when previous studies were done,
masked the connection between agespecific
behaviors (eg, mouthing) and
EBLLs. Sale of leaded gasoline was
discontinued in Thailand by 1996.31
Other factors significant in bivariate
analyses have conceivable physiologic
explanations, although they did not
remain in our final models (Table 3).
Infrequent milk consumption may be
a proxy for calcium deficiency, thought
to increase absorption and impede excretion
of lead.32 Sucking on pacifiers
may prevent children from mouthing
other items, explaining the apparent
protective effect. The lower prevalence
of EBLL in Mae La compared with
Umpiem and Nupo could not be explained
by our survey. However, large
areas of Mae La had access to electricity
at the time of the investigation,
whereas Umpiem and Nupo did not
have such access, and Nupo was the most remote camp of the three. It is
possible, therefore, that fewer families
in Mae La used car batteries or other
alternative electricity sources.
This investigation is the first we are
aware of to identify pre-resettlement
lead exposures among US-bound refugee
children. This investigation provides
an example of how clinicians and
refugeehealthpartnersin resettlement
countries can impact the health of
refugees living overseas through detecting
and reporting health issues
encountered during routine examinations;
in our case, notifications of EBLLs
among resettled Burmese refugee children
led to coordinated educational
campaigns at the camp level. Continued
monitoring of BLLs in children arriving
from Thailand-Burma border refugee
camps would help assess the success
of camp remediation efforts. US public
health agencies should periodically review rates of EBLLs among children
from resettling refugee populations,
making results available to health
officials in camps and resettlement
countries.