Awareness, Prevalence and Factors Associated with Respiratory Morbidities Among Selected Petrol Pump Workers in Bengaluru City?

INTRODUCTION: Petrol pump workers are exposed to fumes emanated during petrol filling and vehicular exhaust thus falling prey to several respiratory diseases.
OBJECTIVES: To assess the awareness and prevalence of respiratory morbidities among petrol pump workers of selected petrol pumps in Bangalore.
METHODOLOGY: This cross-sectional study was conducted among 158 petrol pump workers from 11 selected pumps in Bengaluru. Following IEC approval, the baseline socio-demographic data, knowledge regarding respiratory morbidities and current morbidity pattern were ascertained. Medical examination and Peak Expiratory Flow rate (PEFR) was estimated.
RESULTS: The 158 workers were all male, mostly between 18-27 years (65.19%) and high school educated (49.37%). Knowledge regarding respiratory morbidities was 56%, while prevalence of respiratory morbidity was 61%. Those workers who had completed their higher education (>10th standard), earning monthly income (>Rs. 5000) had better knowledge regarding respiratory morbidities. RECOMMENDATION: Pre-employment and regular medical examination including lung function tests and promotion of use of PPEs to be implemented. Copyright:

INTRODUCTION

Petrol (gasoline) is a complex combination of hydrocarbons. Among the numerous constituents of petroleum products, gasoline constituents (benzene, toluene, ethyl benzene and xylene (BTEX)) are designated as the most toxic compounds to humans.[1] These compounds are volatile and lipophilic in nature and workers may be exposed through inhalation, ingestion or dermal routes.[2] These exposures can be accidental or intentional and are insidious in nature.[34]

Petrol filling station is a place where workers are exposed to both petrol/diesel vapours and vehicular exhaust. In India, petrol-pumps are usually manned by attendants while self-filling stations are scarce hence there is greater chance of exposure to toxic exhaust. Petrol-pump attendants usually do not wear personal protective equipment and personal hygiene is also variable at the workplace.[5] The health effects of occupational exposure to petroleum vapour and air pollution from vehicular sources is relatively unexplored among petrol filling workers. Studies on health conditions in petrol-pump workers have concentrated on clinical symptoms with limited reports on their lung function or the respiratory morbidity of workers exposed to petrol-pump vapour.

OBJECTIVES

To assess the awareness regarding respiratory morbidities related to their occupation among petrol pump workers of selected petrol pumps in Bangalore.

To assess the prevalence and factors associated with respiratory morbidities among select petrol pump workers in Bengaluru city

METHODOLOGY

This cross-sectional study was conducted among 158 petrol pump workers from eleven selected petrol pumps in South and South-east urban areas of Bangalore city. The study population were purposively sampled and all male workers who were 18+ years of age and engaged in fuel filling and vehicle oil replacement work at the petrol pumps were included in the study. Females were not part of this study as they were mostly involved in non-fuel filling operations such as cashier, clerk or customer service representative and hence did not fulfill our inclusion criterion.

Sample size was calculated to be 158. The prevalence of respiratory morbidities was taken as 28% based on a study conducted in Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, to assess the respiratory symptoms among petrol pump workers (n = 75) with an absolute precision of 7% and 95% confidence interval.[6] (Reference of study) Ethical clearance was obtained from the Institutional Ethics Committee at St. John’s Medical College, Bangalore.

After obtaining written informed consent, the workers were interviewed at their workplace by the principal investigator regarding their baseline socio-demographic data. Knowledge regarding respiratory morbidities was ascertained using a 30-item questionnaire. The questionnaire had five sections: Causes of respiratory morbidities (7 questions), effects of environmental pollution and petroleum fumes on respiratory system (3 questions), signs, symptoms and complications of respiratory morbidities (6 questions), diagnosis and treatment of respiratory morbidities (2 questions) s and preventive measures of respiratory morbidities (12 questions). Each item had four options and one correct answer. Each correct answer was given 1 mark. The knowledge scores were arbitrarily categorized as adequate knowledge (70-100%) and inadequate knowledge (0-69.9%). Current morbidity pattern (respiratory signs and symptoms) were ascertained and classified into five cardinal symptoms namely- cough, expectoration, wheezing, dyspnoea and chest tightness. This checklist was modified based on ATS-DLD 78 questionnaire developed by the American Thoracic Society. The content validation of the tool was established by obtaining feedback from 11 medical and nursing experts. The tool was pretested in a similar population (8 petrol workers) for its feasibility and practicality. Medical examination of the respiratory system and estimation of the Peak Expiratory Flow using Mini Wright’s Peak Flow Meter was done. Data was analysed by using SPSS v. 20. Means and percentages were estimated. Test of associations such as the Chi square test and Fisher’s exact test was used to determine association between knowledge and selected baseline variables.

