thesis

Chapter 1

INTRODUCTION

Background of the Study

As countries continue to develop, generation of solid wastes has rapidly increased. Together with the enlargement of urbanized society is the lessening of the possible areas for disposal of wastes. Cities’ waste collection system cannot cope with the increasing volume of solid wastes. Because of this, the proper waste management is one of the major concerns both by developed and developing countries. One of their problem is how and where to dispose these garbage.

The disposal of wastes in landfill sites has increasingly caused concern about possible adverse health effects for populations living nearby, particularly in relation to those sites where hazardous waste is dumped. Studies on the health effects of landfill sites have been carried out mainly in North America. Recent publications of large studies both in and outside North America warrant an update of evidence presented in previous reviews. Up-to-date knowledge about epidemiologic evidence for potential human health effects of landfill sites is important for those deciding on regulation of sites, their siting and remediation, and for those whose task it is to respond to concerns from the public in a satisfactory way.

The majority of studies evaluating possible health effects in human populations living near landfill sites investigate communities near one specific waste disposal site, frequently in response to concerns from the public about reported contamination from the site or reported clusters of disease. A small number of studies have addressed the risks of living near waste sites, independent of whether the sites caused concern, by a priori specifying a number of sites for study.

A general problem in studies of landfill sites, is that there is insufficient information regarding potential human exposures from landfill sites. Although landfill sites are numerous and widespread, very few have been evaluated with respect to both the types of chemicals they contain and the extent to which they may be releasing chemicals. Most such work has been conducted in the United States under the Superfund program (Hill, 1988). In other countries, information is largely lacking. Moreover, although chemicals have been found to migrate off site at a number of sites that have been thoroughly investigated (National Research Council. Environmental Epidemiology. 1991.), we know very little about the extent to which residents living near a site are exposed to these chemicals. A few studies that have attempted to measure certain chemicals in blood and urine of populations near waste sites have generally not found increased levels of volatile organic compounds (VOCs), mercury, or PCBs. Because knowledge of whether and to what extent substances from waste sites reach the human population is still largely lacking, and because resources are rarely available to carry out extensive exposure measurements or modeling, epidemiologic studies have based the assessment of exposure to landfills mainly on surrogate measures such as residence in an area close to a waste site or distance of residence from a waste site. The use of such surrogate, indirect exposure measurements can lead to misclassification of exposure which, if not different for diseased and nondiseased persons, will decrease the sensitivity of the study to find a true effect.

In addition to being hampered by insufficient exposure data, the study of landfill exposures is complicated by the fact that if residential populations are exposed to chemicals from landfill sites, it will generally be to low doses of mixtures of chemicals over long periods of time. Associations with such low-level environmental exposures in the general population are by their nature hard to establish. Low-dose exposures are generally expected to generate small increases in relative risk that will be difficult to distinguish from noise effects introduced by confounding factors and biases.

In most of the landfill studies reviewed, residents near waste sites are studied without knowledge of the exact route(s) of exposure to chemicals from the site. Migration of hazardous substances into groundwater is often an important environmental concern in relation to landfill sites, which may represent a public health problem, especially when a site is located near aquifers supplying public drinking water. However, in many situations the drinking water supply of residents near waste sites does not originate from the local area. For people living in the vicinity of these sites, other routes of exposure may be of more concern. Landfill sites may be a source of airborne chemical contamination via the off-site migration of gases and via particles and chemicals adhered to dust, especially during the period of active operation of the site. Very little is known about the likelihood of air exposure from landfill sites through landfill gases or dust. At some research, Low levels of volatile organic chemicals have been detected in indoor air of homes near landfill sites (Paigen B et al, 1987), in outdoor air in areas surrounding sites (Kharrazi M et al, 1997) or in on-site landfill gas (Goldberg MS et al, 1995). Other possible routes of exposure include contamination of soil, ground, and surface water, which may lead to direct contact or pollution of indoor air in the case of evaporation of VOCs into basements of nearby houses. Contamination via the food chain may sometimes be of concern for nearby residents in the case of consumption of home-grown vegetables. Drinking water is a possible route of exposure only if water for domestic use is locally extracted. If this is the case, other domestic water uses (bathing, washing) may also lead to exposure via inhalation of evaporated VOCs and/or direct contact (Clark CS et al, 1982).

The investigation of single landfill sites has been important as a response to community concerns; many of the single-site studies discussed below are prompted by public concerns, often under considerable political pressure. This means that they are prone to recall and reporting biases that may weaken the investigations and partly explain increases in reported health outcomes. Single-site studies have examined a vast range of possible health outcomes, often without a specific disease hypothesis being proposed a priori. Such "fishing expeditions" are thought to be of less scientific value than studies that start with a clear hypothesis (Upton AC. Public health aspects of toxic chemical disposal sites, 1989). Including these fishing expeditions in evaluating the consistency of findings across multiple studies is important nevertheless when assessing evidence for health risks.

A less avoidable problem in single-site studies is that the size of populations living near waste sites generally is small and, especially when the outcome is a rare disease, this can seriously limit the statistical power of an investigation.

Infants and children have been the subject of other Love Canal studies. A cross-sectional study (Paigen B et al, 1989) reported an increased prevalence of seizures, learning problems, hyperactivity, eye irritation, skin rashes, abdominal pain, and incontinence in children living close to the Love Canal site compared to controls from other areas, as reported by the parents of the children. It has been noted in previous reviews (British Medical Association. Hazardous Waste and Human Health. 1991) that this study was conducted in 1980, 2 years after the residents of Love Canal had become aware of the hazardous waste problem, when media and public interest were high, and people were being evacuated. This makes it likely that the results were biased by differential reporting of health problems. However, a similar population of children (spending 75% or more of their childhood in the Love Canal area) had significantly shorter stature for their age than control children after allowing for factors such as birth weight, socioeconomic status, and parental height (Paigen B et al, 1987). Vianna and Polan found an excess of low birth weights (less than 2500 g) during the period of active dumping (1940-1953) in areas of Love Canal where exposure had been highest. Rates of low birth weight between 1960 and 1978 after the site had been closed were comparable to those in upstate New York as a whole. It is not clear whether exposure from Love Canal was highest during the active dumping period or during the period after the site was closed, when the building of houses near the site increased and the landfill was leaking. A study by Goldman et al. reported a 3-fold risk of low birth weight for children exposed during gestational life to the Love Canal area compared to that for control children born elsewhere from 1965 to 1978. Data were analyzed separately for homeowners and renters so that groups of similar socioeconomic status were compared, and after allowing for confounding factors, the risk of low birth weight was significantly increased for homeowners only. This finding is difficult to interpret because there are no strong reasons to believe that homeowners would be more susceptible than renters to the effects of toxic chemicals. In the same study an increased risk of birth defects was observed for both homeowners and renters. Information on birth defects relied mainly on reports from parents. Some recall bias can therefore be suspected, in particular for defects of lesser severity, but this is unlikely to account for the entire association found for major birth defects.

Berry and Bove studied birth weight at the Lipari Landfill in New Jersey, a site for municipal and industrial waste. Leachate from the site migrated into nearby streams and a lake adjacent to a residential area. Inhalation of volatile chemicals emitted from the landfill and contaminated waters was thought to be the most important exposure pathway. The site closed in 1971 after complaints of residents, but the heaviest pollution was estimated to have occurred during the late 1960s to the mid-1970s. The study found a convincing increase in proportion of low birth weight babies (<>

A range of reproductive effects including low birth weight was studied around the large BKK hazardous waste disposal site in Los Angeles County, California (Kharrazi M et al, 1997), after previous investigations of vital records found that trends in low birth weight and neonatal deaths corresponded closely with times and quantities of dumping at the landfill. Results for the whole study period showed no increase in adverse reproductive effects, but during the period of heaviest dumping, birth weights were significantly lower in exposed areas than in control areas using odor complaint frequency zones to classify exposure. All results were adjusted for education, income, and race. The decrease in mean birth weight found in the high-odor complaint zone was small (59 g) compared to that in the Lipari Landfill study (192 g) and was less than a third of birth-weight reductions caused by smoking during pregnancy (Budnick LD, 1984). Odor complaint frequency zones corresponded better with vinyl chloride monitoring data and meteorology around the site than did census tract areas or distance-based exposure zones, and this was therefore thought to be the most accurate method for classifying exposure. Using census tract or distance-based exposure zones, smaller decreases in mean birth weight were found (35.2 g, p = 0.02 and 20.4 g, p = 0.25, respectively).

