Risk factors for children's blood lead levels in metal mining and smelting communities in Armenia: a cross-sectional study

How does formal and informal industry contribute to lead exposure? A narrative review from Vietnam, Uruguay, and Malaysia

INTRODUCTION

Lead industries are one of the major sources of environmental pollution and can affect human through different activities, including industrial processes, metal plating, mining, battery recycling, etc. Although different studies have documented the various sources of lead exposure, studies highlighting different types of industries as sources of environmental contamination are limited. Therefore, this narrative review aims to focus mainly on lead industries as significant sources of environmental and human contamination.

CONTENT

Based on the keywords searched in bibliographic databases we found 44 relevant articles that provided information on lead present in soil, water, and blood or all components among participants living near high-risk areas. We presented three case scenarios to highlight how lead industries have affected the health of citizens in Vietnam, Uruguay, and Malaysia.

SUMMARY AND OUTLOOK

Factories conducting mining, e-waste processing, used lead-acid battery recycling, electronic repair, and toxic waste sites were the primary industries for lead exposure. Our study has shown lead exposure due to industrial activities in Vietnam, Uruguay, Malaysia and calls for attention to the gaps in strategic and epidemiologic efforts to understand sources of environmental exposure to lead fully. Developing strategies and guidelines to regulate industrial activities, finding alternatives to reduce lead toxicity and exposure, and empowering the public through various community awareness programs can play a crucial role in controlling exposure to lead.

Association between lead source exposure and blood lead levels in some lead manufacturing countries: A systematic review and meta-analysis

Lead is one of the 10 most toxic chemicals of greatest concern for its effects on public health. Predominantly, in undeveloped countries, high blood lead levels (BLLs) persist in the population. To develop intervention strategies that may reduce lead exposure in populations, it is a priority to know the sources of lead pollution. The objective of this critical review and meta-analysis is to assess whether there is an association between different sources of lead exposure and the mean difference in blood lead levels in people exposed. To identify the major lead source exposure, a statistical analysis was performed on selection studies. This investigation reveals the limited information available on the sources of lead in Mexico and other lead producer countries, such as Croatia, Ecuador, Brazil, South Korea, India, Nigeria, Turkey, and China. Meta-analysis could be performed only in battery, smelting mining, and glazed ceramic workers. Battery manufacturing workers have the highest mean difference level of lead in their blood worldwide. Mexico has the second highest mean difference BLL in battery workers in the world. An interesting difference between the mean difference in BLL in mining workers from uncontrolled industry (-39.38) and controlled industry (-5.68) was found. This difference highlighted the success of applying strict control of lead sources and community education to reduce BLL and its potential harmful effects on human health and the environment. Children living near mining sites have the highest mean difference BLL (-11.1). This analysis may aid in assessing the source of lead exposure associated with a range of BLLs in people. Furthermore, this review highlights several social and cultural patterns associated with lead exposure and lead levels in control populations. These results could help to develop international lead regulations and appropriate public health guidelines to protect people around the world.

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

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

Social and spatial distribution of soil lead concentrations in the City of Santa Ana, California: Implications for health inequities

BACKGROUND

Lead (Pb) exposure is a problem that disproportionately impacts low-income communities and communities of color. We applied a community-based participatory research approach to assess the distribution of soil Pb concentrations and related social vulnerabilities across Census tracts in Santa Ana, CA.

METHODS

Soil Pb samples (n = 1528) were collected by the ¡Plo-NO! Santa Ana! Lead-Free Santa Ana! partnership in 2018 across Santa Ana, CA, at a high spatial resolution and measured using XRF analysis. Pb concentrations were mapped and spatial interpolation was conducted to generate a continuous smoothed map of soil Pb concentrations across the city. American Community Survey data was used to examine Pb across Census tracts based on social and economic factors, and to allow for the development of a Cumulative Risk Index to identify areas at high risk of health impacts.

