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Lead exposure in indigenous children of the Peruvian Amazon: seeking the hidden source,venturing into participatory research
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction. In 2006, a Peruvian environmental agency reported the presence of elevated blood lead levels (BLLs) in indigenous communities of the Corrientes river basin. This is a territory in the Peruvian Amazon where oil activity has been associated with serious environmental effects, with impact on an ongoing social conflict. This PhD project aimed to determine the lead sources, risk factors and pathways in children of these communities and to suggest control and prevention strategies. Given the arguments attributing the lead source to the oil activity pollution, the second objective was to clarify any potential connection between the two. This project was conducted by a collaborative research partnership with the regional health authorities and the community-based organization. The third objective was to characterize the challenges, facilitating factors and the lessons learned from the research process.

Methods. Two epidemiological studies were conducted. Study I (2009) was carried out in three communities and study II (2010) in six communities with different levels of exposure to oil activity. The participants were children 0–17 years old. Data collection included: determination of BLLs, hemoglobin levels and anthropometric indicators, a risk factor questionnaire, an environmental assessment and a risk map. Data analysis included univariate, bivariate and multivariate logistic regression. Data for the third objective came from field notes, documents, interviews and a process of collective reflection.

Results. Study I (n= 221) found no significant difference in the geometric mean(GM) BLLs between the communities exposed and not exposed to oil activity. Older age and being a boy were found as risk factors for BLLs ≥ 10 μg/dL. In study II (n= 346), age stratified logistic regression models indicated that children 0–3 years whose mothers had BLLs ≥ 10 μg/dL, children 0–6 years who played with pieces of lead and children 7–17 years who fished 3 times or more per weekor chewed pieces of lead to manufacture fishing sinkers had a significant increased risk of having BLLs ≥ 10 μg/dL. Children who lived in communities near oil battery facilities also had a significant increased risk of having BLLs ≥ 10 μg/dL. In both studies, environmental samples showed lead concentrations below reference levels. The challenges and facilitating factors identified focused on five interrelated themes: i) mutual trust, ii) multiple agendas, iii) equal participation, iv) competing research paradigms and v) complex and unexpected findings.

Conclusions. Metal lead appeared to be the main source of exposure. Playing with pieces of lead and chewing pieces of lead to construct fishing sinkers appeared to be pathways of exposure for children aged 0–6 years and 7–17 years, respectively. Mothers’ BLLs > 10 μg/dL was a risk factor for BLLs > 10 μg/dL in children aged 0–3 years. Living in a community with high exposure to oil activity was a risk factor for BLLs > 10 μg/dL. The identified connection with oil activity was the proximity of communities to oil battery facilities and thus greater access to lead from cables and other industrial waste. Despite the numerous challenges, participatory research appears to be the most appropriate approach for this type of context. The study findings led us to recommend:i) a comprehensive community-based lead control and prevention plan,ii) the introduction of substitute non-harmful material(s) for fishing sinkers and iii) secure containment of the oil company’s waste deposits.

Abstract [es]

