! TD'NG QUDN & NGWEN m i
xdng quan ve 6 nhidm khong khi trong nha do khoi chat dot sinh khoi va nguy ctf stfc khoe
Tran Tbi Tuyet Hanh (*), Lfi Thi Thanh Htfdng (*), Tran Khanh Long (*), Tran Nff Quy Linh (**)
Khodng mgt phdn ba ddn sd thi'gidi sddung cdc chdt hdu conhuphdn dgng vdt, miin cUa, go, timn cui, ram rq, vo trdu v.v. ldm nhien hiu de dun ndu. sUdi d'm vd chii'u sdng. Nguon nhlin lieu ndy dugc ggi Id chdt dot sinh khoi vd viic sd dung cdc nhieu lieu ndy dd gdy 6 nhiem mQi trUdng khong khi trong nhd, tdc dgng xdu tdi siic khoe cong dong tqi nhieu qudc gia tren thd gidi. Nhiiu bdng chting cho thd'y phai nhiem vdi cdc chdt 6 nhiim trong khoi chdt dot sinh khdi ldm tdng nguy ca mac cdc binh dudng ho lidp (nhu viem phdi, binh lao, binh phdi tdc nghen man tinh, ung thu phdi vd hen suyen), cdn ndng so sinh thdp, due thuy tinh the vd cdc benh ly ve tim mqch. Ddy Id mgt trong nhitng mdi de dga ldn tdt stic khoe todn cdu. doi hdi phdi co nhiiu nd It/c de phdng chdng thdng qua cdc nghiin ciiu, chinh sdch vd chuong trtnh can thiip. Tuy nhiin. vdn de nay chua duoc quan tdm dung miic. ddc biit Id d cdc nudc dang phdt triin. trong dd cd Viit Nam. O nudc ta, hien cd rdt il nghien Cliu tim hieu ve nhiing dnh hudng cua khdi chdt ddt sinh khdi tdi siic khoe cgng ddng vd chua co nhiing gidi phdp pha hgp de hqn che nhiing tdc ddng cd hqi ldi mdi trudng vd svcc khde c&a khoi chd't ddt sinh khdi. Bdi bdo ndy tdng quan cdc thdng tin sdn co tU cdc nghien cu:u duac cdng bd trin cd sd dit liiu ScienceDirect ve thUc trang sH dung chdt ddt sinh khdi, 6 nhiim khdng khi trong nhd do khoi chd't ddt sinh khdi vd nguy ca stic khoe cgng dong, mgt sdgidi phdp hieu qud gitip gidm nguy ca... tit dd dua ra mot so khuyen nghi ve vdn di nay tqi Viet Nam.
TU khda: chdt ddt sinh khdi. khoi chd't dot sinh kho'i, nguy ca stic khde
A review on indoor air pollution due to biomass smoke and health risks
Tran Thi Tuyel Hanh (•), Le Thi Thanh Huong (*), Tran Khanh Long (*), Tran Nu Quy Linh (*=*)
Il is estimated that animal dmg, sawdust, wood, coal, chaff, dried straw,, hay, and other crop residues, etc. are being used by approximately one third ofthe world's population as their fuel sources for cooking, lighting and heating at home. These energy sources are called biomass fuels and their uses have become sources for indoor air pollution, bringing negative health impacts for the community in many countries worldwide. Scientific evidence shows that being exposed to hazards in biomass smoke increases risks of having various diseases, such as respiratory diseases (e.g. pneumonia, tuberculosis
26 Tap chf Y te C6ng cong, 4.2012, So 24 (24)
I TtTNeQItONs NGHIEN CUUi
and chronic obstructive pulmonary disease, lung cancer, and asthma), low birth weight, cataracts, and cardiovascular problems. Biotnass smoke is one of the major global public health problems requiring greater attention and investment for risk management through research, policy-making and intervention programs. However, in developing countries, including Viet Nam, biomass smoke and its negative health impacts have not been given adequate attention. To date, there have been very few publications on intemational peer review journals and studies on impacts of biomass smoke on public health in the country. This article reviews the available tmtional and international information (available in ScienceDirect Database) on the current status of biomass fuel use, indoor air pollution due lo biomass smoke and potential health risks, effective measures to reduce the health risks due to being exposed to biomass smoke and recommendations made for this issue in Viet Nam.
Key words: biomass fuel, biomass smoke, health risks
C i c tic gia:
(*) - Ths. Trin Thi Tuye't H^ah, Tnrdng Dai hpc Y t^ Cflng cpng, 138 Gilng V5, Ha N^i.
Email: [email protected]
- Ths Lfl Thi Thanh Htfdng. TrtfAog Dai hpc Y te Cflng c§ng. 138 Giang Vo. Ha N§i.
