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INDOOR AIR POLLUTION
Children's Health and the EnvironmentWHO Training Package for the Health Sector
World Health Organization
www.who.int/ceh
TRAINING FOR THE HEALTH SECTORTRAINING FOR THE HEALTH SECTOR [Date …Place …Event…Sponsor…Organizer] [Date …Place …Event…Sponsor…Organizer]
2
Indoor Air Pollution Indoor Air Pollution
LEARNING OBJECTIVESLEARNING OBJECTIVESTO 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
3
Indoor Air Pollution Indoor Air Pollution
OUTLINEOUTLINE
Scope of the problem of indoor air pollution Scope of the problem of indoor air pollution Particulate matterParticulate matter Carbon monoxideCarbon monoxide Secondhand tobacco smokeSecondhand tobacco smoke PesticidesPesticides SolventsSolvents Volatile organic compoundsVolatile organic compounds Biological pollutantsBiological pollutants
- Mites- Mites- Allergens- Allergens- Moulds- Moulds
Built environmentBuilt environment Radon Radon AsbestosAsbestos OccupationOccupation--related contaminantsrelated contaminants
4
Indoor Air Pollution Indoor Air Pollution
CHILDREN’S UNIQUE VULNERABILITYCHILDREN’S UNIQUE VULNERABILITY
Inhale more pollutants per kilogram of body weight than Inhale more pollutants per kilogram of body weight than do adultsdo adults
Because airways are narrower, irritation can result in Because airways are narrower, irritation can result in proportionately greater airway obstructionproportionately greater airway obstruction
WHO
5
Indoor Air Pollution Indoor Air Pollution
SMALLER AIRWAYS MORE VULNERABLESMALLER AIRWAYS MORE VULNERABLE
www.vh.org/pediatric/provider/pediatrics/ElectricAirway/Diagrams/AirwayDIaneterEdema.jpg
6
Indoor Air Pollution Indoor Air Pollution
DEPOSITION OF POLLUTANTS IN RESPIRATORY TRACTDEPOSITION OF POLLUTANTS IN RESPIRATORY TRACT
CDC
7
Indoor Air Pollution Indoor Air Pollution
SIZE MATTERSSIZE MATTERS
Coarse particles (2.5–10 Coarse particles (2.5–10 micrometres) deposited in micrometres) deposited in the upper respiratory tract the upper respiratory tract and large airwaysand large airways
Fine particles (< 2.5 Fine particles (< 2.5 micrometres) may reach micrometres) may reach terminal bronchioles and terminal bronchioles and alveolialveoli
8
Indoor Air Pollution Indoor Air Pollution
RESPIRATORY DEVELOPMENT:RESPIRATORY DEVELOPMENT:CONTINUES THROUGH LINEAR GROWTHCONTINUES THROUGH LINEAR GROWTH
10 X 106 Alveoli300 X 106 Alveoli (age 8)
Growth/structure • Second-hand tobacco smoke• Particulates• Ozone
Function• Indoor air quality• Ambient ozone
Dieter,t 2000
2 to 82 to 8
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
10
Indoor Air Pollution Indoor Air Pollution
CHILDREN’S INDOOR EXPOSURECHILDREN’S INDOOR EXPOSURE
Level of economic development is a key factorLevel of economic development is a key factor
Developing and industrialized countriesDeveloping and industrialized countries Rural and urban areasRural and urban areas Local climateLocal climate Architecture/ventilationArchitecture/ventilation
In urban areas, children In urban areas, children
may spend most of their time indoors.may spend most of their time indoors.
Most exposure to air contaminants occurs Most exposure to air contaminants occurs
inside homes and schools.inside homes and schools.
