title: Outbreak of fatal childhood lead poisoning related to artisanal gold mining in northwestern Nigeria, 2010.
abstract: BACKGROUND
  In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria.
  
  
  OBJECTIVE
  Our goal was to determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children < 5 years of age in need of emergency chelation therapy for lead poisoning.
  
  
  METHODS
  We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children 2-59 months of age, and obtained soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality.
  
  
  RESULTS
  We surveyed 119 family compounds. Of 463 children < 5 years of age, 118 (25%) had died in the previous year. We tested 59% (204/345) of children < 5 years of age, and all were lead poisoned (≥ 10 µg/dL); 97% (198/204) of children had blood lead levels (BLLs) ≥ 45 µg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling, significant risk factors for death in the previous year from suspected lead poisoning included the age of the child, the mother's work at ore-processing activities, community well as primary water source, and the soil lead concentration in the compound.
  
  
  CONCLUSIONS
  The high levels of environmental contamination, percentage of children < 5 years of age with elevated BLLs (97%, > 45 µg/dL), and incidence of convulsions among children before death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities.
authors.affiliation: Healthy Homes and Lead Poisoning Prevention Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. igb7@cdc.gov
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Dooyema
authors.forename: Antonio
authors.initials: A
authors.lastname: Neri
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.forename: James
authors.initials: J
authors.lastname: Durant
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.forename: Todd
authors.initials: T
authors.lastname: Swarthout
authors.forename: Oladayo
authors.initials: O
authors.lastname: Biya
authors.forename: Saheed O
authors.initials: SO
authors.lastname: Gidado
authors.forename: Suleiman
authors.initials: S
authors.lastname: Haladu
authors.forename: Nasir
authors.initials: N
authors.lastname: Sani-Gwarzo
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Nguku
authors.forename: Henry
authors.initials: H
authors.lastname: Akpan
authors.forename: Sa'ad
authors.initials: S
authors.lastname: Idris
authors.forename: Abdullahi M
authors.initials: AM
authors.lastname: Bashir
authors.forename: Mary Jean
authors.initials: MJ
authors.lastname: Brown
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004781:Environmental Exposure; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000097:blood / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008906:Mining; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D012307:Risk Factors; D012424:Rural Population; D012989:Soil Pollutants / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D004785:Environmental Pollutants; D012989:Soil Pollutants; D007854:Lead