Estimates of Blood Lead Levels (BLLs) for Children in Coastal Madagascar: Accounting for Dietary Uptake of Lead (Pb)

Akers, David; Buerck, Adaline M; MacCarthy, Michael F.; Cunningham, J. E.; Mihelcic, James R.

doi:10.1007/s12403-019-00316-w

Cited by 9 publications

(14 citation statements)

References 30 publications

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“…21 Anthropogenic lead concentrations in the water from these systems were shown to frequently exceed the WHO guideline of 10 μg/L, 30 and elevated BLLs are estimated to occur in some children from exposure to drinking water and eating rice and other starches cooked in the pump water. 31 Consistent with these observations, a recent study estimated that Madagascar lost US$117−166 million in 2015 due to lost productivity from pollution, with lead pollution identified as one of the primary causes. 32 In some respects, these informal activities represent sound waste management by prioritizing reuse of waste products over simple disposal, a key concept in the pollution prevention hierarchy.…”

Section: ■ Introductionmentioning

confidence: 81%

“…Water delivered by the pumps is used for both nonpotable and potable uses, including drinking and cooking. 31 In an initial study of 18 households using these pumps, it was observed that lead is detectable in the pumped water, frequently at concentrations above 10 μg/L, and occasionally at levels exceeding 40 μg/L. 30 It was estimated that the presence of this lead in the water correlates with elevated BLLs in children.…”

Section: ■ Materials and Methodsmentioning

confidence: 99%

“…30 It was estimated that the presence of this lead in the water correlates with elevated BLLs in children. 30,31 In 2018, we worked with local pump technicians to replace the lead weights in both check valves with iron (Fe) weights in 504 of these household pump systems. During this retrofit of the piston and foot valve, no plumbing (i.e., piping) below the pump is disturbed, and the only item removed is the pump head (Figure S2).…”

Section: ■ Materials and Methodsmentioning

confidence: 99%

“…Because the Palintest instrument has a lower measurement limit of 2 μg/L, we do not know the median water concentration in the 0−2 μg/L subgroups, and we therefore assumed a concentration of 2 μg/L for these groups to be conservative. For diet, we used the methods described by Akers et al 31 which adjusted the inputs to fit a Malagasy diet. Model inputs are summarized in Table 1.…”

Section: ■ Materials and Methodsmentioning

confidence: 99%

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Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

Buerck

Usowicz

Cunningham

et al. 2021

Environ. Sci. Technol.

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In low- and middle-income countries (LMICs), the presence of an informal economy can lead to human exposure to toxic metals such as lead (Pb). This paper demonstrates the local health and economic benefits of modifying practices within the informal economic sector in Madagascar. Specifically, leaded components in 504 locally manufactured household water pumps were replaced with unleaded components. Prior to the intervention, 32% of the household systems exhibited lead concentrations above the World Health Organization (WHO) provisional drinking water guideline of 10 μg/L, but after the intervention, fewer than 3% of the systems were in exceedance. The reduction of lead concentration is modeled to reduce the fraction of children with elevated BLLs (>5 μg/dL) from 34 to 13%. The reduction in BLLs is estimated to provide an average economic benefit of US$11 800 per child based on predicted increases in lifetime productivity. This corresponds to a total benefit of US$8.7 million for the 730 children aged 1–5 associated with the pumps, representing a return on investment of greater than 1000-to-1. Results demonstrate how the formation of partnerships between public, private, and civil society entities, as suggested by UN Sustainable Development Goal 17, can realize important local economic and health benefits in LMICs.

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Section: ■ Introductionmentioning

confidence: 81%

Section: ■ Materials and Methodsmentioning

confidence: 99%

Section: ■ Materials and Methodsmentioning

confidence: 99%

Section: ■ Materials and Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

Buerck

Usowicz

Cunningham

et al. 2021

Environ. Sci. Technol.

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“…In Toamasina, access to publicly provided potable water is often unavailable, expensive, and unreliable [ 4 , 5 , 6 ]. Accordingly, many households use a decentralized, household water supply (e.g., self-supply) and utilize locally produced, manually operated pitcher pumps for their water needs [ 4 , 5 , 6 ]. There are an estimated 9000 such pitcher pumps in Toamasina serving ~60% of the 280,000 persons in the area [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Midstream Players Determine Population-Level Behavior Change: Social Marketing Research to Increase Demand for Lead-Free Components in Pitcher Pumps in Madagascar

Khaliq

Sommariva

Buerck

et al. 2021

IJERPH

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Lead (Pb) exposure through water contamination is an important issue at the intersection of public health and water, sanitation, and hygiene (WASH). Behavior-change programs designed to address this pressing problem rarely take a behavioral-science-informed approach, nor do they consider the role of intermediate players who often influence and support behavior change. Social marketing segments the population and focuses on the consumer/user throughout program development and implementation. To illustrate the social marketing process, this cross-sectional, qualitative design study investigates the use of Pb in the construction and maintenance of household pitcher pumps for potable water in Madagascar. A sample of 18 technicians were interviewed on their current practices, motivators, barriers, and communication channels for knowledge exchange. The results reveal the importance of peers, those considered experts or “market mavens”, and the need for information on the dangers of Pb as an outdated practice for any future intervention. This study advances the notion of a design shift within engineering WASH projects, whereby social/behavioral approaches are used to consider the needs, concerns, and current behaviors of the consumer. We also advocate for engaging intermediate players who often influence behavior change in the rollout of an engineering innovation.

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Childhood lead exposure of Amerindian communities in French Guiana: an isotopic approach to tracing sources

Maurice

Barraza

Blondet

et al. 2021

Environ Geochem Health

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Estimates of Blood Lead Levels (BLLs) for Children in Coastal Madagascar: Accounting for Dietary Uptake of Lead (Pb)

Cited by 9 publications

References 30 publications

Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

Midstream Players Determine Population-Level Behavior Change: Social Marketing Research to Increase Demand for Lead-Free Components in Pitcher Pumps in Madagascar

Childhood lead exposure of Amerindian communities in French Guiana: an isotopic approach to tracing sources

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