title: Elevated Blood Lead Levels Are Associated with Reduced Risk of Malaria in Beninese Infants.
abstract: BACKGROUND
  Elevated blood lead levels (BLL) and malaria carry an important burden of disease in West Africa. Both diseases might cause anemia and they might entail long-term consequences for the development and the health status of the child. Albeit the significant impact of malaria on lead levels described in Nigeria, no evaluation of the effect of elevated BLL on malaria risk has been investigated so far.
  
  
  METHODS
  Between 2010 and 2012, blood lead levels of 203 Beninese infants from Allada, a semi-rural area 50km North from Cotonou, were assessed at 12 months of age. To assess lead levels, blood samples were analyzed by mass spectrometry. In parallel, clinical, microbiological and hematological data were collected. More precisely, hemoglobin, serum ferritin, CRP, vitamin B12, folate levels, and Plasmodium falciparum parasitemia were assessed and stool samples were also analyzed.
  
  
  RESULTS
  At 12 months, the mean BLL of infants was 7.41 μg/dL (CI: 65.2; 83), and 128 infants (63%) had elevated blood lead levels, defined by the CDC as BLL>5 μg/dL. Lead poisoning, defined as BLL>10 μg/dL, was found in 39 infants (19%). Twenty-five infants (12.5%) had a positive blood smear at 12 months and 144 infants were anemic (71%, hemoglobin<110 g/L). Elevated blood lead levels were significantly associated with reduced risk of a positive blood smear (AOR = 0.38, P-value = 0.048) and P. falciparum parasite density (beta-estimate = -1.42, P-value = 0.03) in logistic and negative binomial regression multivariate models, respectively, adjusted on clinical and environmental indicators.
  
  
  CONCLUSIONS
  Our study shows for the first time that BLL are negatively associated with malarial risk considering other risk factors. Malaria is one of the main causes of morbidity and mortality in infants under 5 years worldwide, and lead poisoning is the 6th most important contributor to the global burden of diseases measured in disability adjusted life years (DALYs) according to the Institute of Health Metrics. In conclusion, due to the high prevalence of elevated BLL, health interventions should look forward to minimize the exposure to lead to better protect the population in West Africa.
authors: Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales (UMR 216-MERIT), Paris, France.|Université Pierre et Marie Curie (UPMC- Paris VI), Ecole doctorale Pierre Louis de Santé Publique, Paris, France.|Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France.
authors: Violeta
authors: V
authors: Moya-Alvarez
authors: Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales (UMR 216-MERIT), Paris, France.|Université Pierre et Marie Curie (UPMC- Paris VI), Ecole doctorale Pierre Louis de Santé Publique, Paris, France.|Ecole des Hautes Etudes en Santé Publique, Département Épidémiologie et Biostatistiques, Rennes, France.
authors: Michael Osei
authors: MO
authors: Mireku
authors: Département de médecine sociale et préventive, Université Laval, Québec, Canada.|Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Québec, Canada.|Direction de la santé environnementale et de la toxicologie, INSPQ, Québec, Canada.
authors: Pierre
authors: P
authors: Ayotte
authors: Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales (UMR 216-MERIT), Paris, France.|PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France.
authors: Michel
authors: M
authors: Cot
authors: Ecole des Hautes Etudes en Santé Publique, Département Épidémiologie et Biostatistiques, Rennes, France.|Inserm UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors: Florence
authors: F
authors: Bodeau-Livinec
mesh_terms: D000740:Anemia / Q000209:etiology; D001541:Benin / Q000453:epidemiology; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D005243:Feces; D005260:Female; D005293:Ferritins / Q000097:blood; D005492:Folic Acid / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007855:Lead Poisoning / Q000097:blood*; D016778:Malaria, Falciparum / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D013058:Mass Spectrometry; D015999:Multivariate Analysis; D010963:Plasmodium falciparum; D012307:Risk Factors; D012424:Rural Population; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D006454:Hemoglobins; D002097:C-Reactive Protein; D005293:Ferritins; D005492:Folic Acid; D014805:Vitamin B 12