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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 140-144

Evaluation of respiratory health among refuse management and sanitation board workers in Kano metropolis


1 Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
2 Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University; Department of Physiotherapy, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Physiotherapy, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Submission02-Jan-2020
Date of Decision05-Jan-2020
Date of Acceptance11-Aug-2020
Date of Web Publication9-Oct-2020

Correspondence Address:
Mr. Yunusa Muhammad
Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_1_20

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  Abstract 


Context: Kano State Refuse Management and Sanitation board workers are constantly exposed to bioaerosol inhalation, including toxins and biotoxins that are been released from the waste. Aims: The aim of this study is to evaluate and determine the respiratory health status of Workers. Methodology: The study was a cross-sectional survey with 129 participants recruited using a convenience sampling technique. Forced vital capacity, forced expiratory volume in 1 s and St. George questionnaire were used to collect data and the result was analysed using descriptive statistics of frequencies, percentages and graphs, while the differences and relationships were obtained using one-way ANOVA and Spearman rank correlation co-efficient, respectively. Results: The mean age of the participants was 34.2 years. Up to 75.2% of the participants were male, whereas 24.8% were female. Up to 40% of participants did not have any respiratory symptoms, 35% had mild symptoms, 14% had moderate symptoms and 11% had severe respiratory symptoms. The symptoms include dyspnea, coughing, excessive mucus secretion and breathlessness. Respiratory symptoms was positively related to the length of exposure (P = 0.029). There was no significant difference in respiratory symptoms between waste collectors, sweepers and drivers. Furthermore, no relationship was found between the age of the workers and respiratory symptom (P = 0.056). Significant difference (P = 0.003) was observed between gender of the participants and respiratory health. Conclusions: Waste disposal work has significant impact on respiratory health. The provision of health education for safety and proper use of personal protection is necessary to reduce the impact of pollutant on respiratory health.

Keywords: Evaluation, exposure, refuse management, respiratory health, sanitation


How to cite this article:
Muhammad Y, Ahmad RY, Dambatta AS, Abubakar Y. Evaluation of respiratory health among refuse management and sanitation board workers in Kano metropolis. Niger J Basic Clin Sci 2020;17:140-4

How to cite this URL:
Muhammad Y, Ahmad RY, Dambatta AS, Abubakar Y. Evaluation of respiratory health among refuse management and sanitation board workers in Kano metropolis. Niger J Basic Clin Sci [serial online] 2020 [cited 2020 Oct 29];17:140-4. Available from: https://www.njbcs.net/text.asp?2020/17/2/140/297596




  Introduction Top


Refuse management and sanitation are becoming the major concern issue for environmental safety and public health by the governments in the growing cities most especially in Africa due to the linear increase in the industrial revolution that leads to the emergence of different types of wastes.[1] These types of wastes did not exist previously in Kano Metropolis. The previously existing waste was mostly ashes dust, dry leaves and stumps from farmlands, waste from animal feces and waste from food processing remnants.

Today, due to the increase in industrialization, there is in addition to the previously existing waste plastic, rubber cans, leathers, broken glasses, decayed and decomposed organic matters and waste from food processing and production and packaging. The decomposition of poorly disposed organic wastes leads to the release of bio-aerosols that lead to the generation of harmful agents such as bacteria and fungi and certain endotoxins and mycotoxins. This agents provoke an inflammatory response in the airway.[2] Activity that involves the physical effort of the respiratory and skeletal muscles during lifting and manhandling (loading of waste in the trucks) in refuse management waste disposal process in the landfills by waste disposal workers provokes a ventilatory response that leads to the increased respiratory frequency and flow volume.[3] An increase in the amount of bioaerosol inhaled, including dust particles, vehicle exhaust fumes and gases are reported to be responsible for the higher incidence of respiratory disease among refuse workers.[3]

Although inadequate waste and refuse disposal methods are being perceived by many people as a narrow ecological problem, in reality, it has a significant physiological, sociological and political ramification.[1] Kano State Refuse Management and Sanitation Board (REMASAB) workers are constantly exposed to bioaerosol inhalation, including toxins and biotoxins that are been released from the waste.