Miron Quarry, a large (the third largest in North America) municipal solid waste site in Montreal, Quebec has prompted studies on both reproductive outcomes (low birth weight and preterm births) Gas from the site was the main environmental and health concern and a range of VOCs, including a number of recognized or suspected human carcinogens, had been detected in the gas. An excess of 20% in low birth weight was found among babies of mothers who were living in the high-exposure area adjacent to the landfill at the time of delivery, taking account of confounding factors such as education and age of the mother. No excess was found in the low-exposure zone compared to a control area. Exposure zones were based on proximity to the site and accounted for the direction of dominant winds. Control areas were selected that were similar to exposure areas on a number of sociodemographic variables so as to limit the potential for confounding. The cancer study used the same exposure zones and control areas and increases were found in incidences of cancers of the stomach, liver, prostate, and lung for men, and stomach and cervix/uterus for women. Incidences of cancers of other organ sites were not increased in the exposed areas. Age and sex were the only confounders that could be controlled for directly and the authors admit that area matching for sociodemographic factors was based on fairly broad zones. The landfill started operation in 1968 and cancer incidence was studied between 1981 and 1988, which allowed a maximum latency of only 20 years among those residents in the area throughout the period.

In Mellery, Belgium, gases containing a complex mixture of VOCs escaped when the clay seal of a landfill site cracked. Because some of the detected chemicals were known mutagens and/or carcinogens, damage to chromosomes was studied and an increase in chromosome damage (sister chromatid exchanges) was found among Mellery residents but not in unexposed subjects in subgroups of both smokers and nonsmokers (Lakhanisky T et al, 1993). In children 8-15 years of age, a more marked difference was found between exposed and unexposed groups than among adults. The findings indicated exposures similar to those of occupationally exposed populations. The adult unexposed comparison subjects were recruited from a volunteer blood donor list and may therefore have comprised a group with risk behavior and exposure to possible risk factors for chromosome damage different from those of the general population. They also reported less occupational exposure than the Mellery inhabitants. It is unclear how occupational exposure was defined and results have not been adjusted for it. A follow-up study after site remediation reduced the concentration of the atmospheric pollutants to background levels reported that chromosomal damages in Mellery children had returned to background levels and were no longer different from those for unexposed populations (Berry M et al, 1997).

At the Drake Superfund Site, an industrial chemical dump in Pennsylvania, widespread on- and off-site contamination of groundwater, soil, and surface water with organic (benzene, chlorinated benzene, phthalates) and inorganic (arsenic, mercury) compounds prompted a cancer mortality and birth defects study (Budnick LD et a, 1984) and a community health survey (Logue JN et al, 1986) Air monitoring near the site identified a small number of organic compounds, but the main exposure route was thought to be direct contact with surface waters and soil in recreational areas near the site. Budnick et al. found an increase in mortality from bladder cancer (cancer of primary a priori concern because of aromatic amines detected on and off site) in the male population of one of the counties surrounding the waste site compared to average mortality rates in the entire state and the United States. Bladder cancer in females did not show such an effect. The authors point out that an occupational effect for males working in the Drake chemical plant may explain the fact that the association was found in men only. No excess in risk of birth defects was found. The subsequent health survey (Logue JN et al, 1986) found increased reporting of sleepiness and skin problems in the exposed community and concluded that it was difficult to say whether toxic chemicals from the site, overreporting of symptoms by the exposed community (reporting bias), or other factors such as stress and occupational exposure caused these symptoms.

A number of other community health surveys have investigated a wide range of health problems, including respiratory symptoms; irritation of skin, nose, and eyes; gastrointestinal problems; fatigue; headaches; psychological disorders; and allergies. These studies have been conducted in response to concerns from the public, often triggered by smells and odors from the sites. In a number of studies, self-reported health problems were increased in exposed populations (people living close to the waste sites) compared to control populations The majority of health surveys rely on residents reporting symptoms and diseases through questionnaires or interviews. The possibility exists that higher reporting rates of symptoms in exposed areas are at least partly explained by reporting and/or recall biases. From a public health point of view, the findings of high symptom reporting, whether or not due to differential self-reporting, may indicate the impact that stress and concerns related to landfill can have on ill health and/or perceived ill health. In the survey by Ozonoff et al., residents who indicated they were worried about neighborhood pollution reported more symptoms than those who were not worried, both in the exposed and the control area. Although this does not eliminate the possibility of an effect of toxic chemicals from the site, it suggests that stress and/or recall bias may have been responsible for the findings. Miller and McGeehin, and Dunne et al. found increased symptom prevalence only in residents who indicated they were worried about, or aware of, an environmental problem in their neighborhood. The study by Lipscomb et al. showed a 2-fold risk in most symptoms for residents who were worried compared to those who were not worried among the exposed population. The authors concluded that being worried, rather than a toxicologic effect from the site, explained the symptoms. Hertzman et al. used medical records to confirm certain symptoms and found no over- or underreporting. They concluded that this finding indicated limited reporting bias; however, only a small proportion of the respondents' records were reviewed. Moreover, seeing a physician (and therefore having a medical record) may itself be related to concerns about the site. Baker et al. studied self-reported health problems as well as mortality, cancer incidence, and pregnancy outcomes from medical registers at the Stringfellow waste dump in California. Self-reported diseases and symptoms were the only outcomes that differed between exposed and unexposed areas. Again, a higher perception of threat was related to a higher risk of nearly all self-reported symptoms.

The complicated relation between worry, odor perception, and symptom reporting related to hazardous waste landfill sites is further discussed by several authors (Neutra R et al, 1991).

Two recent studies around the French landfill of Montchanin used records of prescribed medication and cases from general practitioners to define health outcome, in order to avoid biases related to self-reporting of symptoms. Exposure classification in both studies was based on an individual index, taking into account the concentration of airborne pollutants and daily activities of study subjects. High concentrations of VOCs were detected in areas near the site and both leachates and air from the site were reported to be highly toxic in 1988 and 1989, shortly after site closure. Consumption of drugs prescribed for most conditions from 1987 to 1989 did not show a trend with exposure level, although a slight trend was found for drugs taken for ear, nose, and throat, and pulmonary conditions. In the second study, patients with conditions thought to be associated with dump emissions were compared to other GP patients and an association was found for respiratory symptoms and psychological disorders. Again, consulting a doctor for such conditions and subsequent diagnosis of the conditions by the physician may be related to fears of adverse effects from the landfill rather than to toxic chemical effects.

In addition, a number of reports are available of geographical comparison studies initiated after high rates (clusters) of specific diseases were reported in the vicinity of landfill sites. For example, increased rates of leukemia found in communities nearest a toxic waste dump in North-Rhine Westfalia, Germany, supported a GP report of a cluster near the site (Greiser E et al, 1991). Only short reports of these two investigations have been published.Concerns from residents and a GP about increased rates of congenital abnormalities (specifically gastroschisis, a defect in the abdominal body wall) among the population living near the Welsh landfill of Nant-y-Gwyddon were supported by the finding that rates of congenital abnormalities in exposed wards were almost 1.9-fold those in unexposed wards over the period from 1990 to 1996 (Fielder HMP et al, 1997). However, rates in the exposed wards were already high (1.9-fold those of unexposed wards) between 1983 and 1987 before the site opened, and it is unlikely, therefore, that these increased rates were due to the landfill. Four cases of confirmed gastroschisis indicated a significant 9-fold excess in rates of gastroschisis among exposed wards between 1989 and 1996. A cluster of bladder cancer cases in one town in Illinois in the United States, was observed by researchers and subsequently linked to the presence of two contaminated wells close to a landfill site (Mallin K et al, 1990).

A general problem in the interpretation of all cluster investigations is that localized areas of high disease density may occur even as part of a random pattern of disease. It is difficult to distinguish clusters derived from this random pattern from those where there is a common underlying local cause (Rothman KJ et al, 1990). Also, areas with higher disease densities, although part of the random pattern of disease, may be selectively picked for study.

The presence of chemicals in groundwater and drinking water is an important factor in determining the risk posed by landfill sites. However, it does not tell us what effect, if any, the consumption of contaminated water has on human health. Studies of adverse health effects prompted by the contamination of well water used for drinking water and other domestic uses by hazardous substances from waste disposal sites (mainly sites where chemical waste drums were buried) are discussed below. Literature on contaminated water and potential health effects is more extensive than that presented in this section, which focuses only on water contamination directly related to the disposal of waste. The 1991 review by the National Research Council gives a more comprehensive review of studies on contamination of domestic water supplies and health effects and concludes that although the available literature is scanty and not conclusive, drinking water contamination could lead to adverse health effects. Most of the studies summarized below have been discussed extensively in previous reviews.

