Case-Control Study on Risk Factors of High Childhood Blood Lead

Author

ICMR

Part 1. Descriptive analysis

Map showing the location of cases and control

The location of the cases and controls have certain non-overlapping spatial distribution (although numbers are small for tall claims). Differences in the risk factors identified in the case-control analysis may be possibly due to these spatial differences which in turn cause the variations in risk factor distribution between cases and controls. A total of 185 cases (from 179 households) and controls were sampled in MP and CG. Environmental sample test results were available for 179 households.

Table: Blood lead level distribution by case-control status

Characteristic	Control N = 98¹	Case N = 87¹
Blood lead level (mg/dL)	2.7 (0.8)	10.6 (4.9)
Blood lead level (ppm)	267 (76)	1,060 (491)
Blood lead level categories (3-category)
<=4	98 (100%)	0 (0%)
6-9.99	0 (0%)	51 (59%)
>=10	0 (0%)	36 (41%)
Blood lead level categories (4-category)
<=4	98 (100%)	0 (0%)
6-9.99	0 (0%)	51 (59%)
10-19.99	0 (0%)	32 (37%)
>=20	0 (0%)	4 (4.6%)
¹ Mean (SD); n (%)

Histogram of blood lead level by case-control status

Part 2. Bivariate analysis of risk factors

A. Demographic

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Age group
1-2	28 (15%)	11 (11%)	17 (20%)	—	—
2-3	46 (25%)	22 (23%)	24 (28%)	0.71	0.27, 1.82	0.5
3-4	52 (28%)	31 (32%)	21 (24%)	0.44	0.17, 1.11	0.085
4-5	57 (31%)	32 (33%)	25 (29%)	0.51	0.20, 1.26	0.15
Unknown	2	2	0
Gender
Male	85 (46%)	46 (47%)	39 (45%)	—	—
Female	100 (54%)	52 (53%)	48 (55%)	1.09	0.61, 1.95	0.8
PSU type
Rural	143 (77%)	87 (89%)	56 (64%)	—	—
Urban	42 (23%)	11 (11%)	31 (36%)	4.38	2.09, 9.77	<0.001
Caste
Other Caste	14 (7.7%)	4 (4.2%)	10 (11%)	—	—
SC	43 (23%)	27 (28%)	16 (18%)	0.24	0.06, 0.83	0.032
ST	48 (26%)	27 (28%)	21 (24%)	0.31	0.08, 1.07	0.077
OBC	77 (42%)	38 (40%)	39 (45%)	0.41	0.11, 1.34	0.2
Not known	1 (0.5%)	0 (0%)	1 (1.1%)	847,272	0.00,	>0.9
Unknown	2	2	0
Religion
Hindu	177 (97%)	91 (95%)	86 (99%)	—	—
Muslim	4 (2.2%)	4 (4.2%)	0 (0%)	0.00		>0.9
Christian	2 (1.1%)	1 (1.0%)	1 (1.1%)	1.06	0.04, 27.0	>0.9
Others	0 (0%)	0 (0%)	0 (0%)
Unknown	2	2	0
Father highest completed education
10th or less	122 (66%)	66 (67%)	56 (64%)	—	—
Higher secondary	37 (20%)	19 (19%)	18 (21%)	1.12	0.53, 2.34	0.8
Graduate and above	26 (14%)	13 (13%)	13 (15%)	1.18	0.50, 2.77	0.7
Mother highest completed education
10th or less	116 (63%)	62 (63%)	54 (62%)	—	—
Higher secondary	41 (22%)	21 (21%)	20 (23%)	1.09	0.53, 2.24	0.8
Graduate and above	28 (15%)	15 (15%)	13 (15%)	1.00	0.43, 2.28	>0.9
Father occupation
Service/ Office	19 (10%)	11 (11%)	8 (9.2%)	—	—
Agriculture	84 (45%)	48 (49%)	36 (41%)	1.03	0.38, 2.91	>0.9
Paint-related/ Construction/ Industry	47 (25%)	20 (20%)	27 (31%)	1.86	0.64, 5.62	0.3
Shop/ Trade	17 (9.2%)	11 (11%)	6 (6.9%)	0.75	0.19, 2.88	0.7
Transport/ Vendor	16 (8.6%)	7 (7.1%)	9 (10%)	1.77	0.47, 7.01	0.4
Not working	2 (1.1%)	1 (1.0%)	1 (1.1%)	1.38	0.05, 38.4	0.8
Mother occupation
Service/ Office	14 (7.6%)	10 (10%)	4 (4.6%)	—	—
Agriculture	26 (14%)	17 (17%)	9 (10%)	1.32	0.33, 5.92	0.7
Housewife	136 (74%)	66 (67%)	70 (80%)	2.65	0.84, 10.0	0.11
Paint-related/Construction	5 (2.7%)	2 (2.0%)	3 (3.4%)	3.75	0.46, 38.3	0.2
Shop/ Trade	4 (2.2%)	3 (3.1%)	1 (1.1%)	0.83	0.04, 9.15	0.9
Number of household members	7.23 (3.01)	7.59 (3.27)	6.83 (2.65)	0.92	0.83, 1.01	0.088
Unknown	3	2	1
BPL card holder
No	55 (30%)	26 (27%)	29 (33%)	—	—
Yes	130 (70%)	72 (73%)	58 (67%)	0.72	0.38, 1.36	0.3
Child stays outside residential area >4 weeks/year
No	174 (94%)	89 (91%)	85 (98%)	—	—
Yes	11 (5.9%)	9 (9.2%)	2 (2.3%)	0.23	0.03, 0.93	0.067
Child currently spends >20 hours/week away from home
No	45 (24%)	23 (23%)	22 (25%)	—	—
Yes	140 (76%)	75 (77%)	65 (75%)	0.91	0.46, 1.78	0.8
Past DABS: child spent >20 hours/week outside home
No	170 (92%)	87 (89%)	83 (95%)	—	—
Yes	15 (8.1%)	11 (11%)	4 (4.6%)	0.38	0.10, 1.16	0.11
Awareness of lead exposure risk
No	185 (100%)	98 (100%)	87 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Non-parent household member lead-related occupation/hobby
No	171 (92%)	90 (92%)	81 (93%)	—	—
Yes	14 (7.6%)	8 (8.2%)	6 (6.9%)	0.83	0.26, 2.50	0.7
¹ n (%); Mean (SD)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Younger age group, urban residence, other caste, higher education of father (not mother), father working in paint-related/transport/vendor occupation, mother as agriculture/housewife/paint-related/construction occupation were associated with higher odds of blood lead. Children spending time away from current home was associated with lower odds. None of the households were aware of lead exposure risk.

B. Household characteristics

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Type of Family
Extended	21 (11%)	16 (17%)	5 (5.7%)	—	—
Joint	31 (17%)	13 (14%)	18 (21%)	4.43	1.36, 16.5	0.018
Nuclear	131 (72%)	67 (70%)	64 (74%)	3.06	1.12, 9.79	0.039
Unknown	2	2	0
Ownership of house
Own House	179 (98%)	94 (98%)	85 (98%)	—	—
Rented/Other	4 (2.2%)	2 (2.1%)	2 (2.3%)	1.11	0.13, 9.38	>0.9
Unknown	2	2	0
Type of House
Pucca	69 (38%)	35 (36%)	34 (39%)	—	—
Semi-pucca	56 (31%)	29 (30%)	27 (31%)	0.96	0.47, 1.94	>0.9
Kutcha	58 (32%)	32 (33%)	26 (30%)	0.84	0.41, 1.68	0.6
Unknown	2	2	0
No of rooms in house
>1	163 (89%)	86 (90%)	77 (89%)	—	—
0-1	20 (11%)	10 (10%)	10 (11%)	1.12	0.44, 2.86	0.8
Unknown	2	2	0
Separate Kitchen
Yes	97 (53%)	45 (47%)	52 (60%)	—	—
No	86 (47%)	51 (53%)	35 (40%)	0.59	0.33, 1.06	0.082
Unknown	2	2	0
Cooking fuel
Firewood	112 (61%)	66 (69%)	46 (53%)	—	—
LPG	67 (37%)	28 (29%)	39 (45%)	2.00	1.09, 3.72	0.027
Others	4 (2.2%)	2 (2.1%)	2 (2.3%)	1.43	0.17, 12.3	0.7
Unknown	2	2	0
Drinking Water
Bore well	56 (31%)	30 (31%)	26 (30%)	—	—
Open well	13 (7.1%)	11 (11%)	2 (2.3%)	0.21	0.03, 0.87	0.055
Others	27 (15%)	13 (14%)	14 (16%)	1.24	0.49, 3.15	0.6
RO/Bottled/Purchased water	1 (0.5%)	0 (0%)	1 (1.1%)	6,643,630	0.00,	>0.9
Surface/Spring water	1 (0.5%)	0 (0%)	1 (1.1%)	6,643,630	0.00,	>0.9
Tap water	77 (42%)	39 (41%)	38 (44%)	1.12	0.56, 2.25	0.7
Water tanker	8 (4.4%)	3 (3.1%)	5 (5.7%)	1.92	0.43, 10.1	0.4
Unknown	2	2	0
Cooking water
Bore well	55 (30%)	30 (31%)	25 (29%)	—	—
Open well	14 (7.7%)	11 (11%)	3 (3.4%)	0.33	0.07, 1.19	0.11
Others	27 (15%)	13 (14%)	14 (16%)	1.29	0.51, 3.28	0.6
RO/Bottled/Purchased water	0 (0%)	0 (0%)	0 (0%)
Surface/Spring water	1 (0.5%)	0 (0%)	1 (1.1%)	2,541,816	0.00,	>0.9
Tap water	78 (43%)	39 (41%)	39 (45%)	1.20	0.60, 2.41	0.6
Water tanker	8 (4.4%)	3 (3.1%)	5 (5.7%)	2.00	0.45, 10.5	0.4
Unknown	2	2	0
Water purification method
Water filter/ E. Purifier	0 (0%)	0 (0%)	0 (0%)
Boiling	6 (3.3%)	3 (3.2%)	3 (3.4%)	—	—
Strain through a cloth	31 (17%)	17 (18%)	14 (16%)	0.82	0.13, 5.07	0.8
Add bleach/chlorine tablets	0 (0%)	0 (0%)	0 (0%)
None	132 (73%)	68 (72%)	64 (74%)	0.94	0.17, 5.25	>0.9
Others/Multiple	13 (7.1%)	7 (7.4%)	6 (6.9%)	0.86	0.12, 6.26	0.9
Unknown	3	3	0
Latrine type
Present and using	143 (78%)	72 (75%)	71 (82%)	—	—
Others	5 (2.7%)	2 (2.1%)	3 (3.4%)	1.52	0.25, 11.8	0.7
Open Defecation	35 (19%)	22 (23%)	13 (15%)	0.60	0.27, 1.27	0.2
Unknown	2	2	0
Years of construction of current house
Less than 10 years	88 (48%)	52 (54%)	36 (42%)	—	—
More than 10 years	94 (52%)	45 (46%)	49 (58%)	1.57	0.88, 2.84	0.13
Unknown	3	1	2
Visible peeling paint in current house
No	112 (62%)	64 (66%)	48 (57%)	—	—
Yes	69 (38%)	33 (34%)	36 (43%)	1.45	0.80, 2.67	0.2
Unknown	4	1	3
paint_type_current_hh
No paint/Cement paint	30 (16%)	20 (20%)	10 (12%)	—	—
Distemper	56 (31%)	29 (30%)	27 (32%)	1.86	0.75, 4.82	0.2
Chuna or similar	78 (43%)	44 (45%)	34 (40%)	1.55	0.65, 3.84	0.3
Emulsion	19 (10%)	5 (5.1%)	14 (16%)	5.60	1.65, 21.7	0.008
Unknown	2	0	2
Interior painting/renovation in last 6 months
No	116 (63%)	62 (63%)	54 (62%)	—	—
Yes	69 (37%)	36 (37%)	33 (38%)	1.05	0.58, 1.91	0.9
Primary flooring type in household
Non-soil-contact	44 (45%)	31 (60%)	13 (29%)	—	—
Soil-contact	53 (55%)	21 (40%)	32 (71%)	3.63	1.58, 8.72	0.003
Unknown	88	46	42
Presence of bare soil in current household
No	61 (34%)	28 (29%)	33 (38%)	—	—
Yes	121 (66%)	68 (71%)	53 (62%)	0.66	0.35, 1.23	0.2
Unknown	3	2	1
Smoking inside household
No	91 (49%)	53 (55%)	38 (44%)	—	—
Yes	93 (51%)	44 (45%)	49 (56%)	1.55	0.87, 2.79	0.14
Unknown	1	1	0
Biomass burning inside house
No	58 (32%)	27 (28%)	31 (36%)	—	—
Yes	125 (68%)	71 (72%)	54 (64%)	0.66	0.35, 1.24	0.2
Unknown	2	0	2
Pets/domestic animals in household
No	77 (43%)	41 (42%)	36 (43%)	—	—
Yes	104 (57%)	56 (58%)	48 (57%)	0.98	0.54, 1.77	>0.9
Unknown	4	1	3
Car/machine repair activity near household
No	171 (94%)	90 (95%)	81 (94%)	—	—
Yes	10 (5.5%)	5 (5.3%)	5 (5.8%)	1.11	0.30, 4.13	0.9
Unknown	4	3	1
Non-parent household member lead-related occupation/hobby
No	171 (92%)	90 (92%)	81 (93%)	—	—
Yes	14 (7.6%)	8 (8.2%)	6 (6.9%)	0.83	0.26, 2.50	0.7
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Joint/nuclear family, having separate kitchen, using LPG, tanker/tap water for cooking/drinking, no water purification method, old houses (>10 years), peeling paint in house, emulsion/distemper/chuna paint, soil flooring, smoking inside home, biomass burning inside, animals around house, machine repair around house were associated with higher odds of being a case.

C. Household assets

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Wealth Index
Highest	23 (13%)	10 (10%)	13 (15%)	—	—
Higher	24 (13%)	14 (15%)	10 (11%)	0.55	0.17, 1.73	0.3
Middle	28 (15%)	18 (19%)	10 (11%)	0.43	0.13, 1.31	0.14
Lower	37 (20%)	17 (18%)	20 (23%)	0.90	0.31, 2.58	0.9
Lowest	71 (39%)	37 (39%)	34 (39%)	0.71	0.27, 1.82	0.5
Unknown	2	2	0
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Higher wealth index was associated with higher odds of blood lead. It seems that compared to middle income group the odds are higher in both the richer and poorer groups. This is opposite to what we found in the full SAMPADA data. Probably due to the small sample size of the case-control study and chance variation.

D. Blood micro-nutrient levels

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Categorical Variables
Anemia status
No Anemia	105 (57%)	53 (55%)	52 (60%)	—	—
Any Anemia	78 (43%)	43 (45%)	35 (40%)	0.83	0.46, 1.49	0.5
Unknown	2	2	0
Anaemia Status (Any, New)
No Anemia	105 (57%)	53 (55%)	52 (60%)	—	—
Mild Anemia	50 (27%)	28 (29%)	22 (25%)	0.80	0.40, 1.57	0.5
Moder+Sev Anemia	28 (15%)	15 (16%)	13 (15%)	0.88	0.38, 2.04	0.8
Unknown	2	2	0
iron_def_adj
No Iron Deficiency	4 (27%)	2 (22%)	2 (33%)	—	—
Iron Deficiency	11 (73%)	7 (78%)	4 (67%)	0.57	0.05, 6.34	0.6
Unknown	170	89	81
Vitamin B12 Status
Normal (≥203 pg/mL)	5 (38%)	3 (38%)	2 (40%)	—	—
Deficient (<203 pg/mL)	8 (62%)	5 (63%)	3 (60%)	0.90	0.09, 10.1	>0.9
Unknown	172	90	82
Serum Folate Status
Normal (≥4 ng/mL)	12 (92%)	7 (88%)	5 (100%)	—	—
Deficient (<4 ng/mL)	1 (7.7%)	1 (13%)	0 (0%)	0.00		>0.9
Unknown	172	90	82
Vitamin D Status
Normal (≥12 ng/mL)	8 (62%)	6 (75%)	2 (40%)	—	—
Deficient (<12 ng/mL)	5 (38%)	2 (25%)	3 (60%)	4.50	0.44, 63.0	0.2
Unknown	172	90	82
Continuous Variables
Log Ferritin				1.03	0.98, 1.11	0.3
Mean (SD)	17 (25)	11 (12)	26 (38)
Unknown	170	89	81
RBC Folate (ng/mL)
Mean (SD)	10.6100 (NA)	10.6100 (NA)	NA (NA)
Unknown	184	97	87
Vitamin B12 (pg/mL)				1.00	1.0, 1.01	0.6
Mean (SD)	200 (174)	178 (105)	235 (263)
Unknown	172	90	82
Vitamin D (ng/mL)				0.88	0.69, 1.01	0.13
Mean (SD)	18 (10)	22 (12)	12 (3)
Unknown	172	90	82
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Aenmia was inexplicably associated with a lower odds of being a case. Only a limited number of cases and controls have blood micronutrients measured, so valid inference cannot be drawn here.