Epidemiological studies have been carried out previously on respiratory conditions associated with waste disposal in Palestine.[4] Waste collectors have been shown to suffer from increased airway inflammation and respiratory symptoms compared with controls.[5] A study carried out in Egypt indicated that shortness of breath was the most frequent respiratory complaint among solid waste collectors.[6] In Tanzania, nasal irritation accounted for the most complaint among solid waste collectors.[7] A study in Ethiopia showed that an occupational injury among solid waste collectors was at a level that needed immediate public health action.[8] A study in Port-Harcourt, Nigeria, on the respiratory status of waste disposal workers, shows that a significant number of them had respiratory symptoms, which was attributed to low levels of pollutants present in the waste disposal landfills.[9] Although many studies have shown the impact of refuse management work on the respiratory health of the workers, its necessary to carry out this study in Kano looking at the composition of the waste in Kano might defer from the other countries and this study is planned to measure the lung parameters in relation to the symptoms of respiratory problems giving clear picture by using a sensitive and reliable tool that can determine the respiratory problems. The aim of this study is to evaluate the respiratory health status of REMASAB Workers and to determine the relationship between the length of exposure and respiratory disease symptoms. The study will also determine the relationship between age and the respiratory disease symptoms secondary to the REMASAB work. In addition, this study is also aimed at determining the difference between the type of work, and the respiratory disease symptoms in relation to their level of activity. Furthermore, the study will determine the difference between the gender of the study participants and the activity level secondary to the respiratory disease symptoms.


  Methodology Top


Research design

The study was a cross-sectional survey design.

Participants of the study

The population of the research study was workers of Kano state REMASAB (Collectors, sweepers, drivers). The participants that were included were only those who were between the ages of 18 years and above, had worked for more than 1-year, and those that were not smoking or has stopped smoking for at least 6 months before the study is been conducted. The participants who were excluded were those who were employed for less than a year and those who current smokers at the time where the study was conducted.

Sample size

The sample size was calculated by using the formula as follows: n = z2pqD/d2.[10]

n = Desired minimal sample size (where population < 1000).

The prevalence of respiratory symptoms among waste disposal workers in Africa is 11.1%[11] therefore.

P = 0.111.

z = the standard normal deviation which is equal to 1.96 at 95% confidence level.

So, z2 =3.8416.

q = 1 − p, = 0.95.

D = desired effect = 0.8.

d = degree of accuracy (the level of statistical significance set) which in this case is 0.05,

d2 = (0.05)2 = 0.0025.

Thus,

n = 1.962 × 0.111 × 0.95 × 0.8/0.0025 = 129.6. Therefore, a minimum of 129 REMASAB workers was selected.

The total number of 129 REMASAB workers including male and female (collectors, sweepers and drivers) were recruited in the study.

Sampling technique

Convenience sampling was used to recruit the participants from the study population based on the study purpose and its inclusion and exclusion criteria. Participants who have signed the written informed consent and have agreed to participate in the study were recruited.

Data collection instruments

Spirometer: A spirometer device (CE 0120) was used to measure lung function parameters such as forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC).

St George Respiratory questionnaire[12] is a valid and reliable tool used in assessing respiratory compromise in several pulmonary conditions. It is a self-administered questionnaire divided into three parts with eight questions each and 17 questions all together. The first part addresses the frequency of respiratory symptoms, whereas the second part addresses the activity limitation secondary to respiratory symptoms, and the third part addresses the impact of respiratory symptoms on the participation restrictions.

