A mixed-methods community-based participatory research to explore stakeholder's perspectives and to quantify the effect of crop residue burning on air and human health in Central India: study protocol.

BACKGROUND: Crop residue burning adversely affects air quality and consequently human health. India, being one of the largest agro-economies of the world, produces around 500 Million tonnes of crop residue annually most of which is burnt on-farm. However, integrated studies that simultaneously quantify the effects of crop residue burning while exploring the subjective determinants of the practice are lacking in India. This paper describes the protocol for a longitudinal mixed methods research study employing a community-based participatory approach to fill this gap. METHODS: Both quantitative and qualitative data will be collected in a rural setting of the central Indian province of Madhya Pradesh, over 1 year. A steering committee comprising of the research team and community representatives will be formed. The proportion of cultivable land burnt in one crop burning season will be estimated. The association between crop residue burning, level of ambient air pollutants, and pulmonary function of village residents will be determined. Focus groups, interviews, and participatory rural appraisal methods will be used to explore stakeholder perspectives about crop residue burning. Potential barriers and opportunities for substituting burning with an alternative crop residue management technique will be ascertained as the basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/BPL/IEC/2019-20/1494, dt 06/01/2020). DISCUSSION: This manuscript describes the protocol for a novel community-based participatory study to investigate thoroughly the phenomenon of crop residue burning from the perspective of the agricultural community through their active collaboration. The lack of comprehensive evidence regarding the factors responsible for crop residue burning in India underlines the importance of implementing this study protocol to fill in this critical gap in knowledge. While acknowledging that findings of this study will be not generalizable to agricultural communities other than the one studied, it is expected that the study will generate baseline evidence that might be beneficial in developing and implementing an appropriate intervention strategy.

Assessment of silica dust exposure profile in relation to prevalence of silicosis among Indian sandstone mine workers: Need for review of standards.

BACKGROUND: In Indian mines, the prescribed exposure limit (PEL) for free silica dust is 0.15 mg/m3 which is much higher than those of OSHA and the ACGIH. Because of the reporting of high numbers of silicosis cases among Indian sandstone mine workers, the present study was designed to assess the dust exposure profile of the workers and to substantiate correlation of silica exposure with radiographic findings of silicosis. METHODS: A cross-sectional study of 1012 workers actively engaged in sandstone mining was conducted. Chest x-rays were evaluated by the ILO Classification for the detection of pneumoconiosis. Representative 26 personal dust samples were collected using a personal dust sampler and free silica content estimated. RESULTS: Radiographs compatible with silicosis were seen in 12.3% of workers, of which about 90% were ILO category 1 & 2. Prevalence of abnormal profusion increased from 2.9% to 13.1% to 22% as work exposure increased from <10 to 11 to 20 to >20 years, respectively. In dust samples, the mean silica concentration was 0.12 mg/m3 with 70% samples below the prescribed standard of 0.15 mg/m3 . CONCLUSION: The study indicates that silica exposure below the prescribed limit in India is likely to be harmful. The PEL for crystalline silica in India of 0.15 mg/m3 is not adequately protective. Hence, there is an urgent need to reduce exposure to silica in these workplaces to prevent silicosis and to review the present standards as the government of India remains committed to the elimination of silicosis by 2030.

Exposure profile of respirable crystalline silica in stone mines in India.

Silicosis is one of the major occupational lung diseases among stone miners; currently, it is a major concern in India given its 12-30% prevalence. The objective of this study was to determine the exposure profile of respirable dust and crystalline silica concentrations from sandstone, masonry stone, and granite stone mines in India. Personal respirable dust samples were collected from each type of mine and analyzed for dust and respirable crystalline silica concentrations. The mean dust concentrations were found to be 0.47 mg/m3, 1.24 mg/m3, and 3.28 mg/m3 for sandstone, masonry stone, and granite stone mines, respectively. The mean respirable crystalline silica concentrations were 0.12 mg/m3 for sandstone mines and 0.17 mg/m3 for masonry stone and granite stone mines. The concentrations in sandstone mines was below the standard stipulated by the Directorate General of Mine Safety in India (0.15 mg/m3), whereas in the granite and masonry mines the concentrations just exceeded the limit. The Indian standard for respirable crystalline silica is three to six times higher than the standard set elsewhere (i.e., by OSHA, ACGIH®, and Egyptian Labor Law standards). Considering the large number of silicosis cases among stone miners in India, the present standard appears inadequate. It is recommended that the standard be lowered to match international standards that minimize the risk of silicosis.

Environmental monitoring and health assessment in an industrial town in central India: A cross-sectional study protocol.