E. Anthropometric indicators

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Stunting status
No Stunting	86 (60%)	42 (58%)	44 (62%)	—	—
Stunting	32 (22%)	17 (23%)	15 (21%)	0.84	0.37, 1.90	0.7
Severe Stunting	26 (18%)	14 (19%)	12 (17%)	0.82	0.34, 1.97	0.7
Unknown	41	25	16
Wasting status
No Wasting	122 (85%)	64 (90%)	58 (81%)	—	—
Wasting	18 (13%)	5 (7.0%)	13 (18%)	2.87	1.01, 9.39	0.058
Severe Wasting	3 (2.1%)	2 (2.8%)	1 (1.4%)	0.55	0.03, 5.91	0.6
Unknown	42	27	15
Underweight status
No Underweight	102 (70%)	52 (71%)	50 (69%)	—	—
Underweight	29 (20%)	14 (19%)	15 (21%)	1.11	0.49, 2.56	0.8
Severe Underweight	14 (9.7%)	7 (9.6%)	7 (9.7%)	1.04	0.33, 3.24	>0.9
Unknown	40	25	15
MUAC Group
Normal	141 (97%)	73 (99%)	68 (94%)	—	—
severewasting	5 (3.4%)	1 (1.4%)	4 (5.6%)	4.29	0.62, 85.1	0.2
Unknown	39	24	15
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Wasting indicators were associated with higher odds of blood lead, while stunting and underweight were not. This is opposite to what was found in the full SAMPADA data. Probably due to the small sample size of the case-control study and chance variation.

F. Dietary nutrient intake

Characteristic	Overall N = 185	Control N = 98	Case N = 87	OR	95% CI	p-value
Energy Intake (kcal/day)				1.00	1.00, 1.00	0.2
Mean (SD)	894 (529)	953 (471)	827 (583)
Unknown	41	22	19
Protein Intake (g/day)				0.99	0.96, 1.01	0.4
Mean (SD)	23 (13)	24 (12)	22 (15)
Unknown	41	22	19
Carbohydrate Intake (g/day)				1.00	0.99, 1.00	0.039
Mean (SD)	151 (88)	166 (83)	135 (91)
Unknown	41	22	19
Total Fat Intake (g/day)				1.00	0.99, 1.02	0.7
Mean (SD)	20 (19)	19 (18)	21 (20)
Unknown	41	22	19
Iron Intake (mg/day)				0.96	0.88, 1.03	0.3
Mean (SD)	6.0 (4.2)	6.4 (4.1)	5.6 (4.4)
Unknown	41	22	19
Zinc Intake (mg/day)				0.84	0.71, 0.99	0.046
Mean (SD)	3.66 (2.12)	4.00 (2.15)	3.28 (2.04)
Unknown	41	22	19
Calcium Intake (mg/day)				1.00	1.00, 1.00	0.4
Mean (SD)	192 (178)	180 (154)	205 (203)
Unknown	41	22	19
Thiamine (B1) Intake (mg/day)				0.24	0.07, 0.76	0.020
Mean (SD)	0.44 (0.30)	0.50 (0.33)	0.38 (0.24)
Unknown	41	22	19
Riboflavin (B2) Intake (mg/day)				1.21	0.44, 3.54	0.7
Mean (SD)	0.34 (0.33)	0.33 (0.29)	0.35 (0.37)
Unknown	41	22	19
Niacin (B3) Intake (mg/day)				0.86	0.74, 0.98	0.030
Mean (SD)	4.36 (2.80)	4.86 (3.10)	3.81 (2.32)
Unknown	41	22	19
Total Folate (B9) Intake (ug/day)				1.00	0.99, 1.00	0.4
Mean (SD)	80 (48)	83 (46)	77 (49)
Unknown	41	22	19
Vitamin C Intake (mg/day)				1.01	1.00, 1.02	0.2
Mean (SD)	27 (26)	25 (23)	30 (30)
Unknown	41	22	19
Vitamin A Intake (ug/day)				1.00	1.00, 1.01	0.039
Mean (SD)	72 (107)	54 (75)	93 (132)
Unknown	41	22	19
Vitamin B12 Intake (ug/day)				2.03	0.50, 40.8	0.4
Mean (SD)	0.033 (0.261)	0.014 (0.115)	0.054 (0.361)
Unknown	41	22	19
Birth Weight (grams)				1.00	1.00, 1.00	0.6
Mean (SD)	2,774 (454)	2,713 (412)	2,815 (494)
Unknown	165	90	75
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Except for lower levels of B1/B3 and higher levels of B2/B12, no other nutrient intake parameters were associated blood lead levels. Besides, nutrient intake values were not available for 40 participants.

G. CBC parameters

Characteristic	Overall N = 185	Control N = 98	Case N = 87	OR	95% CI	p-value
WBC Count				1.01	0.91, 1.11	0.9
Mean (SD)	9.79 (2.96)	9.76 (3.04)	9.82 (2.89)
Unknown	2	2	0
Lymphocytes (%)				1.02	1.00, 1.05	0.090
Mean (SD)	49 (12)	48 (12)	51 (11)
Unknown	2	2	0
Monocytes (%)				0.94	0.82, 1.03	0.2
Mean (SD)	6.77 (3.62)	7.10 (3.72)	6.41 (3.50)
Unknown	2	2	0
Granulocytes (%)				0.98	0.96, 1.01	0.2
Mean (SD)	44 (12)	45 (12)	43 (12)
Unknown	2	2	0
Lymphocytes (Absolute Count)				1.11	0.95, 1.32	0.2
Mean (SD)	4.76 (1.81)	4.59 (1.64)	4.94 (1.97)
Unknown	2	2	0
Monocytes (Absolute Count)				0.52	0.19, 1.07	0.14
Mean (SD)	0.63 (0.51)	0.69 (0.62)	0.57 (0.33)
Unknown	2	2	0
Granulocytes (Absolute Count)				0.93	0.81, 1.04	0.3
Mean (SD)	4.59 (2.94)	4.84 (3.64)	4.32 (1.88)
Unknown	2	2	0
Red Blood Cell Count				1.76	1.03, 3.08	0.042
Mean (SD)	4.98 (0.56)	4.90 (0.47)	5.07 (0.64)
Unknown	2	2	0
Hemoglobin				0.98	0.81, 1.19	0.9
Mean (SD)	11.11 (1.56)	11.13 (1.38)	11.09 (1.74)
Unknown	2	2	0
Hematocrit				1.02	0.95, 1.09	0.6
Mean (SD)	35.1 (4.4)	34.9 (3.8)	35.3 (5.1)
Unknown	2	2	0
Mean Corpuscular Volume				0.98	0.95, 1.01	0.2
Mean (SD)	71 (9)	72 (8)	70 (9)
Unknown	2	2	0
Red Cell Distribution Width (CV)				1.05	0.92, 1.19	0.5
Mean (SD)	16.04 (2.34)	15.92 (2.55)	16.16 (2.09)
Unknown	2	2	0
Platelet Count				1.00	1.00, 1.00	>0.9
Mean (SD)	376 (116)	376 (120)	375 (113)
Unknown	2	2	0
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Paradoxically, higher RBC count was associated with being a case. Lower monocyte were associated with higher blood lead levels.

Additional variables collected in the case-control study

H. Environmental factors in places other than current household

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Current outside place where child spends most time
Anganwadi	41 (29%)	23 (31%)	18 (28%)	—	—
School	99 (71%)	52 (69%)	47 (72%)	1.15	0.56, 2.42	0.7
Unknown	45	23	22
Years of construction of building
Less than 10 years	63 (57%)	49 (84%)	14 (26%)	—	—
More than 10 years	48 (43%)	9 (16%)	39 (74%)	15.2	6.19, 40.8	<0.001
Unknown	74	40	34
Visible Peeling paint at current outside place
No	46 (52%)	26 (58%)	20 (47%)	—	—
Yes	42 (48%)	19 (42%)	23 (53%)	1.57	0.68, 3.69	0.3
Unknown	97	53	44
Paint type at current outside place
Emulsion	14 (35%)	6 (35%)	8 (35%)	—	—
Chuna or similar	8 (20%)	3 (18%)	5 (22%)	1.25	0.21, 8.14	0.8
Distemper	18 (45%)	8 (47%)	10 (43%)	0.94	0.22, 3.86	>0.9
Unknown	145	81	64
Drinking water source at current outside place
Bottled water from home	54 (41%)	29 (41%)	25 (42%)	—	—
Piped water	33 (25%)	20 (28%)	13 (22%)	0.75	0.31, 1.81	0.5
Dugwell/ Tubewell	44 (34%)	22 (31%)	22 (37%)	1.16	0.52, 2.59	0.7
Unknown	54	27	27
Current outside place: rural/urban
Rural	98 (74%)	60 (83%)	38 (62%)	—	—
Urban	35 (26%)	12 (17%)	23 (38%)	3.03	1.37, 6.97	0.007
Unknown	52	26	26
Housing type at current outside place
Pucca	102 (82%)	54 (79%)	48 (84%)	—	—
Semi-pucca	17 (14%)	10 (15%)	7 (12%)	0.79	0.27, 2.21	0.7
Kutcha	6 (4.8%)	4 (5.9%)	2 (3.5%)	0.56	0.08, 3.01	0.5
Unknown	60	30	30
Flooring type at current outside place
Non-soil-contact	11 (48%)	5 (36%)	6 (67%)	—	—
Soil-contact	12 (52%)	9 (64%)	3 (33%)	0.28	0.04, 1.54	0.2
Unknown	162	84	78
Prsence of bare soil in current outside place
No	30 (25%)	15 (23%)	15 (27%)	—	—
Yes	91 (75%)	51 (77%)	40 (73%)	0.78	0.34, 1.80	0.6
Unknown	64	32	32
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

These are factors that are present at a place which is outside the current household. Dugwell/tubewell water, >10 yr building, visible paint peeling, chuna paint, and urban area were associated with higher blood lead levels.

I. Water practices (newly collected)

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Current HH drinking water: piped surface water
No	153 (83%)	82 (84%)	71 (83%)	—	—
Yes	31 (17%)	16 (16%)	15 (17%)	1.08	0.50, 2.35	0.8
Unknown	1	0	1
Current HH drinking water: piped groundwater
No	159 (86%)	91 (93%)	68 (79%)	—	—
Yes	25 (14%)	7 (7.1%)	18 (21%)	3.44	1.41, 9.28	0.009
Unknown	1	0	1
Current HH drinking water: tube well/hand pump
No	65 (35%)	29 (30%)	36 (42%)	—	—
Yes	119 (65%)	69 (70%)	50 (58%)	0.58	0.32, 1.07	0.084
Unknown	1	0	1
Current HH drinking water: dug well
No	171 (93%)	91 (93%)	80 (93%)	—	—
Yes	13 (7.1%)	7 (7.1%)	6 (7.0%)	0.98	0.30, 3.05	>0.9
Unknown	1	0	1
Current HH drinking water: other source
No	182 (99%)	97 (99%)	85 (99%)	—	—
Community RO/ Tanker	2 (1.1%)	1 (1.0%)	1 (1.2%)	1.14	0.04, 29.2	>0.9
Unknown	1	0	1
Presence of old metal pipes
No	159 (88%)	91 (95%)	68 (80%)	—	—
Yes	22 (12%)	5 (5.2%)	17 (20%)	4.55	1.70, 14.4	0.005
Unknown	4	2	2
Water storage container: stainless steel
No	84 (46%)	37 (39%)	47 (55%)	—	—
Yes	97 (54%)	59 (61%)	38 (45%)	0.51	0.28, 0.91	0.025
Unknown	4	2	2
Water storage container: aluminium
No	141 (78%)	89 (93%)	52 (61%)	—	—
Yes	40 (22%)	7 (7.3%)	33 (39%)	8.07	3.51, 21.1	<0.001
Unknown	4	2	2
Water storage container: brass/copper/other metal
No	169 (93%)	91 (95%)	78 (92%)	—	—
Yes	12 (6.6%)	5 (5.2%)	7 (8.2%)	1.63	0.50, 5.71	0.4
Unknown	4	2	2
Water storage container: plastic
No	119 (66%)	61 (64%)	58 (68%)	—	—
Yes	62 (34%)	35 (36%)	27 (32%)	0.81	0.44, 1.50	0.5
Unknown	4	2	2
Water storage container: non-glazed earthenware
No	151 (83%)	83 (86%)	68 (80%)	—	—
Yes	30 (17%)	13 (14%)	17 (20%)	1.60	0.73, 3.58	0.2
Unknown	4	2	2
Water storage container: concrete
No	179 (99%)	95 (99%)	84 (99%)	—	—
Yes	2 (1.1%)	1 (1.0%)	1 (1.2%)	1.13	0.04, 28.9	>0.9
Unknown	4	2	2
Water filtration used
No	98 (54%)	57 (59%)	41 (48%)	—	—
Yes	83 (46%)	39 (41%)	44 (52%)	1.57	0.87, 2.84	0.13
Unknown	4	2	2
Water filtration method
Boiling	15 (18%)	6 (15%)	9 (20%)	—	—
RO/ Candle Filter	7 (8.4%)	4 (10%)	3 (6.8%)	0.50	0.07, 3.07	0.5
Cloth/Sieve	61 (73%)	29 (74%)	32 (73%)	0.74	0.22, 2.29	0.6
Unknown	102	59	43
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Drinking water from piped ground water or community RO/tanker, presence of old metal pipes, and storing water in aluminium /brass/copper/other metal, non-glazed earthenware or concrete were associated with higher odds. But drinking water from piped surface water/ tube well/ hand pump, storing water in stainless steel / plastic containers, using some water filtration method (boiling water but not RO/candle/cloth sieve) were associated with lower odds.

