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Environmental Lead: A Public Health Challenge in South Africa

Naicker, Nisha; Mathee, Angela; Barnes, Brendon

doi: 10.1097/EDE.0b013e318296c077

Medical Research Council of South AfricaEnvironment and Health Research UnitHoughton, Johannesburg, South AfricaSchool of Public HealthUniversity of the WitwatersrandJohannesburg, South

School of Human and Community DevelopmentUniversity of the WitwatersrandJohannesburg, South Africa

Supported by The Medical Research Council of South Africa and the National Department of Minerals and Energy of South Africa.

To the Editor:

Blood lead levels in developing countries are generally higher than international guideline levels due to the unabated use of lead in formal and informal industries.1 This is especially worrisome in countries such as South Africa, where there are limited public resources to regulate exposure and mitigate adverse effects. In 2002, a cross-sectional survey had assessed lead exposure in elementary-age children in three South African cities (Kimberley, Cape Town, and Johannesburg), documenting high levels of lead exposure. In 2007, we conducted a follow-up study in elementary-age children attending the same schools in the same cities.

Finger-prick blood tests were conducted using the LeadCare 1 analyser system (ESA Biosciences Inc, Chelmsford, MA). Although this was not the method used in the 2002 survey, this system has been shown to be reliable and with similar results to more formal analytic methods.2,3 The US Centers for Disease Control and Prevention has recently recommended a reference level of 5 µg/dL, based on the US population of children aged 1–5 years. We used this level to dichotomize blood leads.1

A total of 1349 elementary-age students (51% boys and 49% girls) participated in the survey. The mean age was 7.6 years, with ages ranging from 5 to 12 years. Twelve percent were from the smaller city of Kimberley, 36% from Cape Town, and 52% from Johannesburg. The majority of households were impoverished, with 33% earning less than R1000 (USD 125) per month. Mean blood lead in the total sample was 8.0 µg/dL, with a median of 7 µg/dL. Individual blood lead levels ranged from 0.8 to 32.3 µg/dL; 74% of the sample had blood lead levels at 5 µg/dL or higher, and 25% had levels above 10 µg/dL. In Johannesburg, 84% of children had blood lead levels of 5 µg/dL or higher, whereas the proportions were 57% in Kimberley and 66% in Cape Town (Table). In the 2002 survey, 35% of children in the same schools in Johannesburg had had blood lead levels of >10 µg/dL compared with 33% in 2007. This minimal reduction in exposure may reflect the discontinuation of leaded gasoline. Similar decreases have been found in other countries.4–7 However, there was an apparent increase in blood lead levels in Cape Town and Kimberley. In 2002, only 10% of children in the same schools had had blood lead levels in excess of 10 µg/dL, compared with 18% and 13%, respectively, in 2007.8 In just 5 years, an additional 8% of children in Cape Town and an additional 3% of children in Kimberley were classified in the most heavily lead-exposed category. This suggests there are pockets of children in urban South Africa who continue to experience substantial lead exposure, despite the removal of major lead sources. It must be noted that different methods were used to assess blood lead levels in the two surveys; however, previous studies have found results from LeadCare to be comparable to formal laboratory analytical methods.3



We find that 1 to 2 years after discontinuation of leaded gasoline, children’s blood lead levels in urban South Africa remain high, and in some areas are increasing. The disabilities related to childhood lead exposure are well documented and preventable. More attention to this public health problem is urgently needed.

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We thank Mirriam Mogotsi and Rochelle Spadoni for the significant contributions with data collection.

Nisha Naicker

Angela Mathee

Medical Research Council of South Africa

Environment and Health Research Unit

Houghton, Johannesburg, South Africa

School of Public Health

University of the Witwatersrand

Johannesburg, South Africa

Brendon Barnes

School of Human and Community Development

University of the Witwatersrand

Johannesburg, South Africa

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