Indian Journal of Public Health

: 2022  |  Volume : 66  |  Issue : 2  |  Page : 91--97

Assessment of health status and impact of pollution from thermal power plant on health of population and environment around the plant in Udupi District, Karnataka

Ramachandra Kamath1, Sharvanan Eshwar Udayar2, G Jagadish3, Poornima Prabhakaran4, Kishore Kumar Madhipatla5, Research Team6,  
1 Professor and Head, Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Madikeri, Karnataka, India
2 Associate Professor, Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Madikeri, Karnataka, India
3 Biostatistician, Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Madikeri, Karnataka, India
4 Deputy Director, Centre for Environmental Health, Public Health Foundation of India
5 Consultant, Centre for Chronic Disease Control, New Delhi, India

Correspondence Address:
Sharvanan Eshwar Udayar
Department of Community Medicine, Kodagu Institute of Medical Sciences, Government of Karnataka, Madikeri - 571 201, Karnataka


Background: Coal-fired thermal power plants (TPPs) have a serious impact on soil, air, and water quality resulting in deterioration of health and environment around the plant. Objective: The present study was undertaken with the objectives of assessing the respiratory health status of the population around the plant and to measure selected heavy metals in fly ash, air, water, and soil samples. Materials and Methods: The current cross-sectional study was conducted among 3533 adult residents living in two strata within 10 km radius around the TPP in Udupi district of Karnataka state. Data were collected by using semi-structured questionnaire and spirometry and environmental air monitoring by DustTrak aerosol monitor, water, and soil samples were collected for analysis. Results: Majority of the study participants were in the age group of >45 years (41.4%). 70.6% were females and 0.39% were trans-genders. 4.3% were suffering from various respiratory problems. Bivariable logistic regression showed subjects aged 46–65 years and >65 years have 2.91 times and 4.42 times higher odds of respiratory disease as compared to those with age ≤45 years. Multivariable logistic regression showed significant association between higher age group (P < 0.0001) and in subjects who had closed window during cooking (P < 0.006). Levels of heavy metals in soil samples and particulate matter 2.5 were well within permissible limits whereas the ground water samples had excess levels of iron, manganese, and copper. Conclusion: The present study has implications for policymaking to protect the environment and health of vulnerable populations in industrial clusters and the vicinity of power plants.

How to cite this article:
Kamath R, Udayar SE, Jagadish G, Prabhakaran P, Madhipatla KK, Research Team. Assessment of health status and impact of pollution from thermal power plant on health of population and environment around the plant in Udupi District, Karnataka.Indian J Public Health 2022;66:91-97

How to cite this URL:
Kamath R, Udayar SE, Jagadish G, Prabhakaran P, Madhipatla KK, Research Team. Assessment of health status and impact of pollution from thermal power plant on health of population and environment around the plant in Udupi District, Karnataka. Indian J Public Health [serial online] 2022 [cited 2022 Aug 18 ];66:91-97
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Full Text


Coal-based thermal power plants (TPP) contribute around 41% of electricity generated globally and there is increased demand for electricity due to rapid boosting of the economic growth.[1] To meet the demands from increasing population in India, power generation has increased substantially with coal-based plants which account for 60% of electricity generated in our country.[2]

Fly ash containing heavy metals such as nickel, lead, cadmium, chromium, and arsenic can result in serious manifestations on cardiovascular, neurological, and respiratory systems. Fine particles can damage lungs thereby manifesting in pneumoconiosis.[3] In addition to health effects, poisonous gases such as sulfur dioxide, sulfur trioxide, carbon monoxide, and nitrous oxide are released into the atmosphere. All these factors have an impact on air, soil, and water.[4] Previous studies have established the impact of these emissions on humans health.[5],[6],[7] In India, exposure to PM10 released by coal plants had resulted in more than 20 million asthma cases and 80,000–115,000 premature deaths.[8]

Many studies in India[9] have established the impact of environmental abuse on human health, however, there has not been any scientific study done to assess the health impact of environmental abuse in Udupi district so far that could aid tailored regional policy interventions. Hence, the present study was undertaken with the objectives of assessing the respiratory health status of the population of villages within a defined geographical area around the plant and to measure the PM2.5 levels and selected heavy metals in fly ash, air, water, and soil around the thermal power plant (TPP).

