EHI-24-0062 Proof Hi

Environmental Health Insights
Environmental risk factors associated with acute respiratory

diseases in children
Journal: Environmental Health Insights
Manuscript ID EHI-24-0062
Manuscript Type: Research Article

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Date Submitted by the
26-Feb-2024
Author:
Complete List of Authors: Orcellet, Emiliana Elisabet; Universidad Nacional de Entre Rios
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Villanova, Martina; Universidad Nacional de Entre Rios

Noir, Jorge Omar; Universidad Nacional de Entre Rios
Gracia, Laura De; Universidad Nacional de Entre Rios
Caire, Daiana Marisol; Universidad Nacional de Entre Rios
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Acevedo, Eliana Sofia; Universidad Nacional de Entre Rios
outdoor air quality, environmental factors, measurement, health risk,

Keywords:
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child's health
About 3 million deaths a year are related to exposure to outdoor air

pollution. Almost 90% of deaths related to air pollution occur in low and
middle income countries. One of the most vulnerable groups is children.
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The objective of this study was identify the environmental risk factors
associated with acute respiratory diseases in children from the city of
Concepción del Uruguay, Entre Ríos. For this, two sectors of the city
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were considered, a risk zone and a control zone. Interviews were

conducted to relieve particular and socio-environmental factors of the
children, as well as outdoor air quality measurements. On the other
hand, on-call records of the zonal hospital were digitized to obtain
Abstract:
secondary epidemiological data. No specific risk factors associated with
the pathologies and symptoms analyzed were identified in the surveyed
population of both zones; however, were identified particularities related
with access to health services, the presence of illegal sites of waste
disposal and industrial activities. Air quality risk factor identify was the
concentrations of sulfur dioxide and nitrogen dioxide, which exceed the
guide values. It is concluded that there is a primary environmental risk
associated with air quality in both areas, regardless of particular and
general socio-environmental conditions, which influences the occurrence
of diagnosed diseases and/or respiratory symptoms.
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Environmental Health Insights Page 2 of 26
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4 Environmental risk factors associated with acute respiratory diseases in children
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7 Emiliana Elisabet Orcellet1, Martina Villanova1, Jorge Omar Noir1, Laura De Gracia1, Daiana Marisol Caire1,
8 Eliana Sofia Acevedo1.
9 1 Facultad de Ciencias de la Salud, Universidad Nacional de Entre Ríos
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11 Lorenzo Sartorio 2160, Concepción del Uruguay, Entre Ríos, Argentina
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* Corresponding author: Orcellet, Emiliana E. E-mail: orcelletemiliana@gmail.com
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ORCID: 0000-0002-7761-9747
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22 Abstract:
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24 About 3 million deaths a year are related to exposure to outdoor air pollution. Almost 90% of deaths related to
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26 air pollution occur in low and middle income countries. One of the most vulnerable groups is children. The
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27 objective of this study was identify the environmental risk factors associated with acute respiratory diseases in
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29 children from the city of Concepción del Uruguay, Entre Ríos. For this, two sectors of the city were considered,
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30 a risk zone and a control zone. Interviews were conducted to relieve particular and socio-environmental factors
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of the children, as well as outdoor air quality measurements. On the other hand, on-call records of the zonal
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33 hospital were digitized to obtain secondary epidemiological data. No specific risk factors associated with the
34 pathologies and symptoms analyzed were identified in the surveyed population of both zones; however, were
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36 identified particularities related with access to health services, the presence of illegal sites of waste disposal and
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37 industrial activities. Air quality risk factor identify was the concentrations of sulfur dioxide and nitrogen
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39 dioxide, which exceed the guide values. It is concluded that there is a primary environmental risk associated
40 with air quality in both areas, regardless of particular and general socio-environmental conditions, which
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42 influences the occurrence of diagnosed diseases and/or respiratory symptoms.
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Keywords: outdoor air quality, environmental factors, measurement, health risk, child's health
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Introduction
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6 Air pollution represents a significant environmental health risk. About 3 million deaths a year are
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8 related to the exposure of the population to outdoor air pollution. Almost 90% of these deaths occur in low and
9 middle income countries. One of the most vulnerable groups is children. In 2019, 99% of the world's population
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11 lived in places where WHO guidelines on air quality were not respected. (World Health Organization [WHO],
12 2021).
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Each year, hundreds of millions of people suffer from respiratory illnesses and other diseases
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15 associated with air pollution, both indoors and outdoors. Population groups are exposed to fixed sources of
16 atmospheric pollutants that lack sanitary protection zones. Industries that have low height chimneys and in
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18 many cases do not have control measures to reduce air pollution, which increases the polluting action of their
19 emanations. (Romero Placeres, et al. 2006).
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21 Air pollution and its effects on health have been studied in several research. Some studies respond to
22 epidemiological design, such as that of Rosales Castillo et al. (2001), which shows the important impact of high
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24 concentrations of ozone and particulate matter on the health of urban populations.

