CIVLead: preventing and reducing health risks from lead exposure among pregnant women and children in Côte d'Ivoire 

Côte d’Ivoire: a leader in lead regulation in Africa

More than half of countries worldwide still lack binding regulations on lead in paint — among them, many in Sub-Saharan Africa. Côte d'Ivoire has moved faster than most: in 2014, the Ministry of the Environment launched a national strategy on the issue, followed in November 2023 by a draft law on chemical management that now formally regulates hazardous substances, including lead.

This evolving legal framework has spurred a wave of data collection, revealing consistently high levels of lead in household paint across the country. A 2017 study by the Young Volunteers for the Environment showed that 63% of solvent-based paints in Abidjan contained Pb-levels at or above the most stringent limit of 90 ppm, considered standard for many countries. [Ranjbar Z, Pourhadadi D, Montazeri Sh, al. 2023].

A 2023 assessment by the CIVLead project team confirmed the severity of the problem: of 23 paint samples tested, 14 contained lead concentrations above 500 ppm — well above safe thresholds (van Geen et al., 2024).

Evidences on awareness campaigns are essential to prevent lead poisoning

Yet, while these successive initiatives have documented the risks, they have not embarked on translating this acquired knowledge into action. Populations have largely not been informed about the sources and pathways of exposure, nor about the practical steps — regular dust cleaning, washing children's toys, covering painted surfaces — all of which can meaningfully reduce risk. The awareness gap is particularly acute among those most vulnerable, and those for which the burden of disease might be the hardest to bear: expectant mothers and their future newborns, and mothers of young children.

In the project's baseline sample of 200 pregnant women in Abidjan, only 19% knew that lead exposure could harm human health, and just 3% identified paint as a potential source (Gille V, Gubert F, Saint-Macary C, et al., 2025).

It is at the intersection of this knowledge gap and this risk exposure that this project has positioned its intervention.

Rigorous evidence on awareness campaigns in this space remains scarce, particularly in developing and emerging countries. One notable exception is a study from rural Bangladesh, where an initiative targeting lead paint exposure among children and caregivers was formally evaluated — finding a 52% increase in awareness and a greater reported willingness to adopt preventive behaviors in the areas reached (Jahir et al., 2021).

Against this backdrop, the CIVLead pilot project — supported by FID — focuses on personalized prevention: raising awareness among households in Abidjan, with a particular emphasis on pregnant women and mothers of young children, and equipping them with concrete guidance on protective measures. Embedded within the intervention is a research component designed to assess whether information diffusion actually translates into behavioral change.

An innovative approach combining assessment, self-testing, and personalized around prevention measures to assess the presence of lead

The groundwork was laid in Abidjan in 2023, combining three activities: (1) measuring lead concentrations in household paint and children's blood among families of pregnant women; (2) raising awareness about the health risks of lead exposure and available protective measures; and (3) assessing whether that awareness translated into behavioral change.

A central feature of the project is its focus on personalized information. General awareness campaigns, whether media-based or door-to-door, can build knowledge, but do not necessarily mean a shift in behavior. What drives people to act is a sense of personal risk: knowing that the threat is not hypothetical, but present in their own home. Delivering that kind of targeted information has traditionally been costly and technically demanding, relying on X-ray fluorescence analyzers — expensive devices that require trained professionals to operate.

CIVLead introduces a simpler alternative: a low-cost testing kit, priced at under $1 per test, that household members can use themselves to detect lead-based paint in their own environment. The approach rests on a behavioral assumption — that people who conduct the test themselves, rather than having it performed by an outside technician, are more likely to internalize the result and take concrete protective steps, such as keeping children away from contaminated surfaces.

Methodology of the pilot

200 pregnant women were part of this pilot program, and each was visited three times by the team. Participants received general information on lead exposure risks and personalised information about the presence of lead-based paint in their homes. Paint was tested twice in each household: first with simple kits on two surfaces during the initial visit, and later with an X-ray fluorescence (XRF) device.

Each participant also received a free kit after the first visit and was encouraged to use it on other surfaces in the home. The research team evaluated the impact of personalized information on Pb exposure, by looking at the effect of the kit on, first, awareness on Pb exposure, and second, the (self-declared) adoption of preventive measures.

Promising findings: ongoing prevention measures to combat proven and recognized lead exposure among children in Abidjan

The study found that nearly a third of residences tested positive for lead contamination, primarily from paint — with no correlation observed across socioeconomic or educational levels. Blood tests confirmed the presence of lead in children, with an average concentration of 60 μg/L, exceeding levels documented in Europe (Stajnko et al., 2024) and the United States (Teye et al., 2021). The awareness-raising component produced marked results.

Knowledge of lead's health dangers rose sharply among women — from 3% to 59% — as did awareness of available protective measures, climbing from 1% to 66%.

Among the 153 women in the final sample, those living in lead-positive homes were 33–35 percentage points more likely to recognize their own exposure risk.

This heightened awareness also translated into reported behavioral changes: Mothers informed that their home tested positive — by both the kit and XRF — were 23 percentage points more likely to prevent their children from ingesting paint chips, and 41 percentage points more likely to increase handwashing frequency.

No impact was detected on cleaning or renovation behaviors, likely reflecting already high baseline cleaning rates and the longer-term, costlier nature of renovation decisions - which itself constitutes an important barrier to action.

More research is needed: towards a larger experiment in Abidjan

The project team has noted that further research is needed, including studies using objective outcome measures — such as children's blood lead levels — rather than relying solely on self-reported behaviors. Building on these early results, the team plans to scale the pilot into a larger experiment in Abidjan, with the dual aim of testing effects on larger samples and assessing whether behavioral changes are sustained beyond the immediate post-intervention period. Future work will also examine the most cost-effective approaches to disseminating both general hazard information and personalized household reports, with the ultimate objective of informing policy recommendations.

Research team

The French Research Institute for Sustainable Development (IRD) is implementing this project in partnership with Félix Houphouët-Boigny University, the National Laboratory for Quality Testing, Metrology, and Analysis, the National School of Statistics and Applied Economics, the School of Advanced Studies in Public Health, (France), and Columbia University. Led by Flore Gubert and Mathias Kouassi, many other researchers are involved in this initiative: Florence Bodeau-Livinec, Stéphanie Dos Santos, Alex Franck Houffoue, Jacques Gardon, Véronique Gille, Maeva Kone, Hugues Kouadio, Ernest Kouassi Ahoussi, Epiphane Marahoua, Camille Nougbe, Camille Saint-Macary, Petanki Soro and Alexander Van Geen.

To find out more:

• Research publication: Gille V, Gubert F, Saint-Macary C, Dos Santos S, Houffoué F, Kouadio H, et al. (2025) Personalized lead exposure information and preventive behaviors in Ivory Coast: Insights from a pilot study. PLoS One 20(11): e0336949.
• Van Geen, A., Helmbrecht, L., Ritter, E., Ahoussi, K. E., Soro, P., Koné, M., & Noorduin, W. L. (2024). Lead-based paint detection using perovskite fluorescence and X-ray fluorescence. Analytica Chimica Acta, 1307, 342618.
• Ranjbar Z, Pourhadadi D, Montazeri Sh, Roshanzamir Modaberi M. Lead compounds in paint and coatings: a review of regulations and latest updates. Progress in Organic Coatings. 2023;174:107247.
• Talk by Flore Gubert, Researcher for IRD, at the IPORA network conference in Bordeaux (conference website): Strengthening the Africa-Europe academic partnership (SAEAP) to improve intersectoral governance
• Project presentation: A self-test kit to detect lead presence in private homes | Fund for Innovation in Development (FID)