WHO
11
Indoor Air Pollution Indoor Air Pollution
INDOOR AIR QUALITYINDOOR AIR QUALITY
Indoor air quality is influencedIndoor air quality is influenced byby::
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
12
Indoor Air Pollution Indoor Air Pollution
2 000 000 deaths from ARI in < 5 yr olds (½ due to solid fuel use)
Rising trends of “wheezing”
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
HOMES OF POOR CHILDREN MAY BE UNHEALTHY HOMES OF POOR CHILDREN MAY BE UNHEALTHY
WHO
13
Indoor Air Pollution Indoor Air Pollution
ADVERSE HEALTH EFFECTS OF AIR POLLUTANTSADVERSE HEALTH EFFECTS OF AIR POLLUTANTS
Acute: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
14
Indoor Air Pollution Indoor Air Pollution
ADVERSE HEALTH EFFECTS OF AIR POLLUTANTSADVERSE HEALTH EFFECTS OF AIR POLLUTANTS
ChronicChronic::
Long-term exposure decreases lung growth
Impairment of pulmonary function
Increased susceptibility to chronic obstructive lung diseases, including asthma
Other
15
Indoor Air Pollution Indoor Air Pollution
ENVIRONMENT AND POLLUTIONENVIRONMENT AND POLLUTION
Indoor environments also reflect Indoor environments also reflect outdooroutdoor air quality air quality
Industrial or agricultural activities
Treatment of industrial effluents and domestic residues
Traffic
Solid waste management
Cottage industries
Chemical incidents and spills
WHO
16
Indoor Air Pollution Indoor Air Pollution
INDOOR AIR POLLUTION ALSO AFFECTS OUTDOOR AIR INDOOR AIR POLLUTION ALSO AFFECTS OUTDOOR AIR QUALITYQUALITY
Nigel Bruce/ITDG
17
Indoor Air Pollution Indoor Air Pollution
COMBUSTION PRODUCTSCOMBUSTION PRODUCTS
SourcesSources
Gas stoves and appliances
Wood and coal stoves
Gas and propane engines
Fireplaces
Tobacco smoke
Candles and incense
Mosquito coils
Combustion productsCombustion products
Carbon monoxide (CO)
Nitrogen dioxide (NO2)
Sulfur dioxide (SO2)
Nitrogenated compounds (NOx)
Particulate matter (PM)
18
Indoor Air Pollution Indoor Air Pollution
SMOKY COOKING FUELSSMOKY COOKING FUELS
Open fire cooking stoves produce heavy smoke containing: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
WHO
19
Indoor Air Pollution Indoor Air Pollution
HOUSEHOLD ENERGY, IAP AND HEALTHHOUSEHOLD ENERGY, IAP AND HEALTH
3 billion people rely on solid fuels
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
Dung Wood Agricultural residues Charcoal Coal
Nigel Bruce/ITDG
20
Indoor Air Pollution Indoor Air Pollution
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 exposure
INDOOR AIR POLLUTION LEVELS ARE VERY HIGHINDOOR AIR POLLUTION LEVELS ARE VERY HIGH
Nigel Bruce/ITDG
22
Indoor Air Pollution Indoor Air Pollution
AGE DISTRIBUTION OF GLOBAL BURDEN OF DISEASE AGE DISTRIBUTION OF GLOBAL BURDEN OF DISEASE ATTRIBUTABLE TO SOLID FUEL USEATTRIBUTABLE TO SOLID FUEL USE
Age group (yrs)
Attributable mortality
Attributable DALYs
0–4 56 83 5–14 0 0 15–59 5 8 60+ 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!
WHO
23
Indoor Air Pollution Indoor Air Pollution
LeadLeadLeadLeadClimate changeClimate change
Perc
ent
Perc
ent a
geage
of to
tal
of t
otal
bu
rden
burd
en (w
ithin
regi
on)
(with
in re
gion
)
1% -1% -
5% -5% - Water, sanitation and hygiene (5.5%)Water, sanitation and hygiene (5.5%)
UnderweightUnderweight
Solid fuel use (3.7 %)Solid fuel use (3.7 %)
Ambient airAmbient air Occupational injuriesOccupational injuries
Developing countriesDeveloping countries(high mortality)(high mortality)
Industrialized countriesIndustrialized countries
Occupational risksOccupational risks
Alcohol Alcohol Tobacco Tobacco
Overweight Overweight Unsafe sexUnsafe sex
Tobacco Tobacco Alcohol Alcohol
Ambient airAmbient air Water, sanitation and hygieneWater, sanitation and hygieneOverweight Overweight Unsafe sexUnsafe sex
Physical Physical inactivityinactivityZinc deficiencyZinc deficiency
GLOBAL BURDEN OF DISEASE ATTRIBUTABLE TO GLOBAL BURDEN OF DISEASE ATTRIBUTABLE TO SELECTED MAJOR RISK FACTORSSELECTED MAJOR RISK FACTORS
24
Indoor Air Pollution Indoor Air Pollution
WHAT INTERVENTIONS ARE AVAILABLE TO REDUCE WHAT INTERVENTIONS ARE AVAILABLE TO REDUCE INDOOR AIR POLLUTION FROM SOLID FUELS?INDOOR AIR POLLUTION FROM SOLID FUELS?