Introducción. En el 2006, una agencia ambiental del Perú informó de la presenciade niveles elevados de plomo sanguíneo en las comunidades indígenas dela cuenca del río Corrientes. Este es un territorio en la Amazonía peruana, dondela actividad petrolera ha sido asociada con graves efectos ambientales, originandoun continuo conflicto social.Este proyecto de tesis doctoral tuvo como objetivo determinar las fuentes, factoresde riesgo y vías de exposición de plomo en niños de estas comunidades paraproponer estrategias de control y prevención. Teniendo en cuenta previos argumentosque relacionaban la exposición de plomo con la contaminación por laactividad petrolera, el segundo objetivo fue esclarecer cualquier conexión entreambos. Este proyecto se condujo con la participación de miembros de la DirecciónRegional de Salud de Loreto (DIRESA Loreto) y de la organización indígenaFECONACO. El tercer objetivo fue caracterizar los desafíos, las oportunidades ylos aprendizajes del proceso participativo.Métodos. Se condujeron dos estudios epidemiológicos. El estudio I (2009) sedesarrolló en tres comunidades y el estudio II (2010) en seis comunidades condiferentes niveles de exposición a la actividad petrolera. Los participantesfueron niños de 0–17 años. La recolección de datos incluyó: determinación deplomo sanguíneo, de niveles de hemoglobina y de indicadores antropométricos,un cuestionario de factores de riesgo, una evaluación ambiental y un mapa deriesgo. El análisis de datos incluyó análisis univariado, bivariado y multivariadode regresión logística. Para el tercer objetivo, los datos provinieron de notas decampo, documentos oficiales, entrevistas informales y un proceso de reflexióncolectiva.Resultados. En el estudio I (n = 221) no se encontró diferencia estadísticamentesignificativa entre las medias geométricas de los niveles de plomo sanguíneo delas comunidades expuestas y no expuestas a la actividad petrolera. Los niños degénero masculino y los del grupo etario de mayor edad tuvieron un riesgo significativamentemayor a presentar niveles de plomo sanguíneo > 10 μg/dL. Enel estudio II (n = 346), los modelos estratificados por edad indicaron que losniños de 0–3 años cuyas madres tenían niveles de plomo > 10 μg/dL, los niñosde 0–6 años que jugaban con piezas de plomo y los niños de 7–17 años que pescaban3 veces o más por semana o masticaban piezas de plomo para fabricarpesas de pescar tenían un riesgo significativamente mayor de presentar nivelesde plomo sanguíneo > 10 μg/dL. Los niños que vivían en comunidades cercanasa las baterías de petróleo también tuvieron un riesgo significativamente mayora presentar plomo sanguíneo > 10 μg/dL. Las muestras ambientales en ambosestudios mostraron concentraciones de plomo por debajo de los niveles de referencia.En cuanto al proceso de investigación, los desafíos y oportunidades másimportantes se centraron en cinco temas interrelacionados: i) la confianza mutua,ii) múltiples agendas, iii) participación equitativa, iv) competencia de paradigmasen la investigación y v) diseminación de resultados complejos e inesperados.Conclusiones. La fuente de exposición principal sería el plomo metálico. Jugarcon piezas de piezas de plomo y masticar piezas de plomo para la construcciónde pesas de pescar serían vías de exposición para los niños de 0–6 años y 7–17años, respectivamente. Niveles de plomo sanguíneo > 10 μg/dL en las madressería un factor de riesgo para presentar niveles de plomo sanguíneo > 10 μg/dLen niños de 0–3 años. Vivir en una comunidad con alta exposición a la actividadpetrolera sería también un factor de riesgo para presentar niveles de plomo sanguíneo> 10 μg/dL. La conexión con la actividad petrolera parece estar en laproximidad de las comunidades a las baterías del petróleo y por ende, el mayoracceso al plomo proveniente de cables y otros residuos industriales.A pesar de los varios desafíos, la investigación participativa parece ser el enfoquemás apropiado para este tipo de contextos. Los hallazgos nos llevaron a recomendar:i) un programa comunitario de control y prevención de plomo, ii) laintroducción de pesas de pescar de materiales seguros, alternativos al plomo yiii) el control de la disposición de residuos de la actividad petrolera.

Place, publisher, year, edition, pages
Umeå: Umeå university , 2012. , 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1529
Keyword [en]
lead exposure, children, indigenous, Corrientes river, participatory research, Peruvian Amazon
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-61254ISBN: 978-91-7459-500-0 (print)OAI: oai:DiVA.org:umu-61254DiVA: diva2:565317
Public defence
2012-11-30, Major Grove, Byggnad 6, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2012-11-09 Created: 2012-11-07 Last updated: 2015-04-29Bibliographically approved
List of papers
1. Lead exposure in indigenous communities of the Amazon basin, Peru
Open this publication in new window or tab >>Lead exposure in indigenous communities of the Amazon basin, Peru
Show others...
2011 (English)In: International journal of hygiene and environmental health (Print), ISSN 1438-4639, E-ISSN 1618-131X, Vol. 215, no 1, 59-63 p.Article in journal (Refereed) Published
Abstract [en]

