Environmental Pollution 249 (2019) 1091e1105

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Environmental Pollution
journal homepage: www.elsevier.com/locate/envpol

Lead-based paints and children's PVC toys are potential sources of

domestic lead poisoning e A review
Shukuru Yusufu Njati a, *, Mihayo Musabila Maguta b
a
Tanzania Rural and Urban Roads Agency (TARURA), P.O.Box 11042, Dodoma, Tanzania
b
Department of Environmental Planning, Institute of Rural Development Planning (IRDP), P. O. Box 138, Dodoma, Tanzania

a r t i c l e i n f o a b s t r a c t

Article history: Lead (Pb) both in paints and children's Polyvinyl chloride (PVC) toys is a major public health concern
Received 12 July 2018 which has attracted attention of the international community. Concentrations of Pb both in lead-based
Received in revised form paints and children's PVC toys have been assessed through various studies across the globe. Therefore,
21 February 2019
the purpose of this article was to summarize the results reported in these studies and provide some
Accepted 15 March 2019
Available online 20 March 2019
comprehension on their implications to human health for law enforcement as well as for awareness
raising to the general public. Highlights on identified gaps have been provided to pave ways for further
research interventions in order to establish comprehensive information on the subject.
Keywords:
Lead-based paint
Regardless of regulatory limits on the content of lead, both in paints and children's PVC toys existing in
Children toy different countries in the world, some of the reviewed articles have revealed significant levels of lead in
Neurotoxin these two items far above the permissible limits.
Carcinogenic High lead levels in paints have been recorded in China (116,200 ppm), Cameroon (500,000 ppm), South
Regulation on lead-based paint Africa (189,000 ppm), Tanzania (120,862.1 ppm), Uganda (150,000 ppm), Thailand (505,716 ppm) and
Brazil (170,258.4 ppm) just to mention a few.
Lead poisoning cases in children have been reported in several countries including France, Morocco,
South Africa and United States. Countries where high levels of lead in children's PVC toys have been
recounted include; China (860,000 ppm), South Africa (145,000 ppm), United States (22,550 ppm),
Thailand (4,486.11 ppm), Palestine (6,036 ppm) and India (2,104 ppm).
Awareness raising among parents is vital to impart them with knowledge on the matter so that they
can take strenuous measures to protect their children from lead poisoning emanating from playing with
toys and paint dust. Law enforcement on phasing out lead-based paints and control of lead content in
children's PVC toys worldwide is also highly recommended.
© 2019 Elsevier Ltd. All rights reserved.

1. Introduction
1.1. General introduction
Lead and its associated compounds have been used as compo-
nents in various products including paints, batteries, gasoline,
pipes, ceramics and cosmetics due to their abundances, low cost
and physical properties (Bawa et al., 2015; Johnson et al., 2009a;
Juberg, 2000; Landrigan and Todd, 1994). Lead is a heavy metal,
naturally occurring, non-degradable in nature, highly toxic at very
* Corresponding author.
E-mail addresses: shukuru.njati@tarura.go.tz (S.Y. Njati), mmaguta@irdp.ac.tz
(M.M. Maguta).
low exposure levels thereby imposing acute and chronic effects on
human health and the environment (Adebamowo et al., 2006b;
Hernberg, 2000; Ja €rup, 2003; Karrari et al., 2012; Landrigan and
Todd, 1994; Lessler, 1988; UNEP, 2016; WHO, 2009, 2010a). This
heavy metal is also a neurotoxin, carcinogenic (Gidlow, 2004;
Ismail et al., 2006; Lanphear et al., 2005) and at high level of human
exposure it damages the reproductive organs, immune system,
nervous system, liver, kidneys and cardiovascular system (Bhagwat
et al., 2008; Patil et al., 2007; Pratinidhi et al., 2014; Tong et al.,
2000; Wani et al., 2015). Lead poisoning is an environmental dis-
ease (Meyer et al., 2008) with cumulative and irreversible health
effects (Needleman and Bellinger, 1991). Furthermore, lead is also
considered as one of the anthropogenic pollutants and human
beings become exposed to lead through leaded soils and dusts,
contaminated air, water, food as well as formerly used leaded-

