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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 117-125

Assessment of the air quality and its impact on health and environment in India


1 Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
2 Department of Environmental Sciences, Central Pollution Control Board, New Delhi, India

Date of Submission08-Mar-2019
Date of Decision14-Apr-2019
Date of Acceptance15-Apr-2019
Date of Web Publication19-Aug-2019

Correspondence Address:
Prof. Mradul Kumar Daga
Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJMS.INJMS_15_19

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  Abstract 

Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM10 and PM2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.

Keywords: National Ambient Air Quality Standards, pulmonary function test, respirable suspended particulate matter


How to cite this article:
Daga MK, Mawari G, Bharali D, Banker H, Mehar P, Saluja P, Kumar D, Kumar D, Jha MK, Gargava P. Assessment of the air quality and its impact on health and environment in India. Indian J Med Spec 2019;10:117-25

How to cite this URL:
Daga MK, Mawari G, Bharali D, Banker H, Mehar P, Saluja P, Kumar D, Kumar D, Jha MK, Gargava P. Assessment of the air quality and its impact on health and environment in India. Indian J Med Spec [serial online] 2019 [cited 2019 Nov 12];10:117-25. Available from: http://www.ijms.in/text.asp?2019/10/3/117/264523


  Introduction Top


Burning of fireworks such as crackers and sparkles during festival time in India leads to increase in the metal pollution and contamination in air. Metal concentrations in ambient air have been observed to be very high as compared to background values on previous days. Influence on the immediate and long-term air quality due to these festival celebrations and impact on health and well-being is a major area of concern. In 2016, it was discovered that, on the next day of Diwali, PM2.5(particulate matter2.5) levels in air had crossed 700 μg/m 3 at R.K. Puram in South Delhi. These were the highest levels recorded in the world and about 25 times above the standards as laid down by the World Health Organization.[1] As per the National Ambient Air Quality Standards, 24-h average for PM2.5 is 60 μg/m 3 and PM10 is 100 μg/m 3. Broadly stated, the presence of PM2.5 should range between 40 and 60 μg/m 3 and the presence of PM10 should range between 60 and 100 μg/m 3.

It was revealed in earlier published literature that all fireworks contain carbon and sulfur which are necessary for burning.[2] In addition, a range of toxic substances such as arsenic, manganese, sodium oxalate, aluminum, iron dust powder, potassium perchlorate, strontium nitrate, and barium nitrate are also present. Hence, burning of fireworks releases a large amount of air pollutants, particularly sulfur dioxide (SO2), carbon dioxide (CO2), carbon monoxide (CO), and PM along with several metal salts, for example, aluminum, manganese, and cadmium.[3] Crackers and fireworks also cause a cumulative harm to health resulting from loud noise, air pollutants containing particulates and noxious gases, and also water pollution to some extent. Even healthy people can experience health impacts from polluted air including respiratory irritation or breathing difficulties during exercise or outdoor activities. High air pollution levels can cause immediate health problems including aggravated cardiovascular and respiratory illness and added stress to the heart and lungs, long-term exposure to polluted air can have permanent health effects such as accelerated aging of the lungs; loss of lung capacity and decreased lung function; development of diseases or rapid worsening such as asthma, bronchitis, emphysema; and possibly cancer and shortened life span.

Aims and objectives

This study was designed to assess the air quality pre- and post-Diwali and Dusshera in Delhi main city of North India and also to find out the impact or effect of poor air quality on the health of Indian population. It was also planned to conduct health risk assessment of the same population.


  Materials and Methods Top


Sample size

A total of 470 individuals were interviewed during Dussehra and 787 individuals of different age groups during Diwali. Every fourth house was chosen for the interview in four areas as described below. Pulmonary function testing (PFT) was done on a random basis (fifty in each area as described below before and after Diwali) on the individuals who did not have any respiratory problem. Data of admissions attributable to acute cardiac and cerebral events (heart attacks and cerebrovascular accidents), respiratory disorders (asthma and exacerbation of disorders such as chronic obstructive pulmonary disease), skin or eye burns, as well as ear problems due to firecrackers were collected from hospitals.