Data collection procedure

Ethical approval for the study was sought and obtained from the relevant bodies. Consent was obtained from participants who are willing to participate in the study after being informed of the nature of the study. The relevance and nature of the study was be explained in the Hausa language, and the questionnaire was also translated in the Hausa language for easy understanding to all the participants, and they were informed that they could opt-out of the study at any point if they wished to do so. The participants were also been assured of their confidentiality on all the information given.

Measurement of pulmonary function by spirometry

The pulmonary function of each participant was assessed. This includes the FVC and FEV1. The measurement was carried out using the American Thoracic Society guideline. The test was performed with the participants seated comfortably, but in an upright positing with both feet flat on the floor. They were instructed to take a deep breath and have their lips sealed around the spirometer's mouthpiece and exhale fast and forcefully as they can over at least a 6-s period through the sensor.

Administration of the St George respiratory questionnaire

The questionnaire was designed for self-administration (translated in the Hausa language); it was completed in a quiet area, free from distraction with the participant sitting on a desk or table. The participant was told the importance of completing the questionnaire honestly and the need to answer all questions. The scoring of the questionnaire was based on the St George respiratory questionnaire manual.[12]

Data analysis

The descriptive data obtained were described and summarised using descriptive statistics of frequencies, percentages and graphs. One-way ANOVA was used to compare the means of St George questionnaire and spirometric values obtained with the three independent groups of sweepers, waste collectors and drivers. Spearman rank correlation coefficient was used to determine the relationship between duration of exposure (length of work), age of the study participants and respiratory health. An independent t-test was used to determine the variation in gender with respiratory health. All statistical analyses were performed at 0.05 alpha levels using the Statistical Package for the Social Sciences (SPSS) version 20.0 software (SPSS Inc. Chicago, Illinois, USA).


  Results Top


The mean age of the participants was 34.2 years, up to 72% (75.2%) of the participants were male, while 24.8% were female. All the research participants were adult between the age groups of 18–29 years (6.2%), 30–41 years (32.6%), 42–53 years (34.1%) and 54–65 years (21.7%). Most of the workers (69.8%) have spent 11–20 years working in REMASAB, 22.5% have spent between 1 and 10 years working with the agency, 6.2% have 21–30 years, while the remaining 1.6% spent between 31 and 40 years [Table 1].
Table 1: Sociodemographic data

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Respiratory health status of the REMASAB workers showed many symptoms of respiratory impairments, including dyspnea, coughing, excessive mucus secretion and breathlessness. As much as 40% of the participants did not have any respiratory symptoms, while the remaining 60% of the participants had mild-to-severe symptoms [Figure 1]. The manifestation of respiratory disease symptoms was directly proportional to the length of exposure P = 0.029 [Table 2]. Moreover, there was no relationship between the age of the workers and respiratory disease symptoms P = 0.056 [Table 2]. However, a significant variation (P = 0.003) was observed between the gender of the participants and respiratory health. There was no significant difference between waste collectors, sweepers and drivers in respiratory disease symptoms [Table 3].
Figure 1: Respiratory health status of the participants

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Table 2: The relationship of duration of work (length of exposure), age gender and the respiratory disease

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Table 3: Variation among waste collectors, waste sweepers, and drivers in manifestation of respiratory disease symptoms

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  Discussion Top


Respiratory impairments are diffuse and diverse with different kinds of signs and symptoms ranging from cough, phlegm, breathlessness, wheezing, crackling and fatigue.[7] REMASAB workers in Kano were found to have many symptoms of respiratory impairments, such as dyspnea, coughing, excessive mucus secretion and breathlessness.

