Environmental geohydrochemistry and health of the high altitude population in Ladakh

Abstract

Background: Radiographic signs of Pneumoconiosis found in farming Ladakhi despite absences of mines and industries were believed to be due to exposure to frequent dust storms and domestic fire pollutions. Seasonal Koilonychia (spoon nail) occurring predominantly in farming women in absences of iron deficiency anaemia was thought to arise from exposure to water made alkaline by weathering of hornblende minerals. The relation of these health conditions to environmental geohydrochemistry is postulated as the source of irrigation water in the affected population originates from glaciers in trans-Himalaya range of sedimentary geology and steep landscape favouring flushing of silica/silicate containing silts. Methods and results: Survey in two central Ladakh villages revealed radiographic evidence of silicosis in all middle aged women and half in middle aged men. In a large-scale study of 3105 subjects aged over 30 years from three villages; 101 (22.5%) of the 449 radiographed showed signs of pneumoconiosis (ILO 1980 criteria) including eggshell calcification of hilar gland and progressive massive fibrosis. Indoor dust analyzed using Philips 400T electron microscope with energy dispersive analysis system attached showed SiO2 levels upto 53.27% with particle size of 0.5 to 5.0 microns and the concentration during cooking period in the worst affected area was 7.495 mg/m 3. Microscopy and histopathology from the subject was characteristic of pneumoconiosis. Analysis of the inorganic dust in the lung showed 40.2% muscovite, 37.3% quartz with the extracted dust wt 147.9 mg/gm of dry tissue. Prevalence of chronic cough with chronic phlegm and percentage of villagers with FEV1/FVC ratio of less than 65% rose with age. Of 70 subjects studied 19 women and 2 men had Koilonychia with incidence being highest in summer. Absence of seasonal Koilonychia in villages fed by water derived from northern mountain range glaciers with mainly igneous geology supports our hypothesis. Conclusions: Clinical, epidemiological, radiological, environmental and histopathological studies and analysis of dust samples in the lungs proved beyond doubt that high prevalence of pneumoconiosis in central Ladakh is due to inhalation of respirable particles of SiO2 and soot. Seasonal Koilonychia in the study area with high pH and siliceous content of the soil in absence of iron deficiency anaemia support our hypothesis.