|Year : 2021 | Volume
| Issue : 3 | Page : 226-230
Pulmonary function parameters and its determinants among cement factory workers in Chhattisgarh: A cross-sectional study
Pradeep Kumar Dewangan1, Nirmal Verma2, Neha Shrivastava3, Manish A Prasad4
1 Postgraduate Scholar, Department of Community Medicine, Pt. J.N.M. Medical College, Raipur, India
2 Professor and Head, Department of Community Medicine, Pt. J.N.M. Medical College, Raipur, India
3 Assistant Professor, Department of Community Medicine, Pt. J.N.M. Medical College, Raipur, India
4 Associate Professor, Department of Community Medicine, Government Medical College, Ambikapur, Chhattisgarh, India
|Date of Submission||18-Jan-2021|
|Date of Decision||23-Feb-2021|
|Date of Acceptance||13-May-2021|
|Date of Web Publication||22-Sep-2021|
M-5, Shivajee Park, Saddu, Raipur, Chhattisgarh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Cement in one hand is the most used substance for construction all over the world but on the other hand prolonged exposure from cement dust particles along with smoking, long working duration in dusty environments and increasing age impairs pulmonary functions. Objectives: The study aimed to determine the effect of cement dust on the pulmonary functions of cement factory workers. Methods: It was a cross-sectional observational study conducted from October 2019 to February 2020 among 360 workers of cement factories of Chhattisgarh state selected by systematic random sampling who were interviewed. Spirometry was done and their forced vital capacity, forced expiratory volume in one second, Forced expiratory flow, peak expiratory flow rate, and lung age were determined with a flow-sensing spirometer. Data were collected, entered in MS Excel spreadsheet, and analyzed using SPSS software (version 20.0) for Chi-square test, linear regression, and general linear model. Results: One-third of the study subjects had pulmonary dysfunction, out of which 10% and 30% were having severe and moderate dysfunction, respectively. Significant higher Odds for developing impaired pulmonary functions were seen among >40 years of age (adjusted odds ratio [AOR] =1.88 [1.13, 3.12]), more than 10 years of service (AOR = 4.69 [2.32, 9.53]) and smokers (AOR = 4.45 [2.53, 7.83]) Conclusion: Working in dusty environment along with other factors in cement factories significantly decrease lung parameters. Exposure with dust is strong predictor for chronic respiratory symptoms.
Keywords: Cement, dust, pulmonary, respiratory symptoms, spirometry, workers
|How to cite this article:|
Dewangan PK, Verma N, Shrivastava N, Prasad MA. Pulmonary function parameters and its determinants among cement factory workers in Chhattisgarh: A cross-sectional study. Indian J Public Health 2021;65:226-30
|How to cite this URL:|
Dewangan PK, Verma N, Shrivastava N, Prasad MA. Pulmonary function parameters and its determinants among cement factory workers in Chhattisgarh: A cross-sectional study. Indian J Public Health [serial online] 2021 [cited 2022 Dec 1];65:226-30. Available from: https://www.ijph.in/text.asp?2021/65/3/226/326394
| Introduction|| |
The Indian cement industry is the second-largest producer of cement in the world. Cement dust contains respirable particles with aerodynamic diameters ranged from 0.05 to 5 μm which has the ability to deposit in the alveoli. Persistent exposure above the range which can be accommodated by homeostatic mechanisms, may lead to progressive impairment of lung function. There is debatable evidence between exposure of dust and the development of respiratory symptoms and decline in pulmonary function.,,,,,,,,,,, Therefore the study was conducted with the objective to determine the effect of cement dust on the pulmonary function of cement factory workers.
| Materials and Methods|| |
Study design, study area, and subjects
It was a cross-sectional observational study conducted among workers of three randomly chosen cement factories with more than five years of an establishment situated in Chhattisgarh. The data collection was done from October 2019 to February 2020. Full-time cement factory workers aged between 18 and 60 years, working for at least 6 h/day, having minimum 1 year of work experience in cement factories and who gave informed verbal consent were included in the study. Workers having any identified pulmonary disease before joining the job; who had worked in dust-generating industries or factories other than cement factories; and not willing to participate in the study were excluded.
