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

In 2014, the Ivorian Ministry of the Environment implemented a national strategy, adopting a draft law on chemical management in November 2023, which now regulates the management of hazardous substances, including lead. This legal framework led to numerous data collection initiatives, revealing high levels of lead in the paint used in households.

Following an initial study published in 2017 by the Young Volunteers for the Environment, a national workshop was held in November 2023, supported by the WHO and UNEP, to present the findings from an assessment of lead concentrations in paint used to decorate homes in Côte d’Ivoire (IPEN, 2017). The CIVLead project team conducted another assessment in 2023, which revealed that 9 of the 15 paint pots analyzed contained worryingly high lead concentrations (van Geen et al., 2024).

While these various initiatives have highlighted the health risks of lead and the importance of raising awareness, they did not involve concrete action to inform populations about the sources and routes of exposure, or about hygiene and dust control measures to reduce health risks, particularly in children. Until now, very few awareness campaigns have been subject to an impact evaluation in developing and emerging countries. As an example, an initiative was evaluated in a rural region of Bangladesh, which aimed to reduce exposure to lead paint among children and their caregivers. The study revealed a 52% increase in awareness and a greater willingness to adopt behaviors that help prevent lead exposure in the regions affected (Jahir et al. 2021).

Supported by FID, the CIVLead project is focusing on prevention, by raising awareness about the risks associated with lead-based paint among households in Abidjan, particularly among pregnant women and mothers of young children, and by providing information on the preventive measures that need to be implemented.

The initial work carried out in 2023 in Abidjan involved, firstly measuring among families of pregnant women lead concentrations in the paint used in homes and in children’s blood, and, secondly, raising awareness about the health risks associated with lead exposure and preventive measures.

The Lumetallix test kit, a major innovation developed by the Dutch company of the same name, was incorporated into the research protocol. The use of this kit, which enables households to self-test their own environment, is based on the behavioral assumption that they will be more likely to adopt risk reduction strategies (for example, keeping children away from contaminated areas) if they carry out the test themselves, rather than tests being performed by external workers.

The pilot project implemented in Abidjan has shown that a significant number of children are exposed to dangerous levels of lead. A study conducted in the homes of 200 women revealed that nearly a third of residences were contaminated, mainly by paint, while no correlation was found with the socio-educational level of these households. Blood tests also confirmed the presence of lead in children’s blood, with an average concentration of 60 μ/L, higher than the levels found in Europe (Stajnko et al., 2024) and the United States (Teye et al., 2021).

Following this initiative, women’s awareness of the dangers of lead increased significantly (from 3% to 59%), as well as of the measures that reduce the risk of lead exposure (from 1% to 66%). Nevertheless, this awareness did not always lead to changes in behavior: only 40% of participants said they had adopted some of these measures, particularly those aimed at children (e.g. washing hands more frequently). According to the research team, the 23.5% attrition rate among pregnant female participants over the course of these visits can be partly explained by women travelling to their place of birth to have their babies.

The assumption that engagement would increase if households could self-test their own environment will need to be assessed in a later phase of the project. The reasons for attrition also need to be more clearly identified, so that corrective measures can be taken to encourage women’s participation. Finally, further research is needed to confirm other potential sources of lead contamination, such as cooking utensils.

The interdisciplinary approach of the research team, made up of physicians, environmental chemists, and social science researchers, has been key to the project’s success. 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.

As Flore Gubert said at the IPORA network conference in April 2025: “The longstanding history of collaboration between the project's research partners, and between Côte d'Ivoire and France, meant that everyone quickly assumed their roles, while working in complement with each other. The researchers’ complementary range of backgrounds and disciplines was a major positive for the program’s implementation, particularly with the work done by physicians to raise awareness among pregnant women.”

In summary, this initiative, led by multidisciplinary research teams, offers a promising model for evaluation and awareness-raising to prevent lead exposure, and could be scaled up to support public health policy in Côte d’Ivoire, as well as in other West African countries facing similar challenges.

To find out more:

• Research publication: 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.

• 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)