Lead exposure and poisoning among artisanal kohl manufacturers in Fez, Morocco

Artisanal kohl production using galena remains a widespread traditional practice in Morocco and constitutes a significant source of lead. We aimed to assess environmental exposure, clinical manifestations, and therapeutic outcomes in a family chronically exposed to lead through domestic kohl manufacturing. A family-based cross-sectional biomonitoring study was conducted. Sociodemographic characteristics, clinical findings, and biological parameters were collected. Blood and urinary lead concentrations and urinary δ-aminolevulinic acid were determined using inductively coupled plasma mass spectrometry. Elevated blood lead levels were observed (91.7%), with a mean concentration of 426 ± 217 µg/L. Clinical manifestations included anemia (50%), neurological involvement (33.3%), metabolic disturbances, and early renal tubular dysfunction. After chelation therapy and cessation of exposure, mean BLLs significantly decreased to 158 ± 100 µg/L (p < 0.0001). Findings indicate severe lead exposure associated with artisanal kohl production, underscoring the need for regulatory policies and community education to prevent intoxication and protect vulnerable populations.