Assessment of ESR, Serum Protein and Body Mass Index among quarry workers at Okposi Umuoghara, Ezza North Local Government Area of Ebonyi State -Nigeria

Abstract

Introduction: Occupational hazards associated with stone crushing and inhalation of stone dust is well documented. Quarrying/stone crushing is increasingly becoming the main stay of Ebonyi state economy and major source of internally generated revenue yet there is little or no government policy towards safety of workers and environment. Aim: This study assessed the effect of long time exposure to quarry dust on the ESR, total serum protein and the body mass index (BMI) of quarry workers at Okposi Umuoghara, Ezza LGA of Ebonyi State-Nigeria. Methods: Cross-sectional, descriptive and analytical study was carried out on 100 quarry workers (age; between 18-57 years) who were exposed to stone dust for more than one year and 96 age/sex matched workers not exposed to quarry dust as control. The ESR, serum protein and BMI were estimated using standard methods. Results: Majority of the quarry workers in Okposi-Umuaghara Industrial Estate were female, low income and uneducated who are not aware of the health implications of their carrier. There were significant increases in the mean values of ESR and serum protein when compared with control. The BMI was within normal healthy range. Conclusion: The exposure/inhalation of quarry dust by these workers possibly led to increase in ESR and total protein. There is no health policy governing quarry industry in Nigeria or environmental health impact assessment. There is need therefore for governmental health policy aimed at protecting the workers and the environment.

Full text

Assessment of ESR, Serum Protein and Body Mass Index among quarry
workers at Okposi Umuoghara, Ezza North Local Government Area of
Ebonyi State – Nigeria
Chukwurah Ejike Felix
Haematology & Immunology Unit, Dept. of Medical Laboratory Sciences, Faculty of Health Sciences & Technology,
Ebonyi State University, Abakaliki – Nigeria.
e-mail: medichemlabenugu@yahoo.com
Ejeromedoghene Rukevwe Frances
Dept. of Medical Laboratory Sciences, Faculty of Health Sciences & Technology, Ebonyi State University, Abakaliki –
Nigeria.
e-mail: ejerorukky124@gmail.com
Chukwurah Felix Chinedum
Shenyang Medical College, Shenyang Liaoning P.R. China/Dept of Surgery, Enugu State University Teaching Hospital,
Enugu – Nigeria.
e-mail: felixciz042@gmail.com
*Corresponding author:
Chukwurah Ejike Felix (medichemlabenugu@yahoo.com)
ARTICLE INFO
Article history
Received 5 April2020
Received in revised form 24 April, 2020
Accepted 29 April 2020
Keywords:
Quarry dust, ESR, serum
protein, BMI
ABSTRACT
Introduction: Occupational hazards associated with stone crushing and
inhalation of stone dust is well documented. Quarrying/stone crushing is
increasingly becoming the main stay of Ebonyi state economy and major source
of internally generated revenue yet there is little or no government policy
towards safety of workers and environment. Aim: This study assessed the effect
of long time exposure to quarry dust on the ESR, total serum protein and the
body mass index (BMI) of quarry workers at Okposi Umuoghara, Ezza LGA of
Ebonyi State – Nigeria. Methods: Cross-sectional, descriptive and analytical
study was carried out on 100 quarry workers (age; between 18 -57 years) who
were exposed to stone dust for more than one year and 96 age/sex matched
workers not exposed to quarry dust as control. The ESR, serum protein and BMI
were estimated using standard methods. Results: Majority of the quarry workers
in Okposi - Umuaghara Industrial Estate were female, low income and
uneducated who are not aware of the health implications of their carrier. There
were significant increases in the mean values of ESR and serum protein when
compared with control. The BMI was within normal healthy range. Conclusion:
The exposure/inhalation of quarry dust by these workers possibly led to increase
in ESR and total protein. There is no health policy governing quarry industry in
Nigeria or environmental health impact assessment. There is need therefore for
governmental health policy aimed at protecting the workers and the
environment. copyright @ 2020 cepa
Contents lists available at
Journal of Environmental Management and Safety
Journal homepage: www.cepajournal.com

