Effectiveness of introducing point of care capillary testing and linking screening with routine appointments for increasing blood lead screening rates of young children: a before-after study

Abstract

BackgroundLead has significant neuro-toxic effects, particularly for young children. Voluntary screening of pre-school aged children for elevated blood lead levels has been an important part of the lead management program in the mining town of Broken Hill (NSW, Australia) since 1991, where lead remains a significant public health issue for young children despite average blood lead levels having fallen by two-thirds. The annual proportion of children screened declined to 0.39 in 2008. The objective of this study was to determine the impact of changing to capillary screening and linking screening with existing routine health programs on participation in blood lead screening by young children in the community.MethodsWe used a before-after study. Screening rates were determined from routinely collected service data and analysed using cross-sectional and cohort analyses.ResultsThe proportion of children screened annually increased from 0.39 in 2008 to 0.75 in 2012, with the greatest increases among 11–23 and 48–59 month old children. The proportion of children screened at least once by 24 months increased from 0.63 for children born in 2007 to 0.98 for children born in 2010. Attendance stabilized after capillary screening was introduced, and increased markedly after screening was offered at immunization.ConclusonsChanging from venous to capillary screening stabilized attendance and improving convenience was associated with dramatically increased screening. Linking screening with well-accepted mainstream child health programs is an effective strategy to improve participation in blood lead screening programs. The findings have implications for improving participation in other health screening programs.

A Pilot Study of Children’s Blood Lead Levels in Mount Isa, Queensland

“…The use of rapid point-of-care capillary testing, which is less invasive and provides immediate results, may reduce parental concerns about the discomfort to children from venous blood lead testing. Capillary testing can be used at clinic sites to screen all children annually at immunisation visits, which has been a successful approach in Broken Hill [ 40 ]. Screening can also be conducted annually at community daycare centres, and blood lead testing can be required for annual entrance to these locations.…”

Blood lead levels among Broken Hill children born 2009–2015: a longitudinal study to inform prevention strategies

“…Blood lead testing was conducted using capillary blood collected via finger prick. 17,18 A confirmatory venous blood test was offered for children with BLLs ≥10 µg/ dL. Not all parents gave permission for the confirmatory test, particularly for children with BLLs in the 10-14 µg/dL range.…”

House Sparrows as Sentinels of Childhood Lead Exposure

“…The LeadCare II instrument has a narrower detection range (3.3–65.0 μg/dL) than the LeadCare Plus instrument and this may lead to an overestimation of child blood Pb levels in some contexts. However, a comparison of results obtained from the LeadCare II instrument with previous data from analyses using inductively coupled plasma mass spectrometry did not indicate a consistent change in blood Pb across the population of screened children . Sparrow blood Pb data obtained from the LeadCare Plus instrument was validated with inductively coupled plasma mass spectrometry (ICP-MS) of paired blood samples taken from the same sparrow, as detailed below.…”