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Indoor air pollution

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Indoor air pollution

  2. 2.  Hazards of indoor air pollution to children’s health Different toxicants in indoor air, according to sources, settings and activities Characteristics and issues relating to indoor air pollution in industrialized and developing countries How to recognize, assess and address health effects How to prevent exposure to indoor air contaminants 2
  3. 3.  Scope of the problem of indoor air pollution Particulate matter Carbon monoxide Secondhand tobacco smoke Pesticides Solvents Volatile organic compounds Biological pollutants - Mites - Allergens - Moulds Built environment Radon Asbestos Occupation-related contaminants 3
  4. 4.  Coarse particles (2.5–10 micrometres) deposited in the upper respiratory tract and large airways Fine particles (< 2.5 micrometres) may reach terminal bronchioles and alveoli 4
  5. 5. Indoor air quality is influenced by: Outdoor air pollution: vehicles and industrial plants Secondhand tobacco smoke Fuels used for heating and cooking Confined and poorly ventilated spaces Overcrowded homes and insufficient living space Customs, habits, traditions Level of economic development: Industrialized ≠ developing countries 5
  6. 6. HOMES OF POOR CHILDREN MAY BE UNHEALTHY  2 000 000 deaths from ARI in < 5 yr olds (½ due to solid fuel use)  Rising trends of “wheezing” WHO Coal and biomass fuel: a major source of indoor air pollution Suspended particulate matter increases the risk of acute respiratory infections CO and other toxic gases may impair development and health Secondhand tobacco smoke a major concern 6
  7. 7. Acute: Irritation of the mucous membranes (eyes, nose, throat) Cough, wheeze, chest tightness Increased airway responsiveness to allergens Increased incidence of acute respiratory illness:  "cold", pneumonia, otitis media Tracheobronchitis Exacerbation of asthma 7
  8. 8. Chronic: Long-term exposure decreases lung growth Impairment of pulmonary function Increased susceptibility to chronic obstructive lung diseases, including asthma Other 8
  9. 9. Indoor environments also reflect outdoor air quality Industrial or agricultural activities Treatment of industrial effluents and domestic residues Traffic Solid waste management Cottage industries Chemical incidents and spills WHO 9
  10. 10. 10Nigel Bruce/ITDG
  11. 11. Sources Combustion productsGas stoves and appliances Carbon monoxide (CO)Wood and coal stovesGas and propane engines Nitrogen dioxide (NO2)Fireplaces Sulfur dioxide (SO2)Tobacco smokeCandles and incense Nitrogenated compounds (NOx)Mosquito coils Particulate matter (PM) 11
  12. 12. Open fire cooking stoves produce heavy smoke containing: Fine particles Carbon monoxide (CO) Polycyclic aromatic hydrocarbons (PAHs) Strongly linked to pneumonia Suggested link to low birth weight In adults: chronic obstructive pulmonary disease, lung cancer 12 WHO
  13. 13. HOUSEHOLD ENERGY, IAP AND HEALTH Dung Wood Agricultural residues 3 billion people rely on solid fuels Charcoal Coal Solid fuels comprise 10--15% of the total fuels used worldwide Cooking and heating levels indoor air pollution Most concern: particulate matter and carbon monoxide Women and children heavily exposed Nigel Bruce/ITDG 13
  14. 14. INDOOR AIR POLLUTION LEVELS ARE VERY HIGH  Level of particulates in home using biofuel: >1000 µg/m3 (24 hr mean)  Can reach 10 000 µg/m3 PM10 (if using an open fire)  EPA: 50 µg/m3 PM10 annual mean  Women and young children have greatest exposureNigel Bruce/ITDG 14
  15. 15. Age Attributable Attributable group mortality DALYs (yrs)0–4 56 835–14 0 015–59 5 860+ 38 9 Young children at high risk due to:  Lung immaturity High exposure to IAP: nearly 1 million children under 5 yrs die every year due to solid fuel use! 15 WHO
  16. 16. GLOBAL BURDEN OF DISEASE ATTRIBUTABLE TO SELECTED MAJOR RISK FACTORS Underweight Tobacco Unsafe sex Alcohol OverweightPercentage of totalburden (within region) 5% - Water, sanitation and hygiene (5.5%) Solid fuel use (3.7 %) Physical Zinc deficiency inactivity Tobacco Alcohol Occupational risks 1% - Overweight Unsafe sex Occupational injuries Ambient air Water, sanitation and hygiene Ambient air Lead Climate change Lead Developing countries Industrialized countries (high mortality) 16
  17. 17. Source of pollution Home environment User behaviour- Improved stoves -Hoods and chimneys - Fuel drying- Cleaner fuels -Windows, ventilation - Use of pot lids (kerosene, gas, holes, eaves - Good electricity) spaces maintenance -Separate kitchen - Keeping children away from smoke 17
