Estimation of the risk factors in Estimation of the risk factors in chronic respiratory diseases of chronic respiratory diseases of

the childrenthe children

Cebanu SergiuState Medical and Pharmaceutical University “Nicolae Testemitanu” Republic of Moldova

According to the World Health Organisation recommendations and declarations of the European Conferences (Budapest, 2004; Parma, 2010), the Member countries of the WHO have signed to implement a series of measures to improve health status of children in relation with residential and training environmental factors, including development and implementation of the National Action Plans for Health in Relation with Environment.

Some of the most common diseases recorded in the medical practice, both to children and adults are diseases of the respiratory system.

The acute respiratory infections determine 50% of the early child’s diseases and 30-40% of the preschool and school children diseases.

It is estimated for Republic of Moldova that the incidence of these diseases for children population is growing and varies within 270-390 ‰.

Most of these diseases become chronic affecting the health level of the children for many years. Among the chronic respiratory diseases, children frequently suffer of recurrent bronchitis and chronic asthma.

After various statistics, chronic bronchitis represents 26-42% from all the bronchopulmonary diseases with recurrent and persistent nature.

The aim of the study was hygienic estimation of training and residential conditions of pupils with chronic respiratory diseases and risk evaluation.

The studying was realized in one of the projects of Academy of Science of Moldova for young scientists “Hygienic evaluation of training and residence conditions of children with chronic respiratory diseases from rural places”.

Materials and methods

• There were studied training conditions at 6 schools from different regions of the Republic of Moldova and residential conditions of 120 pupils suffering from chronic respiratory diseases.

• For the assessment of physical and chemical factors of residential and training environment was used a complex of hygienic methods: discriptive, instrumental and laboratory.

• Using microbiological methods it was determined the type and extent of the fungi growth spread in houses and in educational institutions.

• There were used statistical methods of correlation, which permitted the interrelations’ elucidation between the training conditions and habitual factors and pupil’s state of health. Shares were determined based on the relative risk for each risk factor separately.

In winter cold period air temperatures value was very less during of studying (15oC).

Relative air humidity in the classrooms varies during the lessons, but exceed hygienic normative level (hygienic norm 30-60%) in all investigated schools.

Dynamic of the exchange of air temperature during the lessons

I II III IV V lectia

0

10

20

30

c cold period transition period hot period

Concentration of the carbon dioxide exceed in 3 times admissible limits in the end of the lessons in all schools

Dynamic of the exchange of chemical indexes (concentration CO2) during the lessons in different years

period

I II III IV V lectia

0

0,1

0,2

0,3

0,4

0,5

cold period transition period hot period

It was determined that the temperature during the cold period of the year (winter) in the residential complexes of the study group varies from 17,8± 0,5 to 18,9 ± 0, 30C, in the control group from 18,1 ± 0,3 up to 19,7± 0, 40C (optimal rule being 20-220C), represented 67,1% non standard and 42.9% respectively.

During the period of transition (spring) it was established that the average temperature of the air is 15,4 ± 0, 60C, ranging from 14,5±0, 30C up to 16,1±0, 30C in the housing of the study group, which does not correspond to the hygienic norms, in the control group the air temperature was 17,11 ± 0,50C.

The characteristics presented in the living conditions of pupils with low temperature during the cold period of the year and excess of humidity has adverse consequences expressed by the advent of wetlands and building materials affected by the occurrence of the advent rising damp.

Based on these data were collected and examined 53 air samples and 33 surface lavages and was determined the type of fungus in the house of pupils. In houses with a high humidity and a smell of mold from which have been collected the air samples the contamination of the air by fungi were recorded in all collected samples.

A large parts of isolated fungal species have toxigen potential and belong to the genus Penicillium, Aspergillus. A significant number of potentially pathogenic fungi which have been isolated must not be in the studied buildings microclimate.

In all classrooms was noticed high pollution with fungus Penicillium – 48,27%, Mucor – 20,69%, Aspergillus and Scopulariopsis –10,34%.

Type of fungus located in examined probes

No

Gen

Schools

Air Lavage

No. % No. %

1. Penicillium 14 48,27 2 25,0

2. Mucor 6 20,69 1 12,5

3. Cladosporium 2 6,90 1 12,5

4. Aspergillus 3 10,34 1 12,5

5. Alternaria - - - -

6. Cefalosporium - - 1 12,5

7. Scopulariopsis 3 10,34 1 12,5

8. Paecilomyces - - - -

9. A. niger - - - -

10. Neidentificat 1 3,45 1 12,5

11. Total 29 100 8 100

For the public health it is important to mark the risk degree of the medium factors. The evaluation of medium factors role in the initiation of the chronic respiratory diseases for pupils through calculation of the relative risk (RR) permits their social ladder arrangement, quantification of activity directions in prophylactic goal.

To analyze the causal factors we decided to delimit them in several groups: microclimatic factors, chemical factors, residential conditions, social, age, gender.

The study presented a significant relationship between the children presence of chronic respiratory diseases included in the study, and the low air temperatures in rooms (RR-3,0, p<0,001), increased relative humidity (RR-2, 1, p<0,001) the presence of mold (RR-1, 57, p< 0,001), increased CO2 concentrations (RR-2, 85, p<0,001), etc.

A significant impact on the development of chronic respiratory diseases at children has the tobacco smoking. In our case 35,4% of children from the study group and 18,6% of children from the control group are exposed to the influence of passive smoking. The relative risk for this factor constitutes 1,2 (p<0,001).

Conclusions:1. Residential conditions are unfavourable at children suffering from chronic respiratory diseases. In most cases they are characterized by lower temperatures in comparision with hygienic norms during the cold period of the year, the increased concentration of CO2, venting channels blocking, rising damp and mildew, which provides conditions and determining factors in bronchitis asthma and chronic bronchitis.

2. Pollution of the buildings with fungus (Penicillium, Mucor etc.) and high relative air humidity present determinativ factors in development of chronic respiratory diseases.

Conclusions:3. Conditions of training of the pupils in the school are characterized by low temperatures, which does not correspond to the hygienic norms, major content of carbon dioxide in comparision with hygienic norm exceeding 3 times (norm 0,1%).

4. The results of the study of health and environmental factors of training and living of pupils from rural areas allowed us to develop and implement a series of specific prophylactic measures.

Thanks for attention!