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cement dust, chronic respiratory symptoms, exposure, residents, public health, India
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Janakiraman B, Ravichandran H, Susheel Shetty K et al. Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:682 (https://doi.org/10.12688/f1000research.147324.1)
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Research Article
Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study
[version 1; peer review: 1 approved with reservations]
PUBLISHED 24 Jun 2024
OPEN PEER REVIEW
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Abstract
Corresponding author:
Mshari Algadhier
Competing interests:
No competing interests were disclosed.
Grant information:
This study was supported via funding from Prince Sattam bin Abdulaziz University project number (PSAU/2023/R/1444) Saudi Arabia.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2024 Janakiraman B et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Janakiraman B, Ravichandran H, Susheel Shetty K et al. Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:682 (https://doi.org/10.12688/f1000research.147324.1)
First published: 24 Jun 2024, 13:682 (https://doi.org/10.12688/f1000research.147324.1)
Latest published: 24 Jun 2024, 13:682 (https://doi.org/10.12688/f1000research.147324.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Background
Unplanned atmospheric pollution from heavy industrialization, population explosion, and urbanization degrades air quality.1 According to estimates, vehicular pollution is the main cause of air pollution in urban areas (60%), followed by industries (20-30%). The international pollution control board lists the cement industry as one of the 17 most polluting industries.1,2 Cement dust exposures at work and home cause persistent respiratory symptoms such coughing, phlegm, wheezing, shortness of breath, and chest pain. The health and economic effects of chronic respiratory disorders make them a public health issue in developed and developing nations.3–5 The World Health Organization (WHO) reported in 2019 that non-communicable diseases account for 82% of deaths worldwide, and chronic respiratory diseases, asthma, and COPD caused 4 million or 10.7% of deaths.6 In developing nations like India, occupational and residential respiratory symptoms and diseases are a huge burden due to investment growth, high unemployment, and the use of outdated machines that produce excessive dust to the work environment. Workers and nearby residents are likely to continue working and living even with poor health.4,6
The worldwide community, especially the people in developing countries, is facing increasing risk of respiratory health symptoms due to production of smoke and dust in different occupational and industrial sectors. The World health organization (WHO) 2016 reported that, globally more than 1 billion people suffering from chronic respiratory conditions and about 4 million people die each year prematurely from chronic respiratory disease. These problems always come after different chronic respiratory symptoms.7 India is one of the developing nations, occupational and residential related respiratory symptoms are extensively abundant and the expansion of investment, especially in workers exposed to cement products and nearby residents for dusty environment and are not well informed about health effect their working and living environment.8 Dust is one of the main occupational and nearby residential hazards that cause chronic respiratory problems in cement manufacturing industries. Workers and nearby residents in cement factories are exposed to different public health hazards during cement production including cement dust, high temperature, and noise. However, the major occupational and residential hazards in the cement production industry are cement particles which are emitted to the environment at most stages of production process with higher concentration in the packing and crusher section.2,9
One of the major industrial businesses, the cement industry exposes workers and local populations to dust during production. Calcium oxide, silicon oxide, aluminum tri oxide, ferric oxide, magnesium oxide, sand, and other contaminants make up Portland cement dust. The aerodynamic diameter of cement dust particles is respirable.9,10 Thus, occupational and residential cement dust exposure can induce acute or chronic respiratory illnesses and pulmonary function deficiencies. Cement dust particles enter the body by inhalation or eating. Cement exposes both pathways, notably the respiratory tract, to many hazardous chemicals. Concrete industry pollutants include particulate matter (suspended and respirable), nitrogen oxides, sulphur oxides, carbon monoxide, volatile organic compounds (VOC), and green-house gases (GHG); acidic compounds, heavy metals (Cadmium, Lead, Mercury, and Nickel). Cement dust exposure has been associated to persistent respiratory problems in humans in several studies.4,9,11 Skin, eye, and respiratory irritations result from cement dust. Near pollution sources, associated disorders are more common. Chronic respiratory problems are rising in fast-developing Asian nations and linked to cement dust. Cement dust increases the risk of liver, lung, and cancer in the workplace and home.12,13 Cement dust exposure caused chest discomfort, coughing, and eye difficulties in village people. Due to the emission’s diversity and dispersion, respiratory health issues may influence the quality of life for neighbors of cement product workers.6,14
Many studies have revealed that cement industry workers with high dust exposure had higher rates of cough, sputum, dyspnea, and wheezing than the control group. Researchers from Iran, India, UAE, Ethiopia, and Zambia14–18 found that cement factory dust exposure increases chronic respiratory symptoms like chest tightness, cough, sputum, wheezing, and dyspnea. Though cement dust exposure and respiratory health symptoms are extensively established in cement industry workers, chronic respiratory health issues in nearby individuals are not.19,20 Therefore, the main objective of the study was to assess prevalence of chronic respiratory health symptoms and associated factors among exposed and non- exposed residents to cement dust pollution from a cement factory in Dakshina Kannada district, Karnataka.
