INDOOR AIR POLLUTION - Children''''s Health and the Environment potx

1 INDOOR AIR POLLUTION Children's Health and the Environment WHO Training Package for the Health Sector World Health Organization www.who.int/ceh TRAINING FOR THE HEALTH SECTOR TRAINING FOR THE HEALTH SECTOR [Date [Date … … Place Place … … Event Event … … Sponsor Sponsor … … Organizer] Organizer] July 2008 version <<NOTE TO USER: Please add details of the date, time, place and sponsorship of the meeting for which you are using this presentation in the space indicated.>> <<NOTE TO USER: This is a large set of slides from which the presenter should select the most relevant ones to use in a specific presentation. These slides cover many facets of the problem. A number of slides refer to the specific issues related to indoor air pollution in developing countries, as it represents a major determinant of the burden of disease in children. Present only those slides that apply most directly to the local situation in the region.>> 2 Indoor Air Pollution Indoor Air Pollution LEARNING OBJECTIVES LEARNING OBJECTIVES TO UNDERSTAND, RECOGNIZE AND KNOW: TO UNDERSTAND, RECOGNIZE AND KNOW:  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 <<READ SLIDE>> 3 Indoor Air Pollution Indoor Air Pollution OUTLINE OUTLINE   Scope of the problem of indoor air pollution Scope of the problem of indoor air pollution   Particulate matter Particulate matter   Carbon monoxide Carbon monoxide   Secondhand Secondhand tobacco smoke tobacco smoke   Pesticides Pesticides   Solvents Solvents   Volatile organic compounds Volatile organic compounds   Biological pollutants Biological pollutants - - Mites Mites - - Allergens Allergens - - Moulds Moulds   Built environment Built environment   Radon Radon   Asbestos Asbestos   Occupation Occupation - - related contaminants related contaminants <<READ SLIDE>> <<NOTE TO USER: When selecting the slides to include in your presentation, please choose only those of relevance to the region/country and/or the interests of your audience.>> The indoor contaminants addressed in this module include: •Particulate matter •Carbon monoxide •Secondhand tobacco smoke •Pesticides •Solvents •Volatile organic compounds •Biological pollutants - Mites - Allergens - Moulds •Built environment •Radon •Asbestos •Occupation-related contaminants 4 Indoor Air Pollution Indoor Air Pollution CHILDREN CHILDREN ’ ’ S UNIQUE VULNERABILITY S UNIQUE VULNERABILITY   Inhale more pollutants per kilogram of body weight than Inhale more pollutants per kilogram of body weight than do adults do adults   Because airways are narrower, irritation can result in Because airways are narrower, irritation can result in proportionately greater airway obstruction proportionately greater airway obstruction WHO Infants and young children have a higher resting metabolic rate and rate of oxygen consumption per unit body weight than adults because they have a larger surface area per unit body weight and because they are growing rapidly. Therefore, their exposure to any air pollutant may be greater. In addition to an increased need for oxygen relative to their size, children have narrower airways than do adults. Thus, irritation caused by air pollution that would produce only a slight response in an adult can result in potentially significant obstruction in the airways of a young child. Ref: •Moya J et al. Children’s behavior and physiology and how it affects exposure to environmental contaminants. Pediatrics, 2004, 113:996. •American Academy of Pediatrics Committee on Environmental Health. Pediatric Environmental Health, 2 nd ed. Etzel RA, Ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003. •Children's Health and the Environment – A global perspective. A resource guide for the health sector, WHO, 2005. 5 Indoor Air Pollution Indoor Air Pollution SMALLER AIRWAYS MORE VULNERABLE SMALLER AIRWAYS MORE VULNERABLE www.vh.org/pediatric/provider/pediatrics/ElectricAirway/Diagrams/AirwayDIaneterEdema.jpg The effect of oedema on the adult airway is much less dramatic than it is on the newborn’s airway. One millimetre of oedema reduces the diameter of the adult airway by about 19% whereas it reduces the diameter of the infant airway by 56%. Compared to that of adults, the peripheral airway (bronchioles) is both relatively and absolutely smaller in infancy allowing intralumenal debris to cause proportionately greater obstruction. In addition, infants have relatively larger mucous glands, with a concomitant increase in secretions. They also have the potential for increased oedema because their airway mucosa is less tightly adherent. Lastly, there are fewer interalveolar pores (Kohn’s pores) in the infant, producing a negative effect on collateral ventilation and increasing the likelihood of hyperinflation or atelectasis. The resting minute ventilation normalized for body weight in a newborn infant (400 cc/min/kg) is more than double that of an adult (150 cc/min/kg). Ref: •Bar-on ME et al. Bronchiolitis. Prim Care, 1996, 23:805-19. Picture: www.vh.org/pediatric/provider/pediatrics/ElectricAirway/Diagrams/AirwayDIaneterEdema.jpg - Copyright protected material used with permission of the authors: Drs. Michael and Donna D'Alessandro - and the University of Iowa's Virtual Hospital, www.vh.org 6 Indoor Air Pollution Indoor Air Pollution DEPOSITION OF POLLUTANTS IN RESPIRATORY TRACT DEPOSITION OF POLLUTANTS IN RESPIRATORY TRACT CDC Respirable particles and gases affect different parts of the respiratory tree depending upon their inherent characteristics. For gases, relative solubility is important. For particles, size is important. This slide shows the upper, middle and lower respiratory tract. Note that sulfur dioxide, because it is highly water soluble, initially affects the upper airway, whereas ozone, which has medium solubility, initially affects the middle airways, and nitrogen dioxide, which has low solubility, initially affects the lower airways. 