Ecological and Demographic Factors and Their Role in the Formation of Pathology among the Child Population of Kursk Oblast

The dissertation is devoted to a comprehensive study of the influence of ecological and population-demographic factors on the morbidity of the child population of Kursk Oblast. The research addresses the impact of agrochemicals, pesticides, and atmospheric air pollutants on children's health, and also analyzes the role of demographic characteristics of the region — age structure, migration processes, inbreeding, and assortative mating — in the formation of childhood pathology. The work is based on data from the 2002 dispensary examination and materials of social and hygienic monitoring.

During the course of the research, an assessment of the ecological load on the air basin and soils of the rural districts of Kursk Oblast was carried out, and a ranking of the districts by the level of childhood morbidity was performed. Statistically significant relationships between individual types of pesticides and atmospheric pollutants and the prevalence of individual nosological forms in children have been established. The results obtained have been used to develop socio-medical recommendations and a regional program for the protection of children's health, taking into account the ecological load and population-demographic structure of the region.

Relevance of the Topic.

One of the most significant indicators of the health of a nation is the morbidity of the child population [148, 283]. The urgency of the problem is underscored by the deteriorating ecological situation [236, 237]. Scientific and technological progress has brought about substantial changes in the environment, which in most cases have had an unfavorable impact on human health [78, 135, 294]. Virtually without interruption, thousands of laboratories worldwide are engaged in the development and synthesis of new chemical substances, such as pharmaceutical preparations, household chemicals, pesticides, and so forth [91, 92]. Currently, the number of such chemical compounds, together with industrial waste, exceeds 60,000, which significantly disrupts the human habitat, leading to increased morbidity, disability, and mortality, and consequently to a worsening of the demographic situation [59, 61, 133, 149, 152].

According to data from the dispensary examination of the child population conducted in 2002 in Russia, the level of morbidity continues to rise steadily. A similar trend is observed worldwide [222, 249, 276, 284].

In recent years, the problem of environmental pollution and the associated deterioration of public health has been examined quite extensively [63, 65, 66]. Special attention has been given to such factors as the state of the air basin, soil, composition of drinking water, quality of food products, atmospheric phenomena, and solar activity [5, 228]. The use in agriculture of such chemical preparations as herbicides, fungicides, seed disinfectants, and others has become widespread. The mechanisms of their effects on living organisms are discussed in the literature, but mainly on the basis of experiments on animals or under conditions of high concentrations of substances at production facilities, or through direct contact during their application in the fields [49].

According to data from the Main Administration of Natural Resources for Kursk Oblast, more than 300 types of polluting substances related to human economic activity are emitted into the atmospheric air of our oblast. The most common pollutants detected in the atmosphere of every populated area are suspended matter (dust, soot, ash, etc.), nitrogen oxides, carbon oxides, sulfur oxides, as well as hydrocarbons. Within the territory of the oblast there are 5,300 enterprises and organizations that have emissions of polluting substances into the atmosphere. These substances spread many kilometers from the source and enter the human body by various pathways [64].

Currently, a large number of works are devoted to the study of the effects of high concentrations of xenobiotics on the human body and of direct contact with them [2]. However, the problem of morbidity among the population, and especially among children, residing in territories adjacent to these enterprises at various distances, has not yet been sufficiently studied. In the vast majority of works carried out on this subject, the role of population-demographic indicators of regions is underestimated, which undoubtedly affects the representativeness of the data obtained.

The importance of conducting research of this kind is reflected in the resolutions of the Government of the Russian Federation, in particular in the Law of March 30, 1999, No. 52-FZ "On the Sanitary and Epidemiological Well-being of the Population," and the Resolution of the Government of the Russian Federation of June 1, 2000, No. 426 "On the Approval of the Regulations on Social and Hygienic Monitoring." A unique system of social and hygienic monitoring (SHM) has been established in the country, which serves as the basis for studying the influence of environmental factors on health and for developing and implementing effective preventive measures, as noted at the collegium of the Ministry of Health of Russia on May 28, 2002, when considering the question "On the work of conducting social and hygienic monitoring in 2000–2001 and the tasks of the state sanitary and epidemiological service of the Russian Federation for its improvement" [65].

The above considerations determined the goal and objectives of the present study.

Goal of the Study:

On the basis of a comprehensive assessment of the influence of population-demographic and ecological factors on the level of childhood morbidity, to scientifically substantiate and develop socio-medical proposals and recommendations for the protection of children's health in the territory of Kursk Oblast.