- Fuel drying- Fuel drying
- Use of pot lids- Use of pot lids
- Good - Good maintenancemaintenance
- Keeping children- Keeping children away from smoke away from smoke
-Hoods and chimneys-Hoods and chimneys
-Windows, ventilation -Windows, ventilation holes, eaves holes, eaves spacesspaces
-Separate kitchen-Separate kitchen
- Improved stoves- Improved stoves
- Cleaner fuels- Cleaner fuels (kerosene, gas, (kerosene, gas, electricity) electricity)
UserUser behaviourbehaviourHomeHome environmentenvironmentSource of pollutionSource of pollution
25
Indoor Air Pollution Indoor Air Pollution
CARBON MONOXIDE: THE "SILENT KILLER"CARBON MONOXIDE: THE "SILENT KILLER"A COMMON CAUSE OF ACUTE AND LETHAL POISONINGA COMMON CAUSE OF ACUTE AND LETHAL POISONING
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
Intoxication results in tissue hypoxia
Multiple organ systems are affectedwww.cdc.gov/nceh/airpollution/carbonmonoxide/checklist.htm
26
Indoor Air Pollution Indoor Air Pollution
CARBON MONOXIDE (CO): SOURCESCARBON MONOXIDE (CO): SOURCES
Gas, kerosene, wood stoves and coal Fires, fireplaces, furnaces Leaking chimneys and vents Room and water heaters Vehicle exhaust in closed garage Tobacco smoke
Any place where combustion is incompleteEPA
28
Indoor Air Pollution Indoor Air Pollution
PREVENTION OF EXPOSURE TO CO PREVENTION OF EXPOSURE TO CO
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
29
Indoor Air Pollution Indoor Air Pollution
CARBON MONOXIDE POISONING CAN KILL CARBON MONOXIDE POISONING CAN KILL
Symptoms:
Headache, dizziness, fatigue, dyspnoea
Nausea, vomiting
Irritability
Sleepiness, confusion, disorientation
Unconsciousness, coma
Death
Delayed neuropsychological sequelae (in survivors)
Incr
ea
sin
g C
OH
b
30
Indoor Air Pollution Indoor Air Pollution
MANAGEMENTMANAGEMENT
Diagnosis: Measurement of COHb
nonsmokers 1–3 % smokers 3–8%
Not useful: Pulse oximeter Arterial blood gases
Treatment: Remove patient from
CO source Life support Oxygen 100% Hyperbaric oxygen? Monitoring
31
Indoor Air Pollution Indoor Air Pollution
CHRONIC EXPOSURECHRONIC EXPOSURE
Acute or chronic exposure to low levels of carbon monoxide (research in animals and humans):
Linked to development of arteriosclerosis ?Aggravation of cardiovascular diseases ?Poor performance on certain psychomotor tasks Limited exercise capacity
32
Indoor Air Pollution Indoor Air Pollution
Can lead mainly to :
Cardiovascular effects.
Central nervous system effects
Increased susceptibility to acute respiratory infections
CHRONIC EXPOSURECHRONIC EXPOSURE
33
Indoor Air Pollution Indoor Air Pollution
FIRE INJURIESFIRE INJURIES
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
34
Indoor Air Pollution Indoor Air Pollution
SECONDHAND TOBACCO SMOKE SECONDHAND TOBACCO SMOKE
SCOPE OF THE PROBLEMSCOPE OF THE PROBLEM
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)
35
Indoor Air Pollution Indoor Air Pollution
SECONDHAND SMOKE INCREASES RISK OF:SECONDHAND SMOKE INCREASES RISK OF:
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)
36
Indoor Air Pollution Indoor Air Pollution
THE LIFE CYCLE OF THE EFFECTS OF SMOKING ON THE LIFE CYCLE OF THE EFFECTS OF SMOKING ON HEALTHHEALTH
SIDsSIDsRSV/BronchiolitisRSV/BronchiolitisMeningitisMeningitis
InfancyInfancy
Low Birth WeightLow Birth WeightStillbirthStillbirth
In uteroIn utero
AsthmaAsthmaOtitis MediaOtitis MediaFire-related InjuriesFire-related Injuries
InfluencesInfluencesto Startto StartSmokingSmoking
Nicotine AddictionNicotine Addiction
CancerCancerCardiovascular DiseaseCardiovascular DiseaseCOPDCOPD
AdulthoodAdulthood
AdolescenceAdolescence
ChildhoodChildhood
Aligne, 1997
37
Indoor Air Pollution Indoor Air Pollution
PESTICIDES PESTICIDES
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
38
Indoor Air Pollution Indoor Air Pollution
PESTICIDES: INSECTICIDESPESTICIDES: INSECTICIDES
Classes commonly used for insect control indoors:Classes commonly used for insect control indoors:
Pyrethroids: allergenic, CNS toxicity at high levels Cholinesterase inhibitors: neurotoxicants,
neurodevelopmental toxicants Insect repellents (DEET) Mosquito coils
