A protocol for a systematic review of the effectiveness of interventions to reduce exposure to lead through consumer products and drinking waterReport as inadecuate

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Systematic Reviews

, 3:36

First Online: 15 April 2014Received: 30 January 2014Accepted: 27 March 2014DOI: 10.1186-2046-4053-3-36

Cite this article as: Pfadenhauer, L.M., Burns, J., Rohwer, A. et al. Syst Rev 2014 3: 36. doi:10.1186-2046-4053-3-36


BackgroundThe toxic heavy metal lead continues to be a leading environmental risk factor, with the number of attributable deaths having doubled between 1990 and 2010. Although major sources of lead exposure, in particular lead in petrol, have been significantly reduced in recent decades, lead is still used in a wide range of processes and objects, with developing countries disproportionally affected. The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels and associated health outcomes in children, pregnant women and the general population.

Methods-designThe databases MEDLINE, Embase and the Global Health Library GHL will be searched using a sensitive search strategy. Studies in English, German, French, Spanish, Italian or Afrikaans will be screened according to predefined inclusion and exclusion criteria. We will consider randomized and non-randomized studies accepted by the Cochrane Effective Practice and Organization of Care EPOC Group, as well as additional non-randomized studies. Screening of titles and abstracts will be performed by one author. Full texts of potentially relevant studies will be independently assessed for eligibility by two authors. A single author will extract data, with a second reviewer checking the extraction form. Risk of bias will be assessed by two researchers using the Graphical Appraisal Tool for Epidemiological studies, as modified by the Centre for Public Health at the UK National Institute for Health and Care Excellence. Any inconsistencies in the assessment of eligibility, data extraction or quality appraisal will be resolved through discussion. Where two or more studies report the primary outcome blood lead levels within the same population group, intervention category and source of lead exposure, data will be pooled using random effects meta-analysis. In parallel, harvest plots as a graphical method of evidence synthesis will be used to present findings for blood lead levels and secondary outcomes.

DiscussionThis systematic review will fill an important evidence gap with respect to the effectiveness of interventions to reduce lead in consumer products and drinking water in the context of new WHO guidelines for the prevention and management of lead poisoning. It will also contribute to setting a future research agenda.

AbbreviationsBLLblood lead level

CBAcontrolled before-and-after study

CDCCenter for Disease Control and Prevention

CNScentral nervous system

CSScross-sectional studies

DALYdisability-adjusted life years

GATEGraphical Appraisal Tool for Epidemiological Studies

GFRglomerular filtration rate

EPOCCochrane Effective Practice and Organization of Care

ITSinterrupted time series study

K-TEAKaufman Test of Educational Achievement

NHANESNational Health and Nutrition Examination Survey

NICENational Institute for Health and Care Excellence

UBAuncontrolled before-and-after study

USEPAUS Environmental Protection Agency

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-2046-4053-3-36 contains supplementary material, which is available to authorized users.

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Author: Lisa Maria Pfadenhauer - Jacob Burns - Anke Rohwer - Eva Annette Rehfuess

Source: https://link.springer.com/

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