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Background Removing lead sources is the main measure against child lead poisoning. Medical treatment is ineffective for most mild cases and particularly against long-term complications in neurological development. However, the effectiveness of interventions to eliminate sources of lead exposure has not been fully established, mainly because of the diversity of situations. The objective of this study was to determine the influence of several interventions (housing counselling, rehabilitation and relocation) on blood lead levels in two situations (stable unhealthy housing with old flaked lead paints, slums with family recycling practices by incineration). Methodology A historical cohort of lead poisoning in children has been established in Marseille, France. Medical follow-up followed national guidelines. Environmental interventions followed legal procedures, where available. In slums, counselling was adapted to the exposure. A generalized mixed model was developed to study the kinetics of blood lead levels after the interventions. Results 151 children were included; age = 5.4 (SD = 7.8) years; 85 (56%) lived in stable unhealthy housing, others lived in slums. Medical follow-up included 492 blood lead levels. For children living in stable unhealthy housing, blood lead level decrease was significantly associated with every intervention: housing counselling, rehabilitation and relocation (respectively p &amp;lt; 0.005; p &amp;lt; 0.05 and p &amp;lt; 0.005). For children living in slums, blood lead level decrease was only associated with relocation in a stable housing (p &amp;lt; 0.005). Conclusions Several interventions are effective to decrease blood lead levels in unhealthy housing. In slums, access to a stable housing first is a prerequisite for any intervention against child lead poisoning, even when related to family practices. Key messages In stable unhealthy housing, several interventions against lead exposure can be effective to raise a strategy. But, environmental health and access to housing first needs to be addressed for their implementation.

Against lead poisoning: effectiveness of housing first and counselling in the home