 Materials and Methods

Study setting

The TPP in Udupi district of the southern Indian state of Karnataka is a coal-based TPP established in 2008 and is situated in Yellur village and within 7–8 km proximity to Shambavi river. The plant has a capacity of 1200 MW and became operational in September 2012. This cross-sectional study was conducted within 10 km radius of the TPP in Padubidri from July 2018 to April 2019. The total villages in and around the TPP were divided into two strata based on proximity (a) 0 to <5 km of radius and (b) >5–10 km from the plant. Five villages were selected randomly for the study. Line listing of households in the two strata was done by collection of the information from the respective panchayaths and from each stratum of villages, about 325 households were selected. The required number of households from each stratum was proportionately distributed to the selected villages.

There are three villages within 5 km radius of the power plant and as per the 2011 Census,[10] the population in Yellur, Santhoor, and Palimar were 5453, 2461, and 3319, respectively. Other two villages in the proximity (>5 and <10 km) are Pilar (3221) and Nandicoor (2987).

As the information on the current health status was not readily available, 3500 individuals were enrolled for the study based on sample size calculation by considering the prevalence rate of respiratory symptoms ranging from 6.6% to 26.7%[1] from the previous study. Considering two adults from each household, about 325 households were required to be selected from each village.

Inclusion and exclusion criteria

Persons residing since January 2012 in the study areas were included . Exclusion criteria were: those who started residing in the study area within the past 6 months, and, known cases of respiratory and neurological disease before the plant was operational.

Data collection tools and methods

Systematic random sampling procedure was adopted for the selection of households from each village. As the risk in each household was uniform in the study area, a sampling with replacement approach was adopted. For the selection of first household, a coin was tossed from the center of the village to select the direction in which the first house will be selected. If the selected house was locked, then the very next one was included for the study. Data were collected from the head of the family or a responsible member from the household consented to be part of the study. Patient consent declaration form was prepared in local language and consent was taken after explaining risk and benefits of the study to the participants. The study protocol was approved by the Institutional Ethics Committee (soc/sisec/22.1/2017/11 dated 09-10-2017).

Information was gathered by using interviewer-administered semi-structured questionnaires. The questionnaire was prepared in English and translated in the local language. The reliability and validity of the questionnaire were tested through a pilot study among 50 participants. It included questions on sociodemographic details, cooking practices, lifestyle factors, and respiratory symptoms. The presence of cough, wheeze, phlegm, chest pain, and shortness of breath were considered as respiratory symptoms. Detailed history of any preexisting condition and examination of respiratory health was done. Medical records for any illness of the residents, if available was scrutinized for verification of morbid conditions. Spirometry tests were performed by trained research staff to assess the lung function among a subset (around 20%) of population residing near the TPP. For this, a fully integrated PC-driven Easy On PC spirometer which is approved by the Food and Drug Administration was used.

Environmental sampling

Particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) levels were monitored in neighborhoods located in the downwind direction of the power plants, while soil and water samples were collected in multiple buffer zones (0–10 km) around the plant.

DustTrak aerosol monitor was used for real-time and gravimetric-based PM2.5 mass concentration measurements. Hand driven Auger was used to collect soil samples at five locations and at each location, samples were collected from 2 sites (separated by a distance of at least 50 m to maintain representability) at depths between 0–15 cm and 15–30 cm, which were later pooled together to obtain a composite sample and collected in airtight bags, labeled, and transported in ice boxes to the central location for analysis.

Five samples of surface and groundwater were collected, labeled, and transported in iceboxes to the central location. The samples were later stored in 4°C refrigerator in Public Health Foundation of India laboratory until its transfer to Postgraduate Institute of Medical Education and Research Chandigarh for the analysis.

The collected data was coded and entered and exported to STATA (16.1), StataCorp,College Station,Texas USA. for analysis. Percentages, Chi-square test, and Fisher's exact test were applied for categorical data. To determine the factors associated with respiratory disease, binary logistic regression model was performed and P < 0.2 were considered for multivariable logistic regression analysis. Unadjusted odds ratio (UOR) and adjusted odds ratio (OR) with 95% confidence interval were calculated for bivariate and multivariate logistic regression, respectively. Statistically significant association was considered for variables with P < 0.005 in the multivariate logistic regression.


Out of 3533 study participants, majority (27%) were from Pilar village followed by Yellur (24.3%), Nandicoor (23.9%). Fourteen transgenders were also interviewed in our study. More than forty percent of the study participants were aged <45 years and 37.5% were in the age group of 45–65 years. Two-thirds of the participants were females and 0.39% were transgenders, and 64.5% were currently married. Around 98% of study participants were using sanitary latrine facility in their houses. Majority (87.96%) of the participants were literates. The proportion of current smokers was around 3.6% only and 0.8% of the participants were smoking more than 20 cigarettes per day. More than 90% of the current smokers used to consume tobacco for more than 5 years [Table 1].{Table 1}

Almost all the respondents (98.4%) had separate room for cooking purpose but only 18% study subjects gave response that they have chimney or smoke outlet in their houses. Majority (97.1%) of the cooking rooms had windows and 96.7% of them were kept open while cooking. Only 65% were using LPG as fuel for cooking purpose followed by firewood (34.1%).

