Air pollution is a serious public health issue in Nepal where a total of 33,000 deaths annually occur due to air pollution. The indoor, outdoor and transboundary forms of air pollution are major causes of a burden to public health. In Kathmandu valley, PAHCs are major threats mostly in children. Due to lack of available health and AAQ related database, it is difficult to establish the relationships on adverse health effects of air pollution in Nepal The government must provide opportunities to environmental health researchers and academicians in research. South Asian countries must integrate to solve the air pollution-related health issues. As an environmental epidemiologist, I am eagerly looking forward to joining the researchers who are working in this area. Related links: http://kutniti.com/index.php/2015/09/20/air-pollution-a-migraine-for-south-asia/ http://kathmandupost.ekantipur.com/news/2018-01-25/nepals-air-quality-is-worst-in-the-world-epi-report.html https://danwatch.dk/en/undersoegelse/massive-pollution-at-carlsberg-brewery-in-nepal/ http://janatapostdaily.com/news-details/1046/2018-02-07 http://kutniti.com/index.php/2015/07/08/adverse-health-consequences-of-climate-change-south-asian-perspective/

1. Presented at one day interaction program, Department of Environment,
Ministry of Population and Environment Nepal
Venue: World Trade Center, Kathmandu

2. What is air pollution?
 Air is a mixture of gases including: nitrogen, oxygen,
carbon dioxide, water vapor and trace of other gases.
 Any change in the atmosphere that has harmful effects
is called air pollution. Air pollution is basically classified
as: outdoor and indoor.
 Any substance that cause pollution is called a pollutant.

3.  Causes of air pollution
 Natural
Example: volcanoes
 Human Activities
Example: combustion of fossil fuels as energy
 Major sources of air pollution remain construction,
transport and industrial.
http://nepalitimes.com/blogs/

4. Air Pollutants of Human Health Concern
 Carbon monoxide
 Sulfur dioxide
 Nitrogen dioxide
 Ozone
 Particulate matter
 Toxic substances
 Major air pollutants

5.  Colorless, odorless gas
 Formed from the incomplete combustion of fuels
 Commonly found in automobile and industrial
emissions
 Exposure to carbon monoxide includes CO-
poisoning, symptoms such as headaches, fatigue,
breathlessness, nausea, loss of consciousness and
lack of concentration at moderate to high levels.
Carbon Monoxide (CO)

6.  Formed from the burning of coal containing pyrite
that combines with oxygen in the atmosphere.
 Exposure to moisture in the atmosphere produces sulfuric
acid (acid rain).
 Exposure to sulfur dioxide includes symptoms such as
respiratory illnesses, decreased lung functions, and
aggravation of existing heart disease.
Sulfur Dioxide (SO2)

7.  Formed from the burning of fuels
 Common component of smog (smoke and fog)
 Commonly found in industrial areas and areas with a high
concentration of motor vehicles
 Exposure to nitrogen dioxide includes symptoms such as eye
irritation, stuffy nose, coughing, sore throat, lung
inflammation, and various illnesses of the human
respiratory system
Nitrogen Dioxide (NO2)

8.  Found in Earth’s upper and lower atmosphere
 Upper atmosphere
 Protects Earth from harmful solar radiation
 Lower atmosphere
 Pollutant that can cause (chronic) respiratory tract
infections, eye irritation, coughing, shortness of
breath, nausea, wheezing and headache.
Ozone (O3)
Ozone can cause the
muscles in the
airways to constrict,
trapping air in the
alveoli. This leads to
wheezing and
shortness of breath.

9.  Solid particles present in air
 Common particulate matter includes soil, construction
dust, bites of tire rubber, asbestos from brake linings,
and vehicle exhaust
 Exposure to particulate matter includes symptoms
such as irritation and illness of human respiratory
system and certain kinds of cancers
Particulate Matter (PM 2.5, PM10)

10. PM2.5 and PM10
The health risks from particulates are
due in part to the small size. The
smaller the size, the bigger health risk.
PM2.5 stays in the air much longer than
PM10, taking days to weeks to be blown
away.

11.  Nearly 200 toxic substances are known to be air
pollutants
 Example: lead is a highly toxic metal when
ingested or inhaled. Affects young children and
infants more. It is still found at high levels in
urban and industrial areas.
 Polycyclic aromatic hydrocarbons (PAPs) are
formed when fossil fuels and waste materials
are burned. PAPs cause the skin irritation, soar
throat, respiratory problems; and high
concentration may cause the failure of liver and
damage to kidney.
Toxic Substances

12. Indoor Air Pollution
 People spend most of their time indoors.
 According to EPA, levels of some pollutants,
such as formaldehyde, chloroform etc. range
from 2 to 50 times higher in indoor than
outdoor levels.
 Exposure to pollutants such as environmental
tobacco smoke and radon occurs almost
entirely indoors.

