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
479Sourueast 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