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The 1997 Haze Disaster in Indonesia: Its Air Quality and Health Effects

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Abstract

In this study, the authors assessed air quality and health effects of the 1997 haze disaster in Indonesia. The authors measured carbon monoxide, carbon dioxide, sulfur dioxide, nitrogen dioxide, ozone, particulate matter with diameters less than or equal to 10 microm, inorganic ions, and polycyclic aromatic hydrocarbons. The authors also interviewed 543 people and conducted lung-function tests and determined spirometric values for these individuals. Concentrations of carbon monoxide and particulate matter with diameters less than or equal to 10 microm reached "very unhealthy" and "hazardous" levels, as defined by the Pollution Standards Index. Concentrations of the polycyclic aromatic hydrocarbons were 6-14 times higher than levels in the unaffected area. More than 90% of the respondents had respiratory symptoms, and elderly individuals suffered a serious deterioration of overall health. In multivariate analysis, the authors determined that gender, history of asthma, and frequency of wearing a mask were associated with severity of respiratory problems. The results of our study demonstrate the need for special care of the elderly and for care of those with a history of asthma. In addition, the use of a proper mask may afford protection.
The 1997 haze disaster in Indonesia: Its air quality and health effects.
Osamu Kunii; Shuzo Kanagawa; Iwao Yajima; Yoshiharu Hisamatsu;
Sombo Yamamura; Takashi Amagai; Ir T. Sachrul Ismail.
Author's Abstract: COPYRIGHT 2002 Heldref Publications
In this study, the authors assessed air quality and health effects of the 1997 haze disaster
in Indonesia. The authors measured carbon monoxide, carbon dioxide, sulfur dioxide,
nitrogen dioxide, ozone, particulate matter with diameters less than or equal to 10
[micro]m, inorganic ions, and polycyclic aromatic hydrocarbons. The authors also
interviewed 543 people and conducted lung-function tests and determined spirometric
values for these individuals. Concentrations of carbon monoxide and particulate matter
with diameters less than or equal to 10 [micro]m reached "very unhealthy" and
"hazardous" levels, as defined by the Pollution Standards Index. Concentrations of the
polycyclic aromatic hydrocarbons were 6-14 times higher than levels in the unaffected
area. More than 90% of the respondents had respiratory symptoms, and elderly
individuals suffered a serious deterioration of overall health. In multivariate analysis, the
authors determined that gender, history of asthma, and frequency of wearing a mask were
associated with severity of respiratory problems. The results of our study demonstrate the
need for special care of the elderly and for care of those with a history of asthma. In
addition, the use of a proper mask may afford protection.
<Key words: forest fires, haze, health effects, Indonesia, particulates, respiratory
symptoms>
Full Text: COPYRIGHT 2002 Heldref Publications
BIOMASS BURNING (i.e., burning of living and/or dead vegetation for land-clearing
and its land-use change or as fuel for cooking and heating) is a significant source of trace
gases and aerosol particulates. It ultimately affects atmospheric chemistry and cloud
properties, and the global radiation budget is also profoundly affected by this practice. (1-
3) Consequently, climate dictates (4,5) that the bulk of the world's biomass burning
occurs in the tropical forests of Southeast Asia and South America and in the savannas of
Africa; approximately 90% of the burning results from human actions, and only about
10% occurs as a result of "natural" fires triggered by atmospheric lightning. (6)
Among nations that have dense, tropical forests, Archives of Environmental Healt
Indonesia has historically been affected repeatedly by forest fires (e.g., in 1982, a 3.5-
million hectare [ha] area was burned; in 1987, a 50,000-ha area was burned; in 1991, a
120,000-ha area was burned; and, in 1994, a 160,000-ha area was burned (7)). In 1997,
the dry conditions that prevailed in Southeast Asia that resulted from the El Nino
Southern Oscillation climate phenomenon (El Nini), together with land-clearing
practices, caused the second largest forest fire disaster in this century in Indonesia.
Subsequent to June 1997, more than 1,500 fires consumed more than 300,000 ha (i.e.,
mainly in the Kalimantan and Sumatra islands) and had generated intense smoke, which
affected neighboring countries (e.g., Singapore, Malaysia, Thailand) and the Indonesian
Islands for several months. The haze smoke paralyzed transportation and triggered
secondary disasters (i.e., airbus and tanker crashes).