Email: [email protected]
-CN. Trin Khanh Long, Tnrdng Dai hgc Yte Cflng cpng, 138 GiaugVo, Ha Npi. Email: tkl^hsph.edu.vn (**) CN, Trin Nff Qu^ Linh, Trung tam Y te dtf phong Hk Tmh, 71B Dtfdng H^i Thtfdng Lan 6ng,
Thdnh ph^H^ Tinh. Email: [email protected]
1. Phtfdng p h a p t i m kig'm t a i li$u y v a n va m $ t s 6 ' k g ' t qua
N h d m tac gia da siJ d u n g cd sd dit lipu ScienceDirect d e tim k i e m c i c nghien ctfu v e khdi chat dd't sinh khd'i va anh htfdng stfc khde dtfdc dang tai tren c i c t a p chi khoa hpc, s i c h , b i o c i o v.v. Tuf khda dflng d e tim kie'm tai lieu la: biomass smoke and health effect (khdi cha't dot sinh khd'i va a n h htfdng stfc k h d e ) . Kfi't qua cho tha'y d e n thdi d i ^ m 15 t h i n g 3 n a m 2012 cd ti't ca 3.179 tai lifiu cd lien quan de'n chii d e nay dtfdc cdng bd", trong dd cd 2.848 b i i b a o d i n g iren c i c t a p chi quQ'c tfi', 438 cud'n sach va 123 b i o c a o cd lifin quan. Ne'u tinh t b e o thdi gian thi cd 1.415 tai lipu dtfdc xui't b a n trong 5 n a m gan d a y (tinh tir 1/2008). trong d o 275 bai xua't b a n n a m 2 0 0 8 , 247 bai xua't ban n a m 2009, 267 b a i xui't b i n n i m 2010, 4 3 0 b a i xu£t b a n
n a m 2011 va 198 b a i xui't ban trong qu;^ I n a m 2012. Hinh 1 mfi ta c i c t i i lifiu tim thi'y, p h i n theo mpt so chii d e lifin quan ldi khdi chat ddt sinh khdi va i n h htfdng stfc k h d e .
Khdng phai ta't ca 3.179 tai lieu h i e n thi d phan kfi't qua deu cd n^i dung cu th^ vi chu d^ khdi cha't
SclenctUlrrcl
Hinh 1. Kit qud tim kiein tdi lifu y vdn tren cO sd dS liiu ScienceDirect, phdn theo cdc ch^ de lien quan tdi khoi chdt doi sinh kho'i va dnh hiidng sdc khoe
ITfi'NBQUaN&NGHIENClilfl
dfft sinh khdi va anh htfdng stfc khde. Nhdm lac gia chpn che^dp gidi ban "limit search" de chpn cic bai bao cd chu de lifin quan (Hinh 1) vi chon dtfdc 447 bii. Nhdm tic gia dpc lifiu de ciia cic tai lieu nay de chpn ltfa cic bai bao cd ndi dung Uen quan den
"khdi chat dot sinh khoi" vi "anh htfdng stfc khde", sau dd doc phan ldm tat va nhdm lic gia chon dtfdc 43 bai bio cd npi dung chuyen sau vl thtfc trang stf dung chat dot smh khdi, d nhiem khdng khi trong nha do khdi cbsft dot sinb khoi, anh htfdng stfc khde cdng dong va giai phip giam nguy cd stfc ichde (tfu lien chpn cic bai tong quan tai heu) de stf dung phan tich vi viet bai long quan nay.
2. Gitfi thi$u ve cbS't 6&t sinb khd'i Chi't ddt sinh khoi la nhien heu ttf nhifin tiJf thtfc vat hoic dfing vit (nhtf gd, miin ctfa, phin dfing v$t, than cui, rdm ra, cd kho, vd trau v.v.). Day li nhdm nhien lifiu dtfdc stf dung pho bien trong dun nau va stfdi i^m tai nhieu qudc gia iren the gidi, dac bifit la tai cic ntfdc dang phat trien va cung li nguon gay d nhiem mdi trtfdng kbdng khi nghifim trpng. To cbtfc Y tfi'Thfi'gidi (WHO) danh gii mtfc dfi giy fi nhifim khdng kbi, hifiu qua va chi phi cic chi't dd^t qua mo hinh "thang ning Itfdng" [38]. Nhffng nguyfin lieu re va sSn cd nhtf phan dpng vit, rdm ra canh cay khd va cd kho la nhffng chat dot kfim hifiu qua va gay d nhiem ldn nhi't nen dtfdc xep d bac dtfdi cung cua thang ning Itfdng. Miin ctfa, go va than cui li chat dd't sinh khdi hifiu qua cao hdn va d bic ti^p theo.
