AIR POLLUTION AND RESPIRATORY ILLNESS AMONG SCHOOL CHILDREN IN MAE MOH DISTRICT, THAILAND: THE IMPACT OF POLICY Lakkana Thaikrueal, Amara Thonghong! Nongnuch Suvitvong?, Junya Pattaraarechachai ‘Thongchai Thavichachart' Napadol Somboon*, Pipat Yingsaeri?, and Chaiyanan Tayawiwat™ ' Division of Epidemiology, Ministry of Public Health; ? Lampang Provincial Health Office, Ministry of Public Health; > Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Abstract. In May 1991, residents of Mae Moh district complained that air pollution produced by the Mae ‘Moh Lignite Mine which caused an increased incidence of respiratory diseases. Epidemiologists from the Division of Epidemiology, Lampang Provincial Health Office and other institutes performed a study to determine the prevalence and incidence of respiratory problems among schoolchildren aged 10 - 15 years in Mae Moh district compared with those in Chachom district (50 km distant) which was assumed to have no exposure to air pollution ‘The study was a cohort design with 9 months periods. There were 640 students from Mae Moh district and 872 from Chaehom district (male:female ratio= 1:1). Ateach round (rainy, winter, and summer seasons) data were collected by using self-administered questionnaires, physical examination by physicians, and ‘measuring peak expiratory flow rate (PEFR) by mini Wright peak flow meters. The study populations were similar in demographic data, socioeconomic status, height, and weight. By multiple logistic regression analysis, the children who resided in Mac Moh exhibited a 3-fold increased risk of developing respiratory signs and symptoms compared to those who resided in Chaehom (OR = 3.1: 95% CI= 1.4 - 6.7; p-value < 0.01) in the rainy season. Furthermore, on multiple linear regression analysis, the Mae Moh children had PEFR values decreased by 28.6 l/minute (95% CI= 14.7 - 42.5; p-value = 0,001) compared to the Chachom children, In the rainy season, children who reported that members of their families smoked, were more likely to report respiratory signs and symptoms, compared to those from families where no one smoked, During the study period, Mae Moh students had more respiratory illness episodes (2-3 episodes) than Chachom students (0-1 episode) with a relative risk (RR) equal to 1.86 (95%Cl = 1.68,2.06). Thus, Mac Moh children had higher prevalence and incidence of respiratory illness than Chaehom children; lack of concurrent air quality information in the 2 districts limits the causal association between air pollution ‘caused by the lignite mine and respiratory illness. INTRODUCTION Ina developing country like Thailand, air pollu- tion is a major health problem. In May, 1991, the residents of Mae Moh district complained that air pollution produced by the Mae Moh lignite mine caused respiratory illness. An epidemiologist from the Division of Epidemiology, Ministry of Public Health, Thailand went to investigate and found that there were more cases of respiratory illness during that month than usual (Siraprapasiri, 1991) Surveillance reports of respiratory infection in Mae Moh district increased more than 2-3 times com- pared to other areas of Lampang province during 1989-1991 (Tayawiwat,1991) Mae Moh district is located in a basin sur- 478 rounded by mountains except in the southeastern ‘area. There were monsooms during late Febuary and early September from the southwest and during mid September and mid Febuary from the northeast. Mae Moh Electrical Generating Plant started in 1972 with 7 generating units using 5.59 million tons of lignite and reached 10 million tons/ year in 1991 used by 9 generating units. The lignite mine is an open pit mine in Mae Moh valley. It is located in the same area of the plant as a source of energy. The mining process causes some autocombustion of lignite which produces sulfur dioxide. In addition, the transportation of lignite from the mine to the plant, the process of electricity generation itself, the climate, and the geographical basin of this area led to contamination of the air with sulfur dioxide, hydrogen sulfide, carbon mon- Vol 26 No.3 September 1995‘Ain POLLUTION AND RESPIRATORY ILLNESS ‘oxide, dust, and total suspended particles (TSP) (EGAT, 1989, 1994; Kumpera, 1994). Although in June 1989 the air monitoring during 1978-1988 by the Ecology and Environmental Project of the Elec- trical Generating Authority of Thailand (EGAT, 1989) reported that the air quality was within the standard limits for Thailand, this did not guarantee that there was no low level air pollution effect on respiratory function, in view of the report by Jaakkola et al (1991) showing that low level air pollution can cause respiratory illness. Because smoking affects the respiratory system (Higgins, 1968; Nadakavukaren, 1986; Graham, 1990) and also for reduce lose of long term follow-up, we chose to study school children who were old enough to understand the questionnaires but not old enough to smoke. The objectives of this study were as follows. 