Between September 1997 and November 1997 in Indonesia, there were 527 haze-related
deaths, 298,125 cases of asthma, 58,095 cases of bronchitis, and 1,446,120 cases of acute
respiratory infection reported. In South Sumatra, the number of acute respiratory
infection cases increased 3.8 times during the aforementioned time period, compared
with the prior year. (7) However, there were no data or information about the health
effects of this haze episode on the general public. Even for the other vegetation fire
episodes--such as the 1987 forest fires in California and the 1994 Sydney bush fires--
there were hospital-based studies, but there was a lack of community-based studies. In
the current study, we (1) assessed air quality, (2) investigated overall health effects and
factors that influenced the severity of respiratory problems, and (3) determined the
affected community's perceptions and practices in response to the haze in Indonesia.
Methods
All of the following surveys were conducted between September 29, 1997, and October
7, 1997. This period of time was in the middle of the forest fire disaster that occurred
from June 1997 through December 1997. During this period, the haze smoke had
constantly covered many pans of Indonesia.
1. Air quality. The size distribution of particulates and the concentration of carbon
monoxide (CO) and carbon dioxide (C[O.sub.2]) were measured at 8 sites between
Jakarta (in Java), which was affected only minimally by the haze, and Jambi (in
Sumatra), which was severely affected by the haze. To determine if remaining indoors
could be protective, we measured particulates inside and outside 3 types of buildings in
Jambi. The size distribution of particulates was determined with a light-scattering panicle
analyzer (RION KM-07). Carbon monoxide and C[O.sub.2] were measured with the
detector and tubes.
We measured sulfur dioxide (S[O.sub.2]), nitrogen dioxide (N[O.sub.2]), ozone
([O.sub.3]), particulate matter less than 10 microns in diameter (P[M.sub.10]), CO, and
C[O.sub.2] at 3 sites of Jambi. Sulfur dioxide, N[O.sub.2], and [O.sub.3] were measured
by the Parazosanilin, Saltzmann, and kalium iodine methods, respectively. P[M.sub.10]
was collected and measured with a low-volume air sampler. Airborne particulate samples
were collected with a high-volume air sampler, and inorganic ions (e.g., chloride [Cl],
nitrate [N[O.sub.3]], sulfate [S[O.sub.4.sup.2-]], and ammonium [N[H.sub.4.sup.+]] were
analyzed with ion chromatography. From other samples, which were also collected with a
high-air volume sampler, we analyzed polycyclic aromatic hydrocarbons (PAHs [also
known as carcinogens]) with the high performance-liquid chromatography
spectrofluorometric/computer system.
2. Health effects, perception, and preventive behavior. A face-to-face structured interview
was administered in Indonesian language to 543 persons who were selected by
convenience sampling at 6 sites in Jambi City (i.e., 105 in an elementary school, 102 in a
secondary high school, 110 in a high school, 53 in a nursing home, 94 in a local
government office, and 79 in a small village). The interview, which required 10-15 min,
included the following: 41 questions about past histories of asthma, bronchitis, and heart
diseases; 21 questions about types of health problems (i.e., whether health problems
developed or worsened following exposure to haze and determination of the severity of
each health problem [classified as "mild"--to the extent that daily life was undisturbed;
"moderate"--to the extent that daily life was disturbed, but medical help was not required;
and "severe"--to the extent that daily was disturbed and medical help was required]). We
also asked whether the interviewees wanted to evacuate to safer places, whether they
were worried about their future prospects as a result of the haze, and, while remaining
outside, how often they put on a mask for protection.
We examined every 4th respondent who developed or exhibited exacerbated respiratory
problems (a total of 138 individuals), to establish whether they had conjunctivitis and
abnormal respiratory sound, as determined by inspection and by auscultation,
respectively. We also tested lung functions of these individuals with spirometry.
Statistical analysis. Data were stored and analyzed with the SPSS statistical package
version 7.5 developed by SPSS Inc. (8) We used the chi-square test to assess the
significance of the differences in the severity of respiratory problems between those who
had and those who did not have preexisting histories of asthma or heart problems. We
also used it to examine the significance of differences in the change of general health
conditions between age groups and between males and females, as well as the difference
between age groups with respect to perception and protective practices taken in response
to the presence of haze. We used Student's t test to examine the differences in lung
function (i.e., forced vital capacity [FVC] and forced expiratory volume in 1 sec
[FE[V.sub.1.0]]) between 2 age groups and between males and females.