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
25
INTRODUCTION
Ebonyi State Nigerian is fast developing
with changes in social, economic and
public health concern. There is changing
paradigm in economy; significantly
shifting from agrarian (by peasant farmers)
to quarry industries (Nwibo et al., 2012)
springing up from all nukes and cranny of
the state and has become the major source
of the state’s internally generated revenue.
Evidence abound on the health
implications of occupational exposure to
stone dust among quarry workers (Al-
Otaibi et al., 2018). Epidemiologic studies
indicate that workers exposed to quarry
dusts have increased risk of developing
lung cancer, pulmonary tuberculosis and
airway diseases (NIOSH, 2003; Ezeonu &
Ezejiofor, 1999). Respiratory problems
and occupational lung diseases are the
major health hazards in dust-exposed
workers and major cause of morbidity and
mortality all over the world (WHO, 2006;
Rom& Markowitz, 2007). In the
workplaces in developing countries health
hazard and safety issues get less attention
and such laborers are often exposed to dust
without being aware of its threat to their
health.
In the process of crushing stone;
mineralogical materials (dust, fumes, ashes
or other industrial waste) may be released
into the environment and constitute toxic
elements that may cause health risk to
workers. The bulk of the quarry employees
are mainly poor and illiterate men and
women who depend on the quarrying as a
means of livelihood with little or no
knowledge of health implications. More so
the type of quarrying industry present in
Ebonyi State ranges from manual stone
crushing to small and medium scale
quarrying industries that use heavy
machinery for crushing stones without
adequate safety protection and no
environmental impact assessment. These
generate wide range occupational hazards
causing injury or damage to human health
and well-being (Achalu, 2000;
Shrivastava, 2018). A large number of
workers are exposed to vibration and
noise, explosives and dangerous chemicals
like ammonium triphosphate and dust that
contains sodium silicate (Ajayi &
Osibanjo, 1999; Hussein, 2006).
In developed world, there is continuous
research and education on occupational
health and safety (OSHA, 2004; NOISH
2003) for quarry workers, the reverse is
the case with developing countries and
indeed in Nigeria. Though it is a major
source of internally generated revenue
(IGR) to the government, there is no health
policy aimed at protecting quarry workers
and the public from the adverse effects of
quarry industries. Previous study in the
same environment recognizes the
occupational health risks associated with
quarry dust exposures (Nwibo et al.,
2012), none actually address the
nutritional implication. This study
therefore, assessed the effect of quarry
dust exposure on ESR, total protein and
BMI on workers and may serve as
evidence-based research toward
prioritization and health policy
formulation aim at protecting the workers
and the environment.

