Access to safe water supply--a major determinant of public health--is less than 50% in Madagascar, and access to piped, treated water remains out of reach financially for many in the urban and peri-urban areas where available. The Self-supply option of the Pitcher Pump has been meeting the need for household water in coastal areas of Madagascar since the early 1960s and has proven a sustainable option for many. These pumps make use of leaded components in the construction, however, which may pose a health risk for heavy metal intoxication and therefore cause the water to be unsafe for drinking and cooking. This study assesses the potential for lead (Pb) leaching from Pitcher Pump systems into water at levels of health concern. The objectives of this study are to assess Pb concentrations in water drawn from Pitcher Pumps, to determine the relationship between various factors and the Pb levels, to make a preliminary assessment of public health implications of Pb contamination, and to offer informed recommendations to reduce the likelihood of consuming contaminated water. A field study was undertaken to measure concentrations of dissolved Pb in water from Pitcher Pumps under recently flushed and first-draw pumping conditions at 18 households in the city of Tamatave, Madagascar. Variables potentially affecting Pb leaching were determined including pump age, depth to the well screen, pump manufacturer, season of sample collection, and basic water quality indicators. Sampling campaigns were conducted three times over the course of eight months. Time-release case studies were also carried out at two households to determine the time scale over which the Pb concentration in stationary water reaches equilibrium with the Pb-containing system components. Pilot studies of iron (Fe)-for-Pb substitution of select pump system components were carried out at the same two households to attribute the major contribution of Pb leaching to one set of parts and to assess one strategy for decreasing dissolved Pb concentrations. Finally, the Internal Exposure Uptake Biokinetic Model for Lead in Children (IEUBK Model) of the US Environmental Protection Agency (EPA) was employed to estimate realistic blood lead levels (BLLs) in children under five years of age, based on Pb concentrations measured in the water. Of the 18 pumps sampled, 15 produced at least one sample exceeding the World Health Organization (WHO) provisional guideline of 10 [um]g/L dissolved Pb in water. Specifically, 67% of all samples showed concentrations above 10 [um]g/L under first-draw pumping conditions. Flushing the pumps prior to use decreased the Pb levels significantly (p < 0.0001), with only 35% of samples exceeding the provisional guideline. Under flushed conditions, the median Pb concentration in pumped water was 9 [um]g/L, down from 13 [um]g/L at one hour of inactivity. No statistically significant correlations were observed between measured Pb concentrations and factors like the season of sample collection, pump age, manufacturer, or water quality indicators like pH or temperature. Under first-draw conditions, the concentration of Pb in water increased with increasing duration of pump inactivity, until equilibrium was reached with the leaded pump components. For two pumps, substitution of Fe valves for Pb greatly decreased Pb concentrations in the water, from 37-100 [um]g/L and 7-24 [um]g/L down to 3-4 [um]g/L and 2-8 [um]g/L, respectively. Model-predicted geometric mean BLLs in children range from about 2-8 [um]g/dL, in some instances exceeding the Centers for Disease Control and Prevention (CDC) guideline for an elevated BLL (5 [um]g/dL), depending on the exposure concentrations. This study finds that water provided by Pitcher Pump systems in Madagascar frequently exceeds the WHO provisional guideline value for safe consumption under first-draw conditions, and may do so even after flushing the pumps. The Pb concentrations measured in the field have the potential to elevate BLLs in children under five to levels implicated in serious health issues. Leaching of Pb into the water is therefore an issue of concern for users of the Pitcher Pump systems in Tamatave, and likely for other areas served by this technology. Flushing the pumps before water collection generally reduces Pb levels in the water. These results suggest that most of the Pb leaches from pure Pb check valve weights at the mouth of the pump, and consequently, a substitution of Fe weights on the valves greatly reduces Pb concentrations and the probability for exceeding the WHO provisional guideline. Relatively simple operational changes on the part of the pump manufacturers and the pump users might, therefore, help to ensure the continued sustainability of Pitcher Pumps in eastern Madagascar.