25 Other studies aimed at describing the public perception of air pollution and its health risks (Catalán
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Vázquez, 2006), through an exhaustive bibliographic search and the analysis of the most significant results.
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28 On the other hand, Vargas Marcos (2005) estimated that in industrialized countries a 20% of the total
29 incidence of diseases can be attributed to environmental factors. The environmental agents involved are
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31 nitrogen and sulfur oxides, suspended particles, ozone, metals, and volatile organic compounds.
32 For his part, Ballester (2005) expressed that many of the public health functions are related to the
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34 physical environment, particularly air quality, and that, in summary, the main effects observed in the short term
35 range from an increase in the number of from deaths, hospital admissions and emergency visits, especially in
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respiratory and cardiovascular causes, to alterations in pulmonary function, heart problems and other symptoms.
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38 Blanco et al. (2015) carried out an investigation whose main objective was to study air pollution and
39 associated effects on child health in the district of Lomas de Zamora in Buenos Aires province, for which a
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41 combined methodology composed of quality air measurements, epidemiological surveys and clinical studies.
42 The results showed that vehicular traffic is an important factor to determine ambient air quality.
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44 In particular, Marcó (2014) developed an epidemiological study of asthma in children of Concepción
45 del Uruguay, establishing unspecific risk factors. In this work, air pollution is considered a factors associated
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47 with the occurrence of asthma, principally in the risk areas close to the poultry meat processing plants located
48 in the city.
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However, at the regional and local level, there are not antecedents that considered air quality
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51 measurement and the possible effects on child´s health. The main objective of this work was characterize the
52 environmental risk factors associated with acute respiratory diseases in children from 0 to 14 years of age, from
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54 the city of Concepción del Uruguay, according to the area of residence, social conditions and outdoor air quality.
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5 Materials and methods
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8 To define the risk zone, the atmospheric dispersion of the pollutants emitted from the point source
9 was simulated using the complex industrial source dispersion model (ISC3) developed by the United States
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11 Environmental Agency [EPA] (1995) for the period from May 2017 to April 2018.
12 As a result, the daily average pollutant concentration for the risk area was obtained considering a unit
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emission factor, because no measurements available for the gaseous emission of industry considered, that is
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15 why the results obtained are useful only to evaluate the variation of the concentration depending on the
16 distance.
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18 According to the results of the modeling carried out, presented in Fig. 1, the concentration is inversely
19 proportional to the distance. The maximum concentration values are observed mainly towards the eastern
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21 sector, followed by the southeast and northeast.
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25 [Insert: Fig. 1 distribution of the concentration of pollutants as a function of the distance (meter) and direction
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(grade) of the plume according to the ISC3 model].