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
26
METHODS:
Subjects and Sampling
This cross-sectional, descriptive and
analytical study was conducted at Quarry
Industrial layout, Okposi Umuoghara,
Ezza North LGA of Ebonyi State –Nigeria.
Only workers involved in crushing,
clearing and loading of quarry products
were sampled for ESR, total serum protein
and some anthropometric parameters;
weight, height (and used to calculate the
BMI). Written informed consent was
obtained from each participant and study
protocol was approved by Ebonyi State
University Ethical Review Committee.
Strict anonymity was observed throughout
the study and intervention programmed
aimed at educating the quarry workers on
the safety and health implications of their
work instituted. Sample size was
calculated using the method of Cochiran
(1977).
A total of 196 individuals comprised of
100 quarry workers (age between 18 -57
years) and 96 age/sex-matched manual
workers not exposed to quarry dust as
control population were sampled beween
October to December 2019. Quarry
workers with less than one year experience
were excluded. Six milliliters of blood was
collected from each participant and
adequately distributed into EDTA bottles
for ESR and plain vial for serum protein.
The ESR was done without preservation
and not more than 1 hour after collection
while serum for protein was separated
within one hour after centrifugation,
labeled appropriately preserved at -70oC.
Measurements of variables:
Anthropometric parameters (weight,
height) of donors were measured using
standard protocol. The height (in meter),
weight (in kilogram) were used to
calculate the body mass index (kg/m2)
using the following formula. Body mass
index is the current weight (kg) divided by
height (m2).
The serum protein was estimated using
RANDOX TP reagent kit method. The
ESR estimations were done without
preservation within 1hour using standard
methods. Data were analyzed using
Pearson correlation and Student T-test,
adapted from Statistical Package for Social
Sciences (SPSS) version 22 and Microsoft
excel software. Statistical significance was
set at p < 0.05.
RESULTS:
There are 68 stone crushing plants at
Quarry Industrial Layout Okpossi
Umuoghara, Ebonyi State – Nigeria.
About 1250 workers are daily engaged in
plants stone processing and transportation.
The machines are mainly operated by men
while the majority of females are engaged
in grading and sorting of products. All the
workers work for 9hours daily between
8am and 5pm except on Sundays.
Mean value of 55.92 ± 29.75mm/hr, 7.18 ±
0.60g/dl and 23.81 ± 5.37kg/m2 were
recorded for ESR, total protein and BMI in
quarry workers respectively, compared
with mean values of 17.02 ± 15.42, 6.44 ±
1.86 and 22.37 ± 3.55 in control

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
27
population (Table 1). There were
significant differences (p<0.05) in ESR
and total protein between the quarry
workers and control groups, while the BMI
between the two groups showed no
significant difference. There was no
significant difference based on gender
when the three parameters were compared
among the quarry workers (Table 2).The
ESR differed significantly in all the age
brackets when compared with controls
(Table 3). The effect of duration of
quarrying activity on ESR, total protein
and BMI respectively were not significant
though those who had worked for 2-3
years had the least values in ESR, serum
protein and BMI (Table 4).
Table 1: Mean ± SD of ESR, Total Protein and BMI among quarry workers
compared with control
Parameters
QW (N=100)
Contl. (N=96) T-value
p-value
ESR (mm/hr)
55.92 ± 29.75
17.02 ± 15.42 8.068
0.000
Total Protein (g/dl)
7.18 ± 0.60
6.44 ± 1.86 2.817
0.007
BMI (kg/m2)
23.81± 5.37
22.37 ± 3.55 1.831
0.073
Key:
QW = Quarry workers
Contl. = Control population
ESR = Erythrocyte sedimentation rate
BMI = Body mass index
Table 2: Comparison of male & female Mean ± SD values of ESR, Total Protein and
BMI among different genders of quarry workers.
Parameters
Males
(N =38)
Females
(N=62) T-value
p-value
ESR (mm/hr)
53.00 ± 33.24
58.62 ± 26.60 0.662
0.511
Total Protein (g/dl)
7.11 ± 0.54
7.17 ± 0.66 0.304
0.763
BMI (kg/m2)
24.49 ± 5.55
23.16 ± 5.24 0.868
0.380