RESULTS

Soil Pb concentrations varied by landuse type and socioeconomic factors. Census tracts with a median household income below $50,000 had over five times higher soil Pb concentrations than high-income Census tracts. Soil samples collected in tertiles with the highest percent children, residents without health insurance, renter-occupied housing units, and lowest percent college educated residents had 90.0%, 96.1%, 75.2%, and 87.0% higher Pb concentrations on average, respectively, compared to their counterparts. Overall, 52.7% of residential samples had Pb concentrations in excess of the 80 ppm California EPA recommendation, and 11 Census tracts were characterized as high risk according to our Cumulative Risk Index.

DISCUSSION

This study underscores the need for precautionary measures relating to disturbances of the soil, particularly for areas where children play outside, given children's higher absorption of lead. It also informs environmental justice initiatives and identifies vulnerable subpopulations at greater risk of Pb exposure, thus warranting community-driven recommendations for policies and initiatives to remediate soil Pb and protect public health and health equity.

Childhood lead poisoning in Gaza Strip, the Palestinian Authority

PURPOSE

To assess lead poisoning among a pediatric population in Gaza Strip, the Palestinian Authority.

METHODS

A total of 1705 questionnaires and blood samples were collected from children aged 2-6 years, by the finger stick capillary procedure, for the assessment of blood lead level (BLL), using the LeadCare kits. The samples were collected from children living close to lead processing units (hotspots) and far 100-500 m away (general population). Management of elevated BLL was achieved by gavage of chelating agent d-penicillamine at a dose of 30 mg kg^-1 body weight/day for two weeks for children having BLL above 20 μg/dl. Data were statistically analyzed using SPSS computer program version 22.

RESULTS

Distribution of children in Gaza Strip by sampling process illustrated those 326 children (19.1%) living in lead processing units (hot spots) and 1379 children (80.9%) from location far away 100-500 m from host spot (general population). The mean BLL was 10.4 μg/dl. A total of 440 children (25.8%) were found to be having BLL ≥ 10 μg/dl while 1265 children (74.2%) have BLL < 10 μg/dl. BLL < 10 μg/dl was taken as a cut point due to CDC standards. The prevalence of BLL in hotspot areas in children who were exposed to lead and have BLL ≥ 10 μg/dl was 95.7% while in general population it was 9.3%. The difference between the study population was statistically significant (p < 0.01). Statistical significant differences between the study populations were found among several independent variables of risk factors such as household location and exposure sources, and occupational exposure. Gavage of d-penicillamine significantly reduced BLL to the acceptable level (BLL < 10 μg/dl).

CONCLUSIONS

Childhood lead poisoning accounts for a substantial burden in Gaza Strip. Hotspots of lead-related industries are the high risk areas that contributing to high BLLs in children. d-Penicillamine was effective in the treatment of lead poisoning among children. Health education and treatment campaigns should be designed to minimize or prevent childhood lead poisoning in Gaza Strip.

Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like behavior

BACKGROUND AND OBJECTIVE

Mounting evidence showed that lead exposure increased the risk of child attention-deficit-hyperactivity disorder (ADHD). Epidemiologic studies have typically used the blood-lead as a biomarker of lead exposure; blood-lead levels mostly reflect recent lead exposure. However, few studies have examined the relationship between bone-lead, a biomarker of cumulative exposure, and ADHD. Therefore, we aimed to compare the associations of bone-lead vs blood-lead levels with child ADHD symptoms and comorbidities.

METHODS

A total of 164 children aged 3-15 years were enrolled during 2014-2015. The Vanderbilt-ADHD-Diagnostic-Parent-Rating Scale (VADPRS) was used to evaluate the children's ADHD symptoms and comorbidities. Children's blood and bone lead concentrations were assessed, the latter using a non-invasive K-X-ray-fluorescence technique. According to blood-lead levels, children were classified into high (blood-lead ≥ 10.0 μg/dL) and low (blood-lead < 10.0 μg/dL) blood-lead groups. According to bone-lead levels, children were classified into high (bone-lead ≥ 2.66 μg/g) and low (bone-lead < 2.66 μg/g) bone-lead groups. We associated blood/bone lead with VADPRS data using multi-variable binary logistic regression models.

