= ENVIRONMENTAL HEALTH ASSESSMENT: A Case Study Conducted in the City of Quito and the County of Pedro Moncayo, Pichincha Province, Ecuador WASH Field Raport No. 401 PRITECH Repc'rt No, HSS-1331R - October 1993 - Technologies for Primary Health Care Sponsored by the U.S. Agency for International Development Operated by CDM and Associates WASH Field Report No. 401 PRITECH Report No. HSS-133IR ENVIRONMENTAL HEALTH ASSESSMENT: A Case Study Conducted in the City of Quito and the County of Pedro Moncayo, Piclrincha Province, Ecuador Prepared jointly by the WASH Project and the PRITECH Project for the Office of Health, Bureau for Regarch and Development, U.S. Agency for International Development, under WASH Task No. 315A and PRITECH Assignment No. HSS-133IR (in alphabetical order) Gustavo Arcia Eugene Brantly Robert Hetes Bany Levy Clydette Powell Jo& Su6rez and Linda Whiieford October 1993 This activity was jointly conducted by the WASH Project and PRITECH (Technologies for Primary Health Care). PRITECH is operated by Management Sciences for Health, in cooperation with the Academy for Educational Development, Inc.; the Department of International Health, School of Hygiene and Public Health, Johns Hopkins University; the Program for Appropriate Technology in Health; the Centre for Development and Population Activities; and Creative Associates International. Water and Sanitation for Hdth Project Contract No. 5973-2-00-8081-00,Project No. 936-5973 is VJIISO~C~by the Office of Hdth, Buruu for Resurch and Development U.S. Agency for International Development Washington, DC 20523 Technologies for Primuy Hulth Cue (PRITECH) Project Contract No. AIDIDPE-55%9-Z-O0-706440,Project No. 9365969 ie supported by the Office of H,\dth, Bunru for 1barch and Development U.S. Agency for rntenutional Development Washington, DC 20523 RELATED WASH REPORTS Envfronmental Health Assessment: An Integrated Methodology for Rating Envlronmental Health Problems. Field Report No. 436. Prepared by Eugene Brantly, Robert Hetes, Bany Levy, Clydette Powell, and Linda Whiteford. October 1993. Public Partlclpatton In Urban Environmental Management: A Model for Promotlng Community-Based Environmental Management In Perf-Urban Areas. Technical Report No. 90. Prepared by May Yacoob, Eugene P. Brantly, and Linda Whiteford. October 1993. Guidelines fotlmprovlng Wastewater and Solid Waste Management. Technical Report No. 88. Prepared by Richard N. Andrews, William B. Lord, Laurence J. OToole, L. Fernando Requena, with assistance from Eugene Brantly, Philip Roark, and Fred Rosemweig. August 1993. (Available in English and Spanish.) The Unique Challenges of Improving Peri-Urban SanltaHon. Technical Report No. 86. Prepared by Wiiam Hogrewe, Steven D. Joyce, and Eduardo A. Perez. July 1993. Constraints In Pror)lding Water and Sanftatton Servlces to the Urban Poor. Technical Report No. 85. Prepared by Tova Maria Solo, Eduardo Perez, and Steven Joyce. March 1993. CONTENTS ACKNOWLEDGMENTS ......................................... v ABOUT THE AUTHORS ........................................ vii ACRONYMS ................................................ ix EXECUIlVESUMMAFtY ........................................ xi 1.1 Background ......................................... 1 1.2 Approach and Scope of Work ............................. 1 1.3 Objectives of the Assessment .............................. 2 1.4 Organization of this Report ............................... 4 2 . METHODOLOGY ...........................................5 2.1 Overview ........................................... 5 2.2 Health Risk Assessment .................................. 7 2.2.1 Hazard Identification ............................ 7 2.2.2 Exposure Assessment ............................ 8 2.2.3 Dose-Response Assessment ........................ 8 2.2.4 Risk Characterization ............................ 9 2.2.5 Limitations .................................. 10 2.3 Health Effects (Outcome) Assessment ....................... 10 2.4 Ethnographic Methods ................................. 11 2.4.1 Focus Groups ................................ 11 2.4.2 Structured Observations ......................... 12 2.4.3 In-depth Interviews ............................ 13 2.4.4 Integrating Ethnographic Data with Other Data .......... 13 2.5 Rating Environmental Health Risks ......................... 13 2.6 Lidations of the Study ................................ 16 2.6.1 Scope of Work ............................... 17 2.6.2 Methodology ................................ 17 2.6.3 Data Availability and Quality ...................... 18 3. RESULTS OF THE ENVIRONMENTAL HEALTH ASSESSMENT: QUITO .... 19 3.1 Environmental and Sodoeconomic Conditions .................. 19 3.1.1 Overview of Environmental Problems in Quito ........... 