Job-Specific Lead Exposure Gradients and Personal Protective Equipment Paradox in Informal Occupational Settings: A Case-Control Study from The Gambia

Occupational lead exposure remains a significant public health concern in low- and middle-income countries, yet within-industry exposure gradients are poorly characterized. This case-control study assessed job-specific blood lead level (BLL) gradients and personal protective equipment (PPE) use patterns among 145 auto repair workers and 68 healthcare controls in The Gambia. BLLs were measured using LeadCare II analyzers. Exposed workers had significantly higher BLLs than controls (median: 7.40 vs. 5.80 μg/dL; p < 0.001). A striking 5.3-fold gradient was observed across specialties: battery repairers (35.62 μg/dL), electricians (15.17 μg/dL), panel beaters/welders (11.45 μg/dL), mechanics (9.08 μg/dL), and spray painters (6.67 μg/dL). All battery repairers had BLL ≥10 μg/dL. Paradoxically, high-risk workers (battery repairers, electricians) had the lowest PPE use rates (14.3%) despite having the highest exposure levels. Adjusted regression confirmed battery repairers had BLLs 27.14 μg/dL higher than mechanics (95% CI 17.69 to 36.58; p < 0.001). These findings underscore the need for targeted, specialty-specific interventions prioritizing battery repair and electrical work in informal occupational settings.