7 Indoor Air Pollution Indoor Air Pollution SIZE MATTERS SIZE MATTERS   Coarse particles (2.5 Coarse particles (2.5 – – 10 10 micrometres micrometres ) deposited in ) deposited in the upper respiratory tract the upper respiratory tract and large airways and large airways   Fine particles (< 2.5 Fine particles (< 2.5 micrometres micrometres ) may reach ) may reach terminal bronchioles and terminal bronchioles and alveoli alveoli Particle size is the most important factor in determining where particles are deposited in the lung. Compared with large particles, fine particles can remain suspended in the atmosphere for longer periods and be transported over longer distances. Some studies suggest that fine particles have stronger respiratory effects in children than large particles. This diagram shows that particles greater than 10 micrometres rarely make it past the upper airways, whereas fine particles smaller than 2 micrometres can make it as far as the alveoli. Ref: •World Health Organization. Air Quality Guidelines. Geneva, World Health Organization: Department of Protection of the Human Environment, 2005. 8 Indoor Air Pollution Indoor Air Pollution RESPIRATORY DEVELOPMENT: RESPIRATORY DEVELOPMENT: CONTINUES THROUGH LINEAR GROWTH CONTINUES THROUGH LINEAR GROWTH 10 X 10 6 Alveoli 300 X 10 6 Alveoli (age 8) Growth/structure • Second-hand tobacco smoke • Particulates • Ozone Function • Indoor air quality • Ambient ozone Dieter,t 2000 2 to 8 2 to 8 Like the nervous system, the respiratory system continues to grow and develop through linear growth. The upper section of the diagram depicts the different developmental phases of the lungs corresponding to the age of the embryo/fetus. It may be seen that at birth, a baby has about 10 million alveoli, but at age 8 years, the lungs have grown and the number of alveoli has reached 300 million. Exposures during this growth period are known to have adverse consequences on both structure (growth of the lungs, as illustrated in the diagram) and function (which is affected by indoor air quality and ozone exposure). Figure: Dietert RR et al. Workshop to identify critical windows of exposure for children's health: immune and respiratory systems – work group summary. Environmental Health Perspectives, 2000, 108:483-90. Reproduced with permission from Environmental Health Perspectives 9 Indoor Air Pollution Indoor Air Pollution 0 20000 40000 60000 80000 100000 120000 140000 160000 Underweight Unsafe water, sanitation and hygiene Indoor smoke from solid fuels Zinc deficiency Vitamin A deficiency Iron deficiency Unsafe sex Lead exposure Climate change Unsafe health care injections Ambient air pollution Alcohol Illicit drugs Attributable burden of disease 0–4 years 1000 DALY World Health Report 2002 In analyses by the World Health Organization (WHO) in 2002, the indoor smoke from solid fuels accounted for the third highest disability-adjusted life years (DALYs) for children 0 to 4 years of age. The DALY is a health measure that incorporates loss of quality of life as well as loss of years of life. One DALY is the loss of one healthy life year. Ref: •World Health Report 2002 (www.who.int/whr/2002/en/). Picture: World Health Report 2002 10 Indoor Air Pollution Indoor Air Pollution CHILDREN CHILDREN ’ ’ S INDOOR EXPOSURE S INDOOR EXPOSURE Level of economic development is a key factor Level of economic development is a key factor   Developing and industrialized countries Developing and industrialized countries   Rural and urban areas Rural and urban areas   Local climate Local climate   Architecture/ventilation Architecture/ventilation In urban areas, children In urban areas, children may spend most of their time indoors. may spend most of their time indoors.   Most Most exposure to air contaminants occurs exposure to air contaminants occurs inside homes and schools. inside homes and schools. WHO <<READ SLIDE>> The level of economic development is a key factor in determining children’s exposures and the potential for responding to or improving their environment. The level of social and economic development is linked closely to determinants of indoor air pollution (IAP). There are major differences between developing and industrialized countries: IAP results from solid fuel use in the former, and from "chemicals" and "new substances" (e.g. formaldehyde, insecticides and phthalates) in the latter. However, secondhand tobacco smoke is a pollutant common to both settings. IAP also differs between rural and urban areas due to the different