UNPRECEDENTED LEAD POISONING OUTBREAK IN ZAMFARA, NIGERIA: A MULTIDISCIPLINARY HUMANITARIAN RESPONSE TO AN ENVIRONMENTAL PUBLIC HEALTH DISASTER IN A RESOURCE SCARCE SETTING

From 2010-2013, epidemic lead poisoning in Zamfara State, northern Nigeria was unprecedented in morbidity and mortality, as well as in the health and environmental response implemented to reduce blood lead levels and environmental exposures. More than 17,000 villagers were poisoned and 400-500 young children died from conducting artisanal gold mining. Socio-economic, logistic, and security challenges in these remote villages required a response undertaken within the context of local resources, labor practices, and cultural traditions. This dissertation comprises three papers covering different aspects of the multidisciplinary response to the Zamfara lead poisoning outbreak. The first paper addresses remediation, which was implemented using U.S. hazardous waste removal protocols. Soil lead exposures were reduced by 97% and allowing 2,349 children to receive chelation treatment. Mean blood lead levels for children under five years of age declined from 173�g/dl to