We performed multivariate analysis with the stepwise linear-regression model to
determine if factors associated with severity of respiratory problems developed or
worsened following exposure to haze. In this model, we used a 4-point scale to present
the severity of respiratory problem(s) (0 = none, 1 = mild, 2 = moderate, 3 = severe) as
dependent variables, and we used 7 items (i.e., gender, 1 age, history of allergy, asthma,
bronchitis, heart problems, and frequency of using a mask) as independent variables. All
tests were two-tailed, and a p value of [less than or equal to] .05 was indicative of a
statistically significant difference.
Results
Air pollution. The concentration of particulates 0.3~ 5.0 [micro]m in size gradually
increased as one moved closer to the heavily affected area, whereas the concentration of
particulates > 5.0 [micro]m in size increased very little (Fig. 1). The concentrations of
CO and C[O.sub.2] also increased in the affected sites, although the concentrations
increased only slightly in Jakarta; perhaps this increase reflected typical urban air
pollution (Fig. 2).
A major air pollutant of the haze in Indonesia was particulates that far exceeded the
"hazardous" level and the maximum value of 500 in the Pollutant Standards Index (PSI)
(Table 1). The concentration of 1,864 [mirco]g[m.sup.3] was more than 10 times higher
than that in Jakarta, and it was approximately 8 times higher than the maximum level of
P[M.sub.10] in the 1987 forest fire disaster in California, which consumed more than 2.4
million ha. (9) CO also exhibited a high concentration at the "very unhealthful" level of
the PSI, but S[O.sub.2], N[O.sub.2], and [O.sub.3] were at a "good" or "moderate" level.
There was little difference in particle concentrations in the ~0.3-5.0-[micro]m size range
in the indoor/outdoor air of 3 buildings in Jambi. The indoor/outdoor particle
concentrations were 428,978 particles/[m.sup.3] and 435,719 particles[m.sup.3],
respectively, of a farmer's house (not air conditioned); 432,283 and 436,234, respectively,
of a hotel (air conditioned); and 438,172 and 454,215, respectively, of a local government
office (air conditioned). However, outdoor concentrations of the coarse particles (i.e., 5.0
[micro]m) were considerably higher than indoor concentrations. The indoor and outdoor
concentrations were 209 and 226, respectively, for the farmer's house; 218 and 401,
respectively, for the hotel; and 155 and 275, respectively, for the local government office
(air conditioned).
With respect to inorganic ions in suspended particulates, the concentration of
S[O.sub.4.sup.2-] (i.e., 37.98 [micro]g/[m.sup.3]) was 5-10 times higher than
concentrations in Tokyo, whereas CI- (4.98 [micro]g/[m.sup.3]) and N[O.sub.3-] (5.3
[micro]g/[m.sup.3]) concentrations were almost identical, and N[H.sub.4+]
concentrations (0.69 [micro]g/[m.sup.3]) were slightly less than concentrations of CI- and
N[O.sub.3-]. The concentrations of the 5-7-ring PAHs in the affected area were 6-14
times those in the unaffected area (i.e., an almost proportional value to the particle
concentration), and the 4-ring PAHs in Jambi were 40-60 times higher than in Jakarta
(Table 2).
Health effects. Of the 543 interviews conducted, we collected 539 usable answers. The
mean age of the 539 respondents was 24.9 yr (standard deviation [SD] = [+ or -] 18.9 yr);
296 (54.9%) of the respondents were male. Some of the respondents had a preexisting
history of allergy (20.8), asthma (7.4), bronchitis (8.2), and heart problems (2.8%).
Almost all of the respondents (98.7%) developed or suffered from an exacerbation of
symptoms, and 91.3% had respiratory symptoms (Table 3). Most of the health problems
were mild, but 13.1% perceived their health problems as severe (i.e., to the extent that
they required medical help), and 49.2% reported that the health problems disturbed their
daily life. Among those with respiratory problems, 31.1 % exhibited fever, 46.6% were
short of breath when they walked, 34.1% experienced chest discomfort, 18.5%
experienced depression, and 28.8% experienced appetite loss.
In Table 4 are shown preexisting illnesses and severity of health problems. The chi-
square test revealed that those with a past history of asthma and heart problems presented
the most severe health problems. The group of individuals 60+ yr of age had a higher
proportion of persons who perceived that their health condition was "much worse";
among females, there was a slightly higher proportion who perceived that their health
condition worsened (Table 5).