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
28
Table 3: Comparison of Mean ± SD values of ESR, Total Protein and BMI among
different age groups compared with control.
Age
group
ESR(mm/hr)
Total protein(g/dl)
BMI(kg/m2)
Exp
Ctrl
p-value
Exp
Ctrl
p-value
Exp
Ctrl
p-value
18-27
(N=36)
46.2± 22.4
18.8± 16.5
0.006
7.0± 0.5
6.5± 2.0
0.361
23.2 ± 5.8
22.3± 3.2
0.577
28-37
(N=29)
70.7± 30.1
22.8± 21.5
0.011
7.4± 0.7
6.5± 2.1
0.138
23.9± 5.9
23.4 ±4.2
0.867
38-47
(N=21)
54.6± 34.5
13.2± 11.3
0.002
71.9±0.38
7.1± 0.5
0.730
24.0± 4.8
21.0± 3.0
0.057
48-57
(N=14)
53.1± 29.1
13.5 ± 9.4
0.002
7.0± 0.84
5.8± 2.0
0.093
24.3± 5.5
22.9± 3.7
0.400
Table 4: Comparison of Mean ± SD values of ESR, Total Protein and BMI based on
duration of work at the quarry site
Duration of
Quarrying
activity
< 2 yrs
(N=41)
2 – 3 yrs
(N=32)
> 3yrs
(N=27)
F – Value
P - Value
ESR (mm/hr)
63.1± 33.3
49.1± 27.5
68.0± 32.7
1.734
0.188
Total
Protein(g/dl)
7.25± 0.7
7.07± 0.6
7.21± 0.6
0.442
0.645
BMI (kg/m2)
25.76± 7.0
23.58± 5.1
23.11± 3.5
0.767
0.470
DISCUSSION:
Erythrocyte sedimentation rate (ESR) is a
nonspecific test that indirectly measures
the degree of inflammation; acute caused
by trauma, injury or infection or chronic
conditions such as autoimmune
diseases or malignancies (Liagat et al.,
2009; Yousuf, et al., 2010, Swami et
al.,1994). The red cells settle at a faster
rate in the presence of an increased level
of proteins, particularly acute phase
reactants such as C-reactive protein
(CRP) and fibrinogen in response to
inflammation as part of the body's early-
induced non adaptive immune response

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
29
(Ogbanshi & Akubugwo). The rise in
globulin which is among the total proteins
in the blood encourages rouleax formation
and hence the red blood cells sediment at
a faster rate (Osbaldison, 1997).
Evidences suggest that inhaled quarry
dust elicits an inflammatory response in
workers and hence affects the ESR
(NOISH, 1996; Hetland et al., 2001).
In this study, the ESR increased
significantly among the quarry workers
and at different durations of exposures
when compared with control. It suggests
that the inhaled quarry dust elicits an
inflammatory response in the test group
hence the raised ESR values observed.
The ESR elevation has been associated
with acute-phase proteins produced by the
liver and the rise in globulin which is
among the total serum proteins
(Osbaldison, 1997). This is similar to the
findings of previous researchers (Ashwini
et al., 2016; Osaro et al., 2013; Bitik et al.,
2015). A single and short term exposure
to these dusts may presents little or no
hazard but prolonged or repeated
exposure depending on the duration, level
of exposure and individual sensitivity may
present with health implications on the
skin, eye, respiratory and hematological
systems. This may be associated with
genotoxic effects seen in people
occupationally exposed to cement dust
causing genetic damage like minor
chromosomal aberrations, decrease in
mitotic index and increased frequency of
sister chromatid exchanges (Jude et al.,
2002).
A serum protein is closely regulated, but
alterations in serum protein may occur in
wide range of diseases. Protein estimation
has diagnostic and prognostic utilities and
changes in their concentrations during
disease process may provide important
information for assessing health state
(Zalewska et al 2014). Hence total serum
protein was assessed among quarry
workers in this study.
Mean significant in difference was
observed when compared with control but
there were no significance difference in
gender and duration of exposure. The
mean increase in the quarry workers in
this study could not be explained. This
probably may be due to elevation of some
inflammatory mediators produced by the
liver and the rise in globulin which is
among the total serum proteins
(Osbaldison, 1997). The acute phase
proteins; C-reactive proteins (Lepic et al.,
2019), tumour necrosis factor (TNF-α) (El
Shafy et al 2018) as well as Clara proteins
(Bernard et al., 1994; Gaballash et al
2008) have been found to be elevated in
inflammatory disease associated with
quarry dust exposures. There is need
therefore for protein profile studies which
may possibly explain the reason for the
significant elevation in mean serum
protein level among the quarry workers.
Another important inflammatory mediator
that may possible be examined is the
mannan-binding lectin (MBL); which is
important in host defense against
pathogens and possibly against cancer
(Turner, 2003; Staurt et al., 2005; Gong et
al., 2007; Erdemir et al., 2015). Mannan-