In Hardeman County, Tennessee, well water used as drinking water by residents was found to be contaminated with high concentrations of carbon tetrachloride and other chlorinated compounds after complaints were received about the taste of the water. A nearby landfill where 300,000 barrels of pesticide waste had been buried was responsible for the contamination. Analysis of indoor air and bathroom air while showers were running both indicated detectable levels of carbon tetrachloride and other organic compounds in houses that received water from the contaminated wells. Carbon tetrachloride has been identified in toxicologic studies as a strong liver toxin. The investigation, conducted several months after the population had stopped using the water for drinking, showed abnormally high levels of liver enzymes (indicating liver damage) in residents who had used contaminated water compared to controls, who had not (Clark CS et al, 1992). The authors concluded that these high liver enzyme levels probably resulted mainly from exposure due to washing and toilet water uses, and possibly from previous exposure through drinking and cooking. Two months later, when use of the well had completely stopped, liver function in the exposed population had returned to normal. This study benefited from relatively well-documented exposure information and a clear hypothesis about the possible health effects (i.e., liver disease) related to exposure to carbon tetrachloride.

Leakage from an industrial dump of chemical waste drums in New Jersey caused contamination of groundwater and well water with organic chemicals (including benzene, toluene, trichloroethylene, and lead). Najem et al. found higher self-reported prevalence of respiratory disease and seizures but not cancer, liver illness, and skin disease in people living in a high-exposure area estimated on the basis of groundwater flow patterns. Residents in the high-exposure area used private drinking-water wells, ate home-grown food, and smoked more often than populations living in unexposed areas, and when these factors were adjusted for, differences in health outcomes disappeared. Adjusting for possible exposure routes such as local food consumption and use of private wells may have led to overadjustment, however, which would explain why no differences in health outcome were found.

An ex-military base in Dauphin County, Pennsylvania contained drums of toxic chemicals, fly ash, and other waste; well water for homes located on the perimeter of the site was contaminated with trichloroethylene, PCBs, pesticides, and other chemicals (Logue JN et al, 1985). Residents were instructed to stop using the water. Higher rates of eye irritation, diarrhea, and sleepiness were reported by residents of households with contaminated well water than by residents of households not having contaminated water.

Most studies, however, were not able to distinguish between different types and pathways of contamination and, in absence of better exposure data, based their assessments of exposure on distance of residence from the sites or residence in an area with a site. Exposure misclassification, if nondifferential, may be expected to dilute true effects in these investigations. Multisite studies mainly investigated cancers and reproductive outcomes.

Shaw et al. conducted a study on the risk of congenital malformations and low birth weight in areas with landfills, chemical dump sites, industrial sites, and hazardous treatment and storage facilities in the San Francisco Bay, California area. Census tracts were classified as a) no hazardous site in area, b) hazardous site in area but no evidence of human exposure, and c) hazardous site and plume in the area with evidence of potential human exposure. A small increase (1.5-fold) in risk was found for heart and circulatory malformations in the areas with potential human exposure. This increased risk was present across chemical classes and exposure routes. Risk of other malformations or low birth weight was not significantly increased. Results were adjusted for some potential risk factors (maternal age, race, sex of child, birth order) but not for socioeconomic status.

Reproductive outcomes have been studied in a number of other multisite studies. Sosniak et al. investigated the risk of adverse pregnancy outcomes for people living within 1 mile of a total of 1,281 NPL sites over the entire United States. The risk for low birth weight and other pregnancy outcomes (infant and fetal death, prematurity, and congenital anomaly) was not associated with living near a site after taking into account a large number of potential confounding factors, including socioeconomic variables collected through questionnaires. However, only around 63% of women originally sampled for the study returned the questionnaire and were included in the study. Also, it is unclear how congenital anomalies were defined, and no subgroups of malformations were studied.

Geschwind et al. investigated the risk of congenital malformations in the vicinity of 590 hazardous waste sites in New York State. A 12% increase in congenital malformations was found for people living within 1 mile of a site. For malformations of the nervous system, musculoskeletal system, and integument (skin, hair, and nails), higher risks were found. Some associations between specific malformation types and types of waste were evaluated and found to be significant. A dose-response relationship (higher risks with higher exposure) was reported between estimated hazard potential of the site and risk of malformation, adding support to a possible causal relationship. However, a follow-up study of Geschwind's findings found no relation between two selected types of malformations (central nervous system and musculoskeletal) and living near a hazardous waste disposal site. The study did report an increased risk of central nervous system defects for those living near solvent- or metal-emitting industrial facilities. Subjects for the first 2 years of this study were also included in Geschwind's study, and 2 more years were studied. Marshall et al. attempted to improve the exposure measurement in the first study by assessing the probability of specific contaminant-pathway combinations in 25 sectors of the 1-mile exposure zones. The risk of particular pathways or contaminant groups could not be investigated, however, because of limited numbers of cases in each subgroup. Hall et al. used the same method of exposure assessment to study renal disease near 317 waste sites in 20 counties in New York State. Increased risks were found for associations between renal disease and residential proximity to a site (within 1 mile), the number of years lived near a site, and a medium or high probability of exposure, although the associations did not reach statistical significance.

A study by Croen et al. based exposure measurement on both residence in a census tract containing a waste site and distance of residence from a site. Three specific types of birth defects (neural tube defects [NTDs], heart defects, and oral clefts) were studied; little or no increase in the risk was found using either measure of exposure. Risks of neural tube (2-fold) and heart defects (4-fold) were increased for maternal residence within 1/4 mile of a site, although numbers of cases and controls were too small (between 2 and 8) for these risk estimates to reach statistical significance. Births were ascertained from nonmilitary-base hospitals only, and the authors point out that the increased risk of NTDs may have resulted from lower ascertainment of exposed controls than exposed cases where exposure zones included military bases. Military base residents with pregnancies affected by NTDs may have been more likely to deliver in nonmilitary hospitals than residents with unaffected pregnancies.

A first European multisite study recently reported a 33% increase in all nonchromosomal birth defects combined for residents living within 3 km of 21 hazardous waste sites in 10 European regions (Dolk H et al, 1998) Neural tube defects and specific heart defects showed statistically significant increases in risk. Confounding factors such as maternal age and socioeconomic status did not readily explain the results. The study included both open and closed sites that ranged from uncontrolled dumps to relatively modern controlled operations. This disparity makes it difficult at this stage to conclude, if indeed the association is causal, whether risks are related to landfill sites in general or whether specific types of sites may be posing the risks.

The presence of large quantities of mixtures of potentially hazardous chemicals in landfill sites close to residential populations has increasingly caused concern. Concerns have led to a substantial number of studies on the health effects associated with landfill sites. From this review we can conclude that increases in risk of adverse health effects have been reported near individual landfill sites and in some multisite studies. Although biases and confounding factors cannot be excluded as explanations for these findings, the findings may indicate real risks associated with residence near certain landfill sites.

An increase in self-reported health outcomes and symptoms such as headaches, sleepiness, respiratory symptoms, psychological conditions, and gastrointestinal problems has been found consistently in health surveys around sites where local concerns were evident. In these health surveys symptoms were usually reported by the exposed population without further confirmation of the diagnoses by medical examination. It is not possible at this stage to conclude whether the symptoms are an effect of direct toxicologic action of chemicals present in waste sites, an effect of stress and fears related to the waste site, or an effect of reporting bias (the tendency of exposed people to remember and report more symptoms than unexposed people). Several authors have discussed the possibility that odor complaints and related worry about a site may trigger symptoms of stress-related disease or lead to an increased awareness of existing symptoms (Neutra R et al, 1987). Further research in this area is urgently needed to improve our understanding of the impact of social factors and risk perceptions on both actual and perceived ill health in waste site communities. Issues of environmental equity and environmental justice must form an integral part of such research. Other adverse health outcomes such as abnormalities in liver function (Clark CS et al, 1982) and in renal disease (Hall HI et al, 1996) have also been reported in relation to hazardous waste exposure, although in single studies only.

In 1937, the first modern sanitary landfill was built at Fresno, California, the “Fresno Municipal Sanitary Landfill”. Sanitary Landfills are engineered landfills, secured with physical barriers such as liners to save the public from exposure to the disposed wastes. Four basic conditions should be met before a site can be regarded as a sanitary landfill. First, the site must have formal engineering preparations. Designs should be developed from local geological and hydrogeological investigations. A waste disposal and a final restoration plan should also be developed. Second, the site must have a planned waste emplacement and covering. Waste are spread in layers and compacted which is then be covered daily to make the waste less accessible to pests. Third, the site must have a trained staff to supervise site preparation ad construction, the depositing of the waste and the regular operation and maintenance. And lastly, a sanitary landfill must have a full/partial hydro geological isolation. Additional lining materials should be used to help reduce breakage from the base of the site and help reduce contamination of ground water and surrounding soil with leachates. (Thurgood, 1999).

