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

BACKGROUND AND OBJECTIVES: Between November 2007 and March 2008, 18 children died from a rapidly progressive central nervous system disease of unexplained origin in a community involved in the recycling of used lead-acid batteries (ULAB) in the suburbs of Dakar, Senegal. We investigated the cause of these deaths. METHODS: Because autopsies were not possible, the investigation centered on clinical and laboratory assessments performed on 32 siblings of deceased children and 23 mothers and on 18 children and 8 adults living in the same area, complemented by environmental health investigations. RESULTS: All 81 individuals investigated were poisoned with lead, some of them severely. The blood lead level of the 50 children tested ranged from 39.8 to 613.9 microg/dL with a mean of 129.5 microg/dL. Seventeen children showed severe neurologic features of toxicity. Homes and soil in surrounding areas were heavily contaminated with lead (indoors, up to 14,000 mg/kg; outdoors, up to 302,000 mg/kg) as a result of informal ULAB recycling. CONCLUSIONS: Our investigations revealed a mass lead intoxication that occurred through inhalation and ingestion of soil and dust heavily contaminated with lead as a result of informal and unsafe ULAB recycling. Circumstantial evidence suggested that most or all of the 18 deaths were due to encephalopathy resulting from severe lead intoxication. Findings also suggest that most habitants of the contaminated area, estimated at 950, are also likely to be poisoned. This highlights the severe health risks posed by informal ULAB recycling, in particular in developing countries, and emphasizes the need to strengthen national and international efforts to address this global public health problem.

Ethical issues in measuring biomarkers in children's environmental health.

BACKGROUND: Studying the impact of environmental exposures is important in children because they are more vulnerable to adverse effects on growth, development, and health. Assessing exposure in children is difficult, and measuring biomarkers is potentially useful. Research measuring biomarkers in children raises a number of ethical issues, some of which relate to children as research subjects and some of which are specific to biomarker research. OBJECTIVE: As an international group with experience in pediatric research, biomarkers, and the ethics of research in children, we highlight the ethical issues of undertaking biomarker research in children in these environments. DISCUSSION: Significant issues include undertaking research in vulnerable communities, especially in developing countries; managing community expectations; obtaining appropriate consent to conduct the research; the potential conflicts of obtaining permission from an ethics review board in an economically developed country to perform research in a community that may have different cultural values; returning research results to participants and communities when the researchers are uncertain of how to interpret the results; and the conflicting ethical obligations of maintaining participant confidentiality when information about harm or illegal activities mandate reporting to authorities. CONCLUSION: None of these challenges are insurmountable and all deserve discussion. Pediatric biomarker research is necessary for advancing child health.

Why carry out a longitudinal birth survey?

In spite of technological progress throughout the world, ill health, both physical and mental, is widespread - but much of this is preventable. With rapid globalization, populations in both industrialised and developing countries are being exposed to various stresses and to new environmental factors, such as those related to climate change and to an increasing range of chemicals of unknown effect. There is substantial evidence that exposures to environmental risk factors in pregnancy and childhood have a major influence on health and development even into adulthood and future generations. In this paper we discuss the importance of longitudinal studies in identifying the processes underlying health and developmental problems and thus, by using the strengths of birth cohort studies, identifying preventative and other strategies which will protect public health from adverse environmental influences.

Choice of environmental components for a longitudinal birth cohort study.

Various aspects of the environment of the mother and child may have major influences on the health and development of the child. Long-term influences can even affect chronic diseases of adulthood. Here we describe the major psychosocial and physical environmental factors that should be measured in longitudinal birth cohort studies.

Impactos ambientales sobre la salud respiratoria de los niños: carga global de las enfermedades respiratorias pediátricas ligada al ambiente / Environmental impacts on the respiratory health of children: global burden of paediatric respiratory diseases linked to the environment

The child's respiratory system is a primary target for air pollutants, including tobacco smoke, biomass fuels and pollution from mobile and fixed sources. Children are, in general more susceptible to the effects of air pollutants; however, individual susceptibility also plays a role. Exposure to pollutants in early life decrease lung growth and results in reduced lung function. The range of respiratory illnesses with an environmental contribution includes: acute viral and bacterial lower respiratory infections; otitis media; asthma and chronic respiratory diseases. This review presents an overview of the identified risks posed by the environment to children's health and their health consequences.

El sistema respiratorio de los niños es un blanco primario para la contaminación del aire, incluyendo el humo de tabaco, combustibles de biomasa y polución de fuentes móviles y fijas. Los niños son, en general, más susceptibles a los efectos de los contaminantes del aire; sin embargo, la susceptibilidad individual también juega un rol. La exposición a temprana edad reduce el crecimiento pulmonar y resulta en función pulmonar disminuida. El rango de enfermedades respiratorias con una contribución causal ambiental incluye: infecciones agudas virales y bacterianas bajas; otitis media; asma y enfermedades respiratorias crónicas. Esta actualización es una revisión sobre los riesgos ambientales identificados como riesgos para la salud de los niños y sus consecuencias.

Children's environmental health in the twenty-first century.

