Vol. 12 No. 3 (2020): Archives of Public Health
Public Health

Systematic review and comparative analysis of current methodological approach for risk assessment of “Ohis Plant Skopje”

Sandra Kosteska
Institute for Accreditation of the Republic of North Macedonia
Dragan Gjorgjev
Institute of public health of Republic of North Macedonia; Medical Faculty, University Ss Ciril and Methodius, Skopje, Republic of North Macedonia

Published 2020-12-15


  • health impact assessment,
  • health risk assessment,
  • industrially contaminated sites,
  • epidemiological studies,
  • exposure assessment

How to Cite

Kosteska S, Gjorgjev D. Systematic review and comparative analysis of current methodological approach for risk assessment of “Ohis Plant Skopje”. Arch Pub Health [Internet]. 2020 Dec. 15 [cited 2024 Apr. 21];12(3):16-29. Available from: https://id-press.eu/aph/article/view/5654


Considering complicity in ecological health and social aspects of industrial contaminated sites (ICSs), the methodologies and approaches of health impact assessments are very heterogeneous. ICSHNet together with WHO recommend two main methodological approaches: health risk assessments and epidemiological studies. Some countries have necessary experience for impact assessment of ICSs, but others have limited resources and less intensity studies. In the Republic of North Macedonia, 16 ICSs are identified, but one of them, lindane dumpsite in OHIS Plant is characterized as the most ecological and public health risk. The general aim: Systematic review of literature data about methodological approaches for health risk assessment of ICSs on international and national level in order to make comparative analysis of current methodological approaches in the Republic of North Macedonia using the case study of ICS OHIS PLANT SKOPJE. Material and methods: The review of scientific and grey literature was performed. The selected scientific studies were searched in the PubMed and Medline databases from 2000-2017, in English and Macedonian. The selected studies and data were analyzed by required information for identification of hazards, exposure assessment and risk characterization. Additionally, the review was performed on published reports of risk assessment of OHIS Plant. Results: A total of 14 original papers were investigated. Continuous monitoring systems for gathering environmental data related to ICSs were used only in two cases and in other studies the concentrations of contaminants in the source were calculated or several ad hoc monitoring campaigns were performed. Exposure assessment was conducted according to qualitative definition for the presence/absence of a source, distance to a source and biomonitoring in the study. Mortality, cancer incidence, congenital abnormalities and hospitalizations were used health data. The study of risk assessment of OHIS Plant has ecological design and indirect quantitative exposure assessment model was used. Conclusion: All investigated studies used three main methodological approaches for exposure assessment: measurement of hazard concentration, distance from source and biomonitoring. Comparable, conducted risk assessment of OHIS Plant follows the recommendations of US EPA and ATSDR with weakness of no existing continual monitoring process and also deficiency of health data and this is the reason for limitation of health impact assessment and setting up EPHT or other public health surveillance system.