Leachates and landfill gas are two major contaminants in a landfill. Leachates is formed when water flows through the waste in the landfill. This water can be from rain or the waste itself. As the liquid moves through the landfill, many organic and inorganic compounds are transported in the leachate (Monroe, 2001). Leachates move to the base of the landfill and collects. To prevent this leachates from leaking out, and contaminates the ground water and surrounding soil, leachate collection and treatment must be stressed as a basic requirement. These leachate have potential health effects once leaked out in the landfill sites. Leachates from paints contains lead, phenols, cadmium compounds and xylene that can cause nausea, vomiting, diarrhea, abdominal pain, dyspnea, chest pain, pneumonia, skin irritation and dermatitis once exposed. Other leachates from the wastes such as batteries, glass, glues, and plastic contains elements such as mercury and nickel can cause health effects as stated above. Landfill gas is also major contaminants in landfills. These include carbon dioxide, nitrogen, volatile organic compounds, and hazardous air pollutants such as benzene, methane, vinyl chloride. Methane, primary content of landfill gas, is an odorless, colorless, flammable gas that can cause dizziness and headache once inhaled. It can also displace oxygen in an enclosed space which may result to asphyxia, a condition of severely deficient supply of oxygen to the body that leads to deprivation of oxygen supply to the brain tissue causing confusion, fainting and even death in extended periods (Brooks, 2005).

Another chemical produced by the leachate is the lead, Lead is a naturally occurring metal found in the earth's crust. However, most of the lead dispersed throughout the environment comes from human activity. The sources of lead released to the air include burning of fuel, such as coal and oil, industrial processes and burning solid waste. The largest used of lead is found in the production of some types of batteries. It is also used in ammunition, ceramic glazes and medical equipments. The release of lead is now less than the release of lead in the soil. Most the elevated levels of lead in soil comes from landfills, leaded paint and mining wastes. Lead is removed from the air by rain and, once deposited on soil, usually adheres to soil particles. The levels of lead may build up in plants and animals in areas where air, water, or soil are contaminated with lead. If animals eat contaminated plants or animals, most of the lead that they eat will pass though their bodies. It is the small amount absorbed that can cause harmful effects. For the general population, most exposure results from eating foods containing lead or from leaded paint. Lead can be found in a variety of foods including produce, meats, grains, seafood, soft drinks and wine. Usually, low levels of lead are found in drinking water. However, the amount of lead in drinking water can increase if the water supply is acidic, leaching lead from lead pipes, solder or brass faucets. Large numbers of workers are potentially exposed to lead in the workplace. People employed in lead smelting and refining jobs, rubber products and plastic industries, steel welding or cutting operations, battery manufacturing plants, construction work, those who work at municipal waste incinerators, pottery and ceramics industries or remove old lead-based paint may all be exposed. The Occupational Safety and Health Administration (OSHA) requires that a worker with a blood-lead level over 40 ug/deciliter be removed from the area of exposure. A study of workers in a ceramics industry indicated that family members of exposed workers also had elevated blood-lead levels, most likely because of the dust accidentally brought home by workers. Inhalation is the main pathway of exposure for people whose occupation exposes them to lead particles. Once in the lower respiratory tract, lead is almost completely absorbed. Absorption of lead in adults through ingestion is relatively low, unless ingested while the person is fasting. However, the rate of absorption through ingestion for young children is four to five times higher than for adults. Exposure data is expressed in terms of absorbed dose, usually measured as levels of lead in the blood. Estimates of blood-lead levels for children under five years old indicated that nearly nine percent, or approximately two million children have blood-lead levels of 10 ug/deciliter or higher, which the Center for Disease Control considers to be the level indicating lead poisoning. There is no beneficial purpose for lead in the human body. Lead has been shown to affect virtually every major organ in the body. The most sensitive organs appear to be the nervous system (particularly in children), the circulatory system and the cardiovascular system. In addition, colic is a consistent early symptom of lead poisoning. In adults, symptoms of neurological effects include dullness, irritability, poor attention span, headaches, muscular tremors, loss of memory, and hallucinations. The condition may then worsen, sometimes abruptly, to delirium, convulsions, paralysis, coma and death. In children, many of the same symptoms occur along with hyperirritability and convulsions. There is a greater incidence of permanent neurological and cognitive impairments in children. Even at lower levels without the severe symptoms described above, there may be permanent damage. A large body of literature clearly indicates that high levels of lead cause adverse effects on both male and female human reproductive functions. Lead is a teratogen that can cause fetal malformation, a mutagen that can affect both sperm and eggs, and a reproductive toxin that can impair fertility. Women who are exposed during pregnancy have experienced miscarriages and stillbirths. Several studies in males indicates that at moderate blood-lead levels (40-50 micrograms (ug)/deciliter) sperm production may be affected. Other studies, while of limited sample size or lacking a matched control group, provide evidence for lead-induced endocrine disturbances and reproductive disjunction in male workers exposed to lead.

Another chemical found on leachate is the CADMIUM. Most cadmium used worldwide is a byproduct of refining other metals, such as zinc, lead or copper. Cadmium is used mainly in batteries, pigments, metal coatings and plastic. Cadmium does not break down in the environment, but it can change forms, some of which dissolve in water. Dissolved cadmium can bioaccumulate up the food chain. The U.S. Environmental Protection Agency (USEPA)had classified cadmium as a probable human carcinogen. The two main routes of exposure for the general population are by inhalation of cadmium particles and ingestion of food or water containing cadmium. Most cadmium in the environment is in the form of particulate matter in the air and is generated from human activities such as mining, smelting, fuel combustion and incineration of waste or sewage sludge. Cigarette smokers inhale cadmium in the smoke. Dissolved cadmium can bioaccumulate up the food chain, so ingestion is a common route of exposure. The accumulation of cadmium has been reported in food crops, livestock, wildlife and aquatic organisms. Cadmium entering the body is excreted slowly over time, but too much cadmium can overload the kidneys and cause damage. Cadmium is a cumulative toxin, so long-term exposure at an elevated level is a concern. Workers exposed to cadmium through inhalation have shown signs of renal damage. At higher levels of exposure, calcium deficiencies and bone disorders are may also occur. Another chemical produced through the leachate by garbages particularly coming from the medical field is the MERCURY, a commonly used items as thermometers, sphygmomanometers used to detect blood pressure, and switches in thermostats and vehicles and in certain pigments. Studies show that 75 percent of the airborne mercury deposited in the environmental is from human, not natural, sources. As a metal, mercury persists in the environment. It is difficult to destroy by burning or bacterial breakdown and in bioaccumulates in the body. Mercury can easily exist as a vapor, so it can be inhaled and absorbed into the blood. It affects a variety of internal organs and methylmercury, an organic form of mercury, affects the central nervous system.

CHROMIUM is also one of the chemical found on leachate, it is a natural element found in rocks, animals, plants, and soil. Chromium can take several different chemical forms or valent states; chromium, trivalent chromium or hexavalent chromium. Trivalent chromium occurs naturally, and in small amounts is an essential nutrient for humans. Hexavalent chromium and chromium are generally produced by industry. Hexavalent chromium rarely occurs in nature. It is very toxic and is used in chrome plating, in manufacturing dyes and pigments, leather tanning and wood preserving. Individuals who work in industries that process or use chromium compounds can be exposed to higher than normal levels of chromium. An estimated 305,000 workers in the United States are exposed occupationally. Those industries include stainless steel welding, chromate production, chrome platers, chrome pigment manufactures, painters, battery makers, printers, candle makers, and cement makers. People who live near industrial facilities that use or manufacture hexavalent chromium, cement plants, or landfills with wastes that contain chromium may also be exposed to higher levels of chromium than the general population. Busy roadways that generate vehicle exhaust and cement particles may also increase exposure for near-by residents. Tobacco products also contain chromium. There are three routes of exposure for hexavalent chromium, inhalation of airborne particles, ingestion, and to a much lesser extent, through the skin. For the general population, the most common route of exposure is by eating foods containing hexavalent chromium. Only very small amounts of hexavalent chromium can enter the body through the skin unless the skin is damaged. Occupations that lead to exposure by inhalation to hexavalent chromium, such as chromate and chromate pigment production and chrome plating, are associated with respiratory disease and lung cancer. Nasal septum perforation and other respiratory effects have been reported among workers chronically exposed to hexavalent chromium compounds. The Department of Health and Human Services and the International Agency for Research on Cancer has determined that the following hexavalent chromium compounds are carcinogenic in humans: calcium chromate, zinc chromate, strontium chromate, lead chromate as well as those compounds used in chromate production, chromate pigment production and chromium plating. Oral exposure indicates that hexavalent chromium has the most impact on human blood-cell profiles and the gastrointestinal system. Nausea and vomiting were reported when hexavalent chromium dust was ingested. Oral ulcers, diarrhea, abdominal pain, indigestion, and vomiting resulted from drinking badly contaminated well water. However, no evidence of cancer has been found in mice following long-term exposure to hexavalent chromium in drinking water. Reproductive effects have not been reported in humans, but oral exposure to hexavalent chromium caused severe reproductive and developmental effects in mice.