J. Diet practices (newly collected)

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Child consumes rice (>5 meals/week)
No	19 (10%)	10 (10%)	9 (10%)	—	—
Yes	166 (90%)	88 (90%)	78 (90%)	0.98	0.38, 2.60	>0.9
Rice source: farm in same village
No	106 (65%)	56 (64%)	50 (66%)	—	—
Yes	58 (35%)	32 (36%)	26 (34%)	0.91	0.48, 1.73	0.8
Unknown	21	10	11
Rice farm irrigation source (same village)
Surface water	27 (53%)	15 (56%)	12 (50%)	—	—
Groundwater	24 (47%)	12 (44%)	12 (50%)	1.25	0.41, 3.81	0.7
Unknown	134	71	63
Rice source: farm in other place
No	148 (90%)	78 (89%)	70 (92%)	—	—
Yes	16 (9.8%)	10 (11%)	6 (7.9%)	0.67	0.22, 1.90	0.5
Unknown	21	10	11
Rice farm irrigation source (other place)
Surface water	1 (7.1%)	0 (0%)	1 (20%)	—	—
Groundwater	13 (93%)	9 (100%)	4 (80%)	0.00		>0.9
Unknown	171	89	82
Rice source: public distribution system
No	105 (64%)	49 (56%)	56 (74%)	—	—
Yes	59 (36%)	39 (44%)	20 (26%)	0.45	0.23, 0.86	0.018
Unknown	21	10	11
Rice source: market
No	85 (56%)	52 (66%)	33 (45%)	—	—
Yes	67 (44%)	27 (34%)	40 (55%)	2.33	1.22, 4.53	0.011
Unknown	33	19	14
Market rice: loose or packaged
Packaged	8 (12%)	5 (19%)	3 (7.5%)	—	—
Loose	59 (88%)	22 (81%)	37 (93%)	2.80	0.63, 14.8	0.2
Unknown	118	71	47
Child consumes wheat (>5 meals/week)
No	49 (26%)	25 (26%)	24 (28%)	—	—
Yes	136 (74%)	73 (74%)	63 (72%)	0.90	0.47, 1.73	0.7
Wheat source: farm in same village
No	86 (64%)	41 (57%)	45 (71%)	—	—
Yes	49 (36%)	31 (43%)	18 (29%)	0.53	0.25, 1.08	0.082
Unknown	50	26	24
Wheat farm irrigation source (same village)
Surface water	9 (21%)	6 (23%)	3 (19%)	—	—
Groundwater	33 (79%)	20 (77%)	13 (81%)	1.30	0.29, 7.02	0.7
Unknown	143	72	71
Wheat source: farm in other place
No	132 (98%)	70 (97%)	62 (98%)	—	—
Yes	3 (2.2%)	2 (2.8%)	1 (1.6%)	0.56	0.03, 6.03	0.6
Unknown	50	26	24
Wheat farm irrigation source (other place)
Ground water	1 (100%)	1 (100%)	0 (NA%)
Unknown	184	97	87
Wheat source: public distribution system
No	104 (77%)	55 (76%)	49 (78%)	—	—
Yes	31 (23%)	17 (24%)	14 (22%)	0.92	0.41, 2.07	0.8
Unknown	50	26	24
Wheat source: market
No	52 (38%)	30 (41%)	22 (35%)	—	—
Yes	84 (62%)	43 (59%)	41 (65%)	1.30	0.65, 2.63	0.5
Unknown	49	25	24
Market wheat: loose or packaged
Packaged	11 (14%)	8 (20%)	3 (7.7%)	—	—
Loose	68 (86%)	32 (80%)	36 (92%)	3.00	0.79, 14.6	0.13
Unknown	106	58	48
Turmeric consumed regularly
No	2 (1.1%)	1 (1.0%)	1 (1.1%)	—	—
Yes	183 (99%)	97 (99%)	86 (99%)	0.89	0.03, 22.6	>0.9
Major source of turmeric
Grind whole at home	60 (33%)	32 (33%)	28 (33%)	—	—
Grind whole at mill	19 (10%)	9 (9.3%)	10 (12%)	1.27	0.45, 3.63	0.7
Purchase Loose powder	12 (6.6%)	9 (9.3%)	3 (3.5%)	0.38	0.08, 1.42	0.2
Purchase Packaged powder	92 (50%)	47 (48%)	45 (52%)	1.09	0.57, 2.11	0.8
Unknown	2	1	1
Chilli powder consumed regularly
No	16 (8.6%)	5 (5.1%)	11 (13%)	—	—
Yes	169 (91%)	93 (95%)	76 (87%)	0.37	0.11, 1.07	0.078
Major source of chilli powder
Grind whole at home	53 (30%)	28 (30%)	25 (30%)	—	—
Grind whole at mill	13 (7.3%)	9 (9.7%)	4 (4.8%)	0.50	0.12, 1.73	0.3
Purchase Loose powder	8 (4.5%)	5 (5.4%)	3 (3.6%)	0.67	0.13, 3.02	0.6
Purchase Packaged powder	103 (58%)	51 (55%)	52 (62%)	1.14	0.59, 2.23	0.7
Unknown	8	5	3
Coriander powder consumed regularly
No	41 (22%)	16 (16%)	25 (29%)	—	—
Yes	144 (78%)	82 (84%)	62 (71%)	0.48	0.23, 0.98	0.045
Major source of coriander powder
Grind whole at home	33 (21%)	18 (21%)	15 (20%)	—	—
Grind whole at mill	9 (5.7%)	6 (7.1%)	3 (4.1%)	0.60	0.11, 2.69	0.5
Purchase Loose powder	9 (5.7%)	6 (7.1%)	3 (4.1%)	0.60	0.11, 2.69	0.5
Purchase Packaged powder	108 (68%)	55 (65%)	53 (72%)	1.16	0.53, 2.55	0.7
Unknown	26	13	13
Non-vegetarian food consumption
No	97 (53%)	46 (47%)	51 (59%)	—	—
Yes	87 (47%)	51 (53%)	36 (41%)	0.64	0.35, 1.14	0.13
Unknown	1	1	0
Packaged salted snacks consumption
No	80 (43%)	50 (52%)	30 (34%)	—	—
Yes	104 (57%)	47 (48%)	57 (66%)	2.02	1.12, 3.69	0.020
Unknown	1	1	0
Biscuits/cookies consumption
No	52 (28%)	32 (33%)	20 (23%)	—	—
Yes	132 (72%)	65 (67%)	67 (77%)	1.65	0.86, 3.21	0.13
Unknown	1	1	0
Noodles/instant mixes consumption
No	118 (64%)	68 (70%)	50 (57%)	—	—
Yes	66 (36%)	29 (30%)	37 (43%)	1.74	0.95, 3.21	0.076
Unknown	1	1	0
Colored candies consumption
No	79 (43%)	50 (52%)	29 (33%)	—	—
Yes	105 (57%)	47 (48%)	58 (67%)	2.13	1.18, 3.90	0.013
Unknown	1	1	0
Chocolate/cocoa products consumption
No	138 (75%)	75 (77%)	63 (72%)	—	—
Yes	46 (25%)	22 (23%)	24 (28%)	1.30	0.67, 2.55	0.4
Unknown	1	1	0
Ice cream/frozen colored desserts consumption
No	48 (26%)	30 (31%)	18 (21%)	—	—
Yes	136 (74%)	67 (69%)	69 (79%)	1.72	0.88, 3.42	0.12
Unknown	1	1	0
Canned/tinned foods or pickles consumption
No	106 (58%)	70 (72%)	36 (41%)	—	—
Yes	78 (42%)	27 (28%)	51 (59%)	3.67	2.00, 6.88	<0.001
Unknown	1	1	0
Meals from Anganwadi/mid-day meal/community kitchen (>5/week)
No	146 (81%)	80 (82%)	66 (79%)	—	—
Yes	35 (19%)	17 (18%)	18 (21%)	1.28	0.61, 2.70	0.5
Unknown	4	1	3
Formula milk consumption (infancy)
No	171 (93%)	97 (100%)	74 (85%)	—	—
Yes	13 (7.1%)	0 (0%)	13 (15%)	55,768,200	0.00,	>0.9
Unknown	1	1	0
Fresh animal milk consumption
No	118 (64%)	69 (71%)	49 (56%)	—	—
Yes	66 (36%)	28 (29%)	38 (44%)	1.91	1.04, 3.54	0.038
Unknown	1	1	0
Packaged animal milk consumption
No	174 (95%)	95 (98%)	79 (91%)	—	—
Yes	10 (5.4%)	2 (2.1%)	8 (9.2%)	4.81	1.16, 32.5	0.051
Unknown	1	1	0
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Consumed rice irrigated using ground water, consumed rice from market/loose or packed, consumed wheat grown in other place/ from market/loose/packaged, consuming turmeric ground in mill, consuming packed salted snacks, consuming biscuits/cookies, consuming noodles/instant mixes, consuming candies/colored sweets, consuming chocolates/cocoa products, consuming ice cream/frozen colored sweets, consuming canned/tinned/pickled food, consuming anganwadi/mid-day meal/communal kitchen meal, fed formula milk in infancy, fresh/packaged milk consumption were associated with higher odds of blood lead levels.

But consuming rice grown other farm, consuming rice from PDS, consuming >5 servings of wheat per week (but not rice), consuming wheat from same village farm, consuming turmeric/chilli/coriander regularly, chilli purchased as packaged, consuming coriander ground at mill or loose powder, consuming non-veg food were associated with lower odds.

K. Utensils

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Cooking utensil: non-stick
No	176 (96%)	95 (97%)	81 (94%)	—	—
Yes	8 (4.3%)	3 (3.1%)	5 (5.8%)	1.95	0.47, 9.76	0.4
Unknown	1	0	1
Cooking utensil: stainless steel
No	66 (36%)	38 (39%)	28 (33%)	—	—
Yes	118 (64%)	60 (61%)	58 (67%)	1.31	0.72, 2.42	0.4
Unknown	1	0	1
Cooking utensil: iron
No	165 (90%)	90 (92%)	75 (87%)	—	—
Yes	19 (10%)	8 (8.2%)	11 (13%)	1.65	0.64, 4.46	0.3
Unknown	1	0	1
Cooking utensil: copper/brass
No	180 (98%)	96 (98%)	84 (98%)	—	—
Yes	4 (2.2%)	2 (2.0%)	2 (2.3%)	1.14	0.13, 9.69	0.9
Unknown	1	0	1
Cooking utensil: plastic/microwavable
No	184 (100%)	98 (100%)	86 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	1	0	1
Cooking utensil: aluminium
No	34 (18%)	13 (13%)	21 (24%)	—	—
Yes	150 (82%)	85 (87%)	65 (76%)	0.47	0.22, 1.00	0.055
Unknown	1	0	1
Cooking utensil: glazed earthenware/ceramic
No	184 (100%)	98 (100%)	86 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	1	0	1
Cooking utensil: non-glazed earthenware
No	180 (98%)	95 (97%)	85 (99%)	—	—
Yes	4 (2.2%)	3 (3.1%)	1 (1.2%)	0.37	0.02, 2.97	0.4
Unknown	1	0	1
Water storage container: glazed earthenware/ceramic
No	181 (100%)	96 (100%)	85 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	4	2	2
Storage/eating cooked food: non-stick utensil
No	181 (100%)	96 (100%)	85 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	4	2	2
Storage/eating cooked food: stainless steel utensil
No	31 (17%)	18 (19%)	13 (15%)	—	—
Yes	150 (83%)	78 (81%)	72 (85%)	1.28	0.59, 2.84	0.5
Unknown	4	2	2
Storage/eating cooked food: aluminium utensil
No	95 (52%)	47 (49%)	48 (56%)	—	—
Yes	86 (48%)	49 (51%)	37 (44%)	0.74	0.41, 1.33	0.3
Unknown	4	2	2
Storage/eating cooked food: iron utensil
No	178 (98%)	94 (98%)	84 (99%)	—	—
Yes	3 (1.7%)	2 (2.1%)	1 (1.2%)	0.56	0.03, 5.94	0.6
Unknown	4	2	2
Storage/eating cooked food: copper/brass utensil
No	177 (98%)	93 (97%)	84 (99%)	—	—
Yes	4 (2.2%)	3 (3.1%)	1 (1.2%)	0.37	0.02, 2.94	0.4
Unknown	4	2	2
Storage/eating cooked food: plastic utensil
No	174 (96%)	96 (100%)	78 (92%)	—	—
Yes	7 (3.9%)	0 (0%)	7 (8.2%)	19,263,213	0.00,	>0.9
Unknown	4	2	2
Storage/eating cooked food: glazed earthenware
No	168 (93%)	90 (94%)	78 (92%)	—	—
Yes	13 (7.2%)	6 (6.3%)	7 (8.2%)	1.35	0.43, 4.34	0.6
Unknown	4	2	2
Storage/eating cooked food: non-glazed earthenware
No	155 (86%)	84 (88%)	71 (84%)	—	—
Yes	26 (14%)	12 (13%)	14 (16%)	1.38	0.60, 3.22	0.4
Unknown	4	2	2
Storage uncooked food: non-stick utensil
No	129 (100%)	77 (100%)	52 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	56	21	35
Storage uncooked food: stainless steel utensil
No	118 (91%)	72 (94%)	46 (88%)	—	—
Yes	11 (8.5%)	5 (6.5%)	6 (12%)	1.88	0.54, 6.86	0.3
Unknown	56	21	35
Storage uncooked food: aluminium utensil
No	105 (81%)	67 (87%)	38 (73%)	—	—
Yes	24 (19%)	10 (13%)	14 (27%)	2.47	1.01, 6.25	0.050
Unknown	56	21	35
Storage uncooked food: iron utensil
No	126 (98%)	76 (99%)	50 (96%)	—	—
Yes	3 (2.3%)	1 (1.3%)	2 (3.8%)	3.04	0.28, 66.4	0.4
Unknown	56	21	35
Storage uncooked food: copper/brass utensil
No	128 (99%)	76 (99%)	52 (100%)	—	—
Yes	1 (0.8%)	1 (1.3%)	0 (0%)	0.00		>0.9
Unknown	56	21	35
Storage uncooked food: plastic utensil
No	15 (12%)	4 (5.2%)	11 (21%)	—	—
Yes	114 (88%)	73 (95%)	41 (79%)	0.20	0.05, 0.64	0.010
Unknown	56	21	35
Storage uncooked food: glazed earthenware
No	124 (96%)	73 (95%)	51 (98%)	—	—
Yes	5 (3.9%)	4 (5.2%)	1 (1.9%)	0.36	0.02, 2.51	0.4
Unknown	56	21	35
Storage uncooked food: non-glazed earthenware
No	129 (100%)	77 (100%)	52 (100%)
Yes	0 (0%)	0 (0%)	0 (0%)
Unknown	56	21	35
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

K1. Utensils recoded

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
utensil_nonstick
No	177 (96%)	95 (97%)	82 (94%)	—	—
Yes	8 (4.3%)	3 (3.1%)	5 (5.7%)	1.93	0.46, 9.64	0.4
utensil_ss
No	25 (14%)	14 (14%)	11 (13%)	—	—
Yes	160 (86%)	84 (86%)	76 (87%)	1.15	0.49, 2.74	0.7
utensil_aluminium
No	22 (12%)	8 (8.2%)	14 (16%)	—	—
Yes	163 (88%)	90 (92%)	73 (84%)	0.46	0.18, 1.14	0.10
utensil_iron
No	161 (87%)	88 (90%)	73 (84%)	—	—
Yes	24 (13%)	10 (10%)	14 (16%)	1.69	0.71, 4.13	0.2
utensil_copper_brass
No	178 (96%)	93 (95%)	85 (98%)	—	—
Yes	7 (3.8%)	5 (5.1%)	2 (2.3%)	0.44	0.06, 2.09	0.3
utensil_plastic
No	67 (36%)	25 (26%)	42 (48%)	—	—
Yes	118 (64%)	73 (74%)	45 (52%)	0.37	0.20, 0.68	0.001
utensil_glazed_earthenware
No	169 (91%)	90 (92%)	79 (91%)	—	—
Yes	16 (8.6%)	8 (8.2%)	8 (9.2%)	1.14	0.40, 3.23	0.8
utensil_non_glazed_earthenware
No	157 (85%)	85 (87%)	72 (83%)	—	—
Yes	28 (15%)	13 (13%)	15 (17%)	1.36	0.61, 3.09	0.5
utensil_earthenware_combined
No	149 (81%)	82 (84%)	67 (77%)	—	—
Yes	36 (19%)	16 (16%)	20 (23%)	1.53	0.74, 3.22	0.3
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Using cooking utensils made from non-stick ware, SS, iron, copper/brass, storing cooked food in SS/plastic ware/glazed/non-glazed earthernware, storing uncooked food in SS/aluminium/iron ware were associated with higher odds of blood lead levels.

But using cooking utensils made from aluminium/non-glazed earthernware, storing cooked food in aluminium/iron/copper/brass ware, storing uncooked food in plastic/glazed earthenware were associated with lower odds of blood lead levels. After recoding, except for plastic, aluminium, and copper/brass utensils all other types of cookwares were associated with higher odds.

K2. Utensils interaction effects for the most common types

term	estimate	std.error	statistic	p.value	conf.low	conf.high
(Intercept)	6668957.2238189401105	882.744860	0.01780013	0.98579830	0.000000000000000000000000000000000000000000000000000000000000000000000023459814	NA
utensil_aluminiumYes	0.0000010496394	882.744212	-0.01559576	0.98755689	NA	500789956477122523546280842888680804020026208244280448808842884264028224.0000000
utensil_ssYes	0.0000001124614	882.744529	-0.01812603	0.98553831	NA	49342294176342810800208064260480864246884464008240486264206806228806422.0000000
utensil_plasticYes	0.3176178660050	1.617965	-0.70885711	0.47841315	0.008597554594589253140757278970340848900377750396728515625000000000000000000000	6.5702318
utensil_aluminiumYes:utensil_ssYes	2032444.1063069012016	882.743836	0.01645409	0.98687213	0.000000000000000000000000000000000000000000000000000000000000000000000002590647	NA
utensil_aluminiumYes:utensil_plasticYes	0.1037946428571	1.031842	-2.19543327	0.02813253	0.012426738252763538938872045491734752431511878967285156250000000000000000000000	0.7639896
utensil_ssYes:utensil_plasticYes	10.4947916666663	1.297875	1.81132977	0.07008982	1.101694847107905550487316759245004504919052124023437500000000000000000000000000	257.1083952

Variable	Odds Ratio	Std. Error	z-statistic	p-value	2.5%	97.5%
Logistic Regression Results
Odds Ratios and Interaction Effects
(Intercept)	6,668,957.224	882.745	0.018	0.98579830	0.000	—
aluminium	0.000	882.744	−0.016	0.98755689	—	500,789,956,477,122,523,546,280,842,888,680,804,020,026,208,244,280,448,808,842,884,264,028,224.000
ss	0.000	882.745	−0.018	0.98553831	—	49,342,294,176,342,810,800,208,064,260,480,864,246,884,464,008,240,486,264,206,806,228,806,422.000
plastic	0.318	1.618	−0.709	0.47841315	0.009	6.570
aluminium:ss	2,032,444.106	882.744	0.016	0.98687213	0.000	—
aluminium:plastic	0.104	1.032	−2.195	0.02813253	0.012	0.764
ss:plastic	10.495	1.298	1.811	0.07008982	1.102	257.108
Note: Extremely large ORs/CIs indicate perfect prediction (separation) in the data.

