Prevalence of lead toxicity in adolescents in Kuwait

Reem Jallad 1, Muddanna S Rao 2, Abdur Rahman 3

Affiliations

22 June 2021

-

doi: 10.1186/s12889-021-11210-z

Abstract

Background: Elevated blood lead level (EBLL) is a public health problem in both developing and industrialized countries. Being a petrochemical-based economy, lead (Pb) levels are expected to be high in Kuwait, but systematic data on population exposure are lacking. This study aimed at determining the prevalence of EBLL in adolescents in Kuwait.

Methods: Adolescents (N = 1385; age range 11-16 years) were cross-sectionally selected from public middle schools from all Governorates of Kuwait, utilizing multistage cluster random sampling. Pb in whole blood was analyzed by inductively coupled plasma mass spectrometry. Distribution of blood Pb levels (BLL) among Governorates and sexes were compared by non-parametric tests and the prevalence of EBLL (defined as BLL above the CDC reference level of ≥5 μg/dL) was estimated by χ2 test. Binary logistic regression was used for assessing the association between EBLL and Governorate.

Results: Median (IQR) BLL was 5.1(3.6-7.1) μg/dL [4.9 (3.8-6.5) μg/dL in males and 5.4 (3.3-7.6) μg/dL in females; p = 0.001]. In the overall sample, 51% had BLL ≥5 μg/dL; 13% had ≥10 μg/dL and 3% > 20 μg/dL. Prevalence of EBLL was 47% in males and 56% in females (p < 0.001). EBLLs were clustered in Al-Asima, Al-Ahmadi (in both sexes); Al-Jahra (in males) and Mubarak Al-Kabeer (in females) Governorates.

Conclusions: EBLL is a significant public health problem in adolescents in Kuwait. Urgent public health intervention is required in areas with EBLL, and the sources of exposure need to be identified for prevention.

Keywords: Adolescents; Cross-sectional; Kuwait; Lead toxicity; Prevalence.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1 Kuwait map showing locations of selected schools and potential sources of exposure. The basic outline of the map was taken from the openly available sources from the internet, and final figure with the names of schools and potential sources of Pb exposure in each Governorate was prepared by the authors

Fig. 1 Kuwait map showing locations of selected schools and potential sources of exposure. The basic outline of the map was taken from the openly available sources from the internet, and final figure with the names of schools and potential sources of Pb exposure in each Governorate was prepared by the authors

Fig. 2 Boxplot showing distribution of Pb levels (μg/dL) stratified by Governorates (A), Governorates and sex (B), Governorates and age categories (C). Boxes show Pb distribution as median and interquartile range. Extremes values are shown above each box. For presentation, the maximum at Y-axis was set at 30 μg/dL. A total of 16 cases had blood Pb levels > 30 μg/dL. These are distributed as follows: Male; 1 in Hawally, 1 in Mubarak Al-Kabeer and 3 in Al-Ahmadi. Female; 1 in Al-Asima, 1 in Farwaniya, 1 in Al-Ahmadi and 8 in Mubarak Al-Kabeer. Statistics: A; Median test p < 0.001; B; Governorate, χ2 = 65.5, p < 0.001; sex, χ2 = 15.3, p < 0.001, Governorate*sex, χ2 = 94.5, p < 0.001; C; Governorate, χ2 = 149.2, p < 0.001; age, χ2 = 15.6, p < 0.001, Governorate*age, χ2 = 49.6, p < 0.001. Horizontal line represents the overall median. BLL: Blood Pb level show full caption

Fig. 2 Boxplot showing distribution of Pb levels (μg/dL) stratified by Governorates (A), Governorates and sex (B), Governorates and age categories (C). Boxes show Pb distribution as median and interquartile range. Extremes values are shown above each box. For presentation, the maximum at Y-axis was set at 30 μg/dL. A total of 16 cases had blood Pb levels > 30 μg/dL. These are distributed as follows: Male; 1 in Hawally, 1 in Mubarak Al-Kabeer and 3 in Al-Ahmadi. Female; 1 in Al-Asima, 1 in Farwaniya, 1 in Al-Ahmadi and 8 in Mubarak Al-Kabeer. Statistics: A; Median test p < 0.001; B; Governorate, χ2 = 65.5, p < 0.001; sex, χ2 = 15.3, p < 0.001, Governorate*sex, χ2 = 94.5, p < 0.001; C; Governorate, χ2 = 149.2, p < 0.001; age, χ2 = 15.6, p < 0.001, Governorate*age, χ2 = 49.6, p < 0.001. Horizontal line represents the overall median. BLL: Blood Pb level show full caption

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