Data on injuries and serious medical conditions leading to hospital admission were obtained from different hospitals in the vicinity of the identified areas. The hospitals were provided with a specifically designed questionnaire.

Procedure

The study was conducted during Dusshera and Diwali festivals. Four areas in different zones of Delhi, India, were identified in consultation with the Central Pollution Control Board (CPCB). The selected areas were Pitampura, Kotla, Siri Fort, and Parivesh Bhawan. The families in these areas were interviewed by means of a specifically designed questionnaire considering the respiratory, skin, ear, eye, and other relevant symptoms. To identify acute skin, eye, respiratory, and ear problems, the study was conducted in two phases. The first phase comprised 2 days before Dusshera festival (September 27–29, 2017) and after Dusshera (October 1 and 2, 2017) and the second phase comprised 3 days before Diwali (October 16–18, 2017) and 3 days after Diwali (October 20–22, 2017). A team was constituted to interview the participants. The interview questionnaire was pretested and validated by the senior members of the research team.

Each team included a physician, a spirometry technician, and a trained volunteer for questionnaire filling. A total of 223 individuals also underwent portable spirometry test to assess their lung functions.

Estimation of eight heavy metals such as arsenic, mercury, lead, strontium, antimony, barium, potassium, and sulfur was done in urine sample from forty individuals chosen randomly (ten from each different locality). Estimation of the trends of various elements such as sulfur, chlorine, potassium, calcium, titanium, iron, zinc, copper, strontium, antimony, and barium in air PM2.5 pre and post-Diwali was also done in the respective areas.

Ambient air quality was also evaluated by the CPCB. Health risk assessment for air PM (PM10 and PM2.5) and gaseous pollutants such as SO2 and nitrogen dioxide (NO2) was also performed.

Hazard quotient (HQ, which is always unit less) is calculated using field average daily dose (FADD in μg/kg/day) and safe average daily dose (SADD).[4]

(HQ = FADD/SADD). Health Risk Index (HI) index was also calculated where HI is the magnitude of adverse effect that will be proportional to the sum of multiple air particulates.




  Results Top


A total of 462 and 460 residents were included for the survey pre- and post-Dushehra, respectively, from four residential areas, whereas 788 and 787 residents were included for the survey pre-and post-Diwali, respectively, from the same residential areas.

Pre- and post-Dushehra hospital admission-based data

The youngest participants were found in Parivesh Bhawan and age groups were similar in the four areas. The male:female ratio was approximately 1:1. The maximum percentage of males interviewed was 54.5% in Siri Fort, whereas the maximum percentage of females interviewed was 48.5% in Parivesh Bhawan. Smoking, alcohol drinking, and tobacco chewing were reported highly from Siri Fort (11.8%, 12.7%, and 11.8%, respectively). The majority of complaints reported by the participant from pre-Dussehra showed that 9.3% of participants of Pitampura complained about sputum production, 5.4% about chest pain in Siri Fort, 25% of participants of Kotla reported weakness, and 14.2% had other chronic illness in kotla area. The majority of complaints reported by the participants post-Dussehra showed that 3.7% of participants of Pitampura complained about abnormal breathing, 3.7% of participants had fever in Siri Fort, 90.9% of Parivesh Bhawan participants reported noisy environment, and 4.5% had eye problem in Siri Fort area.

Comparison of respiratory disease between pre- and post-Dussehra showed no difference in the complaints of cough and breathlessness in Kotla and Siri Fort (P > 0.05) [Table 1]. However, there was a significant decrease in cough (17.2% vs. 8.3%) post-Dussehra in Parivesh Bhawan although the presence of phlegm was higher (P = 0.0003). The complaints of breathlessness and cough decreased post-Dussehra in Pitampura (P = 0.04) as well [Table 1]. The marginal increase in phlegm could be due to poor ambient air, so bursting of crackers may be the sole factor. The detailed data on hospital admission due to cardiac problems, stroke, respiratory problems, and burns pre- and post-Dussehra were collected from twenty hospitals of Delhi in a prescribed format. There was an increase in hospital admission post-Dussehra in eight (40%) hospitals.
Table 1: Comparison of respiratory disease pre- and post-Dussehra area wise

