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Personal exposure to particulate matter and heart rate variability among informal electronic waste workers at Agbogbloshie: a longitudinal study.

TL;DR: In this paper, the authors used linear mixed-effects models to assess the association between PM fractions and cardiac function and found that PM fractions are associated with increased risk of developing cardiovascular disease from cardiac autonomic dysfunction.
Abstract: BACKGROUND Informal electronic waste recycling activities are major contributors to ambient air pollution, yet studies assessing the effects or relationship between direct/continuous exposure of informal e-waste workers to particulate matter and cardiovascular function are rare. METHODS Repeated measurements of fractions of PM2.5, PM10-2.5, and PM10 in personal air of informal e-waste workers, (n = 142) and a comparable group (n = 65) were taken over a period of 20 months (March 2017 to November, 2018). Concurrently, 5-min resting electrocardiogram was performed on each participant to assess resting heart rate variability indices. Linear mixed-effects models were used to assess the association between PM fractions and cardiac function. RESULTS SDNN, RMSSD, LF, HF and LH/HF ratio were all associated with PM. Significant associations were observed for PM2.5 and Mean NN (p = 0.039), PM10 and SDNN (p = 0.035) and PM 10-2.5 and LH/HF (p = 0.039). A 10 μg/m3 increase in the concentrations of PM 2.5, PM10-2.5, and PM10 in personal air was associated with reduced HRV indices and increased resting HR. A 10 μg/m3 per interquartile (IQR) increase in PM10-2.5 and PM10, decreased SDNN by 11% [(95% CI: - 0.002- 0.000); (p = 0.187)] and 34% [(95% CI: - 0.002-0.001); (p = 0.035)] respectively. However, PM2.5 increased SDNN by 34% (95% CI: - 1.32-0.64); (p = 0.493). Also, 10 μg/m3 increase in PM2.5, PM10-2.5 and PM10 decreased RMSSD by 27% [(- 1.34-0.79); (p = 0.620)], 11% [(- 1.73, 0.95); (p = 0.846)] and 0.57% [(- 1.56-0.46); (p = 0.255%)]. CONCLUSION Informal e-waste workers are at increased risk of developing cardiovascular disease from cardiac autonomic dysfunction as seen in reduced HRV and increased heart rate.

Summary (3 min read)

Introduction

  • Increasing evidence implicates informal electronic waste (e-waste) recycling activities as a major contributor to ambient air pollution and yet studies describing the effects of continuous exposure to airborne particulates on cardiovascular (CV) function of informal e-waste workers are unavailable.
  • Heart rate or rhythm abnormalities without hypoxia or respiratory distress in response to exposure to airborne particulates have been observed in many studies (19) (20) (21) .
  • Other studies have consistently shown that inhaled airborne PM 2.5 and PM 10 are associated with lower HRV in infants, the elderly, individuals with compromised CV integrity, as well as healthy individuals (12, (22) (23) (24) (25) (26) .
  • Due to the geographic layout, prevailing wind conditions, and intensity of smoke production due to open air burning of e-waste, there is a great public health concern regards to health implications of these exposures among e-waste workers and nearby populations.

2.1 Study design and study area

  • The comparable or e-waste unexposed site, Madina Zongo, is also a densely populated suburb located at the La Nkwantanang Municipality; more than 15km from the Agbogbloshie e-waste site.
  • Majority of the residents of Madina Zongo, like Agbogbloshie, are migrants from northern Ghana, and are Moslems.
  • The community members are mainly traders, engaged in a diverse mix of small-scale, informal businesses, mostly petty trading of items such as used clothing, charcoal, cold drinks, street foods, bicycle spare parts, staple foods, etc.