https://doi.org/10.1016/j.envpol.2019.03.062
0269-7491/© 2019 Elsevier Ltd. All rights reserved.
1092 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
gasoline (Monna et al., 2006). Due to public health concern linked
to lead poisoning from lead-based paints, phase-out of lead-based
paints by 2020 is currently being targeted by the forged Global
Alliance under the leadership of United Nations Environment Pro-
gramme (UNEP) and the World Health Organization (WHO).
1.2. Heavy metals
Heavy metals are naturally occurring elements that have a high
atomic weight and a density of at least five times greater than that
of water (Tchounwou et al., 2012). Heavy metals have a wide range
of applications covering industries, domestic, agriculture, medical
and technological. This has led to their wide distribution in the
environment; raising concerns over their potential effects on hu-
man health and the environment (Tchounwou et al., 2012). All the
heavy metals are toxic at relatively high concentration. The heavy
metals are heterogeneous group of elements which greatly differ in
their chemical properties and biological function. Their toxicity
depends on several factors including the dose, route of exposure,
and chemical species, as well as the age, gender, genetics, and
nutritional status of exposed individuals (Tchounwou et al., 2012).
2. Methodology
The articles reviewed in this paper were obtained through a
comprehensive literature search in scientific databases including,
ScienceDirect, Google scholar and PubMed. Other articles were
obtained through searching in research for life databases (HINARI,
OARE, and AGORA). The focus was on the peer-reviewed journals,
academic reports like master or PhD thesis and government re-
ports. The key words used during the searching process were;
“lead-based paints”, “lead in paints”, “leaded toys”, “lead content in
PVC children's toys”, “lead poisoning in children”, children expo-
sure to lead”, “Blood lead levels in human”, “pica habit and lead
poisoning”, “regulations on lead-based paints” and “control of
leaded paints”. References in the obtained articles were also ana-
lysed and those found to bear titles relevant to the objective of this
article were searched and scrutinized. The inclusion criteria
considered all publications that reported on effects of lead to
mankind, lead-based paint and lead levels in children toys, regu-
lations as well as control of lead-based paints and lead content in
children toys. Publications reported on epidemiology studies,
hospital admissions and clinical reports associated with lead
poisoning were also included.
3. Problem statement
Lead poisoning is among the current global key issues of public
health concern. According to UN Environment, every year,
approximately 800,000 people die of lead exposure worldwide,
with the highest burden in developing countries. Lead exposure is a
major contributor to the development of intellectual disability in
children. There is no level of lead exposure considered safe; the
neurological and behavioural effects of lead exposure are irre-
versible. The global population is being exposed to Pb poisoning
through various sources, children being a group which is at high
risk of lead poisoning. Elevated blood lead (BPb) levels are thought
to cause mental retardation of more than 0.6 million children
globally each year. Significant sources of Pb in the environment
include; dust originating from deterioration of house walls painted
with lead-based paints and PVC toys which in particular affect
children. Lead compounds are used as ingredients in
manufacturing of both paints and PVC toys. In PVC toys the prob-
lems is aggravated when lead-based paints are used to paint them.
Records indicate that, the business of both paints and PVC toys is
growing each year signifying that, the problem of lead poisoning
from the two products is likely to continue growing as well unless
the current move led jointly by WHO and UNEP to phase-out lead-
based paints by 2020 are well supported by the global community
and alternatives are sought to replace the lead additives used in
manufacturing of PVC toys. Various studies conducted to assess the
levels of lead both in paints and PVC toys have reported significant
levels of lead far above the recommended limits. Furthermore,
human blood samples involved in various studies from people
linked to lead poisoning from lead-based paints and PVC toys have
been detected with elevated lead (Pb) levels above the WHO rec-
ommended limits of <10 mg dL
1. Several lead poisoning incidences
in children emanating from playing with toys have been reported in
the United States. Also lead poisoning cases in children from lead
dust linked to lead-based paints have been recorded in various
countries around the globe. With all these observations, this review
article has been prepared to shed light on the existing problems
related to lead poisoning in particular from lead-based paints as
well as children's PVC toys. Research gaps have been highlighted
and recommendations on measures to be taken to alleviate the
situation have been provided.
4. Lead-based paints overview
Paint is any liquid which, after application to a substrate in a thin
layer, it is converted into an opaque solid form. Paint normally
functions as a protective or decorative material in the interior and
exterior of buildings and other surfaces deemed to be important.
“Enamel decorative paint” refers to oil-based paints into which
leaded compounds are added and act as drying catalysts as well as
anti-corrosive agent on metal surfaces (IPEN, 2016). Due to low
prices, enamel paints are readily available compared to water-
based paints.
Historically, paint manufacturers normally add lead compounds
purposely to paint formulations for various reasons including
colour improvement, protecting surfaces from corrosion and rust as
well as hastening drying (Johnson et al., 2009b; Kessler, 2014). In
their study Johnson et al (2009a,b) reported that, the commonly
used lead compounds as pigments include lead (II) chromates
(produce yellow, orange, red and green paints), lead (II) carbonate
(white lead), lead oxides (red lead) and lead molybdates (red
orange).
Furthermore, Johnson et al (2009a,b) noted that, substitutes for
lead additives which are less toxic including non-leaded pigments,
driers and anti-corrosive agents are currently available in the
market and have been in use since 1980's. Paint manufacturers use
the available lead substitutes to produce the highest quality paints
which are sold mostly to countries with strict regulations on the
use of leaded paints. Lead containing paints manufactured by
different industries worldwide enter markets in the countries
where no rigorous regulations to control lead-based paints exist
and the public is less aware of their hazards.
In general, lead exposure poses health risks to all humans (Tong
et al., 2000) but children are considered to be at higher risk than
adults due to increased gastrointestinal lead absorption in children
(Fels et al., 1998; Markowitz and Rosner, 2000; Meyer et al., 2008;
Rastogi, 2008). In children, lead has been associated with neuro-
logical and behavioural disorders such as poor memory and mental
retardation (Agency for Toxic Substances and Disease Registry
(ATSDR), 2015). Regional-wise, Asia is leading in production of
paints globally followed by Europe while the oceanic are the least
producers as indicated in Fig. 1 below.
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
Fig. 1. World production of paints and coatings in 2011, Data source: (Chemical Economics Handbook: Paint and Coatings Industry Overview, 2015)
5. Children's polyvinylchloride (PVC) toys
5.1. Overview
Polyvinylchloride (PVC) materials are the most common used
material in the manufacturing of soft plastic children's toys. Lead
compounds are incorporated in Polyvinylchloride material so as to
improve its stability, softness, brightness and flexibility hence
making toys more attractive to children (Ghaly et al., 2013; Ismail
et al., 2006; Kumar and Pastore, 2007; Livingstone et al., 2014;
Yousif and Hasan, 2015). Lead compounds used in PVC include,
basic lead carbonate, lead stearate, basic lead stearate, tribasic lead
stearate, basic (dibasic) lead stearate, and basic lead phthalate
(Omolaoye et al., 2010). Lead is also added to PVC or other plastic
products as colouring agent in the form of organo-metallic com-
pounds (Kumar and Pastore, 2007).
It is noted from Livingstone et al. (2014) that, with time, the free
chlorine radicals from the surface of PVC react with the hydrogen
radicals forming hydrochloric acid (HCl); the HCl formed auto-
digest and completely weaken the PVC surface and eventually
leaching of lead to the surface of PVC occurs which when ingested/
inhaled become available in the blood stream.
In soft plastic children's toys, lead originates from the PVC ma-
terials and also from paints used to colour the toys. When a child
chew, lick or swallow this type of toys become exposed to lead
poisoning (Kelley et al., 1993). Owing to children's high gastroin-
testinal uptake and the permeable blood/brain barrier, they
become more susceptible to the effects of lead poisoning (Decharat
et al., 2013).
5.2. Global toys production and sales
Between the years of 2012e2015, the total world toys produc-
tion and the plastic toys production increased by average of 1.3%
and 6.1% per year respectively. The total world toys production
increased to 370 billion U.S dollars while plastic toys production
increased to 140 billion U.S dollars in 2015. The share of plastic toys
production within the total toys production share which was 33% in
2012, increased to 38% in 2015 as indicated in Table 1 (Kara and
1093
Erkan, 2018).
Between 2007 and 2012, the trend on toys sales worldwide
portrayed an up and down pattern then a steady increase was
observed from 2012 to 2017 as indicated in Fig. 2 below.
In the year 2015, North America was leading in terms of revenue
from toys sales in the world. That year, the toy market generated
approximately 28.9 billion U.S. dollars in revenue in the region
followed by Asia which earned approximately 27.4 billion U.S dol-
lars while the least revenue of 2.0 billion U.S dollars was recorded in
Australia (Fig. 3).
The growth rate of toys sales in major regions anticipated for the
period from 2013 to 2016 is presented in Table 2. Among these
regions, China shows a significant growth from 15% in 2013 to 17%
in 2016. This was attributed to the big market size and increasing
urbanization in the country (Economic Services Group National
Productivity Council (ESGNPC), 2017).
Global brand owner companies, contract companies in which
productions are made, distributors and toys stores are the main
four key players in the toy industry in the world. Due to cheap la-
bour and integrated side industry, contract manufacturing is
mainly performed in China as well as in Italy, Spain, England and
Germany (Kara and Erkan, 2018). Countries which are mainly
involved in the toy business are presented in Table 3.
6. Lead exposure
6.1. Sources of lead exposure
6.1.1. Adult exposure to lead
Adult exposure to lead mostly occurs in the workplace with
inhalation being the usual route of exposure. If the processes of
manufacturing, application or removal of lead-based paints are not
carried out in a safe manner, they result into occupational exposure.
Studies have revealed that, the potential occupational activities
to lead exposure include; smelting, mining, refining and informal
recycling of lead, use of leaded petrol, production and recycling of
lead-acid batteries, jewellery making, soldering, informal and cot-
tage manufacturing of ceramics and leaded glass, leaded paints,
electronic waste and use of leaded water pipes (Clark et al., 2006;
1094 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105

Table 1
World toys production from 2012 to 2015 (billion $).

2012 2013 2014 2015 Compound annual growth rate (%)

Total toys 357 354 368 370 1.3

Plastic toys 117 125 136 140 6.1
Percent of Plastic toys 33 35 37 38

Data source: (Kara and Erkan, 2018).

Fig. 2. Total revenue of global toys market from 2007 to 2017 in billion U.S dollars, Data source: (Statista, 2019).

Fig. 3. Revenue of the toys market worldwide in 2015, by region in billion U.S. dollars, Data source: (Statista, 2019).

Table 2 Johnson et al., 2009a; Meyer et al., 2008; Tong et al., 2000). Con-
Expected growth rates of toys sales in major regions, 2013e2016 (%). struction workers experience high risk of lead exposure during
Country 2013 2014 2015 2016 repainting or disturbing old surfaces painted with leaded industrial
China 15.48 15.83 16.11 17.14
paints in which large quantities of dust with significant lead con-
US 3.74 3.48 1.90 2.44 tent is produced (Gottesfeld, 2015; Patrick, 2006). In general, peo-
European Union (EU) 3.99 4.16 4.02 3.98 ple working with industrial paints become exposed to high
Other 6.94 6.95 7.31 7.24 concentrations of lead during manufacturing, application, mainte-
nance, repainting or removal. Exposure to lead can also be of the
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105 1095