Sample size and selection of study subjects
Using the prevalence of the least common symptom in respiratory morbidities i.e., Occupational Asthma as 25% taken from a study done by Anand [2012) among the workers of cement industry in South India, the sample size was calculated by the following formula: n = Z2 (p)×(q)/d2; where Z = 1.96 (95% confidence interval [CI]); P = Prevalence value (Reference); q = 1 − P; d = Margin of error which was taken as 4.5%.
The sample size came out to be 356 which was rounded off to 360.
Before the day of the survey, permission from the human resource (HR) Head of selected cement factories was obtained. From each cement factory, 120 workers were chosen by systematic random sampling method from the worker's enrolment sheet.The sampling interval was calculated by dividing the total number of enrolled workers by 120 which came out to be different for each factory. The first worker was chosen within the first sampling interval from the enrolled list. Thereafter, the next factory worker was selected with a gap of the sampling interval. Workers who were willing to participate in the study and fulfill the subject's criteria were included in the study.
A total of 360 cement factory workers were selected by systematic random sampling. It was later found that 140 workers were working in direct dust exposure areas (taken as exposed) and rest 220 were working in office or administrative area (taken as nonexposed).
Following study tools were used for the present study:
- Predesigned, pretested semi-structured questionnaire was used consisting of sociodemographic characteristics, occupational exposure, and lifestyle factors
- Semi-Structured Modified British Medical Research Council questionnaire for assessing chronic respiratory symptoms among study participants
- Spirometry of study participation was done by precalibrated MOKSHIT Helios 702 spirometer
- Weight in Kilogram was measured by Ultra-lite, personal scale, Model; PS-126 and Height in meters measured by stadiometer and body mass index (BMI) calculated simultaneously.
Information of fixed date of the survey in respective cement factories were given to the Head of HR and after getting permission, data collection was started. On the day of data collection, informed, verbal consent was taken from the study subjects and they were ensured that their identity would be kept confidential during and after the study. For this, all the study subjects were given unique ID and their names were not mentioned in the questionnaire to ensure confidentiality.
The purpose of the study was explained to the subjects and later study subjects were interviewed and questionnaire which was checked for its completeness and correctness. After fulfilling the pro forma, their weight and height were measured and BMI was calculated. Thereafter, pulmonary function test was performed by using Spiro meter-Helios 702, according to the standards of lung function testing of the American Thoracic Society/European Respiratory Society. The procedure for the pulmonary function test was explained individually to the subjects. Then they have been given a practice test, which was taken while sitting. Three reading was obtained and the best result chosen by spirometer were used as the final reading.
Ethics approval: Before starting the study, Institutional Scientific and Ethics Committee approval of Pt. J. N. M. Medical College, Raipur, Chhattisgarh was taken.
All analysis was performed by SPSS statistical software, version 20. SPSS South Asia, Bangalore, Karnataka (India). Chi-square test was applied for the association between exposure and chronic respiratory symptoms and association between abnormal pulmonary functions and risk factors. Univariate and multivariate regression were used to analyze the contribution of risk factors for abnormal pulmonary functions. General linear univariate and general linear bivariate model were used to analyze the difference of lung function parameters like forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC%, Forced expiratory flow (FEF)25%–75%, peak expiratory flow rate (PEFR) and lung age among the subjects with exposure to dust in working sections of cement factories, age, duration of exposure, and smoking habits of study subjects.
| Results|| |
This cross-sectional study revealed that 106 (29%) of the study subjects were having pulmonary dysfunction, 42 (40%) of them were having moderate to severe and obstructive type pulmonary dysfunction. Study participants were comparable with respect to mean years of age, mean year of service and dust exposure and in Weight, Height, BMI. Higher proportion of 349 (96%) of workers were males and all exposed participants were male. Higher education level was seen in unexposed participants 206 (94%) compared with exposed 122 (87%). More of the exposed study participants 43 (31%) were smokers.