13. Indoor Air Pollution contd.
Pollutants
 Toxic gases (CO, O3, formaldehyde)
 Particulate matter (Smoke, pet
dander, candles)
 Radiogenic susbtances (Radon-220,
Polonium-210)
 Biological organisms (mold, dust
mites, bacteria)

14. Some Specific Indoor Air Pollutants ( )?
 Acetone - in cosmetics, fragrances, human breath
 Ammonia - in cleaning products
 Benzene - in laser printers, particle board, paint, tobacco
 Benzaldehyde - in detergents and fragrances
 Benzyl acetate - in air fresheners, fragrances
 Chloroform - in chlorinated tap water
 Formaldehyde - in particle boards, carpets, clothes, glue
 Limonene - in deodorants, disinfectants, fragrances
 Terpinen - in deodorants, fragrances
 Toulene - in glue, laser printers, paint and particle board
 Trichloroethyl - in photocopiers
 Xylene - in glue, laser printers, paint and particle board

15. Volatile Organic Compounds (VOCs)
 Products of incomplete combustion, evaporation of
liquid fuels, atmospheric reactions, and release from
vegetation
 Health effects may include
 Eye, nose and throat irritation
 Headaches, loss of coordination and nausea
 Damage to liver, kidney and central nervous system
 Some are suspected or known to cause cancer in
humans.

16. Air Quality Trend in Kathmandu valley (24-hr average): May,
2017 (Source : Quest Forum/MoPE Report, 2017)
321
115
467 518
1289
838
4749
737
1232 1340
230
0
1000
2000
3000
4000
5000
inμg/m3
TSP
Air Quality of Nepal/Kathmandu Valley

17. 178 72 278 336
696
362
2938
315 545 620
120 50
0
1000
2000
3000
4000
inμg/m3
PM10
11 21
95
1
147
195
134
226
115
190
50
25
0
50
100
150
200
250inμg/m3
Air Quality Trend in Kathmandu valley (24-hr average): May,
2017 (Source : Quest Forum/MoPE Report, 2017)
PM2.5

18. PM2.5 measurements at Thamel residential station during
winter season: 6 hourly sampling, 29 Nov – 9 Feb 2005 (Source
: Quest Forum/MoPE Report, 2017)

19. 0
10
20
30
40
50
60
70
80
90
0
100
200
300
400
500
600
700
800
Falgun2070
Chaitra2070
Baishak2071
Jestha2071
Ashad2071
Shrawan2071
Bhadra2071
Aswin2071
Kartik2071
Manshir2071
Poush2071
Magh2071
PM2.5
CO&NO2
NO2
CO
PM2.5
Pearson correlation coefficient in between AAQ and weather factors (for
all three stations) (Data Source: NHRC report, 2015).
Climate factors
PM2.5 CO NO2
Monthly Monthly Monthly
Temperature -.863** -0.197 -.634*
Humidity -0.404 0.053 -0.388
Rainfall -.724** -0.282 -.633*
Monthly assessment of PM2.5, NO2 and CO scenarios of Kathmandu
valley (for all three stations)

20. List of major cities and their annual-average PM2.5 concentrations,
with each city’s ranking listed above the bars. Green line indicates
the WHO guideline for long-term exposure to PM2.5 (10 µg/m3).
(Source: WHO Global Urban Ambient Air Pollution Database, 2016)

21. 40 40
11 6 3
26
34
22
6
12
0
10
20
30
40
50
Percentage
Global percentage of diseases caused by
pollution (WHO, 2014)
Outdoor Indoor
Global Burden of Air Pollution

22. Deaths attributable to PM 2.5 pollution by year and cause (Cohen AJ
et al, 2017; Lancet).

23. WHO, 2017

24. Burden of air pollution in Children
 Air pollution has brought the neuro degeneration in
children in Delhi (UNICEF, 2017)

26. Deaths attributable to ozone per 100,000 people in 2015
Proportion of deaths attributable to ozone in 2015 (Cohen AJ et al, 2017; Lancet).

