Blood lead levels in low-income and middle-income countries: a systematic review

Ericson, Bret; Hu, Howard; Nash, Emily; Ferraro, Greg; Sinitsky, Julia; Taylor, Mark Patrick

doi:10.1016/s2542-5196(20)30278-3

Cited by 82 publications

(76 citation statements)

References 21 publications

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“…Leaded petrol was still in use in nine mostly low income countries as late as 20099 but as of 2021 was entirely phased out 11. Para-occupational or environmental exposure, as well as occupational exposures in pregnant women, are significant sources of exposure in low income countries, including in unregulated mining and cottage industries 39…”

Section: What Are the Sources Of Exposure?mentioning

confidence: 99%

“…The diagnosis may be missed or delayed2 as symptoms are not specific. About 48.5% of children in low and middle income countries have high exposure to lead (blood lead concentration (BLC) ≥5 μg/dL (0.24 μmol/L)) as per estimates using data collected since 2004 3. High levels of exposure are increasingly uncommon in high income countries, but vigilance is required owing to globalisation and increased migration, and the continued risk of exposure to lead from its widespread use in the past.…”

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confidence: 99%

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Lead exposure in children

Roberts¹,

Bradberry²,

Butcher³

et al. 2022

BMJ

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Section: What Are the Sources Of Exposure?mentioning

confidence: 99%

mentioning

confidence: 99%

Lead exposure in children

Roberts¹,

Bradberry²,

Butcher³

et al. 2022

BMJ

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“…Numerous comparisons of BLL distributions were made against a recent meta-analysis of BLLs in LMICs (Ericson et al, 2021). This analysis compiled study-wise "pooled" means and standard deviations.…”

Section: Data Processing and Statisticsmentioning

confidence: 99%

“…The majority of children globally with elevated BLLs reside in low-and middle-income countries (LMICs). A recent literature review of BLL data in LMICs determined 'background' (i.e., non-exposed in terms of occupation or nearby point sources) country-level mean childhood BLLs to range between 1.7 and 9.3 µg/dL globally, and that 49% of children in these countries have BLLs exceeding 5 µg/dL (Ericson et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Childhood Blood Lead Levels and Environmental Risk Factors in Madagascar

Champion

Buerck

Nenninger

et al. 2022

Preprint

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One-third of children globally have blood lead levels (BLLs) exceeding the US CDC reference value of 5 µg/dL; this value may be as high as one-half for children in low- and middle-income countries (LMICs). Lead exposure occurs through a variety of routes (e.g., water, dust, air), and in LMICs specifically, informal economies (e.g., battery recycling) can drive lead exposures due in part to absent regulation. Previous work by our team identified a ubiquitous source of lead (Pb), in the form of Pb-containing components used in manually-operated pumps, in Toamasina, Madagascar. Characterization of BLLs of children exposed to this drinking water, and identification of additional exposure routes were needed. BLLs were measured for 362 children (aged 6 mo to 6 yr) in parallel with surveying to assess 14 risk factors related to demographics/socioeconomics, diet, use of pitcher pumps, and parental occupations. BLL data were also compared against a recent meta-review of BLLs for LMICs. Median childhood BLL (7.1 µg/dL) was consistent with those of other Sub-Saharan African LMICs (6.8 µg/dL) and generally higher than LMICs in other continents. Risk factors significantly associated (p<0.05, univariate logistic regression) with elevated BLL (at ≥5 µg/dL) included male gender, living near a railway or major roadway (owing potentially to legacy lead pollution), having lower-cost flooring, daily consumption of foods (beans, vegetables, rice) commonly cooked in recycled aluminum pots (a previously identified lead source for this community), and a maternal occupation (laundry-person) associated with lower socioeconomic status. Findings were similar at the ≥10 µg/dL BLL status. Our methods and findings may be appropriate in identifying and reducing lead exposures for children in other urbanizing cities, particularly in Sub-Saharan Africa, where lead exposure routes are complex and varied owing to informal economics and substantial legacy pollution.

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“…Heavy metals are a common harmful environmental exposure within these settings and are frequently found to exceed the recommended levels. Currently, an estimated 632 million children living in LMICs have a blood lead level greater than the US Centers for Disease Control’s prior public health action level of 5 μg/dL [ 5 ], which was updated in 2021 to be lowered to 3.5 μg/dL [ 6 ]. Over 50 countries, including Bangladesh, Cambodia, Egypt, and Ghana, have levels of manganese exceeding 400 μg/L in their drinking water.…”

Section: Introductionmentioning

confidence: 99%

Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review

et al. 2022

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Background The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases worldwide and detrimentally affects child neurodevelopment. Few resources succinctly summarize the existing literature on this topic. Our objective is to systematically review and characterize the evidence regarding the relationship between heavy metals and neurodevelopment of children in LMICs. Methods We conducted a medical librarian-curated search on multiple online databases to identify articles that included individuals <18 years living in a LMIC, quantitatively measured exposure to a heavy metal (either prenatal or postnatal), and used a standardized measurement of neurodevelopment (i.e. cognitive, language, motor, and behavior). Reviews, editorials, or case studies were excluded. Results were analyzed qualitatively, and quality was assessed. Results Of the 18,043 screened articles, 298 full-text articles were reviewed, and 100 articles met inclusion criteria. The included studies represented data from 19 LMICs, only one of which was classified as a low-income country. Ninety-four percent of postnatal lead and all postnatal manganese studies showed a negative association with metal exposure and neurodevelopment, which were the strongest relationships among the metals studied. Postnatal exposure of mercury was associated with poor neurodevelopment in only half of studies. Limited data on postnatal arsenic and cadmium suggests an association with worse neurodevelopment. Findings were mixed for prenatal arsenic and lead, although some evidence supports that the neurotoxicity of lead was amplified in the presence of manganese. Conclusions and potential impact We found that lead and manganese appear to consistently have a detrimental effect on the neurodevelopment of children, and more evidence is needed for mercury, arsenic, and cadmium. Better characterization of these effects can motivate and inform prioritization of much needed international policies and programs to reduce heavy metal exposures for young children within LMICs.

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Blood lead levels in low-income and middle-income countries: a systematic review

Cited by 82 publications

References 21 publications

Lead exposure in children

Lead exposure in children

Childhood Blood Lead Levels and Environmental Risk Factors in Madagascar

Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review

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