Country of Implementation: Malaysia

Activity Name:  Air Pollution Impacts

Operating Unit: Funding:  ANE/TS             Managing: USAID/GH

Operating Unit Objective:  East Asia and Pacific Environmental Initiative (EAPEI)     

Objective Number:  498-015   SEA-21

	Estimated Expenditure by Fiscal Year of Implementation
Fiscal Year	1998
Amount	$270,000

Implementing Institutions:  Centers for Disease Control and Prevention (CDC)

Host Country Counterpart Institutions :  Malaysian Ministry of Health (MOH)

Brief Activity Description:  In 1997, uncontrolled forest fires in Indonesia resulted in severe smoke pollution in seven countries throughout Southeast Asia. Peak episodes occurred in September 1997 and again in March-April 1998 when ambient concentrations of fine particulate matter increased more than tenfold. During those same periods, respiratory-related hospital admissions increased significantly. Principal findings of studies that the World Health Organization compiled indicated that the haze episodes presented a substantial health risk to the public. In Malaysia, haze concentration levels exceeded ambient air quality standards and guidelines for particulate matter in most exposed areas of the country.

In February 1997, the Ministry of Science and Technology of Malaysia requested the U.S. government's assistance in assessing short- and long-term public health impacts of haze. HSB and the Air Pollution and Respiratory Health Branch of the Centers for Disease Control and Prevention's (CDC) National Center for Environmental Health were given the assignment. In collaboration with the Ministry of Health, the team evaluated the feasibility of conducting 1) an environmental exposure assessment, 2) a study of children < 12 years of age and selected health outcomes related to the constituents of haze, and 3) a study of maternal exposure to haze during pregnancy and birth outcomes.

This activity was funded under SEAEI in FY 1998 with the U.S. Centers for Disease Control and Prevention (CDC) to investigate the risk factors associated with the adverse human health effects arising from air pollution from the forest and peat fires in Indonesia.  CDC is implementing the activity in cooperation with the Malaysian Ministry of Health (MOH).  A 3-year schedule is programmed for the activity.  During the first field site visit by the study team in May-June 1999, seven US/CDC scientists worked with numerous Malaysian counterparts during the 3-week visit.  The team traveled to 11 areas in 8 states and the federal district of Kuala Lumpur to assess appropriate field sites and methodologies for conducting the overall assessment.

The CDC team plans to conduct four studies in areas with different haze exposures to evaluate the impact of haze exposure.  The four studies include:

·           a retrospective study of children £ 12 years of age with selected respiratory and ophthalmologic conditions presenting to rural polyclinics to assess risk with haze exposure.

·           a baseline cross-sectional study of current biological and environmental exposures to the constituents of haze among the children less than 12 years of age identified in the retrospective study, as well as a survey of risk factors for respiratory and ophthalmologic illnesses among households of  selected children.  When transboundary haze recurs, this group will be used to identify a cohort to be followed for 6 months (phase two) to conduct environmental exposure assessments, clinical examinations, and household surveys to assess risk factors. 

·           a retrospective study of polyclinic records of pregnant women and their newborns to determine relationships between maternal exposure to haze during periods of pregnancy and adverse birth outcomes, primarily low birth weight.

·           an assessment of excess deaths and hospital re-admissions among adults ³ 50 years of age admitted to hospitals with selected cardiopulmonary diseases prior to the 1997 haze.

During the site visit, the team developed further details of the study protocols in collaboration with MOH counterparts, assessed the availability of data needed for the study, obtained approval to receive critical meteorological information, and developed plans for several capacity-building activities. At the end of the visit, the CDC team presented “Analyses related to environmental exposures and health outcomes:  the disaster approach” at the Workshop on Analysis of Data Related to Haze and Public Health, sponsored by the MOH and CDC.

Links: CDC National Center for Environmental Health

Publications:

Closeout report for the South East Asian environmental initiative associate award : award no. GH-99-004, cost center 072 -- CAN CH95 Component 5: Establishment of smoke and haze conditions and health effect monitoring/analysis systems in Southeast Asia, to develop strategies to respond to and mitigate health effects on vulnerable populations. Dec 2003 U.S. Public Health Service. Centers for Disease Control and Prevention (CDC) | USAID. Regional Support Mission for East Asia | USAID. Bur. for Global Health. Ofc. of Health, Infectious Diseases, and Nutrition Contract Number: AAG-P-00-98-00003-00 Project Number: 9365994 [12 p.] PD-ABZ-201 PDF 43kb

Malaysia-U.S. Transboundary Haze Health Investigation Team. 2003 Health assessment among children and pregnant women in Malaysia potentially exposed to transboundary haze from the Southeast Asian forest fires: a progress report. Environmental Health Research Centre, Institute for Medical Research (IMR), Ministry of Health Malaysia and National Center for Environmental Health, United States Centers for Disease Control and Prevention (CDC). 6 pp. To be published October 2003 issue of Environmental Health Journal of the Environmental Health Research Centre of the Institute for Medical Research, Ministry of Health Malaysia

Contacts:

Borrazzo, John	Environmental Health Team Leader USAID Bureau for Global Health	(202) 712-4816 F (202) 216-3702	JBorrazzo@usaid.gov
Maliday, Josephine	National Center for Environmental Health Centers for Disease Control and Prevention 1600 Clifton Rd., NE (Mailstop E-23) Atlanta, GA 30333	(404) 498-1359 F (404) 639-2565	jym7@cdc.gov JMalilay@cdc.gov

Updated: January 12, 2004