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1. WHO. Contaminated sites and health. Reports of two workshops, 2011, Siracuse, Itali, 18 November 2011, Catania, Italy, 21-22 June 2012, Copenhagen WHO Regional Office for Europe, 2013.
2. Lavarone I. Industrially Contaminated Sites and Health Network. First Plenary Conference. Industrially Contaminated Sites and Health Network (ICSHNet, COST Action IS1408). Istituto Superiore di Sanità. Rome, October 1-2, 2015.
3. Guidance on human health impact of industrially contaminated sites. Joint COST Action ad WHO Report. ICSNET Network COST Action. Edited by: Ivano Lavarone and Marco Martuzzi, (http://www.icshnet.eu/wp-content/uploads/2019/05/WHO-COST-Action-Guidance-Document.pdf, пристапено во март 2020.)
4. Lavarone I, Pasetto R. ICSHNet. Environmental health challenges from industrial contamination. Epidemiol Prev 2018;42(5-6) Suppl1:5-7.
5. Pasetto R, Martin-Olmedo P, Martuzzi M, Iavarone I. Exploring available options in characterising the health impact of industrially contaminated sites. Ann Ist Super Sanita 2016;52(4):476-82.
6. US EPA Guidelines for Human Exposure Assessments. EPA/100/B-19/001.2016, Updated 2019. (https://www.epa.gov/sites/production/files/2020-1/documents/guidelines_for_human_exposure_assessment_final2019.pdf, во март 2020)
7. Swartjes FA. Human health risk assessment related to contaminated land: state of the art. Environ Geochem Health 2015;37(4):651-73.
8. Agency for Toxic Substances and Disease Registry. Public Health Assessment Guidance Manual (2005 Update). Достапно на: https://www.atsdr.cdc.gov/hac/phamanual/pdfs/phagm_final1-27-05.pdf. Пристапено во март 2020.)
9. Crocetti E, Pirastu R, et al. SENTIERI Project: results. Epidemiol Prev 2014; 38 (2) Suppl. 1: 29-124. Достапно на: https://www.ncbi.nlm.nih.gov/pubmed/24986500. Пристапено во март, 2020.
10. IPCS. IPCS risk assessment terminology. Part 1: IPCS/OECD key generic terms used in chemical hazard/risk assessment; Part 2: IPCS glossary of key exposure assessment terminology. Geneva, World Health Organization, International Programme on Chemical Safety (Harmonization Project Document 1), 2004.
11. Albertini R, Bird M, Doerrer N, Needham L, Robison S, Sheldon L, Zenick H. The use of biomonitoring data in exposure and human health risk assessments. Environ Health Perspect 2006;114(11):1755-62.
12. Stafilov T, Peeva L, Nikov B, De Koning A. Industrial hazardous waste in the Republic of Macedonia. Applied Environmental Geochemistry – Anthropogenic İmpact on Human Environment in the SE Europe, Ljubljana, Proceedings Book (ŠAJN, R., ŽİBERT, G. & ALİJAGİĆ, J., (Eds.)), 2009, ISBN 978-961-6498-18-0, 108-112.
13. Stafilov T. Environmental pollution with heavy metals in the Republic of Macedonia.– Contributions, Section of Natural, Mathematical and Biotechnical Sciences, MASA, 2014, 35/2, 81–119.
14. Bloemen ЈThH. Biomonitoring of Macedonia. Report of Twinning Project MK 12 IB EN 01– Further strengthening the capacities for effective implementation of the acquis in the field of air quality 2016, 20 стр; Report No. 1.
15. Industrial Contaminated Sites (“hotspots”) National Waste Management Plan and Feasibility Studies. Contract No.: 01/MAC05/05/002. Ref. No.: EUROPEAID/115138/D/SV/MK.
16. Old environmental burdens in chemical plant Ohis, Skopje, Updated risk assessments, November 2009, Project of Development Cooperation of the Czech Republic and Macedonia, ENACON. http://pops.org.mk/wp-content/uploads/2020/03/Macedonia_OHIS_URA_report_final_2009.pdf. Пристапено во март 2020.
17. Removal of technical and economic barriers to initiating the clean-up activities for alpha-HCH, beta-HCH and lindane contaminated sites at Ohis Project ID 100122 - Risk Assessment Analysis Update, 2019– EMGRISA, http://pops.org.mk/wp-content/uploads/2020/03/Risk-Assessment-Analysis-Update-final.pdf, пристапено во март 2020.
18. Ganann R, Ciliska D,Thomas H. Expedityng systematic reviews: method and implications of rapid reviews. Implementation Science 2010; 5:56.