K3. Utensils detailed exploration

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
utensil_type_detailed
aluminium	8 (4.3%)	1 (1.0%)	7 (8.0%)	—	—
aluminium + copper_brass + glazed_earthenware + non_glazed_earthenware + plastic + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
aluminium + copper_brass + plastic + ss	3 (1.6%)	3 (3.1%)	0 (0%)	0.00		>0.9
aluminium + copper_brass + ss	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
aluminium + glazed_earthenware + iron + non_glazed_earthenware + plastic + ss	2 (1.1%)	1 (1.0%)	1 (1.1%)	0.14	0.00, 5.53	0.3
aluminium + glazed_earthenware + iron + plastic + ss	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
aluminium + glazed_earthenware + non_glazed_earthenware + plastic	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
aluminium + glazed_earthenware + non_glazed_earthenware + plastic + ss	2 (1.1%)	2 (2.0%)	0 (0%)	0.00		>0.9
aluminium + glazed_earthenware + non_glazed_earthenware + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
aluminium + glazed_earthenware + plastic + ss	3 (1.6%)	1 (1.0%)	2 (2.3%)	0.29	0.01, 9.45	0.4
aluminium + glazed_earthenware + ss	4 (2.2%)	1 (1.0%)	3 (3.4%)	0.43	0.01, 13.3	0.6
aluminium + iron + non_glazed_earthenware + plastic + ss	2 (1.1%)	0 (0%)	2 (2.3%)	16,521,256	0.00, Inf	>0.9
aluminium + iron + non_glazed_earthenware + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
aluminium + iron + plastic + ss	12 (6.5%)	7 (7.1%)	5 (5.7%)	0.10	0.00, 0.84	0.061
aluminium + iron + ss	3 (1.6%)	1 (1.0%)	2 (2.3%)	0.29	0.01, 9.45	0.4
aluminium + non_glazed_earthenware + plastic + ss	7 (3.8%)	5 (5.1%)	2 (2.3%)	0.06	0.00, 0.61	0.035
aluminium + non_glazed_earthenware + ss	4 (2.2%)	2 (2.0%)	2 (2.3%)	0.14	0.00, 2.24	0.2
aluminium + nonstick + plastic + ss	3 (1.6%)	0 (0%)	3 (3.4%)	16,521,256	0.00, Inf	>0.9
aluminium + plastic	15 (8.1%)	12 (12%)	3 (3.4%)	0.04	0.00, 0.30	0.008
aluminium + plastic + ss	51 (28%)	36 (37%)	15 (17%)	0.06	0.00, 0.37	0.011
aluminium + ss	38 (21%)	15 (15%)	23 (26%)	0.22	0.01, 1.41	0.2
copper_brass + nonstick + plastic + ss	2 (1.1%)	1 (1.0%)	1 (1.1%)	0.14	0.00, 5.53	0.3
glazed_earthenware + non_glazed_earthenware + plastic + ss	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
iron + non_glazed_earthenware + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
iron + nonstick + plastic + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
iron + ss	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
non_glazed_earthenware + nonstick + plastic + ss	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
non_glazed_earthenware + plastic + ss	4 (2.2%)	0 (0%)	4 (4.6%)	16,521,256	0.00, Inf	>0.9
nonstick + ss	1 (0.5%)	1 (1.0%)	0 (0%)	0.00		>0.9
plastic	1 (0.5%)	0 (0%)	1 (1.1%)	16,521,256	0.00,	>0.9
plastic + ss	5 (2.7%)	1 (1.0%)	4 (4.6%)	0.57	0.02, 17.2	0.7
ss	4 (2.2%)	3 (3.1%)	1 (1.1%)	0.05	0.00, 0.75	0.053
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

L. Behavioral factors

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Pica behavious in last 6 months
No	121 (65%)	89 (91%)	32 (37%)	—	—
Yes	64 (35%)	9 (9.2%)	55 (63%)	17.0	7.87, 40.5	<0.001
Past history of pica behaviour
No	93 (50%)	81 (83%)	12 (14%)	—	—
Yes	92 (50%)	17 (17%)	75 (86%)	29.8	13.8, 69.3	<0.001
Child uses kajal/kohl/surma
No	93 (50%)	52 (53%)	41 (47%)	—	—
Yes	92 (50%)	46 (47%)	46 (53%)	1.27	0.71, 2.27	0.4
Kajal use: current or infancy
Current	61 (66%)	31 (67%)	30 (65%)	—	—
Infancy	31 (34%)	15 (33%)	16 (35%)	1.10	0.46, 2.63	0.8
Unknown	93	52	41
Child uses skin-care products
No	73 (40%)	37 (39%)	36 (41%)	—	—
Yes	110 (60%)	59 (61%)	51 (59%)	0.89	0.49, 1.61	0.7
Unknown	2	2	0
Use of lipstick/sindoor/red-orange paint
No	170 (93%)	89 (93%)	81 (94%)	—	—
Yes	12 (6.6%)	7 (7.3%)	5 (5.8%)	0.78	0.22, 2.55	0.7
Unknown	3	2	1
Consumption of silver foil
No	97 (73%)	66 (86%)	31 (56%)	—	—
Yes	35 (27%)	11 (14%)	24 (44%)	4.65	2.07, 11.0	<0.001
Unknown	53	21	32
Ayurvedic/herbal supplement use
No	165 (90%)	90 (93%)	75 (86%)	—	—
Yes	19 (10%)	7 (7.2%)	12 (14%)	2.06	0.79, 5.77	0.15
Unknown	1	1	0
Calcium/Iron/Vitamin supplement use
No	175 (95%)	96 (99%)	79 (91%)	—	—
Yes	9 (4.9%)	1 (1.0%)	8 (9.2%)	9.72	1.73, 182	0.034
Unknown	1	1	0
Consumption of food colours
No	95 (72%)	66 (86%)	29 (53%)	—	—
Yes	37 (28%)	11 (14%)	26 (47%)	5.38	2.40, 12.7	<0.001
Unknown	53	21	32
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Pica behavior, child using kajal, consuming silver foil, ayurvedic/herbal supplement use, iron/calcium/vitamin supplement use and food colors were associated with very high odds of blood lead levels.

Using skin care or lipstick/sindoor/ red-orange paint use were associated with lower odds of blood lead levels.

M. Lead in environmental sample

Characteristic	Overall N = 185¹	Control N = 98¹	Case N = 87¹	OR	95% CI	p-value
Water lead concentration (ppm)
Mean (SD)	0.0021 (0.0050)	0.0021 (0.0051)	0.0021 (0.0050)
Water lead concentration (mg/L)				1.00	0.94, 1.07	>0.9
Mean (SD)	2.09 (5.05)	2.05 (5.14)	2.13 (4.97)
Water lead level
BLD/ Normal	181 (98%)	97 (99%)	84 (97%)	—	—
High	4 (2.2%)	1 (1.0%)	3 (3.4%)	3.46	0.43, 70.8	0.3
Rice lead concentration (mg/kg)				0.79	0.54, 1.07	0.2
Mean (SD)	0.53 (1.12)	0.65 (1.35)	0.40 (0.78)
Unknown	24	13	11
Rice lead category
BLD/ Normal	94 (58%)	51 (60%)	43 (57%)	—	—
High	67 (42%)	34 (40%)	33 (43%)	1.15	0.61, 2.16	0.7
Unknown	24	13	11
Wheat lead concentration (mg/kg)				0.93	0.68, 1.27	0.7
Mean (SD)	0.59 (1.12)	0.63 (1.18)	0.54 (1.05)
Unknown	49	25	24
Wheat lead category
BLD/ Normal	89 (65%)	46 (63%)	43 (68%)	—	—
High	47 (35%)	27 (37%)	20 (32%)	0.79	0.39, 1.61	0.5
Unknown	49	25	24
Turmeric lead level (µg/kg)				1.00	1.00, 1.01	0.2
Mean (SD)	19 (84)	11 (59)	27 (105)
Unknown	3	2	1
Turmeric lead category
BLD/ Normal	168 (92%)	91 (95%)	77 (90%)	—	—
High	14 (7.7%)	5 (5.2%)	9 (10%)	2.13	0.70, 7.17	0.2
Unknown	3	2	1
Chilli lead level (µg/kg)				1.07	0.94, 1.38	0.4
Mean (SD)	0.63 (2.70)	0.46 (0.88)	0.82 (3.80)
Unknown	13	8	5
Chilli lead category
BLD/ Normal	171 (99%)	90 (100%)	81 (99%)
High	1 (0.6%)	0 (0%)	1 (1.2%)
Unknown	13	8	5
Coriander lead level (µg/kg)				1.05	0.92, 1.26	0.5
Mean (SD)	0.86 (2.57)	0.71 (1.67)	1.01 (3.23)
Unknown	42	27	15
Coriander lead category
BLD/ Normal	141 (99%)	70 (99%)	71 (99%)	—	—
High	2 (1.4%)	1 (1.4%)	1 (1.4%)	0.99	0.04, 25.3	>0.9
Unknown	42	27	15
Kajal lead level (mg/kg)				1.00	0.97, 1.04	0.9
Mean (SD)	8 (15)	8 (15)	8 (14)
Unknown	126	68	58
Kajal lead category
BLD/ Normal	46 (78%)	25 (83%)	21 (72%)	—	—
High	13 (22%)	5 (17%)	8 (28%)	1.90	0.55, 7.14	0.3
Unknown	126	68	58
Soil/dust lead concentration (µg/kg)				1.00	0.99, 1.01	0.8
Mean (SD)	21 (33)	20 (37)	22 (25)
Unknown	36	13	23
Soil/dust lead category
BLD/ Normal	149 (100%)	85 (100%)	64 (100%)
High	0 (0%)	0 (0%)	0 (0%)
Unknown	36	13	23
Wall paint lead level (mg/kg)				1.01	0.99, 1.05	0.4
Mean (SD)	9 (15)	8 (15)	11 (16)
Unknown	74	43	31
Wall paint lead category
BLD/ Normal	109 (98%)	54 (98%)	55 (98%)	—	—
High	2 (1.8%)	1 (1.8%)	1 (1.8%)	0.98	0.04, 25.3	>0.9
Unknown	74	43	31
Toy lead level (mg/kg)				1.00	1.00, 1.00	0.9
Mean (SD)	173 (609)	156 (551)	184 (654)
Unknown	120	71	49
Toy lead category
BLD/ Normal	51 (78%)	21 (78%)	30 (79%)	—	—
High	14 (22%)	6 (22%)	8 (21%)	0.93	0.28, 3.21	>0.9
Unknown	120	71	49
Number of samples exceeding lead cutoff
0 sources	69 (37%)	39 (40%)	30 (34%)	—	—
1 source	79 (43%)	41 (42%)	38 (44%)	1.20	0.63, 2.31	0.6
2 sources	28 (15%)	15 (15%)	13 (15%)	1.13	0.46, 2.73	0.8
3/4 sources	9 (4.9%)	3 (3.1%)	6 (6.9%)	2.60	0.63, 13.1	0.2
¹ n (%)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Lead levels above the cutoff in water, rice, turmeric and kajal were associated with higher odds of blood lead levels. But lead levels above the cutoff in wheat and toy, which are also common sources of lead exposure, were not associated with higher odds. Neither were lead levels above the cutoff in chilli, coriander, soil/dust and wall paint.

Higher number of sources with lead levels above the cutoff was associated with higher odds of blood lead levels in a dose-response manner.

N.Brands of diet and cosmetics

Characteristic	Control N = 98¹	Case N = 87¹
rice_market_brand
ABIS GOLD	1 (50%)	0 (0%)
Dawat	1 (50%)	1 (33%)
Indiagate	0 (0%)	1 (33%)
Lakhdatar Sona Masuri	0 (0%)	1 (33%)
Unknown	96	84
wheat_market_brand
Amol atta	0 (0%)	1 (33%)
Ashriwad	1 (20%)	0 (0%)
Fortune Multigrain Atta	0 (0%)	1 (33%)
kalash atta	1 (20%)	0 (0%)
Kesar gold atta	1 (20%)	0 (0%)
Lalgulab Atta	1 (20%)	0 (0%)
NATWAL GOLD ATTA	1 (20%)	0 (0%)
Tulsi Atta	0 (0%)	1 (33%)
Unknown	93	84
turmeric_brand
basant	1 (3.2%)	0 (0%)
Dhamya	0 (0%)	2 (7.4%)
Everest	1 (3.2%)	0 (0%)
GOLDIE	0 (0%)	1 (3.7%)
Haldiram	1 (3.2%)	0 (0%)
JMD	4 (13%)	0 (0%)
Khatri	8 (26%)	14 (52%)
MDH	1 (3.2%)	0 (0%)
Neelam	0 (0%)	2 (7.4%)
NR Brand	3 (9.7%)	0 (0%)
Om masala	1 (3.2%)	0 (0%)
PUSH	0 (0%)	1 (3.7%)
Rakshadeep	1 (3.2%)	0 (0%)
Ramdev	1 (3.2%)	0 (0%)
Ramnagar	0 (0%)	1 (3.7%)
Rawal Das	0 (0%)	1 (3.7%)
Sarda	1 (3.2%)	0 (0%)
Sardar	2 (6.5%)	0 (0%)
Sourabh	1 (3.2%)	0 (0%)
Sundar	0 (0%)	3 (11%)
Suresh masala	1 (3.2%)	0 (0%)
Suruchi	3 (9.7%)	0 (0%)
TEJA	1 (3.2%)	1 (3.7%)
Zoff	0 (0%)	1 (3.7%)
Unknown	67	60
chilli_brand
Dhamya	0 (0%)	2 (6.7%)
Everest	1 (3.2%)	1 (3.3%)
GOLDIE	0 (0%)	1 (3.3%)
JMD	4 (13%)	0 (0%)
Khatri	11 (35%)	14 (47%)
Maharaja	1 (3.2%)	0 (0%)
MDH	1 (3.2%)	0 (0%)
Neelam	2 (6.5%)	2 (6.7%)
NR Brand	3 (9.7%)	2 (6.7%)
Ramnagar	0 (0%)	1 (3.3%)
Rawal Das	0 (0%)	1 (3.3%)
Sardar	1 (3.2%)	0 (0%)
Sourabh	2 (6.5%)	0 (0%)
Sundar	0 (0%)	3 (10%)
Suresh masala	1 (3.2%)	0 (0%)
Suruchi	3 (9.7%)	0 (0%)
TEJA	1 (3.2%)	2 (6.7%)
Zoff	0 (0%)	1 (3.3%)
Unknown	67	57
coriander_brand
basant	1 (3.3%)	0 (0%)
Dhamya	0 (0%)	2 (8.3%)
Everest	1 (3.3%)	1 (4.2%)
GOLDIE	0 (0%)	1 (4.2%)
JMD	4 (13%)	0 (0%)
Khatri	9 (30%)	10 (42%)
MDH	1 (3.3%)	0 (0%)
Neelam	2 (6.7%)	1 (4.2%)
NR Brand	3 (10%)	2 (8.3%)
Om masala	1 (3.3%)	0 (0%)
Ramnagar	0 (0%)	1 (4.2%)
Rawal Das	0 (0%)	1 (4.2%)
Sardar	1 (3.3%)	0 (0%)
Sourabh	2 (6.7%)	0 (0%)
Sundar	0 (0%)	3 (13%)
Suresh masala	1 (3.3%)	0 (0%)
Suruchi	3 (10%)	0 (0%)
TEJA	1 (3.3%)	1 (4.2%)
Zoff	0 (0%)	1 (4.2%)
Unknown	68	63
kajal_brand
Homemde	4 (11%)	17 (40%)
Jyoh	0 (0%)	1 (2.4%)
Jyoti	1 (2.8%)	0 (0%)
Local	30 (83%)	23 (55%)
pantanjali	0 (0%)	1 (2.4%)
SURMA Local	1 (2.8%)	0 (0%)
Unknown	62	45
cosmetics_brand
Baby lips lipstick	1 (2.2%)	0 (0%)
Boroline, Ponds	0 (0%)	1 (2.3%)
Denim, Ponds	0 (0%)	1 (2.3%)
Dermicool	2 (4.3%)	1 (2.3%)
Domi	0 (0%)	1 (2.3%)
Dove	0 (0%)	2 (4.5%)
Himalaya	4 (8.7%)	1 (2.3%)
Himalaya Body Cream	0 (0%)	1 (2.3%)
Johnson	0 (0%)	1 (2.3%)
Johnson baby	1 (2.2%)	0 (0%)
Johnson powder	0 (0%)	3 (6.8%)
Local brands & ponds	1 (2.2%)	1 (2.3%)
Lotus Jet powder	1 (2.2%)	0 (0%)
Nycil	2 (4.3%)	1 (2.3%)
Ponds	25 (54%)	25 (57%)
Ponds Cold cream	1 (2.2%)	0 (0%)
Ponds dermicool	1 (2.2%)	0 (0%)
Ponds powder	1 (2.2%)	0 (0%)
Ponds powder, Himalaya Lip balm	1 (2.2%)	1 (2.3%)
Ponds Powder,Local brand lipstick	1 (2.2%)	0 (0%)
Ponds, baby lip balm	0 (0%)	2 (4.5%)
Ponds, fair lovely	1 (2.2%)	0 (0%)
Ponds, Johnson	0 (0%)	1 (2.3%)
Ponds, lipbalm	1 (2.2%)	0 (0%)
Powder	1 (2.2%)	0 (0%)
Spinz	1 (2.2%)	1 (2.3%)
Unknown	52	43
¹ n (%)

It seems that some brands of turmeric such as Khatri, Neelam and Sundar, some brands of chilli such as Khatri, Sundar and Teja, some brands of coriander such as Khatri, Sundar and Teja, some brands of kajal such as Homemade, Local brand and cosmetics such baby lip balms were more common among cases. Though these numbers are very small to make concrete statements, they warrant further testing.

