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ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 5  |  Page : 687-690  

Study of respiratory diseases, children residing in stone quarry


1 Professor, Dr D.Y. Patil Medical College, Hospital and Research Center & Dr. D.Y.Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
2 Associate Professor, Dr D.Y. Patil Medical College, Hospital and Research Center & Dr. D.Y.Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
3 Professor and Head of Department, Dr D.Y. Patil Medical College, Hospital and Research Center & Dr. D.Y.Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Submission10-Mar-2021
Date of Decision07-Jan-2022
Date of Acceptance08-May-2022
Date of Web Publication04-Jun-2022

Correspondence Address:
Dr. Manojkumar G Patil
Associate Professor, Dr D. Y. Patil Medical College, Hospital and Research Center and Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra - 411018
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_190_21

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  Abstract 


Objective: The aim is to study respiratory diseases in children staying in a stone quarry. Methods: Prospective longitudinal study. All 85 children staying in the stone quarry near Pune were followed for respiratory symptoms and nutritional status by monthly visits for a period of 18 months. At the time of enrolment, Hemogram, Chest X- ray Postero-anterior view (PA), Tuberculin Test (TT), Peak Expiratory Flow Rate{PEFR }(Of children age: 5-12 yrs.) was done. Results: In those 85 children, there were 394 episodes of respiratory infections (3.09 episodes per child per year). They had 53 episodes of pneumonia requiring admission. TT test was positive in 9.4%of children. Eosinophilia was present in 16.47% of children. PEFR in these children was significantly lower than that of children of the same height (P < 0.05); 64.2% of all children were malnourished; 42.8% had moderate malnutrition and 21.4% had severe malnutrition. None of them had received even vaccines provided under EPI completely. Conclusion: Children staying in the stone quarry have frequent respiratory infections. They have a higher rate of pneumonia requiring admission. TT positivity is high. They have a lower PEFR. Immunization coverage is poor.

Keywords: Pneumonia, respiratory disease, stone quarry


How to cite this article:
Tambolkar SA, Mishra AD, Patil MG, Salunkhe SR, Agarkhedkar SR. Study of respiratory diseases, children residing in stone quarry. Med J DY Patil Vidyapeeth 2022;15:687-90

How to cite this URL:
Tambolkar SA, Mishra AD, Patil MG, Salunkhe SR, Agarkhedkar SR. Study of respiratory diseases, children residing in stone quarry. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Dec 10];15:687-90. Available from: https://www.mjdrdypv.org/text.asp?2022/15/5/687/346566




  Introduction Top


A quarry is typically a large, deep pit, from which stone or other materials are or have been extracted.[1] The stone quarry has a high level of dust in the air. These dust particles remain in the lungs for a long time and have increased potential to cause diseases. The hazardous effect of dust depends on (1) chemical composition, (2) size, (3) concentration of dust in the air, (4) period of exposure, and (5) the health status of the person exposed.[2]

Children residing in the quarry play and live in this dust-ridden environment. Hence, they have increased morbidity from respiratory (pneumonia, tuberculosis, etc.) and kidney diseases (glomerulonephritis).[3] These children are from migrant workers' families and live in temporary shift residences. They are from a low socioeconomic class, staying in poor hygienic conditions. Hence, children staying in stone quarries are also vulnerable to malnutrition and food scarcity. Chronic malnutrition at an early age leads to restriction of growth and brain development.[3]

The lung is not fully developed till 6 years of age. During early childhood, the bronchial tree and lung epithelium are still developing. This results in greater permeability of the epithelial layer.[4] Exposure to air pollution during this critical period may have a lasting effect on the respiratory system.

This study was planned to study the effect of pollution, poverty, and poor hygiene on the health status of children staying in a quarry.


  Material and Methods Top


Study Design: This was a prospective longitudinal study done in a stone quarry situated at Wagholi, Pune after Ethical Committee Approval dated 2018.

Study Population: A total of 91 children between the ages of 2 months and 12 years living in a quarry were included in the study. Out of these, six children did not turn up for follow-up. Thus, 85 children were included in the study.

Study Methods: On the first visit to the quarry, detailed history and examination with special emphasis on nutritional status were recorded. All children were investigated at Dr. D. Y. Patil medical college, and Hemogram, CXR (PA), TT test, and PEFR (5-12 yrs) were done. PEFR was measured by a portable flow gauge device (peak flow meter [PFM]), which was carried out on all children. A monthly visit for the next 17 months was done. A recording of respiratory complaints in the last 1 month, weight, and height was done during each visit. For emergencies, the ambulance service was provided with a mobile phone number. Any child requiring further management was admitted to our hospital by hospital transport. Management of these children was done as per the protocol of the hospital. Children with positive TT were referred to the Revised National Tuberculosis [TB] Control Programme (RNTCP) center for management.