Health effects:Health effects:
Acute poisoning Allergic and general symptoms
39
Indoor Air Pollution Indoor Air Pollution
MOSQUITO COILSMOSQUITO COILS
Household use in Africa, Asia, South America
Major active ingredient – pyrethrins
Long-term exposures linked to asthma
and wheezing
ehp.niehs.nih.gov/members/2003/6177/6177.html
40
Indoor Air Pollution Indoor Air Pollution
SOLVENTS AND VOLATILE ORGANIC COMPOUNDSSOLVENTS AND VOLATILE ORGANIC COMPOUNDS
Alkanes, aromatic hydrocarbons, alcohols, aldehydes, ketonesAlkanes, aromatic hydrocarbons, alcohols, aldehydes, ketones
Sources:Sources: 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
www.epa.gov/oppfead1/cb/10_tips/
41
Indoor Air Pollution Indoor Air Pollution
VOLATILE ORGANIC COMPOUNDS: HEALTH EFFECTSVOLATILE ORGANIC COMPOUNDS: HEALTH EFFECTS
Acute:Acute: Irritation of eyes and respiratory tract General: headache, dizziness, loss of coordination, nausea,
visual disorders Allergic reactions, including asthma and rhinitis
Chronic:Chronic: Damage to liver, kidney, blood system and
central nervous system (CNS) Some may cause cancer in humans (formaldehyde)
42
Indoor Air Pollution Indoor Air Pollution
FORMALDEHYDEFORMALDEHYDE
Sources: differ according to countrySources: differ according to country
Developing countriesDeveloping countries Use of solid fuels indoors Mosquito coils Furniture (pressed wood)
Industrialized countriesIndustrialized countries Household cleaners and deodorizers Glues and resins Tobacco smoke Carpeting Furniture and dyed materials Pressed wood products Urea formaldehyde insulating foam (UFFI) Others
43
Indoor Air Pollution Indoor Air Pollution
FORMALDEHYDE: HEALTH EFFECTSFORMALDEHYDE: HEALTH EFFECTS
Irritation of eyes, nose and throat
Breathing difficulties
Skin rash
Asthma and other allergic reactions
May be a sensitizer
May cause cancer
PreventionPrevention::
Reduce exposure
Provide adequate ventilation
Maintain moderate temperature and humidity levels
44
Indoor Air Pollution Indoor Air Pollution
BIOLOGICAL POLLUTANTSBIOLOGICAL POLLUTANTS
Biological pollutants are/were living organisms:
Animal dander, dust mites, moulds, infectious agents, pollen
Sources 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
45
Indoor Air Pollution Indoor Air Pollution
DUST MITESDUST MITES
Feed on human dander Prefer warm, humid environments Sources:
bedding, carpets, upholstery, soft toys
Prevention: Encasing mattress and pillows Washing bedding in hot water Frequent vacuuming / damp mopping Decreasing clutter Removing carpets
CDC
46
Indoor Air Pollution Indoor Air Pollution
ANIMAL ALLERGENSANIMAL ALLERGENS
Cat dander (most allergenic) Dog dander Birds Cockroach parts and faeces
Prevention: 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
47
Indoor Air Pollution Indoor Air Pollution
MOULDSMOULDS
A frequently undetected environmental problem Occur in damp indoor areas Allergies and nonspecific symptoms are common, but
infections are rare
EPA
48
Indoor Air Pollution Indoor Air Pollution
MOULD-RELATED DISEASESMOULD-RELATED DISEASES
Airway and conjunctival irritation
Headache
Difficulty in concentrating
Hypersensitivity reactions: asthma, rhinitis
Systemic infections (immunosuppressed child)
Acute exposure associated with pulmonary haemorrhage in infants
49
Indoor Air Pollution Indoor Air Pollution
CHEMICAL AGENTS PRODUCED BY MOULDSCHEMICAL AGENTS PRODUCED BY MOULDS
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)
50
Indoor Air Pollution Indoor Air Pollution
INDOOR AIR QUALITY: INDOOR AIR QUALITY: BUILDING COMPONENTSBUILDING COMPONENTS
The importance of:The importance of: Materials in houses and schools: Materials in houses and schools:
Asbestos, wood preservatives, paints and others
VentilationVentilation HeatingHeating Use (overuse) and location of electric appliancesUse (overuse) and location of electric appliances Air conditioningAir conditioning
51
Indoor Air Pollution Indoor Air Pollution
SICK BUILDING SYNDROMESICK BUILDING SYNDROME
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 area
Building related illness: symptoms of identified illness attributed to airborne contaminants in the building