[Table 1] shows the relationship of pulmonary function with different variables. Study participants who were ≥40 years of age, low level of education, subjects who were working in dust exposed section, subjects with ≥10 years of service, working duration of more than 18 hours per week in dusty sections of cement factories, and smokers had significantly abnormal pulmonary function. Study participants with chronic respiratory symptoms such as cough, phlegm, and shortness of breath had abnormal pulmonary function.
|Table 1: Association of pulmonary function with different risk factor variables|
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[Table 2] shows that workers aged ≥40 years were more likely to develop pulmonary dysfunction (adjusted odds ratio [AOR] =1.9, 95% confidence interval [CI] =1.13, 3.12) than workers aged less than 40 years. Illiterate workers were more likely to develop pulmonary dysfunction (AOR = 3.39, 95% CI = 1.43, 8.02) than workers who were more educated. Workers working in sections where the dust emission is known to be high were significantly associated to develop low PFT values (AOR = 1.95, 95% CI = 1.18, 3.24) and the long exposure in the working section for more than 10 years were at higher risk (AOR = 2.09, 95% CI = 1.29, 3.40) of developing low pulmonary function. Subjects with a greater duration of exposure (more than 18 hours per week) in dust were found to be at higher risk of low PFT values (AOR = 1.56, 95% CI = 0.82, 2.94) although insignificant. Study participants who were ever smokers were at almost 5 times higher risk (AOR = 4.45, 95% CI = 2.53,7.83) for pulmonary dysfunction. Those who had chronic respiratory symptoms of cough (AOR = 6.47, 95% CI = 3.41, 12.31) and phlegm (AOR = 11.63, 95% CI = 1.36, 99.91) were at significant higher risk of compromised pulmonary function.
|Table 2: Associated risk factors and pulmonary functions among cement factory workers|
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[Table 3] shows that the pulmonary function parameters (FVC, FEV1, FEV1/FVC%, FEF25–75, PEFR, and lung age) were significantly decreased in dust-exposed workers. It was also significantly low in subjects of more than 40 years of age and more than 10 years of working experience in cement factory, except FVC.
|Table 3: Difference of pulmonary function parameters according to exposure status, age and employment years|
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[Table 4] shows the decreased pulmonary function parameters (FVC, FEV1, FEV1/FVC%, FEF25-75, PEFR, and lung age) among dust exposed workers and other variables like smokingand longer duration of work in years (>10 years), which is statistically significant, except FVC.
|Table 4: Difference of pulmonary function parameters according to exposure status and smoking, age and years of work experience|
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| Discussion|| |
This cross-sectional study is an effort to determine the pulmonary function indices and the factors detrimental to pulmonary function among cement factory workers in the Chhattisgarh state of India. Cement factory workers were exposed to cement dust during various production processes, from limestone mines to packaging and transporting. Administrative or office workers were less exposed to cement dust compared to working sections in cement industries with high dust emissions. Exposed and unexposed workers are of similar characteristics with respect to age, weight, height, BMI, age of study subjects, and completed years of service in cement industries with the exception of education level, smoking habits, and gender (97% of study subjects were male). Exposed participants had significantly higher respiratory symptoms like cough and breathlessness. Factors like greater age, prolonged working duration in cement factories and chronic respiratory symptoms, increases risk for developing pulmonary dysfunction due to consistent exposure to dust particulates, hence proving dose-response, and duration of exposure-response relationship. The strength of this study is that it is one of the few studies assessing pulmonary function, conducted among cement factory workers in Chhattisgarh. The limitation of the present research work is its small sample size of 360 and results can only be generalized to cement factory workers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Burange L, Shruti Y. Performance of the Indian cement industry: The competitive landscape. Artha Vijñāna 2019;51:209-42.
