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Department of Family Medicine and Community Health; Center for Integrated Primary Care

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Alternative and Complementary Medicine | International Public Health | Medical Toxicology | Pediatrics


Background: Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 microg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied.

Methods: We assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer.

Results: The study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 microg/dL (SD = 3.5; range, 3.5-20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 microg/dL and 8.5 microg/dL, respectively (P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 microg/dL vs 5.3 microg/dL, P = .03).

Conclusions: It is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.


Ayurvedic medicine, blood lead levels, children, kohl, pediatric, traditional medicine

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Copyright © The Author(s) 2019. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

DOI of Published Version



Glob Adv Health Med. 2019 Aug 22;8:2164956119870988. doi: 10.1177/2164956119870988. eCollection 2019. Link to article on publisher's site

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Global advances in health and medicine

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Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License