1, To determine the prevalence and incidence of respiratory problems among school children aged 10-15 years in Mae Moh district, Lampang province. 2. To determine the effect of air pollution by comparing respiratory illness in school children Mae Moh and Chaehom districts. MATERIAL AND METHODS It was a fixed cohort with 2 follow-up within 9 months (Kleinbaum ef af, 1982). There were 2 study areas. Mae Moh, where the electrical gener- ating plant and lignite mine is located, was defined as an exposed area. The district of Chachom was defined as an unexposed area. It is approximately ‘50 km northwest of Mae Moh. The population had similar socioeconomic characteristies, but had no factory nearby. The study population comprised school chil- dren, aged 10-15 years old in 1991, who were divided into two groups: (1) the exposed group was defined as students who resided in Mae Moh district at least 1 year commencement of the study: (2); the other was an unexposed group which was defined as students who resided in Chaehom dis- trict, who were assumed to have no exposure to air pollution, at least 1 year prior to the study com- mencement. ‘The first data collection was done in the rainy Vol 26 No.3 September 1995 season (August, 1991). The second and third rounds were done in winter (November, 1991) and summer (March, 1992), respectively. At each round, data collected included a self- administered questionnaire, a physical examina- tion by a physician, weight and height measure- ment, and a measure of peak expiratory flow rate (PEFR) using mini Wright peak flow meters. Results were analyzed in two parts, the first beinga univariate analysis of baseline demographic data and the prevalence of respiratory signs and symptoms, using chi-square, Fisher's exact, ANOVA, and Wilcoxon two-sample tests. The second part involved multivariate techniques in- cluding using multiple logistic regression analysis for associations between respiratory signs and symptoms and study factors. RESULTS Baseline demographic data There were 1512 students included in the study. In Mae Moh the 640 students accounted for 50% of the school children aged 10-15 years old residing in that district. ‘The unit of selection wwas a primary school located within 10 kilometers of the plant and the only high school in Mae Moh district. In Chachom, 872 students were selected, who accounted for 45% of school children aged 10-15 years old in this area. The units of selection were a primary school and the only one high school in Chaehom, Table 1 shows that the population characteris- tics, were similar between Mae Moh and Chachom districts, in terms of average age, ratio of males to females, number of members in the family, socio- economic status, amount of money for buying lunch at school, and number of meals per day. ‘The difference was father’s occupation, Respiratory symptoms by season In the rainy season there was a significantly higher percentage of respiratory symptoms among Mae Moh students than among Chachom students, eg chronic cough, productive cough during I month prior to interview, phlegm every day for any 1 479Sourueast ASIAN J Tor Meo PusLic HEALTH Table 1 Baseline demographic data of schoo! children from 2 districts. Variables Mae Moh Chaehom Number of students 640 872 ‘Average age 13 yrs 13 yrs Ratio male: female I re ‘Average number of member in family 5 4 Use charcoal or wood or gas for cooking >90% > 90% Occupation of father: - government officer 34% 0% + farmer, planter 21% 59% Occupation of mother: = government officer 38% 12% + farmer, planter 24% 65% Socioeconomic status electrical instrument® : - <3 pieces 12% 41% = 4-8 pieces 78% 36% -family own vehicle: - bike or motorcycle 36% 35% and motorcycle 33% 48% - car and / or motoreycle 13% 15% student had 3 meals per day 91% 94% Amount of money for buying lunch at school 8 baht @ Sbaht Amount of money for buying dessert at school 2baht 2baht Note: * electrical instruments mean fan, reftigerator, television, radio, stereo, ar condition, rice cooker, and electric kettle. @ approximately 25 baht = 1 US dollar ‘month in the previous year, runing nose at least one time during 3 months prior to interview, a cold in the prior 3 months,dyspnea in the prior 3 months, asthma-like syndrome in the prior 1 month, history of bronchitis or pneumonitis (Table 2). In winter and summer a similar pattern occurred as in the rainy season: Mae Moh students had a higher per- 480 centage of respiratory symptoms in most categories (Figs 1,2). Respiratory signs by season In the rainy season there was a significantly higher percentage of abnormal physical examina- Vol 26 No.3 September 1995