; 2University of Santo Domingo, Santo Domingo, Dominican RepublicIn August 1997 we performed a follow-up survey of 146 lead-poisoned children from a community near a previously active auto battery recycling smelter in Haina near Santo Domingo, Dominican Republic. Our follow-up survey confirmed a severe incidence of elevated blood lead (BPb) and erythrocyte protoporphyrinlzinc protoporphyrin (EP-ZnPP)

In August 1997 we performed a follow-up survey of 146 lead-poisoned children from a community near a previously active auto battery recycling smelter in Haina near Santo Domingo, Dominican Republic. Our follow-up survey confirmed a severe incidence of elevated blood lead (BPb) and erythrocyte protoporphyrinlzinc protoporphyrin (EP-ZnPP) levels. The mean BPb level was 32 pg/dL and the mean EP-ZnPP level was 128 pg/dL. The frequency distribution of BPb showed that only 9% ofthe children had BPb levels below the curendy acceptable 10 pgdL threshold level, 23% had between 10 and 19 pg/dL, 40% had between 20 and 39 pg/dL, 27% had between 40 and 99 pgldL, and the remainder had > 100 pg/dL. These findings are significandy greater than the mean BPb and EP-ZnPP levels of 14 and 35 pg/dL, respectivel, in a comparison group of 63 children in Barsequillo, 4 miles away. BPb frequency distrbutions for these groups were < 10 pg/dL (42%), 10-19 pg/dL (32%), and 20-39 pg/dL (16%); in the remainig 10%, BPb levels were between 40 and 99 pg/dL Similarly, the corresponding frequency distribution of EP-ZnPP levels in Haina children were proportional to the severity of lead poisoning and significantly higher than those of the Barsequiilo comparison group. This study reveals that at least 28% of Haina children require immediate treatment; of these, 5% with lead levels > 70 pg/dL are also at risk for severe neurologic sequelae, and urgent action is imperative. Key words. auto batteries, blood lead, Carribean, environmental pollution, erythrocyte protoporphyrin, graphite furnace (AAS), hematofluorometer, iron deficiency, lead poisoning, smelting. Environ Health Persect 107:917-920 (1999).

Environmental remediation efforts in low‐ and middle‐income countries have yet to be evaluated for their cost effectiveness. To address this gap we calculate a cost per Disability Adjusted Life Year (DALY) averted following the environmental remediation of the former lead smelter and adjoining residential areas in Paraiso de Dios, Haina, the Dominican Republic, executed from 2009 to 2010. The remediation had the effect of lowering surface soil lead concentrations to below 100 mg/kg and measured geometric mean blood lead levels (BLLs) from 20.6 μg/dL to 5.34 ug/dL. Because BLLs for the entire impacted population were not available, we use environmental data to calculate the resulting disease burden. We find that before the intervention 176 people were exposed to elevated environmental lead levels at Paraiso de Dios resulting in mean BLLs of 24.97 (95% CI: 24.45–25.5) in children (0–7 years old) and 13.98 μg/dL (95% CI: 13.03–15) in adults. We calculate that without the intervention these exposures would have resulted in 133 to 1,096 DALYs and that all of these were averted at a cost of USD 392 to 3,238, depending on assumptions made. We use a societal perspective, meaning that we include all costs regardless of by whom they were incurred and estimate costs in 2009 USD. Lead remediation in low‐ and middle‐income countries is cost effective according to World Health Organization thresholds. Further research is required to compare the approach detailed here with other public health interventions.