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The highest number of hospital admission was seen in Deep Chand Bandhu Hospital (288 patients) followed by ESI Hospital, Basaidharpur (179 patients), whereas the lowest number was found in Shanti Mukund Hospital (5 patients) and Sunder Lal Jain Hospital (5 patients). There was a significant increase in hospital admission in Deep Chand Bandhu Hospital post-Dussehra. There was an increase in hospital admission due to cardiac problem post-Dussehra in six (30%) hospitals [Table 2]. Deep Chand Bandhu Hospital showed a significant increase in cardiac problems post-Dussehra as compared to other hospitals. There was an increase in hospital admission due to stroke post-Dussehra in two (10%) hospitals [Table 2]. Deep Chand Bhandu Hospital showed a significant increase in respiratory problems post-Dussehra compared to other hospitals. The highest and lowest number of hospital admission due to stroke were seen in Hindu Rao Hospital (86 patients) and Sunder Lal Jain Hospital (3 patients), respectively. There was an increase in hospital admission due to respiratory problems post-Dussehra in nine (45%) hospitals [Table 2].
Table 2: Details of hospital admission pre- and post-Dussehra

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Pre- and post-Diwali hospital admission-based data

788 and 787 residents pre- and post-Diwali, respectively, from these areas were included in the study. The number of participants interviewed in different residential areas showed that the youngest participants were from Parivesh Bhawan and age groups were similar in the four areas. The maximum percentage of males interviewed was 62.9% in Siri Fort, whereas the maximum percentage of females interviewed was 47.8% in Parivesh Bhawan. Smoking and tobacco chewing were reported majorly from Siri Fort (16.5% each). Alcohol drinking (22.2%) was reported to be the highest from Kotla. The majority of complaints reported by the participants showed that 24.7% and 26.8% of participants in Kotla complained about sputum and chronic illness, respectively, where 24.4% and 44.3% complained about chest pain and weakness, respectively, from Parivesh Bhawan. Nearly 25% of Kotla participants reported weakness and 14.2% had chronic illness. Clinical findings such as abnormal pulse rate (18.6%) and abnormal blood pressure (BP) (34.7%) were highest in Pitampura and abnormal respiratory rate (5.7%), icterus (33%), cyanosis (12.4%), and clubbing (10.3%) were highest in Siri Fort. The presence of pallor (30.8%) was highest in Parivesh Bhawan.

General complaints by participants post-Diwali revealed that 27.3% of participants of Pitampura complained about abnormal breathing. Nearly 6.7% and 37.1% reported fever and fatigue, respectively, in Kotla. Health problems such as headache, hair problem, and itching were found to be 7.2%, 4.1%, and 2.6%, respectively, in participants of Kotla, and high BP (6%) was reported in Parivesh Bhawan. The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan [Table 3].
Table 3: Comparison of respiratory disease pre- and post-Diwali

