Household interventions for preventing domestic lead exposure in children

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

doi:10.1002/14651858.CD006047.pub4

Cochrane Database of Systematic Reviews

Household interventions for preventing domestic lead exposure in children

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DOI:

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

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

15 diciembre 2014see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Problemas de desarrollo, psicosociales y de aprendizaje

Copyright:

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

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Autores

Berlinda Yeoh

Correspondencia a: 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

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Child, Preschool; Female; Humans; Infant; Male;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

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

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Analysis 1.4

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 2.4

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

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Analysis 2.5

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

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Analysis 2.6

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

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Analysis 2.7

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

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Analysis 2.8

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

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Analysis 2.9

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

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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/dL^1,2	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)	⊕⊕⊕⊝ moderate^4,5
	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)	⊕⊕⊕⊝ moderate^4,5
	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

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

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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 (dichotomous ≥ 10 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 (dichotomous ≥ 15 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)	⊕⊕⊕⊝ moderate^4,5
	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

Summary of findings 2. Environmental strategies (dust control) for preventing domestic lead exposure in children

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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

2.6‐2.7

>20

10‐14

<10

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

Table 1. Mean blood lead level and age at baseline

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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

Table 2. Intervention type by study

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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

Table 3. Outcome measures by study

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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]

Comparison 1. Education

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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]

Comparison 2. Environmental ‐ Dust control

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Household interventions for preventing domestic lead exposure in children

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