 Lead Exposure Among Refugee Children
Introduction
On January 21, 2005, the Centers for Disease
Control and Prevention (CDC) released
Elevated Blood Lead Levels in Refugee Children – New Hampshire,
2004, a report that describes blood lead levels among
refugee children who have resettled in New Hampshire. The report
indicates that refugee children are at high risk for lead
exposure as a result of exposure in their country of origin as
well as health, social, and economic burdens.
Methods and Results
During October 1, 2003 – September 30, 2004, 242
refugee children resettled to New Hampshire; Most of these
children were from Africa. Ninety-two of the children were
tested twice, once tested upon arriving in the United States and
again 3-6 months after the initial screening. The tests measured
their blood lead levels (BLLs). Most children had initial BLLs
less than 10 micrograms per deciliter (<10 µg/dL) -- the target
level for lead poisoning elimination in U.S. children by the end
of the decade. The results of the second tests showed that 37
(40%) of the 92 children had BLLs > 10 µg/dL (range: 10 to 72
µg/dL). Seven of 19 (37%) families had at least one child with a
BLL >20 µg/dL.
Findings
The findings in this report suggest that lead exposure for these
37children occurred in the United States.
The investigation revealed the following risk factors for lead
poisoning:
• Environmental sources of lead.
Environmental investigations revealed residential lead hazards
and lead contaminated soil in play areas.
• Lack of awareness. State and local lead programs find most
refugee families do not know the danger of lead or how to
prevent exposure.
Other known risk factors for lead poisoning among refugee
children are:
• Iron deficiency. Iron deficiency,
prevalent among refugee children, increases lead absorption
through the gastrointestinal (GI) tract.
• Malnutrition. Previous studies found 95% of Somali Bantu
children <6 years old living in Kenya are anemic. Of the New
Hampshire children tested, 37% were chronically malnourished
and 25% had acute malnutrition.
• Eating soil. Eating soil, common in this population, also
increases risk for lead exposure.
Recommendations
Until federal standards for blood lead testing
and lead risk assessment in refugee children are implemented,
the following interim practices are recommended:
• BLL testing of all refugee children 6
months to 16 years old on arrival in the United States.
• Providing daily pediatric multivitamin with iron for refugee
children 6 to 59 months immediately upon arrival in the United
States.
• Further study of the value of iron therapy in refugee
children to reduce the risk of elevated BLLs.
• Develop training for health care and social service
providers and for resettlement case workers.
• Blood lead testing, nutritional assessments, and hemoglobin
or hematocrit level testing for children younger than 6 years
within 90 days after arrival in the United States, and a
follow-up blood lead test 3-6 months after placement in a
permanent residence.
• Blood lead screening for refugee children aged 6 years and
older if lead hazards are evident.
For additional information from CDC’s
Childhood Lead Poisoning Prevention Program, visit:
http://www.cdc.gov/nceh/lead/lead.htm
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