52
Indoor Air Pollution Indoor Air Pollution
SICK BUILDING SYNDROMESICK BUILDING SYNDROME
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
53
Indoor Air Pollution Indoor Air Pollution
SICK BUILDING SYNDROMESICK BUILDING SYNDROME
Symptoms:Symptoms:
Headache Irritation of eyes, nose or
throat Dry cough Dry or itchy skin Difficulty in concentrating Fatigue Sensitivity to odours
Solutions:Solutions:
Remove source of pollutant
Increase ventilation Air cleaning: filters Education and
communication
54
Indoor Air Pollution Indoor Air Pollution
RADONRADON
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
55
Indoor Air Pollution Indoor Air Pollution
RADON MITIGATION SYSTEMRADON MITIGATION SYSTEM
A – Gas-permeable layer A – Gas-permeable layer
B - Plastic sheeting B - Plastic sheeting
C - Sealing and caulkingC - Sealing and caulking
D - Vent pipe D - Vent pipe
E - Junction boxE - Junction box
It is recommended that homes be It is recommended that homes be tested for radon on the lowest tested for radon on the lowest lived-in level – basement or lived-in level – basement or ground floorground floor
www.epa.gov/iaq/radon/construc.html
56
Indoor Air Pollution Indoor Air Pollution
RADON IN SCHOOLSRADON IN SCHOOLS
Schools should also be tested for radon:Schools should also be tested for radon: Levels above 4 pCi/L call for action to reduce exposureLevels above 4 pCi/L call for action to reduce exposure
www.epa.gov/radon/pubs/schoolrn.html
57
Indoor Air Pollution Indoor Air Pollution
ASBESTOSASBESTOS
Sources: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 parents
Health effects:Health 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
58
Indoor Air Pollution Indoor Air Pollution
OCCUPATION-RELATED CONTAMINANTSOCCUPATION-RELATED CONTAMINANTS
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 work
Prevention Change work clothes and shower before hugging or playing
with children
59
Indoor Air Pollution Indoor Air Pollution
CHILDREN WORKING INDOORSCHILDREN WORKING INDOORS
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
60
Indoor Air Pollution Indoor Air Pollution
OUTCOME-EFFECTS:- Acute poisonings- Respiratory diseases- Allergies- Developmental
disturbances- Cancer
SUSCEPTIBILITIES:SUSCEPTIBILITIES:
-Lungs still immature
-Higher breathing rate
-More time indoors
-Nutritional status
-Poverty
SUMMARY SLIDESUMMARY SLIDE
HAZARDS:
Particulates,
CO, Solvents,
Pesticides,
Lead, moulds,
Mites, pollen
MEDIUM
Air
SETTINGS:
-Home
-Child care
-School
-Workplace
Playground
Sports placeACTIVITIES
Playing, Studying, Eating, Drinking, Working, Sleeping
(photo credit US NIEHS CERHR logo)
61
Indoor Air Pollution Indoor Air Pollution
APPROACHES TO REDUCE INDOOR AIR POLLUTIONAPPROACHES TO REDUCE INDOOR AIR POLLUTION
1. Eliminate or control the sources of pollution Improved stoves Clean fuels (kerosene, gas) Venting stoves for cooking and heating Regular maintenance of cooking, heating and cooling systems Choose non-volatile, non-toxic building materials Maintaining dry homes and schools
2. Ventilation – building design Dilute and remove pollutants through ventilation with outdoor air
3. Air cleaning – NOT air fresheners! Air filters and ionizers may remove some airborne particles Gas adsorbing material is used to remove gaseous contaminants
62
Indoor Air Pollution Indoor Air Pollution
OZONE GENERATORS – CAUTIONOZONE GENERATORS – CAUTION
Ozone can be harmful to health Chest pain, coughing, throat irritation
Ozone is ineffective in controlling indoor air pollution below health standards levels NIOSH / OSHA recommends an upper limit of 0.10 ppm ozone
High concentrations are used to decontaminate unoccupied spaces from chemical and biological contaminants or odours
63
Indoor Air Pollution Indoor Air Pollution
EDUCATION AND ADVOCACYEDUCATION AND ADVOCACY
Education of:Education of: Children Family and community Health care providers
Environment policy-makingEnvironment policy-making Framework Convention on Tobacco Control Clean indoor air regulations Community actions
ResearchResearch
64
Indoor Air Pollution Indoor Air Pollution
