Effectiveness of soil remediation intervention of abandoned used lead-acid battery recycling sites to reduce lead exposure among children: A three-arm pretest-posttest non-equivalent comparison group trial

BACKGROUND: Lead exposure remains a substantial risk to public health, especially among children, in low- and middle-income countries. This study assessed the efficacy of a soil remediation intervention on reducing blood lead level (BLL) among children living near an abandoned used lead-acid battery (ULAB) recycling site in Mirzapur, Bangladesh. METHODS: We conducted a pretest-posttest, non-equivalent comparison group study with 167 children aged 6 months to 12 years across three study arms (ULAB intervention, ULAB control, and non-ULAB control). Blood and environmental samples were collected at baseline and 12 months post-intervention. BLL was analyzed by Graphite Furnace Atomic Absorption Spectrophotometry, and environmental lead levels were assessed using portable X-ray fluorescence analyzer. RESULTS: Over the 12-month post-intervention period, geometric mean BLLs declined from 90.1 to 70.4 μg/L in ULAB intervention group, from 88.5 to 81.1 μg/L in ULAB control group, and from 42.8 to 37.8 μg/L in non-ULAB control group. Difference-in-differences analysis revealed a 15% greater BLL decline in the intervention arm compared to the ULAB control arm and 11% greater BLL decline in the intervention arm compared to the non-ULAB control arm. Subgroup analysis in the intervention arm revealed that older children (>5 years), those living closer to the site (median) experienced the greatest reduction in BLL. CONCLUSION: The soil remediation intervention significantly reduced BLLs in children. However, levels remained above the CDC reference value of 35 μg/L, highlighting the need for broader and sustained public health initiatives to reduce lead exposure.