The most common ailments in the study population were hypertension (44.1%) followed by diabetes mellitus (14.8%), asthma (4.3%), allergy (3.1%), coronary artery diseases (2.3%), hypothyroidism (1.6%), respectively. Spirometry was done on 848 subjects, among them, 409 (48.23%) had normal spirometry, 52 (6.13%) had moderate obstruction, and 357 (42.09%) had restrictive pulmonary function. There was statistically significant association between age, presence of respiratory symptoms, smoking, and the respiratory function tests in the present study (P < 0.001)

In [Table 2], the bivariable analysis shows that the proportion of subjects was more in those with age group 46–65 years and >65 years with respiratory disease as compared to no respiratory disease and was statistically significant. The proportion of smokers was more in those with respiratory disease as compared to not with respiratory disease (5.9% vs. 3.5%) but was not statistically significant. The proportion of subjects who have open window during cooking have less respiratory disease as compared to no respiratory disease and was statistically significant (92.8% vs. 96.9%, P = 0.006).{Table 2}

Our study objective was to find the association of respiratory disease with demographics and other risk factors. In adjusted model, we have reported OR adjusting for all other covariates reported in [Table 3]. We did not assess the fit of the model reported and the overall model is statistically significant (χ2 = 62.91, P < 0.001). All 3533 observations were used in the analysis. The likelihood ratio Chi-square is 62.83 with a P = 0.0001. The pseudo R2-value was 0.0499. In bivariable logistic regression, analysis showed age and open ventilation were found to be significantly associated with respiratory disease. The subjects with age 46–65 years and >65 years have 2.91 times and 4.42 times higher odds of respiratory disease as compared to those with age ≤45 years (UOR, 95% CI: 2.91 [1.85,–4.57]; 4.41 [2.77–7.04]). The multivariable logistic regression analysis showed the odds (95% CI) among subjects with age 46–65 years and >65 years was 2.79 (1.77–4.41) and 4.33 (2.66–7.07) times more, respectively, as compared to the subjects having age ≤45 years while adjusting for other variables (area, gender, occupation, ever smoking, open window, chimney, and open ventilation). In those who have open window, the odds of respiratory disease was 0.41 times less (95% CI: 0.21– 0.79) as compared to those who do not have open window.{Table 3}

[Table 4] shows analysis of environmental samples collected from the two zones of the study area. It can be observed that a high concentration of heavy metals, especially aluminum, chromium, manganese, iron, nickel, copper, zinc, arsenic, cadmium, and lead was found in the samples of ground water collected from the inner zone when compared to the outer zone however except for iron, manganese and copper all other metals concentrations were within the specified limits Bureau of Indian Standards.[11]{Table 4}

There was high heavy metal concentration in soil samples collected in inner zone in contrast to samples from outer zone except for mercury levels. However, there are no available Indian standards to comment whether these levels are within the permissible limits or not. The heavy metals concentration in air samples collected from both the zones are within the permissible levels given by Central Pollution Control Board (CPCB) standards.[12] The average PM 2.5 levels in the location which is <5 km is around 20.6 ± 4.6 μg/m3 whereas it is about 17.6 ± 5 μg/m3 in the places which is more than 5 km. Although the PM2.5 levels appear to be more in the places which is close to the TPP, it is far low when compare with the CPCB[13] and WHO standards.[14]


This study was conducted with the aim of assessing the health status and impact of pollution from coal-fired TPP (CFTPP) on health of population and environment around the plant. Our study reported that majority of participants are middle aged, women by gender and home makers which are similar to study findings by Adappa et al.[1] This is probably due to the fact that most of the males go for working during daytime and it is difficult to interview them during that time. Although this information could be collected from female members, there would be serious gaps in the data collected as male members even if reached wouldn't reveal their lifestyle habits and other important information. This could introduce a bias in the study findings as occupational exposure to environmental pollutants can be strongly associated with gender in this study setting.

