Healthy Cities for Healthy Brains: Implementation of a Lead Exposure Intervention Program in Nairobi

Background

In the U.S., marked reductions in child lead exposure is noted as one of its greatest public health accomplishments. Core features of successful programs in the U.S. include screening to identify children with higher blood lead levels (BLLs), “healthy home” programs to identify household sources, surveillance, and regulatory policy to remove lead from the environment. Yet lead toxicity remains a major global public health concern, accounting for 63% of the global burden of idiopathic intellectual disability. Evidence is clear that child blood lead levels (BLLs) once considered “safe” (< 10 ug/dL) are linked to compromised cognitive and behavioral development. Among the one in three children with BLL exceeding current WHO guidelines (≥ 5 ug/dL), 90% reside in low and middle income countries (LMICs). Both WHO and UNICEF highlight the need for programs to identify children with higher BLLs in LMICs, including sub-Saharan Africa (SSA), and need for protocols to respond to cases of elevated exposure. Kenya has promising institutional strength in lead exposure science, and the team leverages a 30-year research collaborative joining the University of Washington and the University of Nairobi.

Aims

The aim will be to adapt BLL screening and “healthy home” lead prevention program experience in the U.S. for an SSA city context – where BLL testing and follow up protocols are needed most and can leverage the city context to build awareness – and evaluate them in foundational implementation activities in Nairobi.

Project plan

1. Protocols for a Nairobi-relevant Lead Exposure Intervention Program (LEIP) will be developed and refined with input from key stakeholders, then piloted in the team’s ongoing cohort of mother-child dyads in Nairobi (age 24-36 months, N=356). Mother exit interviews will inform acceptability and understanding of exposure risk surveys and risk mitigation messaging for further refinement.

2. The refined LEIP protocol will be implemented, providing blood lead testing during routine pediatric care visits at a public Nairobi clinic (N~500 children, age 9-24 month), and two implementation strategies will be evaluated. Caregivers of children with BLL ≥5 ug/dL (N=100) will be randomized (N = 50 each arm) to immediate tailored risk reduction messaging alone versus additional home visit for enhanced messaging informed by an observational checklist for home risk factors.

3. Follow-up at 3 and 9 months will include BLL rechecks and assessment of caregiver knowledge and risk reduction behaviors.

4. We will identify barriers to lead exposure mitigation and strategies to overcome them, using semi-structured interviews with key persons (provider and policy level) and caregivers (individual level) involved in stage 2.

The project will inform on minimum implementable urban SSA appropriate delivery models, based on approaches reducing lead exposure for millions of children in high income countries for decades, and will identify contextual factors critical for sustainable program success in future iterations. Capacity building activities and data on child BLLs and household lead sources will fill existing critical gaps and stimulate multi-level momentum for policy changes.

Publications and output

To access publications and other outputs relating to this project, see our publications webpage.

Funding organisations

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