Tiep den li d^u ltfa, than, khi ga (khong thudc nhdm chat dot sinb khd'i) la nguon nang Itfdng de chay, hieu qui d6ng thdi il gSy d nbiem hdn. 6 bac cao nhat cua thang nang Itfdng la di^n, la nguon ning Itfdng ft gay 6 nhifim khdng khi nhat,
3. Td'ng quan vl thtfc trang stf diing cha't dd't sinh khd'i
3.1. Thttc trqng sddung chdt ddt sinh khdi tren thegidi
Sd' lifiu tff Bang 1 cho thi'y Itfdng chat dd't sinh kho'i dtfdc stf dung hang nim khoang Iff 1-2 Giga tan, chie'm 8-14% nang Itfdng tifiu ihu trfin the'gidi (Bang 1). Tuy nhien, mtfc tieu ihu ning ltfdng ttf chat dd't sinh khdi cd stf khac biet ldn giffa cac ntfdc cd nen kinh t^ khic nhau. 6 cic ntfdc phit irien, nang Itfpng tff cha't dd't sinh khd'i chie'm ty lfi ri't thap trong khi d cac ntfdc dang phit iri^n ty le nay
Bdng 1. Luang tiiu thq ndng Itifflig toan cdu hdng ndm (dan vi Giga tan; 1 Giga td'n = 1.000.000.000 ton), 2010 [32]
NtufD lieu ti6a thacb Dia TliaD K h i g l B) nhiGD Ha[ nhan NSng Itrcmg tdi ! ? • K h l H y d n i
Gid, nSng lilpng mSI ItiTi. chai dSl ifufttog m a i Chi't d t f i sinb khtfr i « c l i n h (truydn t h t f n g l T ^ n g l><0iE t i e u th(i n i n e l i f i ^ g l o a n c J u
10,45 4,03 3,56 1 8 6 0.63 0.94 0,78 0,16 1-2
12,00 Ciga i£n nSng linrng ihtftfng m a i ho^c
13,0-14,0 Giga [ f a bao gam c i c h f t ddi n n h khfii
thtfdng chiem khoang 50% va tham chi Ifin dfi'n 95%
dmptsd'ntfdccd thu nhap thap [33]. Khoang 2,41^
ngtfdi hipn su" dung cha't dd't sinh khd^i lim nguon nhifin lifiu chinh cho viec dun ni'u, stfdi am vi thap sing [33]; [40]. Trung Qud'c, Han Qudc, Nam Phi vi mpt sd' ntfdc khic cung stf dung than lim nhien Ueu pho bi^n dip tfng nhu cau dun nau [14]. KM stfdung chaft dd't sinh khd'i trong nha mi thifi'u stf Itfto thong gid, hoic thong gid kem (do b^p thifi't kfi'sai quy cich, khdng cd ong khoi hoac lo thdng gid) d^ day khi, tro bui va cac cha't dpc hai phit sinh tff qua trinh dd't chiy ra ngoai se giy d nhiem mdi trtfdng khfing khi trong nha. Nhu clu stf dung chi't dd'i sinh khd'i 6 cic qud^c gia vi cic khu vtfc khic nhau li khic nhau do 4 nhdm nhan td anh htfdng de'n hinh vi stf dung nhien lieu, bao gom: (a) gii ca cua nhien Hfiu, dang bep Id va kha ning tie'p can nguon nhien heu; (b) tinh chat ky ihual cua bep Id va cac vat dung dun ni'u; (c) yd'u to" vin hda, l§p tuc cua tffng ntfdc va (d) nhffng anh htfdng stfc khde tilm tang cua mfii loai nhifin lieu [20].
3.2. Thifc trqng sut dffng chd't ddt sinh khdi tqi VietNam
Vifit Nam la mdt ntfdc ndng nghiep nfin c6 nguon nhifin lieu sinh khdi ldn va da dang ttf gfi, cui, than, tri'n, mun ctfa, ba ca phfi, rdm ra, bi mia v.v.
Phe pham ndng nghiep ri't phong phii d6i dao 5 vung d6ng bang sdng Ctfu Long, chidm khoang 50% t^ng san Itfdng phd pham nfing nghidp trfin toin qudc vi viing dong bang sdng Hong vdi 15%
tong san itfdng loan qudc [19]. Hifin nay, khoang 90% san Itfdng sinh khd'i dtfdc dung de dun nau trong khi chl cd khoang 2% dtfdc dilng lam phin bdn hffu a) vi phin bdn vi sinb (iff ngu6n phd pham chan nudi trong Irpt, biin va ba mia tff cic nhi miy 28 Tap chi Y te Cdng cdng, 4.2012, Sd 24 (24)
ITg'NGeilAK&NGHllNCtlUI
dtfdng); 0,5% dtfdc stfdung de irong ni'm va khoang 7,5% chtfa dtfdc stf dung [19]. Tbeo dieu tra nam 2010 vi thtfc trang stf dung cic Ioai nhifin lifiu trong dun ni'u tai huyfin Cbi Linh, Hai Dtfdng do CHILILAB Ihtfc hien cho tha'y: cd 66,1% trfin tdng sfi' 3954 hd gia dinh (HGD) stf dung nhifin heu sinh khd'i (cui, gd, rdm ra, than cui, than bun, than chi, mffn ctfa, iri'u) trong dun n^u, stfdi i'm (Bieu do 1).
Biiu do I. Thifc trqng s&dqng nhien li^u trong dun ndu tqi CHILILAB, thi xd Cht Unh, tinh Hdi Duong ndm 2010
Cling theo ke't qua dieu tra nay, trung binh moi ngay cac HGD danh kha nhieu ihdi gian cho dun nau. Cu the cd 52,1% trong tdng sd3.954HGD dieu ira danh ttf 1 den 2 gid cho nau ntfdng, 27,8% HGD dinh it hdn 1 gid, 14,7% HGD danh 2-3 gid, 3%
HGD danh ttf 3 dfi'n 5 gid va ci bifit cd 2,5% HGD danh ldi tren 5 gid cho boat dpng dun nau mdi ngay (Bieu do 2). Do thtfc trang stf dung nhifin lifiu sinh khdi khi phd bie'n va thdi gian danh cho boat ddng dun ni'u khi dai nen nguy cd stfc khoe cua ngtfdi dan d huyfin Chi Linh do phdi nhiem vdi cic cha't ddc hai trong khdi chi't dfi'i sinh khdi dtfdc cho la ldn. Tuy nhien, di^u tra nam 2010 cua CHILILAB chtfa dinh gia cu thd anb htfdng stfc khde cua ngtfdi din do phdi nhifim vdi yfi'u id' nguy cd niy.
