Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Household interventions for preventing domestic lead exposure in children

This is not the most recent version

Information

DOI:
https://doi.org/10.1002/14651858.CD006047.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 15 December 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Developmental, Psychosocial and Learning Problems Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Berlinda Yeoh

    Correspondence to: Royal Far West, Manly, Australia

    [email protected]

  • Susan Woolfenden

    Sydney Children's Hospitals Network, Sydney Children's Community Health Centre, Randwick, Australia

  • Bruce Lanphear

    Child and Family Research Institute, BC Children's Hospital, Simon Fraser University, Vancouver, Canada

  • Greta F Ridley

    Ridley Research, Glenbrook, Australia

  • Nuala Livingstone

    Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK

  • Emile Jorgensen

    Childhood Lead Poisoning Prevention Program, Chicago Department of Public Health, Chicago, USA

Contributions of authors

BY, SW, GR, NL and BL developed and wrote the text of this review. The search strategy was developed in concert with Jo Abbott and Margaret Anderson, the former and current Trials Search Coordinator of the Cochrane Developmental, Psychosocial and Learning Problems Group.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • Financial Markets Foundation for Children, Australia.

  • Commonwealth Government Department of Health, Australia.

Declarations of interest

Berlinda Yeoh ‐ none known
Susan Woolfenden ‐ none known
Bruce Lanphear ‐ was an investigator in two trials included in this review (Lanphear 1996a; Lanphear 1999)
Greta F Ridley ‐ none known
Nuala Livingstone ‐ none known

Acknowledgements

The authors would like to thank those trialists who provided us with information. We thank Dr Katrina Williams for her advice and assistance with methods and meta‐analysis. We commend and appreciate the continued efforts of the Cochrane Developmental, Psychosocial and Learning Problems Group for their help with literature searching, review and editing, in particular the support of Jane Dennis, former Managing Editor. We would also like to thank Danielle Wheeler for her contribution to the original review.

Version history

Published

Title

Stage

Authors

Version

2020 Oct 06

Household interventions for secondary prevention of domestic lead exposure in children

Review

Barbara Nussbaumer-Streit, Verena Mayr, Andreea Iulia Dobrescu, Gernot Wagner, Andrea Chapman, Lisa M Pfadenhauer, Szimonetta Lohner, Stefan K Lhachimi, Laura K Busert, Gerald Gartlehner

https://doi.org/10.1002/14651858.CD006047.pub6

2016 Oct 16

Household interventions for preventing domestic lead exposure in children

Review

Barbara Nussbaumer‐Streit, Berlinda Yeoh, Ursula Griebler, Lisa M Pfadenhauer, Laura K Busert, Stefan K Lhachimi, Szimonetta Lohner, Gerald Gartlehner

https://doi.org/10.1002/14651858.CD006047.pub5

2014 Dec 15

Household interventions for preventing domestic lead exposure in children

Review

Berlinda Yeoh, Susan Woolfenden, Bruce Lanphear, Greta F Ridley, Nuala Livingstone, Emile Jorgensen

https://doi.org/10.1002/14651858.CD006047.pub4

2012 Apr 18

Household interventions for preventing domestic lead exposure in children

Review

Berlinda Yeoh, Susan Woolfenden, Bruce Lanphear, Greta F Ridley, Nuala Livingstone

https://doi.org/10.1002/14651858.CD006047.pub3

2008 Apr 23

Household interventions for prevention of domestic lead exposure in children

Review

Berlinda Yeoh, Susan Woolfenden, Danielle M Wheeler, Garth Alperstein, Bruce Lanphear

https://doi.org/10.1002/14651858.CD006047.pub2

2006 Apr 19

Household interventions for prevention of domestic lead exposure in children

Protocol

Berlinda Yeoh, Susan Woolfenden, Danielle M Wheeler, Garth Alperstein, Bruce Lanphear

https://doi.org/10.1002/14651858.CD006047

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Comparison 1 Education, Outcome 1 Blood lead level (continuous).
Figures and Tables -
Analysis 1.1

Comparison 1 Education, Outcome 1 Blood lead level (continuous).

Comparison 1 Education, Outcome 2 Blood lead level (dichotomous) ≥10 µg/dL.
Figures and Tables -
Analysis 1.2

Comparison 1 Education, Outcome 2 Blood lead level (dichotomous) ≥10 µg/dL.

Comparison 1 Education, Outcome 3 Blood lead level (dichotomous) ≥15 µg/dL.
Figures and Tables -
Analysis 1.3

Comparison 1 Education, Outcome 3 Blood lead level (dichotomous) ≥15 µg/dL.

Comparison 1 Education, Outcome 4 Floor dust ‐ hard floor.
Figures and Tables -
Analysis 1.4

Comparison 1 Education, Outcome 4 Floor dust ‐ hard floor.

Comparison 2 Environmental ‐ Dust control, Outcome 1 Blood lead level (continuous).
Figures and Tables -
Analysis 2.1

Comparison 2 Environmental ‐ Dust control, Outcome 1 Blood lead level (continuous).