2.3 Data collection

  • The authors also performed 5-minute resting electrocardiograms (ECG) for each participant according to a standardized protocol (Task Force of The European Society of Cardiology and The North American & Society of Pacing and Electrophysiology, 1996) to evaluate HRV.
  • A questionnaire was also administered to elicit information on socio-demographic and other selected covariates.
  • Three rounds (I, II, and III) of panel data collection were aligned to the prevailing weather patterns (dry, rainy, harmattan seasons) in the study areas.
  • The comprehensive organizational procedures are documented elsewhere (41).

2.3.1 Interview with a structured Questionnaire

  • At enrolment, data on sociodemographic and economic factors (age, sex, religion, ethnicity, education, occupation, socioeconomic and marital status), detailed current and previous job history and exposures; home exposures including indoor cooking and biomass fuel use, pre-existing medical conditions, and lifestyle habits such as cigarette smoking and alcohol use were collected using a comprehensive questionnaire.
  • Data on cigarette smoking included age at smoking initiation, duration of smoking, sticks smoked per day, current or ex-smoker de ned as smoking cessation greater than a month's duration.
  • The questionnaire was administered by trained interviewers in a local dialect, Dagbani or Twi, or English according to the participant's preference.
  • Limited interview guides were administered in subsequent follow-up data collection that explored possible changes in home and work exposures, and other cardiovascular and respiratory conditions.

2.3.2 Personal Particulate Matter monitoring

  • Personal level ambient temperature, relative humidity and barometric pressure were also measured every 1 minute using logging instrumentation (UX100-003 data logger; Onset Corporation, Bourne, MA, USA).
  • All the measuring instruments were carried in a customized backpack with inlets in the breathing zone of participants for 4 hours of the working day, usually between 8am and 2pm.
  • As a quality control measure, PM concentrations were considered invalid when TSP exceeded 2000µg/m 3 (38).
  • During round III however, the sampling duration was reduced to approximately 2-hrs due to the high levels of PM measured from PM laden (dust) harmattan winds.

2.3.3 Heart Rate and Heart Rate Variability Measurement

  • The QRS complex corresponds to the depolarization of the right and left ventricles of the human heart and contraction of the large ventricular muscles.
  • The instantaneous heart rate (R-R interval) can be calculated from the time between any two QRS complexes.
  • It occurs when the sinus node creates an action potential that depolarizes the atria.
  • The T wave occurs after the QRS complex and is a result of ventricular repolarization.

2.4 Ethical clearance

  • Ethical clearance for the study was obtained from the ethical and protocol review committee of the College of Health Sciences (CHS-Et/M.4-P.
  • Independent sample t-test was applied for the two-group comparisons of normally distributed data and the Mann Whitney U test to the two group comparisons of non-normally distributed data.
  • The authors observed signi cant reductions in all the Log 10 transformed HRV indices (i.e., SDNN, RMSSD, MEANNN, LF, HF and ratio of LH/HF) for e-waste workers compared to controls across all three sampling periods (rounds I-III).
  • Mixed models with a random participant effect and covariance structure were used to analyze the association between air pollutants (PM 10 , PM 10 − 2.5 and PM 2.5 ) and the ECG parameters taking into account the repeated measurements over time for each individual.

3.2 Variations in particulate matter concentrations in personal air of study participants

  • The levels of PM 2.5 , PM 10 − 2.5 and PM 10 across the study period increased at each round with the highest concentrations recorded during the third sampling round (from Jan to March 2018), corresponding to the harmattan season (a period when dry and dust laden winds blows along the northwest coast of Africa from the Sahara Desert).
  • The median/IQR concentrations of PM (2.5, 10 − 2.5 and 10µm) among e-waste workers and comparable population (Table S1 ) over study time were consistently higher than the WHO air quality standards of 25µg/m 3 and 50µg/m 3 per 24-hour mean.
  • Higher concentrations (2x) of PM 2.5 were recorded in the breathing zone of the e-waste workers compared to the comparable group.