RESULTS

A total of 158 male workers were included in the study. Majority of the workers were aged between 18-27 years (65.19%), educated till the high school (49.37%) and earned monthly income between Rs. 2001-Rs. 6000 (43.03%).

Most pump attendants worked >12 hours (58.2%) and had between 1-5 years of experience (63.9%). Dust allergy was reported by 15 workers (9.5%), smoking (11.4%) and alcohol consumption was (6.9%) while both smoking and alcohol consumption was reported by 14 workers (8.9%).

Workers had highest knowledge scores regarding the causes of respiratory morbidity and least knowledge regarding the signs, symptoms as well as complications of respiratory morbidities [Table 1].

Table 1

Knowledge regarding the common respiratory morbidities among petrol pump workers (n=158)

Variables	Maximum score	Range of score	Mean score±SD	Mean percentage
Causes of respiratory morbidities	7	0-7	5.03±1.48	71.86
Effects of pollution and petroleum fumes on respiratory system	3	0-3	1.71±0.80	57
Signs and symptoms, complications of respiratory morbidities	6	0-6	3.39±1.32	56.5
Diagnosis and treatment of respiratory morbidities	2	0-2	1.20±0.63	60
Preventive measures	12	0-12	8.23±2.20	68.58

On auscultation of the chest, only 3.2% of the workers had wheeze.

Almost 17% of petrol pump workers present with history of respiratory signs and symptoms most commonly chest tightness (9.5%), presence of sputum (6.3%) and cough (5.1%). On auscultation of the chest only 3.2% of the workers had wheeze [Table 2].

Table 2

Distribution of petrol pump workers according to presence of signs and symptoms and decreased PEFR (n=158)

Respiratory morbidity	Frequency	Percentage
Respiratory symptoms and signs only	7	4.43%
Reduced PEFR only	68	43.04%
Both respiratory symptoms and signs and reduced PEFR	21	13.3%

Most workers (56%) had reduced Peak expiratory flow rate (<80%) [Table 2].

A total of 96 workers (61%) were found to suffer from respiratory morbidity (which includes presence of any signs/symptoms/abnormal auscultatory findings/decreased PEFR)

Specific prevalence is nearly 83% among workers aged 37+ years and among those with more than 10 years of service (81%). Monthly income was significantly associated with presence of respiratory morbidities. Greater prevalence of respiratory morbidities were seen among workers with monthly income >Rs. 5000. Furthermore, greater prevalence of respiratory morbidities were seen among those who had longer work experience (>10 years) [Table 3].

Table 3

Association between baseline variables and prevalence of respiratory morbidities

Variable	Respiratory morbidity Present n (%)	Respiratory morbidity Absent n (%)	Test statistic	P
Age
18-37 years	86 (58.9)	60 (41.1)	2.78b	0.13
38-57 years	10 (83.3)	2 (16.7)
Education status
≤10th std	56 (56.0)	44 (44.0)	2.6a	0.12
>10th std	40 (68.9)	18 (31.03%)
Monthly income
≤Rs. 5000	73 (57.0)	55 (43.0)	3.93a	0.047*
>Rs. 5000	23 (76.0)	7 (24.0)
Experience (in years)
1-10 years	75 (56.8)	57 (43.2)	5.29a	0.02*
>10 years	21 (80.8)	5 (19.2)

aChi square test, bFischers exact, *P<0.05

Table 4 shows the association between baseline variables and knowledge of workers regarding respiratory morbidities in the petrol industry.