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31 Considering the area characteristics, the risk zone was defined between the 500 and 1200 m, in
32 accordance with the criteria set out by Marcó (2014). Within the total extension of the area, the most densely
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34 populated sector was considered defining a regular area delimited by passable streets and guaranteeing safe
35 access.
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Subsequently, the control zone was selected, considering common criteria with the risk zone, such as:
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38 primary residential use, the socioeconomic level of the population, basic sanitary conditions, access and
39 security conditions. In this way, it was sought to reduce the influence of possible indirect risk factors,
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41 considering as a key aspect that the distance to the point source exceeded at 1200 m. (Fig. 2)
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45 [Insert: Fig. 2 location of the two areas under study in the city of Concepción del Uruguay]
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48 The total area of the risk zone is 1,275 km2 and that of the control zone is 0.905 km2. The total
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population density is 6500 inhabitants/km2 and 5700 inhabitants/km2, respectively. While the density of
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51 children between 0-14 years is 1222 children/km2 for therisk zone and 1143 children/km2. (INDEC, 2010).
52 To collect the health data of each child and the socio-environmental conditions, a specific structured
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54 questionnaire with closed questions was designed to facilitate its subsequent analysis. The variables surveyed
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were: initial data (address, number of inhabitants in the house and number of inhabitants aged 14 years or
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5 less), general data of the child (date of birth, age, gender, chronic respiratory diseases, acute respiratory
6 diseases diagnosed in the last year, undiagnosed respiratory diseases, etc.), behaviors and family history
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8 (smoking, frequent respiratory diseases, etc.), of the home (type of home, time spent in the neighborhood,
9 time spent in that house, characteristics of the house, vehicular traffic in the area).
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11 The inclusion criteria defined were: age group 0-14 years, residing in one of the areas considered and
12 parent or guardian willing to respond with informed consent (Declaration of Helsinki with the amendments of
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Tokyo, Venice, Hong Kong, South Africa, Scotland, Seoul and Fortress 2013).
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15 The air quality measurements were carried out with a portable and automatic equipment model
16 YESAIR, developed by Critical Environment Technologies Canada Inc., which allows obtaining
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18 instantaneous, continuousor intermittent concentration values for the pollutants of interest (NO2, SO2, H2S and
19 MP2.5), through the use of electrochemical sensors. The measurement ranges of each sensor are as follows:
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21 SO2 0-20 ppm, NO2 0-5 ppm, H2S 0-50 ppm and PM 2.5 0-100 ug/m3.
22 Each one of the defined zones (Fig. 1) was subdivided into sectors of lesser surface area for
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24 operational purposes, being defined 10 sub-zones in total (5 in each zone). From this delimitation, the air
25 quality measurement points were selected, which were located according to the accessibility conditions and
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the evasion of possible interferences in the normal air flow, defining two measurement points in each sub-
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28 zone (10 points in total for each zone) such a way as to have greater spatial representativeness of the measured
29 concentrations.
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31 Considering the short-term exposure, established by the WHO (2021), records were taken every 2
32 minutes, in a total period of 10 minutes, placing the equipment at the average breathing height of the population
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34 (1.5 m).
35 In addition, the spatial analysis of the average concentrations determined for each point, by zone, was
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carried out using the Inverse Distance Weighted (IDW) interpolation method, applied with the QGis software.
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38 This method assumes that the variable that is mapped decreases its influence at a greater distance from its
39 location (Toro and Melo, 2009).
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41 Spatial analysis of diseases: For this analysis, the on-call records of the local hospital were accessed,
42 from which a digital database was created, including cases of acute respiratory diseases in children from 0
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44 to 14 years of age living in the city of Concepción of Uruguay. The cases admitted from May 2017 to April
45 2018 were registered.
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47 This database was structured to can identify the geographical location of each registered case
48 (indicating the patient's residence address), the diagnosis, the age and thedate of admission to the guard. In
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particular, the diseases were selected were: bronchospasm, bronchiolitis (BQL), bronchitis, asthma attack, flu
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51 syndrome, acute community pneumonia (CAP), lower airway catarrh (CVAI), recurrent obstructive bronchitis
52 (BOR), exacerbation of BOR, influenza-like illness (ILI), and in the category `others´ thosewith more than
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54 one of these diagnoses. (Manisalidis, Stavropoulou, Stavropoulo and Bezirtzoglou, 2020).
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Once the data was normalized domiciliary, a composite type geolocator was created with which the
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5 digitalized cases were georeferenced in such a way that the location of each one was identified with a point
6 on the general map. For doing this, the digitized database, a database on streets and heights of the city and a
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8 layer `shape´ of the streets of the city were registered. (OpenStreetMap contributors, 2015).
9 Finally, with the free and open source geographic information system, QGIS, an algorithm was
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11 executed to obtain the number of cases located in the different areas of interest and evaluate the trends.
12 (QGIS,2021).
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15 Results and discussion
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18 Analysis of the data collected in the surveys
19 A total of 500 surveys were carried out, 250 in the risk zone (1) and 250 in the control zone (2).
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21 Of the total of those surveyed, 46% (n = 230) were girls and the remaining 54% (n = 270) were boys.
22 The mean age for children in zone 1 was 7.3 ± 4.1 years and forchildren in zone 2 it was 7.0 ± 4.1 years.
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24 A Chi² test was performed with Yates continuity, with a significance level of 5%, to determine the
25 existence of an association between the zones and the presence of chronic respiratory diseases. As a result, it
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was found that there is no association between both variables (p = 0.500).