Discussion

  • Occupational exposure to PM have been associated with adverse cardiovascular health outcomes.
  • The authors observed a consistently decreased HRV indices (when values were log 10 transformed over time and frequency) among informal e-waste workers across the three sampling periods compared to the control group.
  • The in uence of the cardiac autonomic nervous system in balancing the cardiovascular system during rest and work can be assessed with HRV and, in occupational health, this is commonly describe using the frequency domain and time domain HRV parameters (e.g. RMSSD, HR MEANNN, LF, HF, SDNN) (54) .
  • Concurrent exposure to vehicular exhaust particles, smoke from biomass, entrained dusts and other sources of PM be accountable for the observed results.
  • Further studies of the effects of workplace PM 2.5 on HRV should examine the role of exposure level and exposure composition in larger and more varied worker populations.

Conclusion

  • Overall, their study is consistent with several epidemiological studies which support the hypothesis that ambient concentrations of PM represent an environmental stressor that could alters autonomic balance, leading to ischemia, fatal arrhythmia, or myocardial infarctions.
  • At this point in time, it seems that the most important challenge is to better understand the mechanisms and to pursue further the possibility that cardio-protective therapy and/or dietary supplementations can abrogate the adverse effects of PM in susceptible populations.

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Page 1/28
Personal Exposure To Particulate Matter And Heart
Rate Variability Among Informal Electronic Waste
Workers At Agbogbloshie: A Longitudinal Study
Afua A. Amoabeng Nti ( aaamoabeng_nti001@st.ug.edu.gh )
University of Ghana
Thomas G. Robins
University of Michigan
John Arko Mensah
University of Ghana
Duah Dwomoh
University of Ghana
Lawrencia Kwarteng
University of Ghana
Sylvia Takyi
University of Ghana
Augustine Acquah
University of Ghana
Niladri Basu
McGill University
Stuart Batterman
University of Michigan
Julius N. Fobil
University of Ghana
Research Article
Keywords: Personal particulate matter, Informal e-waste recycling, PM2.5, PM10, PM 10-2.5, cardiac
function, Heart rate variability, Agbogbloshie, Madina-Zongo
Posted Date: June 14th, 2021
DOI: https://doi.org/10.21203/rs.3.rs-555469/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License. 
Read Full License

Page 2/28
Abstract
Background: Informal electronic waste recycling activities are major contributors to ambient air pollution,
yet studies assessing the effects or relationship between direct/continuous exposure of informal e-waste
workers to particulate matter and cardiovascular function are rare.
Methods: Repeated measurements of fractions of PM
2.5
, PM
10-2.5
, and PM
10
in personal air of informal e-
waste workers, (n=142) and a comparable group (n=65) were taken over a period of 20 months (March
2017 to November, 2018). Concurrently, 5-minute resting electrocardiogram was performed on each
participant to assess resting heart rate variability indices. Linear mixed-effects models were used to
assess the association between PM fractions and cardiac function.
Results: SDNN, RMSSD, LF, HF and LH/HF ratio were all associated with PM. Signicant associations
were observed for PM
2.5
and MEANNN (
p
= 0.039), PM10 and SDNN (
p
= 0.035) and PM 10-2.5 and
LH/HF (
p
= 0.039). A 10µg/m
3
increase in the concentrations of PM
2.5
, PM
10-2.5
, and PM
10
in personal air
was associated with reduced HRV indices and increased resting HR. A 10µg/m
3
per interquartile (IQR)
increase in PM
10-2.5
and PM
10
, decreased SDNN by 11% [(95% CI: -0.002- 0.000); (
p
= 0.187)] and 34%
[(95% CI:-0.002-0.001); (
p
= 0.035)] respectively. However, PM
2.5
increased
SDNN by 34 % (95% CI: -1.32-
0.64); (
p
= 0.493). Also, 10µg/m
3
increase in PM
2.5
, PM
10-2.5
and PM
10
decreased RMSSD by 27% [(-1.34-
0.79); (
p
= 0.620)], 11% [(-1.73, 0.95); (
p
= 0.846)] and 0.57% [(-1.56-0.46); (
p
= 0.255%)].
Conclusion: Informal e-waste workers are at increased risk of developing cardiovascular disease from
cardiac autonomic dysfunction as seen in reduced HRV and increased heart rate.
Introduction
Increasing evidence implicates informal electronic waste (e-waste) recycling activities as a major
contributor to ambient air pollution and yet studies describing the effects of continuous exposure to
airborne particulates on cardiovascular (CV) function of informal e-waste workers are unavailable.
Studies have associated air pollution with adverse CV outcomes such as increased heart rate and
reduced heart rate variability (HRV) (1–3), ventricular tachycardia (4), vascular tone (5, 6) and morbidity
and mortality due to cardiac arrhythmias(7, 8).
Reduced heart rate variability (HRV) is reported as an independent predictor of CV disease and death
across diverse populations(9–11). It is a marker for poor health and increased risk for cardiac events
(12). Reduced HRV is a prognostic factor of increased risk for all-cause and CV mortality(13–15).
Previous studies have related reduced HRV with CV outcomes such as myocardial infarction (3, 16, 17)
and coronary artery disease (18). Heart rate or rhythm abnormalities without hypoxia or respiratory
distress in response to exposure to airborne particulates have been observed in many studies (19–21).
Other studies have consistently shown that inhaled airborne PM
2.5
and PM
10
are associated with lower
HRV in infants, the elderly, individuals with compromised CV integrity, as well as healthy individuals (12,