Table 3 substances (Coltman, 1969). Various studies revealed that Pica

Leading countries in world toy import and export. habit for Pb is counted as a major cause of Pb poisoning in children.
Importing Countries Import % Share Exporting Countries Export % Share In the United States between 2004 and 2010; 145 children under
USA 31.3 29.5 China 42.7 46.1
18 years were tested positive for lead poisoning with a major risk
Germany 6.7 6.3 Hong Kong 7.4 8.0 factor of 36% of tested children being pica habit (Elsevier, 2016). In
England 6.4 6.0 USA 6.2 6.7 Great Britain, pica habit was identified as a source of lead poisoning
Hong Kong 5.8 5.4 Germany 4.5 4.9 in children aged between 1 and 5 years old (Burrows et al., 1951). In
Japan 5.2 4.9 Czech Republic 3.2 3.4
the United Kingdom, a 2-years and 10 months old boy was referred
France 4.5 4.3 Holland 2..3 2.5
Canada 4.1 3.9 Taiwan 2.1 2.3 to the paediatric clinic by his general practitioner with pallor and
Holland 2.4 2.3 England 2.0 2.1 pica. He was reported to have a habit of consuming non-food ma-
Italy 2.3 2.2 Italy 1.7 1.8 terials including paint, plaster and wood. Blood tests reported
Turkey 0.6 0.6 Turkey 0.1 0.1
extremely high BPb concentrations at 34.58 9 mg dL
1. In-
Data source: (Kara and Erkan, 2018). vestigations at his family home revealed that, the boy was living
with his parents and siblings in a house built in 1970s where
extensive evidence of pica was discovered; some walls and bath-
non-occupational type where people of all ages come into contact room doorframe were severely affected. The child had chewed
with lead in air, dust, soil, contaminated fruits, vegetables and through newer layers of paint, down to old lead-containing paint,
drinking water (Finster et al., 2004; Landrigan and Todd, 1994). which was considered to be his source of exposure (McManus and
Lead contained in the paints contributes to this kind of exposure Hendersen, 2018). In Romania, a 16-year old female working on
(non-occupational) by accumulating in indoor dust and in the soil pottery presented with severe abdominal pain, vomiting and
outdoors. arterial hypertension was diagnosed with lead poisoning. The lead
levels detected in her blood and urine were 66.28 mg dL
1 and 419.7
6.1.2. Children's exposure to lead mg dL-1 respectively. The incidence was linked to inhalation of lead
Another group which is at high risk of lead exposure are chil- possibly originating from lead additives used in pottery. The
dren mainly through playing with toys painted with lead-based pottery-making process involves ceramic glazes and decorative
paints as well as from dust and soil contaminated with lead origi- paints, which both contain lead (Marginean et al., 2016). In France a
nating from deterioration of lead paint (Akkus and Ozdenerol, 2-year old boy was clinically diagnosed with acute lead poisoning
2014; Dapul and Laraque, 2014; Farfel and Chisolm, 1991; (BPb levels at 31.26 mg dL
1) where medical history revealed that,
Williams et al., 1952). Various studies to ascertain the total content the child had pica behaviour (Guillard et al., 2006). In Oporto
of lead in PVC toys and other soft toys have been conducted (Porto), Portugal, Mayan et al. (2001) conducted a study with
worldwide. Results show that, most samples tested positive for lead several objectives one of them being to evaluate childhood lead
(Ahmad et al., 2014; Ahmad et al., 2012; Al-Qutob et al., 2014; Cui poisoning among children aged 1-5 years living in Oporto Historical
et al., 2015; Decharat et al., 2013; Ghaly et al., 2013; Greenway Centre. The findings indicated that, the geometric mean of BPb
and Gerstenberger, 2010; Ismail et al., 2006; Kumar and Pastore, concentration was 13.9 mg dL
1, and lead poisoning prevalence
2006, 2007; Livingstone et al., 2014; Omolaoye et al., 2010). Chil- (blood lead levels > 10 mg dL
1) was 85.8%, among the 240 children
dren's habit of chewing, sucking and licking on PVC toys results in involved in the study. Identified important sources of lead
the ingestion of measurable amount of lead. poisoning to these children were; father's occupation, mother's
Exposure to soil that contains particulate lead has been shown smoking habits, poor hygiene as well as pica habits associated with
to be significantly hazardous to children who are more commonly contaminated soils and lead paint. History of pica habit was also
exposed through ingestion of house dust or soil than by paint chips identified as a risk factor of lead poisoning for children in Pakistan,
(New Zealand Ministry of Health, 2008; Patrick, 2006; Peng et al., India, Morocco, Malaysia and South Africa (Alexander and Delves,
2019). A recent study conducted by Peng et al. (2019) detected 1972; Ismail et al., 2006; Jouhadi et al., 2016; Mathee et al., n.d;
significant amount of lead in soil as well as in equipment dust at Mathee et al., 2004).
different children's play grounds in Beijing, China. The average lead In 2002, an epidemiological survey involving 383 grade I chil-
concentrations in equipment dust and in soil were 80.5 ppm and dren attending schools in the Johannesburg suburbs in South Africa
36.2 ppm respectively which signify that, children using those play was conducted. Amongst the surveyed pupils, 42% were found to
grounds are at high risk of lead poisoning. During mouth contact, have blood lead levels exceeding the internationally acceptable
Pb in paint dust or wearing of plastic painted toys can be mobilized blood lead levels of 10 mg dL
1. The highest blood lead level of
through saliva and pose a threat to children's health. Painted plastic 44.4 mg dL
1 belonged to a 7 year old female pupil. The girl was
toys made of PVC materials have been reported to be the major observed to have a pica habit, ingesting putty, paint from walls and
source of lead poisoning to children worldwide owing to the fact soil from her home environment and she was medically diagnosed
that, PVC contain lead and cadmium (Ismail et al., 2006; Kumar and with microcytic anaemia. Samples from walls of the girl's home and
Pastore, 2007). Auto-digestion process tends to weaken the PVC the school she attended were analysed and found to have high lead
structure and hence release of lead from the PVC structure occurs. levels of 3,940 ppm and 2,601 ppm respectively (Mathee et al., n.d).
Furthermore, it has been demonstrated that, when women with
child-bearing age ingest lead, it is stored in the bones and then 7. The effects of lead on human health
released during gestation (Gomaa et al., 2002).
In the human body, lead content has no beneficial role rather it
6.1.2.1 Reported lead poisoning cases in children linked to inhala- is a potent and permanent neuro-toxicant, taken up by humans
tion or ingestion of dust from leaded-paints primarily through ingestion and inhalation. Meyer et al. (2008)
reported that, once lead is absorbed into the body it binds to the
Lead poisoning cases in children associated with inhalation, or red blood cells and travels in the blood to soft body tissues such as
ingestion of dust from lead-based paints have been reported in kidneys, liver, spleen, brain, lungs, muscles and heart. About 80%e
various countries across the globe. Pica habit is defined as an un- 90% of ingested lead is then excreted, while the remainder bio-
usual craving for and ingestion of either edible or inedible accumulates in insoluble form in hair as well as in bones and
1096 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
teeth where it can stay for decades (DeSilva, 1981; Meyer et al.,
2008). Studies show that lead stored in bones is released into
blood stream during illness or prolonged acidosis resulting in se-
vere lead poisoning (Lessler, 1988; Meyer et al., 2008).
Owing to its toxicity concerns, developed countries have phased
out the application of lead-based paints for residential use. It has
been scientifically proven that, in the general population, preschool
aged children and pregnant women and their foetuses are the most
vulnerable groups to the effects of lead even at very low levels in
the blood (Finkelstein et al., 1998).
Being the integral part of child's development process; children
play with toys through which they learn about the world. Kumar
and Pastore (2007) mentioned that, over time or in response to
light, metal stabilizers (lead, cadmium etc.) in material and paints
can leach out easily from toys. Chewing, licking and swallowing
behaviour of children is a common source of lead and cadmium
exposure (Dapul and Laraque, 2014; Heckenberg, 2013; Insight
Explorer (IE), 2016; Ismail et al., 2006; Kumar and Pastore, 2006,
2007).
Lead can significantly displace most of the calcium, iron and zinc
from the body cells and hence impair the vital roles of these ions in
human body (Flora et al., 2012(Sanders et al., 2009)). Furthermore
Sanders et al. (2009) reported that, ability of lead to replace calcium
is believed to be a probable cause of its ability to pass through and
damage the blood/brain barrier, though lack of a blood/brain bar-
rier is believed to be a reason for the susceptibility of infants to lead
neurotoxicity. Exposure to lead affects the neuro-behavioural and
growth development, haematological, gastrointestinal, cardiovas-
cular and renal system (Johnson et al., 2009a; Makokha et al., 2008;
Tong et al., 2000; WHO, 2010b). Childhood lead exposure, in some
cases causes irreversible neurological damage (Needleman and
Bellinger, 1991; WHO, 2011) and eventually intellectual disabil-
ities due to blockage of receptors of glutamate e a neurotransmitter
crucial for learning (Crow, 2007; Finkelstein et al., 1998).
Blood lead measurements reflect both recent and past expo-
sures, the latter being significantly resulting from mobilization
from bone back into blood (Gulson et al., 1997), and even in persons
without excessive exposure to lead, bone can contribute from 45%
to 55% of BPb. The results from the study by Gulson et al. (1997)
showed that, mobilization from bones (long-term stores) contrib-
utes significantly to blood lead levels during pregnancy.
High levels of BPb eventually cause anaemia; this is due to the