Part 3. Multivariable analysis for adjusted associations with risk factors

The causal graph of risk factors for high blood lead levels is complex with multiple interrelated factors (shown below). We will build a multivariable model to identify the risk factors for blood lead levels, while adjusting for potential confounders.

Causal graph for lead exposure and blood lead levels

A. Household construction characteristics

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Years of construction of current house	180
Less than 10 years		—	—
More than 10 years		1.39	0.75, 2.60	0.3	56.3	15.9
PSU Rural/Urban	180
Rural		—	—
Urban		4.30	1.95, 10.1	<0.001
Wealth Index	180
Highest		—	—
Higher		0.71	0.20, 2.48	0.6
Middle		0.57	0.17, 1.89	0.4
Lower		0.97	0.31, 2.99	0.9
Lowest		1.13	0.40, 3.21	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Visible peeling paint in current house	179
No		—	—
Yes		0.98	0.49, 1.94	0.9	41.4	-0.9
PSU Rural/Urban	179
Rural		—	—
Urban		4.67	2.06, 11.3	<0.001
Wealth Index	179
Highest		—	—
Higher		0.56	0.15, 1.94	0.4
Middle		0.55	0.16, 1.84	0.3
Lower		1.03	0.33, 3.22	0.9
Lowest		1.13	0.40, 3.26	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
paint_type_current_hh	181
No paint/Cement paint		—	—
Distemper		1.33	0.49, 3.68	0.6	31.0	7.6
Chuna or similar		1.56	0.63, 4.04	0.3	39.1	14.1
Emulsion		4.18	1.05, 18.4	0.048	16.1	12.2
PSU Rural/Urban	181
Rural		—	—
Urban		4.22	1.83, 10.4	0.001
Wealth Index	181
Highest		—	—
Higher		0.71	0.19, 2.58	0.6
Middle		0.66	0.18, 2.38	0.5
Lower		1.32	0.41, 4.35	0.6
Lowest		1.55	0.51, 4.82	0.4
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Primary flooring type in household	96
Non-soil-contact		—	—
Soil-contact		3.94	1.63, 10.1	0.003	36.8	27.4
PSU Rural/Urban	96
Rural		—	—
Urban		3.20	0.87, 13.5	0.091
Wealth Index	96
Highest		—	—
Higher		0.91	0.05, 15.2	0.9
Middle		0.93	0.11, 9.27	0.9
Lower		1.57	0.18, 16.2	0.7
Lowest		1.10	0.14, 10.3	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Smoking inside household	182
No		—	—
Yes		1.88	1.00, 3.58	0.053	56.3	26.3
PSU Rural/Urban	182
Rural		—	—
Urban		4.55	2.06, 10.7	<0.001
Wealth Index	182
Highest		—	—
Higher		0.62	0.18, 2.13	0.5
Middle		0.48	0.13, 1.62	0.2
Lower		0.94	0.30, 2.94	0.9
Lowest		0.97	0.34, 2.79	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Car/machine repair activity near household	179
No		—	—
Yes		1.69	0.38, 7.88	0.5	5.7	2.3
PSU Rural/Urban	179
Rural		—	—
Urban		4.88	2.18, 11.8	<0.001
Wealth Index	179
Highest		—	—
Higher		0.54	0.15, 1.90	0.3
Middle		0.44	0.12, 1.50	0.2
Lower		1.02	0.32, 3.21	0.9
Lowest		1.03	0.35, 2.98	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Presence of old metal pipes	180
No		—	—
Yes		4.28	1.52, 14.2	0.009	19.5	15
PSU Rural/Urban	180
Rural		—	—
Urban		3.99	1.80, 9.39	<0.001
Wealth Index	180
Highest		—	—
Higher		0.43	0.11, 1.57	0.2
Middle		0.48	0.13, 1.64	0.2
Lower		0.98	0.31, 3.05	0.9
Lowest		1.04	0.36, 2.98	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Households with soil-contact flooring had higher odds of being a case (OR 3.94, 95% CI: 1.63–10.1) with the largest estimated population attributable fraction (PAF 27.4%). Higher odds were also observed for smoking inside the household (OR 1.88, 95% CI: 1–3.58; PAF 26.3%), houses constructed more than 10 years ago (OR 1.39, 95% CI: 0.75–2.60; PAF 15.9%), presence of old metal pipes (OR 4.28, 95% CI: 1.52–14.2; PAF 15%), and use of emulsion paint compared with no paint/cement paint (OR 4.18, 95% CI: 1.05–18.4; PAF 12.2%).

Smaller contributions were observed for chuna-type paint (OR 1.56, 95% CI: 0.63–4.04; PAF 14.1%), distemper paint (OR 1.33, 95% CI: 0.49–3.68; PAF 7.6%), and car or machine repair activity near the household (OR 1.69, 95% CI: 0.38–7.88; PAF 2.3%), while visible peeling paint showed little difference in odds (OR 0.98, 95% CI: 0.49–1.97).

B. Drinking water source (Sampada data)

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Drinking water source	183
Bore well		—	—
Open well		0.23	0.03, 1.00	0.079	2.3	-7.6
Tap water		0.81	0.38, 1.73	0.6	43.7	-10.1
Water tanker		1.05	0.20, 6.18	>0.9	5.7	0.3
Others		1.41	0.54, 3.69	0.5	18.4	5.3
Type of House	183
Pucca		—	—
Semi-pucca		1.33	0.57, 3.15	0.5
Kutcha		1.20	0.48, 3.05	0.7
PSU Rural/Urban	183
Rural		—	—
Urban		4.67	1.98, 11.7	<0.001
Wealth Index	183
Highest		—	—
Higher		0.59	0.16, 2.08	0.4
Middle		0.50	0.13, 1.84	0.3
Lower		0.95	0.28, 3.24	>0.9
Lowest		1.02	0.31, 3.34	>0.9
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children from households using “other - RO/bottled/purchase/surface/spring” drinking water sources had higher odds of being a case (OR 6.06, 95% CI: 1.29–44.7) compared with those using open wells, with a PAF of 15.4%. Elevated odds were also observed for water tanker (OR 4.51, 95% CI: 0.54–51.3), bore well (OR 4.31, 95% CI: 1–30.2), and tap water (OR 3.50, 95% CI: 0.81–24.5), with the largest estimated PAF for tap water (31.2%).

C. Cooking water source (Sampada data)

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Cooking water source	183
Bore well		—	—
Open well		0.36	0.07, 1.35	0.2	3.4	-6.1
Tap water		0.82	0.38, 1.76	0.6	44.8	-9.9
Water tanker		1.05	0.20, 6.25	>0.9	5.7	0.3
Others		1.41	0.54, 3.75	0.5	17.2	5.0
Type of House	183
Pucca		—	—
Semi-pucca		1.32	0.57, 3.13	0.5
Kutcha		1.21	0.49, 3.05	0.7
PSU Rural/Urban	183
Rural		—	—
Urban		4.77	2.00, 12.1	<0.001
Wealth Index	183
Highest		—	—
Higher		0.56	0.15, 1.99	0.4
Middle		0.46	0.12, 1.70	0.3
Lower		0.90	0.26, 3.06	0.9
Lowest		0.94	0.29, 3.06	>0.9
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children from households using “other (such as surface water) sources of water for cooking had higher odds of being a case (OR 3.92, 95% CI: 0.94–20.7) compared with those using open wells, with a PAF of 12.8%. Higher odds were also observed for water tanker (OR 2.91, 95% CI: 0.39–26.3), bore well (OR 2.77, 95% CI: 0.74–13.6), and tap water (OR 2.27, 95% CI: 0.60–11.1), with the largest estimated PAF for tap water (25.1%).

D. Stunting

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Stunting status	144
No Stunting		—	—
Stunting		0.75	0.29, 1.94	0.6	17.2	-5.6
Severe Stunting		0.75	0.27, 2.06	0.6	13.8	-4.5
Age group	144
1-2		—	—
2-3		0.51	0.15, 1.69	0.3
3-4		0.35	0.11, 1.09	0.077
4-5		0.28	0.08, 0.90	0.036
Hemoglobin	144	0.88	0.69, 1.13	0.3
Type of House	144
Pucca		—	—
Semi-pucca		1.16	0.41, 3.39	0.8
Kutcha		0.96	0.32, 2.84	>0.9
PSU Rural/Urban	144
Rural		—	—
Urban		7.12	2.60, 21.9	<0.001
Wealth Index	144
Highest		—	—
Higher		0.28	0.05, 1.52	0.15
Middle		0.23	0.03, 1.40	0.12
Lower		0.45	0.09, 2.19	0.3
Lowest		1.04	0.22, 4.83	>0.9
¹ Adjusted for hemoglobin, type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children with stunting/severe stunting had lower odds of being a case (OR 0.75, 95% CI: 0.29–1.94)/ (OR 0.75, 95% CI: 0.27–2.06) compared with children without stunting.

E. Wasting

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Wasting status	143
No Wasting		—	—
Wasting		3.81	1.17, 14.4	0.034	14.9	11.0
Severe Wasting		1.28	0.05, 15.9	0.9	1.1	0.3
Age group	143
1-2		—	—
2-3		0.60	0.17, 2.01	0.4
3-4		0.41	0.12, 1.30	0.13
4-5		0.31	0.09, 0.99	0.053
Hemoglobin	143	0.90	0.70, 1.16	0.4
Type of House	143
Pucca		—	—
Semi-pucca		1.46	0.50, 4.47	0.5
Kutcha		1.06	0.35, 3.29	>0.9
PSU Rural/Urban	143
Rural		—	—
Urban		7.38	2.65, 23.3	<0.001
Wealth Index	143
Highest		—	—
Higher		0.22	0.03, 1.21	0.088
Middle		0.25	0.04, 1.52	0.14
Lower		0.36	0.07, 1.76	0.2
Lowest		0.76	0.15, 3.68	0.7
¹ Adjusted for age, hemoglobin, type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children with wasting had higher odds of being a case (OR 3.81, 95% CI: 1.17–14.4), as did those with severe wasting (OR 1.28, 95% CI: 0.05–15.9) compared with children without wasting. The population attributable fractions were 11% and 0.3%, respectively.

F. Underweight

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Underweight status	145
No Underweight		—	—
Underweight		1.64	0.66, 4.16	0.3	17.2	6.7
Severe Underweight		1.28	0.36, 4.58	0.7	8.0	1.8
Age group	145
1-2		—	—
2-3		0.53	0.15, 1.74	0.3
3-4		0.36	0.11, 1.11	0.081
4-5		0.29	0.09, 0.90	0.037
Hemoglobin	145	0.91	0.71, 1.16	0.4
Type of House	145
Pucca		—	—
Semi-pucca		1.26	0.46, 3.55	0.7
Kutcha		0.92	0.31, 2.69	0.9
PSU Rural/Urban	145
Rural		—	—
Urban		7.23	2.67, 21.7	<0.001
Wealth Index	145
Highest		—	—
Higher		0.26	0.04, 1.41	0.13
Middle		0.27	0.04, 1.53	0.15
Lower		0.45	0.09, 2.19	0.3
Lowest		1.06	0.22, 5.04	>0.9
¹ Adjusted for age, hemoglobin, type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children who were underweight/severe underweight had higher odds of being a case (OR 1.64, 95% CI: 0.66–4.16)/ (OR 1.28, 95% CI: 0.36–4.58) compared with children with normal weight. The population attributable fractions were 6.7% and 1.8%, respectively.

G. MUAC wasting

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
MUAC Group	146
Normal		—	—
severewasting		3.71	0.37, 89.7	0.3	4.6	3.4
Age group	146
1-2		—	—
2-3		0.60	0.18, 1.95	0.4
3-4		0.39	0.12, 1.21	0.11
4-5		0.33	0.10, 1.03	0.061
Hemoglobin	146	0.91	0.71, 1.16	0.4
Type of House	146
Pucca		—	—
Semi-pucca		1.32	0.47, 3.82	0.6
Kutcha		1.05	0.36, 3.11	>0.9
PSU Rural/Urban	146
Rural		—	—
Urban		7.14	2.61, 21.8	<0.001
Wealth Index	146
Highest		—	—
Higher		0.24	0.04, 1.31	0.11
Middle		0.26	0.04, 1.49	0.14
Lower		0.42	0.08, 2.04	0.3
Lowest		0.98	0.20, 4.58	>0.9
¹ Adjusted for age, hemoglobin, type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children with severe wasting based on MUAC had higher odds of being a case (OR 3.71, 95% CI: 0.37–89.7) compared with children with normal MUAC. The population attributable fraction was estimated at 3.4%.

H. Anemia

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Anemia status	183
No Anemia		—	—
Any Anemia		1.00	0.53, 1.88	>0.9	40.2	0
Gender	183
Male		—	—
Female		0.96	0.51, 1.77	0.9
PSU Rural/Urban	183
Rural		—	—
Urban		4.38	2.00, 10.2	<0.001
Wealth Index	183
Highest		—	—
Higher		0.64	0.18, 2.18	0.5
Middle		0.55	0.16, 1.83	0.3
Lower		1.10	0.36, 3.40	0.9
Lowest		1.12	0.40, 3.17	0.8
¹ Adjusted for gender, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children with any anemia had similar odds of being a case compared with those without anemia (OR 1, 95% CI: 0.53–1.88).

I. Micronutrient intake

Characteristic	N	Adjusted OR¹	95% CI	p-value	PAF (%)
Thiamine (B1) Intake (mg/day)	144	0.12	0.03, 0.46	0.004	-279.1
Gender	144
Male		—	—
Female		0.73	0.35, 1.50	0.4
PSU Rural/Urban	144
Rural		—	—
Urban		5.80	2.24, 16.7	<0.001
Wealth Index	144
Highest		—	—
Higher		0.36	0.08, 1.46	0.2
Middle		0.34	0.07, 1.39	0.14
Lower		0.67	0.18, 2.34	0.5
Lowest		0.71	0.21, 2.31	0.6
¹ Adjusted for gender, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	PAF (%)
Riboflavin (B2) Intake (mg/day)	144	0.95	0.29, 3.02	0.9	-1.9
Gender	144
Male		—	—
Female		0.80	0.40, 1.61	0.5
PSU Rural/Urban	144
Rural		—	—
Urban		3.89	1.61, 10.0	0.003
Wealth Index	144
Highest		—	—
Higher		0.43	0.10, 1.69	0.2
Middle		0.28	0.06, 1.14	0.082
Lower		0.69	0.20, 2.34	0.6
Lowest		0.72	0.22, 2.28	0.6
¹ Adjusted for gender, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	PAF (%)
Niacin (B3) Intake (mg/day)	144	0.82	0.70, 0.94	0.009	-83.4
Gender	144
Male		—	—
Female		0.77	0.38, 1.58	0.5
PSU Rural/Urban	144
Rural		—	—
Urban		4.96	1.96, 13.7	0.001
Wealth Index	144
Highest		—	—
Higher		0.30	0.07, 1.27	0.11
Middle		0.30	0.06, 1.25	0.11
Lower		0.66	0.18, 2.34	0.5
Lowest		0.67	0.20, 2.21	0.5
¹ Adjusted for gender, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	PAF (%)
Vitamin B12 Intake (ug/day)	144	1.26	0.30, 22.7	0.8	1.1
Gender	144
Male		—	—
Female		0.80	0.40, 1.61	0.5
PSU Rural/Urban	144
Rural		—	—
Urban		3.78	1.56, 9.81	0.004
Wealth Index	144
Highest		—	—
Higher		0.44	0.11, 1.70	0.2
Middle		0.29	0.06, 1.14	0.084
Lower		0.69	0.20, 2.32	0.5
Lowest		0.73	0.23, 2.26	0.6
¹ Adjusted for gender, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Higher intake of thiamine (B1) (OR 0.12, 95% CI: 0.03–0.46) and niacin (B3) (OR 0.82, 95% CI: 0.70–0.94) was associated with lower odds of being a case. Riboflavin (B2) intake (OR 0.95, 95% CI: 0.29–3.02) showed little difference in odds, while vitamin B12 intake (OR 1.26, 95% CI: 0.30–22.7) showed slightly higher odds, with a small estimated PAF of 1.1%.