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28 When the respondents were consulted as to whether the child had suffered acute respiratory diseases
29 diagnosed by a doctor in the last year, in zone 1 it was found that 34.4% of the children (n = 86) had been
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31 diagnosed during the last year and in in zone 2, this value was 29.2% (n = 73).
32 The same test was performed, with a significance level of 5%, to determine the existence of an
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34 association between the areas and the presence of acute respiratory diseases diagnosed by a doctor in the last
35 year. As a result, it was found that there is no association between both variables (p = 0.249), that is, there is
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no relationship between children with the presence of respiratory diseases and the areas studied.
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38 Children diagnosed with of disease during the previous year were initially cared for at different sites.
39 In zone 1 the highest percentage of sick children received their first care in the zonal hospital with 60.5%
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41 (n = 52), while in zone 2 this percentage was also in the zonal hospital but only in 41.1% (n = 30) of the
42 cases, the private office being the second place of primary care with 38.4% (n = 21). When carrying
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44 out the test of equality of proportions, it was obtained that there were significant differences between the
45 proportions of individuals treated in private places between both areas (p <0.001).
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47 Considering the remaining respondents by area (children without a diagnosis of chronic disease and
48 without a diagnosis of respiratory diseases by a doctor during the last year), we proceeded to identify those
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children who presented symptoms, but did not manifest to have a diagnosis of disease.
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51 In zone 1, a total of 15 children presented at least one symptom, while in zone 2 there were 14. The
52 presence of cough upon waking up was the most recurrent symptom inboth zones. When applying the Chi²
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54 test for the presence/absence of symptoms according to area, it was found that the presence of symptoms is
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independent of the area where theyoccur.
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5 Regarding the children's homes, during the visual inspection of them, it was possible to verify in 50%
6 of the cases the presence of humidity in some environment of thehomes in zone 1. Of that 50%, 89 homes
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8 (71.2%) presented humidity in one or more environments, including the child's bedroom. In zone 2 the
9 presence of humidity was detected in 64.8% in some room of the dwellings. Of this value, 107 (66%) presented
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11 humidity in one or more rooms, including the child's bedroom. Regarding the location of the rooms of the
12 house, in zone 1 44.8% and in zone 2 31.6% have windows to the street.
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In zone 1.50% of the homes with rooms that have windows facing the street are in areas with heavy
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15 traffic, while for zone 2 the percentage drops to 32.9%.
16 There are significant differences between the type of traffic according to the zone (p <0.001):
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18 Considering by zone, 42.8% of the traffic in zone 1 corresponds to heavy traffic, while in zone 2 the percentage
19 was 28%.
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21 Table 1 shows the percentages resulting from the surveys, referring to the presence of factories or
22 industrial establishments near the home in both areas, with significant differences (p <0.001).
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25 Table 1 presence of factories or industries close to the home.
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28 Factory Zone
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presence Total
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32 Yes 150 1 151
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(30.0%) (0.2%)
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35 No 100 249 349
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(20.0%) (49.8%)
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38 Total 250 250 500
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41 Taking into account the distribution by zone, 99.3% of those surveyed in zone 1 indicated the
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43 presence of factories or similar near their home, while in zone 2 this percentage was only 0.66%.
44 Regarding the existence of urban solid waste disposal sites near the home, the situation is different
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between both areas (p <0.001), as can be seen in Table 2.
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Table 2 presence of clandestine waste disposal sites in both areas
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Presence of Zone
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9 Disposal sites Total
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Yes 72 138 210
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14 (14.4%) (27.6%)
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16 No 178 112 290
17 (35.6%) (22.4%)
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19 Total 250 250 500
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22 When asked about the perception of air quality annoyances, the situation in both areas is different (p
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<0.001). It is observed that 34.9% of children in zone 1, who present one or more respiratory symptoms,
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25 perceive discomfort associated with air quality, while in zone 2 this percentage drops to 23.3%.
26 Results of air quality measurements: A total of 380 measurements were made, 190 in each area and
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28 19 for each individual point, during 38 days in the period March – May 2021. In all cases, the environmental
29 concentration was determined at 1.5 m height of SO2, NO2, H2S and PM2.5.
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31 The statistical analysis of the data collected was performed from the analysis of variance (ANOVA)
32 to one factor, however, the general results indicate non-parametric distributions of the data collected, whereby
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in most cases it was used the Kruskal-Wallis test. In all cases, 95% confidence was used (α = 0.05).
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35 From the analysis of SO2 for both zones, a value p = 0.556 was obtained, so that it can be stated with
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95% confidence, that there are no significant differences between the measured concentrations. The median
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38 value for the risk zone is equal to 0.330 ppm and for the control zone 0.340 ppm, both exceeding the limit
39 established by WHO (2021), equal to 0.191 ppm.
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41 Fig. 3 shows the spatial distribution of the mean concentration for the period March-May 2021,
42 obtained by interpolation of the data measured at each point by area studied. The highest concentrations are
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44 highlighted for the risk zone in points 1, 2, 3 and 4 and for the control zone in points 1, 2 and 3.
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48 [Insert: Fig 3 average spatial distribution of SO2]
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51 According to the statistical analysis of the PM 2.5 measurements made in both areas, it can be stated
52 with 95% confidence that there are significant differences between them (p = 0.007). The median for the risk
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54 zone is 3.7 µg/m3 while for the control zone it is 2.8 µg/m3.
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Fig. 4 shows the average spatial distribution for the PM2.5 concentrations measured throughout the
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5 period for both zones. The highest values for the risk zone are located at points 3 and 4, coinciding with an
6 important access road of the town where small and large vehicles pass. In the control zone, the highest
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8 concentration is observed atpoint 2, highlighting the presence of streets of calcareous material.
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12 [Insert: Fig. 4 average spatial distribution of PM2.5]
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15 Based on the statistical analysis performed on the measured H2S data in both areas, it can be stated
16 with 95% confidence that there are no significant differences between them (p = 0.7197). The median value is
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18 equal to 0.400 for the two zones.
19 Fig.5 shows the average spatial distribution for H2S in both areas for the entire period measured,
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21 identifying the highest concentration at point 8 of the risk area, which may be attributable to the emission
22 source, located to the southwest of the same.
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[Insert: Fig.5 average spatial distribution of H2S]