Day mdi chi la dieu tra ban dau ve Ihufc irang stf dung cha't do't sinb khd'i nham muc dich cung cap
Bieu do 2. Trung binh thdi gian cdc HGD danh cho hoqt dgng nd'u nudng moi ngdy, CHILILAB, thixd Chi Linh, HaiDUttng, ndm 2010
sd lieu tdng quan de mang Itfdi cac cd sd thtfc dia giam sat dan sd'vi stfc khoe lai cac ntfdc dang phat tridn (INDEPTH) vifi't de ctfdng nghifin ctfu chuyen sau ve chu Ai niy tai cac cd sd thtfc dia d mdt sd qufi'c gia trfin thfi' gidi trong dd cd cd sd thtfc dia CHILILAB cua irtfdng Dai hpc Y id Cdng cdng, dat tai huyfin Chi Linb, tinh Hai Dtfdng. Vdi thtfc trang stf dung chat ddt sinh khdi Irong dun ni'u pb^ bie'n nhtf hifin nay, he thdng thong gid kfim va thdi quen na'u an hang ngiy tai cic HGD d Vifit Nam ndi chung vi Chi Linh ndi rifing, va'n de 6 nhifim mdi trtfdng khdng khi trong nha va nguy cd anh htfcing stfc khde li rat dang lo ngai. Tbeo WHO (2006), Vipt Nam thudc nhdm cic qudc gia cd ti lfi ttf vong do cic nguyfin nhan lien quan dfi'n d nhifim khdng khi ngoii trdi cao nhat (200 - 230 ca/trifiu dan/nam) va do 6 nhiem khdng khi trong nha cao thtf 2 Iren the gidi (300-400ca/lripu dan/nam). Tuy nhien, d Viel Nam chtfa cd nhffng nghifin ctftf, danh gia cu the dtfdc cdng bd trfin cic lap chi khoa boc ve nhiftig tac ddng tifiu ctfc Ifin stfc khde cdng ddng cua khdi chat ddt smh khdi va dong thdi cung chtfa cd nhffng canh bao, nhiJng khuyfi'n nghi vi chtfdng trinh quan ly nguy cd phii hdp, kip thdi de giam nguy cd stfc khde cho ngtfdi dan,
4. Phf^ nhi&m vdi khoi chS't dd't sinh khd'i v^ nguy crf stfe khoe
4.1. Cdc chdt 6 nhiem khong khi phdt sinh til chdt ddt sinh khoi
Qua trlnh dot chay khong hoan loan ciia cac chat dot sinh khd'i da sinh ra nhi^u chat gay d nhiem khdng khi trong nhi d n6ng dd cao bao gdm cic hdp chi't dfi bay hdi, cic hat Id Itfng, cacbon monoxil (CO), cacbon dioxit (CO2), formandehit, nitd oxit (NO), nitd dioxit (NO2), oxit lirti huynh, polycyclic aromatic bydrocacbon (PAH) v.v, [42]. Ngoai cic khi ddc thi vific dot cac nhien lieu sinh khdi trong dun ni^u hay stfdi i'm cffng sinh ra cac hat bui Id lihig giy d nhifim khdng khi trong nhi. Thanh phan cac hat trong Ichi thai dtfdc pbin loai theo kich cd dtfdng kinh. Nfi'u dtfdng kinh hat bui < 10|mi dtfdc gpi li PMiQ. Theo quy dmh cua WHO lieu chuan cha't Itfdng khdng khi li SOfig/m' ddi vdi PMJQ vi 25M.g/m' do'i vdi PM2 5[36]). Tuy nhien. d nhffng ntfdc dang phit trifi'n, nhidu ndi cd ndng dp khi dot trong nha loai PMJQ vtfdt qua 2000^g/m', cao hdn tifiu chuan 40 lan [12]; [29].
ITi'HGQUAN&NGHIENUiUI
4.2. Mgt sdbfnh tqt co lien quan vdi phai nhiem khdi chdt ddt sink khdi
6 nhifim khdng khi li mdt trong nhffng nguyfin nhan giy nfin benh t$t va ttf vong. Anh htfdng cua d nhiem khdng khi ddn stfc khde tbd hipn rd net nha't d nhffng ngtfdi ngheo va nhtfng nhdm ddi ttfdng de hi tdn thtfdng. Mtfc phdi nhiem the hipn d sd' ngtfdi, ctfdng dp phdi nhiem va ihdi gian phdi nhifim d nhiJng ntfdc dang phil trien ldn hdn rat nhieu so vdi cac ntfdc phit trien Irfin the gidi [34]. Xa'p xi 76% trtfdng hdp phdi nhiem hen quan dfi'n d nhifim khdng khi li do d nhilm khi ddt trong nhi d nhffng ntfdc dang phil trien. 6 nhifim khdi chat dot sinh khdi dtfdc cho la nguyen nban dSn tdi gan 2 tripu ca itf vong d cic qudc gia dang phit trien va khoang 4% ganh ning bfinh tat loan cau [37]. Phdi nhifim khdi cha't dot sinh khfi'i dtfdc cic nhi nghien ctfu dinh gii la da gay ra 0.5% sd ca ttf vong vi 0,4%
irtfdng hdp bfinh tat d Nam Phi vao nam 2000 [25].
