title: Respiratory symptoms and illnesses related to the concentration of airborne particulate matter among brick kiln workers in Kathmandu valley, Nepal.
abstract: BACKGROUND
  Bricks have been manufactured in Nepal for hundreds of years and are seen as a component of Nepalese sculpture and architecture. Large quantities of hazardous materials including high concentrations of particulate matter are emitted on a daily basis from brick kilns. Exposure to these hazardous materials can lead to adverse consequences on the environment and human health. This study was conducted to  estimate the prevalence of respiratory symptoms/illnesses and the magnitude of respirable and total dust exposures among Nepalese brick kiln workers.
  
  
  METHODS
  Respiratory symptoms/illnesses were evaluated by questionnaire among brickfield workers (n= 400) and a referent group of grocery workers (n= 400) in Kathmandu valley. Work zones (WZs): green brick molding (GBM), green brick stacking/carrying (GBS/C), red brick loading/carrying (RBL/C), coal preparation (CP) and firemen (FM) were the similar exposure groups (SEGs) from where personal air samples and interviews were taken. Among brickfield workers, personal monitoring was conducted across SEGs for total (n= 89) and respirable (n= 72) dust during February-March 2015 and March-April 2016. Applying multi-stage probability proportionate to size sampling technique, 16 kilns and 400 brick workers for interview were selected. Proportions, means, medians and ranges were calculated for the demographics, samples and respiratory symptoms/illnesses. One-way ANOVA was applied to compare the significance differences of the level of particulate matter among SEGs. Bivariate and multivariate logistic regression analysis were performed to evaluate association between respiratory symptoms/illnesses and participants groups, and SEGs among brick kiln workers at 0.05 level. Statistical analyses were performed using IBM SPSS Statistics 21.
  
  
  RESULTS
  Chronic cough (14.3%), phlegm (16.6%) and bronchitis (19.0%) were higher (P< 0.05) among brickfield compared with grocery workers (6.8, 5.8 and 10.8%). Mean respirable (5.888 mg/m3) and total (20.657 mg/m3) dust exposures were highest for red brick loading tasks. The prevalence of chronic cough, chronic phlegm, chronic bronchitis, wheezing and asthma were significantly higher for other WZs workers (p< 0.05) compared with CP; for GBM: 22.9, 34.6, 15.0 and 7.5%; for GBS/C: 13.5, 15.8, 10.0, 8.8 and 7.5%; for RBL/C: 11.1, 17.1, 27.4, 19.0 and 11.9%; for FM: 18.4, 12.5, 28.4, 4.9 and 0.0%; and for CP: 4.9, 6.3, 13.3, 9.3 and 4.0% respectively.
  
  
  CONCLUSIONS
  High dust exposures identified in this study may explain the increased prevalence of respiratory symptoms/illnesses among Nepalese brickfield workers, warranting action to reduce exposures.
authors.affiliation: Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre Nepal.
authors.forename: Seshananda
authors.identifier: 0000-0002-0163-6946
authors.initials: S
authors.lastname: Sanjel
authors.affiliation: Environment Science, Department of Environment Science and Engineering, School of Science, Kathmandu University, Dhulikhel, Nepal.
authors.forename: Sanjay N
authors.initials: SN
authors.lastname: Khanal
authors.affiliation: Environmental and Occupational Health, Department of Health Science, Brigham Young University, Provo, UT USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Thygerson
authors.affiliation: Environmental Management, University of Findlay, Findlay, OH USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Carter
authors.affiliation: Environmental and Occupational Health, Department of Health Science, Brigham Young University, Provo, UT USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Johnston
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu University, Kathmandu, Nepal.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Joshi
keywords: Brick kiln; Nepal; Respiratory symptoms/illnesses; Similar exposure group; Suspended particulate matter