Newly published research confirms the on-going risk of elevated blood lead levels among refugee children from various developing countries. Recent concerns have centered around Burmese children from refugee camps in Thailand. Two published research articles have documented the prevalence of elevated blood lead as high as 7.1% in Burmese children resettled in Indiana  and 14.5% among Burmese infants and toddlers in Thai camps . Of particular concern is the association of daily use of thanakha, a traditional cosmetic, with elevated lead levels.
In addition, an epidemiologic study of longitudinal data on blood lead levels among refugee children resettled in Massachusetts confirmed suspicions that residence in older housing in the U.S. is associated with elevated blood lead levels with prevalence as high as 23% among refugee children from Africa and 27% among those from Latin America and the Caribbean .
Resettlement agency staff should ensure that refugee children are placed in lead-free housing in the U.S. and assess families for use of traditional cosmetics that may include lead, like Burmese thanakha or Somali kohl. Kohl, a shiny black substance used as eyeliner or eyeshadow, is also known by many other names around the world, such as kohal, kojal, surma, and tiro. With prevention and prompt treatment, refugee children will avoid the negative health effects on organs and the nervous system that result from lead poisoning.
Contributed by Paul Geltman M.D., M.P.H.
 Ritchey MD, et al. Lead poisoning among Burmese refugee children – Indiana 2009. Clinical Pediatrics. 2011;50:648-656.
 Mitchell T, et al. Lead poisoning in United States-bound refugee children: Thailand-Burma border, 2009. Pediatrics. 2012;129:e392–e413.
 Eisenberg K, et al. Blood lead levels of refugee children resettled in Massachusetts, 2000 – 2007. Am J Public Health. 2011;101:48–54.