TX_1~ABS:AT/ADD:TX_2~ABS:AT 1 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2021, 5 (2): 1-5 ReseaRch aRticle Occupational Exposures and Associated Health Effects among Dumpsite Workers: A Case Study of Kani Qirzhala Landfill Site, Erbil, Iraq Tanya S. Salih, Ameena S. M. Juma, Muhsin H. Ubeid Department of General Biology, Cihan University-Erbil, Kurdistan Region, Iraq ABSTRACT Eighty-nine male workers from the landfill site in (Kani Qirzhala), Erbil, Iraq, aged from 12 to 65 years were investigated in this study. Each one had filled out a questionnaire sheet, in addition to their signed consent to take a blood sample from them. Plus, a 7  ml of venous blood samples were collected from them. Total IgE and syphilis antibodies were detected. Thus, CBC was conducted on each sample. The results recorded 92.13% of the workers lived in rural areas, while 7.87% lived in urban areas. Further, there were 58.43% smokers and 41.57% non-smokers. Furthermore, the research sample contained 38.20% single and 61.80% married people. As education illustrated, 37.08% had no schooling, primary school education 40.45%, less than 20% had secondary school education, 2.25% acquired a diploma, and a B.Sc. degree. The serum concentration of total IgE of dumpsite workers revealed a significant increase when compared to the healthy group. None of the workers’ sera revealed syphilis antibodies except one case which was positive; however, it shows non-significant differences between both groups. WBC count was soared significantly in dumpsite workers when compared to the healthy individuals, yet, lymphocyte and granulocyte numbers showed non-significant increment, while monocyte numbers showed a statistically insignificant rise in workers as compared to healthy group. The number of RBCs and Hb level of the landfill workers exhibited a substantial increase. Even though, both groups’ platelets did not show significant variance. The rise in WBC counts and IgE levels may be due to the exposure of these workers to allergens at the dumpsites as for allergies is the common consequence when exposed to waste and garbage. Keywords: IgE and allergy, dumpsite workers, complete blood count, syphilis and hematological factors INTRODUCTION Wastes management using open landfill sites is considered a primitive practice and an inadequate service that is still used in many parts of the globe, in addition to the absence of efficacy and scientific concepts. These sites commonly are located at the brinks of towns. Such dumpsites are considered health and environmental hazard,[1] they will affect and infect not only the contacted workers but they also will influence the communities who live in the surrounding adjacent areas.[2,3] As such, those people who work and live in a dirty atmosphere are at risk of illness as of their surroundings. They have a high possibility to be caught by many microbial diseases and exposure to many chemical substances causing them, namely, irritation (allergies) of skin, nose, and eyes, in addition to chest and stomach pains, headaches, and diarrhea.[4-7] In fact, the study had isolated various of pathological species of bacteria from the site’s surroundings; top soils, leachates, and the study group for instance; Bacillus, Staphylococcus, Escherichia coli, Proteus, Streptococcus, Klebsiella, Pseudomonas, Citrobacter, Bacteroides, Clostridium, and Serratia. All these bacteria are known to cause serious respiratory, skin, gastrointestinal, and even central nervous system infections.[8,9] Further, dumpsites are known to emit air pollutants, that is, bioaerosols, which are hazardous to those who work in landfill sites and put them at risk of respiratory diseases. Admittedly, cough was the most reported symptom by the investigated literature.[10] Furthermore, surveys of community Corresponding Author: Tanya S. Salih, Department of General Biology, Cihan University- Erbil, Kurdistan Region, Iraq. E-mail: tanya.salam@cihanuniversity.edu.iq Received: May 31, 2021 Accepted: July 28, 2021 Published: August 10, 2021 DOI: 10.24086/cuesj.v5n2y2021.pp1-5 Copyright © 2021 Tanya S. Salih, Ameena S. M. Juma, Muhsin H. Ubeid. This is an open-access article distributed under the Creative Commons Attribution License (CC BY-NC-ND 4.0). Cihan University-Erbil Scientific Journal (CUESJ) Salih, et al.: Occupational Exposures and Associated Health Effects among Dumpsite Workers 2 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2021, 5 (2): 1-5 health from Africa had documented a vast of well-being issues: Psychological disorders, gastrointestinal problems, respiratory symptoms, skin inflammation besides to nose, and eyes.