Effects of Occupational Exposures on the Lung Functions and Quality of Life of Garbage Collectors in the Urban Area.

BACKGROUND: The present study was aimed to investigate the lung functions and health-related quality of life (HRQoL) of garbage collection workers of the urban cities in India. STUDY
SETTING: Urban city in India.
MATERIALS AND METHODS: The cross-sectional study encompassed 110 participants, 55 garbage collection workers in a garbage depot in the urban city of India and 55 age-matched control group volunteering to participate in the study. Assessment of the lung function was done by using computerized spirometry and HRQoL with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. STATISTICAL ANALYSIS: Various statistical measures such as mean, standard deviations (SD), test of significance were utilized to analyze the data. Parametric data were analyzed by unpaired t-test and nonparametric data by Mann-Whitney U test.
RESULTS: A statistically significant difference was seen in the lung functions and quality of life in garbage collection workers except for the psychological component of WHOQoL-BREF questionnaire.
CONCLUSION: The study concludes that there is a greater impairment in the lung functions of garbage collection workers as compared to that of normal individuals. Moreover, the quality of life is lower in garbage workers than that of normal individuals considering the physical, social, and environmental aspects. Copyright:

INTRODUCTION

The workplace environment greatly influences the health of the workers. Individuals working in a dusty environment are at a higher risk of inhaling particulate materials which may lead to adverse respiratory effects. Garbage collection is one such occupation. Garbage collectors undergo occupational exposure to various hazardous substances in their regular life, leaving bad impacts on their lung functions which can adversely affect their quality of life.[1] Garbage collectors play an important role in maintaining health and hygiene in the cities. In many countries including India, waste collection is mainly done manually.[2] This job exposes the workers to a variety of risk factors such as dust, bioaerosols, chemicals caused by burning solid waste, smoke and fume arising from automobile exhaust and noise, unfavorable climatic conditions, ultraviolet rays, infrared and visible light, and mechanical stress which makes them susceptible to certain occupational diseases. Nevertheless, handling and disposal of waste are associated with inevitable exposure to a large number of pathogenic and nonpathogenic microorganisms and germs.[3]

Lung diseases resulting from occupational exposures are most likely to be caused by the inhalation of dust and deposition of inhaled particles in the lungs. The site of deposition is determined by a number of factors such as the size, chemical and physical characteristics of the aerosol, and the duration and frequency of exposure, along with the host response to theinhaled particles.[4]

In India, a reduction in the lung function has been reported in cotton mill workers, coal miners, grain and flour mill workers, and building and construction workers.[567] There is a growing evidence regarding the incidence of respiratory disorders, dermatological problems, and musculoskeletal complaints among the waste collectors as compared to other occupations from different parts of the world.[89] Hence, there is a need to recognize it in various geographical regions of India.

In India, garbage collection is considered as a job of the underprivileged class. Most of the garbage workers are below the poverty line, without much education, dwelling in poor housing environments, and acquiring very little medical attention.[10]

Health-related quality of life (HRQoL) is a well-established aspect of health and general well-being, which can be measured with a variety of validated instruments. In recent years, the issue of quality of life is increasingly being considered in occupational health research; with assessments of the relationship between occupational diseases and quality of life, and in relation to a specific occupation.[111213] Therefore, the present study was aimed to determine the lung functions and quality of life of garbage collection workers in India.

METHODOLOGY

The study was a cross-sectional study conducted in Pune region in India. After receiving approval from the Institutional Ethics Committee participants were screened as per the inclusion and exclusion criteria as described below. The participants were divided into two groups by purposive sampling method, Group A constituting garbage collectors (n = 55) and Group B having age-matched controls (n = 55). Those willing to participate in the study were briefed about the nature of the study in the language best understood by them and written informed consent was obtained. The data collection sheet and PFT readings were taken. Participants were asked to fill the WHOQOL-BREF questionnaire in Marathi and Hindi version, according to their present performance in day-to-day life. Permission for using WHOQOL-BREF was taken prior to the study from World Health Organization (WHO).