fact that, maturation process of erythroid elements in blood and
heme biosynthesis is impaired by lead and hence resulting in
decreased blood haemoglobin concentration and red blood cells
counts (Kühl and Imhof, 2014; Patil et al., 2006; Pratinidhi et al.,
2014; Waldron, 1966). WHO recommends a blood lead level of
not exceeding 10 mg dL
1, although studies have reported inverse
relationship between lead exposure and intellectual performance
even at blood lead concentration of <10 mg dL
1 (Bawa et al., 2015;
Bellinger and Bellinger, 2006; Canfield et al., 2003; Chiodo et al.,
2004; Johnson et al., 2009a; Lanphear et al., 2000; Lanphear
et al., 2005). The symptoms of lead intoxication include anaemia,
headache, insomnia, dizziness, irritability, body muscles’ weakness,
hallucination and renal damage (Fu and Wang, 2011). In a recent
published population-based cohort study conducted to investigate
on low-level lead exposure and mortality in the United States
adults revealed that, 20% of the involved population (14,289), had
BPb levels of 5 mg dL
1. A median follow-up of 19.3 years depicted
the death of 4,422 people, 1,801 being from cardiovascular disease
and 988 from ischaemic heart disease. An increase in the concen-
tration of lead in blood from 1.0 mg dL
1 to 6.7 mg dL
1 was linked to
all-cause mortality. The population attributable fraction of the
concentration of lead in blood for all-cause mortality was 18.0%,
which is equivalent to 412,000 deaths annually (Lanphear et al.,
2018).
7.1. Neurological toxicity of lead
The nervous system in both adults and children is the main
target for lead toxicity. Lead affects both the peripheral and central
nervous systems; with peripheral being prominently affected in
adults whereas in children the central nervous system is more
profoundly affected (Flora et al., 2012). Furthermore, Flora et al.
(2012) listed the major symptoms of lead exposure being dull-
ness, irritability, poor attention span, headache, muscle tremor,
memory loss and hallucinations; at very high exposure to lead, it
results into delirium, lack of coordination, convulsions, paralysis,
coma and ataxia. The cognitive impairment in lead poisoned chil-
dren is associated with the effects of lead on the development of
nervous system (Bellinger, 2008; Flora et al., 2012; Johnson et al.,
2009a; Lidsky and Schneider, 2003; Meyer et al., 2008). Various
studies have reported an inverse relationship between blood lead
levels and cognitive deficit. A WHO report of 2010 on Childhood
Lead Poisoning reported that, early life lead exposure results into
untreatable and irreversible brain injuries and other effects like loss
of intelligence, shortening of attention span and behavioural
disruption.
Lanphear et al. (2000) examined the relationship between blood
lead concentrations and the performance on four measures of
cognitive functioning (reading skills, arithmetic skills, nonverbal
reasoning and short-term memory) on a representative sample of
4,853 children aged 6e16 years in the U.S. The results showed that,
for every 1 mg dL
1 increase in blood lead level there was a decre-
ment in mean scores on the four measures of cognitive functioning.
Furthermore, it was observed that, there was a decrement in
arithmetic and reading scores even for children with blood lead
levels lower than 5.0 mg dL
1. In another study which involved 456
children aged 7 years, the analyses revealed significant relation-
ships between blood lead levels and poorer achievement, lower IQ
scores as well as increased behavioural problems including
decreased attention (Chiodo et al., 2007).
7.2. Immunological toxicity
The crucial role of the immune system in human is to protect the
body from bacteria, viruses, parasites, fungi as well as to destroy the
malignantly transformed cells (Marth et al., 2001). The immune
system is among the most sensitive body systems to the effects of
lead. Johnson et al., (2009a,b) reported that, lead being an immune
toxicant; it alters hormonal levels and immunity parameters. Lead
induced immunotoxicity alters the metabolism and production of
macrophages and T lymphocytes (Dietert and Piepenbrink, 2006).
This induces functional alterations of the immunocompetent cells
and their counts resulting into immuno-suppression which raises
the body's risk to infectious diseases agents, auto immune diseases
and cancer (Cojocaru and Chicos, 2014; Gidlow, 2004; Mishra,
2009; Nriagu, 1988).
7.3. Renal toxicity function
Several studies recognized and documented a relationship be-
tween renal diseases in human and lead poisoning. Acute exposure
to high lead levels can result into renal proximal tubular damage
manifested in aminoaciduria and glycosuria conditions (Loghman-
Adham, 1997). Chronic high lead concentrations exposure results
into kidney's glomerulus damage hence loss of the glomerulus
ability to selectively filter high molecular weight proteins. This
results in increased urinary excretion of high molecular weight
proteins like albumin and macroglobulin (Gerhardsson et al., 1992;
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
Loghman-Adham, 1997). Furthermore, chronic lead nephropathy
leads to irreversible renal failure associated with hypertension,
hyperuricemia and gout (Rastogi, 2008).
7.4. Reproductive effects
Lead toxicity causes a number of adverse effects on the repro-
ductive health of both males and females (Bellinger, 2005; Flora
€ m et al., 1979; Nriagu, 1988). Lead is consid-
et al., 2012; Nordstro
ered as one of the foetal-toxin agent capable of crossing a placental
barrier in a pregnant woman and cause degenerative effects in a
developing foetus. Nriagu (1988) and Flora et al. (2012) mentioned
a wide range of negative pregnancy outcomes associated with lead
toxicity including; early membrane rupture, low birth weight,
premature delivery, spontaneous abortion, pregnancy hyperten-
sion, increased incidences of prenatal mortality, inhibition of
postnatal growth and development. On the other hand, Nriagu
(1988) reported that, men are more susceptible to abnormal sper-
matogenesis (number, morphology and motility) and reduced li-
bido, abnormal prostatic function as a result of lead toxicity.
7.5. Cardiovascular toxicity
A complex interaction between the vascular endothelium,
smooth muscle, the immune system and nervous system de-
termines the function of the cardiovascular system. Lead is among
the toxic heavy metals and an environmental toxicant as well.
Chronic exposure to lead poses serious risks to human health as
evidently listed in the Agency for Toxic Substances and Disease
Registry priority list of hazardous substances (Agency for Toxic
Substances and Disease Registry (ATSDR), 2015). Majority of risk
factors to cardiovascular diseases are preventable and these include
hypertension, cholesterol, obesity, tobacco use, sedentary lifestyle,
diabetes and chronic lead exposure (Navas-Acien et al., 2007;
Sharma and Purohit, 2014). Various studies have established a
relation/connection between environmental lead exposure and
development of cardiovascular diseases such as hypertension,
coronary heart disease, stroke, peripheral arterial disease and
alteration of cardiac rhythm (Alissa and Ferns, 2011; Navas-Acien
et al., 2007; Prozialeck et al., 2008; Schwartz, 1991; Sharma and
Purohit, 2014; Vaziri and Gonick, 2008).
7.6. Hematological toxicity
Upon absorption, lead enters the blood where over 95% of blood
lead is bound to the erythrocytes (Patil et al., 2006; Sakai, 2000).
Anaemia has been named to be one of the clinical manifestation of
lead poisoning in human being; primarily caused by impairment of
heme biosynthesis as well as increased rates of erythrocytes
destruction (Landrigan and Todd, 1994; Nikoli c et al., 2008;
Waldron, 1966; WHO, 2010a). In the heme biosynthesis pathway,
lead is known to inhibit the activities of three crucial enzymes
which are; delta-aminolevulinic acid dehydratase (ALAD), ferro-
chelatase and coproporphyrin oxidase (Patrick, 2006). Mitochon-
drial ferrochelatase enzyme is responsible for forming Feþ2 from
Feþ3 and incorporating the Feþ2 into protoporphyrin-IX to form
heme. Lead toxicity inhibits the reduction of Feþ3 to Feþ2 hence
decrease transportation of Feþ2 into the mitochondria resulting to
the build-up and accumulation of protoporphyrin in erythrocytes
which then binds with zinc to form zinc protoporphyrin (ZPP)
(Bhagwat et al., 2008; Hunter et al., 2011; Patil et al., 2006; Sakai,
2000). Measurement of zinc protoporphyrin in red blood cells has
been used as a screening test for lead poisoning (Martin et al., 2004;
Verschoor et al., 1987) and for iron deficiency (Crowell et al, 2006).
Delta-aminolevulinic acid dehydratase (ALAD) catalyses the
1097
condensation of two molecules of aminolevulinic acid to form a
molecule of porphobilinogen in the heme biosynthesis pathway.
Landrigan and Todd (1994); Sakai (2000); Patil et al. (2006) and
Bhagwat et al. (2008) all reported that, lead decreases the activities
of ALAD by interacting with the enzyme functional groups leading
to accumulation of aminolevulinic acid in the blood and elevated
aminolevulinic acids levels in urine. Haematological results re-
ported by Patil et al. (2006) and Bhagwat et al. (2008), of battery
manufacturing workers who were occupationally exposed to lead
for about 15 years revealed a decrease of erythrocytes counts and
haemoglobin concentration as a result of disturbances of heme
biosynthesis caused by lead intoxication.
7.7. Possible carcinogenic effects to human
Based on sufficient animal data and insufficient human data, the
International Agency for Research on Cancer (IARC) has classified
lead as a possible human carcinogen. Few studies have identified
the most likely types of cancer caused by lead in human to be; lung
cancer, stomach cancer and brain cancer (gliomas) (Ja €rup, 2003;
Patrick, 2006; Steenland and Boffetta, 2000). Carcinogenic effect of
lead is regarded as permissive rather than causative (Silbergeld
et al., 2000). According to Steenland and Boffetta (2000) and
Silbergeld et al. (2000); lead is considered to be a weak mutagenic
agent. The most likely means of lead carcinogenicity in human
