Multiple Indicator Cluster Survey (MICS)

What is Multiple Indicator Cluster Survey (MICS)? One of the largest household surveys carried out by UNICEF in various countries to assess the situation of children and women

MICS Georgia 2018 Survey was carried out by National Statistics Office of Georgia (GeoStat) UNICEF provided technical support to GeoStat Partners: Government of Georgia National Center for Disease Control and Public Health Other Donor Organizations

MICS Georgia 2018 Data Collection: from September 21 to December 20 Sample size: 14 120 household Target population: 15-49 years old men/women, 5-17 years old children and children up to 5 years of age. Determination of lead level in blood: 2-7 years old children from selected households (in total 1578 children) Drinking Water Quality Testing: drinking water was tested on E. coli contamination in every fourth family

MICS Georgia 2018 – data collection 13 Teams Tbilisi (4 teams) Marneuli Telavi Gori Akhaltsikhe Kutaisi Samtredia Zugdidi Batumi Ozurgeti Team composition Supervisor - 1 Interviewer - 4 Measurer - 1 Phlebotomist - 1 MICS Georgia 2018 – data collection

MICS Georgia 2018 – Data Collection Household Questionnaire Personal questionnaire for 15-49 years old women Personal questionnaire for 15-49 years old men Questionnaire for 5-17 years old children Questionnaire for children up to 5 years of age Lead testing questionnaire for 2-7 years old children Water quality assessment questionnaire MICS Georgia 2018 – Data Collection

Household – 12 270 (87%) Response 15-49 years old women (80%) 5-17 years old children (89%) 15-49 years old men (61%) Water quality testing (from glass – 76%; from source – 69%) Lead testing of 2-7 years old children (60%) Household – 12 270 (87%) Children up to 5 years of age (90%)

Lead - Global Problem of Public Health Institute of Health Metrics and Evaluation (IHME) estimated that, based on 2016 data, lead exposure accounted for 540 000 deaths and 13.9 million years lost to disability and death (DALYs) The highest burden of mortality falls on low and middle income countries. Lead exposure accounted for 63.8% of the global burden of idiopathic developmental intellectual disability, 3% of the global burden of ischaemic heart disease and 3.1% of the global burden of stroke.

Lead - Public Health Problem in Georgia Historical Overview Year Project Title Result 1979-86 On lead exposure resulted from launch of leaded antihail rockets in Kakheti region (Telavi) Main source - food 1999 Lead monitoring and epidemiology Average lead level in blood - 22 μg/dL and 15 μg/dL Prevention of industrial effect of lead 38.3% of tested workers of printing house had moderate elevation of lead level while 62% had noticeable elevation 1998-2000 „GEO-2110 study of feasibility of phasing out of lead in gasoline in Georgia” Based on mathematical modeling: in infants - 21.0 μg/dL ; in children - 14.2 μg/dL; in adolescents - 9.4 μg/dL; in elderly - 12.7 μg/dL; assumed source – leaded gasoline

International week of lead poisoning prevention since 2013

Lead - Public Health Problem in Georgia Historical Overview Year Project Title Result 2015 Determination of lead level in blood of 254 children aged 2-5; NCDC-CDC  ≥5 μg/dL- 33% Average indicator - 3.9 μg/dL Bolnisi/Dmanisi ≥5 μg/dL- 30.5% 2017-18 Testing children with BLL prevalence at ≥ 5 μg/dL in 2015 ≥5 μg/dL- 36.6% Testing lead level in air, water, spices, soil 2018 MICS - 1578 children Technical and financial support of Italian Institute of Health; Blood sampling guidelines Cold chain ICP-MS

≥5 μg/dL and ≥10 μg/dL lead Prevalence (%) Basic Results Lead Prevalence (%) ≥5 μg/dL and ≥10 μg/dL lead Prevalence (%)

≥5 μg/dL lead prevalence by regions (%) Main Results ≥5 μg/dL lead prevalence by regions (%)

Basic Results Mean lead concentration (μg/dL) Median lead concentration (μg/dL)

State Response Long-term strategic response Government’s vision on environmental policy – “Green Economy” strategy Key focus of green policy – protection of environment to improve ecology and preserve natural resources for future generations. Two priorities: (1) eradicate bitter legacy and (2) use unique wealth of the country and in the nearest future to achieve the results facilitating positioning of Georgia as a country with Green Economy.

State Response Long-term strategic response „National Environmental Health Action Plan 2018-2022 NEHAP 2“,approved by the Government of Georgia on December 29, 2018 by resolution No. 680 March 26 - Environmental Health Action Plan (NEHAP2) Inter-sectoral Coordination Council Meeting under the leadership of the Prime Minister where various agencies were given relevant assignments. On April 19 the Government of Georgia issued an Order (N--) on “Early Identification of Toxic Effect of Lead in Children and Management Measures “. Amendment envisaging addition and development of lead component to the Resolution No. 693 of December 2018 of the Government of Georgia on the Approval of 2019 Health Protection State Programmes has been prepared.

State Response Immediate response 16 children (with BLL≥30 μg/dL) and members of their families were tested (NCDC, pediatrician, National Environment Agency) Based on recommendations of the US Centers for Disease Control and Prevention and American Academy of Pediatrics, the Ministry of Health approved clinical protocol of Early Identification of Toxic Effect of Lead in Children and Management Measures which aims at prevention of harmful effect of lead, timely identification of lead level alleviation and efficient management of cases.

2019 State program All children participating in the survey, members of their families up to 18 years of age and pregnant women will be tested, treated and given relevant recommendations as per the protocol. Up to 18 years old children/population at risk will be tested by prescription of a doctor and relevant interventions will be made according to the long-term multisectoral programme to be developed within the following two months as per the order of the Government. To add subcomponent of the Health Promotion State Programme “Environment and Health”; 2 key priorities: air pollution and lead (educational and awareness raising campaign).

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