Comparison 2 Environmental ‐ Dust control, Outcome 2 Blood lead level (dichotomous ≥10 µg/dL).
Figures and Tables -
Analysis 2.2

Comparison 2 Environmental ‐ Dust control, Outcome 2 Blood lead level (dichotomous ≥10 µg/dL).

Comparison 2 Environmental ‐ Dust control, Outcome 3 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.01.
Figures and Tables -
Analysis 2.3

Comparison 2 Environmental ‐ Dust control, Outcome 3 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.01.

Comparison 2 Environmental ‐ Dust control, Outcome 4 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.1.
Figures and Tables -
Analysis 2.4

Comparison 2 Environmental ‐ Dust control, Outcome 4 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.1.

Comparison 2 Environmental ‐ Dust control, Outcome 5 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.2.
Figures and Tables -
Analysis 2.5

Comparison 2 Environmental ‐ Dust control, Outcome 5 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.2.

Comparison 2 Environmental ‐ Dust control, Outcome 6 Blood lead level (dichotomous ≥15 µg/dL).
Figures and Tables -
Analysis 2.6

Comparison 2 Environmental ‐ Dust control, Outcome 6 Blood lead level (dichotomous ≥15 µg/dL).

Comparison 2 Environmental ‐ Dust control, Outcome 7 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.01.
Figures and Tables -
Analysis 2.7

Comparison 2 Environmental ‐ Dust control, Outcome 7 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.01.

Comparison 2 Environmental ‐ Dust control, Outcome 8 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.1.
Figures and Tables -
Analysis 2.8

Comparison 2 Environmental ‐ Dust control, Outcome 8 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.1.

Comparison 2 Environmental ‐ Dust control, Outcome 9 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.2.
Figures and Tables -
Analysis 2.9

Comparison 2 Environmental ‐ Dust control, Outcome 9 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.2.

Summary of findings for the main comparison. Education strategies for preventing domestic lead exposure in children

Education strategies for preventing domestic lead exposure in children

Patient or population: Children
Settings: Households
Intervention: Education strategies for prevention of domestic lead exposure
Comparison: Regular environment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Regular environment

Education strategies for prevention of domestic lead exposure

Blood lead level (continuous)
Blood lead levels after intervention Scale from: 0 to 30
Follow‐up: 6 to 18 months

The mean blood lead level (continuous) ranged across control groups from
1.24 to 2.13 µg/dL1,2

The mean blood lead level (continuous) in the intervention groups was
0.02 higher
(0.09 lower to 0.12 higher)

814
(5 studies)

⊕⊕⊕⊕
high

Blood lead level (dichotomous)10 µg/dL
blood lead level
Follow‐up: 6 to 18 months

Medium risk population3

RR 1.02
(0.79 to 1.3)5

520
(4 studies)

⊕⊕⊕⊝
moderate4,5

238 per 10004

243 per 1000
(188 to 309)4

Blood lead level (dichotomous)15 µg/dL
blood lead level
Follow‐up: 6 to 18 months

Medium risk population3

RR 0.6
(0.33 to 1.09)

520
(4 studies)

⊕⊕⊕⊝
moderate4,5

110 per 10004

66 per 1000
(36 to 120)4

Floor dust ‐ hard floor (continuous)
Floor dust lead levels

Scale from: 0 to 40
Follow‐up: 6 to 18 months

The mean floor dust level ‐ hard floor ‐ ranged across control groups from
1.65 to 2.28 µg/ft2

The mean floor dust level ‐ hard floor ‐ in the intervention groups was
0.07 lower
(0.37 lower to 0.24 higher)

318
(2 studies)

⊕⊕⊕⊝
moderate6

Cognitive and neurobehavioural outcomes ‐ not reported

See comment

See comment

Not estimable

See comment

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Change in blood lead level
2 These are logged values
3 Baseline based on median of control groups
4 Total number of events less than 300
5 95% CI around pooled estimate includes no effect and appreciable harm or benefit
6 Total population is less than 400

Figures and Tables -
Summary of findings for the main comparison. Education strategies for preventing domestic lead exposure in children
Summary of findings 2. Environmental strategies (dust control) for preventing domestic lead exposure in children

Environmental strategies (dust control) for preventing domestic lead exposure in children

Patient or population: Children
Settings: Households
Intervention: Environmental strategies (dust control)
Comparison: Regular environment

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Environmental strategies (Dust Control)

Blood lead level (continuous)
Blood lead level at end of duration. Scale from: 0 to 30
Follow‐up: 6 to 18 months

The mean blood lead level (continuous) ranged across control groups from
2.4 to 2.9 µg/dL1

The mean blood lead level (continuous) in the intervention groups was
0.15 lower
(0.42 lower to 0.11 higher)

298
(3 studies)

⊕⊕⊕⊝
moderate2

Blood lead level (dichotomous10 µg/dL)
blood lead level
Follow‐up: 6 to 18 months

