Research | Children’s Health Childhood Lead Poisoning Associated with Gold Ore Processing: a Village-Level Investigation—Zamfara State, Nigeria, October–November 2010 Yi-Chun Lo,1 Carrie A. Dooyema,1 Antonio Neri,2 James Durant,3 Taran Jefferies,2 Andrew Medina-Marino,1 Lori de Ravello,4 Douglas Thoroughman,5 Lora Davis,6 Raymond S. Dankoli,7 Matthias Y. Samson,7 Luka M. Ibrahim,7 Ossai Okechukwu,7 Nasir T. Umar-Tsafe,8,9 Alhassan H. Dama,9 and Mary Jean Brown 2 1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 2Healthy Homes and Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 3Agency of Toxic Substances and Disease Registry, Atlanta, Georgia, USA; 4National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 5Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 6One Health Office, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 7Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; 8Blood Lead and Inorganic Metals Laboratory, Ministry of Health, Gusau, Zamfara State, Nigeria; 9Zamfara State Rapid Response Team on Lead Poisoning Outbreak, Ministry of Health, Gusau, Zamfara State, Nigeria Background : During May–June 2010, a childhood lead poisoning outbreak related to gold ore processing was confirmed in two villages in Zamfara State, Nigeria. During June–September of that year, villages with suspected or confirmed childhood lead poisoning continued to be identified in Zamfara State. o Bjectivs : We investigated the extent of childhood lead poisoning [≥ 1 child with a blood lead level (BLL) ≥ 10 µg/dL] and lead contamination (≥ 1 soil/dust sample with a lead level > 400 parts per million) among villages in Zamfara State and identified villages that should be prioritized for urgent interventions. Methods : We used chain-referral sampling to identify villages of interest, defined as villages sus- pected of participation in gold ore processing during the previous 12 months. We interviewed vil- lagers, determined BLLs among children < 5 years of age, and analyzed soil/dust from public areas and homes for lead. r sulte : We identified 131 villages of interest and visited 74 (56%) villages in three local govern- ment areas. Fifty-four (77%) of 70 villages that completed the survey reported gold ore processing. Ore-processing villages were more likely to have ≥ 1 child < 5 years of age with lead poisoning (68% vs. 50%, p = 0.17) or death following convulsions (74% vs. 44%, p = 0.02). Soil/dust contamina- tion and BLL ≥ 45 µg/dL were identified in ore-processing villages only [50% (p < 0.001) and 15% (p = 0.22), respectively]. hTe odds of childhood lead poisoning or lead contamination was 3.5 times as high in ore-processing villages than the other villages (95% confidence interval: 1.1, 11.3). c onclusion : Childhood lead poisoning and lead contamination were widespread in surveyed areas, particularly among villages that had processed ore recently. Urgent interventions are required to reduce lead exposure, morbidity, and mortality in affected communities. k ey words : environmental health, lead poisoning. Environ Health Perspect 120:1450–1455 (2012). http://dx.doi.org/10.1289/ehp.1104793 [Online 5 July 2012] During routine meningitis surveillance in Zamfara State conducted during February– April 2010, Médecins Sans Frontières (MSF) and local public health officials iden- tified > 200 children < 5 years of age with convulsions during the previous 3 months among four villages. Approximately 40 of these children were reported to have died. Environmental causes were suspected because of a recent increase in gold ore–processing activities in the region. Diagnostic tests on Address correspondence to M.J. Brown, Healthy Homes and Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-60, Chamblee, GA 30341 USA. Telephone: (770) 488-3300. Fax: (770) 488- 3635. E-mail: mjb5@cdc.gov We thank the Nigerian Federal Ministry of Health; the Zamfara State Ministry of Health; Emir of Zamfara; Emir of Anka; Emir of Bukkuyum; Emir of Maru; Emir of Dansadau; the public health officials, translators, and local guides at the Anka, Bukkuyum, and Maru Local Government Areas; the clinicians, veterinarians, laboratorians, environmentalists, and other members of the Zamfara State Rapid Response Team on Lead Poisoning Outbreak; P. Nguku, A.N. Isa, M. Dalhat, I.J. Manu of the Nigeria Field Epidemiology and Laboratory Training Program; and the Centers for Disease Control and Prevention Nigeria Office for their support and active participa- tion in this field work. We are grateful for the con- tribution and assistance of Médecins Sans Frontières, Blacksmith Institute, Terragraphics Environmental Engineering Inc., the World Health Organization, and the United Nations International Children’s Fund. At the U.S. Centers for Disease Control and Prevention we acknowledge the Center for Global Health, the Global Disease Detection Program, and the Division of Laboratory Sciences at the National Center for Environmental Health for their contribu- tions and partnership in this investigation. Financial support was provided by the United States Agency for International Development’s Office of Foreign Disaster Assistance. The findings and conclusions in this report are those of the authors and do not necessarily repre- sent the official position of the Centers for Disease Control and Prevention. The authors declare they have no actual or potential competing financial interests. Received 29 November 2011; accepted 3 July 2012. ovlume 120 | number 10 | October 2012 • Environmental Health Perspectives Lead is highly toxic and can cause damage to the brain, kidneys, bone marrow, and other body systems in humans, especially among young children (Needleman 2004). Lead exposure among children is associated with developmental problems including impaired cognitive function, reduced intelligence, impaired hearing, and reduced stature; no toxicologically safe blood lead level (BLL) has been identified (Canfield et al. 2003; Jusko et al. 2008). At high BLLs, lead can cause con- vulsions, coma, and death (Needleman 2004). In the United States, the Centers for Disease Control and Prevention (CDC) defines an elevated child BLL as a BLL ≥ 10 µg/dL for initiating public health actions, and recom- mends that children with BLLs ≥ 45 µg/dL receive intensive medical management and chelation therapy (CDC 2002). Among developing countries, major sources of childhood lead poisoning include lead mining and smelting, paint, leaded 1450 gasoline, battery recycling, and traditional medicines (Falk 2003; Meyer et al. 2008). Exposure to lead ore dust through ingestion or inhalation can result in high BLLs in chil- dren. A limited number of studies have docu- mented environmental lead contamination or adults with elevated BLLs in small-scale gold ore–processing communities (Appleton et al. 2001; Betancourt et al. 2005; Odumo et al. 2010; Ogala et al. 2002). However, childhood lead poisoning was not reported to be associ- ated with gold ore processing in these studies. Zamfara State is located in northwestern Nigeria and has an estimated population of 3.6 million people, and approximately 20% are children < 5 years of age (Joint United Nations Environment Programme/Office for the Coordination of Humanitarian Affairs Environment Unit 2010). Although farm- ing is the major livelihood in Zamfara State, gold ore processing increasingly constitutes an important income source in selected areas.