December 12, 2019

Local public health agencies have identified children with elevated blood lead levels attributed to products used by some South Asian communities and people of Hindu and Muslim faiths. Commonly used lead exposure screening tools will miss some of these culturally associated risks.

We are asking local health care providers who see pregnant women and children to:

  1. Ask about exposure to the products described below: sindoor, kumkum, roli, kohl, and turmeric;

  2. Order a blood lead test for those at risk; and,

  3. Educate patients about the potential risks of these products.

These recommendations are in addition to childhood standard lead screening recommendations at 1 and 2 years of age or between ages 3 and 5 if not previously screened.

Screening blood lead levels above 5 micrograms/dL will be reported to the local public health agency in the patient’s county of residence.

For specific questions about lead testing providers and patients can contact the Multnomah County Leadline at 503-988-4000.

Ask patients about products of concern

Sindoor, Kumkum, Tikka, and Roli

These bright red-orange powders are commonly used for hindu religious purposes and among communities from and around South Asia. Lead is sometimes used to brighten the color or to increase the weight of the product. People can be exposed to lead when powders that may contain lead enter the body through the eyes or mouth. 

Health officials have discovered high lead content in samples of sindoor purchased locally under the brands:

  • Ancient Veda 

  • Divine Supplies

Kohl

Also known as kajal, surma or sormeh, this black ore is applied to the eyes for spiritual, medicinal or cosmetic purposes. It is traditionally used on babies and young children for religious purposes. The FDA has banned the import of Kohl because one way of making the product is by grinding a mineral called galena—also known as lead ore—into a powder and then mixing it with other ingredients. 

Multnomah County has found lead in products purchased locally and abroad, including in the brands:

  • Hashmi Surma Special 

  • Al-Asmad Alharmain Zam Zam & Rose Water

Turmeric 

This yellow-orange root and spice is used frequently in South Asian cuisine, medicine and traditional practices. It has become widely used around the world. Lead powder is sometimes added to turmeric root or powder to make the product more vibrant and to cover insect damage. People are then exposed to the lead when that spice is eaten. Health officials are primarily concerned about the spice brought in from India or Bangladesh, rather than products sold in major U.S. supermarkets.

More about lead

Lead can affect almost every organ system and even low levels of blood lead levels are associated with neurological effects. Identifying and eliminating the source of the exposure is key for treatment, though primary prevention of exposure is the most important intervention. 

Symptomatic lead poisoning varies based on the acuity and dose of exposure. High level lead exposures may result in stomach pain, weakness or paralysis, encephalopathy, seizures and death. Low to moderate exposures may cause more subtle or nonspecific symptoms such as headache, lethargy, abdominal discomfort, arthralgia, paresthesia, and cognitive impairment. 

Children and babies exposed while their mothers are pregnant are especially at risk because lead is particularly toxic to the developing nervous system. Lead exposure in children can lead to problems with behavior, learning, hearing, speech, and slowed growth and development. Lead poisoning can also be asymptomatic, so blood lead screening is important for identifying cases.

If you have questions, please contact your local public health department:

  • Multnomah County Public Health: 503-988-3406

  • Clark County Public Health: 564-397-8182 

  • Washington County Public Health: 503-846-3594

  • Clackamas County Public Health: 503-655-8411

Learn More