Page 3/28
22–26). Numerous studies have examined HRV in association with the total mass of PM
2.5
and PM
10
in
various populations. A meta-analysis estimated the pooled effects of the total mass of PM
2.5
, nding a
1–2% decrease in HRV associated with each 10µg/m
3
increase in PM
2.5
concentration (24). However,
associations between PM
2.5
and cardiovascular-related markers have been reported by only a few
studies(27, 28). Few occupational studies have also established association between reduced HRV and
exposure to airborne PM
2.5
and PM
10
(29–31).
E-waste recycling at Agbogbloshie in Accra, Ghana is conducted in an unhealthy and unsafe
environment. The Blacksmith Institute, now Pure Earth has classied the site among the ten most
polluted areas on earth (32). Due to the geographic layout, prevailing wind conditions, and intensity of
smoke production due to open air burning of e-waste, there is a great public health concern regards to
health implications of these exposures among e-waste workers and nearby populations. Open-air burning
of cables and manual dismantling of lead-acid batteries are common practices, and these activities could
result in signicant environmental pollution and impact negatively on human health. Due to the improper
processing of e-waste, workers are commonly exposed to toxic chemicals and are at increased risk of
several health effects. Previous studies have documented evidence of several pollutants in the soil (33),
water (34), and biological materials (blood, urine, breast milk) of both workers and by-standers (35–37).
Recent air pollution data has reported very high concentrations of PM in ambient air (38, 39) and
personal air of the waste recyclers(40–42). The levels were above the WHO-24hr air quality standards of
25µg/m
3
and 50µg/m
3
for PM
2.5
and PM
10
as well as the background levels of 30 µg/m
3
for PM
2.5
in the
city of Accra. Informal e-waste workers at Agbogbloshie may be at higher risk of developing PM-related
cardiovascular diseases or experiencing premature deaths due to inammation-induced cardiac
autonomic dysfunction. The link between inhalation of ambient air particles and effects on cardiac
rhythm may be the induction of an inammatory response in the lung with a subsequent release of
chemical mediators that alter the autonomic nervous system's control of cardiac rhythm(43). Our study
aimed to investigate the association between direct exposure to elevated levels of ambient particulates in
the breathing zone of informal e-waste workers and alterations in cardiac autonomic function control.
Specically, this study was designed to determine whether high concentrations of PM is associated with
the impaired cardiovascular function, as measured by the analysis of heart rate (HR), HRV and blood
pressure.
Materials And Methods
2.1 Study design and study area
A longitudinal panel study design with repeated data collection at four sampling points for personal PM
and health outcomes among e-waste workers at Agbogbloshie e-waste and comparable population was
selected from populations at Madina Zongo was employed for this study. By the Ghana Statistical
Services denition (44), both Agbogbloshie and Madina Zongo are classied as slum communities.

