CHILD ENVIRONMENTAL HEALTH

UNDERGRADUATE LECTURE

PROFESSOR A. M. YAKUBU

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INTRODUCTION�

Environmental health involves all aspects of natural and built environment that affect human health. 3 key elements involved include:

- Physical

- Chemical

- Biological External Factors and other

- Related factors that impact on behaviours.

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�WHO definition of Environmental Health �“Those aspects of the human health and diseases that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health”. This definition excludes behaviour, culture, traditions not related to environment.�

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DISCIPLINES�Other Phrases Used in the Field of Environmental Health�- Public Health�- Environmental Science�- Environmental Medicine�

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Areas of Environmental Health�a. Air quality (indoor, outdoor)�b. Body cosmetics (Human factor)�c. Climate change�d. Food safety including processing�e. Harzardous materials e.g. waste management�f. Housing including substandard apartments for institionalised humans�g. Childhood lead poisoning�h. Liquid waste disposal – septic tanks

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i. Medical waste management disposal�j. Noise pollution�k. Radiological health procedures�l. Recreational water – swimming pools�m. Safe drinking water�n. Vector controls�o. Pesticide�p. Rodent control�q. Natural and manmade disasters �

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Homes and Communities�- People spend more time at home, work place or schools. These environment expose humans:� i. Indoor and outdoor air pollution. � Poor air quality → premature death, asthma and other respiratory disorders, asbestos, carbon monoxide poisoning etc.� � ii. Inadequate heating and sanitation� � iii. Electrical and fire hazards� � iv. Structural problems e.g. collapse building� � v. Lead paint hazards.�

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Age factors in the immediate environment of children:

- Intranatal

- Perinatal

- Neonatal

- Infancy

- Toddler

- School age

- Adolescent

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Statistics (WHO) 2012

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Causes of Death

- 1.7m children death among under 5 linked to polluted air (indoor cooking, smoking, pneumonia, respiratory infections).

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- 270,000 of diarrhoeal death due to lack of access to good drinking water.

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- Malaria, 200,000 unhealthy environment

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- Unintentional injuries accounted for 200,000

INTRAUTERINE ENVIRONMENT� �Chemicals including drugs, biological agents and radiation all affects foetus adversely with effect manifesting postnatally. Maternal exposure during pregnancy to:� Postnatal Effect�A (a) Diethylstibesterol → Adenocarcinoma of the vigina� � (b) Thalidomide → Phoecomelia� � (c) Tobaco smoke → sudden infant death syndrome, Asthma etc� � (d) Lead → Neurobehavioral disturbances� � (e) Alcohol → Foetal alcohol syndrome�

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FOETAL ALCOHOL SYNDROME�Signs and Symptoms�i. Growth deficiency ranked� Mild – Both weight and height between 3^rd and 10^th percentile� Moderate – Either ht or wt < 3^rd percentile but not both� Severe – Ht and wt < 3^rd percentile.�

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ii. Facial� Craniofacial Abnormalities� a. Smooth philtram flat groove between nose and upper lip� b. Thin vermillion – Thin upper lips� c. Small palpebral fissures� d. Small eye opening�

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iii. CNS:� a. Structural: microcephally, agenesis of corpus callosum, cerebellar hypoplasia� � b. Functional: Learning difficulties, Impaired memory attention, and judgment� �Neurological Manifestation - Epilepsy, hearing loss, Abnormal gait.� �Related Conditions BUT NOT FAS�Cardiac: VSD, ASD, Transient murmur, Fallots Tetralogy�Renal: Horse Shoe Kidney�Skeletal: Webbed neck, Joint abnormalities�

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B MATERNAL EXPOSURE TO RADIATION� Biologic Effects:� - Genetic mutations in DNA → Chromosomal damage.� - Cell death and or carcinogenesis� �Radiation damages DNA directly through absorption via fluid in cell or by free radical generation.�

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Carcinogenesis Involves:� - Morphologic cell changes� - Cell immortality� - Tumor genicity� �Leukamias and Others�Syndromes:� Downs syndrome� Fanconi syndrome� Gonodal failure�

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BIOLOGIC AND CHEMICAL TERRORISM�Aims of terrorist, cause injury, fear and chaos.� �Terrorist Use:�i. Chemicals – Flammable gases and liquids� - Corrosives and industrial acids � - Poisonous substances like cyanide, nitrites � - Explosives� �ii. Biologic – Viruses: Variola (smallpox) Congo haemorrhagic fever virus, � - yellow fever virus� - Bacteria: Bacillus anthracis (anthrax) B. abortus, Yersina pestis (plague)� - Toxin: Botulinum toxins, C. perfringes toxin, staphenterotoxin.�

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EFFECTS OF CHEMICAL, BIOLOGIC POLLUTANTS ON CHILDREN� �Children most vulnerable because:�- Immature metabolic pathways�- Growth and developmental processes are very sensitive to disruption by chemicals�- Have time to develop multi stage chronic diseases that may be triggered by early exposure�- Proportionally children eat, drink more food and water and breathe more air per kg than adult�- Hand to mouth exposure in infants and toddlers�

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Emerging Issues�A Climate change is seriously impacting on sea level�- Threat to aquatic animals especially fish�- Severe natural disasters (flood, draughts)�- Pattern of infectious diseases are changing e.g malaria in temperate countries�- Air quality is constantly being polluted with major airway disease burden�

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B. Biosphere Vs Technosphere�Interaction between biosphere and technosphere, a creation of human environmental changes have the following effects:�- Depletion in ozone layer. In the presence of sunlight ozone molecule produces oxygen in high concentration lethal to life.� �- Solar radiation released from interaction between sunlight and ozone molecules produces temperature elevation (Global warming)� �- Disequilibrium in the ecosystem and the resultant high temperature increases proliferation of certain vector disease due to increase survival of these vectors.�

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Effect On Life�a) Low crop production → Low food production → accentuation of protein energy malnutrition.� �b) Interruption of sea animals – fish life and survival thereby cutting source of protein.� �c) Direct effects on humans� ↑ Cataract in young people� ↑ Skin damage and skin cancer� ↑ Cardiovascular and cerebrovascular disease�

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ECOSYSTEM SERVICES�

Ecosystem is a dynamic complex of plant, animals, micro-organisms communities and the non-living environment acting as functional unit.

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Environmental changes and ecosystem impairment�

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Climate changes

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Stratosphere Zone

Depletion

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Escalation Forest clearing

Of and land cover

Human changes

pressure

On global Land degradation

Environment

Wet land loss

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Biodiversity loss

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Fresh water Depletion

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Urbanization Effect

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Damage to costal

and ecosystem

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Community Environmental Factors Affecting Child Health � �Common structural underlying causes of maternal, newborn and U5 deaths and nutrition are:�- Poor resourced, unresponsive and culturally inappropriate health and nutrition services�- Food insecurity�- Inadequate feeding practices�- Poor hygiene and inadequate sanitation�- Lack of access to safe drinking water�

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- Female illiteracy�- Early pregnancy�- Discrimination and exclusion* of mothers and children from access to essential health and nutrition services due to:� a) Poverty� b) Political� c) Geographical marginalisation�- Poor and lack of appropriate intervention for continuum of care� �Pregnancy → Birth → Neonate → Infancy�

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TROPICAL ENVIRONMENT AND CHILD HEALTH�

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Tropical Countries:

Those countries situated between latitudes 23.5⁰ North (Tropic of cancer) and 23.5⁰ South (Tropic of capiricon) of the Equator respectively.

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Comprises largely:

West, Central, East Africa, South and SE Asia, central part of North America (Mexico), Middle East, SE Australia.

Climate:

Dry, Wet seasons

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Characteristic of the Population:

- 45 – 60% young persons under 15 yrs.

- Added to this women of reproductive age = 75%

- Low life expectancy

- 80% rural population

- Rapid urbane growth

- Low income, low literacy rate

- High fertility rate

- Poor sanitation

- Overcrowding slums.

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- Conflicts and violence (Sectarian, Boko Haram, Gunmen)

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- Disasters natural or manmade

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→ INTERNAL DISPLACEMENT

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- Natural disaster: Droughts, Floods, Volcanic eruptions, wildfire

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Man Created Disasters:

- Development projects

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- Mining

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- Commercial industries

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- Wild life sanctuaries

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Negative Impacts on Child Health:

- Denial of child rights (Health Education, Nutrition)

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- Psychological – Disruption of family life

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- Children forced to carry arms

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- Victims of forced labour

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- Orphanage

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- Disability (Post Traumatic Stress Disorders)

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Preventive Measures in the Homes

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1. Tackle indoor air pollutions as well as globally – ventilation etc

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2. Improve water and sanitation, storage at home

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3. Promote maternal health

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4. Reduce environmental health hazards to mothers and children.

(a) Keep from homes automobiles away

(b) Store chemicals out of reach of children

(c) Keep any lead paint away

(d) Use only clean water for preparing children food and drinking

(e) Prevent pest from coming into the room/residence

(f) Install carbon monoxide monitor

(g) Keep house free from leak

(h) Keep plastics away from children

(i) Keep organic produce out of the way of children

(j) Avoid storage of kerosene in bottles or containers use for storing drinking water.