Reducing Childhood Lead Exposure in Ghana

Last registered on August 04, 2026
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Pre-Trial

Trial Information

General Information

Title
Reducing Childhood Lead Exposure in Ghana
RCT ID
AEARCTR-0019098
Initial registration date
July 30, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
August 04, 2026, 9:36 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Hannah Timmis
Affiliation
University of Oxford
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Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2026-03-08
End date
2026-11-30
Keywords
Environment & Energy, Health
Additional Keywords
Lead exposure, child health, environmental health
JEL code(s)
I18, Q53, C26
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Childhood lead exposure remains a major public health problem in low- and middle-income countries, where around half of children have elevated blood lead levels that can cause lifelong harm to their health and development. A key challenge in addressing this problem is the limited evidence on which lead sources contribute most to child exposure, and therefore which interventions are likely to be effective. This study addresses this gap by experimentally evaluating the effects of removing two commonly contaminated household products — cookware and traditional eyeliner — on children's blood lead levels. We randomly assign 300 households in Ghana's Northern Region, a known lead exposure hotspot, to receive lead-free replacements for contaminated cookware, contaminated eyeliner, both products, or neither, and compare changes in children's blood lead levels across treatment and control households using venous blood samples collected at baseline and endline. The findings will identify the contribution of these two products to child lead exposure, informing the prioritisation of lead-remediation strategies and the design of a second, larger-scale randomised trial to estimate the causal effects of reduced lead exposure on children's cognitive development.
External Link(s)

Registration Citation

Citation
Timmis, Hannah. 2026. "Reducing Childhood Lead Exposure in Ghana." AEA RCT Registry. August 04. https://doi.org/10.1257/rct.19098-1.0
Sponsors & Partners

Sponsors

Partner

Name
Pure Earth
Type
ngo
URL
https://www.pureearth.org/
Experimental Details

Interventions

Intervention(s)
Households are randomly assigned to receive lead-free replacements for contaminated cookware, contaminated eyeliner ("chilo"), both, or neither. Treatment households have their cookware and/or eyeliner tested for lead using a portable X-ray fluorescence (XRF) analyser; items exceeding reference thresholds are replaced with lead-free equivalents and removed from the household. Compliance is monitored through monthly follow-up visits.
Intervention Start Date
2026-07-06
Intervention End Date
2026-08-31

Primary Outcomes

Primary Outcomes (end points)
Child blood lead level (BLL), measured in µg/dL via venous blood sample analysed by ICP-MS, at endline (approximately three months after product delivery).
Primary Outcomes (explanation)
Not applicable — BLL is measured directly rather than constructed from component variables.

Secondary Outcomes

Secondary Outcomes (end points)
Contaminated cookware use and contaminated eyeliner use, each constructed as the child's exposure-weighted use of contaminated products (lead concentration × frequency of use over the previous seven days). These serve as first-stage/mechanism outcomes in the IV analysis.
Secondary Outcomes (explanation)
Contaminated cookware use is the sum, across all cookware items in the household, of each item's lead concentration (ppm) multiplied by the number of meals prepared in that item for the sampled child in the past seven days. Contaminated eyeliner use is constructed analogously, using lead concentration multiplied by number of applications to the child in the past seven days.

Experimental Design

Experimental Design
A randomised controlled trial testing whether providing lead-free replacements for contaminated cookware and/or traditional eyeliner reduces children's blood lead levels. 300 children aged 4–6 in Ghana's Northern Region, selected for elevated BLL and regular use of both products, are randomised into four arms: control, cookware replacement, eyeliner replacement, and both. BLL is measured via venous blood sample at baseline and approximately three months after product delivery. Treatment effects are estimated using two-stage least squares, instrumenting product use with random assignment.
Experimental Design Details
Not available
Randomization Method
Randomisation conducted by computer. Within each locality (stratum), children were ranked by screening BLL, divided into blocks of six, and randomised in a 2:2:1:1 ratio across the four arms; remainders not divisible by six were randomised independently using the same allocation probabilities.
Randomization Unit
Individual child/household.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
Not applicable (individual-level randomisation, not clustered).
Sample size: planned number of observations
300 children
Sample size (or number of clusters) by treatment arms
101 households control, 102 households cookware replacement, 49 households eyeliner replacement, 48 households cookware and eyeliner replacement.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Oxford Tropical Research Ethics Committee (OxTREC)
IRB Approval Date
2025-08-05
IRB Approval Number
722127
IRB Name
Ghana Health Service
IRB Approval Date
2026-09-03
IRB Approval Number
034/05/25
Analysis Plan