Respiratory conditions such as asthma (4.3%) and allergy (3.1%) reported in our study was high when compared with national figures in population more than 15 years old (INSEARCH) in which the prevalence of asthma was around 2.05%.[15] However, Masud et al.[16] (14%) and Pala et al. (8%)[17] reported inhabitants suffering from allergy, asthma, skin diseases, and other respiratory problems. The reasons may be air pollution caused by combustion of coal resulting in generation of toxic waste such as fly ash which contains not only dust but also hydrocarbons and heavy metals which are known to have impact on respiratory health status of the residents around the power plant.[2],[3],[4],[5],[6],[7],[8],[9],[10] Studies around the world have reported similar findings in those populations who are exposed to environmental pollution resulting from the CFTPP.[18]

Significant difference (P < 0.05) was observed with respect to increased symptoms and variables like age, smoking, and proximity to the TPP. There are chances of getting more symptoms in those who are residing close to the power plant. Similar findings were reported by Adappa et al.[1] and by Pala et al.[17] (2012).

Bivariable and multivariable analysis shows that older age, occupation, and open ventilation are significantly associated with respiratory diseases. This might be due to the subjective responses given by the study participants. In our study, the prevalence of respiratory diseases is very minimal. In depth pulmonary function tests (as it was done in only subset of study population) might throw light on the prevalence of respiratory diseases in association with various confounding factors.

In our study, there was significant association between abnormalities in pulmonary function tests and increasing age, smoking, and those living in the vicinity of the plant. Those who are living near the plant had higher abnormal lung function test compared to those who are residing far. Our findings were consistent with findings by Pala et al.[17] and Hill and Baum.[19] Although higher abnormal spirometric test was observed in females and those residing near to the power plant than males and those who are residing far from the plant, respectively, the difference was not statistically significant. This finding was consistent with study by Adappa et al.[1]

Analyses of air, water, and soil samples in two different zones was performed to find out the concentration of heavy metals and particulate matter levels in air. Twenty four hour concentration of heavy metals and PM2.5 levels in air in both the inner and outer zones were well within the standards given by CPCB. However, Tiwari et al.[20] reported high levels of PM2.5 levels ranging from 27 to 79 μg/m3 in study done around TPPs in Chhattisgarh. Similar findings were reported by studies done in India.[21],[22]

Soil sample analysis showed high concentration of mercury levels in outer zone when compared to inner zone. Huang et al.[23] reported similar findings in China. However, Sengupta et al.[24] reported higher concentration of Pb, Cd, and As in the soil vicinity to the TPP. Özkul[25] reported heavy contamination by As, Hg, and Ni in the soil around TPP. Whereas da Silva Júnior et al.[26] reported soil contamination by Mn. These variations might be due to various factors like topography, local source near to the site of monitoring which could influence the metal concentrations in the soil.

Heavy metal concentrations (except iron and copper) in water samples of both the zones are well within the limits prescribed by the standards. Kanchan et al.[27] reported high levels of lead (0.04 mg/l) and cadmium (0.004 mg/l) when compared to our study but it was within the permissible limits. However, Bhardwaj et al.[28] reported high concentration of Pb and Cd but only As levels were exceeding the permissible limits. Verma et al.[29] reported levels of Pb, Ni, Fe, Cr, and Mn in groundwater which were in excess of WHO permissible limits. The reason for variations in these studies could be due to the factors such as pH, physiochemical nature of water, and bonding between fly ash and the element and its chemical properties.[30]


The present study highlights environmental pollution with a special emphasis on respiratory health status of the population around TPP. However, continuous monitoring of the environmental samples for the presence of pollutants will aid in taking up risk reduction measures. The cross-sectional nature of the study meant that environmental sampling that accounts for temporal variation across seasons could not be captured. The sampling was all done during the summer months. A larger study with more detailed health assessments for other effects as well as collection of environmental samples across seasons may provide additional insights regarding the impact of CFTPP on health and environment in these vulnerable populations. Additional efforts to collect information on the working male population in this area may provide important differences on attributable risk of living and working in the vicinity of the coal-fired TPPs. The study results could be used for framing evidence-based operational guidelines for CFTPP. To minimize the pollution caused by fly ash activities like recycling and its usage as raw material in industries such as bricks manufacturing, cement, ceramics, and road construction can be done.

Although our study attempted to include the desired sample size, there were differences in gender ratio as most males could not be contacted during the survey period. Another important limitation could be recall bias due to self-reported illness and behavior, but literature has shown high agreement between medical and self-report. As ours was a community-based study and we had the advantage of getting more accurate results through cooperation from the study population.

Financial support and sponsorship

Centre For Chronic Disease Control, GurugramPostgraduate Institute of Medical Education and Research, Chandigarh.

Conflicts of interest

There are no conflicts of interest.


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