http://proteus.pca.state.mn.us/waste/listedmetals.html (Minnesota)

A study conducted at StatenIsland, NU about the largest landfill in the world-Fresh Kills, is over 2965 acres, and produces 4 million gallons of leachate per day, or1.5 billions gallons per year. Materials in landfills were combined to characterize landfill leachate. The studies reported finding 82 chemicals in landfi1l 1eachate, including 63 types of organic chemicals.In the 70 landfill studies, concentrations of VOCs (volatile organic chemicals) in leachate varied widely, but the researchers were able to calculate a median concentration for each chemical by averaging all of the data. Of the 14 chemicals whose median concentrations exceeded federal drinking water standards, 12 are known or probable carcinogens, and 2 are considered toxic to humans. Median values for some of the carcinogenic chemicals were so high that those leachate samples would have to be diluted over 1000 times to reach an “acceptable” level. Other studies have also found instances where municipal landfills contaminated groundwater with volatile organics.

In a Wisconsin Department of Natural Resources study, leachate- contaminated groundwater samples were taken from 19 of the state's municipal landfills and tested for VOCs. Even in the diluted samples, 9 VOCs (volatile organic chemicals) frequently exceeded Wisconsin's groundwater quality standards. The VOCs (volatile organic chemicals) most commonly found in the study(benzene, tetrachloroethylene, trichloroethylene and vinyl chloride) were also the most toxic. The findings of the Wisconsin study are confirmed by a study of Florida's municipal landfills. There, researchers found that various VOCs(volatile organic chemicals), especially forms of benzenes and xylenes, contaminated the groundwater near landfills. In 100 percent of the samples,benzene exceeded federal drinking water standards. VOCs a(volatile organic chemicals) particularly problematic when they reach groundwater supplies because they are highly mobile and can travel with groundwater far beyond the borders of an landfill. For example, the Florida study found that some chlorinated benzenes had migrated with the groundwater 800 meters (872 yards) away from the landfill without being naturally degraded. This is especially significant in states where groundwater provides much of the population with its drinking water; in Florida, 90 percent of the people rely on groundwater for household consumption.

Samples of this Volatile Organic Chemicals are Benzene, a human carcinogen, mutagen, and possible teratogen which can cause blood cell disorders, allergic sensitization, eye and skin irritation. Next is Chloroform a probable human carcinogen and possible teratogen which can cause kidney and liver damage. Another chemical is Methylene Chloride a possible carcinogen that can cause blood disorders, eye and skin irritation. Next is Tetrachloroethylene which can cause upper respiratory tract infection. And the last is Vinyl Chloride which can also cause kidney and liver damage.

Another study was conducted at Municipality of Olavarria, Argentine regarding the contaminated water near the Olavarria Sanitary Landfill. The study revealed that the gastrointestinal diseases resulting from contaminated water are the biggest health problem facing the village population, affecting particularly the young and th elderly. (http://www.cleanairnet.org/lac_en/1415/article-59485.html)

Other contaminants from sanitary landfill are dust and vapors. Inhalation of these contaminants can cause headaches, dizziness, nausea and diarrhea. It can also irritate the eyes, nose and mouth that could lead to respiratory diseases. Extreme exposures can cause coma and death. The effect of sanitary landfill to the respiratory system can be attributed to the periodic volume reduction that is accomplished by an open burn that often leads to short-term effects such as wheezing, watery eyes, “cold” symptoms, pneumonia and bronchitis and long-term effects that include allergies, sinus infections, asthma and emphysema.

Dump sites for toxic waste have become a public health concern in both developed and developing countries. People living in the proximity of landfill sites believe that these toxic waste to be serious threats to their health and demand public health assessments and thorough clean up. One epidemiologic study have shown a high prevalence of subjective symptoms, such as headache, vertigo, insomnia, skin rash and upper airway irritation, although it has not been possible to demonstrate whether these symptoms are related to a direct toxological effect (Boucharlout, 1994).

To protect ourselves from illness especially from the hazardous substance brought upon by the toxic wastes, good personal hygiene must be sustained. it includes hand washing, bathing, oral care and simple but effective things like covering your mouth with a clean tissue when sneezing. Infections are acquired easily when we are off-guard. Unknowingly, a dirty hand touches food we eat that may bed us up in a hospital suffering from gastroenteritis. To ensure you don’t carry bacteria to other parts of your body or to other individual, you should wash your hands as needed.

Health maintenance such as exercises, eating nutritious foods at least 3x a day, taking vitamins, and having regular check up is also important to prevent occurrence of diseases, studies shows that a healthy body is a disease free body. Sleep and Rest is essential for the restoration and repair of the body’s normal function. At the end of the day, the body has worn out from the strenuous activity and the only remedy is proper rest and sleep, it is like resetting a machine or computer, after a tough day, it needs to take a time out. However, environment is one of the factors that affect the sleeping pattern of people.

In the Philippines, solid wastes are disposed in open dumpsites. This type of waste management would cause environmental and health problems. Samples gathered from Carmona and Payatas, dumpsites in Manila, showed high levels of toxic metals which includes lead, nickel, copper, and chromium which as discussed above, has an effect to health. In Makati, an average of 2, 500 cubic meters of garbage is generalized daily which can fill up 120 garbage trucks. The country is having a hard time treating and handling this garbage, in fact, there are 13 billion kilos of solid waste generated from its 89 million residents. There are 718 open dumpsites and 376 controlled dump sites, which should be closed under Republic Act 9003, The Solid Waste Management Law.

(http://www.gmanews.tv/story/63908/Garbage-crisis-in-Metro-looms-MMDA-urged-to-find-new-dumpsite-soon).

Health dangers posed by open landfills to the Filipino community include the proliferation of organic waste and damage to the human respiratory system. Organisms such as mosquitoes and rats are drawn to food sources at dumps in search of either reproduction sites, mosquitoes, or food sources, these organisms then pass on germs as unwitting carriers. The effect to the respiratory system can be attributed to the fact that open dumps require a periodic volume reduction that is usually accomplished by an open burn. These burn often lead to such short-term effects as wheezing, watery eyes, “cold” symptoms, pneumonia, and bronchitis and long-term effects that include allergies, sinus infections, asthma, heart disease, and even cancer. Adverse effects also include nervous system disorder, integumentary diseases, bone disorders and anemia. Inhaled dust can irritate nose, mouth, and eyes, which may lead to dizziness, diarrhea, and nausea and vomiting. Eventually may lead to death. The most commonly reported effect of living near a landfill is low birth weight and small size among children.

(http://www.state.ak.us/dec/dsps/compass/7pdf).

(http://www.gaia.com/Greenpeace/Manila.htm).

In San Fernando City, La Union, an engineered sanitary landfill was constructed in 2005 and situated at Barangay Mameltac with a contract to last for 10 years. There are about 1, 300 metric tons of garbage being dumped coming from different barangays of San Fernando City every month. Garbage from city establishments, public and private sectors are also collected and being delivered at the city sanitary landfill. Last January, 2008, 1, 226 metric tons of garbage has been collected. Before the collection of garbage, the dumping site is being prepared. It is done by placing a very large high density poly ethylene plastic (HDPE) above the soil so that the secretions coming from the garbage will not contaminate the soil. Above this is a filter cloth and gravel which filters and slows down the fluid and the movement of dirt from the garbage. From here, they will suction all filtered fluid and dirt using the HDPE pipe and will be brought at the pumping station and being filtered again in the leachate pond thus, being released at the rice field.