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The data on hospital admission pre- and post-Diwali were collected from twenty hospitals of Delhi in a prescribed format. The details of hospital admission pre- and post-Diwali due to cardiac problems, stroke, respiratory problems, and burns showed that there was an increase in post-Diwali hospital admission in ten (50%) hospitals. The highest number of hospital admission was seen in Deep Chand Bhandu Hospital (493), while the lowest number of hospital admission was seen in Shanti Mukund Hospital and Puspawati Singhaniya Hospital (three each). However, around 11 hospitals did not show any increase in hospital admissions/visits for respiratory problems, cardiac diseases, and stroke. There was increase in hospital admission due to cardiac problem during post-Diwali in eight (40%) hospitals. The highest and lowest percentage increase of hospital admission due to cardiac problems were seen in Sardar VB Patel Hospital (196.5%) and Hindu Rao Hospital (1.7%), respectively. However, around 11 hospitals did not show any increase in hospital admissions/visits for respiratory problems, cardiac diseases, and stroke. Deep Chand Bandhu Hospital and Sardar VB Patel Hospital showed significant increase in cardiac problems post-Diwali as compared to other hospitals. There was an increase in hospital admission due to stroke post-Diwali in four (20%) hospitals. The highest number of hospital admission due to stroke was seen in Hindu Rao Hospital and the lowest number of hospital admission due to stroke was seen in Sunder Lal Jain Hospital and Sardar VB Patel Hospital (one each). There was an increase in hospital admission due to respiratory problems post-Diwali in nine (45%) hospitals. The highest number of hospital admission due to respiratory problems was seen in Deep Chand Bhandu Hospital (375), whereas the lowest number was seen in Shanti Mukund Hospital and Puspawati Singhania Hospital (two each). Deep Chand Bhandu Hospital and Sardar VB Patel Hospital showed significant increase in respiratory problems post-Diwali compared to other hospitals. There was an increase in hospital admission due to burns post-Dussehra in two (10%) hospitals.

The PFT using spirometry did not show any statistically significant change in forced expiratory volume 1 s/forced vital capacity ratio, and it was found within normal range [Table 4].
Table 4: Distribution of force expiratory volume 1 s/forced vital capacity pre- and post-Diwali in patients from different places in Delhi

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Air quality during Dushera and Diwali

The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to SO2 and NO2, but there was an increase in the levels of PM10 and PM2.5 post-Diwali. There were increased complaints of eye problems due to increased PM10 and PM2.5 concentration in air. The participants from Kotla and Pitampura mainly reported eye problems (48.5% and 43.4%, respectively) in which 19 (21.3%) participants had watering of eyes. Burn cases (3%) were also reported from Parivesh Bhawan, Siri Fort, and Pitampura post-Diwali [Table 5], [Table 6], [Table 7].
Table 5: Ambient air quality pre- and post-Diwali

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Table 6: Ambient air quality and respiratory disease pre- and post-Diwali

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Table 7: Ambient air quality during Diwali days 2017

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Attitude of people toward the custom of using firecrackers is very important and was looked for in the survey population. The analysis revealed that nearly 13.5% interviewed felt that this custom should not be stopped, i.e., those who want to use and play with crackers should be allowed to do so. Another 70% were of the opinion that such bursting of firecrackers should be carried out in open spaces with community participation. Around 16.5% felt that only display of lights should be enough to celebrate the festival. The respondents who overwhelmingly felt that lights only should be used belonged to Parivesh Bhawan. This is probably due to the presence of educated population with high socioeconomic status.

Element levels in urine samples of four residential areas post-Diwali

Mercury and antimony levels were not detectable in urine samples of all the four areas. The level of arsenic in urine was found to be within the permissible limits, whereas the level of barium in urine was above the permissible limits in all the four areas. The urine level of Pb was above the permissible limit in 9/10 samples in Siri Fort area. The urine level of strontium was above the permissible limit in 4/10 samples in Siri Fort and Parivesh Bhawan areas. Other areas also showed high Pb and strontium levels [Table 8].
Table 8: Element levels in urine post-Diwali (n=10)

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Trends of various elements such as sulfur, chlorine, potassium, calcium, titanium, iron, copper, zinc, strontium, antimony, and barium in PM2.5 Diwali