BACKGROUND: Textile industry has been widely implicated in environmental pollution. The health effects of residing near manufacturing industries are not well documented in India, especially in central India. Hence, a cross-sectional environmental monitoring and health assessment study was initiated as per directions of the local authorities. METHODS: Comprehensive exposure data about the concentrations of relevant pollutants in the ambient air and ground water samples in the study area will be collected over one year. Using stratified random sampling, 3003 apparently healthy adults will be selected from the study area. Sociodemographic and anthropometric information, relevant medical and family history, and investigations including spirometry, electrocardiogram, neurobehavioral tests, and laboratory investigations (complete blood count, lipid profile and random blood glucose) will be conducted. Finally Iodine azide test and heavy metal level detection in urine and blood samples respectively will be conducted in a subset of selected participants to assess individual pollution exposure. Ethics approval has been obtained from the Institutional Ethics Committee of the National Institute for Research in Environmental Health (No: NIREH/IEC-7-II/1027, dated 07/01/2021). DISCUSSION: This manuscript describes the protocol for a multi-disciplinary study that aims to conduct environmental monitoring and health assessment in residential areas near viscose rayon and associated chemical manufacturing industries. Although India is the second largest manufacturer of rayon, next only to China, and viscose rayon manufacturing has been documented to be a source of multiple toxic pollutants, there is a lack of comprehensive information about the health effects of residing near such manufacturing units in India. Therefore implementing this study protocol will aid in filling in this knowledge gap.

Silicosis, progressive massive fibrosis and silico-tuberculosis among workers with occupational exposure to silica dusts in sandstone mines of Rajasthan state: An urgent need for initiating national silicosis control programme in India.

CONTEXT: Silicosis is a progressive, irreversible and incurable respiratory morbidity and often becomes a cause for pre-mature mortality among occupationally silica dust-exposed workers in India and similar countries. It has a dual problem of associated silico-tuberculosis as a co-morbidity. The present study was done to assess the respiratory morbidity caused by silicosis in sandstone mine of Rajasthan, India. METHODS: The chest X-rays of 529 subjects having history of employment in stone mines with respiratory morbidity were subjected for this study and evaluated in accordance with ILO Classification 2000. The X-rays were classified into various categories of silicosis and progressive massive fibrosis (PMF) in relation to years of work in stone mines. RESULTS: Out of 529 chest radiographs evaluated, 275 (52%) showed radiological evidence of silicosis. Of them, 40 (7.5%) subjects showed large opacities suggestive of progressive massive fibrosis. Both silicosis and progressive massive fibrosis were associated with increasing duration of work in stone mines. Sixty-one (12.4%) subjects with silicosis also had associated pulmonary tuberculosis, termed as silico-tuberculosis. CONCLUSION: The present study showed a high prevalence of silicosis, progressive massive fibrosis and silico-tuberculosis among stone mine workers. It appears that that unless silicosis is controlled, elimination of tuberculosis is far from reality in the country. Hence, states and central authorities must work together towards control of both silicosis as well as silico-tuberculosis. Similarly, there is an urgent need of initiation of national silicosis control programme, similar to existing national tuberculosis control programme, considering the huge burden of silicosis in India.

Pulmonary Tuberculosis among Stone Miners of India vis-à-vis Silica Exposure.

BACKGROUND: Tuberculosis is one of the biggest public health concerns in India with a prevalence of 195 cases per 100000. Silica is cytotoxic to macrophage which is primary defense mechanism to tubercular bacilli and, hence, exposure to silica dust increases risk for TB. Silica exposed persons are at 2.8 to 39 times greater risk of affected by pulmonary tuberculosis in comparison to healthy subjects. METHODOLOGY: A cross-sectional epidemiological study was conducted among 935 workers in sandstone mining. Full-size posteroanterior view (PA) chest X-ray in full inspiration was evaluated and evidence of tuberculosis was noted. Fourier transform infrared spectrophotometer was used for determining the free silica in 23 dust samples. RESULTS: 6.4% X-rays showed evidence of TB and silica dust concentration was 0.11 to 0.16 mg/m3. The TB cases significantly increased from 2% to 6% to 12.7% as the work exposure increased from <10 years to 11-20 years to >20 years respectively. 8.5% of the TB cases were seen among the workers having more than 10 years of work exposure. The odds ratio (95% CI) for work exposure more than 10 years to less than 10 years was 4.53 (1.92-10.65). CONCLUSION: Reduction of silica particles from work environment can significantly reduce the number of TB cases and hence wet drilling should be practiced and personal protective equipment should be regularly used.