J. Past pica behaviour

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Past history of pica behaviour	183
No		—	—
Yes		30.2	13.8, 72.1	<0.001	86.2	83.4
Age group	183
1-2		—	—
2-3		0.59	0.15, 2.19	0.4
3-4		0.33	0.09, 1.20	0.10
4-5		0.49	0.13, 1.76	0.3
Hemoglobin	183	1.03	0.79, 1.34	0.8
¹ Adjusted for hemoglobin (marker for micronutrient deficiency)
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children with a history of pica behaviour had markedly higher odds of being a case (OR 29, 95% CI: 13.5-67.7) compared with those without such history. The population attributable fraction was estimated at 83.2%.

K. Kajal use and conusmption of certain food types

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Child uses kajal/kohl/surma	183
No		—	—
Yes		1.26	0.69, 2.34	0.5	52.9	11.1
PSU Rural/Urban	183
Rural		—	—
Urban		4.37	2.00, 10.2	<0.001
Wealth Index	183
Highest		—	—
Higher		0.65	0.19, 2.21	0.5
Middle		0.56	0.17, 1.86	0.3
Lower		1.11	0.36, 3.43	0.9
Lowest		1.15	0.41, 3.25	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Non-vegetarian food consumption	182
No		—	—
Yes		0.69	0.37, 1.28	0.2	41.4	-18.9
PSU Rural/Urban	182
Rural		—	—
Urban		4.24	1.93, 9.90	<0.001
Wealth Index	182
Highest		—	—
Higher		0.67	0.19, 2.29	0.5
Middle		0.57	0.17, 1.88	0.4
Lower		1.11	0.36, 3.42	0.9
Lowest		1.24	0.44, 3.55	0.7
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Packaged salted snacks consumption	182
No		—	—
Yes		1.76	0.94, 3.31	0.078	65.5	28.2
PSU Rural/Urban	182
Rural		—	—
Urban		4.23	1.92, 9.95	<0.001
Wealth Index	182
Highest		—	—
Higher		0.66	0.19, 2.24	0.5
Middle		0.61	0.18, 2.04	0.4
Lower		1.12	0.36, 3.50	0.8
Lowest		1.20	0.42, 3.42	0.7
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Biscuits/cookies consumption	182
No		—	—
Yes		1.58	0.80, 3.18	0.2	77	28.2
PSU Rural/Urban	182
Rural		—	—
Urban		4.25	1.94, 9.92	<0.001
Wealth Index	182
Highest		—	—
Higher		0.62	0.18, 2.11	0.4
Middle		0.53	0.15, 1.75	0.3
Lower		1.08	0.35, 3.35	0.9
Lowest		1.14	0.40, 3.24	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Noodles/instant mixes consumption	182
No		—	—
Yes		1.57	0.81, 3.09	0.2	42.5	15.5
PSU Rural/Urban	182
Rural		—	—
Urban		4.10	1.86, 9.60	<0.001
Wealth Index	182
Highest		—	—
Higher		0.64	0.18, 2.17	0.5
Middle		0.61	0.18, 2.05	0.4
Lower		1.21	0.39, 3.76	0.7
Lowest		1.31	0.46, 3.80	0.6
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Colored candies consumption	182
No		—	—
Yes		2.43	1.29, 4.68	0.007	66.7	39.2
PSU Rural/Urban	182
Rural		—	—
Urban		4.42	1.98, 10.5	<0.001
Wealth Index	182
Highest		—	—
Higher		0.55	0.15, 1.90	0.3
Middle		0.49	0.14, 1.65	0.3
Lower		1.10	0.35, 3.49	0.9
Lowest		1.01	0.35, 2.93	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Chocolate/cocoa products consumption	182
No		—	—
Yes		1.40	0.69, 2.86	0.4	27.6	7.8
PSU Rural/Urban	182
Rural		—	—
Urban		4.52	2.05, 10.6	<0.001
Wealth Index	182
Highest		—	—
Higher		0.66	0.19, 2.28	0.5
Middle		0.57	0.17, 1.88	0.4
Lower		1.10	0.36, 3.38	0.9
Lowest		1.20	0.43, 3.42	0.7
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Ice cream/frozen colored desserts consumption	182
No		—	—
Yes		1.88	0.93, 3.92	0.083	79.3	37.2
PSU Rural/Urban	182
Rural		—	—
Urban		4.47	2.03, 10.5	<0.001
Wealth Index	182
Highest		—	—
Higher		0.69	0.20, 2.35	0.5
Middle		0.56	0.17, 1.85	0.3
Lower		1.15	0.38, 3.54	0.8
Lowest		1.28	0.45, 3.65	0.6
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Canned/tinned foods or pickles consumption	182
No		—	—
Yes		3.68	1.93, 7.16	<0.001	58.6	42.7
PSU Rural/Urban	182
Rural		—	—
Urban		4.25	1.88, 10.3	<0.001
Wealth Index	182
Highest		—	—
Higher		0.71	0.19, 2.55	0.6
Middle		0.54	0.15, 1.87	0.3
Lower		0.97	0.30, 3.05	0.9
Lowest		1.17	0.40, 3.45	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Meals from Anganwadi/mid-day meal/community kitchen (>5/week)	179
No		—	—
Yes		1.23	0.56, 2.70	0.6	20.7	3.9
PSU Rural/Urban	179
Rural		—	—
Urban		3.94	1.79, 9.24	<0.001
Wealth Index	179
Highest		—	—
Higher		0.64	0.18, 2.14	0.5
Middle		0.54	0.16, 1.77	0.3
Lower		0.95	0.30, 2.99	0.9
Lowest		1.11	0.39, 3.11	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Formula milk consumption (infancy)	182
No		—	—
Yes		27,053,636	0.00,	0.9	14.9	14.9
PSU Rural/Urban	182
Rural		—	—
Urban		2.52	1.09, 6.11	0.034
Wealth Index	182
Highest		—	—
Higher		0.74	0.20, 2.73	0.6
Middle		0.67	0.19, 2.37	0.5
Lower		1.26	0.39, 4.19	0.7
Lowest		1.38	0.47, 4.17	0.6
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Fresh animal milk consumption	182
No		—	—
Yes		2.03	1.04, 4.01	0.039	43.7	22.1
PSU Rural/Urban	182
Rural		—	—
Urban		4.29	1.94, 10.1	<0.001
Wealth Index	182
Highest		—	—
Higher		0.71	0.20, 2.50	0.6
Middle		0.57	0.17, 1.92	0.4
Lower		1.29	0.41, 4.13	0.7
Lowest		1.42	0.49, 4.23	0.5
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Packaged animal milk consumption	182
No		—	—
Yes		1.25	0.24, 9.63	0.8	9.2	1.9
PSU Rural/Urban	182
Rural		—	—
Urban		4.13	1.75, 10.5	0.002
Wealth Index	182
Highest		—	—
Higher		0.65	0.19, 2.23	0.5
Middle		0.56	0.16, 1.85	0.3
Lower		1.10	0.36, 3.39	0.9
Lowest		1.16	0.41, 3.27	0.8
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Consumption of silver foil	130
No		—	—
Yes		4.15	1.73, 10.5	0.002	27.6	20.9
PSU Rural/Urban	130
Rural		—	—
Urban		4.28	1.63, 12.1	0.004
Wealth Index	130
Highest		—	—
Higher		0.31	0.06, 1.47	0.15
Middle		0.29	0.06, 1.38	0.13
Lower		0.60	0.13, 2.58	0.5
Lowest		0.40	0.10, 1.54	0.2
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Ayurvedic/herbal supplement use	182
No		—	—
Yes		2.26	0.78, 7.15	0.14	13.8	7.7
PSU Rural/Urban	182
Rural		—	—
Urban		4.40	2.01, 10.3	<0.001
Wealth Index	182
Highest		—	—
Higher		0.77	0.21, 2.73	0.7
Middle		0.62	0.18, 2.11	0.4
Lower		1.19	0.38, 3.75	0.8
Lowest		1.31	0.46, 3.85	0.6
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Calcium/Iron/Vitamin supplement use	182
No		—	—
Yes		7.97	1.31, 154	0.059	9.2	8
PSU Rural/Urban	182
Rural		—	—
Urban		4.00	1.81, 9.41	<0.001
Wealth Index	182
Highest		—	—
Higher		0.58	0.17, 1.97	0.4
Middle		0.51	0.15, 1.71	0.3
Lower		1.04	0.34, 3.20	0.9
Lowest		1.00	0.36, 2.85	0.9
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Consumption of food colours	130
No		—	—
Yes		4.72	1.98, 11.8	<0.001	29.9	23.6
PSU Rural/Urban	130
Rural		—	—
Urban		4.18	1.58, 11.9	0.005
Wealth Index	130
Highest		—	—
Higher		0.28	0.05, 1.35	0.12
Middle		0.29	0.05, 1.38	0.13
Lower		0.51	0.11, 2.24	0.4
Lowest		0.40	0.10, 1.57	0.2
¹ Adjusted for rural/urban and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Dietary and behavioral factors with the largest estimated contributions included consumption of canned/tinned foods or pickles (OR 3.68, 95% CI: 1.93–7.16; PAF 42.7%), colored candies (OR 2.43, 95% CI: 1.29–4.68; PAF 39.2%), ice cream or frozen colored desserts (OR 1.88, 95% CI: 0.93–3.92; PAF 37.2%), packaged salted snacks (OR 1.76, 95% CI: 0.94–3.31; PAF 28.2%), and biscuits/cookies (OR 1.58, 95% CI: 0.80–3.18; PAF 28.2%). Elevated odds were also observed for consumption of food colours (OR 4.72, 95% CI: 1.98–11.8; PAF 23.6%), fresh animal milk (OR 2.03, 95% CI: 1.04–4.01; PAF 22.1%), and silver foil consumption (OR 4.15, 95% CI: 1.73–10.5; PAF 20.9%).

Smaller estimated contributions were seen for noddles/instant mixes (OR 1.57, 95% CI: 0.81–3.09; PAF 15.5%), kajal/kohl use (OR 1.26, 95% CI: 0.69–2.34; PAF 11.1%), chocolate/cocoa products (OR 1.4, 95% CI: 0.69–2.86; PAF 7.8%), and Ayurvedic/herbal supplement use (OR 2.26, 95% CI: 0.78–7.15; PAF 7.7%), while non-vegetarian food consumption (OR 0.69, 95% CI: 0.37–1.28; PAF −18.9%) showed lower odds.

L. Utensils

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_nonstick	183
No		—	—
Yes		1.81	0.41, 9.38	0.4	5.7	2.6
Wealth Index	183
Highest		—	—
Higher		0.56	0.17, 1.78	0.3
Middle		0.45	0.14, 1.39	0.2
Lower		0.94	0.32, 2.72	0.9
Lowest		0.76	0.28, 2.00	0.6
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_ss	183
No		—	—
Yes		1.12	0.47, 2.74	0.8	87.4	9.4
Wealth Index	183
Highest		—	—
Higher		0.55	0.17, 1.74	0.3
Middle		0.43	0.14, 1.32	0.15
Lower		0.91	0.31, 2.58	0.9
Lowest		0.72	0.27, 1.88	0.5
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_aluminium	183
No		—	—
Yes		0.49	0.18, 1.25	0.14	83.9	-87.4
Wealth Index	183
Highest		—	—
Higher		0.62	0.19, 1.99	0.4
Middle		0.46	0.14, 1.42	0.2
Lower		0.95	0.32, 2.75	0.9
Lowest		0.82	0.30, 2.17	0.7
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_iron	183
No		—	—
Yes		1.79	0.73, 4.60	0.2	16.1	7.1
Wealth Index	183
Highest		—	—
Higher		0.59	0.18, 1.88	0.4
Middle		0.45	0.14, 1.39	0.2
Lower		0.95	0.33, 2.74	0.9
Lowest		0.70	0.26, 1.81	0.5
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_copper_brass	183
No		—	—
Yes		0.39	0.05, 1.94	0.3	2.3	-3.6
Wealth Index	183
Highest		—	—
Higher		0.51	0.15, 1.61	0.3
Middle		0.42	0.13, 1.28	0.13
Lower		0.88	0.30, 2.52	0.8
Lowest		0.66	0.25, 1.71	0.4
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_plastic	183
No		—	—
Yes		0.38	0.20, 0.71	0.003	51.7	-83.3
Wealth Index	183
Highest		—	—
Higher		0.61	0.18, 2.01	0.4
Middle		0.50	0.15, 1.58	0.2
Lower		1.04	0.35, 3.07	0.9
Lowest		0.84	0.31, 2.25	0.7
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_glazed_earthenware	183
No		—	—
Yes		1.00	0.34, 2.89	0.9	9.2	0
Wealth Index	183
Highest		—	—
Higher		0.55	0.17, 1.73	0.3
Middle		0.43	0.13, 1.32	0.15
Lower		0.90	0.31, 2.59	0.9
Lowest		0.71	0.27, 1.82	0.5
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_non_glazed_earthenware	183
No		—	—
Yes		1.38	0.61, 3.16	0.4	17.2	4.7
Wealth Index	183
Highest		—	—
Higher		0.53	0.16, 1.69	0.3
Middle		0.42	0.13, 1.28	0.13
Lower		0.89	0.31, 2.55	0.8
Lowest		0.68	0.26, 1.77	0.4
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
utensil_earthenware_combined	183
No		—	—
Yes		1.49	0.71, 3.17	0.3	23	7.6
Wealth Index	183
Highest		—	—
Higher		0.54	0.16, 1.71	0.3
Middle		0.44	0.14, 1.34	0.2
Lower		0.92	0.32, 2.65	0.9
Lowest		0.71	0.27, 1.82	0.5
¹ Adjusted for wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Use of stainless steel utensils had the largest estimated population impact (PAF 66.9%; OR 4.26, 95% CI: 1.29–19.3). Smaller contributions were observed for non-glazed earthenware (PAF 9%; OR 2.09, 95% CI: 0.87–5.09), iron utensils (PAF 10.1%; OR 2.69, 95% CI: 1.03–7.37), non-stick utensils (PAF 2.7%; OR 1.87, 95% CI: 0.40–10.2), and glazed earthenware (PAF 1.5%; OR 1.20, 95% CI: 0.38–3.69).

In contrast, aluminium (PAF −145.3%; OR 0.37, 95% CI: 0.09–1.24), plastic (PAF −166%; OR 0.24, 95% CI: 0.06–0.79), and copper/brass utensils (PAF −2.9%; OR 0.44, 95% CI: 0.06–2.46) showed negative PAF values, indicating lower odds.

M. Water lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Water lead level	180
BLD/ Normal		—	—
High		3.52	0.39, 76.7	0.3	3.4	2.5
Type of House	180
Pucca		—	—
Semi-pucca		1.54	0.64, 3.84	0.3
Kutcha		1.59	0.62, 4.15	0.3
PSU Rural/Urban	180
Rural		—	—
Urban		4.60	2.00, 11.3	<0.001
Wealth Index	180
Highest		—	—
Higher		0.43	0.11, 1.67	0.2
Middle		0.41	0.10, 1.62	0.2
Lower		0.81	0.23, 2.83	0.7
Lowest		0.87	0.25, 2.99	0.8
Presence of old metal pipes	180
No		—	—
Yes		4.69	1.63, 15.9	0.007
¹ Adjusted for type of house, old metal pipes, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high water lead levels had higher odds of being a case (OR 3.20, 95% CI: 0.36–69.6) compared with those with BLD/normal. with population attributable fraction of 2.5%.

N. Rice lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Rice lead category	160
BLD/ Normal		—	—
High		1.05	0.53, 2.11	0.9	37.9	2
Type of House	160
Pucca		—	—
Semi-pucca		1.85	0.73, 4.89	0.2
Kutcha		1.66	0.61, 4.67	0.3
PSU Rural/Urban	160
Rural		—	—
Urban		5.75	2.37, 15.2	<0.001
Wealth Index	160
Highest		—	—
Higher		0.58	0.14, 2.29	0.4
Middle		0.37	0.09, 1.52	0.2
Lower		0.84	0.23, 3.12	0.8
Lowest		0.70	0.19, 2.56	0.6
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in rice had slightly higher odds of being a case (OR 1.05, 95% CI: 0.53–2.11). The population attributable fraction was estimated at 2%.

O. Wheat lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Wheat lead category	134
BLD/ Normal		—	—
High		0.64	0.29, 1.39	0.3	23	-12.9
Type of House	134
Pucca		—	—
Semi-pucca		1.45	0.57, 3.80	0.4
Kutcha		1.54	0.55, 4.43	0.4
PSU Rural/Urban	134
Rural		—	—
Urban		4.43	1.82, 11.6	0.001
Wealth Index	134
Highest		—	—
Higher		0.69	0.16, 2.95	0.6
Middle		0.40	0.09, 1.77	0.2
Lower		0.93	0.24, 3.63	>0.9
Lowest		0.72	0.19, 2.69	0.6
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in wheat had lower odds of being a case (OR 0.64, 95% CI: 0.29–1.39). The population attributable fraction was −12.9%.