comprise direct DNA damage, clastogenicity, or inhibition of DNA
synthesis or repair. Furthermore, lead may also produce reactive
oxygen chemical species which result into oxidative damage to
DNA (Silbergeld et al., 2000).
8. Lead content in lead-based paints and children's PVC toys
reported in previous studies
8.1. Lead content in lead-based paints
In the year 2009, the U.S EPA permissible limit in paints which
was also in use (adapted) in many other countries worldwide was
revised hence changed from the former 600 ppm to 90 ppm. In
September 2017, UN Environment introduced 90 ppm of total lead
as “Model Law and Guidance for Regulating Lead Paint”. Apart from
the U.S, other countries including Philippines, Canada, China, India,
Nepal, Tanzania, Kenya and the E.U also have adapted the 90 ppm as
the permissible limit of soluble lead in paints while most of the
countries are still using 600 ppm. This implies that, from 2009 the
two limits have been simultaneously used.
Initial background research to determine the concentration of
total lead (Pb) in new decorative paints available in developing
countries was organized in 2008 by Toxic Link and International
POPs Elimination Network (IPEN) in collaboration with other
partner organizations located in different countries. This move was
a follow up on the resolution of the sixth session of the Intergov-
ernmental Forum on Chemical Safety (IFCS), held in Dakar, Senegal
in 2008. In that research, paint samples were collected and ana-
lysed in a number of countries comprising of Brazil, Belarus,
Mexico, Nigeria, Phillipines, Senegal, South Africa, Sri Lanka,
Tanzania and Thailand. The results from this study indicated that,
majority of the samples in all studied countries had lead levels
higher than the permissible limit i.e. 600 ppm (Kumar, 2009; Toxic
Link/IPEN, 2009).
In the study conducted in India in 2008 to determine lead levels
in enamel paints, 84% of the analysed samples had lead levels
exceeding the permissible limit of 600 ppm. The lead concentra-
tions ranged from 25 ppm to 140,000 ppm (Kumar and Gottesfeld,
2008).
A follow-up study on high lead concentrations in new
1098 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
decorative enamel paints available in Egypt conducted by Clark
et al. (2013), portrayed a situation similar to those which have been
reported in many other countries. The lead concentrations in the
tested samples ranged from 4.5 ppm to 122,000 ppm with an
average concentration of 11,900 ppm. Furthermore, IPEN 2017 test
results of lead levels in enamel decorative paints in Egypt showed
that, 62% of the analysed samples (36 out of 58 samples) had lead
levels ranging from 60 ppm to 43,000 ppm (IPEN, 2017).
A UNEP funded study carried out by IPEN in 2013, assessed 234
cans of enamel paints from nine countries including; Argentina,
Azerbaijan, Chile, Cote d’Ivoire, Ethiopia, Ghana, Kyrgyzstan,
Tunisia and Uruguay. The results showed that, the average value of
lead concentration in the 67% of the analysed paint samples from 5
countries (Azerbaijan, Cote d'Ivoire, Ethiopia, Kyrgyzstan and
Tunisia) exceeded the current U.S-EPA allowable limit of 90 ppm.
The highest lead concentration of 260,000 ppm was recorded in
samples obtained from Cote d’Ivoire. Samples from Chile had a
maximum concentration of 1,100 ppm and those from Uruguay
recorded the highest concentration of 63 ppm. According to the
IPEN/UNEP report of 2013, the low lead levels in samples from
Uruguay was attributed to the imposed law and regulations con-
trolling lead content in paints where the maximum permitted
concentration was 600 ppm (IPEN/UNEP, 2013).
In a similar study conducted in Kenya in 2012; out 27 analysed
samples, 25 which is 93% of all tested samples had lead content
higher than the former Kenyan Lead limit level of 600 ppm and
among these samples 9 (33%) of them had lead content exceeding
10,000 ppm (Nganga et al., 2012).
In collaboration with IPEN, in 2008, AGENDA which is an NGO
based in Tanzania, conducted the first study in Tanzania on the
levels of lead in decorative paints and found that, all samples
(100%) from the oil-based paints had lead content above 600 ppm
(Kumar, 2009). Furthermore, in 2015, AGENDA conducted a second
study in Tanzania on solvent-based enamel paints only. The study
reported that, 64% of the analysed samples contained lead above
90 ppm (AGENDA, 2015). Presence of lead in solvent-based enamel
paints is a global problem which has been reported in Chile,
Ethiopia and Tunisia (IPEN/UNEP, 2013); China (Insight Explorer
(IE), 2016); India (Johnson et al., 2009a; Kumar, 2007); Kenya
(Nganga et al., 2012), and Cameroon (Gottesfeld et al., 2013). In
2016/2017, AGENDA in Tanzania conducted a follow up study in
which 21 (46%) out of 46 analysed solvent based paints contained
lead concentrations above 90 ppm (AGENDA, 2017). Similar studies
were also conducted in Zambia and Uganda in 2016 and the results
were as follows; 14 out of 39 i.e. 36% of the analysed samples of
solvent-based paints in Zambia had lead concentration above
90 ppm (Children's Environmental Health Foundation (CEHF),
2017) while in Uganda, 20 out of 30 i.e. 67% of the analysed oil
based paints contained lead levels above 90 ppm (National
Association of Professional Environmentalists (NAPE), 2017).
The reviewed studies also divulged that, surfaces that have aged,
weathered and chipped or scraped surfaces previously painted
with lead-based paints are significant sources of childhood and
residential lead exposure (Mathee et al., 2009; Meyer et al., 2008;
Needleman and Bellinger, 1991; Nganga et al., 2012; Tong et al.,
2000; Vivier et al., 2011; WHO, 2010a).
Concentrations of lead measured in lead-based paints from
different countries are summarised in Table 4 below.
Analysis of the results reported in the reviewed articles has
revealed that, the levels of lead in paints vary with colour. High lead
levels have been measured in brighter colours including yellow,
orange, red and green, while white and black coloured paints were
reported to contain the lowest lead levels as depicted in Table 5.
A clear picture of lead content variation with colour in paints can
be observed from the study conducted by Hossain et al. (2013) in
Bangdesh for a period of four months in 2012. The study involved
twenty five enamel paint samples from five brands manufactured
by the major paints market players in Bangladesh namely, Berger,
Asian, Roxy, Pailac and Elite Paints. Five colours (yellow, orange,
green, black and white) were tested from each brand.
The average concentration of lead in yellow enamel paints of all
the five brands was 75286 ppm followed by orange 54708.2 ppm,
green 28926 ppm, black 14967.2 ppm and lastly white enamel paint
357.4 ppm. The results indicated that, colours are the main de-
terminants of lead content in paints. The findings from that study
are summarised in Fig. 4 below.
8.2. Lead content in children's PVC toys
A number of studies to ascertain the levels of heavy metals in
children's plastic toys have been conducted in various countries
across the planet where concentrations above the permissible
limits of dangerous heavy metals including lead have been re-
ported. Despite these findings, little attention has been paid to the
matter in order to alleviate the situation especially in developing
countries; rather, more emphasis has been directed to the elimi-
nation of lead-based paints. This signifies continued exposure of
children to lead through playing with painted toys particularly
those made of PVC materials.
Presented here are results of studies from different countries
with toys tested covering both new and used ones, PVC and non-
PVC as well as soft toys with surface coatings. No soft toys
without surface coating were tested. In Nigeria, Omolaoye et al.
(2010) randomly purchased Chinese-made toy products from
shops in Zaria, Kano and Kaduma markets and analysed them to
establish whether they were made of PVC material and the levels of
heavy metals they contained. The results showed that, 75% of the
tested toys were PVC and all of them contained lead and other
heavy metals at varying concentrations. The lead concentrations
varied from 2.50 ppm to 1,445 ppm with lower and higher con-
centrations being detected in non-PVC and PVC toys respectively.
The results were compared to European permissible limit (90 ppm
for lead) - this is parts per million total lead content by weight in a
dried paint sample). According to the International Organization for
Standardization (ISO) the acceptable limit for Pb migration from
toys is 90 ppm (ISO 8124-3:2010-E). Out of the 12 analysed sam-
ples, 2(17%) of them contained lead higher than 90 ppm. Kumar and
Pastore (2006) investigated on 88 samples of plastic soft toys
collected from metropolitan cities of Delhi, Chennai and Mumbai in
India to ascertain them as possible sources of lead and other heavy
metals exposure to children. The results disclosed that, lead and
other heavy metals such as cadmium were present in all analysed
samples at different concentrations with 20% of them tested with
lead in concentrations ranging from 878.6 ppm to 2,104 ppm far
above the Indian standard of 90 ppm.
In Thailand, Decharat et al. (2013) examined lead levels in 100
inexpensive children's plastic toys imported from China and found
that, 13% of the tested samples had lead levels higher than the U.S.
Consumer Product Safety Commission permissible limit of 600
ppm. The higher measured lead levels ranged from 634.155 ppm to
4,486.11 ppm.
A survey in Chicago which was later expanded to cover 10 major
cities in the U.S and Montreal revealed varieties of vinyl children's
products to contain hazardous levels of lead and cadmium. The test
results portrayed that, 28(21%) out of 131 sampled products con-
tained lead concentrations in a range of 104 ppm to 22,550 ppm.
Out of these 28 samples, 24(85.7%) of them contained lead levels
above 200 ppm which is the limit advocated by the U.S Consumer
Product Safety Commission for vinyl miniblinds (Di Gangi, 1997).
Furthermore, Greenway and Gerstenberger (2010) conducted an
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105 1099

