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Lead Exposure Among Refugee Children


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.


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.


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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