27. http://www.who.int/heli/risks/indoorair/en/iapmap.pdf

28. WHO, 2016

29. http://breathelife2030.org
2018/02/03-5 PM
Annual mean of PM2.5 is higher in South Asian cities than WHO standard

30. National Burden of air pollution
 A cross sectional comparative study done by Sanjel et al during
March 2015-April 2016 in 800 participants (400 brick workers
exposed and 400 grocery workers as referent) was conducted in
the brick industries of Kathmandu valley and found that higher
proportion of air pollution related health problems such as
breathlessness and persistent cough were found in exposed group.
They concluded that the high level of particulate matter in brick
field requires the action for the protection of workers (KUMJ, 2016).
LTRI; 740
COPD;
1.770
Lung
cancer;
932
IHD;
3328
Stroke;
3183
 In Nepal, a total of 9,953
cases were died from the
diseases with the air
pollution as major risk factor
(WHO, 2016)

31. In a case cross over study among the daily inpatient hospital
admission data during 2004-2007 from 6 major hospitals of
Kathmandu valley, percent change in admission per 10-μg/m3
of PM10 was found higher for cardiovascular diseases than
respiratory and others. In age group, percentage change of
risk was found higher in 65-100 years followed to ≤ 14 years
(Gurung et al; 2017. American Journal of Epidemiology).

32. Percent increase PM10 (10-μg/m3) for respiratory and
cardiovascular was higher at daily- lag0.
A study conducted between
April 2013-March 2014 found
that high amount of poly
aromatic Hydrocarbon (PAHs)
concentration in Kathmandu
valley in comparison other
Asian cities (Cehn et al; 2015.
Sci Tot Envt)

33.  In an ecological study of NHRC related to pollution
effects on respiratory hospitalization that was conducted
from 13 February 2014 to 12 February 2015. The
respiratory disease related data were collected from 6
major hospitals of Kathmandu valleys and air pollution
data were collected from 3 measuring stations fixed in
different sites of each 3 districts. The important findings
are:
 Each 10 μg/m3 rise in PM2.5 was associated to 3.2-4.7%
increase in pneumonia hospitalizations at 7 day mean
lag effects and 0.8-3% increase in respiratory
hospitalizations for aged persons 50 and above.

34. Similarly, each 1 μg/m3 rise in CO was associated to
increase the cases of respiratory hospitalizations of
elderly persons with age 50 and over. CO is found to be
positively associated with a 5.8-5.9% increase in
respiratory hospitalizations at day lag0.
Likewise, each 1 μg/m3 rise in NO2 showed a significant
and positive correlation with COPD hospitalizations at 2nd
and 7th day lag. At 2nd day mean effect, respiratory
hospitalizations of aged persons with age 50 and above
with varied effects of 9-31% increase in COPD
hospitalizations and 7-10% increase in respiratory
hospitalizations of people aged 50 and above.

36.  Community-based cross-sectional study was performed to
identify effects of indoor air pollution by simplified
measurement approach in Sunsari District of Nepal.
Representative samples of 157 housewives involving more
than 5 years in kitchen were included by cluster sampling.
Reported health problems due to indoor air pollution (Raabhat et al
2015. Frontiers in Health)

37. My Republica, March 21, 2017

38. Both figures indicate that diseases with air pollution risk
factors are main cause of deaths in Nepal

40. Air pollution work gaps in Nepal  Awareness and Control
Beijing Government Releases Official Air Quality
Monitoring App (26 Jan 2013)

41. Gaps contd.. Government Database
AAQ Surveillance Cause specific mortality
Spatiotemporal dd/mm/yy (AD/BS) or mm/dd (AD)
Data should available to the national researchers
freely with certain terms and conditions
Statistical modelling/dose-response relationship/
meta-analysis/AAQ Threshold wrt specific disease,
regression analysis, lag study……..
Policy implementation
 Research
 Dissemination of findings
Ecological Database (?)

42.  Air pollution is invisible silent killer. It is 4th highest
ranking risk factors globally. It is also main risk factor for
premature deaths.
 The major health associated burdens of air pollution are
found in South Asia.
Conclusions
 Nepal’s air is 5th worst in the world. It might be associated
to burden of several diseases as CVD, IHD, asthma, COPD
etc. (IHME, 2016). GoN must consider these issues
seriously.
Yale University 2018
EPI ranking

43.  The lack of national ecological databases is also one of
the problems in study of air pollution related health
burden in Nepal.
 In Kathmandu valley, high concentration of poly-cyclic
aromatic hydrocarbons (PAHs) are found. PAHs are
carcinogens and mutagens. Strict monitoring on their source is
necessary.
 As found in UNICEF study, air pollution might be severely
affecting our children’s brain. Lets integrate to protect
ourselves as well as to make our healthier future progenies.
 Multi-sectorial collaborations and efforts are essential for the
control of air pollution.

44. Acknowledgements
 Mr. Mahendra Gurung, Secretary, OPMCM Nepal
 Mr. Durga Prasad Dawadi, Director General,
Environment Division, MoPE
 Mrs. Safala Shrestha, Deputy Director General,
Environment Division, MoPE