Abstract on the magister dissertation

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SOUTH – KAZAKHSTAN MEDICAL ACADEMY

on the manuscript

ABDRAKHMAN ULZHAN SAPARBEKKYZY

Abstract on the magister dissertation

The state of health of children living in the area oil processing plant

Shymkent, 2018

Work is performed in South Kazakhstan Medical Academy

Scientific adviser:	Doctor of Philosophy PhD, acting as associated professor Buleshova A. M.
Official reviewer:	Candidate of medical sciences Akhmetov A. R.

The master's dissertation can be found in the scientific library of South Kazakhstan Medical Academy by the address: Shymkent city, Al-Farabi square, 1.

Actually of the problems. At present, one of the most important and at the same time, of course, complex problems of medicine, especially public health, is the task of identifying and linking changes in the health status of the population with the impact of environmental factors.

Ecologically, oil refining is a complex and responsible activity of the company. Its consequences are manifested in the form of pollution of bowels, groundwater, surface water, air, and finally, soil and natural and territorial complexes with various harmful chemical pollutants, oil, sewage. In areas where oil refineries are located, a high level of atmospheric pollution (hydrogen sulphide, sulfur dioxide, hydrocarbons, nitrogen oxide, carbon monoxide, etc. ) and water objects (petroleum products, ammonium nitrogen, nitrates, suspended solids) can occur.

Dangerous pollution of atmospheric air in the areas where oil refineries are located poses a threat to human health. Risk factors are increasing due to increased equipment wear and increased accident rate. For Shymkent, environmental protection is an extremely important and topical task also because it concentrates a large number of enterprises of other economic sectors, which are mainly located in the residential area. All of the above indicates the relevance of studying the medical and environmental aspects of protecting public health in the locations of oil refineries.

The aims of the research work: Proceeding from the foregoing, we set the goal of the work: development of scientific principles for the preservation and strengthening of the health of the child population in the environmentally stressful conditions of a large oil refinery.

Proceeding from this work are the next following Tasks:

- give an ecological and hygienic assessment of risk factors for laboratory indicators characterizing the refinery;

- analyze the dependence of the children's population on the complex influence of various environmental factors;

- the prognosis of the incidence of children, taking into account the total factor of environmental pollution;

- to develop measures aimed at medical and ecological rehabilitation of the territory of the oil refinery and preservation of the health of the child population;

- to study the effectiveness of improving the environment and reduce the incidence of disease in the study areas.

Object of the research work. Harmful environmental factors, children from 0 to 14 years living in the area
oil distilling factory.

Methods of the research work. To solve the set tasks, the main methodical approaches adopted in public health were used:

- an estimation of an exposition of children to harmful factors of the industrial environment by results of studying of sanitary-and-hygienic conditions of residing, and in particular the maintenance of harmful substances in air;

- an estimation of an exposition of the children's population to the basic factors of a surrounding environment;

- epidemiological assessment of the prevalence of various types of health disorders in children;

- statistical testing of hypotheses to identify significant links between the level of exposure to harmful substances on the body and the health problems of the child population;

- method of standardization; the statistical processing program SAS 7. 01 (Statistic Analytical System) and MS Excel 6. 0.

The scientific novelty of the research results is as follows:

- the comprehensive assessment of risk factors in the area of the Shymkent oil refinery;

- the quantitative relationship was established between the incidence of children and multi component air pollution (respiratory system diseases, allergic diseases, immunological reactivity disorders and harmony of physical development);

- The calculated linear regression equations allow predicting the incidence of children with respiratory diseases, depending on the level of air pollution;

- developed and proposed a system of measures to improve the environment and protect the health of children in the area of the oil refinery in Shymkent.

The main provisions of the dissertation research, put on the defense:

1. Comprehensive ecological and hygienic assessment of environmental pollution in the area of location of oil refineries in the city of Shymkent and its impact on the health of the child population with the rationale for health improvement measures.

2. Regional comprehensive system of measures to improve the environment and protect the health of the children of the region.

3. The implemented measures to reduce environmental pollution and protect the health of the child population have been effective.