Tre em vi phu nff la hai nhdm ddi ttfdng de bi tdn Ihtfdng ddi vdi d nhilm khdi cha't do't sinh khdi, do d trfi em, qui trinh chuyen hda. trao ddi chdt chtfa phit trien hoin thien cdn phu ntf ihtfdng li ddi ttfdng dam nhifim vai trd nfii trd chinh trong gia dinh nen thdi gian vi l^n sudt lidp xdc vdi khdi cha't dd't sinh khdi ldn [15]. O Viet Nam. ngtfdi gii cung cd the la nhdm nguy cd cao do stfc khoe ydu va thdi gian phdi nhifim dai cung nhtf thdi quen stfdi dm bing than vao mffa dong. Vdn de d nbifim khong khi trong nha ttf vific stf dung chai ddt sinh khdi da lam nay sinh rdt nhidu van dd vd stfc khoe nhtf cic bfinh liy nhidm qua dtfdng hd hi'p, vifim phoi. lao, ung thtf, cic bpnh ve lim. dpi quy, cic benh vd mat..
[18]; [28]; [30]; [33] (Hinh 2).
De c6 cii nhin cu the ve anh htfdng cua khdi chdt dd't sinh khd'i tdi md hlnh benh tit. phan nay
Htnh 2. Phtri nhiem vdi khoi chd't dot sinh khoi vd dnh h stfc khoe
Vi Unil,eosffd6 cda Kl ttai 2011113)
phan loai thanh nhdm bfinh lien quan de'n hd hi'p va nhdm bpnh khdng^H quan idi hd ha'p d tre em \a ngtfdi ldn. ^
4.2.1. Cdc binhf^ lid'p d tre em Tre em sdng trong cac HGD stf dung chat do'i sinh khd'i trong dujTinSu. stfdi a'm cd nguy cd m3c cic benh nbifimflW dtfdng ho ha'p dtfdi cdp tinh gdp 2 - 3 l^n so vdi nhffng tre sdng irong cic HGD stf dung nhifin Hfiu Jach [15], Nam 1968 da c6 nhifng bio cio dau ti€n \fi anh htfdng cja khdi cha'i do't sinh kho'i Iron^^^ tdi vifim phdi va vifim phe quan dire em Nigeria [34]. tuy nhien. phai tdi hdn 20 nam sau, van d e S y mdi dtfdc quan tam \a de cip d nhidu nghien cff^ khic [6],[31]. Cic hat Cacbon - thinh pban cd trong khdi chi't do't sinh khd'i cd mit trong ^ # dai thu'c bao (te' bao bach cau, phan nhdm tttfc bao) d dtfdng hd ha'p ciia nhtfng Ire em cd tifi'p xuc vdi chat dot sinh khdi.
Ham Itfdng cacbon^^g te bao bach cau cao da lam giam chtfc ning cua phdi [20]: [31],
4.2.2. Phoi nhiim vdi khoi chdt dot sinh khoi va mot sdbinh khdng ^m quan den ho hdp d tre em
Nhe cdn ^ ^
Di c6 nhffng cdng bd ve mdi ben quan giffa trpng Itfdng Iiic sinh.fl&ap. thai nhi cham phat men va ttf vong chu sinh vdi 6 nhiem khong khi |7]; [39], Mpt nghifin ctfu d Guatemala da xac dinh dtfdc mo'i hen quan giffa can ning tre sd smh va loai nhien lieu mi HGD stf dung trong dun ni'u. stfdi am. Cu thd, kdi qua nghien ciJu cho tha'y cac em be cua cac bime stf dung chdt ddt smh kho'i dedun nii'u co can ning lmng~binh nhe hdn 63g so vdi cac tre co me stf dung loai nhifin M l sach [3].
Suy dinh dudng ™
Mgt bio cao nam 2007 cho tha'y tiep xuc vdi khdi chdt ddt sinh khdi d tre nhd gdp phan gay suy d i ^ dtfdng man tinh bao gom thieu m a u j ^ cham phit trifi'n 122). Day la mdt DgUfin ctfu quy mo idn. Iren ddi ttfdng gan 30.000 tre em vi da kie'm soat mfit sfi ydu to' nhieu tiera tang nhtf phdi nhiem vdi jhdi thudc la. tinh trang stfc khoe gin diy. trinh dp nhan thtfc cua ba me, dieu kipn kinh tdva cac yfi'u tdkhic, M6hmhhdiqu> da bie'n dtfdc stf dung de giam tdi ml stf sai lech ke't qua. Tuy nhifin, van co the cdn cac ye'u to' gay nhifiu khic chtfa kifi'm soat dtfdc chang 30 Tap chi Y te Cdng cdng, 4.2012, Sd 24 (24)
|TfK&9UAN&NGHIlNeiiB|
han nhtf tre em tidp xtic vdi chat dd't sinh khdi cd nhieu kha nang sdng d vtfng ndng thdn va irong cic HGD vdi mtfc sdng thdp hdn, chat Itfdng nha d thap bdn vi cac bi me it cd cd h0i udng bd sung sal trong thdi k5' mang thai. Ngoii ra, dff lipu dieu tra qudc gia thieu cac sd' lieu ve tre nhiem giun mdc vi cic loai giun sin khic - mdt trong nhffng nguyen nhan quan trpng giy thidu miu va suy dinh dtfdng d tre em. Vi vay, md'i lifin quan gitfa ihifi'u hut dinh dtfdng va phdi nhifim vdi khdi chdt dd't sinh khd'i can dtfdc tim hifi'u va nghien cttu thfim.