Table 4

Association between baseline variables and knowledge regarding respiratory morbidities

Variable	Inadequate knowledge	Adequate knowledge	Test statistic	P
Age (in years)			2.73a	0.233
18-37	90 (61.6)	56 (38.4)
38-57	9 (75.0)	3 (25.0)
Educational status			10.16a	0.0014*
≤10th std	72 (72.0)	28 (28.0)
>10th std	27 (46.5)	31 (53.5)
Monthly income			4.1a	0.04*
≤Rs 5000	74 (58.7)	52 (41.3)
>Rs 5000	25 (78.1)	7 (21.9)
Years of experience (in years)			4.37a	0.03*
1-10	78 (59.1)	54 (40.9)
>10	21 (80.8)	5 (19.2)
Presence of respiratory morbidities			0.002a	0.95
Present	39 (62.9)	23 (38.9)
Absent	60 (62.5)	36 (37.5)

aChi square test, *P<0.05

There was a statistically significant association between educational status, monthly income, years of experience and knowledge regarding respiratory morbidities. Those workers who had completed their higher education (>10th standard) had better knowledge regarding respiratory morbidities as compared to those educated till high school level. Those who worked for >10 years had better knowledge regarding respiratory morbidities.

There was no significant association between respiratory morbidity and knowledge levels (P > 0.05).

DISCUSSION

Socio-demographic results obtained are reflective of the relatively younger male dominated workforce of this industry.

Most common chest symptoms reported among the workers were chest tightness, cough, expectoration and difficulty in breathing. These symptoms can be attributed to the chronic inhalation of petrol fumes and vehicular exhaust at the filling stations. These findings are similar to another study conducted among the petrol workers in Nigeria which showed cough (26.9%), chest pain (21.2%) and difficulty in breathing (9.8%) to be the most commonly reported morbidity.[7]

Overall knowledge regarding workplace hazards, awareness of respiratory morbidities seen in this line of work and the methods of prevention was found to be moderate [Table 1]. None of the workers were using any personal protective devices such as face masks at work.

Education, higher monthly income (>Rs. 5000) and longer work experience (.10 years) resulted in greater awareness regarding respiratory problems encountered at the workplace [Table 4]. These finding are similar to a study conducted among traffic policemen in Kathmandu, Nepal where education affected the level of knowledge of respiratory problems among traffic police but however did not translate to better practice to prevent these respiratory problems.[8]

Longer work experience (>10 years) and higher income probably translated to longer working hours and longer duration of exposure to the harmful fumes and vapour hence resulting in respiratory illness [Table 3].

More than half of the workers had reduced lung function capacity as seen by reduced PEFR values (<80% of the expected) [Table 2]. Reduced PEFR indicates that the chronic exposure to solvents and air pollutants leads to a type of restrictive lung disease among the workers. The probable cause is due to the accumulation of particulate matter in peri-bronchial lymphoid and connective tissues along with varying degrees of wall thickening and remodelling in terminal and respiratory bronchioles.[9]

Reduced respiratory function as measured by PEFR <80% in our study is comparable to a similar study done among construction workers (64.5%) in Bengaluru city.[10] However, PEFR normograms for the Indian general population is yet to be developed. While the organized sector, both private and public, has reasonably well developed basic occupational health services (BOHS) based on ILO conventions however it does not extend to cover the safety and health for workers in unorganized sectors.[11]

Recommendation

Regular monitoring of health status i.e., medical observation including pre-employment and periodic health check-ups for pulmonary function tests and spirometry should be undertaken for the workers at the petrol pumps.

Health education regarding the harmful effects of petrol products and the methods of prevention should be incorporated into the initial pre-placement training of the workers.

Provision of personal protective equipment especially face masks and promotion of its use through regular health education should be encouraged.

Future studies focussed on these cadre of workers taking a larger representative sample is recommended for obtaining further information.

Installation of a petrol vapour recovery system has controlled the occupational exposure to petrol/diesel compounds in many countries such as USA and UK. These can be introduced in a phased manner as a long term solution to this problem.

Limitations of the study

The study was limited to include only the male petrol pump workers hence the specific morbidities related to females were not captured.

Peak flow meter was used to measure lung function instead of a spirometer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.