Lead-based paint on playground equipment in public children’s parks in Johannesburg, Tshwane and Ekurhuleni, South Africa

Objective: To determine the use of lead-based paint in public playgrounds in the South African municipalities of Johannesburg, Tshwane and Ekurhuleni. Methods: Forty-nine public parks were selected from the municipalities of Johannesburg, Ekurhuleni and Tshwane. Lead levels in paint on playground equipment were measured in situ using a handheld Thermo Scientific NITON® XLP 700 Series x-ray fluorescence (XRF) analyzer. Results: Playground lead levels ranged from “too low to detect” to 10.4 mg/cm2. The mean and median lead concentrations were 1.9 and 0.9 mg/cm2 respectively. Forty-eight percent of lead paint measurements exceeded the internationally accepted reference level of 1 mg/cm2. Conclusion: This study shows that lead-based paint is widely used in public children’s playgrounds in the three study municipalities, and most likely throughout South Africa. We suggest key actions to ensure that children’s playgrounds in South Africa are lead-free zones, and that childhood lead exposure in these settings is prevente

Blood lead levels in First Grade South African children : A geographic & temporal analysis

Lead is a toxic heavy metal that has been extensively used in modern society, causing widespread environmental contamination, even in isolated parts of the world. There is now overwhelming evidence associating lead exposure with wideranging health effects, including reductions in intelligence scores, hyperactivity, shortened concentration spans, poor school performance, violent/aggressive behaviour, hearing loss, delayed onset of puberty, anaemia, and in severe cases, coma and death. In recent years consensus has been reached in respect of the absence of a threshold of safety for key health effects associated with lead exposure, and the permanent and irreversible nature of many of the health and social consequences of exposure to lead. The public health problem of environmental lead exposure has been widely investigated in developed countries such as the United States of America where, since the 1970s, policies and interventions have been followed by significant reductions in blood lead levels amongst children. In developing countries, and in African countries in particular, there is a relative dearth of information on the sources, mechanisms of exposure and blood lead distributions in children, and little action has been taken to protect children against lead poisoning. This study was undertaken to determine the current distribution of blood lead concentrations, and associated risk factors, amongst selected groups of first grade school children in the South African urban settings of Cape Town, Johannesburg 7 and Kimberley, a lead mining town (Aggeneys) and two rural towns in the Northern Cape province. A further objective of the study was to compare blood lead distributions determined in the current study with the findings of similar studies undertaken prior to the introduction in 1996 of unleaded petrol in South Africa. The results show that over the past decade, blood lead concentrations amongst first grade school children have declined considerably, but that large proportions of children, especially those living or attending school in impoverished areas, continue to have intolerably high blood lead concentrations, within a range that puts them at risk of detrimental health and social outcomes. The major sources of exposure to lead in the samples studied were leaded petrol, lead-based paint used to decorate homes and schools, lead solder used in “cottage industries” and other home-based lead-related activities, as well as the transfer of lead particles from lead-related work settings into homes. Recommendations for policy and relevant interventions for the South African context are discussed

Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000

Objectives. To estimate the burden of respiratory ill health in South African children and adults in 2000 from exposure to indoor air pollution associated with household use of solid fuels.Design. World Health Organization comparative risk assessment (CRA) methodology was followed. The South African Census 2001 was used to derive the proportion of households using solid fuels for cooking and heating by population group. Exposure estimates were adjusted by a ventilation factor taking into account the general level of ventilation in the households. Population-attributable fractions were calculated and applied to revised burden of disease estimates for each population group. Monte Carlo simulation-modelling techniques were used for uncertainty analysis.Setting. South Africa.Subjects. Black African, coloured, white and Indian children under 5 years of age and adults aged 30 years and older.Outcome measures. Mortality and disability-adjusted life years (DALYs) from acute lower respiratory infections in children under 5 years, and chronic obstructive pulmonary disease and lung cancer in adults 30 years and older.Results. An estimated 20% of South African households were exposed to indoor smoke from solid fuels, with marked variation by population group. This exposure was estimated to have caused 2 489 deaths (95% uncertainty interval 1 672 - 3 324) or 0.5% (95% uncertainty interval 0.3 - 0.6%) of all deaths in South Africa in 2000. The loss of healthy life years comprised a slightly smaller proportion of the total: 60 934 DALYs (95% uncertainty interval 41 170 - 81 246) or 0.4% of all DALYs (95% uncertainty interval 0.3 - 0.5%) in South Africa in 2000. Almost 99% of this burden occurred in the black African population.Conclusions. The most important interventions to reduce this impact include access to cleaner household fuels, improved stoves, and better ventilation

The impact of health behaviour change intervention on indoor air pollution indicators in the rural North West Province, South Africa

Indoor air pollution has been associated with a number of health outcomes including child lower respiratory infections such as pneumonia. Behavi-oural change has been promoted as a potential intervention strategy but very little evidence exists of the impact of such strategies on actual indoor air pollution indicators particularly in poor rural contexts. The aim of this study was to evaluate a community counselling intervention on stationary levels of PM10 and carbon monoxide (CO) as well as CO measured on children younger than five. Using a quasi-experimental design, baseline data was collected in an intervention (n=36) and a control (n=38) community; the intervention was implemented in the intervention community only; and follow-up data was collected one year later amongst the same households. Despite the fact that indoor air pollution was reduced in both communities, the intervention group performed significantly better than the control group when stratified by burning location. The net median reductions associated with the intervention were: PM10=57%, CO=31% and CO (child)=33% amongst households that burned indoor fires. The study provides tentative evidence that a health behaviour change is associated with reductions in child indoor air pollution exposure. The intervention is relatively inexpensive and easy to replicate. However, more powerful epidemiological studies are needed to determine the impact on health outcomes