4.2.3. Benh hd hdp d ngudi ldn
Bpnh ke phdi vi benh phdi tac nghen man linh Cd rat nhidu nghien ctfu cho thdy phdi nhifim khdi chat ddt sinh khd'i cd lien quan vdi bfinh phdi md kfi vi benh phdi lac nghen man linh, die bipl la d phu nff vung ndng thdn [26]; [33]. 0 phu nff nong thon Tbd NhT KJ, tfdc tinh ty le bi bpnh phdi t^c nghen min tinh do tidp xiic vdi khdi sinb khd'i sau khi kidm soil cic yeu td nhieu Ii 23,1% [10]. 6 Nepal va Pakistan, ndi ti 1^ phu nff hiit thudc ra't Ihap nhtfng cic HGD thtfdng stf dung chat ddt sinh khd'i trong sinh hoat thi mpl sdnghien ctftf cung cho thdy ll lfi bfinh phdi lac nghen man tinh rat cao d ca phu ntf va nam gidi.
Benh lao
Bang chtfng khoa hpc cho tha'y ly lp mac bpnh lao tang len trong sdphu ntf cd lidp xiic vdi khdi sinh khd'i. Cic nghien cihi ttf Mehico va An Dp di chtfng minh mdi quan he nhin qua cua tie'p xuc vdi khdi chi't dd't sinh khdi va stf phit tridn cua bfinh lao [23]; [27]. Mdt sdnghien ctfu khac cung cho thdy khdi chdt ddt sinh khdi lam suy ydu cbtfc nang cua le bao bach cau pbe' nang - la dai ihtJc bao quan trpng chdng lai vi khuan lao vi cac vi khuan khac [i];[43l.
Ung thu phdi
So' lieu tff Trung Qud'c cho tha'y phdi nhifim vdi khdi do ddt than trong nha de dun nau, stfdi dm li mdt ye'u tfi' nguy cd quan trpng cua ung thtf phoi [43]. NhiTng nghien ctfu ttf An Dp va Meliico cho thi'y phu nff khong hut thud'c la nhimg cd tie'p xtic lau dii vdi khdi cha't dd't sinh khd'i cd the ling nguy cd ung thtf phdi [2]: [12]. Cd quan Nghifin ctfu Ung thtf Quo'c tfi' (lARC) gin diy gpi khdi chai ddt sinb khfi'i la ye'u td'nguy ca cd ihd giy ung tbtf (nhdm 2a) v i than di (dtfpc stf dung lam nhien lifiu trong nhi) dtfdc goi ia chat gSy ung thtf d ngtfdi (Nhdm 1) [36].
4.2.4. Phai nhiem vdi khoi sinh khdi vd m^t sd binh khdng liin quan di'n hd hdp d ngudi ldn
Binh tim mach
Cic nghifin ctfu thuln tap tien ctfu cho thi'y cd mdi lien quan giffa mtfc dd d nhifim khfing khi bao gdm bui hd hdp vdi dtfdng kinh <= 0,25 micromel (PM2 5) vi nguy cd ttf vong cao do mgi nguyen nhan va benh tim mach [9]. Dff lipu gan day da chi ra rang chtfng thieu miu cue bd khong gay itf vong cung lifin quan vdi stf gia tang ndng do bui hd hi'p trong mdi Irtfdng [24], O nhiem khong khi din dfi'n stf gia tang nhanh va manh cua fibrinogen (ye'u id ddng miu), tang dfi nhdt ciia huyfi't ttfdng vi stf hoat hda ciia lieu clu; ddng thdi, Iam giam endothelins -laye'utdgiupcomachmiu, lao huydt ap [4]. Gin day. nghien ctfu cua McCracken chtfng minh khdi chdt ddt sinh khd'i da lim ling huye't ap tam trtfdng d nhffng phu nff Guatemala vi ting huyfi't ip tam irtfdng li mdl trong nhffng ye'u id' gay nen cic bidn chtfng vd tim mach [21].
Due thtiy tinh the
Ty le mac bfinh due thuy tinh the d cic ntfdc dang pbil trien la khi cao [16]. Cac ngbien cuii dich lfi hpc ttf Nepal vi An Dd cho thi'y cd mo'i lifin quan cd y nghia thdng ke giffa stf dung chdi dot sinh khd'i trong dun ni'u d HGD vdi bfinh due thuy tinh the boac mu mat [27]. Khdi chat dd't smh khd'i lam tang qua trlnh oxy hda vi lim giam Itfdng axit ascorbate trong huydt ttfdng, carotin va glutathione, thanh phan cung cap chat chd'ng oxy hda, bao vfi sii hinh thanh due Ihuy linh thfi'. Trong mot khao sal ldn gdm 89.000 HGD d An Dfi, sau khi loai bd ydu td nhieu liem tang la didu kipn kinh tfi' xa hdi, ti lp phu Dtfbimu trong cac gia dinhcd stfdung chat dd't sinh khdi li cao gi'p 1,3 lan so vdi phu nff trong cic gia dinb stfdung nhien heu sach (OR=l,3).