Physical examination revealed the presence of conjunctivitis in 33.3% of respondents,
wheezing in 8.7% of respondents, and other abnormal respiratory sounds in 2.9% of
respondents. In lung function tests, a restrictive respiratory functional pattern (% FVC
[FVC measured/FVC predicted] < 80%); an obstructive pattern (FE[V.sub.1.0]
[FE[V.sub1.0]/FVC] < 80%); and both patterns were found in 68.2%, 38.6%, and 22.7%,
respectively, of respondents. Whereas there was no significant difference in percentage
FVC between age groups and between male and female groups, elderly individuals (i.e.,
> 60 yr of age) had a significantly (p < .001) lower FE[V.sub.1.0] (65.7[+ or -]27.5%)
than younger individuals (91.1[+ or -] 18.5%). Individuals with severe mucus production
had a significantly (p = .011) lower FE[V.sub.1.0] (59.1[+ or -]30.2%) than individuals
with mild sputum production (85.0[+ or -]20.3%). Individuals with severe breathlessness
when they worked hard had a significantly (0p = .042) lower FE[V.sub.1.0] (62.9[+ or -
]36.7%) than individuals with mild breathlessness (91.8[+ or -]19.6%); individuals with
severe breathlessness had a significantly (p = .047) lower FVC (58.7[+ or -]11.9%) than
those with mild breathlessness (76.4[+ or -]13.0%). Subjects who had a wheezing
respiratory sound by auscultation had a significantly (p < .001) lower FE[V.sub.1.0]
(49.3[+ or -]18.5%) than those who did not have wheezing sounds (86.2[+ or -]22.7%).
Factors associated with the severity of respiratory symptoms. Factors associated with
severity of respiratory symptoms, developed or exacerbated by haze, as determined with
multiple linear-regression analysis, are shown in Table 6. Gender (female), history of
asthma, and less frequent use of a mask were associated significantly with development
or exacerbation of severe respiratory symptoms.
Perception and protective practice toward haze. Of the respondents, 82.2% and 43.2%,
respectively, worried about their future prospects as a result of the haze or wanted to
evacuate to safer places (Table 7). Those who were 60+ yr of age worried less about their
future, and they worried less about evacuation than the other age groups. In this older age
group, 62.5% had never put on a mask when they were outdoors, and the young
generation (i.e., 0-19 yr) used masks less frequently than the other age group.
Discussion
In our study, particulate matter--especially inhalable or respirable particulate matter--was
a major source of air pollution, and its concentration reached levels that were very
hazardous to humans. In addition, this concentration produced an extremely high
incidence of respiratory problems; approximately 30% of the individuals had an infection
and a high prevalence of aggravated lung function. However, given that we used a
convenience sampling method in our study and we made no comparison between
unaffected area or predisaster time, the generalizability of our findings and a cause-effect
relationship between haze and health impact are questionable.
Epidemiological studies of health effects caused by vegetation fires or biomass burning
are limited. An increase in emergency room visits of asthmatic patients was shown in the
reports of an urban warehouse fire (10) and the 1987 bush fire (9) in California. But, in
studies of the 1991 urban wildfire in California (11) and the 1994 Sydney bush fires, (12)
little or no increase in asthma emergency room visits was evident. Several studies have
addressed occupational exposure of forest and wildland fire fighters, and they have
reported relatively mild and reversible respiratory health effects. (13-15) Such public
health impacts of smoke might be determined by exposure patterns (i.e., exposure time
and concentrations of air pollutants), demographic characteristics, and susceptibility of
the affected population group, diagnostic fashions, emergency room practices, etc.
Compared with fire events in previous studies, the 1997 haze disaster in Indonesia
affected more individuals at higher concentrations of particulates for a longer period, thus
producing a greater public health impact.
