Evaluation of a lead screening program in children aged younger than 5 years at an Aboriginal Community Controlled Health Organisation in New South Wales, Australia

OBJECTIVES AND IMPORTANCE OF STUDY: This study aimed to document trends in lead screening rates and blood lead levels among children residing in Broken Hill aged <5 years at an Aboriginal Community Controlled Health Organisation since beginning screening in 2011. METHODS: This was a repeat cross-sectional descriptive analysis of lead screening program data. Data were extracted from the New South Wales Health lead database for all blood lead screening tests among children residing in Broken Hill aged 5-59 months undertaken by Maari Ma Health Aboriginal Corporation, 2011-2022. Key outcomes were annual screening coverage, age-standardised annual geometric mean blood lead levels and categorical distribution of blood lead levels. RESULTS: The number of Indigenous children aged 1 to <5 years screened annually increased from 58 in 2010 to 171 in 2012. Average lead screening coverage in children aged <5 years in 2012-2020 was 78% (range 71-82%). In 2021-2022 during the COVID pandemic, screening coverage declined to 50%. Average lead levels in children screened at Maari Ma have remained unchanged over the past 10 years. Over 70% of these children record a blood lead level over the current National Health and Medical Research Council level of concern of 5 μg/dL. CONCLUSIONS: Screening of Indigenous children increased substantially following Maari Ma's involvement in the lead screening program. We suggest this reflects the effectiveness of Aboriginal Community Controlled Health Organisation involvement in mainstream program delivery to improve engagement with Indigenous communities. Despite high lead screening coverage and a AU$13 million state government investment to address elevated blood lead levels in Broken Hill since 2015, the majority of Indigenous children residing in Broken Hill continue to record a blood lead level above the National Health and Medical Research Council level of concern, and average blood lead levels in this population remained unchanged over the past 10 years. This suggests that current measures are not working for this population, with the lack of lead-safe housing for Indigenous families being the key driver. More comprehensive strategies specifically targeting Indigenous children are required to close the gap in the disproportionate burden of lead in Broken Hill.