5. Mpt sdgiai phap giup giam tac dpng cua khoi chS't dd't sinh khdi
Dfi cic giai phap can thifip cd hieu qua can cd cai nhin toin canh vd cac yfi'u td tic ddng hoic chi phd'i tdi viec stf dung chdt dd't sinh khdi d tffng dia phtfdng cu the. Cac yfi'u to'nay bao gdm mdi trtfdng ttf nhifin, khi bin, muc dicb cua vipc stf dung nang Itfdng (vi du nhtf ni'u an, stfdi a'm, say khd san pham nong nghiep. chie'u sang...), cd sd ha tang, hanh vi ngtfdi stf dung vi hoin canh kinh tfi' - van hda - xa hdi. Ben canh dd, de nhiJng can thifip phii hdp. cln
I TfiNG QUAN & NGHIEN cuu I
dtfa ra nhffng giai phap cu tbd d ca quy md HGD va quy mo loan qudc. Nguyen IJi chung dfi' giam tic dpng cd hai cua khdi chdt dd't sinh khd'i la giam thdi gian va mtfc dp phdi nhifim. Bien phap thtf nhdt la ban che stf dung chat ddt sinh khdi lam nhifin Ueu trong sinh boat ma thay vao dd li tang ctfdng stf dung cic dang nbifin lieu sach hdn (vi du ga, khi bioga, dien, nhien lieu ttf nang Itfdng mat trdi). Tuy nhien, van dd kinh tdcin phai dtfdc cin nhac vi chi phi khi stf dung cic loai nhifin lipu sach cao hdn nhieu so vdi nhifin lifiu sinh khdi.
Mpl sd giai phip ddn gian nhtfng it hifiu qui hdn bao gdm cai tidn dting cu dun nau (stf dung cic loai bdp, 16 lao it khdi hdn, cho hipu qua dd't chiy cao hdn hoic tang nang sudt. giam tbdi gian dun ndu, stf dung ndi cd nap day de gitf nhipt), tang kha nang ltfu tbdng gid (md thfim nhieu ctfa sd, xiy dng khdi.
Id thdng gid ddng thdi xay dtfng, l^p dit be'p 15 vi dng thdng gid cd dp cao phil hdp de tang kha ning ltfu thdng khdi), dich chuyen be'p dun nau ra xa khu vtfc sinh boat chung cua gia dinh [8]. 6 Vifit Nam trong nhffng nim gan day lai mpt sd dia phtfdng cd ip dung mdt sfi'md hinh bdp gas khdng khdi stfdung nguyfin lifiu chat ddt sinh khdi (bdp IRBC); bep gas dun bing trdu, miin ctfa, ric thai vi than di thay cho khf hda long ctfa GS, TS. Tran Binh; bfi'p gas Vina Silic dun bang irdu, sinh khdi va than di cho ngtfdi nghfio, dac biet la vOng nfing thdn ddng b^ng song Ctfu Long; hay bep hda khi khdng khdi stf dung nhien lieu sin cd nhtf rdm ra, than thtfc vit, miin ctfa, phoi bao, ba thai ctia cic nhi miy mia dtfdng ciia Biii Trpng Tuan (giim ddc Cdng ly Co phin Thtfdng mai Thao Nguyfin, Vipl Tri, Phii Thp).,.
Mic dti cic mfi hinh be'p stf dung nhifin lieu sinh khd'i nay giup tin dung ngudn nhien hfiu ddi dao, tifi't kifim nang Itfdng vi giam Itfdng khdi va chdt 6 nhidm thai ra mdi trtfdng, cic be'p nay hifin cd ph^n budng dd't vi bp phin chtfa nhifin lifiu cdn chtfa dtfdc gpn nhe. Ngoai ra cung chtfa nhidu hd gia dinh bifit tdi nhffng loai bfi'p 16 thin thifin vdi mdi irtfdng niy. Trong thdi gian tdi can c6 cic nghifin crfu ve chi phi - hifiu qua cua cic mo hinh bdp Id stf dung nguyfin lieu sinh khd'i va cd cic chtfdng trinh can thi^p de md rdng nhflng md hinh bfi'p khdng khdi phff hdp va hieu qua lai cic dia phtfdng,
Ngoii ra, cd the giam mtfc dp phdi nhiem khdi chdt ddt sinh khd'i bang \iec phdi kho cic chat ddt dang r^n. Viec phdi kho nay vffa gitip rtit ngan thdi gian dun nau ddng th6i giam vific san sinh cac chat
khi gay hai tff qua trinh dot chay khdng hoin toan [5]. Mpt giai phap dfi thtfc hifin va can dtfdc ltfu tam la ban che stf tidp xtic vdi khdi cha't do't sinh khdi cho cic thanh vifin trong gia dinh dac biet la tre nho bang cich khong cho tre lai gan bep in trong qua trinh dun nau. Tuy nhien, giai phap nay khong hieu qua dd'i vdi ngtfdi npi trd chinh trong gia dinh. NhiT vay, de giam mtfc do phdi nhiem vdi khoi chdt dot sinh khdi mdt each hieu qua can kfi't hdp nhidu bien phap vi tuy dieu kien cu the' cua tffng dia phtfdng, tffng gia dinh ma ap dung mot each phti hdp.