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
30
binding lectin (MBL) plays a major role
in innate immunity due to its ability to
opsonize pathogens, to enhance their
phagocytosis, and to activate the
complement cascade via the lectin
pathway. This inflammatory mediator has
been shown to influence the inflammatory
response to the initial injury in critical
illnesses (Ytting et al., 2006; Filho et al.,
2010) and modulates the TNF. The MBL
modulation of TNF has been shown to be
dose dependent. At low doses of MBL,
increasing MBL concentration increases
production of pro-inflammatory
cytokines. But at higher concentrations,
increasing MBL suppresses these
inflammatory cytokines (ibid). It is
possible that in exposure to quarry dust
and the attendant respiratory diseases may
affect the level and functions of MBL and
which may enhance the pro-inflammatory
cytokine response.
The Centre for Disease Control, Atlanta
Georgia; USA defined Body Mass Index
(BMI) as a number calculated from a
person's weight and height (CDC, 2014).
Body mass index provides a reliable
indicator of body fatness for most people
and is used to screen for weight categories
that may lead to health problems. This is a
numerical value of one’s weight in
relation to the height. A BMI between
18.5 and 25 kg/m² indicates a normal
weight. A BMI of less than 18.5 kg/m² is
considered underweight. A BMI between
25 kg/m² and 29.9 kg/m² is considered
overweight. A BMI of 30 kg/m² or higher
is considered obese (AHA, 2014).
Variations in BMI have been associated
with different diseases (Adebamawo et
al., 2003; Ogundiran et al., 2010).
Previous study by Chinedu et al., (2013),
among school adolescents in Sokoto
presented low prevalence of obesity.
Under-nutrition may be caused by a
deficient intake, increased requirements,
or an inability to absorb or use nutrients
(Smolin and Grosvenor, 2008).
In this study there was no significant
difference in BMI between the Quarry
workers and other laborers not exposed to
dust.
There was no case of malnutrition
established; instead they fall within the
acceptable and healthy BMI. The
elevations in ESR and serum proteins are
therefore not associated with malnutrition
suggesting the possible triggers by
respiratory inflammatory responses.
CONCLUSION:
Majority of the quarry workers in Okposi
- Umuaghara Industrial Estate are female,
low income and uneducated who are not
aware of the health implications of
exposure to quarry dust. The inhalation of
quarry dust by these workers possibly
leads to increase in ESR and total protein
observed. There is no health policy
governing quarry industry in Nigeria or
environmental health impact assessment.
There is need for governmental health
policy aimed at protecting the workers
and the environment.

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
31
REFERENCES:
Adebamawo C.A., Ogundiran T.O.,
Adenipekun A.A., Oyesegun R.A.,
Campbell O.B., Akang E.U, Rotimi
C.N. & Olapade O.I. (2003). Obesity
and Height in Urban Nigerian
Women with Breast Cancer. Annals
of Epidemiology, 13 (6): 455-461.
American Heart Association (AHA),
(2014). Body mass index in adults.
(BMI calculator for adults)
{Accessed online, 23rd Feb 2020}.
Al-Otaibi F.S., Ajarem J.S., Abdel-
Maksoud M.A., Maodaa S., Allam
A.A., Al-Basher G.I. & Mahmoud
A.M. (2018). Stone quarrying induces
organ dysfunction and oxidative
stress in Meriones libycus. Toxicol
Ind Health, 34(10): 679-692. doi:
10.1177/0748233718781290.
Ashwini S., Swathi K. & Shaik H.S.
(2016). Effects of cement dust on
haematological and liver function
tests parameters. International
Journal of Current Pharmaceutical
and Clinical Research, 6(1): 70-73.
[Accessed Apr 23 2020].
Bernard A.M., Gonzalez-Lorenzo J.M.,
Siles E., Trujillano G., & Lauwerys
R. (1994). Early decrease of serum
Clara cell protein in silica-exposed
workers. Eur Respir J, 7(11):1932-
1937.
Bitik B., Mercan R., Tufan A., Tezcan E.,
Küçük H., İlhan M., Öztürk M.A.,
Haznedaroğlu S. & Göker B. (2015).
Differential diagnosis of elevated
erythrocyte sedimentation rate and C-
reactive protein level: a rheumatology
perspective. European Journal of
Rheumatology, DOI:
10.5152/eurjrheum.2015.0113.
Centre for Disease Control (CDC),
(2014). The United States Cancer
Statistics: 1999–2012 Incidence and
Mortality Web-based Report. Centre
for Disease control.
Chinedu S.N., Ahmed H. & Airede K.
(2013). Body mass index among
school adolescents in Sokoto, North-
Western Nigeria. Sahel Medical
Journal, 16:5-9.
El Shafy W.S., Manawil M. & El-Sherief
G.H. (2018). Impact of dust exposure
among stone quarry workers on
ventilatory functions and serum level
of tumour necrosis factor- alpha
(TNF-α). Egyptian Journal of
Occupational Medicine, 42 (3): 443-
452. DOI:10.21608/ejom.2018.22491
Erdemir G., Ozkan T.B., Ozgur T., Budak
F., Kilic S.S. & Onay H. (2015).
Mannose-binding lectin gene
polymorphism and chronic hepatitis
B infection in children. The Saudi
Journal of Gastroenterology, 21(2):
84-89.
Ezeonu F.C. & Ezejiofor T.I.N. (1999).
Biochemical indicators of
occupational health hazards in
Nkalagu cement industry workers,

