DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20191040

Accuracy of lead risk assessment questionnaire in predicting elevated blood lead levels in children

Kanimozhi Sadasivam, Balaji Chinnasami, Apurva Hariharan, Balaji Ramraj, Rahul Saravanan, Saravanan Ayyavoo

Abstract


Background: Lead toxicity in children is a serious problem affecting their neurodevelopment. Although CDC mandates screening for lead toxicity regularly in children, India doesn’t have any lead related public health program in place. In resource limited India a prescreening lead risk assessment questionnaire will be more economical than universal screening for blood lead levels (BLL). Authors aim to evaluate the accuracy of a validated modified CDC lead risk assessment questionnaire in predicting elevated BLL.

Methods: Authors conducted an explorative cross-sectional study from July to August 2017 in 340 children aged 6 months to 6 years. A standardized self-administered questionnaire modified from CDC lead risk assessment questionnaire was administered in the children. Also, BLL were measured in all study subjects using lead care II analyser. Data from questionnaire were compared with BLL to test the accuracy of questionnaire.

Results: Blood lead levels was high (>5ug/dl) in 57.9% of study subjects especially in children between 24-35 months. Employment in battery manufacturing companies (P=0.0001), usage of cosmetics (P=0.019), parental smoking history (P=0.001), involvement in painting, arts (P=0.0001) and malnourished children (P=0.018) were the risk factors associated with undesirable BLL. The modified questionnaire had a sensitivity of 87.9% and specificity of 66.7% for detecting elevated BLL.

Conclusions: The modified CDC lead risk assessment questionnaire is a sensitive tool in identifying high risk cases of lead toxicity in children.


Keywords


Children, Lead toxicity, Questionnaire, Risk factors

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References


Spire P. Lead exposure in children: prevention, detection and management. Pediat. 2005;116(4):1036-46.

Kishore K, Nirmala K. Blood lead levels in Urban and Rural Indian children. Indian Pediat. 1999;36(3):303-6.

Gordon BA, Mackay R, Rehfuess E. Inheriting the world: the atlas of children's health and the environment. World Health Organization. 2004.

Gilbert SG, Weiss B. A rationale for lowering the blood lead action level from 10 to 2microg/dL. Neurotoxicol.2006;27(5):693-01.

CDC (Centers for disease control and prevention). 2005a. Blood lead levels-United States. MMWR Morb Mortal Wkly Rep.1999-2002;54(20):513-6.

Charalambous A, Demoliou K, Mendez M, Coye R, Solorzano G, Papanastasiou E. Screening for lead exposure in children in Belize. Revista Panamericana Salud Pública. 2009;25:47-50.

Roy A, Bellinger D, Hu H, Schwartz J, Ettinger AS, Wright RO, et al. Lead exposure and behaviour among young children in Chennai, India. Environmental Health Perspectives. 2009;117(10):1607.

Raymond J, Wheeler W, Brown MJ. Lead screening and prevalence of blood lead levels in children aged 1–2 years-Child blood lead surveillance system, United States, 2002-2010 and national health and nutrition examination survey, United States, 1999-2010. Morbid Mortal Weekly Report. 2014;63(2):36-42.

Shannon M, Rifai N. The accuracy of a portable instrument for analysis of blood lead in children. Ambul Child Health 1997;3:249-54.

Mishra D, Singh HP. Kuppuswamy’s socioeconomic status scale-a revision. Indian J Pediat. 2003;70(3):273-4.

Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Affairs. 2002;21(2):60-76.

McLoyd VC. Socioeconomic disadvantage and child development. Am Psychol. 1998;53(2):185.

Bellinger DC, Stiles KM, Needleman HL. Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study. Pediat. 1992;90(6):855-61.

Zimmermann MB, Muthayya S, Moretti D, Kurpad A, Hurrell RF. Iron fortification reduces blood lead levels in children in Bangalore, India. Pediat. 2006;117(6):2014-21.

Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environmental Health Perspectives.2002;110(7):721-8.

Tejeda DM, Wyatt DD, Rostek BR, Solomon WB. Do questions about lead exposure predict elevated lead levels?. Pediat.1994;93(2):192-4.

Gould E. Childhood lead poisoning: conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117:1162- 67.

Grosse SD, Matte TD, Schwartz J, Jackson RJ. Economic gains resulting from the reduction in children's exposure to lead in the United States. Environmental Health Perspectives. 2002;110(6):563-9.