Assessment of Silicosis Awareness among Stone Mine Workers of Rajasthan State.

BACKGROUND: Silicosis is a known occupational lung disease prevalent among stone mine workers. It is commonly characterized by cough and shortening of breath, and is occasionally associated with tuberculosis and lung carcinogenicity. Silicosis is one of the major occupational disease all over the world and poses detrimental health effects to the workers in developing countries like India. OBJECTIVE: The present study was conducted to assess the level of awareness and knowledge of silicosis among stone mine workers. SUBJECTS AND METHODS: It was a personal questionnaire-based study conducted among stone mine workers of Jodhpur and Nagaur district of Rajasthan, India. The study was conducted during October 2016, and was based on close-ended questions related to silicosis awareness. The study subjects (n = 305) were 30 years or more. The questionnaire was divided into different sections: demographic characteristics, knowledge of silicosis, lifestyle, and educational level. RESULTS: The results of the study revealed that education or literacy highly affects the knowledge about silicosis among stone mine workers. The awareness index was found nonsignificant for the alertness of silicosis in contrast to regions, age groups, and habit of two regions and was significant for literacy in two regions. CONCLUSION: This study concluded that the education level of mine workers affected the knowledge of silicosis. Free seminars, symposiums, and medical camps should be organized to make miners more aware of silicosis.

Risk assessment of chronic poisoning among Indian metallic miners.

The estimated average daily employment in the Indian mining sector is 5,60,000, which comprises 87% in the public sector and 13% in the private sector, of which around 70,000 are working in metallic mines. The mine workers are exposed to dust of various potentially toxic substances. The common toxicants present in the mining environment are lead, mercury, cadmium, manganese, aluminium, fluoride, arsenic, etc. Inhalation and absorption through the skin are common routes of exposure. Low-dose chronic exposure of toxic substances results in the accumulation of toxicants in the body. Hence, there is a need to monitor the mining environment as well as the miners for these toxicants.

Health survey in gypsum mines in India.

BACKGROUND: Mining is a hazardous occupation in which workers are exposed to adverse conditions. In India, gypsum mining is mainly carried out in the state of Rajasthan, which contributes about 99% of the total production. OBJECTIVE: The present study was carried out in 12 different gypsum mines in Rajasthan state to determine the health status of the miners. MATERIALS AND METHODS: One hundred and fifty workers engaged in mining activities were included in the study and their health status was compared with that of 83 office staff of the same mines. The health status of the employees was evaluated using a standardized medical questionnaire and pulmonary function testing. STATISTICAL ANALYSIS: The unpaired 't' test was used to determine whether there was any significant difference between the miners and the controls and the chi-square test to compare the prevalences of various respiratory impairments in workers with that in controls; we also examined the differences between smokers and nonsmokers. RESULTS: Our findings show that the literacy rate is low (42%) among the miners. Pulmonary restrictive impairment was significantly higher amongst smokers as compared to nonsmokers in both miners and controls. Hypertension (22.6%), diabetes (8.8%), and musculoskeletal morbidity (8%) were the common diseases in miners. CONCLUSION: This study shows that there is high morbidity amongst miners, thus indicating the need for regular health checkups, health education, use of personal protective devices, and engineering measures for control of the workplace environment.

Occupational noise-induced hearing loss in India.

Noise is the insidious of all industrial pollutants, involving every industry and causing severe hearing loss in every country in the world. Exposure to excessive noise is the major avoidable cause of permanent hearing impairment. Worldwide, 16% of the disabling hearing loss in adults is attributed to occupational noise, ranging from 7 to 21% in the various subregions. The estimated cost of noise to developed countries ranges from 0.2 to 2% of the gross domestic product (GDP). Noise-induced hearing loss (NIHL) is bilateral and symmetrical, usually affecting the higher frequencies (3k, 4k or 6k Hz) and then spreading to the lower frequencies (0.5k, 1k or 2k Hz). Other major health effects are lack of concentration, irritation, fatigue, headache, sleep disturbances, etc. The major industries responsible for excessive noise and exposing workers to hazardous levels of noise are textile, printing, saw mills, mining, etc. Hearing protectors should be used when engineering controls and work practices are not feasible for reducing noise exposure to safe levels. Earmuffs, ear plugs and ear canal caps are the main types of hearing protectors. In India, NIHL has been a compensable disease since 1948. It is only in 1996 that the first case got compensation. Awareness should be created among workers about the harmful effects of noise on hearing and other body systems by implementing compulsory education and training programs. There are very few published studies of NIHL in India. More extensive studies are needed to know the exact prevalence of NIHL among the various industries in India.