A previous study was conducted in this barangay with regards to the effects of sanitary landfill to the health of the residents. Study shows that in general, residents sometimes experience symptoms of gastrointestinal problems such as diarrhea, nausea and vomiting, abdominal pain, constipation, and boating. They also sometimes experience symptoms of respiratory infections like tonsillitis, bronchitis, asthma, etc.; and as for the integumentary system, they sometimes experience manifestations of skin infections like boils, warts, hives, and others (Uy, et. al. 2006).

As to statistics, the leading cause of morbidity is said to be Acute Respiratory Infection with 53 number of cases in the year 2007, followed by Urinary Tract Infection with 15 cases and Acute Toncillo Pharyngitis with 10 cases. On the other hand, the leading causes of mortality are Cardio Pulmonary Arrest, Respiratory Failure, Heart Failure, Chronic Organ Failure, and Pneumonia with the same number of cases. They have 23% crude birth rate, 4% crude death rate, and 0% infant mortality rate, maternal death, and fetal death.

Since a sanitary landfill has a hazardous effect to the health of the people once the four conditions discussed are unmet, the researchers wants to investigate the health related problems of the city sanitary landfills to the residents of Barangay Mameltac and their living conditions, Furthermore, to fulfill their duty as student-nurses in improving the over-all health status of their target communities by identifying particular health concern as influenced by environmental factors. The result of this study will provide the barangay residents near the landfill area substantial information regarding the advantages and probable health risks of the sanitary landfill. The Department of Health, together with the City Government of San Fernando, the City Health Office, and community health nurse can also use the results of this study as guidelines in identifying and developing the plan of care and interventions for environmental health related problems.

Theoretical Framework

The following health and legal theories were adopted by the researchers as their bases for conducting the study.

According to Florence Nightingale’s Environmental Theory, nursing is an act of utilizing the environment of the client to assist him in his recovery (Kozier, 2004). It involves the nurses’ initiative to configure the environmental settings appropriate for the restoration and promotion of the client’s health. External factors that are associated with the patient’s surroundings affect life or biologic and physiologic processes and his development. In this study, we will investigate the effect of the sanitary landfill (environment) to the health of the residents.

The Ecological Belief Model or the Agent-Host-Environment Model states that there are three dynamic interactive elements of health and illness. First are the agents which are any environmental factors or stressors which by its presence or absence could affect the health status of an individual. In this study, the potential environmental hazards posed by the sanitary landfill are agents which may cause negative effects to the resident’s health status. Second is the host which refers to the person who my or may not be at risk of acquiring a disease based on inherent variables like age, sex, and lifestyle which influence the host’s reaction. And third is the environment which may include external factors that may predisposes the host to the development of the disease. The resident’s proximity to the sanitary landfill also increases their vulnerability or risk of acquiring diseases brought about by the possible pollutants of the sanitary landfill (http://msucares.com/health/health /appa1.htm).

Conceptual Framework

Under Republic Act 9003, or the Comprehensive Solid Waste Management, certain criteria should be followed for sitting a sanitary landfill. With regards to people sensitivity, the site chosen must be accessible from major road ways. The site should have an adequate quantity of earth cover materials that is easily handled and compacted. The site where the landfill operates should not affect environmentally sensitive resources such as ground water reservoir or water shed area. This will prevent the contamination of the environment by hazardous wastes. After sitting and choosing the location, these following criteria should be met in the establishment of the sanitary landfill. The presence of covers and liners should be considered. Liners are a system of clay layers or geosynthetic membrane use to contain leachate and reduce/prevent contaminant flow to ground water. Leachate should be collected through installed pipes of the low areas of the liver. These pipes serve as a storage and eventually treatment and discharge for collected leachates. Landfill gas should also be collected through a gas control recovery system. It is a series of vertical wells/horizontal trenches containing permeable materials and perforated piping placed in the landfill for treatment and productive use of landfill gas as an energy source. Also present in the criteria is the ground water monitoring well system, this will be use to monitor the quality of the ground water.

In relation to RA # 9003 (Comprehensive Solid Waste Management), the government also ensure the maintenance of a pollutant free atmosphere through the establishment of RA 8794 (The Clean Air Act). This act defines air pollutants means any matter found in atmosphere other than oxygen, carbon dioxide, nitrogen, water vapor, and the inert gases in their normal concentration, that is detrimental to health or environment. These air pollutants can be found in sanitary landfill along with the other hazardous substances. The Clean Air Act defines hazardous substances as those substances with present either short-term acute hazards such as acute toxicity or long-term toxicity upon repeated exposure, carcinogenicity.

The government recognizes the right of the people to a healthy environment. The City Government of San Fernando, La Union, contribute to the preservation and enhancement of the Philippine environment through its ordinances. These ordinances includes 2006-012, an ordinance amending City Ordinance No. 2003-007 otherwise known as an Ordinance providing for a Comprehensive Solid Waste Management in the City of San Fernando and for other purposes, and 2006-013, an ordinance enacting the environment code of the City of San Fernando, Province of La Union.

External and internal variables affects individual’s health and wellness, it may or may not predispose him to a developing disease. Those favorable or positive factors can lead somebody’s health to high level of wellness; on the contrary, those unfavorable factors could result to poor health.

In this study, the researchers considered the profile of the respondents of Barangay Mameltac in terms of their age, gender, occupation, and body mass index. The researchers also considered the effects of City Sanitary Landfill to the health of the respondents along with gastrointestinal, respiratory, and integumentary systems so as with their live conditions for the past five years. On the other hand, the health status of the residents of Barangay Mameltac and their present live conditions are considered as the dependent variables.

Statement of the Problem

This study aims to determine the Health Related Problems and the Living Conditions of the Residents of Barangay Mameltac along the proximity of the City Sanitary Landfill

Specifically, it seeks to answer the following questions:

1. What is the profile of the respondents in terms of:

1.1 Age

1.2 Gender

1.3 Weight

2. What is the prevalence of the Health Related Problems along the:

2.1 Gastrointestinal System

2.2 Respiratory System

2.3 Cardiovascular System

2.4 Reproductive System

3. What are the living conditions of the respondents in terms of:

3.1 Personal Hygiene

3.2 Health Maintenance

3.3 Household Chores

3.4 Rest and Sleep

3.5 Recreational Activities

Research Hypotheses

There are varying profiles among the respondents of Barangay Mameltac in terms of their age, gender, and weight.
Health related problems along the Respiratory System are the most prevalent.
The respondents has a healthy living conditions along the:

3.1 Personal Hygiene

3.2 Health Maintenance

3.3 Household Chores

3.4 Rest and Sleep

3.5 Recreational Activities

Research Paradigm

Figure 1

Chapter 2

METHODS

Population and Locale of Study

The respondents for this study are the 43 selected households in Barangay Mameltac along the proximity of the City Sanitary Landfill. The respondents were chosen through some criteria. The proximity of the households to the City Sanitary Landfill were the following: it should be within 600 meters proximity North, within 150 meters proximity west, and 150 meters proximity east. These proximities were used since the researchers believed that respondents within this specified proximity may experience more accurately the health related problems that are related to the Sanitary landfill than those who reside far from the site. The reserachers used the Slovin’s Formula to get the number of samples. Within the specified proximity to the Sanitary Landfill, the population is approximately 215 people. Using the Slovin’s Formula the researchers come up with 139 people as the respondents.

Barangay Mameltac is 4.5 km away from the city proper. It is bounded on the north by Barangay Bato, on the east by Barangay Dallangayan Este, on the south by Barangay Dallangayan Oeste, and on the west by Barangay Biday. It has a land area of 94, 3132 hectares. Based on the latest census, the barangay is composed of 211 households with a total population of 1171. there are two schools at situated at the barangay, the Barangay Mameltac Community School and Dr. Quintin Balcita National Highschool and a Day Care Center. They also have one Barangay Health Center.

Data Gathering Tools

In gathering our data for this study, the researchers will make use of a questionnaire that will be validated and confirmed by the adviser and the defense panel as our main data gathering tool. In constructing the questionnaire, the researchers will based it from books, journals, and Internet sources related to the topic to come up with an supported and well understood questionnaire. The questionnaire will be in both English and Filipino version and will be supported with an informal interview with the respondents to substantiate gathered data from the questionnaire.

Data Gathering Procedures

This study will focus on identifying the Health related problems and living conditions of the residents of Barangay Mameltac. These health problems will be limited only to the Gastrointestinal, Respiratory, Cardiovascular systems, and Reproductive System since these were the areas most commonly affected during an infectious process.

After the approval of the City Mayor, the researchers will proceed to CENRO, then immediately go to the Local Government of Barangay Mameltac to ask permission to conduct a research in their barangay. After that, the researchers will now ask the approval of the Dean of College of Nursing and finally go to the target place and get acquainted with the respondents.