To achieve the stated goal, the following tasks have been set:

1. To assess the population-demographic structure of the region.

2. To study the dynamics of the pesticide load on the soils of rural districts of Kursk Oblast over a period of 5 years.

3. To assess the degree of pollution of the air basins of rural districts of the oblast.

4. To carry out ranking and identify the most unfavorable districts of the oblast by the level of childhood morbidity.

5. To assess the influence of ecological and population-demographic factors on the state of children's health.

6. To substantiate and develop socio-medical recommendations and measures for the prevention of childhood morbidity.

Scientific Novelty of the Study:

For the first time, a comprehensive study has been conducted on the influence of ecological and population-demographic factors on the health of the child population of Kursk Oblast. During the work:

• Population-demographic characteristics of the population have been presented: age structure, ethnic composition, migration processes, and inbreeding. The intensity of correlations between individual parameters of these characteristics and the level of childhood morbidity by various nosological forms has been determined.

• The ecological load on the air basin and soils of the districts of Kursk Oblast has been assessed, along with its dynamics over a period of 5 years.

• Risk groups of districts with a high level of childhood morbidity have been identified.

• Air basin and soil pollutants that have a statistically significant effect on children's health have been established.

Scientific and Practical Significance of the Study:

Population-demographic characteristics of the population (assortative mating; inbreeding; migration processes) and the influence of pesticide load on soils and atmospheric pollutants on the formation of pathology among the child population of Kursk have been studied. The obtained data can serve as an objective source of information for the substantiation and implementation of socio-medical measures for the prevention of morbidity among children.

• During the study, medical-organizational and practical recommendations were developed for practicing physicians and heads of health care institutions on the organization of pediatric care for the population in various districts of the oblast, as well as on the conduct of preventive measures in the territories of these districts.

• The results of the study have been incorporated into the basis of the educational programs of the postgraduate education faculty of the departments of pediatrics, health care organization, and health care management and organization economics at Kursk State Medical University.

• The results of the conducted study served as the basis for the development and substantiation of a regional program for the protection and preservation of children's health, taking into account the ecological load and population-demographic structure of the region.

Practical Relevance of the Study:

The results of the work have been reported at the following conferences: the summary conferences of the scientists of Kursk State Medical University in 2003 and 2004; the IV All-Russian Scientific and Practical Conference "Problems of Ecology and Environmental Safety of the Central Black Earth Region of the Russian Federation" (Lipetsk, 2002); the All-Russian Conference with International Participation "Biological Aspects of Human Ecology" (Arkhangelsk, 2004); the 2nd All-Russian Scientific and Practical Conference "Chemical Pollution of the Habitat and Problems of Ecological Rehabilitation of Disrupted Ecosystems" (Penza, 2004); the II International Scientific and Practical Conference "Medical Ecology"; the IX All-Russian Congress "Ecology and Human Health"; and the sessions of regional and city pediatric societies.

Publications on the Topic of the Dissertation: Fifteen works have been published on the topic of the dissertation.

Main Propositions for Defense:

1. The study period in Kursk Oblast was characterized by an increase in morbidity among the child population. By individual classes of diseases (respiratory, digestive, skin, and endocrine pathology), this indicator increased by 2 to 2.5 times.

2. The ecological stress of the region makes a significant contribution from the volumes and species composition of pesticides used and atmospheric pollutants from stationary sources. Within the territory of the oblast, 24 types of pesticides and 20 atmospheric pollutants have been identified, the volumes of which entering the environment were decisive.

3. A statistically significant role has been established for 10 types of pesticides and 15 atmospheric pollutants that have a reliable effect on the level of morbidity and the prevalence of individual nosological forms among the child population.

4. The population-demographic structure of the adult population of the oblast has an influence on the formation of childhood pathology. A connection between its individual characteristics and the prevalence of individual nosological forms in children has been revealed.

5. The prevalence of certain diseases among children is determined by the combined adverse impact of the volumes of individual types of pesticides, atmospheric pollutants, and certain population-demographic characteristics of the adult population of the region.

Volume and Structure of the Dissertation.

The dissertation is presented in 210 pages of typescript, consisting of an introduction, 5 chapters, a conclusion, findings, proposals, a list of references, and appendices. The work is illustrated with 15 tables, 6 figures, and 14 diagrams. The list of references contains 301 sources, including 235 domestic and 66 foreign.