Self-Reported Mental and Physical Health Problems among Traffic Police due to Air Pollution in Kathmandu Valley

Introduction: Kathmandu valley has its unique bowl shaped topographic features due to which it is highly vulnerable to air pollution. Traffic police personnel (TPP) are at the highest risk of pollution related disease, because they are constantly exposed to the air pollution (vehicular emissions) as the nature of their occupation. The main objective of this study was to assess the mental and physical health problems among traffic police due to air pollution in the selected area of Kathmandu valley. Methods: A cross-sectional descriptive study was carried out in Kathmandu Valley among traffic police. Samples were collected from each police station of ring road area. Total sample calculated and collected was 222. Standard questionnaire for symptoms of physical problem, anxiety and stress i.e.ST-George respiratory questionnaire (SGRQ), Hamilton Anxiety rating scale and Perceived stress scale respectively were used to collect the data. Data was entered and analyzed using SPSS v16, with descriptive statistics. Results: About 73% of traffic police were reported with anxiety while stress related problems were identified among 40.6%. Skin, respiratory and eye problems were the most common physical problems seen among traffic police. Conclusions: Traffic police in Nepal have both physical and mental health problems associated with air pollution. Hence, future interventions for the effort of reducing such problems should be prioritized, planned and implemented with generation of action plan to minimize the problem.


INTRODUCTION
The Kathmandu valley is surrounded by hills that forms a bowl-shaped topography. Due to which the wind movement are restricted and the pollutants in the atmosphere are retained. Hence, the valley is highly vulnerable to air pollution. 1 In addition, other factors like rapid urbanization, industrialization, maintenance and widening of roads, increasing number and poor maintenance of vehicles etc in the valley are responsible for poor quality of the air. 2 Traffic police personnel's (TPP) are at the highest risk of pollution related diseases, because they are constantly exposed to the air pollution (vehicular emissions) as the nature of their occupation. 3 Mainly, air pollution has adverse effects on the crucial system such as cardiovascular system and central nervous system. 4 Most of the TPP in Kathmandu valley complained of health problems such as fatigue, back /neck problems, arthritis, dryness of nostrils, poor memory, headache, irritation, indigestion and pressure/stress. 5 The main objective of this study was to assess the health problems among traffic police due to air pollution in the selected area of Kathmandu valley. synonyms from MESH database to provide the theoretical background to the concept of mental and physical health problem of traffic police and factors related to it. Search was done in order to identify identical and significant studies which were published between 2010 and 2018, in peer reviewed and indexed publication available in local and international journals published in English. The following databases were searched: PUBMED, EMBASE, and MEDLINE.

METHODS
Boolean operators (i.e. AND, OR, NOT or AND NOT) were used as conjunctions to combine or exclude keywords in a search, thereby resulting in more focused and relevant results in PUBMED. Boolean operator, wildcard and truncation were adapted accordingly for the other databases. Table 1 shows physical health problem among the respondents. Out of total respondents, more than half of them had eye problems i.e. 52.3%, upper respiratory tract problem i.e. 52.3%, lower respiratory tract problem i.e. 55.4% and skin problem 55.9% due to air pollution. These were found to be the most common physical health problems among TPP due to air pollution.     Table 4 shows anxiety scoring as per reported by respondent. Out of total respondent, 26.1% of respondents never felt any symptoms of stress, followed by 33.3% of said they had almost never felt stress, 19.9% of respondent said they had sometimes felt symptoms of stress and 20.7% said they had felt the symptoms stress very often.  Table 5 shows the association of eye problems among traffic police with different variables among which the p value at confidence level of 95% for sex and education was less or equal to 0.05 i.e. 0.05 (fisher exact test) and 0.038 respectively, which shows that eye problem is associated with sex and education of the respondents. There was no association of eye problem among traffic police with age of the respondent, alcohol consumption, work experience of respondents, duration of exposure, duty hour of respondent, PPE used by respondents, periodic health check-ups by respondents and free health care services as the p-value was more than 0.05 according to chi-square test and fisher's exact test.

DISCUSSION
Study published in environmental claims journal showed air pollution has same effect in all age group but age groups between 25-34 and above 45 were affected more whereas our study showed that age group of more than 35 were affected significantly higher. 6 According to Gupta  The study conducted in Lucknow, India from April 2012 to September 2012 found that 68% of traffic policemen were suffering from breathlessness, 42% from chest pain and 45% from irritation in respiratory tract. 8 The percentage of policemen suffering from breathlessness is similar to this study i.e. 60.4% but it contrasted with the percentage of policemen suffering from chest pain i.e. 71.6 and irritation in respiratory tract i.e. 68%.
The study conducted in Patiala India found that 68% and 22% of traffic police complained to have coughing and shortness of breath respectively. 3 The percentage of traffic police suffering from coughing is similar to this study i.e. 74.8% but it is contrasted with the percentage of shortness of breath i.e. 60.4%.
This study contradicts to the finding of another study conducted in India 2010, as it reflects 33% of traffic police were suffering from frequent coughing, 2% from shortness of breath,23% from irritation in respiratory tract, 35% from chest pain and 3% from wheezing. 9 It might be due to rapid urbanization, industrialization, maintenance and widening of roads, increasing number and poor maintenance of vehicle in our country.
According to this study, it was found that 52.3 % of respondent had eye problems due to air pollution, 52.3% had upper respiratory tract problems, 55.4% had lower respiratory tract problems and 55.9% had skin problems. It was identified that 73% of the traffic police had anxiety and 40.6% of traffic police were identified of having stress due to air pollution.
In our study, sex and education with eye problem were found to be associated. Also, significant association was seen between sex and upper respiratory tract problem. In contrast, the study conducted in India showed that traffic police who were exposed to various air pollution were associated with incidence of respiratory symptoms. 3 Our study didn't look for PM value and its health effect on traffic police in contrast a study done by Zhao et al showed that most traffic police were exposed to high concentration of PM2.5 in winter season. 10

CONCLUSIONS
Anxiety among the traffic police due to air pollution was found to be higher. It was also found that more than half of the respondents had physical health problems. The effects of mental health problems might not be seen immediately and in near future they might be vulnerable to problems like bronchial asthma, lung cancer, heart disease, severe depression, other occupational disease etc. So, counseling on psychological problem should be provided to traffic police at police hospitals for