Table 4
Concentrations of lead detected in lead-based paints samples from different countries.

Country Reference Maximum concentrations of lead detected Permissible limit

(ppm) (ppm)

China Insight Explorer (IE) (2016) 116,000 600/90a

Kumar and Gottesfeld (2008) 140,000
Johnson et al., (2009a,b) 184,733
Clark et al. (2006) 187,200
Nigeria Adebamowo et al. (2006a) 515.9
Adebamowo et al.(2007) 50,000
Friends of the Environment (FOTE)/Strategic Research and Action for Environmental 129,837
Development (SRADev) (2008)
Cameroon Gottesfeld et al. (2013) 500,000
South Africa Mathee et al. (2007) 189,000
Kumar (2009) 195,289
Tanzania Kumar (2009) 120,862.1
AGENDA for Environment and Responsible Development (2015) 99,000
AGENDA for Environment and Responsible Development (2017) 84,000
Cambodia Lim et al., (2015) 33,150
Egypt Clark et al., (2013) IPEN (2017) 122,000
43,000
Malaysia Clark et al. (2006) 143,000
Singapore 3,500
Kenya Nganga et al. (2012) IPEN (2017) 69,000
160,000
Uganda National Association of Professional Environmentalists (NAPE) (2017) 150,000
Zambia Children's Environmental Health Foundation (CEHF) (2017) 120,000
Sri Lanka Toxic Link/ IPEN (2009) 137,325
Philippines 189,163.5
Thailand 505,716
Senegal 29,717
Belarus 59,387.2
Mexico 163,812
Brazil 170,258.4
Argentina IPEN/UNEP (2013) 130,000
Azerbaijan 20,000
Chile 1,100
Cot d’Ivoire 42,000
Ethiopia 130,000
Ghana 42,000
Kyrgyzstan 99,000
Tunisia 170,000
Uruguay 63
a
Some countries are still using 600 ppm while others have changed to 90 ppm as the Pb permissible limit in paints.

Table 5
Lead concentrations by colour of enamel household paints from various studies conducted in different countries.

Reference Paint Colour

Yellow (ppm) Orange/Red* (ppm) Green (ppm) White (ppm) Black (ppm)

Adebamowo et al. (2007) 42,271 24,457* 12,216 4,110 e

Children's Environmental Health Foundation (CEHF) (2017) 88,000 120,000 13,000 <60 e
1,000*
Kumar (2007) 90,000 4,000 21,250 991.8 3,616.7
National Association of Professional Environmentalists (NAPE) (2017) 150,000 99,000* e 5,600 e
AGENDA for Environment and Responsible Development (2017) 84,000 <60 84,000 2,500 e
28,000*
Johnson et al., (2009a,b) 107,271 103,455 21,227 439.5 12,250
Clark et al., (2013) 122,000 9,040* 17,000 60.5 e
Nganga et al. (2012) 69,000 44,000 e 5,000 e
AGENDA for Environment and Responsible Development (2015) 99,000 69,000 24,000 4,800 7,300
Insight Explorer (IE) (2016) 116,000 92,000* 102,000 1,440 9,100
Centre for Environment Justice and Development (CEJAD) (2017) 160,000 <70 e 6,300 e
55,000*
veloppement (CREPD) (2017)
Centre de Recherche et D'Education pour le De 100,000 220,000 47,000 <200 <300
17,000*
Pesticide Action Nexus Association (PAN-Ethiopia) (2017) 98,000 100,000 e 6,300 e
55,000
Lim et al., (2015) 33,150 43,970* 4,961 1,088 e

investigative study to assess the levels of lead in children's plastic United States. Out of the 535 toys tested, 29(5.4%) samples had lead
toys. In that study, the samples of children's plastic toys were levels ranging from 621 ppm to 8,018 ppm exceeding the former
collected from 10 day-care centres in Las Vegas and Nevada in the limit for lead in painted toys of 600 ppm set by the US Consumer
1100 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105

Fig. 4. Average lead content in enamel paints of various colours from different brands in Bangladesh. (For interpretation of the references to colour in this figure legend, the reader
is referred to the Web version of this article.)

