Ghana – National Blood Lead Level Survey in Children Ages 1-5

In 2022, Pure Earth Ghana, in collaboration with UNICEF and the Ghana Health Service, launched one of Ghana’s largest blood lead level (BLL) testing and home-based assessment programs. The initiative aims to establish baseline data to inform policies and interventions for lead exposure control.

The study spans communities across Ghana’s three ecological zones, with the Public Health Division leading the effort. Testing began in November 2022 in Greater Accra, Ashanti, and the Northern Region, targeting children aged 1–5, who are most vulnerable to lead poisoning. The Ghana Health Service conducted blood tests, while Pure Earth and the Mountain Research Institute (MRI) assessed households for lead sources, including paint, toys, cookware, spices, cosmetics, soil, and water.

Findings from this program, expected in 2023, will contribute to strengthening healthcare capacity and shaping lead poisoning prevention strategies in Ghana.

The Blood Lead Levels (BLL) survey Summary

The study generated evidence of widespread lead exposure among the children under study. Out of a total of 3,227 children tested, 1,725 (53.5%) had BLL >= 5.0 ug/dl, the level at which the World Health Organization (WHO) recommends public health action to reduce or eliminate exposure.

In GAR the prevalence of BLL >=5.0ug/dl was significantly higher among children living near informal and formal lead polluting industries. Between 75-80% of children under study in the NR had BLL >=5ug/dl irrespective of whether they were living near informal lead polluting industries. This may suggest widespread elevated background exposure in this region.

There was no significant difference in prevalence of BLL >=5ug/dl among children living near informal lead polluting industries and those living in areas devoid of such pollution in the towns studied in Ashanti region. Children living near the 2 formal ULAB recycling industries in GAR, recorded very high BLL>=45.0ug/dl, the level at which WHO recommends chelation therapy (immediate treatment is required).

Home-Based Assessment (Environmental Assessment) Summary

Of the 3,227 children aged 12-59 months included in the blood lead survey carried out by the Ghana Health Service across 3 regions of the country, 10% were randomly selected for detailed lead source investigations within the home. These home-based assessments (HBAs) aimed to determine routes of exposure to lead among children, and included data collection on soil, dust, drinking water, paint, metal and ceramic cookware, cooking spices, cosmetics, and toys. With the exception of drinking water, all elements of the assessments were carried out with a portable X-Ray Fluorescence analyzer (XRF), which provides real-time readings in the field.

Based on the results of the HBAs, elevated blood lead levels (BLLs) appear to be driven by both industrial sources as well as certain consumer products, with substantial variation across the study areas.

Industrial sources

• Lead pollution from industrial sources was reflected in both soil surrounding homes included in the study and from dust collected from the homes. Soil concentrations as high as 7,170 ppm were identified, which is nearly 18 times the US EPA’s residential standard of 400 ppm.
• The industrial sites in three of the study areas (Ashaiman, Afienya and Kpone) appear to be the source of the most extreme blood lead levels. All children with BLLs above 30 µg/dL were located in these 3 communities.
• Children are likely to be exposed by crawling or playing in the soil and then touching their hands to their mouths.
• Used lead-acid battery (ULAB) and e-waste recycling, carried out by both formal and informal operators, were identified at these sites.

However, elevated BLLs were also found in areas that did not appear to be affected by industrial soil pollution. In the Northern Region, no soil levels surrounding the included homes exceeded 400 ppm (maximum = 213 ppm) in Yendi and Tolon. Yet, 84% of the children in these two study areas had BLLs above 5 µg/dL.

One suspected source identified through the HBAs is the use of chilo, a traditional eyeliner.

Traditional eyeliner, “chilo”

• The use of traditional eyeliner, chilo, on children was found to be very prevalent in the Northern Region (~93% of children across Yendi and Tolon). A small number of households in the Greater Accra Region were also identified as using chilo on children.
• These eyeliner products are used in many predominantly Muslim areas around the world, and they are known to contain extremely high concentrations of lead and pose a significant risk to children. Some are made almost entirely of lead galena.
• The primary suspected route of exposure is contact between the child’s hand to their eye and their hand to their mouth, although lead may also be absorbed through the eye.
• In the context of the HBAs, 8 chilo samples were assessed with the XRF or in a laboratory. Of these, 6 samples had lead concentrations exceeding 300,000 ppm, with one sample registering as 100% lead with the XRF. All samples were found to exceed the Ghana Standard Authority’s regulatory limit of lead in cosmetics of 1 ppm.

Across all regions, there is also concern about the contribution of lead from metal cookware.

Metal cookware

• Metal cookware, particularly inexpensive, locally produced items, have been found to contain lead which can leach into the food being cooked.
• The amount of lead that leaches out of any particular pot is difficult to predict without specific testing and there are currently no existing international standards for total lead content in metal cookware. However, 224 of the 293 (77%) cooking pots assessed during the study were found to contain levels of lead high enough to indicate the potential for a dangerous amount of lead to leach, based on Pure Earth’s on-going research (above 100ppm).
• Metal cookware items with elevated lead were found in all study areas, with the highest proportion in the Northern Region.

Other sources that were investigated appear not to be of concern for widespread, population-level impacts in the study areas.

Drinking water

• Included representative samples of all drinking water sources – community taps, Ghana Water Company Limited, shallow wells, and boreholes.129 samples, all with lead concentrations below 5 ppb

 Paint

• 210 households had painted walls that could be measured with the XR
• None exceeded US federal limit of lead in paint of 1 mg/cm²

Ceramic cookware/foodware

• 170 items identified and tested
• Only 2 had lead concentration above 100 ppm

Cooking spices

• 41 samples identified and tested in homes
• All but one had no detectable lead. One powdered pepper sample had a lead concentration of 4 ppm.

Toys

• 33 toys were identified that could be analyzed with the XRF (not soft toys)
• 5 items with readings above 100 ppm

Plastic sleeping mats

• 31 mats used by children were sampled.
• Some had high levels of lead (maximum = 3,366 ppm), however, the exposure route is unclear and no correlation with BLL was identified with this limited sample size. This could warrant future investigation.