1. An Intervention in Anemia and Lead Toxicity Screening and Public Health Education in Urban El Salvador Erica R. Freeman MD, Amy L. Wagner BA, Rebecca Mandell BS, Sheela Sathyanarayana MD MPH, Catherine Karr MD PhD, Elinor A. Graham MD MPH BACKGROUND  Limited data exist on causes of anemia and lead poisoning in urban El Salvador  Most current anemia data from National Family Health Survey (FESAL) 2002-03.  19.8% of children between age 12 and 59 months are anemic.  Prevalence in rural areas is 1.5 times higher than in urban areas (23.1 versus 15.8 percent)  Prevalance increased with less maternal education.  Frequent parasitic infections associated with anemia. Low dietary intake of iron documented.  Cases of lead poisoning in children detected in industrial areas  Routine well child care and anticipatory guidance not available as physicians primarily visited for acute illnesses. OBJECTIVES  Perform point of care testing for ZPPH, hemoglobin and lead in a community setting.  Targeted education for parents of children with anemia or elevated lead levels.  Iron therapy for children with anemia or iron deficiency.  Anti-parasitic therapy for all participating children.  Community-wide health education on parasitic infection and nutrition.  Achieve project aims through direct collaboration with NGO and community. ACTIVITIES  Testing and education procedure  Performed at the community center.  Procedure discussed and informed consent signed.  Education provided by community members, using prepared handouts on iron deficiency and lead poisoning.  Point-of-care ZPPH, hemoglobin and lead testing performed via capillary blood sample  Standardized calibrations and techniques used  Indicated dietary and/or environmental interventions discussed.  Treatment protocol  All participants received anti-parasitic treatment with albendazole.  Patients with anemia (hemoglobin 80) received three months of ferrous gluconate treatment.  Community Involvement  With local non-governmental organization (NGO) A-Brazo, we presented the project to the community leadership council and received approval to proceed.  Members of the council raised awareness about the project and scheduled testing appointments.  Community leaders used handouts on lead toxicity and iron deficiency anemia to conduct the educational component of the testing appointments, allowing them to teach their peers.  At the end of the testing, the entire community was invited to attend presentations on parasitic infections and nutrition. TARGET AUDIENCE  Regalo de Dios is a community of 240 families in Soyapango, El Salvador.  Community ‘s health concerns include poor nutrition, parasitic infections and toxic exposures from industry.  Testing and interventions targeted 55 children aged one to four years. OUTCOME MEASURES  Testing results  Seven children were found to have hemoglobin < 11 (13%).  Six children had elevated lead levels greater than 10 µg/dL(11%, range 10.5-20.2 µg/dL).  Three children had elevated ZPPH greater than 80 (5%).  Boys were 2.3 times more likely to have a lead level greater than 10 µg/dL (95% CI 0.31 to 4.5).  The most significantly elevated lead levels were in children whose households included adults with occupational lead exposure.  Educational slideshows were attended by over 100 community members LESSONS LEARNED IN IMPLEMENTATION  Importance of alliance with local NGO, A-Brazo  Fostered a strong relationship with the community council.  Provided an effective way to carry out health education, mobilize the community and increase our sensitivity to local needs during this short- term project.  Running three tests off of one lancet often feasible.  Difficult to obtain medications in-country  Patients received medication a few days after testing, causing some loss to follow up.  Preferable to obtain medication in the United States and import at start of project.  Community council energized to organize future public health projects.  Anemia prevalence in Regalo de Dios lower than the national average in FESAL 2002-03.  Larger studies needed to determine public health burden of iron deficiency anemia and lead intoxication in El Salvador.