economies and lifestyles. For example, dust and organic particles are more common in agricultural areas and mites or fungal contaminants in closed, unventilated urban dwellings. The local climate conditions should also be taken into consideration, as they have an impact on architecture (building materials used, structure, room distribution and characteristics) and – particularly – on the ventilation of the dwelling. Children in urban areas spend most of their time indoors, which means that their primary exposure to air pollution may come from air inside homes and schools rather than outdoors. There are numerous situations in homes and schools which may result in possible exposure to contaminants, such as second-hand tobacco smoke, spraying of insecticides, accumulation of pollutants in carpets, poor quality air and others. Children may also be exposed where they play or at workplaces. The quality of children’s environments can cause or prevent illness, disability and injury. Picture: WHO. [...]... asthma Other 14 Indoor Air Pollution ENVIRONMENT AND POLLUTION 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 15 The indoor environment also reflects outdoor air quality and pollution Outdoor pollution. .. disability-adjusted life year The DALY is a health measure that incorporates loss of quality of life as well as loss of years of life One DALY is the loss of one healthy life year IAP = indoor air pollution Ref: The health effects of indoor air pollution exposure in developing countries Concise summary of the evidence for health effects of exposure to indoor air pollution from solid fuel use in children and. .. pressure and alcohol consumption Notes taken from www.who.int/indoorair/info/en/briefing2.pdf Refs: Indoor air pollution in developing countries: a major environmental and public health challenge Bulletin of the World Health Organization, 2000 •World Health Report 2002 Indoor Air Thematic Briefing 2 (www.who.int/indoorair/info/en/briefing2.pdf) Additional information can be found at: www.who.int/indoorair/publications/en/... and adults Geneva, World Health Organization, 2002 Indoor air pollution: national burden of disease estimates Geneva, World Health Organization, 2007 •Fuel for life: household energy and health Geneva, World Health Organization, 2006 Indoor air pollution from solid fuels and risk of low birthweight and stillbirth Geneva, World Health Organization, 2007 Indoor air pollution and respiratory tract infections... Ultimately, making the transition to gas and electricity will save lives and reduce the physical toll on women and children from gathering wood, freeing time for education and development This problem has been largely ignored by policy-makers Ref: •Gordon B et al Inheriting the world, the Atlas on Children's Health and the Environment Geneva, World Health Organization, 2004 Indoor Air Pollution AGE DISTRIBUTION... www.who.int/indoorair/publications/en/ Indoor Air Pollution WHAT INTERVENTIONS ARE AVAILABLE TO REDUCE INDOOR AIR POLLUTION FROM SOLID FUELS? Source of pollution Home environment - Improved stoves - Cleaner fuels (kerosene, gas, electricity) -Hoods and chimneys -Windows, ventilation holes, eaves spaces -Separate kitchen User behaviour - Fuel drying - Use of pot lids - Good maintenance - Keeping children away from... outdoor air pollutants, indoor sources of pollution, characteristics of the building and the habits of the residents Indoor air pollution may arise from the use of open fires, unsafe fuels or combustion of biomass fuels, coal and kerosene Gas stoves or badly installed wood-burning units with poor ventilation and maintenance can increase the indoor levels of carbon monoxide, nitrogen dioxide and particles... with the percentage of total body surface area burned The lungs and airways are affected in three ways: heat damage, tissue irritation, and oxygen starvation of tissues (asphyxiation) How to make the home safer: 1) Beware of matches and lighters around the house -Store them out of reach and sight -Teach toddlers to tell you when they find one and explain to them that these tools are only for adults -Never... and develop different escape plans -When escaping, crawl low under the smoke Touch doors before opening: if they are hot, use an alternative route -Teach children NEVER to go back inside the house -Practice the fire escape plans and teach children how to cover their nose and mouth to reduce smoke inhalation -If there are babies and toddlers: keep a harness by the crib to be able to carry the baby and. .. high levels of indoor air pollution (IAP), a complex mix of health- damaging pollutants (e.g particulate matter and carbon monoxide) Women and young children, who spend most time at home, experience the largest exposures and health burdens IAP = indoor air pollution Picture: Nigel Bruce/ITDG Used with permission Indoor Air Pollution INDOOR AIR POLLUTION LEVELS ARE VERY HIGH Level of particulates in home . Air Pollution 16 Indoor Air Pollution Indoor Air Pollution INDOOR AIR POLLUTION ALSO AFFECTS OUTDOOR AIR INDOOR AIR POLLUTION ALSO AFFECTS OUTDOOR AIR. asthma  Other <<READ SLIDE.>> 15 Indoor Air Pollution Indoor Air Pollution ENVIRONMENT AND POLLUTION ENVIRONMENT AND POLLUTION Indoor environments