It can be observed that the air concentration of sulfur was as high as 45.64 μg/m 3 on the day of Diwali as compared to pre- and post-festival days in Pitampura. The same scenario can be observed in Parivesh Bhawan area during Diwali day, when the value of sulfur was monitored at 44.8 μg/m 3 as compared to before and after Diwali period. Chlorine is a potent irritant to the eyes, the upper respiratory tract, and lungs. On Diwali day, the value of chlorine in PM2.5 was 19.73 μg/m 3 compared to days before and after Diwali in Pitampura area. Chlorine had reached the point of 19.19 μg/m 3 in Parivesh Bhawan area which was high in contrast to the period of pre- and post-Diwali. The concentration of potassium in PM2.5 has risen from 7.42 μg/m 3 on October 16, 2017 (pre-Diwali), to 96.57 μg/m 3 on the day of Diwali and fallen down to 6.3 μg/m 3 on October 22, 2017 (after Diwali), in Pitampura. The same situation can be observed in the area of Parivesh Bhawan, i.e., potassium was high on the day of Diwali as compared to before and after festival days. It can be seen that there was reduction in the quantum of calcium in both the areas, i.e., Pitampura and Parivesh Bhawan during the day of Diwali. It was 0.76 and 0.71 μg/m 3, respectively, for Pitampura and Parivesh Bhawan on October 19, 2017 (Diwali day) [Table 9].
Table 9: Element levels in particulate matter2.5 pre- and post-Diwali

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In Pitampura and Parivesh Bhawan, the concentration of titanium in PM2.5 during Diwali, 2017, was high compared to other days, i.e., before and after Diwali. It was recorded as 1.25 μg/m 3 and 0.82 μg/m 3 for Pitampura and Parivesh Bhawan, respectively, on October 19, 2017. The quantum of iron was same as before Diwali and during Diwali in Pitampura (1.49 μg/m 3), whereas it decreased to 0.73 μg/m 3 after Diwali. In Parivesh Bhawan, it had risen on the day of Diwali to 1.1 μg/m 3 and then dropped to 0.69 μg/m 3 after Diwali 2017. The concentration of copper in PM2.5 in Pitampura had risen on Diwali day to 0.36 μg/m 3 as compared to pre-Diwali days and then marginally increased to 0.44 μg/m 3 after Diwali. Whereas, in case of Parivesh Bhawan, it can be seen that the value of copper had reduced to 0.1 μg/m 3 after increasing to 1.09 μg/m 3 on Diwali day, i.e., October 19, 2017. The concentration of zinc was as high as 2.32 μg/m 3 on the day of Diwali as compared to pre- and post-festival days in Pitampura. The same scenario can be seen for Parivesh Bhawan during Diwali day, when the value of sulfur is monitored at 3.2 μg/m 3 as compared to before and after Diwali period. On Diwali day, the value of strontium in PM2.5 was 1.17 μg/m 3 as compared to days before and after festival in Pitampura area. In Parivesh Bhawan area too, it has touched a point of 0.83 μg/m 3, which is as high in contrast to the period of pre- and post-Diwali. It can be seen that there was an increase in the quantum of antimony in both the areas, i.e., Pitampura and Parivesh Bhawan, during the day of Diwali. It was 0.05 and 0.26 μg/m 3, respectively, for Pitampura and Parivesh Bhawan on October 19, 2017 (Diwali day). In both the areas, namely, Pitampura and Parivesh Bhawan, the concentration of barium in PM2.5 during Diwali, 2017, was high as compared to other days, i.e., before and after Diwali. It was recorded as 34.55 and 2.75 μg/m 3 for Pitampura and Parivesh Bhawan, respectively, on October 19, 2017 [Table 9].

Health risk assessment in three areas of Delhi showed that in income tax office area bahadur shah zafar marg (ITO), the pre-Diwali 2016 HI index was 3.35 compared to 15.83 post-Diwali, whereas pre-Diwali 2017 HI index was 2.22 compared to 3.70 post-Diwali. In Pitampura area, the pre-Diwali 2016 HI index was 4.25 compared to 23.39 post-Diwali, whereas pre-Diwali 2017 HI index was 3.94 compared to 13.16 post-Diwali. In Parivesh Bhawan, the pre-Diwali 2016 HI index was calculated as 3.28 compared to 21.07 post-Diwali, whereas pre-Diwali 2017 HI index was 3.13 compared to 10.91 post-Diwali.