In typical urban air pollution from fossil fuel combustion, P[M.sub.10], or much-finer
P[M.sub.2.5], is reportedly associated significantly with several indicators of acute health
effects (e.g., mortality, [16,17] hospital admissions, (4,18) emergency visits, (19,20)
physical/functional limitation, (21) symptom manifestations, (22) lung function23,24). In
addition, several studies indicated that P[M.sub.10] or P[M.sub.2.5] was associated
significantly with overall and disease-specific mortality. (12,13,25-2)7 Several reviews of
these studies suggest that a 10-[micro]g/[m.sup.3] change in P[M.sub.10] is associated
with a 1.0-1.6%, 3.4%, and 1.4% change in overall, (26,27) respiratory, and
cardiovascular mortality, (26) respectively. If we apply the formula of urban air pollution
presented by the World Health Organization, (28) excess deaths resulting from the
increase in P[M.sub.10] are estimated at about 15,000 in the haze-affected area of
Indonesia. Nevertheless, only 527 deaths were reported from affected provinces. (7) This
reported number might be underestimated as a result of possible misclassification and
miscoding of haze-related cases, incomplete documentation, and reporting. Nevertheless,
the vast disparity implies that the health effect of P[M.sub.10] arising from biomass
burning is quite different from that of fossil-fuel combustion. One reason is that the
chemistry of respirable particles might be different between 2 types of haze. Another
reason is that the complexity and variability of the mixture of air pollution--the
interaction and intercorrelation for which might be important in producing adverse health
effects--must vary. The technical feasibility and scientific validity of isolating the effect
of single pollutants in such complex mixtures and analyzing the interaction and
intercorrelation of pollutants require further research and careful consideration.
In our study, the result of multivariate analysis might support a hypothesis that the
frequent use of masks contributes to a reduction in severity of respiratory problems
during haze episodes. In Indonesia, we observed that many affected people wore simple
surgical masks or simply covered their mouth with a handkerchief or thin cloths.
However, surgical and other simple masks may not be useful in preventing inhalation of
fine particles because they cannot filter particles of less than 10 [micro]m--the main
pollutant of the haze. Therefore, these devices may give a false sense of security to the
users. Respirators are special masks designed for the protection of workers exposed to
occupational health hazards. Such masks filter almost 100% of particles of less than 0.2
[micro]m or more than 0.4 gm and 80% to 99% of particles between 0.2 [micro]m and
0.4 [micro]m. They are, however, uncomfortable, and they increase the effort of
breathing, thus making them less than suitable for individuals with severe
cardiopulmonary symptoms. Moreover, the efficiency of filtration can last only for 8 hr;
therefore, it may not be feasible to sell or distribute enough respirators to protect all those
affected for several months, especially in developing countries, even though these
respirators cost only 2 or 3 U.S. dollars.
Staying indoors is generally recommended in haze episodes. This action reduces
exposure to particulate air pollution, (26) and evidence shows that indoor particulate
concentrations are one-half the outside particulate concentrations. (29,30) However, in
our study we could not find any such difference in the indoor and outdoor concentrations
of fine particulates. Perhaps the size of particulates was so small as to travel and intrude
into any space; the concentration of pollutants was extremely high, and the indoor
environments of buildings in Indonesia were rarely exempt from these pollutants.
However, staying indoors might play a meaningful role in avoiding physical activities,
thus preventing an excess load on one's cardiorespiratory system and an excess inhalation
of pollutants.
There is little evidence about long-term health effects of biomass-generated air pollution.
Investigators need to evaluate the development of chronic respiratory diseases and
incidence of lung cancer, as well as the longterm change of overall and disease-specific
mortality.
Table 1 .--Air Pollutants Measured in 3 Sites in Jambi,
Indonesia (October 3-4, 1997)
Site
Pollutant A B C PSI
S[O.sub.2] (ppm) 0.01 0.01 0.01 18
N[O.sub.2] (ppm) 0.01 0.02 0.004 --
[O.sub.x] (ppm) 0.03 0.03 0.06 54
CO (ppm) 20 20 20 247
P[M.sub.10]
([micro]g/[m.sup.3]) 1,684 1,635 1,864 1,584
Notes: S[O.sub.2] = sulfur dioxide, N[O.sub.2] = nitrogen dioxide,
[O.sub.x] = oxides, CO = carbon monoxide, and P[M.sub.10] =
particulate matter with a diameter of < 10 [mu]. PSI = Pollutant
Standards Index, developed by United States Environmental Protection
Agency. The PSI determines the daily index number for each of the 5
pollutants herein, and the highest of the 5 figures is reported.
A PSI value < 50 indicates "good" air quality, 51-100 indicates
"moderate" air quality, 101-200 represents "unhealthful"
air, 201-300 indicates "very unhealthy" air, and a value >
300 indicates hazardous air.