Ngoai nhffng giai phip de cap d tren thi can co cic giai phap mang tam \ i mo nhtf tfng dung c^c tie'n b0 khoa hoc ky thuit de san xuat cic nguon nang Itfdng sach cung cdp cho cpng ddng vdi chi phi phil hdp. Ngudn nang ltfdng sach nay cd the du'dc lay tff ning Itfdng mat trdi. nang Itfdng gid.,,, hoac dtfdc san xudt iff cac chit ddt sinh khd'i, Cha't ddt sinh khd'i dtfdc tfdc tinh la se gop phan khdng nho ddn van de cung cap nang ltfdng cho con ngu'di trong Itfdng lai, dac biet la irong khoang 30-50 nam nffa [19]. Giai phap nay mpt mat tan dung du'dc ngudn nhien lieu sinh khd'i cd sin, mat khac giiip giam gii thanh cua nhien lieu sach de cung cap cho dai da sd'ngtfdi dan. ke ca nhffng ngtfdi cd thu nhap thdp. Tai Viet Nam. trong nhffng nam gan day, nang Itfdng sinh khoi dtfdc phat trie'n thong qua viec d3u ttf vao hai ITnh vtfc chinh: san xua't nhifit. dien \a vipc stfdung nang Itfdng sinh khd'i ngay cang difdc cai thien ve tinh hieu qua \a cac ye'u td'anh hu'dng dfi'n mdi trtfdng va stfc khoe.
6. Kdi luan va khujen nghi
0 nhilm khong khi, dac biet la 6 nhiem khong khitrongnha.dostf dung cha't dd't sinh kho'i cdnjiuy cd anh htfdng idn de'n ty lfi benh tat va ttf vong tren toan clu, dac biet la tai cac ntfdc dang phit irien.
trong dd cd Viet Nam. Kfi't qua cua cac nghifin ctfu khoa hpc cho thay nhffng chat khi va bui dpc hai sinh ra itf qua trinh ddt chay cac cha't do't sinh khdi (die bifit.la dd'i chay khdng hoin loan) la nguyen nhan giy nfin cac benh ve dtfdng hd ha'p (vifim pho'i, bpnh phdi la'c nghen man tinh. ung thtf phdi-,-). cac bien chtitig ve mat, tim mach hay lam tram trong hdn tinh trang nhe can va thieu hut dinh dtfdng d tre em. Nhdm ddi ttfdng dfi bi to'n thtfdng nhdt la tre em vi phu nff vi Ire em chtfa phat trie'n day du ve the chat vi hfi thdng mifin dich chtfa hoan thien con phu nff la ddi itfdng chiu trach nhiem ndi trd chinh 32 Tap chi Y te Cfing cdng, 4,2012, Sd 24 (24)
I T I N G HANK NGHIEN c i l l
trong gia dinh, p h a i tifi'p xtic vdi khdi chdt dd't sinh k h d i trong thdi gian d a i va tan suat c a o . Hifin da cd n h i e u nghifin cti^ ve thtfc trang stf dung nhifin lieu sinh k h d i trong dun n d u v a stfdi dm d t r e n the gidi cung nhtf a n h htfdng stfc k h d e d o phdi n h i e m v d i khdi n h i e n lifiu sinh khd'i, d i e bifit l i tai c a c ntfdc An Dfi, B a n g l a d e s h , N e p a l , M e h i c o , T h d Nhi Ky...
NhiTng ntfdc n i y cung dang ittog btfdc nghifin ctftf v i i p d u n g c a c giai p h i p gitip g i a m nguy cd stfc k h o e cho ngtfdi d i n ddi v d i khdi chdi dd't sinh khdi,
T a i V i e t N a m , viec si dung nhifin lieu sinh khdi trong dun nau va stfdi d m l i rdt p h d bidn, d a c biel la d n o n g thdn. H a n g chuc trieu ngtfdi d a n g cd nguy cd phdi n h i e m vdi cac chdt ddc bai trong khdi nhien lifiu sinh khdi v i a n h htfdng stfc k h d e dtfdc cho l i rdt ldn. M a c dff tai Vifit N a m da cd m d l s d m d binh b d p Id khdng khdi stf dting nhifin h e u sinh khdi d i dtfdc thur nghifim t h i n h c d n g nhimg chtfa a p dung trfin difin rdng tai c i c hd gia dinh. Hifin c o ra'l it nghifin ctili v e iinh vtfc n i y d Vifit N a m va cung thidu c i c chtfdng trinh can thifip g i a m nguy cd phdi nhiem vdi khdi chat ddi sinh khd'i cho ngtfdi dan.
Viec trien khai c i c nghifin ctfti d e d a n h gia d a y du tbtfc t r a n g stf dung nhifin lieu sinh khd'i va c a c nguy cd stfc k h d e d o phdi nhifim vdi khdi cha'i dd't sinh khdi lai Viel N a m la rdt c l n thidt dd cung cdp b a n g chtfng khoa bpc cho c i c chinh s i c h va chtfdng trinh can Ihiep n h a m k i e m s o i t nguy cd n i y . N g o a i ra cung c a n irien k h a i c i c nghifin ctftf can thiep d e dtfa ra/ltfa chpn cac md hinh bfi'p 16 khdng khoi hay il k h o i , cai tidn hfi thd'ng thdng gid... \ a cd c d c h d k h u y d n khicb i p d u n g tai c i c H G D . C i c chtfdng trinh I m y e n thdng n i n g cao n h i n thtfc v i thay ddi h a n h vi n h a m giam nguy cd srfc k h d e d o khdi chdt dot sinh khdi can dtfdc trien khai tai c i c tinh thanh trfin ca ntfdc Irong thdi gian tdi.
7. Ltri c a m rfn
Chung tdi xin c h i n t h i n h cam dn Chinh quydn va n h i n dan thi x i Chi Linh, Van phdng tbtfc dia C H I L I L A B cung dpi ngii dieu ira vien, g i a m sat vifin. n h a p lifiu vifin d i tham gia, thu t h i p , cung cdp s d l i e u va hd trd chting tdi ihtfc hien nghien cti^i nay.
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