  Discussion Top


Crackers usually contain highly toxic heavy metals such as cadmium and Pb in addition to other metals such as copper, manganese, zinc, sodium, magnesium, and potassium in nitrate and nitrite forms. Both nitrates and nitrites and some metal radicals are oxidizing agents that are a ready source of oxygen in the process of combustion. The symptoms and signs related to respiratory system were not much different pre- and post-Dusshera and during Diwali. Although there was some increase in cough and breathlessness, it did not translate into any significant illness requiring immediate medical attention. Other system-related complaints were also not much different pre- and post-Dusshera and pre- and post-Diwali. Most of the respondents in the areas surveyed felt that the environment was noisy during the day of Diwali and felt uncomfortable, and few of them were not able to concentrate on their work post-Diwali. There were no significant complaints of hearing difficulties or no need to speak louder or understand the conversation post-Diwali. There were excessive watering from eyes, redness, and burning sensation post-Diwali in some areas. Few cases were observed of itching following firecracker bursting, but there were no significant skin spots or issues with hair dryness or itching post-Diwali.

The harmful effects of ambient air pollutants are caused by the formation of reactive oxygen species, which in turn induce oxidative stress in the lungs, resulting in a powerful cellular- and mediator-induced inflammatory response.[5] When fireworks are set off, chemicals used in their composition react to ignite and propel the explosives with a resultant noticeable and odorous cloud of PM in the atmosphere. Inhalation of such particles is one of the most important routes of exposure to elevated concentrations of these emissions. PM deposition in the respiratory system mainly depends on the particle size. Several metallic elements of PM were found to be at substantially elevated levels in a number of studies during firecracker bursting. The level of suspended particles in the air increases alarmingly during Diwali, causing eye, respiratory, and hypersensitivity (allergic) problems. Although most people do not feel the immediate impact, these problems can develop later in their life assuming serious proportions in susceptible populations.[6] Around 30%–40% increase in the cases of wheezing, respiratory diseases, exacerbation of bronchial asthma, and bronchitis patients of all ages and gender was reported during the Diwali festival.[6]

Firework industry in India is an unorganized sector and is stigmatized for patronizing child labor.[7] The industry is accused to negatively impact children two-folds, first by engaging them as workers in firework manufacturing, and second, by the way of injuries that occur while children use the crackers. In the former case, the working children while still in developing stage have exposure to toxic and hazardous materials which may cause untold harm. In spite of wide publicity to educate them through advertisements and warnings, the preventable harm to children's health continues both in rural and urban areas.[7],[8]

Though firework-related eye injuries have been decreasing over the years, there is still a need to increase awareness about the dangers of fireworks. These injuries constitute an important cause of preventable blindness worldwide, and such injuries are very common among children in India.[9] Injuries to onlookers are also very common. In addition to contributing to hearing loss, high noise levels can affect health in other ways too. There are immediate effects that may be temporary or may become long-lasting. Effects that may be long-lasting include insomnia, nervousness, bulimia, chronically high BP, anxiety, depression, and sexual dysfunction.[10]

It is pertinent to note that the permitted metal components of firecrackers as per the Controller of Explosives and Fireworks are mainly barium nitrate, potassium nitrate, sulfur, charcoal, and strontium. Short-term exposures to sulfur can harm the human respiratory system and make breathing difficult. Children, the elderly, and those who have asthma are particularly sensitive to effects.[11] Excessive potassium can lead to hyperkalemia. Abnormally high calcium concentration activates a series of inflammatory reactions leading to inflammation and cell damage. Titanium is responsible for coughing and difficulty in breathing. It may also cause skin and eye irritation. Exposure to iron causes benign pneumoconiosis. Long-term exposure to copper dust can irritate the nose, mouth, and eyes and cause headaches, dizziness, nausea, and diarrhea. Inhaling large amounts of zinc can cause a specific short-term disease called metal fume fever. It can be observed that antimony in the air can affect the lung. It can also cause heart problems and eye irritation. NO2 is less soluble and hence, penetrates the smaller airways of the lungs where gas exchange occurs. The effect may be a serious impairment of the lining such as alveolar and respiratory bronchiolar regions. This may affect the oxygen transfer during breathing, giving rise to various disorders.[12],[13]

