cd, As, etc) were investigated based on field sampling and questionnaire. Pb was one of the most abundant elements in children's blood, with an elevated blood lead level of 12.45 μg dL(-1). Soil/dust and food were heavily polluted by targeted metal(loid)s. Food ingestion accounted for more than 80% of the total exposure for most metal(loid)s. The non-cancer risks to children were 3-10 times higher than the acceptable level of 1, while the cancer risks were 5-200 times higher than the maximum acceptable level of 1.0 × 10(-4). The study emphasized the significance of effective environmental management, particularly to ensure food security near battery facilities.

Screening for childhood lead poisoning in the industrial region of Fez, Morocco

The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 μg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.

The extent, nature and environmental health implications of cottage industries in Johannesburg, South Africa

Cottage industries comprise a sub-group of informal sector income generation activities which are conducted in the home environment and organized around families or households. Cottage industry workers may be at risk of exposure to harmful substances associated with their work, and given the lack of separation of cottage industry activities from living spaces, their families and neighbors may similarly be at risk of exposure. This study was undertaken to determine the extent and nature of cottage industries in five neighborhoods in Johannesburg (South Africa) A cross-sectional survey was conducted across five communities in Johannesburg in 2012. Data on metal-related cottage industry activities were collected through the administration of a pre-structured questionnaire. Metal-related cottage industry activities were defined as car repairs, spray painting, scrap metal recycling, electrical appliance repairs, welding, hairdressing and metal jewelry making. One fifth of the households interviewed were operating one or more cottage industries associated with the use of toxic substances. Therefore, the potential exists for associated ill health effects in a considerable proportion of the population. Further research is needed to fully assess exposure to the harmful aspects of cottage industry, as are scaled up campaigns to increase awareness of the risks and correct handling of toxic substances.

Environmental exposures, socioeconomics, disparities, and the kidneys

Kidney disease disproportionately affects racial and ethnic minority populations, the poor, and the socially disadvantaged. The excess risk of kidney disease among minority and disadvantaged populations can only be partially explained by an excess of diabetes, hypertension, and poor access to preventive care. Disparities in the environmental exposure to nephrotoxicants have been documented in minority and disadvantaged populations and may explain some of the excess risk of kidney disease. High-level environmental and occupational exposure to lead, cadmium, and mercury are known to cause specific nephropathies. However, there is growing evidence that low-level exposures to heavy metals may contribute to the development of CKD and its progression. In this article, we summarize the excess risk of environmental exposures among minority and disadvantaged populations. We also review the epidemiologic and clinical data linking low-level environmental exposure to lead, cadmium, and mercury to CKD and its progression. Finally, we briefly describe Mesoamerican nephropathy, an epidemic of CKD affecting young men in Central America, which may have occupational and environmental exposures contributing to its development.

Bioaccessibility of lead in airborne particulates from car battery repair work

The bioaccessibility of Pb in air particulate matter from two car battery repair workshops in Kumasi (Ghana) was measured (64 full shift personal aerosol samples). An artificial lung lining fluid simulant (Hatch solution) was applied for leaching the bioaccessible fraction in half of the samples, the other half was leached with synthetic gastric juice. At both locations, the Pb solubility (median) in gastric juice (89% and 92%) is substantially higher than in Hatch solution (4.9% and 5.6%). The high solubility of Pb in gastric juice may be related to the presence of Pb oxides. The low bioaccessibility of Pb in Hatch solution is in good agreement with previous work on mine tailings, urban aerosol, car exhaust, welding fumes and indoor dust. The high bioaccessibility of Pb in the gastrointestinal tract underpins the importance of improving the personal hygienic behavior at the workplace. It is recommended that air monitoring of Pb should include the extrathoracic aerosol fraction using inhalable aerosol samplers, as particles of this size fraction are most likely transferred to the gastrointestinal tract in addition to the non-lung-soluble particles transported from the lung by mucociliary and phagocytosis clearance.

Description of 3,180 courses of chelation with dimercaptosuccinic acid in children ≤ 5 y with severe lead poisoning in Zamfara, Northern Nigeria: a retrospective analysis of programme data

BACKGROUND

In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ≤ 5 y of age with severe paediatric lead intoxication reported to date to our knowledge.

