Analysis of blood lead screening data (2008-2011) for refugee children in Rhode Island.

mAny refugee Children Arrive to the united stAtes With elevated blood lead levels (BLLs) compared to U.S. born children. Immigrant and refugee children are at high risk for lead poisoning due to previous lead exposure in their country of origin, malnutrition and iron deficiency. Upon arrival to Rhode Island most refugees are initially placed in housing units in the Providence area located near essential services at Rhode Island Hospital, the International Institute of RI, and the Diocese of Providence. However, housing units in these Providence neighborhoods are at high risk for lead hazards, thereby putting refugees at high risk for lead poisoning. A study from New Hampshire published in 2004, found that of the 242 refugee children who were resettled in that state during October 1, 2003 – September 30, 2004, 92 received two blood lead level tests, one upon arriving to the United States and the second, 3-6 months after the initial screening. While most children had BLLs below ten micrograms per deciliter (<10 μg/ dL) at the initial screening, 37 (40%) of the 92 children who had two screenings had BLLs >10 μg/dL at the second screening, suggesting that the children experienced lead exposures in the US. Further investigation revealed environmental exposures to lead as well as a lack of awareness among refugee families on the sources and hazards of lead exposure. Based on the results of the New Hampshire study and subsequent recommendations from the Centers for Disease Control and Prevention (CDC), the Rhode Island Department of Health (HEALTH) issued lead screening guidelines specific to the pediatric refugee population in 2006. The HEALTH guidelines require that refugee children up to the age of 16 years receive a health screening within 30 days of their arrival that includes a BLL test. Children whose initial lead screening results in a BLL <10 μg/dL should have a repeat test 3-6 months later. Children with a BLL of 10 μg/dL or greater at any testing point are classified as having elevated BLLs. Children whose initial lead screening results in a BLL between 10 – 19 μg/dL should have a repeat test within three months (90 days) and receive lead education and/or non-medical case management by a lead center as recommended. Children who have an initial BLL test of 20 μg/dL or greater are considered “significantly lead poisoned” and should receive additional medical evaluation and treatment immediately. A previous analysis of blood lead screening data performed by Sunil Hebbar found that between 2004 and 2008, refugees experienced more lead exposures compared to other Providence children. For this period, annual prevalence rates ranged from 14 to 40% for refugee children; prevalence rates for Providence for the same period ranged from four to nine percent. Since the initial analysis was performed, many changes have occurred which have impacted the lead exposures of the refugee population. For example, the housing and foreclosure crisis has reduced the availability of safe and healthy housing; increased the cost to maintain rental units, and increased attention on the placement of newly arrived refugees. This report provides an updated analysis of the prevalence of lead poising among refugee children in Rhode Island from 2008 to 2011, addresses concerns about lead-safe housing placements for refugee children, and offers a recommendation to lower the lead level of concern from 10 μg/dL to 5 μg/dL.