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29 As to the measured concentrations of NO2, it can be stated with 95% confidence that there are no
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31 significant differences between both areas (p = 0.898). The median valueis 0.270 ppm in the two studied areas,
32 exceeding the WHO guide value (0.106 ppm).
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34 Fig. 6 shows the average spatial distribution of NO2 for the entire period considered in both areas,
35 highlighting that the highest measured value is located at point 9 of the risk zone.
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39 [Insert: Fig. 6 average spatial distribution of NO2]
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42 It should be clarified that a clear influence of the wind direction was identified at the time of the
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44 measurements, which indicates statistically significant differences between the points in each zone and for
45 each pollutant considered.
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47 During the digitization, a database of 2815 cases of acute respiratory diseases in children from 0 to
48 14 years of age residing in the city was created, who had been treated and diagnosed in the hospital.
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After normalizing the nomenclature of the residence addresses and controlling the other digitized
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51 data, the geolocator was created, obtaining a total of georeferenced cases of around 92% of these records.
52 The distribution of acute respiratory diseases for the population studied in the cityof Concepción del
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54 Uruguay is shown in Fig. 6.
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By counting cases of acute respiratory diseases within the areas of interest of the project that frames
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5 this work, the results showed that for the risk zone a total of 279 cases were registered, and in turn, in the
6 control zone a total of 121 cases.
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8 When making a comparison, it can be seen that the distribution of cases in the risk zone is uniform in
9 the extension of the compromised area under study. On the other hand, in the control zone a biased distribution
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11 pattern can be observed around a vulnerable sector.
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16 [Insert: Fig. 7 distribution of acute respiratory diseases in children aged 0-14 years since May 2017 to April
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21 Based on the surveys carried out, maps were prepared to analyzethe spatial distribution of acute
22 respiratory diseases diagnosed in the last year and the respiratory symptoms of children living in both areas,
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24 in function of the environmental concentrations of each of the pollutants measured, although it is not possible
25 to make a temporary association of them.
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Fig. 8 shows the distribution of acute diseases and respiratory symptoms in relation to SO2
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28 concentrations, not observing a distribution pattern associable with the maximum average values.
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50 Fig. 8 distribution of respiratory diseases and symptoms as a function of SO2 concentration
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53 Fig. 9 shows the distribution of acute respiratory diseases and symptoms in relation to PM2.5
54 concentrations, observing a concentration of cases of diagnosed respiratory diseases at the points close to the
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average maximum values, in both zones.
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8 [Insert: Fig. 9 distribution of respiratory diseases and symptoms as a function of PM2.5 concentrations]
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11 Fig. 10 shows the spatial relationship of the presence of respiratory diseasesand symptoms and the
12 environmental concentrations of H2S, highlighting that in homes near point 8 of the risk zone, two diagnosed
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cases and one with respiratory symptoms were recorded.
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18 [Insert: Fig 10 distribution of respiratory diseases and symptoms as a function of H2S concentration]
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21 Fig. 11 shows the spatial results of the distribution of diseases and respiratory symptoms in relation
22 to the average concentrations of NO2, highlighting that in the risk zone there is a concentration of these cases
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24 close to point 9 where the maximum average concentration is recorded, while in the control zone a
25 concentration of these cases is observed in point 9.
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29 [Insert: Fig. 11 distribution of respiratory diseases and symptoms as a function of NO2 concentration]
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32 According to the results obtained from the surveys carried out in each zone, there are no significant
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34 differences between the children of the age group considered (0-14 years), in reference to the diagnosis of
35 acute respiratory diseases and the presence of respiratory symptoms, which indicates that there are no specific
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risk factors for the pathologies and symptoms considered.