  18. 18.  Colourless, odourless gas formed by incomplete burning of carbon- based fuels  CO’s affinity for Hb is 240–270 times greater than oxygen Fetal Hb has higher affinity for CO CO causes a leftward shift of the oxyhaemoglobin (OHb) dissociation curve. Multiple organ systems are affected 18
  19. 19.  Gas, kerosene, wood stoves and coal Fires, fireplaces, furnaces  Leaking chimneys and vents Room and water heaters Vehicle exhaust in closed garage Tobacco smoke EPAAny place where combustion is incomplete 19
  20. 20. 20
  21. 21.  Keep fuel-burning appliances in good working condition Check heating systems, chimneys and vents regularly Never burn charcoal indoors Never leave a car running in a closed garage Consider CO detectors 21
  22. 22. Symptoms:  Headache, dizziness, fatigue, dyspnoea  Nausea, vomiting  Irritability  Sleepiness, confusion, disorientation Unconsciousness, comab H OC gn saer c n I   Death i  Delayed neuropsychological sequelae (in survivors) 22
  23. 23. Diagnosis: Treatment: Measurement of COHb  Remove patient from  nonsmokers 1–3 % CO source  smokers 3–8%  Life support Not useful:  Oxygen 100%  Pulse oximeter  Monitoring  Arterial blood gases 23
  24. 24. Can lead mainly to : Cardiovascular effects.  Central nervous system effects Increased susceptibility to acute respiratory infections 24
  25. 25.  From inhaled toxic chemicals and/or thermal burns. The lungs and airways are affected in these ways:  tissue irritation  heat damage  Asphyxiation  potential cyanide poisoning Make the home safer:  Beware of matches and lighters  Install smoke alarms  Have a home fire escape plan 25
  26. 26. Children whose mothers smoke:  70% more respiratory problems  Pneumonia and hospitalization in year 1 is 38% higher  Infant mortality is 80% higher  20% of all infant deaths could be avoided if all pregnant smokers stopped by the 16th week of gestation  5 times higher risk of sudden infant death syndrome (SIDS) 26
  27. 27.  Respiratory tract illness Asthma Middle ear effusions Prenatal complications and low birth weight Fire-related injuries Sudden infant death syndrome (SIDS) Cancers (childhood leukemia and others) 27
  28. 28. THE LIFE CYCLE OF THE EFFECTS OF SMOKING ON HEALTH Asthma Otitis Media Influences Fire-related Injuries to Start Smoking SIDs RSV/Bronchiolitis Meningitis Childhood Infancy Adolescence Nicotine Addiction In utero Adulthood Low Birth Weight Stillbirth Cancer Cardiovascular Disease COPD Aligne, 1997 28
  29. 29.  Spraying pesticides at home / school:  Higher concentrations near the floor  Persistence in some surfaces (carpets, soft toys)  Overuse and misuse Children’s behaviour and inhalation of pesticides  Crawling  Playing close to the floor  Plush toys  Hand-to-mouth  Object-to-mouth 29
  30. 30. Classes commonly used for insect control indoors: Pyrethroids: allergenic, CNS toxicity at high levels Cholinesterase inhibitors: neurotoxicants, neurodevelopmental toxicants Insect repellents (DEET) Mosquito coilsHealth effects: Acute poisoning Allergic and general symptoms 30
  31. 31. Household use in Africa, Asia, South America  Major active ingredient – pyrethrins  Long-termexposures linked to asthma and wheezing 6177.html 31
  32. 32. Alkanes, aromatic hydrocarbons, alcohols, aldehydes, ketonesSources: Solvents, fabric softeners, deodorizers and cleaning products Paints, glues, resins, waxes and polishing materials Spray propellants, dry cleaning fluids Pens and markers Binders and plasticizers Cosmetics: hair sprays, perfumes 32
  33. 33. Acute: Irritation of eyes and respiratory tract General: headache, dizziness, loss of coordination, nausea, visual disorders Allergic reactions, including asthma and rhinitisChronic: Damage to liver, kidney, blood system and central nervous system (CNS) Some may cause cancer in humans (formaldehyde) 33
  34. 34. Sources: differ according to country Developing countries  Use of solid fuels indoors  Mosquito coils  Furniture (pressed wood) Industrialized countries  Household cleaners and deodorizers  Glues and resins  Tobacco smoke  Carpeting  Furniture and dyed materials  Pressed wood products  Urea formaldehyde insulating foam (UFFI)  Others 34
  35. 35.  Irritation of eyes, nose and throat Breathing difficulties Skin rash Asthma and other allergic reactions May be a sensitizer May cause cancerPrevention: Reduce exposure Provide adequate ventilation Maintain moderate temperature and humidity levels 35
