Sanjel S, et al. Ann Occup Environ Med. 2017 Mar;29(1):9. https://doi.org/10.1186/s40557-017-0165-0

Previous studies report high respirable silica exposures among clay brick workers globally; however, there are little data on exposures among workers in fixed chimney Bull's trench kilns, the predominant kiln type in Kathmandu valley, Nepal. We investigated respirable silica exposures among workers (N = 46) in five similar exposure groups (SEGs). Mean exposures were highest for red brick loading/carrying (331 μg/m³), followed by green brick stacking (223 μg/m³), fireman (102 μg/m³), coal crushing/carrying (92 μg/m³), and green brick molding (71 μg/m³). The average free silica content (13.8%) in the respirable dust fraction was similar to levels reported for clay brick workers employed in other types of kilns. Dust control measures and respiratory protection are recommended, with priority given to workers assigned to red brick loading and stacking and green brick stacking and carrying.

Background Level of knowledge regarding oral hygiene among the parents of pre-school children plays an important role on maintaining the good oral hygiene of their children. In Nepal, sufficient research has not been carried out on this area.Objective Objective of this study is to assess the level of knowledge on oral hygiene of pre-school children’s parents attending pediatric outpatient department in Dhulikhel Hospital.Method A descriptive study was conducted from November 2012 to January 2013 among one hundred parents of preschool children visiting pediatrics outpatient department of Dhulikhel Hospital. Paper and pencil based semi structured questionnaire was used for collecting data. Questions related to demographic information and knowledge were asked. Thirty questions were used for assessing knowledge level. Knowledge score was calculated by allocating one point for each correct answer and zero point for each wrong answer. Analyzed data were presented in terms of numbers and percentages. Total knowledge scores were categorized based on percentage. Knowledge score was categorized on four group - exclusive intervals - namely-poor (0-40%), moderate (40-60%), good (60-80%) and excellent (80-100%). Mann-Whitney U test and Kruskal-Wallis test were applied to check significance difference and chi-square test was used to check association among different background characteristic.Result It was found that 81% had moderate knowledge, 15% had poor knowledge and 4% had good knowledge about oral hygiene. Median knowledge score was found to be 15 with range 10 to 21. Following variables were found to be significant difference on knowledge category: Education status (p<0.001), education level (p= 0.041), past experience about oral health problem (p = 0.008), Further significant association was found between knowledge category and educational status (p < 0.001) and between knowledge category and past experience (p < 0.001).Conclusion Knowledge regarding oral hygiene was found satisfactory among the parents of preschool children visiting pediatric OPD of Dhulikhel Hospital.Kathmandu University Medical Journal Vol.13(1) 2015; 38-43

Household air pollution is a major cause of morbidity and mortality worldwide, largely due to particles ≤ 2.5 µm (PM_2.5). The toxicity of PM_2.5, however, depends on its physical properties and chemical composition. In this cross-sectional study, we compared the chemical composition of PM_2.5 in brick workers’ homes (n = 16) based on use of wood cooking fire or liquefied petroleum gas (LPG) cookstoves. We collected samples using RTI International particulate matter (PM) exposure monitors (MicroPEMs). We analyzed filters for 33 elements using energy-dispersive X-ray fluorescence and, for black (BC) and brown carbon (BrC), integrating sphere optical transmittance. Wood fire homes had significantly higher concentrations of BC (349 µg/m³) than LPG homes (6.27 µg/m³, p < 0.0001) or outdoor air (5.36 µg/m³, p = 0.002). Indoor chlorine in wood fire homes averaged 5.86 µg/m³, which was approximately 34 times the average level in LPG homes (0.17 µg/m³, p = 0.0006). Similarly, potassium in wood fire homes (4.17 µg/m³) was approximately four times the level in LPG homes (0.98 µg/m³, p = 0.001). In all locations, we found aluminum, calcium, copper, iron, silicon, and titanium in concentrations exceeding those shown to cause respiratory effects in other studies. Our findings suggest the need for multi-faceted interventions to improve air quality for brick workers in Nepal.

Prior studies suggest brick workers in Nepal may be chronically exposed to hazardous levels of fine particulate matter (PM_2.5) from ambient, occupational, and household sources. However, findings from these studies were based on stationary monitoring data, and thus may not reflect a worker’s individual exposures. In this study, we used RTI International’s MicroPEMs to collect 24 h PM_2.5 personal breathing zone (PBZ) samples among brick workers (n = 48) to estimate daily exposures from ambient, occupational, and household air pollution sources. Participants were sampled from five job categories at one kiln. The geometric mean (GM) PM_2.5 exposure across all participants was 116 µg/m³ (95% confidence interval [CI]: 94.03, 143.42). Job category was significantly (p < 0.001) associated with PBZ PM_2.5 concentrations. There were significant pairwise differences in geometric mean (GM) PBZ PM_2.5 concentrations among workers in administration (GM: 47.92, 95% CI: 29.81, 77.03 µg/m³) vs. firemen (GM: 163.46, 95 CI: 108.36, 246.58 µg/m³, p = 0.003), administration vs. green brick hand molder (GM: 163.35, 95% CI: 122.15, 218.46 µg/m³, p < 0.001), administration vs. top loader (GM: 158.94, 95% CI: 102.42, 246.66 µg/m³, p = 0.005), firemen vs. green brick machine molder (GM: 73.18, 95% CI: 51.54, 103.90 µg/m³, p = 0.03), and green brick hand molder vs. green brick machine molder (p = 0.008). Temporal exposure trends suggested workers had chronic exposure to hazardous levels of PM_2.5 with little to no recovery period during non-working hours. Multi-faceted interventions should focus on the control of ambient and household air pollution and tailored job-specific exposure controls.

Previous studies involving workers at brick kilns in the Kathmandu Valley of Nepal have investigated chronic exposure to hazardous levels of fine particulate matter (PM_2.5) common in ambient and occupational environments. Such exposures are known to cause and/or exacerbate chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD) and asthma. However, there is a paucity of data regarding the status of systemic inflammation observed in exposed workers at brick manufacturing facilities within the country. In the current study, we sought to elucidate systemic inflammatory responses by quantifying the molecular cytokine/chemokine profiles in serum from the study participants. A sample of participants were screened from a kiln in Bhaktapur, Nepal (n = 32; 53% female; mean ± standard deviation: 28.42 ± 11.47 years old) and grouped according to job category. Blood was procured from participants on-site, allowed to clot at room temperature, and centrifuged to obtain total serum. A human cytokine antibody array was used to screen the inflammatory mediators in serum samples from each of the participants. For the current study, four job categories were evaluated with n = 8 for each. Comparisons were generated between a control group of administration workers vs. fire master workers, administration workers vs. green brick hand molders, and administration workers vs. top loaders. We discovered significantly increased concentrations of eotaxin-1, eotaxin-2, GCSF, GM-CSF, IFN-γ, IL-1α, IL-1β, IL-6, IL-8, TGF-β1, TNF-α, and TIMP-2 in serum samples from fire master workers vs. administration workers (p < 0.05). Each of these molecules was also significantly elevated in serum from green brick hand molders compared to administration workers (p < 0.05). Further, each molecule in the inflammatory screening with the exception of TIMP-2 was significantly elevated in serum from top loaders compared to administration workers (p < 0.05). With few exceptions, the fire master workers expressed significantly more systemic inflammatory molecular abundance when compared to all other job categories. These results reveal an association between pulmonary exposure to PM_2.5 and systemic inflammatory responses likely mediated by cytokine/chemokine elaboration. The additional characterization of a broader array of inflammatory molecules may provide valuable insight into the susceptibility to lung diseases among this population.