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38 However, particular characteristics of the population in each zone inherent to access to health services
39 have been identified. In the risk zone (1), the highest percentage ofchildren is cared for in public health services,
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41 while that in the control zone (2), the highest percentage of children resort to private healthcare, although the
42 differences in the distribution of social work and prepaid between both groups is not significant.
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44 Another significant point of interest is the presence of clandestine solid waste disposal sites near the
45 homes where the children surveyed from the control zone reside (2), which can be considered a modifying
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47 factor of ambient air quality in the case of the frequent burning of them, a very common practice in the city.
48 Particularly in the risk zone, the presence of industries or productive establishments of different kinds
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is identified, highlighting the poultry meat processing plants, which are considered a health risk by the
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51 surveyed population because they cause recurrent discomfort such as unpleasant and irritating odors.
52 Regarding air quality measurements, the general averages for both zones show that there are no
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54 statistically significant differences between them (except for the particulate matter); however, a clear
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stratification is observed within each sub-zone, which it is directly related with the wind direction at the time
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5 of measurement.
6 Sulfur dioxide is the one with the smallest difference between the measurements points in both zones,
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8 but even so, the maximum concentrations are observed in the extremes west of each zone, which may indicate
9 the contribution of other sources of contamination. It is noteworthy that the maximum admissible
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11 concentration value for short periods established in WHO guides, is exceeded in both areas, which constitutes
12 an environmental risk to the respiratory health.
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The particulate matter (2.5 µm) presents an increasing trend on the busiest access roads in both zones,
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15 according to the type of vehicular traffic and the type of street material, so that in the risk area the values
16 higher averages are observed on Lauría access. In this sense, it is noteworthy that there are significant
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18 differences in the type of vehicular traffic in each area, and in the average concentrations of PM2.5, which
19 would define an associated risk factor.
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21 On the other hand, hydrogen sulfide has a more homogeneous distribution in both zones, although in
22 the risk zone there are some points of higher concentration towards theeast.
23
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24 Finally, nitrogen dioxide is the pollutant with the lowest average concentration for both zones, with
25 the maximum values being identified towards the eastern end of the risk zone and the western end of the
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control zone, defining a range of almost homogeneous values in the central area of the city. In this case, the
27
28 average values registered for both areas exceed the maximum admissible concentration for short periods,
29 established in the provincial regulations.
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31 The influence of the winds, although is significant in most of the cases studied, is variable, for which
32 reason it is not possible to establish an interrelation with the measured concentrations, nor a descriptive trend
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34 of the same. Each pollutant behaves individually according to the predominant direction of the winds, which
35 indicates that they do not come from a single and individual source of emission, allowing establishing a new
36
iew
working hypothesis associated with factorial multiplicity.