Rachiotis G, Kostikas K, Pinotsi D, Hadjichristodoulou C, Drivas S. Prevalence of lung function impairment among Greek cement production workers: A cross-sectional study. Ind Health 2018;56:49-52.
Meo SA. Health hazards of cement dust. Saudi Med J 2004;25:1153-9.
Health Risk Assessment Guidance for Metals (HERAG) Assessment of Occupational Dermal Exposure and Dermal Absorption for Metals and Inorganic Compounds. HERAG Fact Sheet 12007; 2007.
Kathore V. Study of effect of cement dust on lung function in cement factory workers. MedPulse Int J Physiol 2018;8:42-5.
Al-Neaimi YI, Gomes J, Lloyd OL. Respiratory illnesses and ventilatory function among workers at a cement factory in a rapidly developing country. Occup Med (Lond) 2001;51:367-73.
Zeleke ZK, Moen BE, Bråtveit M. Lung function reduction and chronic respiratory symptoms among workers in the cement industry: A follow up study. BMC Pulm Med 2011;11:50.
Mwaiselage J, Bråtveit M, Moen B, Mashalla Y. Cement dust exposure and ventilatory function impairment: An exposure-response study. J Occup Environ Med 2004;46:658-67.
Neghab M, Choobineh A. Work-related respiratory symptoms and ventilatory disorders among employees of a cement industry in Shiraz, Iran. J Occup Health 2007;49:273-8.
Noor H, Yap CL, Zolkepli O, Faridah M. Effect of exposure to dust on lung function of cement factory workers. Med J Malaysia 2000;55:51-7.
Thepaksorn P, Pongpanich S, Siriwong W, Chapman RS, Taneepanichskul S. Respiratory symptoms and patterns of pulmonary dysfunction among roofing fiber cement workers in the south of Thailand. J Occup Health 2013;55:21-8.
Nagoda M, Okpapi JU, Babashani M. Assessment of respiratory symptoms and lung function among textile workers at Kano Textile Mills, Kano, Nigeria. Niger J Clin Pract 2012;15:373-9. [Full text]
Tobin EA, Ediagbonya TF, Okojie OH, Asogun DA. Occupational exposure to wood dust and respiratory health status of Sawmill Workers in South-South Nigeria. J Pollut Eff Contorl 2016;4:1-6.
Mirzaee R, Kebriaei A, Hashemi SR. Effects of exposure to Portland cement dust on lung function in Portland cement factory workers in Khash, Iran. Iran J Environ Health Sci Eng 2008;5:201-6.
Merenu IA, Mojiminiyi FB, Njoku CH, Ibrahim MT. The effect of chronic cement dust exposure on lung function of cement factory workers in Sokoto, Nigeria. Afr J Biomed Res 2007;10:139-43.
Anand S. The Prevalence of Respiratory Morbidity and the Risk Factors Associated, among the Workers of Cement Industry in South India: A Cross Sectional Study (Doctoral Dissertation, SCTIMST). 2012.
British Medical Research Council's Committee (BMRC): Standardized questionnaire on respiratory symptoms. Br Med J 1960;2:1665.
Moghadam SR, Abedi S, Afshari M, Abedini E, Moosazadeh M. Decline in lung function among cement production workers: A meta-analysis. Rev Environ Health 2017;32:333-41.
Abrons HL, Petersen MR, Sanderson WT, Engelberg AL, Harber P. Symptoms, ventilatory function, and environmental exposures in Portland cement workers. Br J Ind Med 1988;45:368-75.
Rasmussen FV, Borchsenius L, Holstein B, Sølvsteen P. Lung function and long-term exposure to cement dust. Scand J Respir Dis 1977;58:252-64.
[Table 1], [Table 2], [Table 3], [Table 4]