19 3.1.2 Nature and Location of Asentarnlentos Populares ........ 21 3.1.3 Socioeconomic Characteristics of Asentarnlentos Populares . 23 3.1.4 Focus Group Sites ............................. 24 3.1.5 Summary ................................... 26 3.2 Food Contamination: Microorganisms and Pesticides ............. 26 3.2.1 Background ................................. 26 3.2.2 Methods ................................... 27 3.2.3 Exposure ................................... 28 3.2.4 Health Outcomes ............................. 30 3.2.5 Comments .................................. 32 3.3 Water Contamination: Drinking Water and Wastewater ............ 33 3.3.1 Background ................................. 33 3.3.2 Methods ................................... 33 3.3.3 Exposures .................................. 34 3.3.4 Health Outcomes ............................. 41 3.3.5 Comments .................................. 42 3.4 Solid Waste ........................................ 43 3.4.1 Background ................................. 43 3.4.2 Methods .......................... ........ 44 . 3.4.3 Exposure ................................... 45 3.4.4 Health Outcomes ............................. 47 3.4.5 Comments .................................. 48 3.5 Occupational Health ................................... 48 3.5.1 Background ................................. 48 3.5.2 Methods ................................... 48 3.5.3 Exposure ................................... 49 3.5.4 Health Outcomes ............................. 51 3.5.5 Comments .................................. 54 3.6 Toxic Substances: Pesticides (Non-food) ...................... 55 3.6.1 Background ................................. 55 3.6.2 Methods ................................... 55 3.6.3 Exposure ................................... 55 3.6.4 Health Outcomes ............................. 56 3.6.5 Comments .................................. 56 3.7 Toxic Substances: Lead ................................. 56 3.7.1 Background ................................. 56 3.7.2 Methods ................................... 57 3.7.3 Exposure ................................... 57 3.7.4 Health Outcomes ............................. 57 3.7.5 Comments .................................. 58 3.8 Ambient Air Pollution .................................. 58 3.8.1 Background ................................. 58 3.8.2 Methods ................................... 58 3.8.3 Exposu:a ................................... 59 3.8.4 Health Outcomes ............................. 60 3.8.5 Commenis .................................. 62 3.9 Indoor Air Pollution ................................... 62 3.9.1 Background ................................. 62 3.9.2 Methods ................................... 62 3.9.3 Exposure ................................... 63 3.9.4 Health Outcomes ............................. 63 3.9.5 Comments .................................. 64 3.10 Traffic Hazards ........: ............................. 64 3.10.1 Background ................................. 64 3.10.2 Methods ................................... 64 3.10.3 Exposure ................................... 65 3.10.4 Health Outcomes ............................. 65 3.10.5 Comments .................................. 66 3.11 Ratings for Environmental Health Problems: Quito ............... 67 3.11.1 Introduction ................................. 67 3.11.2 Risk Ratings for the Municipality of Quito .............. 67 3.11.3 Ratings for Asentamfentos Populates ................. 71 4 . RESULTS OF THE ENVIRONMENTAL HEALTH ASSESSMENT: PEDROMONCAYO ........................................ 77 4.1 Background ........................................ 77 4.1.1 Potential Environmental Health Problems ............. 77 4.2 Occupational Health ................................... 78 4.2.1 Background ................................. 78 4.2.2 Methods ................................... 78 4.2.3 Exposure ................................... 78 4.2.4 Health Outcopes ............................. 79 4.2.5 Comments .................................. 80 4.3 Toxic Substances: Pesticides .............................. 80 4.3.1 Background ................................. 80 4.3.2 Methods ...................................81 4.3.3 Exposure ................................... 81 4.3.4 Health Outcomes ............................. 81 4.3.5 Comments .................................. 82 4.4 . Traffic Hazards ...................................... 82 4.4.1 Background ................................. 82 4.4.2 Methods ................................... 83 4.4.3 Exposure ................................... 83 4.4.4 Health Outcomes .............................. 83 iii 4.4.5 Comments .................................. 84 4.5 Indoor Air Pollution ..................................