Thara~hyl,~ and Robert S. Chapman1

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THE EFFECTS OF HOUSEHOLD AIR POLLUTION DUE TO BURNING OF MOSQUITO COILS ON RESPIRATORY PROBLEMS IN MYANMER MIGRANTS IN MAE SOT DISTRICT, TAK PROVINCE, THAILAND. Thara~hyl,~ and Robert S.

1 THE EFFECTS OF HOUSEHOLD AIR POLLUTION DUE TO BURNING OF MOSQUITO COILS ON RESPIRATORY PROBLEMS IN MYANMER MIGRANTS IN MAE SOT DISTRICT, TAK PROVINCE, THAILAND. Thara~hyl,~ and Robert S. Chapman1 JCollege of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand 2Number 143, 47th Street, Botahtaung Township, Yangon, Myanmar. AESTFUlC'k The objective of this cross-sectional study was to inv-te whether household buming of mosquito anls is asxiated with increased risk of respiratory problems among Myanmar migrant workers in Mae Ku village, Mae Sot district, Tak Province, in Thailand. 412 adult f d e respondents and 153 children (under 7 years old) were included in the study. The data were collected using a standardized, pretested interviews-mstd questionnaire in March Prevalences of respiratory symptoms such as cough with or without colds, phlegm with or without colds, w h a with or without colds, shortness of breath, sore throat without cold, rhinitis and eye initation at home were assessed in relation to mosquito coil use and other independent variables that could also be asxiated with respiratory symptoms. In respondents, mosquito coil use was sigxticantly adted with cough with or without colds (p<o.ool) and phlegm with or without colds (p=o.o11). Wheeze with or without colds (p-0.091) was maqnauy sigpiicantly d t e d with mosquito coil use. In children, mosquito coil use was si@cantly asxkted with cough with or without and rhin~tis (p=0.042). These results suggest that mosquito coil burning is a respiratory risk factor in the study population, although confoundng with other factors cannot be ruled out. If these asxiations are confirmed in Wer research, other methods of controlling exposure to mosquitoes should be sought for preventing diszases such as malaria and dengue fever. Risks and benefits of mosquito coil burning should be charactenzed. Key words: Indoor air pollution, mosquito coils, respimtory symptoms, Myanmar migrant workers. INTRODUCTION: Globally, indoor and outdoor environments are widely contaminated by complex mixtures of gases and Wcles that are produced by combustion of various types of fuels. Sources of indoor pollution include cooking stoves, agarette smoking, burning of various fuels for indoor heating, burning of mosquito coils and burning of incense.' Globally, IAP ranks eighth in terms of disability adjusted Me years lost (DALYs) and ranks eleventh in terms of m~rtality.~ In South Asia, Indoor Air Pollution ranks third among all Burning one mosquito coil releases the same amount of parbculate matter (PM2.5) as burning cigarettes. Also, the emission of formaldehyde from burning one coil can be as high as that released from buming 51 cigarettes.5 Researchers have found that the gas phase of mosquito coil smoke contain some carbonyl compounds with properties that can produce strong initating effects on upper respiratory tract, for example, formaldehyde and acetaldehyde.6too few studies have been done to examine these major risk factors.3 In many tropical and potentd pollutants in developing tropical subtropical countries, burning mosquito coils is a key strategy for reducing mosquito bites. Although effective at combating mosquitoes, chemical- emitting coils may pose unintended hazards to respiratory health. Despite this, large populations in developing counb-ies use mosquito coils in their daily life to prevent vector-borne diseases.4 countries where the morbidity and mortality due to respiratory illness are of enormous proportions. In Thailand, there were many Myanmar migrant workers who have potential sources of indoor air pollution incluhg cooking stoves, mosquito coils and incense use and passive smoking. The effects due to emission of smoke * To whom correspondence should be addressed. Tel , tharaphy85@gmail.com. J Health Res 20 10,24fi~pp12):

2 from these sources have not been studied in Thailand. This study was undertaken to examine the effects of exposure to mosquito coil smoke on mpiratory health of Myanmar mqpnts in Thailand. MATERIALS AND METHODS: A cross sectional study was done at the Mae Sot District, Tak Province, Thailand in March, The interviewees were asked to complete a simplified Burmese version of The American Thoracic Society's FhpmtoIy or without colds, wheeze with or without colds, shortness of breath, sore throat without cold, rhinitis and eye irritation at home were assessed in relation to mosquito ad use and other independent variables that could also be associated with respiratory symptoms. RESULTS: Selected sociodemogmphic charachktics of the respondents and selected environmental factors are presented in table 1. Most of the Symptom Questi-, supplemented by questions women respondents in the study finished primary on the living environment. 412 respondents (all female) and 153 children (under 7 years old) were school 38.3%. Majority of them were farmers, 6 1.7% and others were mostly housewives. The included in the study. Descriptive statistics was average number of people living in the house was used to describe bdas, 4.40 people. The mean age of the children was Wms, behad E--lctns and prevalences of mpbhy years % of children were age between 1 - symptoms in respondents and children. Chi- square test was used to analyze the association between independent and dependent variables (symptoms). Prevalences of respiratory symptoms such as cough with or without colds, phlegm with 4 years and 58.8% of children were age between 5-7 years. 55.2% of the households used mosquito coils. About half of the households opened windows during cooking. At least one household member smoked in 52.7% of households. Table 1. Selected socio-demographic and environmental factors of the respondents (N= 412) and selected environmental factors Socio-demographic characteristics (N) O/O Age, (Mean=35.02, SD=9.15) Education never went to school primary school secondary and above Occupation Farmers Others (mostly housewife) Total household members, (Mean=4.40, SD= 1.47) Environmental factors Mosquito coil use Yes No Incense use Yes No Main Cooking Fuel Wood Others (Charcoal, Electricity) Household member current smoking Yes No t (one observation was missing in mosquito coil use and main cooking fuel) J Health Res 20 10,24 (stppi2):

