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BACKGROUND: In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response. METHODS AND FINDINGS: We included children aged ≤5 years with VBLL ≥45 µg/dL before any chelation and recorded neurological status. Odds ratios (OR) for neurological features were estimated; the final model was adjusted for age and baseline VBLL, using random effects for village of residence. 972 children met inclusion criteria: 885 (91%) had no neurological features; 34 (4%) had severe features; 47 (5%) had reported recent seizures; and six (1%) had other neurological abnormalities. The geometric mean VBLLs for all groups with neurological features were >100 µg/dL vs 65.9 µg/dL for those without neurological features. The adjusted OR for neurological features increased with increasing VBLL: from 2.75, 95%CI 1.27-5.98 (80-99.9 µg/dL) to 22.95, 95%CI 10.54-49.96 (≥120 µg/dL). Neurological features were associated with younger age (OR 4.77 [95% CI 2.50-9.11] for 1-

Purpose: The purpose of this paper is to explain the rationale and potential for the WHO health promoting schools (HPS) to improve children's oral health, and describe validated quantitative methodologies and qualitative approaches to measure program impact. Design/Methodology/Approach: Critical discussion of the impact of poor oral health and potential for school-based educational intervention, and evaluation methodologies used by the authors. Findings: Using HPS to improve oral health is relevant because dental caries and gingivitis/periodontitis negatively impact children's health and quality of life worldwide. WHO has called for effective community-based oral health promotion programs; intervention is simple and low cost; robust evaluation measures exist--the decayed missing filled teeth index and change in cavity rate allow quantitative comparison of oral health status; and questionnaires document changes in knowledge, practices, diet, health-related quality of life, and pain. Practical Implications: Poor oral health is a major health issue. Established measures to improve oral hygiene offer an achievable, low-cost HPS entry point; the "knowledge" and "healthy practices" components central to the WHO HPS model are tried and tested and multiple potential benefits are documented. Poor oral health is a non-stigmatized issue, hence intervention is readily accepted, and effective evaluation tools provide evidence of program effect over a short (two to three years) timeframe. Originality/Value: Oral health promotion is more affordable and sustainable than the cost of traditional restorative treatments especially in middle- and low-income countries. Success with oral health leads to confidence for expansion of HPS activities to address other health issues relevant to the school community.