37
38 From the spatial analysis of the measurements and the distribution of diagnosed acute respiratory
39 diseases or the presence of symptoms, it is observed that there are patterns that indicate a higher density of
40
41 cases in the places near the points where were recorded the maximum concentrations of PM2.5, H2S and NO2.
42 Regarding the collection of secondary data obtained from the hospital, we can demonstrate the
43
44 complexity and multi-causality of the pathologies corresponding to acute respiratory diseases for children 0–
45 14 years of age, observing that the cases are distributed in the extension of the urban zone, through non-uniform
46
47 patterns.
48 There are areas, towards the northwest of the city, where there is a greater occurrence of cases, which
49
can be associated with characteristics of the territorial order of the city.
50
51 In this sense, it is important to mention access to the health system as a determining factor, given
52 that, according to socioeconomic level, cultural variables and distance from healthcare centers, people can
53
54 choose private or public assistance. This condition has been verified through the methodology used in this
55
56 11
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study, from which significant differences were identified in access to health services among the inhabitants of
4
5 both zones.
6 Regarding the digitization stage, it is worth mentioning that there is a clear deficiency in the current
7
8 records, since they are only in paper format and in most cases incomplete, generating difficulties mainly
9 associated with their statistical analysis and time management.
10
11 In particular, when comparing both study zones, different patterns of spatial distribution are observed;
12 in the risk zone it is uniform over the entire surface, while in the control zone the distribution is skewed towards
13
the most vulnerable area of the settlement.
14
15 However, considering the higher density of cases in the risk zone in reference tothe control zone,
16 we can evidence a slight tendency to the occurrence of acute respiratory diseases in children in the first one.
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22 Conclusions
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25 This study represents a significant precedent for the analysis of environmental risk factors associated
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with the occurrence of acute respiratory diseases in children from 0 to 14 years old related to the socio-
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28 environmental conditions of the population and the outdoor quality of air.
29 According to the data analyzed, no specific risk factors associated with the pathologies and symptoms
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31 consider were identified in the surveyed population of both zones; however, were identified particularities
32 related with access to health services, the presence of sites clandestine disposal of waste and the presence of
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34 industrial activities that alter the quality of life.
35 In reference to the air quality measurements carried out during a period of two months, similar mean
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values were observed between both zones, with no significant differences between them; however, when
37
38 comparing the measurement points within the same zone, variations were observed in the concentration of
39 PM2.5, H2S and NO2.
40
41 The differences between the values measured for each pollutant, depending on thewind direction are
42 significant, but each compound describes an individual behavior, not allowing defining general trends.
43
44 Likewise, it should be noted that, in most cases, the SO2 and NO2 exceed the guide value
45 recommended by WHO (2021) of short periods of time, which represents a risk for the population. To PM2.5
46
47 and H2S, are not considered in the reference values to short periods.
48 Complementarily, from the spatial analysis of the distribution of acute respiratory diseases and
49
symptoms, together with the mean concentrations of each pollutant, a trend towards an increase in the density
50
51 of cases near the points of maximum concentration for PM2.5, NO2 and H2S, which could indicate an
52 association between them.
53
54 It is possible to conclude that exist a primary environmental risk associated with air quality in both
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56 12
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3
areas, regardless of socio-environmental conditions, which influences the occurrence of diagnosed diseases
4
5 and/or respiratory symptoms; however, it is not feasible to establish causality associated with the industrial
6 emission sources considered.
7
8
9
10
11 References
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13
Ballester Diez F., (2005). Vigilancia de riesgos ambientales en Salud Pública. El caso de la
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15 contaminación atmosférica. Gaceta Sanitaria, 19(3): 253-7.
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19 de Buenos Aires. Contaminación Atmosférica e Hídrica en Argentina, (3).
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45 López Saura P., Aldeguer Corbí J., Segura López G., Cayuela Fuentes P. (2015). Factores de riesgo
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47 ambiental en el entorno escolar. Revista de Salud Ambiental, 15(Especial Congreso): 86-174.
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Impacts of Air Pollution: A Review. Public Health. https://doi.org/10.3389/fpubh.2020.00014
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51 Marcó L. (2014). Ambiente y Asma, ¿Qué hay más allá de la Alergia? Estudio epidemiológico del
52 asma infantil en Concepción del Uruguay - Factores inespecíficos de riesgo (Tesis doctoral). Facultad de
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54 Ciencias Médicas- Universidad Nacional de La Plata, La Plata, Argentina.
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Massolo L. (2004). Exposición a contaminantes atmosféricos y factores de riesgo asociados a la
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5 calidad de aire en La Plata y alrededores (Tesis de Grado). Centro de Investigaciones del Medio Ambiente
6 CIMA, Universidad Nacional de La Plata, La Plata, Argentina.
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8 Massolo L., Müller A., Herbarth Olf, Ronco Al., Porta A. (2008). Contaminación Atmosférica y salud
9 infantil en áreas urbanas e industriales de La Plata, Argentina. Acta Bioquímica Clínica Latinoamericana,
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11 42(4): 567-74.
12 OpenStreetMap contributors. (2015). Planet dump. https://planet.openstreetmap.org
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Puliafito E., Guevara M., Puliafito C. (2003). Characterization of urban air quality using GIS as a
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15 management system. Environmental Pollution, 122(1): 105–117.
16 QGIS. (2021). Un Sistema de Información Geográfica libre y de Código Abierto.
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18 https://www.qgis.org/es/site/
19 Romero Placeres M, Diego Olite F., Álvarez Toste M. (2006). La contaminación del aire: su
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21 repercusión como problema de salud. Revista Cubana de Higiene y Epidemiología, 44(2).
22 Rosales Castillo J., Torres Meza V., Olaiz Fernández G., Borja Aburto V. (2001). Los efectos agudos
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24 de la contaminación del aire en la salud de la población: evidencias de estudios epidemiológicos. Revista de