3 Prevalences of respiratory symptoms in (p=0.066). Analysis for phlegm with or respondents: Cough with or whout cold and without colds in respondents is shown in phlegm with or without cold were reported in table 3. Mosquito coil use had positive 83.0% and 49.3%, respectively. Wheeze with sigdicant association with phlegm with or or without cold and shortness of breath were without colds (p=0.011). Incense use was acmunted for 53.4% and 25.5%, rqxhdy. positively and marginally sigmficantly The prevalences of sore throat without cold, associated with phlegm prevalence rhmitis and eye irritation at home Wood fuel for cooking had reported in 55.2%, 50.6% and 36.7%, negative sigdicant association with phlegm respectively. Prevalences of respiratory with or without colds (p=0.015). Analysis for symptoms in children: Cough with or wheeze with or without colds in respondents without cold, phlegm with or without cold is given in table 4. Mosquito coil use was and wheeze with or without cold were positively and marginally sigdicantly reported in 84.3%, 57.5% and 59.5%, associated with wheeze (p=0.091). Wood fuel respectively. Sore throat without cold, for cooking was positively and sigdicantly rhinitis and eye irritation at home were associatedwithwheeze (p=0.013). accounted for 45.4%, 65.1% and 31.1%, Children: Analysis for cough with or without respectively. Analytical fjndings: The tables colds in children is presented in table 5. summe chi-square tests for association of Mosquito coil use had sigmficant positive independent variables and resplratoly symptoms. association with cough with or without colds In the tables, we only included independent (p=0.007). Wood fuel for cooking was vanables with FO. 10. Responden& Analysts for positively signdicantly associated with cough cough with or without colds in respondents with or without colds (p=0.028). Household is shown in table 2. Mosquito coil use was member current smoking was positively positively and sigmficantly associated with associated with cough symptoms and it was cough with or without colds (p<0.001). marginally (p=0.058). Analysis for Household member current smoking was rhinitis in children is given in table 6. positively and margnally significantly Mosquito coil use was positively sigmficantly associated with cough with or without colds associated with rhinitis (p=0.042). Table 2. Analysis for cough with or without colds in respondents Cough with or without colds No (n=70) Yes (n=342) Respondent age (factor, 3 levels) (x2=10.86, df=2, p=0.004) Total members in household (factor, 3 levels) (x2=8.91, df2, =0.012) Respondent education (factor. 3 levels) (x2=7.24, df=2, p=0.027) Rooms in house (factor, 3 levels) (x2=21.71, df=2, pc0.001) Windows in house (factor, 3 levels) (x2=9.84, df=2, p=0.007) Mosquito coil use (covariate, 2 levels) (x2= 12.99, df=l, p<0.00 1) No Yes Windows open during cooking (covariate, 2 levels) (x2=5.18, df=l, p=0.023) Household member current smoking (factor, 3 levels) (x2=5.43, df=2, p=0.066) Never <5 sticks per day sticks per day J Health Res 20 10,24(sybpl2):

4 Table 3. Analysis for phlegm with or without colds in respondents Phlegm with or without colds No (N=209) Yes (N=203) Respondent age (x2=10.89, df=2, p=0.004) Rooms in house (x2=5.91, df=2, p=0.052) Windows in house [x2=8.24, df=2, p=0.016) Mosquito coil use (x2=6.53, df= 1, p=0.011) No Yes Incense use (x2=3.01, df= 1, p=0.082) No Yes Main type of cooking fuel (x2=5.87, df=l, p=0.015) Wood fuel Others (Charcoal, Electricity) Table 4. Analysis for wheeze with or without colds in respondents Wheeze with or without colds No (N= 192) Yes (N=220) Respondent age (x2=4.63, df=2, p=0.099) Total member of household (x2=9.44, df=2, p=0.009) Respondent education (x2=21.78, df=2, p<0.001) Windows in house (x2=10.84, df=2, p=0.004) Mosquito coil use (x2=2.85, df= 1, p=0.09 1) No Yes Windows open during cooking (x2=11.46, df=l, p=0.001) Main type of cooking fuel (x2=6.19, df=l, p=0.013) Wood fuel Others (Charcoal, Electricity) Table 5. Analysis for cough with or without colds in children Cough with or without colds No (N=24) Yes (N=129) Rooms in house (x2=10.63, df=2, p=0.005) Mosquito coil use (x2=7.21, df= I, p=0.007) No Yes Main type of cooking fuel (x2=4.82, df=l, p=0.028) Wood -fuel Others (charcoal, electricity) Household member current smoking (x2=5.70, df=2, p=0.058) Never <5 sticks per day sticks per day Table 6. Analysis for rhinitis in children Rhinitis No (N= 53) Yes (N= 99) Gender (x2=2.09, df=l, p=o. 148) Type of housing (x2=2.74, df=l, p=0.097) Rooms in house (x2=12.51, df=2, p=0.002) Windows in house (x2=9.35, df=2, p=0.009) Mosquito coil use (x2=4.12, df= 1, p=0.042) No Yes Windows open during cooking (x2=3.96, df= 1, p=0.046) Meals cooking per day (x2=6.87, df=2, p=0.032) t one observation was missing in rhinitis in children J Health Res 20 10, 24 (~tpp12):