Inclusion criteria for group A

Age: 35–50 years, both male and female, participants engaged in garbage collection activities, working for 4–8 hours per day and 5 days per week, work experience of more than 5 years

Inclusion criteria for group B

Age: 35–50 years, both male and female, normal healthy individuals having occupation not involving garbage collection as well as hazardous exposure.

Exclusion criteria for both groups

Individuals with a known case of any respiratory disease (pulmonary tuberculosis, bronchial asthma, chronic bronchitis, emphysema, etc.), cigarette smokers, participants with clinical abnormalities of vertebral column and thoracic cage, participants who had undergone abdominal or chest surgery.

Outcome measures

Pulmonary function tests

The pulmonary function tests were performed to evaluate the capacity and volume of the lungs among the participants. Spirometry measurements including FVC, FEV1, the ratio of FEV1 to FVC (FEV1/FVC), and peak expiratory flow rate (PEFR) were obtained before the work shift. A precalibrated computerized RMS medspiror™ was used for the spirometry tests. The participants were given proper instructions and demonstrations prior to the procedure. All participants were trained before the spirometry test. The patients were instructed not to eat heavy meal before the test and not to take hot drinks for 4 to 6 hours beforehand. The participants were asked to sit erect and hold the mouthpiece such that no air is leaking from the corners of the mouth. Nose clips were applied to the participants. The best three readings were considered. Further, the participants were asked to place the mouthpiece attached to the spirometer in their mouth, with a clip over the nose and breathe through the mouth into a tube connected to the spirometer. After breathing normally, participants were asked to slowly blow out air until their lungs are empty. Then they were instructed to take a deep breath, filling up the lungs completely. As soon as the lungs would be full, they were told to blow out as hard and fast as they could until they felt that their lungs were absolutely empty. Then immediately they were asked to inhale as deep and as fast as possible. The test was terminated if the patient showed signs of significant head, chest, or abdominal pain while the procedure was in progress. The following parameters of PFT were included in the study: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) as FEV1%.[14]

World Health Organization Quality of Life-BREF

The WHOQOL-BREF instrument consists of 26 items which measure four broad domains: physical health, psychological health, social relationships, and the environment. It has good discriminant validity, test-retest reliability, and internal consistency, which ranges from 0.66 to 0.87 (Chronbach's alpha coefficient). A WHOQOL-BREF in Marathi and Hindi translations were used. The mean score for each domain was calculated; higher scores denoted a higher QoL.[15]

Statistical analysis

Statistical analysis was done by Graphpad Instat software version 3.06. The data were entered into an excel sheet, tabulated, and subjected to statistical analysis. The results were calculated to be statistically significant with P value < 0.05. Various statistical measures such as mean, standard deviations (SD), test of significance were utilized to analyze the data. Parametric data were analyzed by unpaired t-test and nonparametric data by Mann-Whitney U test.

RESULTS

There was no significant difference between the baseline data in both groups. Hence, the data were comparable [Table 1]. Statistical analysis showed that the lung function values were significantly reduced in garbage collectors (group A) than in the agematched control group (group B). [Table 2]. Also the quality of life in physical, social, and environmental domains was also reduced in this group [Table 3].