19. Biggeri A, Lagazio C, Catelan D, Pirastu R, Casson F, Terracini B. Report on health status of residents in areas with industrial, mining or military sites in Sardinia, Italy. Epidemiol Prev 2006;30(1) Suppl 1:5-95.
20. Brand E, Otte PF, Lijzen JPA. CSOIL 2000: an exposure model for human risk assessment of soil contamination. A model description. RIVM report 711701054/2007. 2007. Available from:https://www.rivm.nl/dsresource?objectid=b1300413-2fb6-4c18 a38332c921f6e592&type=org&disposition=inline
21. Pasetto R, Ranzi A, Togni A, et al. Cohort study of residents of a district with soil and groundwater industrial waste contamination. Ann Ist Super Sanita 2013; 49(4):354-57.
22. Pukkala E. A follow-up of cancer incidence among former Finnish dump site residents: 1999-2011. Int J Occup Environ Health 2014;20(4):313-17.
23. Ranzi A, Fano V, Erspamer L, Lauriola P, Perucci CA, Forastiere F. Mortality and morbidity among people living close to incinerators: a cohort study based on dispersion modeling for exposure assessment. ‎Environ Health 2011;10:22.
24. Cordioli M, Ranzi A, De Leo GA, Lauriola P. A review of exposure assessment methods in epidemiological studies on incinerators. J Environ Public Health 2013; 2013:129470.
25. Porta et. Al. A biomonitoring study on blood levels of beta-hexachlorocyclohexane among people living close to an industrial area. Environmental health 2013,12:57.
26. Pascal L, Pascal M, Stempfelet M, Goria S, Declercq C. Ecological study on hospitalizations for cancer, cardiovascular, and respiratory diseases in the industrial area of Etang-de-Berre in the South of France. J Environ Public Health 2013;2013:328737.
27. García-Pérez J, Morales-Piga A, Gómez-Barroso D, et al. Residential proximity to environmental pollution sources and risk of rare tumors in children. Environ Res 2016;151:265-74.
28. Candela S, Ranzi A, Bonvicini L, et al. Air pollution from incinerators and reproductive outcomes: a multisite study. Epidemiology 2013;24(6):863-70.
29. Davoli E, Fattore E, Paiano V, et al. Waste management health risk assessment: a case study of a solid waste landfill in South Italy. Waste Manag 2010;30(8-9):1608-13.
30. Ranzi A, Ancona C, Angelini P, et al. Health impact assessment of policies for municipal solid waste management: findings of the SESPIR Project. Epidemiol Prev 2014;38(5):313-22.
31. World Health Organization. Environment and health risks: a review of the influence and effects of social inequalities. Copenhagen: WHO Regional Office for Europe; 2010.
32. Pascal M, Pascal L, Bidondo ML, et al. A review of the epidemiological methods used to investigate the health impacts of air pollution around major industrial areas. J Environ Public Health 2013;2013:737926.
33. Savitz D. When is epidemiological research a helpful response to industrial contamination? Epidemiol Prev 2018;42(5-6) Suppl 2:89-92.
34. Martin-Olmedo P, Hams R, Santoro M, et al. Environmental and health data needed to develop national surveillance systems in industrially contaminated sites. Epidemiol Prev 2018;42 (5-6) Suppl1:11-20.
35. http://pops.org.mk/wp-content/uploads/2020/03/CARDS-2006_FEASIBILITY-STUDY_Volume-I_OHIS-Plant.pdf, пристапено во март 2020.
36. Martin-Olmedo P, Sánchez-Cantalejo C, Ancona C, Ranzi A, Bauleo L, Fletcher T et al.Industrial contaminated sites and health: results of a European survey. Epidemiol Prev 2019; 43 (4):238-248.
37. Shaddick G, Ranzi A, Thomas ML, Aguirre-Perez R, Dunbar Bekker-Nielsen M, Parmagnani, F et al. Towards an assessment of the health impact of industrially contaminated sites: Waste landfills in Еurope. Epidemiol Prev 2018, 42, 69-75.
38. Hänninen O, Knol AB, Jantunen M, et al. Environmental burden of disease in Europe: assessing nine risk factors in six countries. Environ Health Perspect 2014;122(5):439-46.
39. Martin-Olmedo P, Hams R, Santoro M, Ranzi A, Hoek G, de Hoogh K et al. Environmental and health data needed to develop national surveillance systems in industrially contaminated sites. Epidemiol Prev 2018, 42, 11-20.