Ryan Wallace

Project title: Childhood Lead Exposures in a Vietnamese Battery Recycling Village

Degree: MPH | Program: Occupational and Environmental Medicine (OEM) | Project type: Thesis/Dissertation
Completed in: 2012 | Faculty advisor: William E. Daniell


Childhood lead poisoning, while diminishing in industrialized nations, continues to be a common and preventable public health threat throughout the world. This is particularly true among poorer communities where lead recycling, especially from used car batteries, is an important source of revenue. Dong Mai village, a rural community of 2,300 in Northern Vietnam, has been a lead battery recycling handicraft village since 1978. A study in 2006 by the Vietnamese National Institute of Occupational & Environmental Health (NIOEH) demonstrated environmental contamination and elevated urine lead levels among a small sample of children. These findings inspired efforts to improve the safety of recycling practices, including a law prohibiting home-based recycling and construction of a centralized recycling facility on the outskirt of the village. Through partnering with the NIOEH, the purpose of this cross-sectional study was to determine current blood lead levels (BLLs) of children ages 0-10 years in Dong Mai, identify risk factors associated with higher BLLs, and enhance the capacity of the public health and medical communities to address lead exposure in Vietnam. A random sample of 120 children was identified. Consent was obtained for 109 and screening was conducted in December 2011 using capillary blood samples and a portable blood lead screening device, the LeadCare ® II, plus a family questionnaire and home observations. Thirty-six (33%) participants had BLLs 10-29.9 µg/dL, 41 (37%) were 30-44.9 µg/dL, 17 (16%) were 45-65 µg/dL, and 15 (14%) were >65 µg/dL. Repeat testing of 24 participants with highest BLL (>50 µg/dL) using venipuncture and laboratory analysis (GFAAS) revealed slightly lower but still clinically important values. Comparing participants in three fingerstick BLL categories (10-29.9, 30-44.9, >45 µg/dL), higher BLLs were associated with: active (illegal) home-recycling (p=0.01); family member involvement in current or past recycling (p=0.001); younger age (p=0.01); living less than 10m from a recycling facility (p=0.1); or brick surfaces in the yard (p=0.07). We recommended that NIOEH focus interventions on terminating illegal recycling, reducing take-home exposures, cleaning/modifying yard surfaces, promoting general exposure reduction through handwashing and indoor dust control, and nutritional counseling. Chelation is recommended for children with BLL >44 µg/dL, after control of household exposures. More investigation is necessary to identify the extent and pathways of exposures in this village and in lead recycling communities across the country. We continue to collaborate with NIOEH and Vietnamese health authorities to develop and implement actions that address the needs of individuals and their communities affected by lead exposure. URI http://hdl.handle.net/1773/21922