  36. 36. Biological pollutants are/were living organisms:Animal dander, dust mites, moulds, infectious agents, pollenSources of biological agents: Water-damaged surfaces and materials Humidifiers and stagnant water Water vapour from cooking and showering Air conditioning systems Mattresses, upholstered furniture and carpets Dirt 36
  37. 37.  Feed on human dander Prefer warm, humid environments Sources:  bedding, carpets, upholstery, soft toysPrevention: Encasing mattress and pillows Washing bedding in hot water Frequent vacuuming / damp mopping CDC Decreasing clutter Removing carpets 37
  38. 38.  Cat dander (most allergenic) Dog dander Birds Cockroach parts and faecesPrevention: Remove animals from indoors  Allergens persist for many months after removal of source Clean environment and pet(s) frequently Ventilate adequately Control dust and moisture 38
  39. 39.  A frequently undetected environmental problem Occur in damp indoor areas Allergies and nonspecific symptoms are common, but infections are rare EPA 39
  40. 40.  Airway and conjunctival irritation Headache Difficulty in concentrating Hypersensitivity reactions: asthma, rhinitis Systemic infections (immunosuppressed child) Acute exposure associated with pulmonary haemorrhage in infants 40
  41. 41. Mycotoxins are associated with human disease andcause acute and chronic effects Mycotoxins  Aflatoxins  Tricothecenes  Ochratoxins and citrinin  Hundreds of others Glucans (cell wall components) Volatile organic compounds (irritating) 41
  42. 42. The importance of: Materials in houses and schools:  Asbestos, wood preservatives, paints and others Ventilation Heating Use (overuse) and location of electric appliances Air conditioning 42
  43. 43. What is this syndrome? Discomfort not related to specific illness Effects appear to be linked to time spent inside the building Cause of symptoms is unknown Most complaints relieved soon after leaving the building An evolving areaBuilding related illness: symptoms of identified illness attributed to airborne contaminants in the building 43
  44. 44. Possible causes: Inadequate building design Occupant activities Remodelled buildings operating in a manner inconsistent with their original design Inadequate ventilation Inadequate maintenance Chemical and biological contaminants 44
  45. 45. Symptoms: Solutions:  Headache  Remove source of  Irritation of eyes, nose or pollutant throat  Increase ventilation  Dry cough  Air cleaning: filters  Dry or itchy skin  Education and  Difficulty in concentrating communication  Fatigue  Sensitivity to odours 45
  46. 46.  Radioactive gas released from soil and rocks Second leading cause of lung cancer (in adults) Geology of the area can predict levels in soil and water Concentrations indoors depend on construction site and building materials Highest levels occur in basements and on the ground floor 46
  47. 47. A – Gas-permeable layerB - Plastic sheetingC - Sealing and caulkingD - Vent pipeE - Junction box It is recommended that homes be tested for radon on the lowest lived-in level – basement or ground floor 47
  48. 48. Sources: Used for insulation and as fire-retardant: asbestos cement, floor and roof tiles, water pipes and others Levels increase if asbestos-containing materials are damaged Levels can be high in clothes of working parentsHealth effects: No acute toxicity Asbestosis results from occupational exposure Main risk for children: long-term exposure may cause cancer in adulthood  Malignant mesothelioma  Lung cancer 48
  49. 49. Parents “take home” exposures related to work: Contaminated clothing, shoes and objects Contaminated skin and exhaled breath Empty containers (pesticide and others)Children are directly exposed when: Visiting parents’ workplaces Participating in workPrevention Change work clothes and shower before hugging or playing with children 49
  50. 50. Child labour and adolescent work: exposure to pesticides, solvents, cleaning agents and other chemicals indoors Young children employed illegally Unregulated temporary work School-based vocational training Family businesses Cottage industries Indoor smoke from solid fuels (e.g. food stands) Volunteer service projects 50
  51. 51. SUMMARY SLIDE HAZARDS: SETTINGS: Particulates, MEDIUM -Home CO, Solvents, Air -Child care Pesticides, -School Lead, moulds, -Workplace Mites, pollen Playground ACTIVITIES Sports place Playing, Studying, Eating, Drinking, Working, SleepingSUSCEPTIBILITIES: OUTCOME-EFFECTS:-Lungs still immature - Acute poisonings-Higher breathing rate - Respiratory diseases-More time indoors - Allergies - Developmental-Nutritional status disturbances-Poverty (photo credit US NIEHS CERHR logo) - Cancer 51
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