The result of the current study indicated that the more the years of working, the more symptoms of the respiratory disease manifest on the individual worker due to constant and prolonged exposure to the polluted air. Symptoms of the inflammatory response in the upper airways were reported in some workers with nose congestion, sore throat and dry cough frequently in connection with symptoms of the eyes like redness and lacrimation, also referred to as mucous membrane irritation subsiding several hours after cessation of exposure.[9]

Studies have indicated an association between waste exposure and respiratory disease symptoms.[13] A study in port Harcourt Nigeria on the respiratory health of waste disposal workers has indicated that the majority of them had respiratory symptoms that may be attributed to low levels of pollutants present in the waste disposal landfills.[14]

The current study indicated that the more the years of working, the more activities of daily living will become impaired due to the respiratory impairment manifestation on the individual worker on account of constant and prolonged exposure to the polluted air. The more the years of working, the more the participation restriction will become marked due to the respiratory impairment on the individual worker on the account of the severity of the respiratory compromise. In a 5-year follow-up study on respiratory disorders and lung function in workers exposed to organic dust from composting plants, 12 compost workers quit their employment due to airway complaints and significantly higher frequency of allergic symptoms.[15]

This study has found a low FVC and FEV1 score for the individuals that work for a very long time in REMASAB with varying degrees of symptoms for respiratory impairments. The result was similar to the findings of post-exposure assessment of pulmonary function, which indicated that 28% of the workers had abnormal spirometry. Force vital capacity was low in 21% of the workers and some pulmonary conditions were detected among workers such as asthma cough and airway dysfunction syndrome.[16] In a 5-year follow-up study on respiratory disorders and lung function in workers exposed to organic dust from composting plants, a 10% decline in FVC in percent of predicted (FVC%) of the non-smoking compost workers was observed compared to controls.[15] This indicates a reduction in lung function parameters due to the constant and prolonged exposure to the waste.

There was no relationship between the age of the participants and postexposure respiratory disease symptoms. It has been theoretically established that aging affects a number of parameters of lung function, such as ventilation, gas exchange and compliance, as well as pulmonary defense mechanisms. The observed nonrelationship might be attributed to the middle age level of the study participants (72.0% of the workers are below the age of 53 years) at this age-related respiratory decline is not expected to be manifested depending on the lifestyle of the individual.

The significant difference was observed between the waste collectors and drivers and waste collectors with waste sweepers with FEV1 of the study participants. The study conducted in England 2003 also found a significant difference in post-exposure respiratory health involvement among waste collectors, sweepers and waste sorting workers and waste incinerators.[16] A study conducted in Chandigarh, India, to assess the occupational exposure of the municipal solid waste workers in 2016 also found a high prevalence of respiratory disorders, which differ injuries among street sweepers, waste collectors and processors and rag pickers who manually handling the municipal solid waste contents.[17] Conversely, this study did not find any difference in St George respiratory questionnaire among the group of workers (waste collectors and drivers and waste collectors with waste sweepers).

A significant difference was observed between gender of the study participants and the respiratory disease health in terms of activity limitation, participation restriction and lung parameters (FEV1 and FVC) secondary to the respiratory impairment. On the other hand, the result indicated that the manifestation of respiratory disease symptoms was relatively the same between the males and female participants. It has been established that physiological and anatomical differences exist between males and females. The fact that men have bigger lungs than women has been observed using different approaches example, chest radiographs[18] and three-dimensional geometric morphometric methods on computed tomography scans.[16] Important sex differences are present in both the volume and configuration of the ribcage. Women are characterised by a disproportionately smaller rib cage size than males.[18],[19] Specifically, the cross-sectional area, the internal anterior-posterior and the lateral diameters are lower at different lung volumes. The thoracic index (i.e., ratio of anterior– posterior/lateral diameters of the rib cage) is similar between males and females at residual volume and functional residual capacity. At total lung capacity, women show a rounder rib cage than men. The anatomical and physiological differences may also contribute to the observed difference in exposure of the waste disposal workers.


  Conclusions Top


Based on the analysis of the data obtained following the evaluation of respiratory health status among REMASAB workers, it can be concluded that there is evidence of respiratory impairment among the workers. They presented with symptoms including dyspnea, coughing, excessive mucus secretion, chest pain and breathlessness, which are all attributed to the constant and prolonged exposure to waste.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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