METHODS AND FINDINGS

In a retrospective analysis of programme data, we describe change in VBLL after DMSA treatment courses in a cohort of 1,156 children ≤ 5 y of age who underwent between one and 15 courses of chelation treatment. Courses of DMSA of 19 or 28 d duration administered to children with VBLL ≥ 45 µg/dl were included. Impact of DMSA was calculated as end-course VBLL as a percentage of pre-course VBLL (ECP). Mixed model regression with nested random effects was used to evaluate the relative associations of covariates with ECP. Of 3,180 treatment courses administered, 36% and 6% of courses commenced with VBLL ≥ 80 µg/dl and ≥ 120 µg/dl, respectively. Overall mean ECP was 74.5% (95% CI 69.7%-79.7%); among 159 inpatient courses, ECP was 47.7% (95% CI 39.7%-57.3%). ECP after 19-d courses (n = 2,262) was lower in older children, first-ever courses, courses with a longer interval since a previous course, courses with more directly observed doses, and courses with higher pre-course VBLLs. Low haemoglobin was associated with higher ECP. Twenty children aged ≤ 5 y who commenced chelation died during the period studied, with lead poisoning a primary factor in six deaths. Monitoring of alanine transaminase (ALT), creatinine, and full blood count revealed moderate ALT elevation in <2.5% of courses. No clinically severe adverse drug effects were observed, and no laboratory findings required discontinuation of treatment. Limitations include that this was a retrospective analysis of clinical data, and unmeasured variables related to environmental exposures could not be accounted for.

CONCLUSIONS

Oral DMSA was a pharmacodynamically effective chelating agent for the treatment of severe childhood lead poisoning in a resource-limited setting. Re-exposure to lead, despite efforts to remediate the environment, and non-adherence may have influenced the impact of outpatient treatment. Please see later in the article for the Editors' Summary.

Towards the prevention of lead exposure in South Africa: contemporary and emerging challenges

The prevention of lead exposure continues to constitute a major public health challenge in developed countries. In well-resourced countries major lead exposure reduction interventions have resulted in significant improvements in childhood blood lead distributions. In developing countries on the other hand, while lead exposure and poisoning remain serious public health concerns, a range of prevailing factors and circumstances, such as poverty, a large informal sector, competing public health challenges, low levels of awareness of lead hazards and weak capacity to enforce legislation, contribute to an increase in the scale and intensity of the challenge, and limit the prospects of comparable success in the foreseeable future. This paper collates available information to illustrate that despite some progress, a wide range of sources of lead exist in South Africa, and that certain settings and groups continue to be at high risk of lead exposure. Lead exposure in relation to paint, mining, lead melting in subsistence fishing communities, the consumption of Ayurvedic medicines and food production is described, and discussed with regard to the key factors hindering efforts to prevent lead poisoning and exposure in South Africa and many other developing countries.

The pediatric burden of disease from lead exposure at toxic waste sites in low and middle income countries

BACKGROUND

The impact of lead from toxic waste sites on children in low and middle income countries has not been calculated due to a lack of exposure data. We sought to calculate this impact in Disability Adjusted Life Years (DALYs).

MATERIALS AND METHODS

Using an Integrated Exposure Uptake Biokinetic (IEUBK) model, we converted soil and drinking water lead levels from sites in the Blacksmith Institute's Toxic Sites Identification Program (TSIP) into mean blood lead levels (BLLs). We then calculated the incidence of mild mental retardation (MMR) and DALYs resulting from these BLLs.

RESULTS

The TSIP included 200 sites in 31 countries with soil (n=132) or drinking water (n=68) lead levels, representing 779,989 children younger than 4 years of age potentially exposed to lead. Environmental lead levels produced a range of BLLs from 1.56 to 104.71 µg/dL. These BLLs equated to an estimated loss of 5.41-8.23 IQ points, resulting in an incidence of MMR of 6.03 per 1000 population and 76.1 DALYs per 1000 population.

DISCUSSION

Soil and water lead levels at toxic waste sites predict BLLs that lower the intelligence quotient (IQ), with the resulting MMR potentially limiting individual- and country-level development. The preventable burden of disease produced by these sites highlights the need for toxic waste sites to be systematically identified, evaluated, and remediated.