Table 1

Comparison of baseline demographic data of the participants

	Group A	Group B	P	t	Difference
Age (years)	41.4±5.53	41.36±4.7	0.89	0.12	Not significant
Height (cm)	161.5±9.8	161.1±9.4	0.84	0.19	Not significant
Weight (kg)	62.54±12.2	66.6±11.4	0.07	0.18	Not significant

Table 2

Between-group comparison of the lung function parameters

Parameters	Group A (mean±SD)	Group B (mean±SD)	P	t	Difference
FVC (L)	2.62±1.04	3.02±0.76	<0.02	2.36	Significant
FEV1 (L)	1.48±0.96	2.27±0.76	<0.001	4.75	Significant
FEV1/FVC (%)	55.54±25.3	74.81±6.43	<0.001	4.72	Significant
PEFR (L/s)	2.37±1.62	4.37±2.12	<0.001	5.55	Significant

Table 3

Comparison of WHOQOL-BREF parameters between both groups

Domains	Group A (mean±SDE)	Group B (mean±SD)	P	Significant
Physical	70.05±8.51	80.50±7.72	< 0.0001	Significant
Psychological	77.87±14.22	79.99±6.77	0.1940	Not significant
Social	80.96±13.2	88.90±11.6	0.003	Significant
Environmental	67.86±16.5	77.11±11.4	0.0027	Significant

DISCUSSION

This study examined the lung functions and quality of life in garbage collectors. The PFT values showed a significant reduction in the lung function parameters such as FVC, FEV1, FEV1/FVC, and PEFR values among the garbage workers as compared to normal individuals.

The reason could be attributed to the exposure to higher concentrations of dust particles, airborne microbial organisms, and gas particles which may result in chronic impairment of the pulmonary function due to high endotoxin levels in garbage collection workers.[16]

Moreover, garbage workers are at a higher risk of inhalation of bioaerosols generated by the decomposition of organic wastes. This process may lead to the formation of various biological agents (bacteria, fungi, viruses) and volatile compounds (endotoxins and mycotoxins) which provoke inflammation of airways resulting in the obstruction in airway passage. Cytokines, such as IL6, IL8, and TNF-alpha may lead to the development of obstructive pulmonary pattern.[161718] All these factors lead to reduction in the lung functions.

These results are in accordance with the study conducted by Mustajbegovic et al. who concluded that sanitation workers may develop chronic respiratory symptoms and the lung function changes, more prominently in FVC and FEV1.[19]

Similarly, significant reductions in the lung function parameters have been reported in waste collectors in other studies.[202122] In a cross-sectional study, Bunger et al.[23] found that reduced lung functions in compost workers may occur due to long-term exposure to high amounts of thermotolerant and thermophilic bacteria (actinomycetes) and filamentous fungi which are found in bioaerosols at the composting sites that produce mycotoxins.

In the present study, QoL was also affected negatively in garbage collection workers particularly in their physical, social, and environmental domains. There is reduced QoL in the physical domain. Since garbage collection is a physically demanding job, the workers have to travel on roads through traffic throughout the year. They also have to do repetitive heavy physical activity such as manual lifting and handling of heavy bins, loading, unloading, and segregation of collected waste.[2425] This may result in reduced work capacity by decreasing the overall physical performance.

The reduced QoL in the social domain can be attributed to individual's social status. Most of the garbage collectors are from low socio-economic strata. Moreover, poverty and illiteracy are the major social factors that hamper their social life.

The maximum number of this population are slum dwellers. Hence, their occupation imposes various hazards in their day-to-day life, making their environment hazardous for work which ultimately may lead to poor quality of life in the environmental domain.

This research has not assessed specific exposure and air pollution measurements of the study area; therefore there is some uncertainty to generalize our results. Nevertheless, the system of garbage collector's occupational exposure is more or less similar in different regions of India. Consequently, up to a certain level we can consider that the results may be representative of this population and can run a preventive awareness program on a wider scale for them.

The small sample size is also a limitation of this study, so in future the study can be carried out on multiple centers by assessing other systems as well.

This study suggests that preplacement and periodic health monitoring among garbage workers should be done along with regular awareness programs to impart education regarding safer work procedures and the use of personal protective devices. Educational counseling such as hygiene maintenance and psychological counseling, should be implemented. The respiratory muscle training program should be imparted.

CONCLUSION

The study concludes that the lung function and quality of life is more impaired in garbage workers as compared to that of normal individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.