Table 2.--Concentrations ([micro]g/[m.sup.3]) of Polycyclic Aromatic
Hydrocarbons (PAHs) in Particulates
Molecular
PAHs Jambi Jakarta weight
Fluoranthene 16.7 0.255 202.3
Pyrene 21.1 0.396 202.3
Triphenylene 20.2 0.411 228.3
Benz(a)anthracene 16.8 0.438 228.3
Chrysene 41.7 0.910 228.3
Perylene 2.60 0.219 252.3
Benzo(e)pyrene 14.7 1.22 252.3
Benzo(b)fluoranthene 15.1 1.62 252.3
Benzo(k)fluoranthene 6.45 0.793 252.3
Benzo(a)pyrene 15.3 1.05 252.3
Indeno(1,2,3-c,d)pyrene 11.1 2.24 276.3
Benzo(g,h, t3perylene 12.8 1.78 276.3
Dibenz(a,c)anthracene 0.428 0.158 278.4
Dibenz(a,h)anthracene 0.823 0.120 278.4
Benzo(b)chrysene 1.66 0.164 278.4
Coronene 0.914 0.121 300.4
Di benzo(a, e)pyrene 3.15 -- 302.24
Characteristic Jambi Jakarta
Particle ([micro]g/[m.sup.3) 1,707 167
Air volume ([m.sub.3]) 565 1,995
Collected amount of
particles (gm) 0.9646 0.3338
Sampling time (hr) 5.2 23.8
Table 3.--Incidence and Severity of Reported Symptoms
that Developed after Exposure to Haze
Severity of symptom
Mild Moderate Severe
Symptom n % n % n % n %
Respiratory 492 91.3 231 47.0 217 44.1 44 8.9
problems *
Eye irritation 425 78.9 276 64.9 135 31.7 14 3.4
Headache 331 61.5 199 60.0 119 35.8 14 4.2
Fatigue 280 61.5 206 73.6 67 24.0 7 2.4
Short of breat
when
walking 239 44.4 155 64.7 77 32.1 8 3.2
Short of breath
with hard
work 192 35.7 109 56.8 71 36.9 12 6.3
Chest
discomfort 175 32.5 109 62.5 59 33.8 6 3.7
Fever 161 29.8 107 66.7 49 30.8 4 2.5
Appetite loss 151 18.0 108 71.3 39 25.9 4 2.8
Sleeplessness 129 23.9 84 65.0 38 29.2 7 5.8
Nausea 126 23.3 101 80.3 23 18.1 2 1.6
Palpitations 121 22.5 88 72.4 33 27.6 0 0.0
Abdominal
pain 121 22.4 89 73.6 28 23.1 4 3.3
Depression 95 17.7 55 57.6 32 33.7 8 8.7
Dizziness 22 4.1 0 0.0 17 77.3 5 22.7
Diarrhea 16 3.0 11 68.8 4 25.0 1 6.2
At least 1
symptom
cited
above[dagger] 532 98.7 200 37.6 262 49.2 70 13.1
* Included cough, sneezing, runny nose, sputum production,
and sore throat.
([dagger]) lndividuals who developed 1 or more symptoms or had a
symptom that worsened. If an individual had at least 1 "severe"
symptom, it was classified as "severe." If an individual
had at least 1 "moderate" symptom, but had an absence of a
severe symptom, it was classified as "moderate." If only mild
symptoms were present, they were classified as "mild."
Table 4.--Preexisting Illnesses and Severity of Health
Problems in 532 Subjects
Severity of illness
Mild Moderate Severe
Illness n * n % n % n % p
([dagger])
Asthma (-) 493 197 40.0 243 49.3 53 10.8
< .001
(+) 39 3 7.7 19 48.7 17 43.6
Heart (-) 518 199 38.4 256 49.4 63 12.2
problem < .001
(+) 14 1 7.1 6 42.9 7 50.0
* Respondents who developed at least 1 symptom or who had
a symptom that worsened.
([dagger]) Chi-square test.
Table 5.--Changes in General Health Condition of Respondents, by Age
and Gender
Health condition
Extremely
worse Worse Unchanged
Age and gender n % n % n %
Total no. of
subjects
(N= 539) 44 8.2 348 64.6 87 16.1
Age (yr)
0-19 (n = 343) 15 4.4 216 63.0 53 15.5
20-59 (n= 149) 19 12.8 105 70.5 24 16.1
60+ (n = 47) 10 21.3 27 57.4 10 21.3
Gender
Male (n = 296) 28 9.5 176 59.5 57 19.3
Female (n = 243) 16 6.6 172 70.8 30 12.3
Health
condition
Better
Age and gender n % p *
Total no. of
subjects
(N= 539) 60 11.1
Age (yr)
0-19 (n = 343) 59 17.2 < .001
20-59 (n= 149) 1 0.7
60+ (n = 47) 0 0.0
Gender
Male (n = 296) 35 11.8 < .05
Female (n = 243) 25 10.3
* Chi-square test.