RESULTS

Children in the high blood-lead group had higher hyperactivity/impulsivity (P = 0.02) scores than the corresponding low blood-lead group. Children in the high bone-lead group had higher hyperactivity/impulsivity (P = 0.02) and oppositional-defiant-disorder (ODD) (P = 0.03) scores than the corresponding low bone-lead group. After adjusting for relevant confounders, children in the high bone-lead group were more likely to have ODD-behavior than the low group (OR = 6.7, 95%CI: 1.2-36.5). However, no adjusted association was observed between blood-lead and any ADHD-domain score.

CONCLUSION

High levels of cumulative lead exposure in children may be an independent risk factor of ODD-behavior.

The State of Public Health Lead Policies: Implications for Urban Health Inequities and Recommendations for Health Equity

Although lead has been removed from paint and gasoline sold in the U.S., lead exposures persist, with communities of color and residents in urban and low-income areas at greatest risk for exposure. The persistence of and inequities in lead exposures raise questions about the scope and implementation of policies that address lead as a public health concern. To understand the multi-level nature of lead policies, this paper and case study reviews lead policies at the national level, for the state of California, and for Santa Ana, CA, a dense urban city in Southern California. Through a community-academic partnership process, this analysis examines lead exposure pathways represented, the level of intervention (e.g., prevention, remediation), and whether policies address health inequities. Results indicate that most national and state policies focus on establishing hazardous lead exposure levels in settings and consumer products, disclosing lead hazards, and remediating lead paint. Several policies focus on mitigating exposures rather than primary prevention. The persistence of lead exposures indicates the need to identify sustainable solutions to prevent lead exposures in the first place. We close with recommendations to reduce lead exposures across the life course, consider multiple lead exposure pathways, and reduce and eliminate health inequities related to lead.

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

BACKGROUND

The ger ("tent city") areas in Mongolia are a product of rapid urbanization and transitional economic development combine with lack of institutional, administrative and financial capacity of governments to cope with the pace. These areas have become traps for inequities in social and environmental services and the associated effects on human health. Disparities in childhood lead exposure in such communities are largely unexplored.

METHODS

We measured the concentrations of lead in blood of children, aged 4-7 years, in Erdenet (Orkhon Province) and Darkhan (Darkhan-Uul Province), the second and third largest cities in Mongolia. A survey instrument was used to gather information on influencing factors on lead exposure and the Strengths and Difficulties Questionnaire (SDQ) was used to assess a spectrum of behavioral problems among the children.

RESULTS

The mean blood lead level (BLL) of children in the two cities was found to be 3.8 ± 2.6 μg/dL (range: < 1.5-17.2 μg/dL) and 27.8% of the children had BLLs ≥5 μg/dL. Average BLL of children in Erdenet (a mining center) was significantly higher than that for children in Darkhan, and there was statistically significant difference between average BLL of children who live in ger district (4.2 ± 2.8 μg/dL) compared to those of children in housing units within the city (3.2 ± 2.4 μg/dL). In spite of the low values, BLLs was significantly associated with a number of effects on the spectrum of behavioral disorders, specifically with the scores for hyperactivity, conduct disorder and pro-social behavior.

CONCLUSIONS

This study shows that childhood lead poisoning is common especially in ger communities of the urban areas of Mongolia. It contributes evidence showing that BLL low as 3.8 μg/dL can selectively activate some effects from a spectrum of likely behavioral disorders in children.

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

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

Environmental Lead Exposure and Adult Literacy in Myanmar: An Exploratory Study of Potential Associations at the Township Level

Environmental lead exposure is a population health concern in many low- and middle-income countries. Lead is found throughout Myanmar and prior to the 1940s the country was the largest producer of lead worldwide. The aim of this study was to examine any potential association between lead mining and adult literacy rates at the level of 330 townships in Myanmar. Townships were identified as lead or non-lead mining areas and 2015 census data were examined with association being identified using descriptive, analytical and spatial statistical methods. Overall, there does appear to be a significant relationship between lead mining activity and adult literacy levels among townships with both low access (p = 0.05; OR = 2.701 (1.136–6.421)) as well with high access to safe sanitation (p = 0.01; OR = 18.40 (1.794–188.745)). Local Indicators of Spatial Association (LISA) cluster maps confirm these findings. This exploratory analysis is a first step in the examination of potential environmental lead exposure and its implications in Myanmar.