Product Safety Commission (US CPSC). 8.3. Reported cases of lead poisoning from PVC toys
Al-Qutob et al. (2014) assessed the content of heavy metals in 50
samples of plastic toys purchased from Palestinian markets. Results The study by Heckenberg (2013) compiled a list of incidences of
bared that, the toys samples contained lead with concentrations lead poisoning in children in the United States (Table 7). The list
ranging from 0.76 ppm to 6036 ppm with an average concentration was extracted from the report released by the U.S. Consumer
of 611.96 ppm. Among the tested toys samples, 20(40%) of them had Product Safety Commission (USCPSC) in 2011. The report included
lead concentrations greater than 90 ppm; the ISO standard 8124-3 incidents reported to the agency by consumers who believed that
acceptable limit of lead migrated from toy materials. their children had been affected by lead from toys, many of whom
High lead concentrations of up to 145,000 ppm were found in were tested with elevated BPb levels. Furthermore, Bapuji and
samples of paint removed from widely used children's toys in South Laplume (2008) compiled a list of toy recalls in the United States
Africa (Mathee et al., 2007). The samples included imported as well from 1988 to 2008. The recalls were ascribed to different reasons
as locally manufactured toys. In the study by Ismail et al. (2006), one of them being threat of lead poisoning to children (Fig. 5).
which involved analysis of heavy metals in plastic children's toys
samples obtained from shops in the urban area of central region
9. Regulations on lead in paints and soft plastic toys
Peninsular, Malaysia, 50% (21 out of 42) of the samples were
ascertained to contain lead material. The average lead concentra-
9.1. Regulations on lead in paints
tion in these 21 samples was 109.85 ppm. Analysis of total and bio-
accessible metal concentrations of 45 different children toys and
In developing countries, very little attention has been paid to the
jewellery in China by Cui et al. (2015) found varying amounts of
public health impact of chronic low-dose lead exposure
lead ranging from 0.08 to 860,000 ppm, others exceeding the EU
(Adebamowo et al., 2006a; Adebamowo et al., 2007). In many
safety limit of 90 ppm. Recently, a study has been conducted in
industrialized countries (in Europe and North America) the
China to investigate on the content of lead in children's toys painted
manufacture, import, sale and use of lead-based paints for interiors
with lead-based paints sold on China's major online shopping
or exteriors of homes, schools and commercial buildings are
platforms. The findings divulged that, the toys sold by JD and TM,
controlled by the enacted laws, regulations or mandatory standards
which are considered as well organized sellers, had average lead
(UNEP, 2016). A recent UN Environment report of 2017 on the global
concentrations of 25 ppm and 32 ppm , respectively, much lower
status of legal limits on the production, import and sale of lead-
than that of toys sold by unorganized sellers on the Taobao (TB)
based paints shows that; only 4 African countries (i.e. South Af-
platform, at 219 ppm . Approximately 12% of the toys purchased
rica, Kenya, Tanzania and Algeria) have confirmed legal limits for
from TB contained paint with total lead concentrations exceeding
lead content in paints purposely to combat lead poisoning among
China's regulatory standard (90 ppm) for paints in toy
their civilians (UN Environment, September 2017).
manufacturing, and nearly 36% of the toys purchased from TB
Taking into consideration the global initiative lead by UNEP/
exceeded the equivalent U.S regulatory standard and EU standard
WHO geared to phasing out lead-based paints globally by 2020;
(Shen et al., 2018). These results suggest for further action to verify
countries are obliged to set restrictions on the manufacture, import,
the health and safety standards of toys sold by such unorganized
use, export and sale of lead-based paints (IPEN, 2016). In many
sellers.
developing countries, people are still exposed to high levels of lead
Lead concentrations measured in children toys from various
from unsafe paints despite the existence of cost effective, safe and
countries are summarised in Table 6.
easily accessible alternatives. Lead exposure is responsible for 0.6%
of the global burden of disease, developing nations carrying the
highest portion (WHO, 2009).
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105 1101

Table 6
Summary of concentrations of lead detected in children toys from different countries in comparison withe ISO permissible limits (90 ppm).

Country Reference Highest concentrations of lead detected (ppm)

Malaysia Ismail et al. (2006) 169.93

China Cui et al. (2015) 860,000
Nigeria Omolaoye et al. (2010) 1,445
Ghana Livingstone et al. (2014) 56
India Kumar and Pastore (2007) 2,104
South Africa Mathee et al. (2007) 145,000
Thailand Decharat et al. (2013) 4,486.11
United States Greenway and Gerstenberger (2010) 8,081
Palestine Al-Qutob et al. (2014) 6,036
United States di Gangi (1997) 22,550

NOTE: The studies cited in the table above compared their findings to different permissible limits which included EU (90 ppm), ISO (90 ppm) and the US-
Consumer Product Safety Commission (100 ppm). But for clarity all of them have been compared to the international Standard (ISO) permissible limit.

Table 7
Statistical snapshot of lead-related injuries from toys reported in the United States in 2011.

Product Narrative

Toys A boy playing with several toys that contained lead was diagnosed and confirmed with lead poisoning
Toy Horse A girl diagnosed with seizure disorder. Consumer report indicated that, the child had a toy horse which was recalled for high content of lead which may have
caused seizures
Toy A child was sick the day after he played with a new toy which had a warning label for lead. Consumer concerned that son's illness was related to lead
Unknown poisoning
Toy A boy suffered possible lead poisoning. Two physicians from poison control department said, symptoms may relate to hard plastic toys that were recalled
Toys A girl was found to have high blood lead levels of 35.5 mg dL
1 during routine physical check- up. She played for years with toys which were then recalled
Toys A girl tested for lead level and results came back with level of 18 mg dL
1. The girl was reported to possess a variety of toys
Toy Lead poisoning of male who suffered over two hours of unconsciousness and severe brain damage
Unknown
Toy Car Consumer's son's hands started itching after playing with remote controlled toy car. It was discovered that, there was a warning on the car box that, the toy
contained lead
Toy Cars A child opened a set of toy cars. After 5 min he developed huge red rash over his hands and diagnosed with lead poisoning. He experienced breathing
problems and nausea and died the following day

Fig. 5. Number of toy recalls in the U.S (1988e2008): Data source: (Bapuji and Laplume, 2008).