CRITICAL ROLES OF HEALTH & ENVIRONMENT CRITICAL ROLES OF HEALTH & ENVIRONMENT PROFESSIONALSPROFESSIONALS
WHO
Diagnose and treatDiagnose and treat
Do research and publishDo research and publish• Detect sentinel cases• Inspire community-based interventions
EducateEducate• Patients and families• Colleagues and students
AdvocateAdvocate
Provide good role modelProvide good role model
66
Indoor Air Pollution Indoor Air Pollution
First draft prepared by Ligia Fruchtengarten MD (Brazil)
With the advice of the Working Group on Training Package for the Health Sector: Cristina Alonzo MD (Uruguay); Yona Amitai MD MPH (Israel); Stephan Boese-O’Reilly MD MPH (Germany); Irena Buka MD (Canada); Lilian Corra MD (Argentina), PhD (USA); Ruth A. Etzel MD PhD (USA); Amalia Laborde MD (Uruguay); Ligia Fruchtengarten MD (Brazil); Leda Nemer TO (WHO/EURO); R. Romizzi MD (ISDE, Italy); S. Borgo MD (ISDE, Italy).
Reviewers: S. Bhave MD (India); S. Boese-O’Reilly MD MPH (Germany); Y. Amitai MD MPH (Israel), E. Rehfuess (WHO), I. Buka MD (Canada)
Reviewer 2008: Ruth A. Etzel, MD, PhD (USA)
Update: July 2008WHO CEH Training Project Coordination: Jenny Pronczuk MDMedical Consultant: Katherine M. Shea MD MPH, USATechnical Assistance: Marie-Noel Bruné MSc.
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
WHO is grateful to the US EPA Office of Children’s Health Protection for the financial support WHO is grateful to the US EPA Office of Children’s Health Protection for the financial support that made this project possible and for some of the data, graphics and text used in preparing that made this project possible and for some of the data, graphics and text used in preparing
these materials.these materials.
67
Indoor Air Pollution Indoor Air Pollution
DISCLAIMERDISCLAIMER The designations employed and the presentation of the material in this publication do not imply the expression of any The designations employed and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
The opinions and conclusions expressed do not necessarily represent the official position of the World Health The opinions and conclusions expressed do not necessarily represent the official position of the World Health Organization.Organization.
This publication is being distributed without warranty of any kind, either express or implied. In no event shall the World This publication is being distributed without warranty of any kind, either express or implied. In no event shall the World Health Organization be liable for damages, including any general, special, incidental, or consequential damages, Health Organization be liable for damages, including any general, special, incidental, or consequential damages, arising out of the use of this publicationarising out of the use of this publication
The contents of this training module are based upon references available in the published literature as of the last The contents of this training module are based upon references available in the published literature as of the last update. Users are encouraged to search standard medical databases for updates in the science for issues of particular update. Users are encouraged to search standard medical databases for updates in the science for issues of particular interest or sensitivity in their regions and areas of specific concern.interest or sensitivity in their regions and areas of specific concern.
If users of this training module should find it necessary to make any modifications (abridgement, addition or deletion) to If users of this training module should find it necessary to make any modifications (abridgement, addition or deletion) to the presentation, the adaptor shall be responsible for all modifications made. The World Health Organization disclaims the presentation, the adaptor shall be responsible for all modifications made. The World Health Organization disclaims all responsibility for adaptations made by others. All modifications shall be clearly distinguished from the original WHO all responsibility for adaptations made by others. All modifications shall be clearly distinguished from the original WHO material.material.