title: Effluents from a pulp and paper mill: a skin and health survey of children living in upstream and downstream villages.
abstract: OBJECTIVE
  A health survey of three villages (upstream village Rantau Baru and two downstream villages, Sering and Pelalawan) in the vicinity of a pulp and paper mill along the Kampar river in the province of Riau, Indonesia was conducted to find whether exposure to the effluents from the mill was related to skin conditions and ill health.
  
  
  METHODS
  A cross sectional survey was carried out of children living in the three villages.
  
  
  RESULTS
  Common skin conditions such as dermatitis, fungal infections, insect bites, and miliaria were found. No significantly increased risk of dermatitis or any illness in general was found with increasing levels of exposure to river water for downstream villages when compared with the upstream village. However, there was an increased risk of diarrhoea in Sering especially with drinking water directly from the river (prevalence rate ratio (PRR) 4.9, 95% confidence interval (95% CI) 0.4 to 63.9). An increased risk was also found within the upstream village Rantau Baru (PRR 2.3, 95% CI 0.9 to 5.8) and downstream village Sering (PRR 1.4, 95% CI 0.4 to 5.2) when children who drank water directly from the river were compared with those who never did. Analysis of the river water also showed physical and chemical variables within the acceptable range except for faecal coliforms (6 MPN/100 ml) found in the sample taken from Sering.
  
  
  CONCLUSIONS
  The effluent from the mill is unlikely to be causing skin conditions and ill health. Diarrhoea may be due to faecal coliform contamination of the water because all raw sewerage is deposited in the river. Community health outreach programmes are being implemented based on these findings.
authors.affiliation: Community, Occupational, and Family Medicine Department, Faculty of Medicine, National University of Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Koh
authors.forename: M
authors.initials: M
authors.lastname: Andijani
authors.forename: S M
authors.initials: SM
authors.lastname: Saw
authors.forename: C
authors.initials: C
authors.lastname: Munoz
authors.forename: S E
authors.initials: SE
authors.lastname: Chia
authors.forename: M L
authors.initials: ML
authors.lastname: Wong
authors.forename: C Y
authors.initials: CY
authors.lastname: Hong
authors.forename: C N
authors.initials: CN
authors.lastname: Ong
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003872:Dermatitis / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007220:Industrial Waste / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010209:Paper; D011078:Polychlorinated Biphenyls / Q000032:analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012423:Rural Health; D012871:Skin Diseases / Q000209:etiology*; D014871:Water Microbiology; D014877:Water Pollution, Chemical / Q000009:adverse effects*; D014881:Water Supply / Q000032:analysis
chemical_list: D007220:Industrial Waste; D011078:Polychlorinated Biphenyls