In the year 2009, the United States changed the permissible
limit for lead decorative paints from 600 ppm to 90 ppm total lead
(dry weight) while mandatory limits adopted by many other
countries lies within a range of 90e600 ppm total lead (dry weight)
(IPEN/UNEP, 2013). The mandatory limit of lead in paints in
Tanzania has been set to 90 or 100 ppm (depending on the type of
paint); Kenya e 90 ppm; South Africa e 600 ppm; and Algeria e
1000 ppm (UN Environment, September 2017).
9.2. Regulations on lead in painted soft plastic toys
Children often play with toys made of PVC materials which are
normally stabilized and/or pigmented with lead compounds. The
hand eto-mouth behaviour of children, especially the infants, puts
them at high risk of lead exposure and intoxication (Cui et al., 2015;
Ghaly et al., 2013; Kelley et al., 1993). Hence setting of safety
standards to control the amount of lead in children PVC toys in
order to safeguard the children from this kind of health risk is
1102 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
something of paramount important. Many developed countries in
Europe and America have passed toy safety standards that regulate
the type of children toys which are allowed to enter their markets.
The former maximum amount of lead in painted toys recom-
mended by USCPSC was 600 ppm (Livingstone et al., 2014). From
the year 2011 the U.S government revised the amount of lead in
children toys and other products for children aged 12 years and
under, to be not higher than 100 ppm (Consumer Product Safety
Improvement Act of 2008). India introduced a voluntary standard
of migratory elements from toy materials; where the permissible
limit for migratory lead from any toy material is 90 ppm (Bureau of
Indian Standards, 1999).
In the year 2017, the European Union modified the EU's directive
on the safety of toys (2009/48/EC) which resulted into new lead
limit of 2.0 ppm, 0.5 ppm and 23 ppm for lead in dry, liquid and
scraped-off toy material, respectively. EU member States were
required to adopt the new lead limit levels into their respective
national laws and regulations by 28 October 2018 (EU Council
Directive, 2017). China has restricted the amount of the soluble
lead content in coatings for toys to 90 ppm (Shen et al., 2018).
Thailand's safety standards for lead in painted toys has been set at
600 ppm (Decharat et al., 2013); whereas in Brazil and Egypt, the
local standard for lead concentration in toys and commercial
products is 90 ppm (Ghaly et al., 2013). Furthermore, lead standard
for children's toys in Malaysia and Sri Lanka has been set at 90 ppm;
whereas in South Africa and Mexico the limit of lead content in toys
has been set at 600 ppm (IPEN, 2016).
10. Identified gaps
From the reviewed articles, various gaps have been spotted
which need to be worked out in order to establish comprehensive
information on the existing threat of lead exposure to mankind
emanating from both lead-based paints and children's PVC toys.
These gaps also can be reckoned as new avenues for further re-
searches as well as for law enactment or enforcement.
The gaps include: - inadequate investigation on lead levels in
plastic toys that are locally marketed in most of the developing
countries; Pb testing in toys have been reported only in few
countries including; Ghana, Nigeria, India, Palestine, Thailand and
South Africa. Also most of the investigated children's toys are those
made in China, thus, more studies are needed to cover toys made in
other countries as well.
Despite the fact that some countries (eg. Philippines and Nepal)
have enacted regulations to eliminate the use of lead additives both
in decorative and industrial paints (Gottesfeld, 2015; IPEN, 2016),
this review article has revealed that, much efforts have been
directed towards controlling the manufacture, import, export, use
and sale of leaded decorative paints only while neglecting indus-
trial paints and children's toys made of PVC materials both of which
contain significant quantities of lead.
Inadequate data on the magnitude of lead contamination in the
environment, weak policy regulatory framework and enforcement
measures for the control of lead pollution, awareness on the public
health impacts of lead pollution in most of the developing countries
including Tanzania is still a challenge.
There are inadequate studies on lead poisoning associated with
lead-based paints and PVC toys across the globe. Therefore, more
researches are craved to establish the status of lead poisoning in the
most vulnerable groups such as children and people working in
paint industries as well as those who frequently apply paints in the
construction industry.
There is also a gap in the public health legislations of many
developing countries which also encompasses the lack of rigorous
laws to combat both lead-based paints and children's PVC toys,
aimed at safeguarding the general public especially children who
are at high risk of suffering the consequences of lead exposure.
The time factor in which the degradation process of PVC toys
occurs to cause bioavailability of lead is missing hence needs to be
investigated. This will establish whether the process is fast or slow.
Furthermore, epidemiological data for hazard identification related
to PVC toys in particular are missing.
The research outputs remain in papers implying that; there is a
gap in the flow of information to the public and policy makers. The
available information is valuable evidence that can be appropriately
used as guidance by policy and decision makers when drafting
effective legal framework on lead-based paint and children's PVC
toys controls.
11. Conclusions and recommendations
11.1. Conclusion
There has been a world-wide concern over the continued use of
lead-based paints in house-holds, decorations and in children's PVC
toys. PVC toys contain lead and cadmium additives, that act as
plasticizers so as to make PVC soft and pliable (Kumar and Pastore,
2006), hence painting them aggravates the lead levels in these
children's attractive playing items. The consequences of environ-
mental lead pollution are a worldwide public health concern. Lead
is a cumulative toxicant affecting multiple body systems. All in-
dividuals who are exposed to lead are subject to experiencing
negative health effects with a larger threat being directed to chil-
dren, pregnant women and those who work with leaded paints on
regular basis. Irreversible negative health effects including learning
disabilities, anti-social behaviours, reduced fertility and cardio-
vascular disease are common to those exposed to lead.
Based on sufficient evidence, the International Agency for
Research on Cancer (IARC) recently upgraded the status of lead
from a possible to a probable human carcinogen (Ja €rup, 2003;
Juberg, 2000; Patrick, 2006). Children and adults working with
lead-based paints are exposed to lead poisoning and it is just a
matter of time before the outcome is vividly revealed to the victims.
Based on scientific and medical findings, children's exposure to
lead especially those under six years of age causes serious harm.
Therefore controlling lead exposure is inevitable so as to reduce
adverse health effects triggered by lead-based paints to the public.
Effective measures aiming at impeding exposure to lead from lead-
based paint and PVC lead painted children's soft toys will help to
achieve Goal 3 of the 2030 Sustainable Development Goal (SDGs)
which focuses on ensuring healthy lives and promote well-being
for all ages. Specifically for hazardous chemicals, SDG 3.9 targets
that, by the year 2030, there should be a substantial reduction in
the number of deaths and illnesses from hazardous chemicals and
air, water and soil pollution and contamination.
The reviewed articles have unveiled that, despite the availability
of substitutes for lead additives in paints and enactment of re-
strictions in many countries and regions of the world; paints con-
taining high levels of lead (of up to more than 280 folds above the
permissible levels) are still manufactured and used for residential
purposes especially in developing countries. Very likely, use of
paints (lead-containing) in households is increasing as a result of
growing personal income. Results from analysis of samples from
different countries show that, solvent based paints and brightly
coloured paints (red, yellow and orange) contain high levels of lead
compared to water-based paints and other colours. Unless stringent
control mechanisms on lead content in new paints during
manufacturing are put in place, exposure of the public to high levels
of lead will persist hence jeopardizing the present and future
general public health. Many countries around the world and other
 S.Y. Njati, M.M. Maguta / Environmental Pollution 249 (2019) 1091e1105
international organizations such as WHO and UNEP, call upon
taking actions to address the preventable risks of lead exposure;
therefore, it is important for both developed and developing
countries to respond positively to such calls through taking
appropriate measures.
11.2. Recommendations
Following the findings from different studies across the globe
summarised in this article on the content of lead both in lead-based
paints and children’s PVC toys and its associated adverse health
effects to the public, we recommend the following for establishing a
comprehensive understanding on the subject of this article as well
as curbing the prevailing situation.
 Further studies are recommended to cover the gaps identified in
this article
 Appropriate national, regional and international legislations and
regulations specifically for manufacture, import, export, use and
sale of paints and children toys have to be enacted and enforced
so as to prevent the availability of lead-based paints and chil-
dren toys with high lead content in the market.
 To prevent future lead poisoning, public awareness raising on
the hazardous effects of leaded paints and children's PVC toys is
urgently required. Lack of awareness among parents on the risks
to which their children are exposed while playing with PVC toys
is disastrous.
 Necessary efforts are needed to encourage paint manufacturers
to make use of the readily available substitutes for lead additives
and hence to put an end to the use of lead as an additive in
paints.
 Manufacturers should put lead warning signs on products and
tinned paints as well as indicating the level of lead content.
 Countries should introduce consumer law that control the lead
level content in paints and materials used.
 In order to phase out sources of lead from the environment
there is a need to introduce lead control measures in all other
sorts of paints and even in children toys hence preventing future
exposure to the public. Meanwhile appropriate measures are
needed to prevent exposure from other lead sources apart from
lead-based paints and PVC toys such as from batteries, electric
and electronic wastes and other lead containing wastes.
 There is a need to initiate blood lead level monitoring to those
groups which are at a high risk of occupational exposure
particularly children, pregnant women, workers in paint in-
dustries and painters as well. All these data should be made
publicly available and use them as evidence for taking appro-
priate measures in policy making and decision taking.
 Full support from the global community to the Global Alliance
under the joint leadership of UNEP and WHO targeting at
phasing out lead-based paints by 2020 globally is highly
recommended.
Acknowledgement
The authors wish to extend their sincere gratitude to Ms. Ivy
Matoju and Dr. Agnes Mrutu for their kind assistance in proof
reading the manuscript.
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