5 DISCUSSION: The study was done only in female and chddren because they have more chance to get reqnratory problems due to indoor air pollution than adult males. Respondents: Mosquito coil use was positively associated with all the respiratory symptoms except shortness of breath. Mosquito coil use was sigmficantly associated with cough and phlegm prevalence, and marginally associated with wheeze prevalence, in respondents. This is consistent with the results of the other studles in adults.7 Age was sgrdicantly associated with almost all respiratory symptoms except rktis and eye irritation. Some of the symptom rates were lower with higher education level. This may be due to the awareness for health care as the respondents' education become hgher. Incense use in the house was positively associated with cough with or without phlegm with or without colds b0.082) and rhinitis (JF0.003). Wheeze with or without colds, shortness of breath and sore throat were negatively associated with incense use. Household member current smoking was positively associated with cough with or without colds lp=0.066), phlegm with or without colds (p=o. 103), and shortness of breath (p<0.001). Children: Mosquito coil use was positively associated with all the respiratory symptoms except phlegm with or without colds and eye irritation. Mosquito coil use was associated with cough with or without and rhinitis lp=0.042) and it is consistent with the results of the other studies in children.8 Age was positively and statistically associated with sore throat without cold (JF0.007). Generally, frequency of incense use was positively associated with symptom prevalences, but not sigdicantly so. CONCLUSION: In conclusion, this study found that exposure to mosquito coil smoke was positively associated with respiratory symptom prevalences in adult female respondents. This result provides support for the hypothesis that use of mosquito coil is associated with increased risk of respiratory symptoms in Myanmar migrant workers. Socio-demographic factors such as age and education were positively associated with the prevalences of respiratory symptoms and had siguficant association with 4 out of 7 symptoms. Also environmental, behavioral, and socio- demographic factors were associated with some of the respiraotty symptoms. Thus, we cannot rule out confounding in the observed associations between mosquito coil use and symptom prevalences. Further research should study in other places to ascertain the association between mosquito coil smoke and prevalences of mpimtory problems. If association between mosquito coil use and respiratory problems is consistently conhned in other m h, alternative methods of controlling exposure to m ~toes should be implemented. ACKNOWLEDGEMENTS: We thank the Thai Fogarty Centre, Chulalongkom University for financial support for thls study. REFERENCES 1 Smith, KR., Samet, J.M., Romieu, I., Bruce, N. (2000). Indoor air pollution in developing countries and acute respiratory infections in chddren. Throax, 55,6, Emti, M., Lopez, A.D., Rodgers, A., Hoom, S.V. and Mmy, C.JL. (2002). Selected major risk factors and global and regional burden of disease. Lancet, 360, Smith, K.R Indoor air pollution and acute respiratory infections. Indian Paediatriics. 40, J Health Res 2010,24(~/@/ 2):

6 4 Liu W, Zhang J, Hashim JH, Jalaludin J, Hashim 2, Goldstein BD. Mosquito coil emissions and health implications. Environ Health Perspect 2003; 111: Chen and Wong et. al, Exposure to Mosquito Coil Smoke may be a risk factor for lung cancer in Taiwan. J Epidemio12008; 18 (1) Chang J, Lin J, 1998, Aliphatic aldehydes and allethrjn in mosquito coil smoke, Chemosphere 36(3): Hu 2. G., Wong C. M, et a1 2004, Binary latent variable modeling and its application in the study of air pollution in Hong Kong. Statist. Med. 2004; 23: Azizi BH, Henry RL. The effects of indoor environmental factors on respiratory illness in primary school children in Kuala Lumpur. Int J Epidemiol 1991; 20: j Health Res 2010,24(~1@p/ 2):

The Relationship Between Prevalence of Asthma and Environmental Factors in Rural Households

The Relationship Between Prevalence of Asthma and Environmental Factors in Rural Households The Relationship Between Asthma and Environmental Factors in Rural Households I Noorhassim, MD K G Rampal, PhD J H Hashim, PhD Department of Community Health; Faculty of Medicine, Universiti Kebangsaan