The respondents will be initially briefed on the purpose of the study, will be interviewed and will be given the questionnaire to fill up. The researchers will guide and assist the respondents on answering the questions.

The researchers hopefully will retrieve one hundred percent of the questionnaires and tabulate the results.

The researchers will also gather some data from the City Health Office about the incidence of commonly occurring disease in the barangay, and their health records for the past five years and these documents could be a basis in concluding and be of help in analyzing the actual effect of the City Sanitary Landfill to the health of the respondents.

Treatment and Analysis of Data

The following statistical treatments will be used to answer the specific problems of the study.

For problem one, the respondents will fill up the questionnaires with their age, gender and their proximity to the sanitary landfill. To answer problem two, percentage and weighted average will be used to show the prevalence health related problems of the respondents. And lastly, for problems three, the respondents will fill up the second part of the questionnaire about their living conditions. Percentage and weighted average will be used to show the extent of their activities of daily living.

Chapter 3

Interpretation, Analysis and Interpretation of Data

This chapter presents the results, analysis and interpretation of data. Only 86% of the questionnaires were retrieved. Out of 139 population only 100 people respond to our interview and questionnaire. This is due to time constraints, lack of understanding about the purpose of the study and their fear of sharing information to the researchers. According to the respondents this will not help their lifestyles and personal problems. Though only 100 questionnaires were retrieved, the data collected were analyzed and given with interpretation.

Profile of the Residents of Barangay Mameltac along the Proximity of the City Sanitary Landfill

Table 1.1 Profile of the Respondents in terms of Age

Age	Frequency (f)	Percentage (%)
7 - 13	7	7%
14 - 20	34	34%
21 - 27	13	13%
28 - 34	17	17%
35 - 41	9	9%
42 - 48	6	6%
49 - 55	5	5%
56 - 62	6	6%
63 - 69	2	2%
70 - 76	1	1%
i = 7	n = 100	100%

Table 1.1 presents the profile of the respondents in terms of age. It shows that most of the respondents is between 14 – 20 years of age. This implies that the respondents are adolescents and early adults who are within their active years of their life.

Table 1.2 Profile of the Respondents in terms of Gender

Gender	Frequency (f)	Percentage (%)
Male	58	58%
Female	42	42%
	n = 100	100%

Table 1.2 presents the profile of the respondents in terms of their gender. It shows that the respondents have higher males than females, though their difference in number is not that significant. It also shows that the distribution of respondents in terms of gender is almost equal.

Table 1.3 Profile of the Respondents in terms of Weight

Weight (kg.)	Frequency (f)	Percentage (%)
10 – 19	1	1%
20 – 29	3	3%
30 – 39	5	5%
40 – 49	31	31%
50 – 59	46	46%
60 – 69	13	13%
70 – 79	1	1%
i = 10	n = 100	100%

Table 1.4 presents the profile of the respondents in terms of their weight. It shows that most of them are within the range of 50 – 59 kg. It implies that their weight is within the normal range in relation to their height and age.

Health Related Problems of the Residents of Barangay Mameltac along the Proximity of the City Sanitary Landfill

Table 2.1 Prevalence of the Health Related Problems of the Respondents along the Gastrointestinal System

	Frequency (f)	Percentage (%)
1. Gastrointestinal System
1.1 Dry Mouth	31	31%
1.2 Vomiting	60	60%
1.3 Loss of Appetite	59	59%
1.4 Abdominal Pain	80	80%
1.5 Watery Stool	65	65%
1.6 Blood in the Stool	11	11%

Table 2.1 presents the prevalence of the Health Related Problems Respondents along the Gastrointestinal System. Abdominal pain got the highest percentage of 80% while Blood in the Stool got the lowest with 11% of the total respondents. These conditions presented in the table may indicate Gastritis which is one of the causes of morbidity in the barangay. As of 2007, 3 cases of Gastritis is reported. One study conducted in Vancouver, Canada revealed that garbage serves as a habitat for pathogens such as Shigella, E. coli and Salmonella that can cause gastrointestinal illnesses. Diarrhea, as manifested by watery stool and abdominal pain, is mainly caused by these microorganisms. (Pablo,2007)

Another study conducted in the Sanitary Landfill of Fresh Kills, in StatenIsland, New York revealed that 4 million gallons of leachate was being produced in the landfill per day. This leachate is one of the contaminants in a landfill. Groundwater samples were taken and the study showed that it is contaminated with leachates that contains Volatile Organic Chemicals (VOC). These chemicals include Benzene and Chloroform, both a human carcinogen, that has an effect to the gastrointestinal system. The study revealed that the groundwater near the landfill was contaminated by various Volatile Organic Chemicals. (http://k3power.org/docs/LandfillManual.pdf )

A study was conducted at Municipality of Olavarria, Argentine regarding the contaminated water near the Olavarria Sanitary Landfill. The study revealed that the gastrointestinal diseases resulting from contaminated water are the biggest health problem facing the village population, affecting particularly the young and th elderly. (http://www.cleanairnet.org/lac_en/1415/article-59485.html)

Table 2.2 Prevalence of the Health Related Problems of the Respondents along the Respiratory System

	Frequency (f)	Percentage (%)
2. Respiratory System
2.1 Common Colds	96	96%
2.2 Shortness of Breath	35	35%
2.3 Cough	94	94%
2.4 Sore Throat	34	34%
2.5 Chest Pain	39	39%
2.6 Fever	74	74%

Table 2.2 presents the prevalence of the Health Related Problems Respondents along the Respiratory System. Colds ranks first followed by cough. These conditions may indicate Acute Respiratory Infections which has morbidity rate at Barangay Mameltac. According to the data of the Barangay Health Center of Mameltac, 53 cases of Acute Respiratory Infections is reported as of 2007.

The Respiratory tract is the most common entry and exit of pathologic agents. These infectious agents may be transmitted through droplets. Coughing as commonly experience by the respondents facilitates the discharge of secretions and foreign bodies that infect the Respiratory tract. (Reyala, et al.)

Leachates from the Sanitary Landfill once leaked out can cause health effects to the Respiratory System. Leachates from paints contains, lead, phenols, cadmium compounds and xylene that can cause respiratory disease such as pneumonia, dyspnea, cough and common colds. (Brooks, 2005)

Volatile Organic Chemicals from leachates such as Ethylbenzene, Tetrachloroethylene, Toulene, Tricholoroethylene has an effect to the respiratory system. (http://k3power.org/docs/LandfillManual.pdf )

Metals from leachates can also have a hazardous effect to the respiratory sytem, these toxic metals include Arsenic, Cadmium, Chromium, Lead and Nickel.(http://www.crtk.org/detail.cfm?docID=28&cat=industrial%20toxics) A study conducted in Minnesota revealed that inhalation of Lead and hexavalent chromium, such as chromate and chromate pigment production and chrome plating, are associated with respiratory disease and lung cancer. Nasal septum perforation and other respiratory effects have been reported among workers chronically exposed to hexavalent chromium compounds. (http://proteus.pca.state.mn.us/waste/listedmetals.html)

In some areas of the Philippines where their Sanitary Landfill is not properly maintained, the presence of respiratory tract infections is common. Conditions such as common colds, bronchitis, pneumonia, influenza and asthma affect the most vulnerable groups like the infants, young children and the elderly. (http://www.gaia.com)

According to some of the respondents, they usually smell foul odor from the Sanitary Landfill during rainy season. These maybe due to the fresh garbage collected and dumped to the Sanitary Landfill. A study was conducted at Georgia, USA about the unpleasant odor coming from the landfill. Many people find the odors emitted from a landfill to be unpleasant. Although these odors are undesirable, no medical attention is usually required. Landfill odors may cause temporary symptoms such as nausea and headache, but their effect on the comfort of individuals is difficult to evaluate, because different individuals may react differently to the same type and intensity of odor. (http://health.state.ga.us/pdfs/hazards/LandfillGas.bro.pdf)

Table 2.3 Prevalence of the Health Related Problems of the Respondents along the Cardiovascular System

	Frequency (f)	Percentage (%)
3. Cardiovascular System
3.1 Headache	91	91%
3.2 Dizziness	70	70%
3.3 Blurred Vision	30	30%
3.4 Nape Pain	28	28%
3.5 Facial Flushing	12	12%
3.6 Fatigue	46	46%

Table 2.3 presents the prevalence of the Health Related Problems Respondents along the Cardiovascular System. It shows that headache is the most prevalent among the six conditions presented. Headache together with dizziness may be related to some conditions such as cardiovascular disorders. One study revealed that Sanitary Landfill contaminants such as dust, vapors and toxic wastes can cause headache, dizziness and fatigue once ingested or inhaled. (Boucharlout, 1996) Another study revealed that inhaled Methane, a component of landfill gas can also cause headache and dizziness. (Brooks, 2005)

Lead has been shown to affect virtually every major organ in the body. The most sensitive organs appear to be the nervous system (particularly in children), the circulatory system and the cardiovascular system. http://proteus.pca.state.mn.us/waste/listedmetals.html

Volatile Organic Chemical such as Methylene Chloride has cardiovascular effects as well as blood disorders as shown in the study conducted at the Sanitary Landfill of Fresh Kills, in StatenIsland, New York. (http://k3power.org/docs/LandfillManual.pdf )

Data gathered from the Barangay Health Center of Mameltac showed that the leading cause of mortality is Cardiopulmonary Arrest.

