THE GLOBAL LEAD PROGRAM

Enabling All Children to Reach Their Potential

Georgia

Georgia

41% of children under age 8 have elevated blood lead levels.

 In Georgia, children’s lead exposure is an emerging issue that has captured the attention of relevant authorities and stakeholders through recent studies. In 2018, a BLL survey was conducted in Georgia as part of the Multiple Indicator Cluster Survey (MICS). The survey showed high rates of elevated BLL, particularly in the western parts of Georgia. The results showed that 41% of children have elevated BLLs over 5 μg/dL. A BLL 5 μg/dL is the reference value used by the U.S. Centers for Disease Control and Prevention to identify children who have been exposed to lead and require case management. The MICS study also showed that 16% of children had BLLs > 10 μg/dL.

Lead added to spices to enhance the weight, color, and flavor has been blamed for elevated blood lead levels in Georgia and other lower- and middle-income countries.

In April 2019, UNICEF reported that that 41 percent of 1,578 children, ages of 2 and 7, tested in 2018 during a random sampling across Georgia had blood lead levels at or above 5 µg/dL and 25 percent of the children had blood lead levels between 5 and 10 µg/dL. In four of the regions, more than 60% of the children had elevated blood lead levels with one region, Adjara, reporting 85% of the children tested with blood lead levels at or above 5 µg/dL and 50% with levels above 10 µg/dL. [ii]

Pure Earth conducted a study seeking to determine the sources of lead exposure in Georgia and found that of all possible sources tested — lead-based paint, soil, water and spices — only adulterated spices contained significant amounts of lead. [iii]

[i] OC Media, Oct. 10, 2018, “Lead: Georgia’s silent killer”  https://oc-media.org/lead-georgia-s-silent-killer/

[ii] “Survey on Lead Prevalence in Children’s Blood in Georgia: Prevalence on a Country Level.” UNICEF. April 2019. https://www.unicef.org/georgia/press-releases/lead-prevalence-childrens-blood-georgia-results-national-survey-unveiled.

[iii] [Ericson, Georgia Pb Exposure Assessment 

Background

The Georgian National Center for Disease Control and Public Health (NCDC) contracted the New York, USA based Non Governmental Organization (NGO), Pure Earth to identify possible sources of lead (Pb) exposure in targeted Georgian homes. The study followed on a Multiple Indicator Cluster Survey (MICS) conducted jointly by NCDC and UNICEF from September to December 2018 that included a nationally representative assessment of children’s blood lead levels (BLL). Blood was analyzed from 1,578 children (age 0–7 years) finding a mean BLL of 6.64 µg/dL (SD:6.10; range:0.68–51.85).

Materials and Methods

A team comprised of NCDC, US Centers for Disease Control and Prevention (US CDC) and Pure Earth staff conducted site visits to 25 Georgian homes and 3 bazaars in July 2019, assessing a range of media including soil, dust, paint, water, spices, toys and cookware. Sixteen of the homes were selected on the basis of having a child with a BLL > 30 µg/dL, while 9 were selected on the basis of having a child with a BLL < 5 µg/dL. The homes were located in the following 4 regions: Adjara (n=9); Guria (n=5); Imereti (n=7); and Shida Kartli (n=4). The study relied heavily on field-portable instrumentation confirmed in part by laboratory wet techniques. In total 671 portable X-Ray Fluorescence measurements were taken, including those from spices (n=114), paint (n=207); soil (91); toys (n=79); and cookware (n=53). In addition 61 dust wipes were collected and analyzed at a certified laboratory in the US. Finally 15 water samples were collected an analyzed at a private laboratory in Tbilisi.

Measured concentrations were inputted into the US EPA Integrated Environmental Uptake Biokinetic Model for Children to assess the relative contribution of each exposure source. Regression analysis was used to assess the relationship between select variables.

Results

Spice Pb measurements revealed highly elevated concentrations. All other media were found to be within internationally accepted guidelines. The following five commonly used spices had severely elevated Pb concentrations: Khmeli Suneli Kharcho (median: 1794.76 mg/kg); Kviteli Kvavili (median: 5771.01 mg/kg); Svanuri Marili (median: 1345.53 mg/kg), Utsko Suneli (median: 13.12 mg/kg); and coriander (median: 8.43 mg/kg). These five spices exceeded the reference levels applied in this study (NYC DOHMH) by 897x, 2,885x, 672x, 6x and 4x, respectively. The available literature appears to indicate that adulteration takes place within the national borders of Georgia, rather than being a result of import. The issue is national in nature but most pronounced in the western region as seen in Table 1 below.

Region

n

n > 2 mg/kg

Mean

SD

Median

25%IQR

75%IQR

 

Min

Max

Adjara

69

37

1,553.21

3,713.76

11.45

< LOD

1,069.81

 

< LOD

20,058.61

Guria

15

6

304.49

894.49

< LOD

< LOD

48.43

 

< LOD

3,461.72

Imereti

23

2

31.39

109.32

< LOD

< LOD

< LOD

 

< LOD

521.79

Shida Kartli

7

2

7.52

6.72

< LOD

< LOD

7.90

 

< LOD

22.15

Table 1. Measurements of spice Pb concentrations by region taken as part of the study

Conclusion and Recommendations

Lead-adulterated spices pose a significant and credible public health risk to Georgians. Additional study is required to effectively isolate the problem actors and develop effective policy. The issue is national in scope but most pronounced in the western region. A short list of recommendations follows.

  1. Supply chain analysis. The sources and motives of spice adulteration should be identified through further research. Anecdotal evidence indicates, for instance, that bazaar vendors may be unlikely to adulterate spices as they seem to procure in weight and sell by volume. Thus the presence of lead, which is heavy, would adversely affect their profit. A more nuanced understanding of the spice supply chain is necessary to develop an appropriate policy response. Given that spices are apparently higher in Georgia than other countries, it seems that importation of adulterated spices is unlikely to be the source. That is, it seems likely that adulteration occurs within Georgia.
  2. Improved monitoring. The pXRF is a robust and field-portable instrument that could allow inspectors to mitigate the sale of adulterated spices. Monitoring could be carried out at the point of sale and further up the supply chain, rapidly facilitating the identification of problem suppliers.
  3. Effective risk communication. It is likely that information about lead-adulterated spices will become available to the public. Measures should be taken in advance of any such release to communicate important information in a thoughtful manner and limit public outrage, hysteria, and adverse social and economic consequences. Experts should be engaged for the purpose of developing an effective and tailored risk communication campaign.