The impact of health behaviour change intervention on indoor air pollution indicators in the rural North West Province, South Africa

Indoor air pollution has been associated with a number of health outcomes including child lower respiratory infections such as pneumonia. Behavi-oural change has been promoted as a potential intervention strategy but very little evidence exists of the impact of such strategies on actual indoor air pollution indicators particularly in poor rural contexts. The aim of this study was to evaluate a community counselling intervention on stationary levels of PM10 and carbon monoxide (CO) as well as CO measured on children younger than five. Using a quasi-experimental design, baseline data was collected in an intervention (n=36) and a control (n=38) community; the intervention was implemented in the intervention community only; and follow-up data was collected one year later amongst the same households. Despite the fact that indoor air pollution was reduced in both communities, the intervention group performed significantly better than the control group when stratified by burning location. The net median reductions associated with the intervention were: PM10=57%, CO=31% and CO (child)=33% amongst households that burned indoor fires. The study provides tentative evidence that a health behaviour change is associated with reductions in child indoor air pollution exposure. The intervention is relatively inexpensive and easy to replicate. However, more powerful epidemiological studies are needed to determine the impact on health outcomes

Distribution of blood lead levels in schoolchildren in selected cape peninsula suburbs subsequent to reductions in petrol lead

Objective. To determine blood lead levels among children attending schools in selected Cape Peninsula suburbs, and to assess the impact of a reduction in the lead content of petrol.Design. A cross-sectional analytical study of children's blood lead levels and associated risk factors.Setting. Selected inner city, suburban, and peri-urban schools in the Cape Peninsula, expected to have differing levels of environmental exposure to lead.Subjects. Grade 1 schoolchildren for whom prior written parental consent had been obtained, and who were present at school on the day of the study.Outcame measures. Blood lead levels (μg / dl), associated with a wide range of potential risk factors.Results. Median blood lead levels in suburbs varied from 14 to 16 μg/ dl, the lowest levels occurring in the peri-urban suburb and the highest in the inner city suburb. Within the inner city suburb of Woodstock, variations in mean blood lead concentrations among schools were substantial, varying from 13 to 19 μg/ dl. Overall, no change occurred in blood lead levels in this suburb subsequent to the lowering of the lead content of petrol.Conclusion. Every effort should be made in South Africa to control sources of lead in the urban environment. The study will serve as a useful baseline against which to measure the impact on blood lead levels of further actions which have been taken to promote the use of lead-free petrol in South Africa

Concentrations of lead in ceramic tableware in South Africa

Ceramic ware is used around the world, usually daily. In the past, lead was used in the glazes and decorative paints applied to ceramic ware, mainly to increase durability, impart a smooth, glasslike finish to glazes and intensify decorative pigments. However, this use of lead at times contributed to lead exposure and poisoning. While measures have been put in place to limit the use of lead in ceramic ware in well-resourced countries, there is relatively little information on the situation in poorly resourced settings. In the current preliminary South African study, we assessed the lead content and leaching rates from newly purchased ceramic ware. The majority of the 44 ceramic ware items had lead levels ≥ 90 ppm. Elevated lead concentrations were found in the leachate from only one item. The findings indicate a need for further research on the potential for lead exposure from ceramic wares, and support calls for increased attention to the many potential sources of lead exposure in poorly resourced settings. Significance: • The study reveals the potential for lead contamination of certain types of ceramic ware available in South Africa. • Daily use of lead-contaminated ceramic ware may increase the risk of lead exposure, especially among the poorest. • The study findings are indicative of a need for further research to fully characterise the extent of lead in ceramic ware

Estimating the burden of disease attributable to lead exposure in South Africa in 2000

Objectives. To estimate the burden of disease attributable to lead exposure in South Africa in 2000.Design. World Health Organization comparative risk assessment (CRA) methodology was followed. Recent community studies were used to derive mean blood lead concentrations in adults and children in urban and rural areas. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in the year 2000. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis.Setting. South Africa.Subjects. Children under 5 and adults 30 years and older. Outcome measures. Cardiovascular mortality and disabilityadjusted life years (DALYs) in adults 30 years and older andmild mental disability DALYs in children under 5 years. Results. Lead exposure was estimated to cause 1 428 deaths (95% uncertainty interval 1 086-l 772) or 0.27% (95% uncertainty interval: 0.21 - 0.34%) of all deaths in South Africa in 2000. Burden of disease attributed to lead exposure was dominated by mild mental disability in young children, accounting for 75% of the total 58 939 (95% uncertainty interval 55 413 - 62 500) attributable DALYs. Cardiovascular disease in adults accounted for the remainder of the burden.Conclusions. Even with the phasing out of leaded petrol, exposure to lead from its ongoing addition to paint, paraoccupational exposure and its use in backyard 'cottage industries' will continue to be an important public health hazard in South Africa for decades. Young children, especially those from disadvantaged communities, remain particularly vulnerable to lead exposure and poisoning