Medium risk population3

RR 0.93
(0.73 to 1.18)

210
(2 studies)

⊕⊕⊕⊝
moderate4

573 per 10004

533 per 1000
(418 to 676)4

Blood lead level (dichotomous15 µg/dL)
blood lead level
Follow‐up: 6 to 18 months

Medium risk population3

RR 0.86
(0.35 to 2.07)5

210
(3 studies)

⊕⊕⊕⊝
moderate4,5

205 per 10004

176 per 1000
(72 to 424)4

Cognitive and neurobehavioural outcomes ‐ not reported

See comment

See comment

Not estimable

See comment

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Change in blood lead level
2 Total population size less than 400
3 Baseline based on median of control groups
4 Total number of events less than 300,
5 95% CI around pooled estimate includes no effect and appreciable harm or benefit

Figures and Tables -
Summary of findings 2. Environmental strategies (dust control) for preventing domestic lead exposure in children
Table 1. Mean blood lead level and age at baseline

Study ID

Aschengrau 1998

Boreland 2009

Brown 2006

Campbell 2011

Charney 1983

Farrell 1998

Hilts 1995

Jordan 2003

Lanphear 1996

Lanphear 1999

Rhoads 1999

Sterling 2004

Wasserman 2002

Weitzman 1993

Mean blood lead level at baseline (µg/dL)

15‐19

15‐19

15‐19

2.6‐2.7

>20

10‐14

10‐14

<10

 

<10

<10

10‐14

10‐14

<10

10‐14

Mean age at baseline

(months)

24‐36

> 36

12‐24

8‐14

> 36

6‐72

24‐36

<12

12‐24

<12

12‐24

> 36

12‐24

24‐36

Figures and Tables -
Table 1. Mean blood lead level and age at baseline
Table 2. Intervention type by study

Study ID

Education

Dust control

Soil abatement

Combination

Aschengrau 1998

Yes

Boreland 2009

Yes

Brown 2006

Yes

Campbell 2011

Yes

Charney 1983

Yes

Farrell 1998

Yes

Hilts 1995

Yes

Jordan 2003

Yes

Lanphear 1996

Yes

Lanphear 1999

Yes

Rhoads 1999

Yes

Sterling 2004

Yes

Wasserman 2002

Yes

Weitzman 1993

Yes

Figures and Tables -
Table 2. Intervention type by study
Table 3. Outcome measures by study

Study ID

Blood lead ‐ continuous

Blood lead ‐ dichotomous

Hard floor lead

Carpet lead

Other

Aschengrau 1998

Yes

Yes

Boreland 2009

Yes

Brown 2006

Yes

Yes

Parent‐Child Interaction scale

Campbell 2011

Yes

Yes

Chicago Parents Knowledge Test

Charney 1983

Yes

Yes

Farrell 1998

Total effect (blood lead levels)

Hilts 1995

Yes

Yes

Yes

Jordan 2003

Yes

Lanphear 1996

Yes

Yes

Yes

Yes

Lanphear 1999

Yes

Yes

Yes

Yes

Rhoads 1999

Yes

Yes

Maternal knowledge lead poisoning

Sterling 2004

Yes

Wasserman 2002

Yes

Yes

Chicago Parents Knowledge Test

Weitzman 1993

Yes

Figures and Tables -
Table 3. Outcome measures by study
Comparison 1. Education

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Blood lead level (continuous) Show forest plot

5

815

Mean Difference (IV, Random, 95% CI)

0.02 [‐0.09, 0.12]

2 Blood lead level (dichotomous) ≥10 µg/dL Show forest plot

4

520

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.79, 1.30]

3 Blood lead level (dichotomous) ≥15 µg/dL Show forest plot

4

520

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.33, 1.09]

4 Floor dust ‐ hard floor Show forest plot

2

318

Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.37, 0.24]

Figures and Tables -
Comparison 1. Education
Comparison 2. Environmental ‐ Dust control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Blood lead level (continuous) Show forest plot

3

298

Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.42, 0.11]

2 Blood lead level (dichotomous ≥10 µg/dL) Show forest plot

2

210

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.73, 1.18]

3 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.01 Show forest plot

2

204

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.73, 1.18]

4 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.1 Show forest plot

2

173

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.72, 1.24]

5 Blood lead level (dichotomous ≥10 µg/dL) ICC 0.2 Show forest plot

2

155

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.72, 1.29]

6 Blood lead level (dichotomous ≥15 µg/dL) Show forest plot

2

210

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.35, 2.07]

7 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.01 Show forest plot

2

204

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.37, 1.81]

8 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.1 Show forest plot

2

173

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.34, 2.03]

9 Blood lead level (dichotomous ≥15 µg/dL) ICC 0.2 Show forest plot

2

155

Risk Ratio (M‐H, Random, 95% CI)

0.75 [0.34, 1.66]

Figures and Tables -
Comparison 2. Environmental ‐ Dust control