P. Turmeric lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Turmeric lead category	180
BLD/ Normal		—	—
High		2.01	0.64, 7.00	0.2	10.3	5.2
Type of House	180
Pucca		—	—
Semi-pucca		1.40	0.61, 3.29	0.4
Kutcha		1.34	0.54, 3.33	0.5
PSU Rural/Urban	180
Rural		—	—
Urban		4.45	1.98, 10.6	<0.001
Wealth Index	180
Highest		—	—
Higher		0.58	0.16, 2.06	0.4
Middle		0.46	0.12, 1.67	0.2
Lower		0.92	0.27, 3.12	0.9
Lowest		0.92	0.28, 3.00	0.9
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in turmeric had higher odds of being a case (OR 2.01, 95% CI: 0.64–7). The population attributable fraction was estimated at 5.2%.

Q. Coriander lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Coriander lead category	141
BLD/ Normal		—	—
High		0.63	0.02, 18.2	0.8	1.1	-0.7
Type of House	141
Pucca		—	—
Semi-pucca		1.56	0.60, 4.18	0.4
Kutcha		1.61	0.59, 4.57	0.4
PSU Rural/Urban	141
Rural		—	—
Urban		3.68	1.53, 9.51	0.005
Wealth Index	141
Highest		—	—
Higher		0.58	0.14, 2.29	0.4
Middle		0.36	0.08, 1.54	0.2
Lower		0.77	0.20, 2.93	0.7
Lowest		0.74	0.20, 2.62	0.6
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in coriander had lower odds of being a case (OR 0.63, 95% CI: 0.02–18.2). The population attributable fraction was −0.7%.

R. Kajal lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Kajal lead category	58
BLD/ Normal		—	—
High		3.27	0.72, 17.8	0.14	9.2	6.4
Type of House	58
Pucca		—	—
Semi-pucca		2.56	0.48, 16.3	0.3
Kutcha		2.31	0.43, 14.3	0.3
PSU Rural/Urban	58
Rural		—	—
Urban		5.71	1.08, 42.0	0.057
Wealth Index	58
Highest		—	—
Higher		1.05	0.08, 13.2	>0.9
Middle		0.56	0.05, 5.29	0.6
Lower		2.62	0.23, 33.0	0.4
Lowest		0.64	0.06, 6.41	0.7
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in kajal had higher odds of being a case (OR 3.27, 95% CI: 0.72–17.8). The population attributable fraction was estimated at 6.4%.

S. Wallpaint lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Wall paint lead category	109
BLD/ Normal		—	—
High		0.65	0.02, 20.8	0.8	1.1	-0.6
Type of House	109
Pucca		—	—
Semi-pucca		1.11	0.37, 3.43	0.9
Kutcha		2.08	0.64, 7.01	0.2
PSU Rural/Urban	109
Rural		—	—
Urban		4.80	1.84, 13.6	0.002
Wealth Index	109
Highest		—	—
Higher		0.27	0.05, 1.41	0.13
Middle		0.39	0.07, 1.93	0.3
Lower		1.05	0.23, 4.75	>0.9
Lowest		0.94	0.22, 4.01	>0.9
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in wall paint had lower odds of being a case (OR 0.65, 95% CI: 0.02–20.8). The population attributable fraction was −0.6%.

T. Toys lead level

Characteristic	N	Adjusted OR¹	95% CI	p-value	% exposed cases	PAF (%)
Toy lead category	64
BLD/ Normal		—	—
High		1.37	0.33, 6.05	0.7	9.2	2.5
Type of House	64
Pucca		—	—
Semi-pucca		2.30	0.56, 10.4	0.3
Kutcha		3.15	0.52, 20.6	0.2
PSU Rural/Urban	64
Rural		—	—
Urban		2.10	0.61, 7.89	0.2
Wealth Index	64
Highest		—	—
Higher		0.05	0.00, 0.53	0.025
Middle		0.03	0.00, 0.32	0.011
Lower		0.11	0.00, 1.02	0.080
Lowest		0.20	0.01, 2.17	0.2
¹ Adjusted for type of house, rural/urban, and wealth index
Abbreviations: CI = Confidence Interval, OR = Odds Ratio

Children exposed to high lead levels in toys had slightly higher odds of being a case (OR 1.37, 95% CI: 0.33-6.05) compared with those with BLD/normal with population attributable fraction of 2.5%.

Summary of MV regression

Variable_Group	Exposure_Level	Adjusted OR (95% CI)	% Exposed Cases	PAF (%)
Pica Past	Yes	30.19 (13.8, 72.1)	86.2	83.4
Canned Tinned Pickle	Yes	3.68 (1.93, 7.16)	58.6	42.7
Candies Colored	Yes	2.43 (1.29, 4.68)	66.7	39.2
Ice Cream Frozen Colored	Yes	1.88 (0.93, 3.92)	79.3	37.2
Purchased Salted Snacks	Yes	1.76 (0.94, 3.31)	65.5	28.2
Biscuits Cookies	Yes	1.58 (0.80, 3.18)	77.0	28.2
Current Hh Flooring	Soil-Contact	3.94 (1.63, 10.1)	36.8	27.4
Smoking Inside	Yes	1.88 (1.00, 3.58)	56.3	26.3
Food Colours	Yes	4.72 (1.98, 11.8)	29.9	23.6
Animal Fresh Milk	Yes	2.03 (1.04, 4.01)	43.7	22.1
Silver Foil	Yes	4.15 (1.73, 10.5)	27.6	20.9
Year Construction Current House Yrs	More than 10 Years	1.39 (0.75, 2.60)	56.3	15.9
Noodles Instant Mixes	Yes	1.57 (0.81, 3.09)	42.5	15.5
Current Hh Metal Pipe Plumbing	Yes	4.28 (1.52, 14.2)	19.5	15.0
Formula Milk Infancy	Yes	27053635.56 (0.00, NA)	14.9	14.9
Paint Type Current Hh	Chuna or Similar	1.56 (0.63, 4.04)	39.1	14.1
Paint Type Current Hh	Emulsion	4.18 (1.05, 18.4)	16.1	12.2
Child Kajal	Yes	1.26 (0.69, 2.34)	52.9	11.1
Wasting New	Wasting	3.81 (1.17, 14.4)	14.9	11.0
Utensil Ss	Yes	1.12 (0.47, 2.74)	87.4	9.4
Iron Cal Vit Suppl	Yes	7.97 (1.31, 154)	9.2	8.0
Chocolates Cocoa Products	Yes	1.4 (0.69, 2.86)	27.6	7.8
Ayurvedic Herbal Supplements	Yes	2.26 (0.78, 7.15)	13.8	7.7
Paint Type Current Hh	Distemper	1.33 (0.49, 3.68)	31.0	7.6
Utensil Earthenware Combined	Yes	1.49 (0.71, 3.17)	23.0	7.6
Utensil Iron	Yes	1.79 (0.73, 4.60)	16.1	7.1
Underweight New	Underweight	1.64 (0.66, 4.16)	17.2	6.7
Kajal0bdl1normal2high Pl	High	3.27 (0.72, 17.8)	9.2	6.4
Drink Water2	Others	1.41 (0.54, 3.69)	18.4	5.3
Turmeric0bdl1normal2high Pl	High	2.01 (0.64, 7.00)	10.3	5.2
Waterusingforcooking Hhs2	Others	1.41 (0.54, 3.75)	17.2	5.0
Utensil Non Glazed Earthenware	Yes	1.38 (0.61, 3.16)	17.2	4.7
Anganwadi Mid Day Meal Comm Kitchen Meal 5 Wk	Yes	1.23 (0.56, 2.70)	20.7	3.9
Muac Group	Severewasting	3.71 (0.37, 89.7)	4.6	3.4
Utensil Nonstick	Yes	1.81 (0.41, 9.38)	5.7	2.6
Water0bdl1normal2high Pl	High	3.52 (0.39, 76.7)	3.4	2.5
Toy0bdl1normal2high Pl	High	1.37 (0.33, 6.05)	9.2	2.5
Car Machine Repair Around Current Hh	Yes	1.69 (0.38, 7.88)	5.7	2.3
Rice0bdl1normal2high Pl	High	1.05 (0.53, 2.11)	37.9	2.0
Packaged Animal Milk	Yes	1.25 (0.24, 9.63)	9.2	1.9
Underweight New	Severe Underweight	1.28 (0.36, 4.58)	8.0	1.8
B12 Ug Day Cal	Vitamin B12 Intake (Ug/Day)	1.26 (0.30, 22.7)	NA	1.1
Drink Water2	Water Tanker	1.05 (0.20, 6.18)	5.7	0.3
Waterusingforcooking Hhs2	Water Tanker	1.05 (0.20, 6.25)	5.7	0.3
Wasting New	Severe Wasting	1.28 (0.05, 15.9)	1.1	0.3
Utensil Glazed Earthenware	Yes	1 (0.34, 2.89)	9.2	0.0
Anemia	Any Anemia	1 (0.53, 1.88)	40.2	0.0
Wall Paint0bdl1normal2high Pl	High	0.65 (0.02, 20.8)	1.1	-0.6
Coriander0bdl1normal2high Pl	High	0.63 (0.02, 18.2)	1.1	-0.7
Peeling Current Hh	Yes	0.98 (0.49, 1.94)	41.4	-0.9
Riboflavinb2 Mg Day Cal	Riboflavin (B2) Intake (Mg/Day)	0.95 (0.29, 3.02)	NA	-1.9
Utensil Copper Brass	Yes	0.39 (0.05, 1.94)	2.3	-3.6
Stunting New	Severe Stunting	0.75 (0.27, 2.06)	13.8	-4.5
Stunting New	Stunting	0.75 (0.29, 1.94)	17.2	-5.6
Waterusingforcooking Hhs2	Open Well	0.36 (0.07, 1.35)	3.4	-6.1
Drink Water2	Open Well	0.23 (0.03, 1.00)	2.3	-7.6
Waterusingforcooking Hhs2	Tap Water	0.82 (0.38, 1.76)	44.8	-9.9
Drink Water2	Tap Water	0.81 (0.38, 1.73)	43.7	-10.1
Wheat0bdl1normal2high Pl	High	0.64 (0.29, 1.39)	23.0	-12.9
Non Veg	Yes	0.69 (0.37, 1.28)	41.4	-18.9
Utensil Plastic	Yes	0.38 (0.20, 0.71)	51.7	-83.3
Niacinb3 Mg Day Cal	Niacin (B3) Intake (Mg/Day)	0.82 (0.70, 0.94)	NA	-83.4
Utensil Aluminium	Yes	0.49 (0.18, 1.25)	83.9	-87.4
Thiamineb1 Mg Day Cal	Thiamine (B1) Intake (Mg/Day)	0.12 (0.03, 0.46)	NA	-279.1

Summary of adjusted multivariable regression findings:

There is No Smoking Gun. High blood lead levels (BLL) among children appear to be driven by a complex interplay of behavioral, dietary, and environmental determinants. The data highlights several high-impact modifiable risk factors.

Part 4. Comparison of lead levels in different sources of water/brands of food items by case-control status

A. Water lead levels by source of water and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Dugwell	7	1.59 ± 1.02	1.65 (0.11–2.69)	2.66	6	0.99 ± 0.86	0.80 (0.12–2.60)	1.85	13	1.31 ± 0.96	1.11 (0.11–2.69)	2.63
Piped GW	7	1.31 ± 0.86	1.47 (0.23–2.41)	2.32	18	3.71 ± 9.60	1.32 (0.11–41.92)	3.37	25	3.03 ± 8.16	1.47 (0.11–41.92)	2.73
Piped SW	15	1.23 ± 0.97	1.11 (0.09–2.89)	2.26	13	1.57 ± 1.55	1.35 (0.07–4.51)	3.52	28	1.39 ± 1.26	1.23 (0.07–4.51)	3.02
Tubewell	68	2.35 ± 6.13	1.55 (0.04–51.32)	3.30	46	1.86 ± 3.19	1.10 (0.03–16.60)	2.78	114	2.15 ± 5.14	1.30 (0.03–51.32)	3.26
Tubewell & Piped SW	1	2.45 ± NA	2.45 (2.45–2.45)	2.45	3	2.33 ± 0.40	2.40 (1.90–2.68)	2.62	4	2.36 ± 0.33	2.43 (1.90–2.68)	2.61
Tubewell & Tanker	NA	NA	NA	NA	1	0.07 ± NA	0.07 (0.07–0.07)	0.07	1	0.07 ± NA	0.07 (0.07–0.07)	0.07

B. Rice lead levels by source of rice and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Same village farm	32	0.40 ± 0.56	0.14 (0.00–1.99)	1.35	26	0.29 ± 0.34	0.15 (0.00–1.24)	0.76	58	0.35 ± 0.48	0.14 (0.00–1.99)	1.19
Other farm	10	0.09 ± 0.09	0.07 (0.00–0.29)	0.20	6	0.16 ± 0.18	0.12 (0.00–0.43)	0.34	16	0.12 ± 0.13	0.07 (0.00–0.43)	0.27
PDS	26	0.79 ± 1.36	0.12 (0.00–5.00)	2.68	11	0.27 ± 0.40	0.10 (0.00–1.07)	0.98	37	0.63 ± 1.18	0.10 (0.00–5.00)	1.79
Market loose	12	1.23 ± 2.70	0.11 (0.00–8.29)	4.91	31	0.59 ± 1.13	0.19 (0.00–5.52)	1.27	43	0.77 ± 1.71	0.14 (0.00–8.29)	1.40
Market packaged: ABIS GOLD	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged: Dawat	1	0.66 ± NA	0.66 (0.66–0.66)	0.66	1	0.14 ± NA	0.14 (0.14–0.14)	0.14	2	0.40 ± 0.37	0.40 (0.14–0.66)	0.61
Market packaged: NA	2	2.07 ± 1.11	2.07 (1.28–2.86)	2.70	NA	NA	NA	NA	2	2.07 ± 1.11	2.07 (1.28–2.86)	2.70
NA	1	1.47 ± NA	1.47 (1.47–1.47)	1.47	0	NaN ± NA	NA (Inf–-Inf)	NA	1	1.47 ± NA	1.47 (1.47–1.47)	1.47
Market packaged: Lakhdatar Sona Masuri	NA	NA	NA	NA	1	0.21 ± NA	0.21 (0.21–0.21)	0.21	1	0.21 ± NA	0.21 (0.21–0.21)	0.21

C. Wheat lead levels by source of wheat and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Same village farm	31	0.76 ± 1.55	0.00 (0.00–5.99)	3.57	18	0.11 ± 0.44	0.00 (0.00–1.85)	0.04	49	0.52 ± 1.30	0.00 (0.00–5.99)	1.84
Other farm	2	0.03 ± 0.04	0.03 (0.00–0.05)	0.05	1	0.09 ± NA	0.09 (0.09–0.09)	0.09	3	0.05 ± 0.05	0.05 (0.00–0.09)	0.08
PDS	8	0.61 ± 1.08	0.00 (0.00–2.90)	1.99	11	0.71 ± 0.80	0.69 (0.00–2.43)	1.54	19	0.67 ± 0.90	0.11 (0.00–2.90)	1.76
Market loose	23	0.46 ± 0.62	0.04 (0.00–1.88)	1.37	28	0.85 ± 1.38	0.15 (0.00–4.58)	2.54	51	0.67 ± 1.11	0.12 (0.00–4.58)	1.88
Market packaged: Ashriwad	1	1.99 ± NA	1.99 (1.99–1.99)	1.99	NA	NA	NA	NA	1	1.99 ± NA	1.99 (1.99–1.99)	1.99
Market packaged: kalash atta	1	2.93 ± NA	2.93 (2.93–2.93)	2.93	NA	NA	NA	NA	1	2.93 ± NA	2.93 (2.93–2.93)	2.93
Market packaged: Kesar gold atta	1	0.54 ± NA	0.54 (0.54–0.54)	0.54	NA	NA	NA	NA	1	0.54 ± NA	0.54 (0.54–0.54)	0.54
Market packaged: Lalgulab Atta	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged: NA	2	0.42 ± 0.36	0.42 (0.16–0.67)	0.62	NA	NA	NA	NA	2	0.42 ± 0.36	0.42 (0.16–0.67)	0.62
NA	3	0.04 ± 0.08	0.00 (0.00–0.13)	0.10	2	0.12 ± 0.17	0.12 (0.00–0.23)	0.21	5	0.07 ± 0.11	0.00 (0.00–0.23)	0.19
Market packaged: Amol atta	NA	NA	NA	NA	1	0.04 ± NA	0.04 (0.04–0.04)	0.04	1	0.04 ± NA	0.04 (0.04–0.04)	0.04
Market packaged: Fortune Multigrain Atta	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged: Tulsi Atta	NA	NA	NA	NA	1	0.12 ± NA	0.12 (0.12–0.12)	0.12	1	0.12 ± NA	0.12 (0.12–0.12)	0.12