Table 6.--Multiple Linear Regression Analysis of Severity of
Respiratory Symptoms
Variable B * [beta] ([dagger]) [rho]
Gender 0.312 -0.143 .001
History of asthma -0.219 0.258 .000
Frequency of using mask 0.754 -0.095 .023
(Constant) -0.049
Multiple R 1.602
Notes: Dependent variable is the severity of respiratory problem
(0 = none, 1 = mild, 2 = moderate, and 3 = severe). Independent
variables and values of the study included are as follows:
gender--1 = male, 0 = female; history of allergy, asthma,
bronchitis, and heart disease--1 = yes, 0 = no; and frequency
of using mask when remaining outside--1 = never, 2 = sometimes,
3 = often, and 4 = always.
* Unstandardized regression coefficients.
([dagger]) Standardized regression coefficients.
Table 7.--Perceptions and Activities of Subjects (N - 539) in
Response to Haze, by Age
Age group (yr)
Total 0-19 20-59 60+
Perception/activity n % n % n % n % p
Worry about future
Yes 443 82.2 290 84.5 130 87.2 23 48.9 < .001
No 96 17.8 53 15.5 19 12.8 24 51.1
Want to evacuate
Yes 233 43.2 216 63.0 86 57.7 4 8.5 < .001
No 306 56.8 127 37.0 63 42.3 43 91.5
Use mask outside
Never 337 62.5 235 68.5 81 54.4 21 44.7 < .001
Sometimes 72 13.4 18 5.2 36 24.2 18 38.3
Often 68 12.6 54 15.7 10 6.7 4 8.5
Always 62 11.5 36 10.5 22 14.8 4 8.5
We wish to thank Yutaka Inaba and Momoko Chiba for their technical assistance, and
Hirofumi Nitta, Hidekazu Matsueda, Kazuo Nomiyama, and Susumu Wakai for their
analysis and interpretation of the results. We also appreciate the cooperation of the
central and local governments of Indonesia, the Environmental Management Center, the
Embassy of Japan, and the Japan International Cooperation Agency Office in Indonesia.
Osamu Kunii was the principal investigator, contributor to, and implementor of the study
design. Dr. Kunii helped with data analyses and wrote the draft manuscript. Shuzo
Kanagawa also contributed to the study design, its implementation, and the writing of the
manuscript. Iwao Yajima, Yoshiharu Kisamatsu, and Takashi Amagai contributed to the
study design, its implementation, and air pollution analysis. Sombo Yamamura and Ir. T.
Sachrul Ismail contributed to the study design, supervised its implementation, and the
analyses of the data. All investigators contributed to the interpretation and the editing of
the final version of the manuscript.
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OSAMU KUNJI
SHUZO KANAGAWA
Department of International Community Health
Graduate School of Medicine
The University of Tokyo
Tokyo, Japan
and
International Medical Center of Japan
Tokyo, Japan
IWAO YAJIMA
Environmental Management Center
Bapedal, Indonesia
YOSHIHARU HISAMATSU
Department of Community Environment Sciences
National Institute of Public Health
Tokyo, Japan
SOMBO YAMAMURA
Department of Protection
of the Human Environment
World Health Organization
Geneva, Switzerland
TAKASHI AMAGAI
Institute of Environmental Sciences
University of Shizuoka
Shizuoka, Japan
IR T. SACHRUL ISMAIL
Department of International Community Health
Graduate School of Medicine
The University of Tokyo
Tokyo, Japan
and
Environmental Management Center
Bapedal, Indonesia
... Beyond storms, a variety of studies looked at the health effects of different types of natural disasters via chart review of patients who presented after the disaster. A large forest fire in Indonesia caused a "haze disaster" in 1997 resulting in increased respiratory complaints [71]. Among 543 respondents, while only 7.4% had a history of chronic respiratory illness (asthma), 98.7% presented with respiratory complaints [71]. ...
... A large forest fire in Indonesia caused a "haze disaster" in 1997 resulting in increased respiratory complaints [71]. Among 543 respondents, while only 7.4% had a history of chronic respiratory illness (asthma), 98.7% presented with respiratory complaints [71]. 49.2% of all respondents reported symptoms which disturbed their daily life [71]. ...