[2] Based on the aforementioned statements, and the scarcity of information, this study is subjected to shed the light on the health status of the local landfill workers. Because of their continuous exposure to toxic materials and allergens, hence, the investigation on the immune status of the mentioned workers was carried out. RESEARCH METHODS Location and Groups Selection From Kani Qirzhala, Erbil, Iraq, dumpsite eighty-nine males were investigated for this study in hand. Age, gender, and apparently healthy subjects had selected as criteria for healthy group. Figure 1 illustrates the questionnaire that was filled by both groups. In addition, they were subjected to all tests mentioned in the next section. Sample Collection To collect 7 ml of venous blood from each worker, a standard clean venipuncture technique was administered by disinfecting the anti-cubital fossa with 70% ethanol and using a disposable hypodermic syringe and 23-gauge needle after tourniquet application. Afterward, 2 ml of venous blood was dispensed; into dipotassium ethylenediaminetetraacetic anticoagulant tube, and evenly stirred, hence, to facilitate the establishment of the hematological criteria (CBC). The remaining, 5 ml were placed in a plain tube and left aside for 60 min at room temperature for blood to clot. Then, the tubes were in a centrifuge for 10 min. Afterward, tubes cooled at 4°C at 450× g to collect the serum. Later, using a Pasteur pipette, the serum was aspirated and dispensed into 0.5 ml sterile glass tubes and frozen at –20℃. Antibody Detection Once they are restored to room temperature, the stored sera were used for the seroprevalence tests. The automated Cobas Table 1: Kani Qirzhala landfill site workers’ Information Characteristics Frequency Percent Live in rural areas 82 92.13 Live in urban areas 7 7.87 Smoker 52 58.43 Non-smoker 37 41.57 Single 34 38.20 Married 55 61.80 Illiterate 33 37.08 Primary school education 36 40.45 Secondary school education 16 17.97 Diploma degree 2 2.25 B.Sc. degree 2 2.25 Figure 1: The study’s questionnaire sheet to investigate worker’s antibodies in the sera, hematological, and other parameters E411 immunoassay analyzer facilitated the total IgE and syphilis antibodies detection. Hematology The hematology tests were achieved after 1 h of blood samples collection using an automated hematological analyzer coulter machine (Mythic 18 Hematology Analyzer, Orphee, Switzerland) for 20 parameters. RESULTS Workers’ Data This research investigated 89 males who were 12–65 years old (no females were found in that site). No significant difference (P> 0.05) was found in the age intervals regarding all results. The majority 92.13% lived in rural areas, while urban areas consisted only of 7.87%. Results demonstrated that there were 58.43% smokers and 41.57% non-smokers. Further, it showed that most of them were married 61.80%, and only 38.20% were single. More into this, the education level illustrated, 37.08% had no schooling, primary school education 40.45%, 17.97% had secondary school education, 2.25% acquired a diploma, and a B.Sc. degree [Table 1]; these workers supported their families financially by going into this occupation. Concentration of Total IgE Table 2 reveals a high and significant increase the serum concentration of total IgE of the dumpsite workers when compared to the healthy group. Frequency of Syphilis Antibodies The results show a non-significant difference between both groups, as none of the collected sera demonstrated the availability of syphilis antibodies except one case was positive [Table 3]. Hematological Parameters Table 4 and Figure 2 indicate that WBC count increased significantly (P< 0.01) in dumpsite workers in comparison Salih, et al.: Occupational Exposures and Associated Health Effects among Dumpsite Workers 3 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2021, 5 (2): 1-5 Table 2: Total IgE concentration in the sera of the dumpsite workers compared with healthy individuals Immunological characteristics Gender Dumpsite workers Healthy Group t-test P-value P-value No. Mean±SE No. Mean±SE IgE ng/ml M 89 255.62±51.47 40 98.40±9.04 0.003 H.S.** P>0.05: Non-significant; *P<0.05: Significant; **P<0.01: Highly significant Table 3: Syphilis antibodies in the sera of dumpsite workers compared with healthy individuals Immunological parameter Gender Dumpsite workers Healthy group t-test P-value P-value No. Mean±SE No. Mean±SE Syphilis ng/ml M 89 0.313±0.019 40 0.296±0.004 0.399 N.S. P>0.05: Non-significant; *P<0.05: Significant; **P<0.01: Highly significant Table 4: Hematological parameters in the sera of dumpsite workers in comparison to healthy individuals Immunological and hematological parameters Gender Dumpsite workers Healthy group t-test P-value P-value No. Mean±SE No. Mean±SE WBC (103/gL) M 89 7.97±0.62 40 6.19±0.21 0.009 H.S.** Lymphocyte (103/gL) M 89 2.70±0.22 40 2.20±0.14 0.058 N.S. Granulocyte (103/gL) M 89 4.51±0.31 40 4.05±0.18 0.209 N.S. Monocyte (103/^L) M 89 0.77±0.11 40 0.47±0.04 0.014 S.* RBC (106/^L) M 89 5.27±0.07 40 4.95±0.09 0.006 H.S.** Hb (g/ml) M 89 16.06±0.24 40 13.86±0.18 0.000 H.S.** Platelet (103/^L) M 89 225.49±13.85 40 242.97±4.74 0.235 N.S. P>0.05: Non-significant; *P<0.05: Significant; **P<0.01: Highly significant Figure 2: Hematological parameters in the sera of dumpsite workers in comparison to healthy individuals to the healthy individuals, while lymphocyte and granulocyte numbers non-significantly increased (P> 0.05), and monocyte number shows a slightly significant rise (P< 0.05) in workers as compared to healthy individuals. The table illustrates also, significant increment in the number of RBC’s and Hb level as contrasted to the control group. Further, it signifies no substantial variance among platelet of groups. DISCUSSION At present, more than 15 million individuals in economically poor countries endure by retrieving domestic waste. Shockingly, children are a big category among those people. They wade through households’ garbage or factories, collecting and selling materials of recycling context to earn their income.