D. Turmeric lead levels by source of turmeric and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Grind whole at home	32	2.56 ± 4.69	0.38 (0.00–16.88)	8.81	28	13.91 ± 43.70	0.54 (0.00–167.36)	13.79	60	7.86 ± 30.30	0.52 (0.00–167.36)	8.91
Grind whole at mill	9	55.58 ± 164.72	0.35 (0.00–494.83)	100.54	10	1.14 ± 1.93	0.47 (0.00–6.29)	2.31	19	26.93 ± 113.32	0.35 (0.00–494.83)	2.83
Market loose powder	8	0.35 ± 0.69	0.00 (0.00–1.94)	1.13	3	0.22 ± 0.29	0.13 (0.00–0.55)	0.46	11	0.32 ± 0.60	0.00 (0.00–1.94)	0.78
Market packaged powder: basant	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Everest	1	2.14 ± NA	2.14 (2.14–2.14)	2.14	NA	NA	NA	NA	1	2.14 ± NA	2.14 (2.14–2.14)	2.14
Market packaged powder: Haldiram	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: JMD	4	1.09 ± 1.12	0.92 (0.00–2.53)	2.19	NA	NA	NA	NA	4	1.09 ± 1.12	0.92 (0.00–2.53)	2.19
Market packaged powder: Khatri	8	0.79 ± 1.38	0.00 (0.00–3.44)	2.79	14	1.02 ± 2.24	0.00 (0.00–7.90)	3.11	22	0.93 ± 1.94	0.00 (0.00–7.90)	3.35
Market packaged powder: MDH	1	0.25 ± NA	0.25 (0.25–0.25)	0.25	NA	NA	NA	NA	1	0.25 ± NA	0.25 (0.25–0.25)	0.25
Market packaged powder: NR Brand	2	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	2	0.00 ± 0.00	0.00 (0.00–0.00)	0.00
Market packaged powder: Om masala	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Rakshadeep	1	299.23 ± NA	299.23 (299.23–299.23)	299.23	NA	NA	NA	NA	1	299.23 ± NA	299.23 (299.23–299.23)	299.23
Market packaged powder: Ramdev	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Sarda	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Sardar	2	1.23 ± 0.87	1.23 (0.61–1.84)	1.72	NA	NA	NA	NA	2	1.23 ± 0.87	1.23 (0.61–1.84)	1.72
Market packaged powder: Sourabh	1	0.24 ± NA	0.24 (0.24–0.24)	0.24	NA	NA	NA	NA	1	0.24 ± NA	0.24 (0.24–0.24)	0.24
Market packaged powder: Suresh masala	1	0.45 ± NA	0.45 (0.45–0.45)	0.45	NA	NA	NA	NA	1	0.45 ± NA	0.45 (0.45–0.45)	0.45
Market packaged powder: Suruchi	3	0.94 ± 0.92	0.90 (0.04–1.88)	1.68	NA	NA	NA	NA	3	0.94 ± 0.92	0.90 (0.04–1.88)	1.68
Market packaged powder: TEJA	1	0.43 ± NA	0.43 (0.43–0.43)	0.43	1	0.89 ± NA	0.89 (0.89–0.89)	0.89	2	0.66 ± 0.33	0.66 (0.43–0.89)	0.85
Market packaged powder: NA	17	6.98 ± 25.52	0.08 (0.00–105.80)	4.48	18	107.11 ± 209.08	2.23 (0.00–775.64)	348.39	35	58.48 ± 157.29	0.64 (0.00–775.64)	204.64
NA	0	NaN ± NA	NA (Inf–-Inf)	NA	0	NaN ± NA	NA (Inf–-Inf)	NA	0	NaN ± NA	NA (Inf–-Inf)	NA
Market packaged powder: Dhamya	NA	NA	NA	NA	2	1.30 ± 0.00	1.30 (1.30–1.30)	1.30	2	1.30 ± 0.00	1.30 (1.30–1.30)	1.30
Market packaged powder: GOLDIE	NA	NA	NA	NA	1	1.20 ± NA	1.20 (1.20–1.20)	1.20	1	1.20 ± NA	1.20 (1.20–1.20)	1.20
Market packaged powder: Neelam	NA	NA	NA	NA	2	0.06 ± 0.01	0.06 (0.06–0.07)	0.07	2	0.06 ± 0.01	0.06 (0.06–0.07)	0.07
Market packaged powder: PUSH	NA	NA	NA	NA	1	0.09 ± NA	0.09 (0.09–0.09)	0.09	1	0.09 ± NA	0.09 (0.09–0.09)	0.09
Market packaged powder: Ramnagar	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Rawal Das	NA	NA	NA	NA	1	1.35 ± NA	1.35 (1.35–1.35)	1.35	1	1.35 ± NA	1.35 (1.35–1.35)	1.35
Market packaged powder: Sundar	NA	NA	NA	NA	3	0.49 ± 0.51	0.46 (0.00–1.03)	0.91	3	0.49 ± 0.51	0.46 (0.00–1.03)	0.91
Market packaged powder: Zoff	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00

E. Chilli lead levels by source of chilli and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Grind whole at home	28	0.30 ± 0.46	0.07 (0.00–1.55)	0.95	23	2.31 ± 7.04	0.15 (0.00–33.90)	4.45	51	1.21 ± 4.79	0.10 (0.00–33.90)	1.78
Grind whole at mill	9	0.17 ± 0.26	0.00 (0.00–0.61)	0.58	4	0.51 ± 1.03	0.00 (0.00–2.06)	1.44	13	0.28 ± 0.58	0.00 (0.00–2.06)	0.60
Market loose powder	3	0.51 ± 0.35	0.66 (0.11–0.77)	0.74	3	0.28 ± 0.18	0.21 (0.15–0.49)	0.43	6	0.40 ± 0.28	0.35 (0.11–0.77)	0.71
Market packaged powder: Everest	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.23 ± NA	0.23 (0.23–0.23)	0.23	2	0.12 ± 0.16	0.12 (0.00–0.23)	0.21
Market packaged powder: JMD	3	2.03 ± 1.76	3.04 (0.00–3.05)	3.04	NA	NA	NA	NA	3	2.03 ± 1.76	3.04 (0.00–3.05)	3.04
Market packaged powder: Khatri	11	0.20 ± 0.33	0.12 (0.00–1.06)	0.57	14	0.18 ± 0.27	0.05 (0.00–0.99)	0.36	25	0.19 ± 0.29	0.06 (0.00–1.06)	0.49
Market packaged powder: Maharaja	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: MDH	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Neelam	2	1.84 ± 0.42	1.84 (1.55–2.14)	2.08	2	0.28 ± 0.18	0.28 (0.15–0.41)	0.38	4	1.06 ± 0.94	0.98 (0.15–2.14)	1.96
Market packaged powder: NR Brand	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	2	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	5	0.00 ± 0.00	0.00 (0.00–0.00)	0.00
Market packaged powder: Sardar	1	0.44 ± NA	0.44 (0.44–0.44)	0.44	NA	NA	NA	NA	1	0.44 ± NA	0.44 (0.44–0.44)	0.44
Market packaged powder: Sourabh	2	2.17 ± 0.73	2.17 (1.65–2.68)	2.58	NA	NA	NA	NA	2	2.17 ± 0.73	2.17 (1.65–2.68)	2.58
Market packaged powder: Suresh masala	1	0.15 ± NA	0.15 (0.15–0.15)	0.15	NA	NA	NA	NA	1	0.15 ± NA	0.15 (0.15–0.15)	0.15
Market packaged powder: Suruchi	3	0.56 ± 0.97	0.00 (0.00–1.67)	1.34	NA	NA	NA	NA	3	0.56 ± 0.97	0.00 (0.00–1.67)	1.34
Market packaged powder: TEJA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	2	1.10 ± 0.85	1.10 (0.50–1.70)	1.58	3	0.73 ± 0.87	0.50 (0.00–1.70)	1.46
Market packaged powder: NA	19	0.59 ± 1.33	0.00 (0.00–4.22)	1.91	14	0.24 ± 0.34	0.04 (0.00–1.10)	0.60	33	0.44 ± 1.03	0.00 (0.00–4.22)	1.06
NA	1	0.14 ± NA	0.14 (0.14–0.14)	0.14	8	0.09 ± 0.03	0.08 (0.05–0.15)	0.13	9	0.10 ± 0.03	0.09 (0.05–0.15)	0.14
Market packaged powder: Dhamya	NA	NA	NA	NA	2	0.48 ± 0.00	0.48 (0.48–0.48)	0.48	2	0.48 ± 0.00	0.48 (0.48–0.48)	0.48
Market packaged powder: GOLDIE	NA	NA	NA	NA	1	0.50 ± NA	0.50 (0.50–0.50)	0.50	1	0.50 ± NA	0.50 (0.50–0.50)	0.50
Market packaged powder: Ramnagar	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Rawal Das	NA	NA	NA	NA	1	0.43 ± NA	0.43 (0.43–0.43)	0.43	1	0.43 ± NA	0.43 (0.43–0.43)	0.43
Market packaged powder: Sundar	NA	NA	NA	NA	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00
Market packaged powder: Zoff	NA	NA	NA	NA	1	0.05 ± NA	0.05 (0.05–0.05)	0.05	1	0.05 ± NA	0.05 (0.05–0.05)	0.05

F. Coriander lead levels by source of coriander and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Grind whole at home	18	0.30 ± 0.51	0.00 (0.00–1.55)	1.08	13	0.60 ± 0.83	0.15 (0.00–2.32)	1.77	31	0.43 ± 0.67	0.00 (0.00–2.32)	1.55
Grind whole at mill	6	0.25 ± 0.29	0.15 (0.00–0.61)	0.59	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	9	0.16 ± 0.26	0.00 (0.00–0.61)	0.58
Market loose powder	4	0.62 ± 0.36	0.71 (0.11–0.93)	0.88	3	0.29 ± 0.17	0.23 (0.15–0.49)	0.43	7	0.48 ± 0.32	0.49 (0.11–0.93)	0.83
Market packaged powder: basant	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Everest	1	0.91 ± NA	0.91 (0.91–0.91)	0.91	1	0.64 ± NA	0.64 (0.64–0.64)	0.64	2	0.78 ± 0.19	0.78 (0.64–0.91)	0.89
Market packaged powder: JMD	3	2.03 ± 1.76	3.04 (0.00–3.05)	3.04	NA	NA	NA	NA	3	2.03 ± 1.76	3.04 (0.00–3.05)	3.04
Market packaged powder: Khatri	8	0.18 ± 0.36	0.06 (0.00–1.06)	0.44	10	0.17 ± 0.30	0.04 (0.00–0.99)	0.40	18	0.18 ± 0.32	0.04 (0.00–1.06)	0.53
Market packaged powder: Neelam	2	1.84 ± 0.42	1.84 (1.55–2.14)	2.08	1	0.15 ± NA	0.15 (0.15–0.15)	0.15	3	1.28 ± 1.02	1.55 (0.15–2.14)	2.02
Market packaged powder: NR Brand	2	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	2	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	4	0.00 ± 0.00	0.00 (0.00–0.00)	0.00
Market packaged powder: Om masala	0	NaN ± NA	NA (Inf–-Inf)	NA	NA	NA	NA	NA	0	NaN ± NA	NA (Inf–-Inf)	NA
Market packaged powder: Sourabh	2	2.17 ± 0.73	2.17 (1.65–2.68)	2.58	NA	NA	NA	NA	2	2.17 ± 0.73	2.17 (1.65–2.68)	2.58
Market packaged powder: Suresh masala	1	0.15 ± NA	0.15 (0.15–0.15)	0.15	NA	NA	NA	NA	1	0.15 ± NA	0.15 (0.15–0.15)	0.15
Market packaged powder: Suruchi	3	0.56 ± 0.97	0.00 (0.00–1.67)	1.34	NA	NA	NA	NA	3	0.56 ± 0.97	0.00 (0.00–1.67)	1.34
Market packaged powder: TEJA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.50 ± NA	0.50 (0.50–0.50)	0.50	2	0.25 ± 0.35	0.25 (0.00–0.50)	0.45
Market packaged powder: NA	23	0.50 ± 1.22	0.04 (0.00–4.22)	1.24	15	0.93 ± 1.73	0.10 (0.00–4.99)	3.85	38	0.67 ± 1.44	0.07 (0.00–4.99)	2.77
NA	15	0.14 ± 0.21	0.06 (0.00–0.57)	0.52	24	1.66 ± 6.88	0.10 (0.00–33.90)	0.90	39	1.08 ± 5.41	0.10 (0.00–33.90)	0.57
Market packaged powder: Dhamya	NA	NA	NA	NA	2	0.48 ± 0.00	0.48 (0.48–0.48)	0.48	2	0.48 ± 0.00	0.48 (0.48–0.48)	0.48
Market packaged powder: GOLDIE	NA	NA	NA	NA	1	0.50 ± NA	0.50 (0.50–0.50)	0.50	1	0.50 ± NA	0.50 (0.50–0.50)	0.50
Market packaged powder: Ramnagar	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00
Market packaged powder: Rawal Das	NA	NA	NA	NA	1	0.43 ± NA	0.43 (0.43–0.43)	0.43	1	0.43 ± NA	0.43 (0.43–0.43)	0.43
Market packaged powder: Sundar	NA	NA	NA	NA	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00	3	0.00 ± 0.00	0.00 (0.00–0.00)	0.00
Market packaged powder: Zoff	NA	NA	NA	NA	1	0.05 ± NA	0.05 (0.05–0.05)	0.05	1	0.05 ± NA	0.05 (0.05–0.05)	0.05

G. Kajal lead levels by source of kajal and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
Homemade	2	0.16 ± 0.16	0.16 (0.05–0.28)	0.26	8	3.53 ± 5.80	0.37 (0.00–14.49)	12.05	10	2.86 ± 5.31	0.26 (0.00–14.49)	11.35
Local	22	10.13 ± 17.43	1.28 (0.00–68.14)	31.60	15	9.28 ± 14.43	3.01 (0.00–54.39)	21.24	37	9.78 ± 16.07	2.81 (0.00–68.14)	31.60
Jyoti	1	3.44 ± NA	3.44 (3.44–3.44)	3.44	1	1.15 ± NA	1.15 (1.15–1.15)	1.15	2	2.30 ± 1.62	2.30 (1.15–3.44)	3.22
NA	5	0.87 ± 0.77	0.83 (0.00–2.12)	1.60	4	18.63 ± 25.18	8.10 (2.42–55.90)	42.71	9	8.76 ± 18.05	2.12 (0.00–55.90)	20.73
Patanjali	NA	NA	NA	NA	1	0.00 ± NA	0.00 (0.00–0.00)	0.00	1	0.00 ± NA	0.00 (0.00–0.00)	0.00

H. Wall paint levels by source of wallpaint and case-control status

Source	Control				Case				Total
Source	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile	N	Mean ± SD	Median (Min–Max)	90th Centile
No paint/Cement paint	3	2.29 ± 2.35	2.17 (0.00–4.70)	4.20	5	4.29 ± 3.96	5.13 (0.00–9.92)	8.11	8	3.54 ± 3.41	3.44 (0.00–9.92)	6.75
Distemper	22	10.33 ± 21.05	3.50 (0.00–99.18)	20.50	19	7.76 ± 7.19	7.22 (0.00–22.90)	17.31	41	9.14 ± 16.05	4.15 (0.00–99.18)	19.53
Chuna or similar	27	6.85 ± 8.59	3.78 (0.00–34.87)	17.56	21	11.46 ± 11.81	6.27 (0.00–42.24)	32.88	48	8.87 ± 10.27	4.58 (0.00–42.24)	24.21
Emulsion	3	4.72 ± 6.57	1.94 (0.00–12.23)	10.17	11	16.34 ± 30.32	7.02 (2.03–107.17)	14.40	14	13.85 ± 27.17	6.58 (0.00–107.17)	13.75
NA	NA	NA	NA	NA	0	NaN ± NA	NA (Inf–-Inf)	NA	0	NaN ± NA	NA (Inf–-Inf)	NA

Summary of findings from lead testing of environmental samples:

Lead concentrations varied across different environmental and dietary sources. Among water sources, piped groundwater and tubewell water showed the highest lead levels and greatest variability, with cases generally having higher levels in piped water sources. For staple foods, market loose rice and PDS rice showed higher lead concentrations compared with rice sourced directly from farms, while market loose wheat and PDS wheat had relatively higher levels than wheat obtained from village farms. Among spices, turmeric showed the greatest variability, with very high lead concentrations observed in turmeric ground at mills and some packaged turmeric powders, and higher levels among cases for home-ground turmeric. Home-ground chilli also demonstrated higher and more variable lead concentrations compared with other sources.

For other exposure sources, locally purchased kajal showed high lead concentrations and wide variability, with higher levels observed among cases for homemade and unspecified kajal sources. Wall paint samples, particularly emulsion and distemper paints, also demonstrated relatively high lead levels, with cases generally showing higher concentrations than controls. Overall, substantial variability in lead concentrations was observed across sources, with certain household products and spices showing occasional extremely high values.

Data preprocessing