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Intervention Review

Household interventions for prevention of domestic lead exposure in children

  1. Berlinda Yeoh1,*,
  2. Susan Woolfenden2,
  3. Danielle M Wheeler3,
  4. Garth Alperstein4,
  5. Bruce Lanphear5

Editorial Group: Cochrane Developmental, Psychosocial and Learning Problems Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 28 FEB 2006

DOI: 10.1002/14651858.CD006047.pub2

Database Title

Additional Information

How to Cite

Yeoh B, Woolfenden S, Wheeler DM, Alperstein G, Lanphear B. Household interventions for prevention of domestic lead exposure in children. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006047. DOI: 10.1002/14651858.CD006047.pub2.

Author Information

  1. 1

    Royal Far West, Manly, NSW, Australia

  2. 2

    Liverpool Hospital, B Wing, Liverpool, NSW, Australia

  3. 3

    Community Child Health, Sydney Children's Hospital, Cochrane Child Health Field, Randwick, New South Wales, Australia

  4. 4

    University of Notre Dame, Child Public Health Medicine, Broadway, NSW, Australia

  5. 5

    Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

*Berlinda Yeoh, Royal Far West, PO Box 52, Manly, NSW, 1655, Australia. berlinday@royalfarwest.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Lead poisoning is associated with physical, cognitive and neurobehavioral impairment in children and many household interventions to prevent lead exposure have been trialled.

Objectives

To determine the effectiveness of household interventions in preventing or reducing lead exposure in children as measured by reductions in blood lead levels and/or improvements in cognitive development.

Search methods

Trials were identified through electronic searches of CENTRAL 2006 (Issue 1), MEDLINE 1966 to March 2006, and thirteen other electronic databases and contacting experts to find unpublished studies.

Selection criteria

Randomised and quasi randomised trials of household educational or environmental interventions to prevent lead exposure in children where at least one standardised outcome measure was reported.

Data collection and analysis

Two reviewers independently reviewed all eligible studies for inclusion, assessed study quality and extracted data. Triallists were contacted to obtain missing information.

Main results

Twelve studies (2239 children) were included. All studies reported blood lead level outcomes and none reported on cognitive or neurobehavioural outcomes. Studies were subgrouped according to their intervention type. Meta-analysis of both continuous and dichotomous data was performed for subgroups where appropriate. Educational interventions were not effective in reducing blood lead levels (continuous: WMD 0.13, 95% CI -0.30, 0.56, I2 = 41.6; dichotomous ≥ 10µg/dL (≥ 0.48µmol/l): RR 1.02 (95% CI 0.79, 1.30, I2=0); dichotomous ≥ 15µg/dL (≥ 0.72µmol/l): RR 0.60, 95% CI 0.33, 1.09, I2 =0). Meta-analysis of the dichotomous data for the dust control subgroup found no evidence of effectiveness.

The studies using soil abatement (removal and replacement) and combination intervention groups were not able to be meta-analysed due to substantial differences between studies.

Authors' conclusions

Currently there is no evidence of effectiveness for household interventions for education or dust control measures in reducing blood lead levels in children as a population health measure. There is insufficient evidence for soil abatement or combination interventions.

Further trials are required to establish the most effective intervention for prevention of lead exposure. Key elements should include longer term follow up and measures of compliance as well as performing trials in developing countries and differing socio-economic groups in developed countries.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Household interventions for prevention of domestic lead exposure in children

Lead poisoning is associated with adverse effects on development and behaviour in children. Many educational and environmental household interventions to prevent lead exposure in children have been studied. This review of 12 studies found that educational and dust control interventions are not effective in reducing blood lead levels of young children. There is currently insufficient evidence that soil abatement or combination interventions reduce blood lead levels and further studies need to address this.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

居家措施以防止兒童之居家鉛暴露

鉛中毒與兒童的生理、認知以及神經行為障礙相關，目前有許多防止鉛暴露的居家措施已進行試驗。

目標

要確認居家措施用以防止或減少兒童鉛暴露的有效性，以血中鉛濃度的減少或認知發展的改善作為測量評估的方法。

搜尋策略

我們搜尋了電子資料庫CENTRAL 2006年(第1期)，MEDLINE1966年至2006年3月，和其他13個電子資料庫，另外也和專家聯繫以尋找尚未發表的研究。

選擇標準

以居家教育或是環境措施來防止兒童鉛暴露的隨機或半隨機的試驗，試驗中至少要包含一個標準化的評估結果。

資料收集與分析

兩名審查者分別審查了符合收納的所有研究，評估研究的品質並萃取資料，另外，也和試驗者聯繫以獲取遺漏的資料。

主要結論

總共收納了12個研究(2239位兒童)，其中全部的研究都是報告血中鉛濃度的結果，而沒有報告認知和神經行為結果。我們根據介入措施的類型將研究分組，並針對不同分組進行適合的連續性或二元化的統合分析。教育性的介入措施沒有降低血中鉛濃度的效果 (continuous: WMD 0.13, 95% CI −0.30, 0.56, I2 = 41.6; dichotomous _ 10μg/dL (_ 0.48μmol/l): RR 1.02 (95% CI 0.79, 1.30, I2 = 0); dichotomous _ 15μg/dL (_0.72μmol/l): RR 0.60, 95% CI 0.33, 1.09, I2 = 0) 。針對灰塵控制此組進行的二元化統合分析，也沒有發現任何有效的證據。運用土壤消除法(移除和替換)及合併介入研究組，因為研究本質的分歧，無法進行統合分析。

作者結論

目前沒有證據支持，教育性或是灰塵控制的居家措施，可以作為一個有效降低兒童的血中鉛濃度的人口健康措施。同時，也沒有足夠的證據支持土壤消除法或合併介入的方法有效。仍需要進一步的試驗以建立預防鉛暴露的最有效措施，關鍵的要素包括長期的追蹤及評估遵從性，同時也應在開發中國家及已開發國家的不同社經族群進行試驗。

翻譯人

本摘要由成功大學附設醫院黃惠群翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

鉛中毒對兒童的發展和行為有負向的影響，已有許多用來防止兒童鉛暴露的教育性及環境上的居家措施進行研究。本次回顧的12個研究發現，教育性和灰塵控制的措施，沒有減少兒童血中鉛濃度的效果。目前還沒有足夠的證據支持土壤移除法和合併介入措施可以減少的血中鉛濃度，仍需要進一步研究來解決這一問題。

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