Page 4/28
Round I of data collection was done from (March-May 2017), round II (August-October 2017), round III
(January-April 2018) and round IV from (August-November 2018).
The Agbogbloshie e-waste recycling site is located in the central business district of Accra, Ghanas
capital, surrounded by commercial centers, densely populated residential areas, the Odaw river and Korle
lagoon. The Agbobgloshie electronic scrap yard, however, has become famous for its pollution and
contamination of the environment, especially due to informal e-waste recycling activities. E-waste
recycling processes include manual dismantling and open-air burning of e-waste fragments, enhanced by
re accelerants such as Styrofoam and tires to retrieve metals such as copper, aluminum, and gold for
sale (32, 45, 46). This continuous and unrestricted burning, however, produces plumes of black toxic
smoke, containing several mixtures of hazardous substances such as PM, into the atmosphere(45).
Informal e-waste workers and the Agbogbloshie community in general are at increased risk of several
health conditions including e-waste related cardiovascular health effects from the continuous inhalation
of airborne particulates present in the atmosphere.
The comparable or e-waste unexposed site, Madina Zongo, is also a densely populated suburb located at
the La Nkwantanang Municipality; more than 15km from the Agbogbloshie e-waste site. Majority of the
residents of Madina Zongo, like Agbogbloshie, are migrants from northern Ghana, and are Moslems. The
community members are mainly traders, engaged in a diverse mix of small-scale, informal businesses,
mostly petty trading of items such as used clothing, charcoal, cold drinks, street foods, bicycle spare
parts, staple foods, etc. However, no e-waste activity is conducted in this community (47).
2.2 Study participants
We recruited a total of two hundred and seven (207) participants, comprising one hundred and forty-two
(142) informal e-waste workers and sixty-four (64) comparable subjects from Madina–Zongo into the
study. At round I, we recruited one hundred and fty-one (151) participants, comprising hundred (100)
informal e-waste workers from Agbogbloshie and (fty-one) 51 participants from Madina Zongo.
Originally, recruitment was planned at wave I only, however, due to the high participant attrition of > 30%
at wave II, new participants were enrolled (
n
 = 42 and n=14 for e-waste workers and the comparable
population respectively), to replace those that were lost to follow-up. The study population comprised of
male e-waste and a comparable population between the ages of 18 to 55 working at the Agbogbloshie e-
waste site or resident at Madina Zongo. There are approximately 4,500-6,000 informal e-waste workers at
the Agbogbloshie site who use rudimentary techniques and tools to recover valuable materials from
waste electrical gadgets (48, 49). A recent detailed study of their time-activity diaries revealed that e-
waste workers work from 7:00 am to 6:00 pm at an average of 10 h per day, 6 to 7 days a week (41).
These workers are engaged in a myriad of job-specic tasks. The major job tasks include collecting and
sorting e-waste.
2.3Data collection