... Among 543 respondents, while only 7.4% had a history of chronic respiratory illness (asthma), 98.7% presented with respiratory complaints [71]. 49.2% of all respondents reported symptoms which disturbed their daily life [71]. In Ecuador, researchers looked at pediatric emergency department visits and found that there was an increase in frequency of visits associated with volcanic eruptions. ...
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... Consequently, (Oniyiah, 2015) develop mathematical expression for these two sets of unit's relationship. Atmospheric testing of nuclear bombs was stopped in the United States and the Soviet Union, and radioactive fallout from this sources has declined concern countries however, over the dangers resulting from massive releases of radioactive materials from nuclear weapons, which, if used on a major scale, could seriously endanger all of humanity (Amagai et al., 2002). The disastrous fog and attendant high levels of Sulphur dioxide and particular late pollution (and probably also sulphuric acid) that occurred in London in the second week of December 1952 led to the death of more than 4,000 people, prized cattle at an agricultural show also died in the same period. ...
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Recent research has identified another biospheric process that has instantaneous and longer term effects on the production of atmospheric gases: biomass burning. Biomass burning includes the burning of the world`s vegetation-forests, savannas. and agricultural lands, to clear the land and change its use. Only in the past decade have researchers realized the important contributions of biomass burning to the global budgets of many radiatively and chemically active gases - carbon dioxide, methane, nitric oxide, tropospheric ozone, methyl chloride - and elemental carbon particulates. International field experiments and satellite data are yielding a clearer understanding of this important global source of atmospheric gases and particulates. It is seen that in addition to being a significant instantaneous global source of atmospheric gases and particulates, burning enhances the biogenic emissions of nitric oxide and nitrous oxide from the world`s soils. Biomass burning affects the reflectivity and emissivity of the Earth`s surface as well as the hydrological cycle by changing rates of land evaporation and water runoff. For these reasons, it appears that biomass burning is a significant driver of global change. 20 refs., 4 figs., 2 tabs.
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We studied cross-seasonal changes in pulmonary function and respiratory symptoms in 52 wildland firefighters in Northern California. The mean cross-seasonal change in forced expiratory volume in 1 second (FEV1) was - 1.2% (95% confidence interval [CI] - 0.5%, - 2.0%) with a corresponding mean change in forced expiratory volume (FVC) of - 0.3% (95% CI 0.4%, - 1.0%). Decreases in FEV1 and FVC were most strongly associated with hours of recent fire-fighting activity (P = .002 and .01, respectively). When the study group was divided into three categories based on recent fire-fighting activity, firefighters in the high activity category (mean +/- SE, 73 +/- 7 hours of fire-fighting in previous week) had a - 2.9% (130 mL) change in FEV1 and a - 1.9% (102 mL) change in forced vital capacity (FVC). There was a significant cross-seasonal increase in most respiratory symptoms evaluated. Several symptoms (eye irritation, nose irritation, and wheezing) were associated with recent fire-fighting. These findings suggest that wildland firefighters experience a small cross-seasonal decline in pulmonary function and an increase in several respiratory symptoms. Research is under way to identify the fire conditions and specific components of exposure that produce pulmonary irritants, and to examine the potential reversibility of acute pulmonary change. (C)1991 The American College of Occupational and Environmental Medicine
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This study evaluated effects on respiratory health of forest firefighters exposed to high concentrations of smoke during their work shift. This is the first study of cross-shift-respiratory effects in forest firefighters conducted on the job. Spirometric measurements and self-administered questionnaire data were collected before and after the 1992 firefighting season. Seventy-six (76) subjects were studied for cross-shift and 53 for cross-season analysis. On average, the cross-season data were collected 77.7 days after the last occupational smoke exposure. The cross-shift analysis identified significant mean individual declines in FVC, FEV1 and FEF25–75. The preshift to midshift decreases were 0.089 L. 0. 190 L. and 0.439 L/sec. respectively, with preshift to postshift declines of 0.065 L. 0.150 L. and 0.496L/sec. Mean individual declines for FVC, FEV1 and FEF25–75 of 0.033 L. 0.104 L. and 0.275 L/sec. respectively, also were noted in the cross-season analysis. The FEV1 changed significantly (p < 0.05). The use of wood for indoor heat also was associated with the declines in FEV1. Although annual lung function changes for a small subset (n = 10) indicated reversibility of effect, this study suggests a concern for potential adverse respiratory effects in forest firefighters. Am. J. Ind. Med. 31:503–509, 1997. © 1997 Wiley-Liss. Inc.