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Abstract
Heavy metal (HM) exposure is a global health concern, particularly in low- and middle-income countries. This study assessed HM exposure and its association with respiratory health and anemia in children living in Tumbes, Peru, where the Puyango-Tumbes River—potentially affected by upstream gold mining—may be a source of environmental contamination. Children living closer to the river had higher hair arsenic and lead levels; arsenic was associated with allergic rhinitis symptoms, and lead with increased odds of anemia. Findings highlight the need for environmental health interventions in river-adjacent communities.