Statistical analysis

The data were compiled and analyzed using Statistical Package for Social Sciences (SPSS) software.

Definitions

  1. Weight: Recorded by electronic machine with minimal clothing.
  2. Height: Recorded by tape fixed to the wall in the quarry.
  3. Nutritional classification as per WHO classification.



  Result Top


All children in the quarry were included. About 32.9% of children were younger than 5 years, 48.2% of children were between 6 and 8 years, and 18.9% in 9 and 12 yrs age group. The male-to-female ratio was (1.8:1) [Table 1].
Table 1: Demographic Character

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There were 394 episodes of ARI over 18 months, that is, 4.63 episodes of ARI per child in 18 months (3.09 episodes per child per year). Out of 85 children, 53 children (62.4%) had at least one episode of pneumonia requiring admission during the 18-month follow-up. More than one episodes of pneumonia were found in 10 children, that is, 32 children did not suffer from pneumonia in 18 months (37.6%) [Table 2].
Table 2: ARI In Quarry Children

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At the time of the initial assessment, 9.4% of children had positive TT tests. Incidence of TT test positivity in children aged <7 years was 6.67% and the incidence of TT positivity in children >7 years was 13%. In children with good nutrition, 5.1% had a positive TT test, while 13% of malnourished children had a positive TT test. This difference was statistically insignificant (P > 0.05). All children with positive TT tests had respiratory symptoms. Mean hemoglobin concentration in TT positive children was significantly lower than in children with a negative TT test (8.05 ± 1.52 vs. 9.78 ± 1.37; P < 0.05).

TT was used as a screening tool so that who were likely to be positive were admitted and their further work up {CBNAAT, CT thorax} was done in our institute and after diagnosing and confirming, treatment was initiated in them with the help of RNTCP Programme in our institute. Out of these postive TT tests, only two children were confirmed with the CBNAAT in Sptum examination and treatment was initiated for them according to RNTCP guidelines.

PEFR was performed in all children above 5 years age at the time of initial assessment. PEFR in children staying in the quarry was significantly less than predicted PEFR for children of the same height in the general population (P < 0.001). These were the standard PEF available for the general population and with them, the comparison was done to know the significance of PEFR for stone quarry children. Children with lower PEFR developed severe respiratory illness on follow-up (ARI grade-2 and more), while children with higher PEFR had milder respiratory disease during 18 months follow-up. Eosinophilia (Eosinophils >500 cells per microliter) was seen in 16.47% of children. Children with eosinophilia had significantly lower PEFR as compared to other children (110 ± 23.7 ml and 132.1 ± 25.5 ml, P < 0.05). Children with high eosinophilic counts were further screened for the worm infestation. All of them received one dose of deworming in the form of Albendazole 400 mg during hospital visits under supervision. PEFR in well-nourished children was significantly more than that in malnourished children (P < 0.001) [Table 3].
Table 3: Functions Affecting PEFR

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The nutritional status of children below 5 years was analyzed. 35.7% of children were well-nourished. 42.8% had moderate malnutrition. The incidence of severe malnutrition was 21.4%. Throughout the follow-up, three more well-nourished children became malnourished. In well-nourished children, 76.7% had hemoglobin more than 10 gm%. While 15.2% of malnourished children had a hemoglobin of more than 10 gm%.

The immunization status of children was studied and it was observed that none of them had received all age-appropriate vaccines provided in the universal immunization program. About 57.6% of children were completely unimmunized and 42.4% were partially immunized. Our team had taken due care to vaccinate these children in subsequent follow-up to receive their vaccination as per the National Immunization schedule from our institute.


  Discussion Top


The stone quarry is a desolate area where mining work continues. Workers are mainly migrants who stay on the same premises. The environment is polluted with dust particles of varied sizes and compositions. These particles are a health hazard. Workers are advised personal protection in the form of masks. Children staying in the quarry are constantly exposed to this environment and use no protection.

The present quarry was located 15 km away from the city. It had 85 children who stayed in tin sheds without toilets. Water was supplied by tankers. These children played in the same closed dusty environment throughout the day and at night slept there. The nearest school was 3 km away, children walked to reach there. The nearest health care center is 5 km, with no transportation to reach after 5 pm.

We included all 85 children staying there in our study. They had 394 episodes of respiratory infections in 18 months (262 episodes/year). This was more than (294 episodes/year) in 1061 children in urban slums observed by Avasthi et al.[5] At the initial visit, 44 children had a respiratory infection. The prevalence of 48.23% was more than the prevalence of 22% reported by Bipin et.al. in a study from Gujarat.[6] A maximum number of respiratory infections occurred in August due to the rainy season.