25 Salud Pública de México, 43(6).
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Toro, Guillermo A., & Melo, Carlos E. (2009). Aplicación de métodos de interpolación
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28 geoestadísticos para la predicción de niveles digitales de una imagen satelital con líneas perdidas y efecto sal
29 y pimienta. Tecnura, 12(24): 55-67. ISSN: 0123-921X.
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31 https://www.redalyc.org/articulo.oa?id=257020606007
32 Vargas Marcos F., (2005). La contaminación ambiental como factor determinante de la salud. Revista
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34 Española de Salud Pública, 1(79): 117-127.
35 World Health Organization
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World Health Organization [WHO] (2021). Global air quality guidelines.

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38 https://apps.who.int/iris/bitstream/handle/10665/345329/9789240034228-eng.pdf
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51 Statements and Declarations
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53 Funding: the authors declare that no funds, grants, or other support were received during the preparation of
54 this manuscript.
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Competing interests: the authors declare that they have no known competing financial interests or personal
4
relationships that could have appeared to influence the work reported in this paper.
5
6 Author Contributions: all authors contributed to the study conception and design. Material preparation, data
7 collection and analysis were performed by Emiliana Elisabet Orcellet, Martina Villanova, Jorge Omar Noir,
8 Laura De Gracia and Daiana Marisol Caire. The first draft of the manuscript was written by Emiliana Orcellet
9 and Eliana Sofía Acevedo and all authors commented on previous versions of the manuscript. All authors read
10 and approved the final manuscript.
11
12 Data availability: the datasets generated during and analyzed during the current study are available from the
13 corresponding author on reasonable request.
14
15 Ethical Approval: this is an observational study; no ethical approval is required.
16
17 Consent to participate: informed consent was obtained from all individual participants included in the study.
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Environmental Health Insights

Environmental risk factors associated with acute respiratory

Journal: Environmental Health Insights

Manuscript Type: Research Article

Villanova, Martina; Universidad Nacional de Entre Rios

Acevedo, Eliana Sofia; Universidad Nacional de Entre Rios

outdoor air quality, environmental factors, measurement, health risk,

About 3 million deaths a year are related to exposure to outdoor air

were considered, a risk zone and a control zone. Interviews were

24 concentrations of ozone and particulate matter on the health of urban populations.

(grade) of the plume according to the ISC3 model].

was found that there is no association between both variables (p = 0.500).

[Insert: Fig.5 average spatial distribution of H2S]

risk factors for the pathologies and symptoms considered.

working hypothesis associated with factorial multiplicity.

24 Respiratorias de México, 19(1): 28-37.

24 de la contaminación del aire en la salud de la población: evidencias de estudios epidemiológicos. Revista de

World Health Organization [WHO] (2021). Global air quality guidelines.

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