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Mapping the health and environmental situation in informal zones in Aleppo, Syria: report from the Aleppo household survey

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Objectives: Despite large communities living in informal zones around major cities in Syria, there is currently no information on the health and environmental situations in these areas. From May to August 2004, the Syrian Center for Tobacco Studies (SCTS) conducted the first household survey aiming to provide a baseline map of main health problems and exposures affecting these communities in Aleppo, the second largest city in Syria (2,500,000 inhabitants). Methods: Information on 1,021 participants randomly selected using stratified cluster sampling were available (46% males, mean age 34±11.7, age range 18–65 years, response rate 86%), including self-reported health/disability, exposures, and saliva cotinine measurement. Results Some positive findings include better than expected access to electricity, piped water, city sewage, and the use of propane for cooking. Particular areas of concern include high fertility rates, overcrowded housing conditions, and gender inequality in education and work. Household features likely to reflect negatively on residents‘ health include the use of diesel chimneys for heating and lack of smoking restrictions. Overall, residents of informal zones suffer from substantial physical and mental health problems and are exposed to high levels of indoor air pollution. All seem to affect women and the elderly disproportionately, while men are more affected by smoking, occupational respiratory exposures, and injuries. Both infectious and non-infectious respiratory outcomes were very common among study participants. Chronic and degenerative disease, including CVD and joint problems, were a source of substantial morbidity among the studied communities. Conclusions: This study highlights major health and environmental specificities of marginalized populations living in Aleppo, where women seem to bear a disproportionate burden of poor health and disability. Smoking and exposure to tobacco smoke seem among the major exposures facing these populations.

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  • Al-Subaie AS, Mohammed K, Al-Malik T (1998) The Arabic Self-Reporting Questionnaire (SRQ) as a psychiatric screening instrument in medical patients. Ann Saud Med 18:308–310

    Google Scholar 

  • Ashford RW, Rioux JA, Jalouk L, Khiami A, Dye C (1993) Twenty years of cutaneous leishmaniasis in Aleppo, Syria. Trans R Soc Trop Med Hyg 91:657–659

    Google Scholar 

  • Brennan EM (1999) Population, urbanization, environment, and security: a summary of the issues. Environ Change Security Project Report 5:4–14

    Google Scholar 

  • Chibli M, Sakkal S (1999) Informal settlements: problems and solutions. Report presented to the Municipality of Lattakia, Syria

    Google Scholar 

  • DiFranza JR, Aligne CA, Weitzman M (2004) Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics 113:1007–1015

    PubMed  Google Scholar 

  • Ezzati M, Kammen DM (2002) Household energy, indoor air pollution, and health in developing countries: knowledge base for effective interventions. Annu Rev Energy Environ 27:33–270

    Article  Google Scholar 

  • Feyerabend C, Russell MA (1990) A rapid gas-liquid chromatographic method for the determination of cotinine and nicotine in biological fluids. J Pharm Pharmacol 42:450–452

    CAS  PubMed  Google Scholar 

  • Howson CP, Fineberg HV, Bloom BR (1998) The pursuit of global health: the relevance of engagement for developed countries. Lancet 351:586–590

    Article  CAS  PubMed  Google Scholar 

  • Jarvis MJ, Primatesta P, Erens B, Feyerabend C, Bryant A (2003) Measuring nicotine intake in population surveys: comparability of saliva cotinine and plasma cotinine estimates. Nicotine Tob Res 5:349–355

    CAS  PubMed  Google Scholar 

  • Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y (1987) Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health 77(11):1435–1438

    CAS  PubMed  Google Scholar 

  • Lighty JS, Veranth JM, Sarofim AF (2000) Combustion aerosols: factors governing their size and composition and implications to human health. J Air Waste Manage Assoc 50:1565–1618

    CAS  Google Scholar 

  • Maziak W (2002) Smoking in Syria: profile of an Arab developing country. Int J Tuberc Lung Dis 6:183–191

    CAS  PubMed  Google Scholar 

  • Maziak W, Tabbah K (2005) Smoking among adults in Syria, proxy reporting by 13–14 year olds. Public Health 119: 578-581

    Article  CAS  PubMed  Google Scholar 

  • Maziak W, Asfar T, Kilzieh N, Mzayek F, Fouad M F (2002) Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo-Syria. Soc Sci Med 54:1419–1427

    Article  PubMed  Google Scholar 

  • Maziak W, Ward KD, Afifi Soweid RA, Eissenberg T (2004) Tobacco smoking using a waterpipe: a re-emerging strain in a global epidemic. Tob Control 13:327–333

    Article  CAS  PubMed  Google Scholar 

  • Maziak W, Ward KD, Rastam S, Mzayek F, Eissenberg T (2005) Extent of exposure to environmental tobacco smoke (ETS) and its dose-response relation to respiratory health among adults. Respir Res 6(1):13

    Article  PubMed  Google Scholar 

  • McMichael AJ (2000) The urban environment and health in a world of increasing globalization: issues for developing countries. Bull World Health Organ 78:1117–1126

    CAS  PubMed  Google Scholar 

  • Population Reference Bureau (2003) 2003 World Population Data Sheet. PRB [World Chart], Washington DC

    Google Scholar 

  • Population Reports (2002) Meeting the urban challenge. Population Information Program, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Available: [accessed Sep 2004].

  • Rastam S, Ward KD, Eissenberg T, Maziak W (2004) Estimating the beginning of the waterpipe epidemic in Syria. BMC Public Health 4:32

    Article  PubMed  Google Scholar 

  • Smith KR, Samet JM, Romieu I, Bruce N (2000) Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax 55:518–532

    Article  CAS  PubMed  Google Scholar 

  • Stoll C, Alembik Y, Roth MP, Dott B (1999) Parental consanguinity as a cause for increased incidence of births defects in a study of 238,942 consecutive births. Ann Genet 42:133–139

    CAS  PubMed  Google Scholar 

  • Tobacco Country Profiles (2003) In: The 12th world conference on tobacco or health, 2nd edn. American Cancer Society, Atlanta GA

  • UNDP (2002) Arab Human Development Report. UNDP: United Nation Development Program. Available: [accessed May 2004]

  • UNPD (2000) United Nations World Population Prospects Population Database (UNPOP). UNPD, United Nations Population Division, New York

  • von Schirnding YE (2002) Health in sustainable development planning: the role of indicators. World Health Organization, Geneva

    Google Scholar 

  • WHO (1995) World Health Report 1995: Bridging the gaps. WHO, Geneva

    Google Scholar 

  • WHO (1999) Environmental health indicators: framework and methodologies. WHO, Geneva; WHO (WHO/SDE/OEH/99.10)

    Google Scholar 

  • World Health Survey (2000–2001) World Health Organization. Available: [accessed June 2003]

  • Zhang JJ, Hu W, Wei F (2002) Children’s respiratory morbidity prevalence in relation to air pollution in four Chinese cities. Environ Health Perspect 110:961–967

    CAS  PubMed  Google Scholar 

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This work is supported by USPHS grants R21 TW006545, R01 TW05962.

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Maziak, W., Ward, K.D., Mzayek, F. et al. Mapping the health and environmental situation in informal zones in Aleppo, Syria: report from the Aleppo household survey. Int Arch Occup Environ Health 78, 547–558 (2005).

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