Practically recommendations:

1. Preventive measures, including a system of medical and preventive measures aimed at preserving the health of the children living in the area of the refinery, should be comprehensive and include;

2. Modernization of technological processes, striving to achieve sanitary and hygienic emission standards by automating work and strengthening control over observance of safety regulations;

3. Use of the methodology for assessing the risk of harm to children's health and the adoption of management decisions based on the results of an integrated assessment of environmental risks;

4. Improvement of methods for early diagnosis of chronic diseases caused by exposure to pollution from the environment.

Results of research. The population living in the areas adjacent to the facilities of the refinery is mainly exposed to the same harmful factors that determine the pollution of the working areas. However, the intensity of the impact of these factors on the body is significantly lower. In General, the number of people at increased risk of exposure to adverse environmental factors in the studied South-Eastern region of the city of Shymkent was up to 15, 000 people.

Adverse changes in indicators characterizing the health of children in recent years have been reflected in the negative dynamics and high levels of primary and General morbidity in the biogeochemical residential area of the city.

The level of total incidence of malignant neoplasms during the study period from 2000 to 2017 increased by 20-26% (Fig. 1). Vbiogeochemical oil district of the city is one of the highest rates of total incidence of malignant tumors (ZNO) in the South Kazakhstan Region. In all other areas of the city the total incidence of ZNO below the average level in the region by 6-18%. Mortality per 1000 patients with malignant neoplasms increased by 19% in Shymkent from 2000 to 2017.

The prevalence of diseases among children from 2000 to 2017 increased in the South-Eastern region of Shymkent by 2. 6 times, in other compared areas by only 10-20%.

The overall morbidity rate of newborns with a weight of 1000 g or more decreased during this period: the South-Western region – by 42%, the North-Western – by 7%, the Central – by 12%, the North-Eastern – by 24%; in the South-Eastern residential area, a significant increase in the levels of morbidity of newborns in 2000 and 2017 (1772. 42% 000).

In 2000-2017, the total incidence of newborns with birth weight of 1000 g or more was relatively higher than the average level in Shymkent by 1. 7% (268. 2 per 1000 newborns).

The overall morbidity rate of children under 1 year of age increased by 12% in all study areas during the decade from 2007 to 2017, with an average regional growth rate of 15%.

Conclusions. Research materials are of great practical importance for assessing the trend of environmental pollution in the studied areas and choosing the most favorable zones for the prospective housing construction in terms of clean air. The presented materials convincingly show that the state of health of the population in the area of the refinery activity tends to further deteriorate, and therefore it is important to adopt additional programs that should be based on the modern concept of the prevention of widespread diseases - the concept of risk factors and include activities aimed at improvement of the sanitary and epidemiological welfare of the population in accordance with the requirements of the legislation.

1. The intensive development of the Shymkent refinery, which was not provided with adequate measures to protect the environment from pollution and preserve the health of the child population, led to the formation of an extensive ecologically crisis zone of technogenic degradation of natural objects that is characterized by excessive accumulation in soil, surface waters, as well as in vegetation of hydrocarbon compounds. Among the atmospheric pollutants the greatest hygienic value is the limiting hydrocarbons.

2. The leading external factors for increasing the level of non-infectious diseases of children living in the area of the refinery's location and the associated risk of high morbidity and premature mortality are pollution of the environment by hydrocarbon compounds.

3. The prevalence of congenital malformations, blood diseases and hematopoietic organs, as well as chronic respiratory diseases, is significantly higher (1. 7-2. 4 times) than the expected regional indicators among the children living in the area of oil refinery production.

4. The low efficiency of health programs and the high risk of health disorders due to the intense environmental impact of the organism contributed to the formation of a stable trend towards depopulation in previous years, which was characterized by a relative decrease in the birth rate (21. 7 per 1, 000 women of fertile age) and the average duration of the forthcoming life (60. 5 years for boys and 71. 6 years for girls).

5. A set of health measures to reduce the risks associated with the impact on the body of children of pollution of environmental objects was developed. The introduction of these measures allowed to reduce the volume of harmful emissions and discharges by 12%, which contributed to a decrease in the overall incidence of children in the last 5 years.

Data on publications: The main provisions of the thesis are presented in 3 published works. Republican scientific journal “Vestnik” №4 (77), 2016; Bulletin of Doctors of the Republic of Kazakhstan No. 1, 2017.; Bulletin of Doctors of the Republic of Kazakhstan No. 2, 2018.

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