Since 2006, three studies have reported elevated levels of lead (Pb) among the indigenous population of the Corrientes river, in the Amazon basin of Peru. Due to the large evidence of environmental pollution related to oil exploitation in the area, this activity has been suggested as the source of exposure. This study aimed to evaluate Pb levels in the population and environment of two communities exposed and one community non-exposed to the oil exploitation activity. Blood lead levels (BLL) were determined by the instrument Leadcare. A comparison with the graphite furnace atomic absorption technique was performed in order to validate the Leadcare results. Environmental samples were analyzed by inductively coupled plasma atomic emission spectroscopy. Among 361 capillary samples, the mean BLL was 9.4μg/dl. Mean BLL of the communities exposed (n=171, x¯=9.5μg/dl) and non-exposed (n=190, x¯=9.2μg/dl) to the oil activity were not significantly different. Pb levels in environmental samples were below the maximum permissible levels. The sources of exposure could not be identified. Elevated levels of Pb in the oil-non-exposed community pointed out at other sources not yet clarified.

Place, publisher, year, edition, pages
Elsevier, 2011
Keyword
lead exposure, corrientes river, Peru, oil exploitation
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-50960 (URN)10.1016/j.ijheh.2011.07.003 (DOI)21835691 (PubMedID)
Available from: 2012-01-02 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
2. Lead exposure among children from native communities of the Peruvian Amazon basin
Open this publication in new window or tab >>Lead exposure among children from native communities of the Peruvian Amazon basin
2012 (English)In: Revista panamericana de salud pùblica, ISSN 1020-4989, E-ISSN 1680-5348, Vol. 31, no 4, 296-302 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To assess potential risk factors associated with elevated blood lead levels (BLLs) among children in two communities from the Corrientes River basin in the Peruvian Amazon.

Methods. Children aged 0-17 years were screened for BLLs, hemoglobin levels, and anthropometric measures. Dwelling, family, and child data were collected through a parental questionnaire. Statistical analysis included descriptive and bivariate analysis. Multiple linear and logistic regressions using generalized estimating equations were also conducted to determine associated risk factors. A map of each community was drawn to examine the spatial distribution of BLLs.

Results. Of 208 children (88 from 23 households of the Peruanito community and 120 from 28 households of Santa Isabel), 27.4% had BLLs >= 10 mu g/dL. The geometric mean (+/- standard deviation) BLL was 8.7 +/- 4.0 mu g/dL (range 3.0-26.8 mu g/dL). In the total population, linear regression analysis indicated that age was positively associated with BLLs (P < 0.05). Logistic regression analysis showed that boys had 2.12 times greater odds of having BLLs >= 10 mu g/dL than girls (P < 0.05). Among the children 0-3 years, those whose mothers had BLLs >= 10 mu g/dL had 45.0% higher odds of presenting BLLs >= 10 mu g/dL than children whose mothers had BLLs < 10 mu g/dL (P < 0.05).

Conclusions. Older age, male gender, and mothers' BLL >= 10 mu g/dL were the main risk factors for elevated BLLs. The higher risk in boys 7-17 years suggests that exposure could be related to specific activities in this group, such as fishing and hunting. Continuous monitoring of BLLs in the Corrientes River population is recommended.