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
32
Nigeria. Science of the Total
Environment, 228(2-3): 275-278.
Filho R.M., Carmo R.F., Catsman C.,
Souza C., Silva A. & Moura P.
(2010). High frequency of variant
alleles of the mannose-binding lectin
2 (MBL2) genes are associated with
patients infected by hepatitis B virus.
Viral Immunology, 23:449-453.
Gaballah F & Rashed A. (2008). Clara
cell protein CC16 as a biological
marker of lung injury among quarry
workers exposed to pm2.5. Egyptian
Journal of Occupational Medicine, 32
(1): 29-58. DOI: 10.21608/EJOM.
2008.659.
Gong M.N., Zhou W., Williams P.L.,
Thompson B.T., Pothier L. &
Christiani D.C. (2007).
Polymorphisms in the mannose
binding lectin-2 gene and acute
respiratory distress syndrome.
Critical Care Medicine, 35(1): 48–
56.
Hetland R.B., Refsnes M., Dahl J.E.,
Dahlman H.J. & Schwarze P.E.
(2001). Rat lung inflammation and in
vitro exposure to various stone
particles. Inhalation Toxicol 13: 789-
805.
Jude C.A.L., Sasikala K., Ashok Kumar
R., Sudha S. & Raichel J. (2002).
Haematological and cytogenetic
studies in workers occupationally
exposed to cement dust. Int. J. Hum.
Genet, 2(2): 95-99.
Lapić I., Padoan A., Bozzato D. &
Plebani M. (2019). Erythrocyte
Sedimentation Rate and C-Reactive
Protein in Acute Inflammation: Meta-
Analysis of Diagnostic Accuracy
Studies. American Journal of Clinical
Pathology, 153(1):14-29.
Liaqat, I. Arshad M., Arshad R. & Arshad
N. (2009) Exposure to textile
chemicals leads to microcytic
anaemia and hypersensitivity in
textile workers. Pakistan Journal of
Zoology, 41(5):381 - 387.
National Institute for Occupational Safety
and Health (NIOSH). Work-Related
Lung Disease Surveillance Report
2002. Publication No. 2003-111;
Cincinnati, OH: National Institute for
Occupational Safety and Health,
2003.
National Institute for Occupational Safety
and Health (OISH), (1996). Health
effects of occupational exposure in
respirable cystalline silica. Journal of
Occupational Health 24: 10-15.
Nwibo A.N., Ugwuja E.I., Nwambeke
N.O., Emelumadu O.F. & Ogbonnaya
L.U. (2012). Pulmonary Problems
among Quarry Workers of Stone
Crushing Industrial Site at
Umuoghara, Ebonyi State, Nigeria.
Int J Occup Environ Med. 3(4):178-
85.
Occupational Safety and Health
Administration (OSHA). (2004).
1218-AB70-2040. Occupational

