Description of 3,180 courses of chelation with dimercaptosuccinic acid in children ≤ 5 y with severe lead poisoning in Zamfara, Northern Nigeria: a retrospective analysis of programme data

In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore...

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Bibliographic Details
Published in:PLoS medicine 2014-10, Vol.11 (10), p.e1001739
Main Authors: Thurtle, Natalie, Greig, Jane, Cooney, Lauren, Amitai, Yona, Ariti, Cono, Brown, Mary Jean, Kosnett, Michael J, Moussally, Krystel, Sani-Gwarzo, Nasir, Akpan, Henry, Shanks, Leslie, Dargan, Paul I
Format: Article
Language:English
Subjects:
Administration, Oral
Biology and Life Sciences
Care and treatment
Chelating Agents - administration & dosage
Chelating Agents - therapeutic use
Chemical reactions
Child, Preschool
Fatalities
Female
Humans
Infant
Lead content
Lead poisoning
Lead Poisoning - blood
Lead Poisoning - drug therapy
Male
Medical research
Medicine and Health Sciences
Methods
Nigeria
Physiological aspects
Retrospective Studies
Succimer
Succimer - administration & dosage
Succimer - therapeutic use
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Summary:In 2010, Médecins Sans Frontières (MSF) discovered extensive lead poisoning impacting several thousand children in rural northern Nigeria. An estimated 400 fatalities had occurred over 3 mo. The US Centers for Disease Control and Prevention (CDC) confirmed widespread contamination from lead-rich ore being processed for gold, and environmental management was begun. MSF commenced a medical management programme that included treatment with the oral chelating agent 2,3-dimercaptosuccinic acid (DMSA, succimer). Here we describe and evaluate the changes in venous blood lead level (VBLL) associated with DMSA treatment in the largest cohort of children ≤ 5 y of age with severe paediatric lead intoxication reported to date to our knowledge. In a retrospective analysis of programme data, we describe change in VBLL after DMSA treatment courses in a cohort of 1,156 children ≤ 5 y of age who underwent between one and 15 courses of chelation treatment. Courses of DMSA of 19 or 28 d duration administered to children with VBLL ≥ 45 µg/dl were included. Impact of DMSA was calculated as end-course VBLL as a percentage of pre-course VBLL (ECP). Mixed model regression with nested random effects was used to evaluate the relative associations of covariates with ECP. Of 3,180 treatment courses administered, 36% and 6% of courses commenced with VBLL ≥ 80 µg/dl and ≥ 120 µg/dl, respectively. Overall mean ECP was 74.5% (95% CI 69.7%-79.7%); among 159 inpatient courses, ECP was 47.7% (95% CI 39.7%-57.3%). ECP after 19-d courses (n = 2,262) was lower in older children, first-ever courses, courses with a longer interval since a previous course, courses with more directly observed doses, and courses with higher pre-course VBLLs. Low haemoglobin was associated with higher ECP. Twenty children aged ≤ 5 y who commenced chelation died during the period studied, with lead poisoning a primary factor in six deaths. Monitoring of alanine transaminase (ALT), creatinine, and full blood count revealed moderate ALT elevation in
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001739