Lead poisoning in refugee children living in the United States: A systematic review of case studies

Background

Exposure to the heavy metal lead (Pb) has serious adverse health effects, particularly in children. Refugee children resettled in the United States are disparately impacted by lead. Research indicates that both pre-migration and post-migration factors play a role in this disparity. A review of case studies of lead poisoning in refugee children was performed to identify specific and unique factors influencing these outcomes.

Methods

Following PRISMA-P guidelines, a search was performed in collaboration with a reference librarian, incorporating keywords and subject headings related to the topic, in 7 databases: Academic Search Premier, APA PsychINFO, CINAHL, Cochrane Library, Ovid MEDLINE, Scopus, and Web of Science Core Collection.

Results

321 non-duplicate articles resulted from the search. After two reviewers screened the titles for eligibility against PICOS criteria, 50 studies remained. 40 studies were eliminated after an abstract review, and 7 remained after a full-text review. One additional article that did not appear in the results was identified and included. Articles discussed single case studies or case series; overall 11 cases covering 13 children with elevated blood lead level were discussed. The studies identified sources of lead poisoning in refugee children including deteriorating lead paint, imported cosmetics or medications, tobacco, traditional herbs/spices, jewelry, and traditional or religious objects.

Conclusions

Refugee families in the US face common environmental sources of lead exposure (e.g., lead paint) and also culturally specific exposures related to the use of imported or traditional herbs, medications, and cosmetics. Prevention efforts in refugee communities should include information related to these hazards, presented with appropriate consideration for language and culture.