[11] Many of the enrolled individuals in this current study were children. Pollution of garbage emissions is one of the reasons for many microbial diseases.A wide variety of diseases and sickness symptoms have been diagnosed in dumpsite workers including cholera, typhoid, malaria, skin diseases gastrointestinal, stomach pain, vomiting, diarrhea, and respiratory allergies. It is should be mentioned that none of the individuals included in this study showed any symptoms of diseases, despite the fact that most of them looked malnourished. Insects and specific mosquitoes can also spread various diseases in the area.[4-7,12,13] Whereas, the International Solid Waste Association reported a variety of microbial diseases that can be caught from garbage including bacterial, viral, fungal, and parasitic, in addition to various allergic infections.[14] In general, degraded living conditions have a direct relationship with the immunological status of a person, which makes them more liable to infections.[15] Landfill wastes are identified of spreading very high- risk diseases. Moreover, the major types are the medical and biowastes.[12] In addition, the dumpsite dwellers are likely to inhale poisonous gases, that is, methane, ammonia, carbon monoxide, and hydrogen sulfide. Moreover, many other medical conditions have been diagnosed in these workers including cardiovascular degeneration, disorders such as osteoarthritic changes and intervertebral disc herniation, problems of skin and respiratory system, and altered pulmonary function parameters.[16] Salih, et al.: Occupational Exposures and Associated Health Effects among Dumpsite Workers 4 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2021, 5 (2): 1-5 The research revealed high levels of IgE and WBCs in the dumpsite workers. This could indicate allergic reaction to the substance(s) that these workers exposed to. It is of interest to emphasize on the fact that none of the workers were on any medication, including anti-allergic medications. Allergic reactions associated with hypersensitivity to substances that are characterized by excessive activation of certain white blood cells named as mast cells and basophil granulocyte by IgE.[17] For instance, hay fever triggers the nose, sneezing, itching, and eyes redness irritation.[18] Inhaled allergens can generate asthmatic indications, causing the lung’s airways to narrow, mucus production, dyspnea, as well as to wheezing and coughing.[19] Further studies have stated that those who work for long hours in compost are vulnerable to acute and (sub-) chronic non-immune or Type III allergic inflammation.[20] In Lebanon, through observation, it was assured the escalation tendency in the acute health symptoms among dumpsite people, such as respiratory, gastrointestinal, constitutional, and dermatological.[21] Values of increased WBCs may refer to their involvement in immunological responses as they tend to engage in a descending form of instances resulting in inflammatory and certain sickness conditions, that is, hypersensitivity, immunosuppression, immunomodulation, and autoregression on exposure to allergens or environmental contamination.[22] Despite the distinct case of syphilis, which have documented in this research, still it is necessary to it put into consideration. This agrees, where evidence indicated that if threats of biological, chemical, and physical exceeded their limitations, work-related diseases may emerge. Many workers, and even retired persons, have been found to have many illnesses including ulcers, bronchitis, in addition to hypertension, heart diseases, arthritis, and diabetes.[23] Multitude studies reported that waste collectors risk their health and safety when exposed to significant concentration of biological aerosols,[20,24-26] namely, respiratory and gastrointestinal complaints,[6,27-30] infectious diseases such as hepatitis (A, B, and C), and HIV, in addition to syphilis.[31-33] It is worthy to mention that there have been some studies in the Kurdistan region regarding the dumpsites. In Sulaymaniyah, poor management and lack of waste treatment have resulted in the severe contamination of soil, water, and air of the surrounding area. Besides, urban waste, oil refineries, and cement plants nearby unload production residues into the city dump. Around 75% of medical waste from local hospitals is also disposed in the same place. Soil and water samples taken in proximity of the landfill showed concentrations of iron (Fe), manganese (Mn), cadmium (Cd), nickel (Ni), cobalt (Co), and chromium (Cr) above permissible levels.[34] Life on Kani Qirzhala has been described elaborately and how it is a family affair and lives of families depend on this occupation.[35] The concern about the protection of the environment has largely increased due to the contaminants mainly with anthropogenic origin and has affected and continues to threaten human resources, especially air quality, surface soil, and groundwater in Erbil City where the government is working hard to prevent any health issues, especially with the rapid development of the city.[36] CONCLUSION Municipal landfills areas and the workers establish a major public health hazard to themselves, families, in addition to nearby communities. 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