Page 5/28
We measured PM (PM
10
, and PM
2.5
) in the breathing zone of each participant using a real-time optical
pump (Aerocet 831, Met One Instruments, Inc, Oregon, USA ). We also performed 5-minute resting
electrocardiograms (ECG) for each participant according to a standardized protocol (Task Force of The
European Society of Cardiology and The North American & Society of Pacing and Electrophysiology,
1996) to evaluate HRV. A questionnaire was also administered to elicit information on socio-demographic
and other selected covariates. Three rounds (I, II, and III) of panel data collection were aligned to the
prevailing weather patterns (dry, rainy, harmattan seasons) in the study areas. The comprehensive
organizational procedures are documented elsewhere (41).
2.3.1 Interview with a structured Questionnaire
At enrolment, data on sociodemographic and economic factors (age, sex, religion, ethnicity, education,
occupation, socioeconomic and marital status), detailed current and previous job history and exposures;
home exposures including indoor cooking and biomass fuel use, pre-existing medical conditions, and
lifestyle habits such as cigarette smoking and alcohol use were collected using a comprehensive
questionnaire. Data on cigarette smoking included age at smoking initiation, duration of smoking, sticks
smoked per day, current or ex-smoker dened as smoking cessation greater than a months duration.
Smokers were classied as current, ex-, or never–smokers. The questionnaire was administered by
trained interviewers in a local dialect, Dagbani or Twi, or English according to the participant’s preference.
Limited interview guides were administered in subsequent follow-up data collection that explored
possible changes in home and work exposures, and other cardiovascular and respiratory conditions.
2.3.2 Personal Particulate Matter monitoring
We measured personal particulates (PM
10
, PM
10− 2.5
, and PM
2.5
) in the breathing zone of each participant
continuously per minute using a real time optical counter at a ow rate of 2.83 L/m. Personal level
ambient temperature, relative humidity and barometric pressure were also measured every 1 minute using
logging instrumentation (UX100-003 data logger; Onset Corporation, Bourne, MA, USA). All the measuring
instruments were carried in a customized backpack with inlets in the breathing zone of participants for 4
hours of the working day, usually between 8am and 2pm. As a quality control measure, PM
concentrations were considered invalid when TSP exceeded 2000µg/m
3
(38). During round III however,
the sampling duration was reduced to approximately 2-hrs due to the high levels of PM measured from
PM laden (dust) harmattan winds.
2.3.3 Heart Rate and Heart Rate Variability Measurement
Heart rate variability is the physiological phenomenon of the variation in the time interval between
consecutive heartbeats in milliseconds. Another name used for HRV is the ‘R-R variability’, where R is the
point corresponding to the peak of the QRS complex (Fig.1) of the ECG wave. The term ‘NN is used in
place of ‘RR’ to show the ‘normal’ to ‘normal’ beats on the ECG (Task Force of the European Society of
Cardiology and the North American Society of Pacing and Electrophysiology 1996). The QRS complex is
the combination of three of the graphical deections seen on a typical ECG. For this study we measured

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01 Jan 2006
TL;DR: The 2006 A&WMA Critical Review on Health Effects of Fine Particulate Air Pollution: Lines that Connect documents substantial progress since the 1997 Critical Review in the areas of short-term exposure and mortality and time scales of exposure.
Abstract: INTRODUCTION Herein is the discussion of the 2006 A&WMA Critical Review1,2 on “Health Effects of Fine Particulate Air Pollution: Lines that Connect.” In the review, Drs. C. Arden Pope III and Douglas Dockery addressed the epidemiological evidence for the effects of particulate matter (PM) on human health indicators. The review documents substantial progress since the 1997 Critical Review3 in the areas of: (1) short-term exposure and mortality; (2) long-term exposure and mortality; (3) time scales of exposure; (4) the shape of the concentration-response function; (5) cardiovascular disease; and (6) biological plausibility. Invited and contributing discussants agree and disagree with points made in the review. Each discussion is self-contained and adds information relevant to the topic. Joint authorship of this article does not imply that a discussant subscribes to the opinions expressed by others. Commentaries are the opinions of the author only and do not necessarily reflect the positions of their respective organizations. In particular, Dr. Costa’s comments have not been reviewed by U.S. Environmental Protection Agency (EPA) and do not reflect official positions or policies of the agency. CRITICAL REVIEW DISCUSSION ISSN 1047-3289 J. Air & Waste Manage. Assoc. 56:1368–1380

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Amoabeng Nti (  aaamoabeng_nti001 @ st.ug.edu.gh ) this paper