Keyword
lead poisoning, nervous system, childhood, risk factors, Peru
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-57762 (URN)000306217800005 ()22652969 (PubMedID)
Available from: 2012-08-15 Created: 2012-08-14 Last updated: 2017-12-07Bibliographically approved
3. Sources and risk factors for lead exposure in indigenous children of the Peruvian Amazon, disentangling connections with oil activity
Open this publication in new window or tab >>Sources and risk factors for lead exposure in indigenous children of the Peruvian Amazon, disentangling connections with oil activity
2012 (English)In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 18, no 4, 268-277 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: In the Corrientes river basin, Peruvian Amazon, lead exposure among indigenous communities was first reported in 2006. To address controversy regarding the main source of exposure, this study aimed to identify the sources and risk factors for lead exposure among children from the communities in question, and to clarify the potential relationship with oil activity.Methods: This cross-sectional study was conducted in six communities. Participants were children aged 0–17 years and their mothers. Data collection included blood lead levels (BLLs) and hemoglobin determination, a questionnaire on risk factors and environmental sampling. We used age-stratified multivariate regression models, with generalized estimating equation to account for correlation within households.Results: Twenty-seven percent of the children had BLLs ≧10 μg/dl. Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps, fishing ≧three times/week, and living in highly oil-exposed communities increased the risk of having BLLs ≧10 μg/dl. Lead concentrations in sediment, soil, dust, and fish samples were below reference values.Conclusions: Mother's BLLs ≧10 μg/dl, playing and chewing lead scraps to manufacture fishing sinkers were the most important risk factors for children’s BLLs ≧10 μg/dl. The connection with oil activity appears to be through access to metal lead from the industry's wastes.

Place, publisher, year, edition, pages
Maney Publishing, 2012
Keyword
Lead, Exposure, Children, Indigenous, Amazon, Peru, Oil activity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-61251 (URN)10.1179/2049396712Y.0000000008 (DOI)000312824200002 ()23433287 (PubMedID)
Available from: 2012-11-07 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically approved
4. Easier said than done: applying the Ecohealth principles to a study of heavy metals exposure among indigenous communities of the Peruvian Amazon
Open this publication in new window or tab >>Easier said than done: applying the Ecohealth principles to a study of heavy metals exposure among indigenous communities of the Peruvian Amazon
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 437Article in journal (Refereed) Published
Abstract [en]

Background

The renewed interest in community participation in health research is linked to its potential for bridging gaps between research and practice. Its main attributes are the generation of knowledge that can lead to socially robust, long-lasting solutions and the creation of a colearner relationship between researchers and research users. Following this philosophy, Ecohealth has evolved into a specialized framework for participatory research on the impact of pollution on ecosystems and human health. However, its principles pose considerable challenges. Its outcomes are strongly influenced by contextual factors that are impossible to control for ahead of time.

This paper describes how the Ecohealth principles were applied to an epidemiological study of heavy metals exposure among indigenous communities of the Peruvian Amazon. It illustrates how knowledge generated from participatory research does not necessarily imply solving a public health problem. This study aimed to contribute to the understanding of the benefits and barriers of following the basic principles of the Ecohealth approach, and assist researchers working in similar contexts.

Research process

Based upon their personal experience as participant observers, the authors describe the research process; then, they discuss the most important challenges faced, their implications, and the attempted strategies for resolution.

Challenges

Challenges were grouped into four themes: (1) building trust; (2) one partnership, many stakeholders, multiple agendas; (3) being a researcher; and (4) communicating complex and unexpected findings.

Conclusions

Integrating the principles of transdisciplinarity and participation posed a series of challenges to the research process that were difficult, and sometimes impossible to overcome. However, positive outcomes from this experience were the lessons learned by the different actors. Despite the lack of immediate action, it is expected that useful interventions to prevent and control lead exposure in the Corrientes population will be implemented in the medium term.

Keyword
Ecohealth, Heavy metals exposure, Indigenous, Amazon, Peru, Participatory research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-61253 (URN)10.1186/1471-2458-13-437 (DOI)
Funder
FAS, Swedish Council for Working Life and Social Research, 20061512
Note

Funding for the epidemiological study described in this paper came from the Comprehensive Health Care Plan for the Corrientes Native Communities (PEPISCO) and a grant from FAS, the Swedish Council for Working Life and Social Research (grant 2006–1512).

Available from: 2012-11-07 Created: 2012-11-07 Last updated: 2017-12-07Bibliographically approved

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