In the twenty-first century, the global burden of disease trends are the result of complex interaction among rapid industrialization and urbanization, unsustainable use of natural resources, and population growth. In addition, global environmental changes due to climate change, ozone depletion, desertification/deforestation, loss of biodiversity, and increased used of some biotechnologies are having an important impact on human health. Many other factors also play an important role in the population's health response to global environmental threats, including poverty, malnutrition, poor sanitation, and infectious diseases. Worldwide, the burden of environmental disease is much higher for children than adults, especially in young children under 5 years of age. Quantification of the burden of diseases attributable to environment shows that environmental risk factors can contribute to more than one-third of the disease burden in children, a fraction of disease that could be prevented. Children are often exposed to multiple environmental threats combined with other behavioral, social, and economic risk factors. Many of the environmental health risk factors are shared among children's home, school, and community. Therefore, an integrated approach should be considered in order to create healthy environments for children. The promotion of safe environments for children has to involve decision makers, nongovernmental organizations (NGOs), families, and various sectors including health, education, housing, environment, agriculture, industry, transport, and energy. Multiple initiatives have been proposed from collection, evaluation, and dissemination of information on children's health and the potential environmental threats to research, monitoring, risk assessment, and policies to improve the environmental conditions and ultimately children's growth and development.

Acute pesticide poisoning: a proposed classification tool.

Cases of acute pesticide poisoning (APP) account for significant morbidity and mortality worldwide. Developing countries are particularly susceptible due to poorer regulation, lack of surveillance systems, less enforcement, lack of training and inadequate access to information systems. Previous research has demonstrated wide variability in incidence rates for APP. This is possibly due to inconsistent reporting methodology and exclusion of occupational and non-intentional poisonings. The purpose of this document is to create a standard case definition to facilitate the identification and diagnosis of all causes of APP, especially at the field level, rural clinics and primary health-care systems. This document is a synthesis of existing literature and case definitions that have been previously proposed by other authors around the world. It provides a standardized case definition and classification scheme for APP into categories of probable, possible and unlikely/unknown cases. Its use is intended to be applicable worldwide to contribute to identification of the scope of existing problems and thus promote action for improved management and prevention. By enabling a field diagnosis for APP, this standardized case definition may facilitate immediate medical management of pesticide poisoning and aid in estimating its incidence.

Workgroup report: public health strategies for reducing aflatoxin exposure in developing countries.

Consecutive outbreaks of acute aflatoxicosis in Kenya in 2004 and 2005 caused > 150 deaths. In response, the Centers for Disease Control and Prevention and the World Health Organization convened a workgroup of international experts and health officials in Geneva, Switzerland, in July 2005. After discussions concerning what is known about aflatoxins, the workgroup identified gaps in current knowledge about acute and chronic human health effects of aflatoxins, surveillance and food monitoring, analytic methods, and the efficacy of intervention strategies. The workgroup also identified public health strategies that could be integrated with current agricultural approaches to resolve gaps in current knowledge and ultimately reduce morbidity and mortality associated with the consumption of aflatoxin-contaminated food in the developing world. Four issues that warrant immediate attention were identified: a) quantify the human health impacts and the burden of disease due to aflatoxin exposure; b) compile an inventory, evaluate the efficacy, and disseminate results of ongoing intervention strategies; c) develop and augment the disease surveillance, food monitoring, laboratory, and public health response capacity of affected regions; and d) develop a response protocol that can be used in the event of an outbreak of acute aflatoxicosis. This report expands on the workgroup's discussions concerning aflatoxin in developing countries and summarizes the findings.

Global perspectives in breast milk contamination: infectious and toxic hazards.

Breast milk is the natural and optimal food for infants. In addition to meeting nutritional needs, breast milk provides numerous immunologic, developmental, psychologic, economic, and practical advantages. It is postulated that breast-feeding may also be related to the prevention of some adult health problems such as diabetes and coronary heart disease. Malnutrition among infants and young children, which remains one of the most severe global public health problems, is among the main reasons that the World Health Organization (WHO) so strongly supports breast-feeding. However, WHO recognizes the growing concern expressed by scientists, health professionals, environmentalists, and mothers about the potential risks posed by the presence of toxicants and infectious agents in breast milk. In this paper we review the main infectious hazards (tuberculosis, hepatitis B, and human immunodeficiency virus) and selected chemical hazards (tobacco, persistent contaminants) and the activities undertaken by WHO. We conclude that in cases where there is a high degree of pollution from chemical sources occurring simultaneously in a bacterially contaminated environment, the choice is not simply between polluted breast milk and risk-free substitutes. Rather, informed choice is based on assessing the known and unknown risks of artificial feeding versus the unknown, but potential, risks of chemical contamination of breast milk. Clearly, the possible toxicity of compounds requires further investigation. Of much greater importance, however, are effective measures to protect the environment for the entire population by controlling the use of these toxic products. Current scientific evidence does not support altering WHO's global public health recommendation of exclusive breast-feeding for 6 months followed by safe and appropriate complementary foods, with continued breast-feeding, up to 2 years of age or beyond.