In these children, 16% of all respiratory infections were pneumonia. Acharya et al.[7] and Awasthi et al.[5] found that 8.75% and 10% of respiratory infections were pneumonia in their studies, respectively. All children with pneumonia needed admission to the hospital. And 10 children had more than one episode of pneumonia. The children staying in the quarry suffered from respiratory infections more frequently than other children. This could have been due to increased dust particles, poor hygienic conditions, and rampant malnutrition.

PEFR was done in all children above 5 years of age, and at the time of enrolment, PEFR was measured by a portable flow gauge device (peak flow meter [PFM]). PEFR in children of all ages was significantly lower than their height-matched control. Children with severe respiratory infections had lower PEFR as compared to children with mild respiratory infections. Children with malnutrition had significantly lower PEFR than well-nourished children. Children with eosinophilia had significantly reduced PEFR as exposure to dust particles is from an early age. This decrease in PEFR could be due to damage to the immature developing lung parenchyma.

The tuberculin test (TT) uses delayed hypersensitivity to tuberculin antigen. A positive test indicates exposure of the immune system to tuberculosis bacterial antigen. In this study, TT positivity was found in 9.4% of children. All TT-positive children were symptomatic; 62% of TT-positive children had abnormal CXR. Many of them were malnourished. The incidence of positive TT was similar in well-nourished and malnourished children (P > 0.05). M. Singh et al.[8] also observed that out of 95 TT-positive children only 74% were well-nourished and 26% of children were malnourished. These children were managed as per the DOTS program.

In this study, prevalence of malnutrition was similar to other studies done in the quarry.[9] Moderate malnutrition was more common than severe malnutrition (57.13% vs. 21.42%). During the observation period, three more children drifted from well-nourished to malnourished group, indicating an ongoing effect of poverty, infection, and ill-literacy.

Immunization coverage of these children was poor. None of them were fully immunized; 57.6% did not receive any vaccine. Interestingly, all patients had received the pulse polio vaccine.

This study tried to understand the health problems of children staying in stone quarry. In this study, all children staying were included. They were followed for 18 months by regular monthly site visitors. Any child requiring indoor medical treatment was transported in a hospital transport system, such as ambulance or visiting vehicles, immediately after intimation by phone call. They were treated at our hospital. From this study, we understand that the medical facility for these children was inaccessible and they require proper nutritional advice and monitoring. Immunization should be provided at the doorstep. Early and adequate treatment of pneumonia is essential. All children should routinely be screened for tuberculosis. The limitation was that we could not reach all children of other neighboring quarries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oxford dictionary. Quarry. Oxford: Oxford University Press; 2018. Available from: https://www.oxfordlearnersdictionaries.com/definition/american_english/quarry_1. [Last accessed on 2018 Dec].  Back to cited text no. 1
    
2.
Parks WR. Occupational Lung Disorder. 2nd ed. London: Butterworths and Co. Publisher LTD; 1982. p. 529.  Back to cited text no. 2
    
3.
Gravies. Tales of Woe: A report on child labour in mines of Jodhpur and Makrana.,Rajasthan,India; Centre for Child Rights, New Delhi; 2004 March 2004. 203 p. Report No.: 1.  Back to cited text no. 3
    
4.
Dunnil MS, Altman PL J. A. Anderson R. C. Ryder, Respiration and circulation.Thorax 1962: 17{1}; 392-394.  Back to cited text no. 4
    
5.
Awasthi D, Pande VK. Seasonal pattern of morbidities in preschool children in Lucknow, North India. Indian Paediatr1997;34:987-93.  Back to cited text no. 5
    
6.
Prajapati B, Talsania N, Lala MK, Sonalia KN. A study of risk factors of acute respiratory tract infections of under-five age group in urban and rural communities of Ahmedabad district, Gujarat. Health line. 2012 January-June; 3(1):16-20.  Back to cited text no. 6
    
7.
Acharya D, Prasanna KS, Nair S, Rao RSP. Acute respiratory infections in children: A community based longitudinal study in south India. Indian J Public Health 2003;47:7-13.  Back to cited text no. 7
[PUBMED]    
8.
Singh M, Mynak ML, Kumar L, Mathew JL, Jindal SK. Prevalence and risk factors for transmission of infection among children in household contact with adults having Pulmonary Tuberculosis. Arch Dis Child 2005;90:624-8.  Back to cited text no. 8
    
9.
Dhaatri Resource Centre for Women and Children- Samata. India's childhood in pits. A report on the impact of mining on children in India. Visakhapatnam, India: Dhaatri Resource Centre for Women and Children-Samata, Visakhapatnam; March 2010. 203 p. Report No.: 4-5. Available from: http://www.indianet.nl/pdf/ChildrenAndMiningIndia.pdf.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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