Table 2.4 Prevalence of the Health Related Problems of the Respondents along the Reproductive System

	Frequency (f)	Percentage (%)
4. Reproductive System
4.1 Strong Urge to Urinate	17	17%
4.2 Burning Sensation when Urinating	29	29%
4.3 Blood in the Urine	2	2%
4.4 Foul Smell in the Urine	4	4%
4.5 Dark/ Cloudy Urine	15	15%
4.6 Swelling in the Perineal Area	0	0%

Table 2.4 presents the prevalence of the Health Related Problems Respondents along the Reproductive System. Among the six conditions presented, 29% of the respondents experienced Burning Sensation when urinating. These condition may indicate a more serious reproductive system problems such as Urinary Tract Infection. UTI is caused by microorganism that infects the urinary tract such as Escherichia coli and Staphylococcus saprophyticus. Barangay Mameltac has 15 cases of UTI as of 2007. This UTI can be due to some risk factors such as unhealthy lifestyle, aging and gender. Women have higher risk to acquire UTI because of short urethra. (Lemone and Burke, 2004)

Chromium a metal found in leachates also has an effect to reproductive system as revealed in the study conducted at Minnesota, USA. (http://k3power.org/docs/LandfillManual.pdf.)

Living Conditionof the Residents of Barangay Mameltac along the Proximity of the City Sanitary Landfill

Table 3.1 Living Condition of the Respondents in terms of Personal Hygiene

	Frequency (f)	Percentage (%)
1. Personal Hygiene
1.1 Handwashing before and after eating meals	97	97%
1.2 Brushing the teeth	94	94%
1.3 Wearing of foot wears	94	94%
1.4 Taking a bath everyday	94	94%
1.5 Wearing of Clean Clothes	97	97%
	n = 100	100%

Table 3.1 presents the living conditions of the respondents in terms of personal hygiene. This shows that 97% of the respondents are washing before and after eating meals and wearing clean clothes. While brushing teeth after eating meals, wearing of foot wears and taking a bath has a 94% which means that most of all the respondents are aware on importance of proper personal hygiene and the benefits that it can make in the health of the respondents.

Table 3.2 Living Condition of the Respondents in terms of Health Maintenance

	Frequency (f)	Percentage (%)
2. Health Maintenance
2.1 Eating meals three times a day	73	73%
2.2 Eating Nutritious food	86	86%
2.3 Taking Vitamins	62	62%
2.4 Regular Exercise	44	44%
2.5 Regular Check-up to the Health Center	65	65%
	n = 100	100%

Table 3.2 presents the living conditions of the respondents in terms of the health maintenance. It reveals that 86% of the respondents eat nutritious food whereas 73% of the respondents eat meals 3 times a day. It implies that the respondents give importance to the daily routine to restore health and prevent illness. Adequate nutrition is required to meet the metabolic demand of the body for a healthy living.

Table 3.3 Living Condition of the Respondents in terms of Household Chores

	Frequency (f)	Percentage (%)
3. Household Chores
3.1 Cleaning the house and the backyard	54	54%
3.2 Washing of clothes	54	54%
3.3 Cooking of food	60	60%
3.4 Washing of Dishes	48	48%
3.5 Going to work or job	54	54%
	n = 100	100%

Table 3.3 presents the living condition of the respondents under household chores. The table shows that 60% of total respondents prioritize cooking foods. Foods contain essential nutrients needed by the body which is converted to as energy. 54% of the total respondents clean the house and the backyard. Cleanliness reduce risk for the spread of microorganisms that may cause health related problems such as cough and colds.

Table 3.4 Living Condition of the Respondents in terms of Rest and Sleep

	Frequency (f)	Percentage (%)
4. Rest and Sleep
4.1 Sleeping at least 8 hours per day	49	49%
4.2 Taking a nap	88	88%
4.3 Watching TV	88	88%
4.4 Listening to radio	87	87%
4.5 Reading newspapers, magazines etc	85	85%
	n = 100	100%

Table 3.4 presents the living conditions of the respondents in terms of rest and sleep. It shows that only 49% of the respondents have at least 8 hours of sleep a day. Adequate rest and sleep helps the body to repair and restore the bodies normal fucntion. However, almost half of the respondents have difficulty sleeping. This condition may be referred to as Insomnia. Predisposing factor such as their lifestyles, as shown in the table, 88% of the respondents during the interview stated that they stay up late at night watching television thus affecting their sleeping pattern. Difficulty of sleeping can also be related to their environment. Since the respondents are within the proximity of the Sanitary Landfill, the continuous dumping of garbage of garbage trucks making the environment too noisy and not conducive for sleep and rest.

Table 3.5 Living Condition of the Respondents in terms of Recreational Activities

	Frequency (f)	Percentage (%)
5. Recreational Activities
5.1 Quality time with family members	79	79%
5.2 Playing basketball or any sports	46	46%
5.3 Going out with friends or other relatives	53	53%
	n = 100	100%

Table 3.5 presents the living conditions of the respondents in term of recreational activities. Quality time with family members have the 79% of the total number of respondents which signifies that most of the respondents still want to spend a quality time together with there family despite of an illness. All most half of the respondents want to hang out with friends or going out with other relatives.

Chapter 4

CONCLUSION AND RECOMMENDATION

This chapter presents the general summary of findings, conclusions and recommendations.

Summary of Findings

The pertinent findings of this study are the following:

1. The findings with regard to the resident’s profile are as follows: in terms of age most of the respondents are adolescents and early adults. The respondents are within the active years of their life; in terms of their gender the difference between male and female respondents is not that significant which implies that the respondents are equally distributed with regards to gender; in terms of height most of the respondents have heights that are within normal in relation with their age and weight; and in terms of weight the respondents have normal weights in relation to their age and height.

2. The health related problems of the residents of Barangay Mameltac along with the gastrointestinal system; most of the residents within the proximity experienced abdominal pain. Under Respiratory System, almost all of the residents had experienced cough and colds. However, under Cardiovascular System, majority of them suffered from headache. Lastly, under Reproductive System, it revealed that burning sensation when urinating was the most prevalent condition.

3. The living conditions of the residents of Barangay Mameltac along the proximity of the City Sanitary landfill are as follows; along with the personal hygiene, almost all of the respondents wash their hands before and after eating meals and also wear clean clothes; along with the health maintainance, eating nutritious food is the priority in sustaining a healthy condition of living; along with the house hold chores, more than half of the respondents are able to cook there food; along with the rest and sleep almost all of the respondents able to take a nap, watching television, listening to radio, reading newspapers and magazines, but some of them are not able to sleep at least 8 hours per day; along with recreational activities spending quality time with family members was given the highest consideration.

Conclusions

Based on the findings of this study, the following conclusions were drawn:

The profile of the respondents in terms of weight and height are within the normal range in relation to their age. With regards to their gender, the males and females are equally distributed.
The most prevalent health related problems experienced by the residents of Barangay Mameltac along the proximity of the City Sanitary Landfill is along the Respiratory System. It supports the high morbidity rate of Acute Respiratory Infections in the barangay.
The respondents have commendable living conditions. They are aware of the importance of maintaining and performing a healthy lifestyle.

Recommendations

The following recommendations are given based from the study’s findings and conclusions.

For the future researchers, the same range in terms of the age, gender, height and weight of the respondents should be taken in order to have an accurate comparative view of present and future researches.
Educate the residents as well as the barangay health worker with regards to the importance of hygienic practices. It contribute much to the prevention of the disease occurrence especially with the extreme prevalence of respiratory diseases.
The respondents of Barangay Mameltac should maintain a healthy conditions along with their personal hygiene,health maintenance,etc .by instructing them not to neglect the said practices.

thesis

Sunday, March 9, 2008

Stages of Developnment

BMI

Whole

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