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
33
Exposure to Crystalline Silica.
OSHA:
http://www.osha.gov/pls/oshaweb/
owadisp.show_document?p_tableUN
IFIED_AGENDA&p_id4189 (April
9, 2020).
Ogbanshi M.E. & Akubugwo E.I. (2013).
(Heavy metal concentration and
toxicity studies on rabbits exposed to
Quarry Dust Journal of
Environmental Science, Toxicology
and Food Technology, 6(1): 64-67.
Ogundiran T.O., Huo D., Adenipekun A.,
Cambell O., Oyesegun R., Akang E.,
Adebamowo C. & Olapede O.I.
(2010). Case control study of breast
size nd breast cancer risk in Nigerian
women. American Journal of
Epidemiology, 172(6): 682-690.
Osaro E., Kebbe B.I., Isaac I.Z., Nasiru
A., Marafa Y. & Augustine N.O.
(2013). Effect of occupational
exposure of cement dust on some
haematological parameters of
workers in a cement company in
Sokoto, Nigeria. International
Journal of Medical Science and
Health, 1(7):21-25.
Osbaldison G.W. (1997). Erythrocyte
sedimentation studies in Sheep Dog
and Horse. Cornell Vet, 61: 386-399.
Rom W.N., Markowitz S., eds. (2007).
Environmental and Occupational
Medicine. 4th ed. Philadelphia, PA:
Lippincott Williams & Wilkins.
Shrivastava A., Tomarz S.P. & Patel M.
(2018). Prevalence of symptoms of
occupational lung diseases in marble
cutting workers. Int J Community
Med Public Health, 5(8):3368-3371
Smolin L.A. & Grosvenor M.B. (2008).
Nutrition: Science and Applications.
Belmont, California: Courier/
Kendallville 411-428.
Stuart L.M., Takahashi K., Shi L., Savill
J. & Ezekowitz R.A. (2005).
"Mannose-binding lectin-deficient
mice display defective apoptotic cell
clearance but no autoimmune
phenotype". Journal of Immunology,
174 (6): 3220–3226.
Swami A., Chopra V.P. & Malik S.L.
(1994). Occupational Health Hazards
in Stone Quarry Workers: A
Multivariate Approach Journal of
Human Ecology, 5(2): 97-103.
doi.org/10.1080/09709274.1994.1190
7078.
Turner M.W. (2003). The role of
mannose-binding lectin in health and
disease. Molecular Immunology,
40:423–429.
World Health Organization (2006).
Elimination of Asbestos-Related
Diseases. Geneva, Switzerland:
World Health Organization;
Yousuf M., Akhter J., Al-Khairy, K., Al-
Saadan M.A. & Bin-Salih S. (2010).
Extremely elevated erythrocyte
sedimentation rate Etiology at a

Chukwurah E.F., Ejeromedoghene R.F. and Chukwura F.C./Journal of Environmental Management and Safety Vol. 11, No. 1, (2020) 24 – 34
34
tertiary care centre in Saudi Arabia.
Saudi Medical Journal, 31 (11): 122.
Ytting H., Christensen I.J., Basse L.,
Lykke J., Thie L.S., Jensenius J.C &
Nielsen H.J. (2006). Influence of
major surgery on the mannan-binding
lectin pathway of innate immunity.
Clinical and Experimental
Immunology, 144(2): 239–246.
Zalewska M., Gawin A., Sciskalska M.,
Moczulski M. & Milnerowicz H.
(2014). Capillary electrophoretic
separation of serum proteins of
workers occupationally exposed to
heavy metals. International Journal of
Environmental Analytical Chemistry.
94(14-15): 1422-1434.
doi.org/10.1080/03067319.2014.9625
30