AIR POLLUTION
Respiratory illness is the cause of many deaths among children each years and has been name as the mane reason for the utilization of health services (Fuggle & Rabie, 1992). Many epidemiology studies has been conducted to illustrate the correlation between respiratory illness and the burning of fossil fuels, however epidemiological data on the impact of air pollution on the community of Greater Johannesburg is not available.

No data is available to illustrate the impact of indoor air pollution such as asbestos, radon and tobacco smoke to name but only the most obvious sources.

The next section of tables shows the impact of air pollution on individuals in Greater Johannesburg for the period of June 1998 until July 1999. These data does not include the comprehensive list of morbidity indicators for air pollution but constitute those being collected by the clinics within the GJMC.

Asthma is most usually related to allergy, however exposure to polluted air can precipitate acute attacks. Studies have shown a correlation between emergency room visits and low and high air pollution days (Von Schrinding in Fuggle & Rabie, 1992).

The worst affected areas with asthma incidents is in the South which constitute Soweto and a high number of informal settlements. Forty of the sixty-five Informal Settlements of GJMC occur in the SMLC with a population of 167413 being at risk to air pollution from the burning of coal for heating and cooking. Asthma incidents in the South total 3700 of the 6727 cases for the year 1998 to 1999. This then correlates with the area surrounding Soweto where coal is still being utilized for cooking and heating. The worst affected areas are mainly areas with informal settlements.

The Eastern MLC constitute the second highest area for asthma incidents where Alexandra is situated surrounded by an Industrial area. The informal population in this area constitute 18082 individuals which is a small number of 22824.

Relatively low incidents of asthma occur within the NMLC if viewed in compareson to population per informal settlement. This may be attributed to the fact that the Informal Settlements in the NMLC are mostly situated in areas further away from Industrial areas as well as the electrification of the settlements. Interesting is that the highest incidents of asthma cases is among the eledery groups which may be attributed to allergies agrevated by air pollution incidents.

High air pollution episodes of particular smoke occur that exceed national guideline up to 20 – 30%, the World Health Organisation (WHO) guideline for particulate matter daily is an average of 70 PPM.

The age group mostly affected by asthma as indicated in table 8 is under six years and above twenty years except for the NMLC where the eldery are mostly effected. Based on studies that high episodes of air pollution agravate asthma the assumption can be made that the high incidents of air pollution episodes among the under six year old can be related to air pollution episodes.

An increase in average annual ozone levels of 0,012 to 0, 013 ppm is shown at the Newtown monitoring station, with a rise in ozone of 2-3 ppb per annum in the inner city. Ozone may cause aggravation of asthma and chronic bronchitis and may furthermore cause irritation to the eyes and mucous membranes as well as ear, now and throat irritations and headaches (Von Shcrinding in Fuggle and Rabie, 1992).

The occurrence of ENT incidents outweighs that of asthma by far, which is an indication of air pollution episodes especially in the winter months. High incidents of ear, nose and throat cases occur within the Southern areas with where it reach levels of 32 764 cases per year. The age group mostly affected in the GJMC is the under six year olds which correlate with the asthma incidents, except for the WMLC where a high number of ENT incidence occurred during this period compare to asthma incidents for the same period.

Lower respiratory tract infections such as pneumonia and bronchitis have been shown to be associated with increased levels of air pollution such as NO₂ and SO₂. Respiratory illnesses are also with diarrhoea one of the leading causes for infant mortality rates in South Africa. An alarming incidents of 88 530 incidents of respiratory illnesses were noted from the GJMC clinics during the period of June 1998 to July 1999.

The Southern area is worst affected with 39100 of the 88 530 incidents occurring in this area. The age group mostly affected is the under six years old with as well supporting the link between infant mortality and respiratory illnesses as 6 844 under one year olds have been affected by respiratory illnesses in the South for June 1998 to July 1999 period.

The second highest incidents of respiratory illnesses occur within the EMLC which total 19 579 incidents of respiratory illnesses out of the 88 530 reported cases.

Factors that aggravate the impact of air pollution on health are the poverty status, which is the worst in the Southern parts of GJMC.

Diarrhoea accounts for over 10 000 deaths annually in South Africa, which mostly occur in children under the age of five years (Von Scrinding in Fuggle & Rabie, 1992). It is alarming that a high percentage of the GJMC population falls within the risk categories for diarrhoeal diseases. Diarrhoeal diseases are closely linked to access of basic services, educational level of mother (personal hygiene, oral dehydration therapy, and preventative knowledge) income and access to clinic.

The incidents of diarrhoeal disease correlates with National studies, which indicate that the diarrhoeal incidents mostly occur among children under the age of six years. During 1998 – 1999 diarrhoea incidents among under six-year-olds constitute 13352 of the 18994 cases being treated at the GJMC clinics. Most of these incidents occur within the South which also have high levels of informal settlements as outlined in table 7, high levels of illiteracy, low income levels and high poverty rates.

Closely linked to diarrhoea are gesture intestinal incidents, which follow the same pattern as diarrhoea as outlined in table 14. Gastro intestinal diseases furthermore reduce absorption of nutrients and affect the body’s general defense mechanisms which in turn lead to susceptibility to diseases such as measles and pneumonia (Von Scrinding in Fuggle & Rabie, 1992).

Vomiting normally occur with incidents of diarrhoea and gastro intestinal incidents which again follow the same pattern as diarrhoea and gastro intestinal incidents with high levels in the South among children under the age of five years old especially in the South as can be seen in table 15.

Ophthalmology incidents is an indication of eye infections which may constitute conjunctivitis and trachoma. Eye infection disease is closely related to personal hygiene and availability of potable water. Most age groups are affected by incidents of eye infections, except for the age group of 15 – 19 years. Although no supportive epidemiological studies exist between the age group and conjunctivitis it is well known that it constitute a major problem in children.

Dermatology constitutes skin diseases such as scabies, which occur mostly among children, except for the EMLC where high incidents occur among the older groups. It is furthermore an indication of vector borne diseases, which are closely related to solid waste services. High numbers of dermatology incidents occur within the EMLC where Alexandra occurs. High population density occurs within the EMLC as well as illegal dumping.