Our hospital data showed some increase in post-Dusshera hospital visit and admission in some hospitals. Analysis of data during Diwali reveals that there was increase in admission related to respiratory problems, cardiac diseases, and stroke. However, air pollution was high during this period throughout Delhi and hence, increase in admissions partly may be related to it in few of the hospitals. There was evidence of increased values of barium and strontium in urine samples of many respondents. These are some of the metals used in firecracker manufacturing. Increased levels in urine do reflect a probability of exposure. However, all the other elements are not increased to substantiate the effect of bursting of firecrackers. It is also possible that the individuals were exposed to bursting of firecrackers directly or indirectly in their locality. Increased levels of some of these metals were also recorded in the CPCB ambient air quality data during Diwali.[14] Deterioration in air quality was observed during Diwali day, whereas it improved post-Diwali as per the ambient air quality data provided by the CPCB. Concentration of most of the elements in PM2.5 level was reportedly increased during the day of Diwali except calcium. There was lot of media and newspaper information for public awareness on firecracker contributing to air pollution. The restriction in the use of firecrackers due to Hon'ble Supreme Court judgment on ban on sale might also have led to less bursting in the 2017 season in Delhi. There was less worsening of ambient air quality in 2017 compared to earlier years as is reflected in the CPCB data. Magnesium content in air is usually high as compared to other metals such as copper, manganese, and zinc. Oxides of sulfur, phosphorous, and nitrogen are very corrosive and highly acidic, whereas CO, one of the oxides of carbon, is an extremely poisonous gas whose presence cannot be detected by our sensory system as it is odorless. CO combines with hemoglobin more than 200 times as readily as oxygen so that low concentration levels have adverse health effects.

In a study conducted by the Centre for Occupational and Environmental Health, Maulana Azad Medical College, in the year 2008–2009, to assess the health impact of Diwali pollution on behalf of the Delhi Pollution Control Board Committee, it was observed that there was a rise in the number of cerebrovascular accidents, commonly known as stroke, during Diwali and after Diwali. Contribution of the pollution levels was believed to be the main reason for stroke development. However, the fact was that nearly 50% were unaware of their BP status. This coupled with the consumption of sweets and other fatty foods during the festival may be related to these events due to a rise in BP.[15]

A detailed study of air pollution caused by firework display during Lantern day festival in Beijing reported 57%, 25%, and 183% increase in SO2, NO2, and PM10 levels, respectively, over previous day.[16] Analysis of different elements and ions in fine particulates revealed that over 90% of the total mineral aerosol and 98% of Pb, 43% of total carbon, 28% of Zn, 8% of NO3, and 3% of SO, 42% in PM2.5 were from the emissions of fireworks on the Lantern night.[16] In Italy, a study on chemicophysical properties of airborne particles during a fireworks episode reported that 1 h concentration of elements such as Sr, Mg, Ba, K, and Cu increased by 120, 22, 12, 11, and 6 times.[17]

In the present study, on Diwali, the level of SO2, NO2, RSPM, and SPM values was found very high compared to any normal day of commercial and residential areas. The values of SO2 and NO2 were within the normal range after Diwali, but RSPM and SPM were found to be much higher than the standard value of U.S. National Ambient Air Quality Standards.


  Conclusion Top


Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in environment affects the standard values of air particulate and causes health complications. Trapping of pollutants in air due to burning of firecrackers during Diwali and Dushehra festivals promotes the formation of smog. This leads to rise in the levels of RSPM and SPM values by three times above the standard values, and it might be the most significant reason of health complications. It may worsen the condition of patients with lung, heart, and nervous system diseases and pregnant women. The level of suspended particles in the air increases alarmingly causing eye, respiratory, and hypersensitivity or allergic problems. However, the study involving larger population in some more areas and collection of data from a large number of hospitals may provide more information to find the immediate impact on health due to bursting of firecrackers worsening the air quality. It is also essential to study this impact for few years continuously by keeping the same population cohort under observation to see the long-term impact.

Acknowledgment

We are grateful to all the laboratory members of the Centre for Occupational and Environmental Health, Maulana Azad Medical College, New Delhi.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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