Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Environmental Health Sciences

Content Description

1 online resource (xi, 194 pages) : illustrations (some color), color maps.

Dissertation/Thesis Chair

Beth J Feingold

Committee Members

Erin Bell, Jenna Krall, Allison A Appleton, Patrick Parsons


Trace elements, Anemia in children, Nails (Anatomy)

Subject Categories

Environmental Health | Environmental Sciences | Public Health


Anthropogenic changes in the Peruvian Amazon, including deforestation, highway development, agriculture, and artisanal and small-scale gold mining (ASGM), have increased community concern about potential exposures toxic trace elements (TTE) including arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb). Such exposures can lead to detrimental health effects in children, such as developmental delays and anemia. The overarching goal of my dissertation was to understand exposure to both toxic and essential (manganese (Mn), selenium (Se), and zinc (Zn)) trace elements, anemia prevalence, and the associations between hemoglobin (Hb) levels and trace elements. To do this, I leveraged existing data from a population based study in the Southern Peruvian Amazon region of Madre de Dios – the Investigación de Migración, Ambiente, y Salud (IMAS). In my first aim I considered sources of TTE exposure among children under 10 years old by conducting generalized estimating equations (GEE) clustered at the household level. I found, on average, As was higher in children from rural areas, and Hg was, on average, higher among children living near AGSM areas. In my second aim, I considered potential factors that may lead to anemia in children under 12 and again used GEE clustered at the household level. Anemia prevalence in 2014 was 78%, and I found decreased Hb levels to be associated with younger age and prior anemia status. Finally, in my third aim, I used linear regression models to understand associations between TTE exposure in nails and Hb levels and accounting for exposure to essential elements. While no statistically significant associations were identified, TTE contamination in nail warrants additional investigation of childhood exposure in Madre de Dios. Further the high burden of anemia identified in this population warrants future attention. Analysis of children’s nails adds to the limited body of research on nail-trace element exposure, helping to improve our understanding of this biomarker.

Available for download on Thursday, August 08, 2024