Methods
Study design
A community-based cross-sectional study was designed to compare the self-reported respiratory health of adults who were exposed and unexposed to cement dust from the cement factory in Dakshini Kannada district, Karnataka. The study protocol was approved by the institutional ethical review committee of the Alvas College of Physiotherapy and Research Centre (ref no; ACP/OP/CL/2022/52). The study adhered to the guidelines bound in the Declaration of Helsinki and is reported according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) checklist.
Study area and period
This study was conducted at the residential perimeter of cement industry located at Dakshina Kannda district of Karnataka, India. The factory starts its production in 2000 with a daily production capacity of 2000 tones clinker per day. The factory expands its capacity to 5000 tones clinker per day in 2012 aiming to satisfy the domestic cement market. Recently the annual capacity of the plant is 900, 000 tones and it is capable of producing Portland cement with or without additives. The data was collected from March 2023 to May 2023.
Exposed community
Alangar is located at a distance of about 1 km radius from Royal Cement Factory with a dense human population. The area is covered with dwarf herbs and grass with some scattered shrubs. Cement pollution in this area is apparent. This site is selected to study the health impact of cement pollution on the community, as the site is near to Royal Cement Factory
Non-exposed community
The comparison communities are residents of Hosabettu which is located 5 km away from the cement production factory. The area apparently does not receive any cement dust from the factory or any other pollution so it was taken as a control site. The population residing in these two sites are similar in terms of culture, residence as both are rural, and socio demographic characteristics apart from the proximity of residence from the factory premise.
Population
Sources of population
The source populations were residents living within the 1 km radius of the cement factory and residents who live 5 km away from the cement plant.
Study population
All systematically selected residents living within 1 km radius of the cement factory and residents who live more than 5 km away from the cement plant.
Study unit
All sampled residents living within 1 km radius of the cement factory and residents who live more than 5 km away from the cement plant.
Eligibility criteria
Individuals aged 15-70 years and resided in either of the study areas for at least 1 year prior to the survey were included. Participants employed in cement factory, construction industry, quarrying and mining, were excluded. In addition, those seriously ill during data collection period or unable to speak and hear were excluded.
Sample size determination
The prevalence of symptoms of interest in the two communities was essentially unknown. However, evidences from studies suggests that the prevalence of respiratory symptoms is around 96%, 79%, 49%, and 26.2%5,21–23 for shortness of breath, phlegm, chest pain, wheezing and cough for cement dust exposed group respectively while the prevalence in the comparison group were found to be 15%, 21%, 11%, 21% and 14.1%24–26 for shortness of breath, phlegm, chest pain, wheezing and cough respectively. Sample size was determined using two –population proportion formula.27 To calculate sample size for this study, the prevalence for the exposed and control communities assumed to be similar to that found in the other studies. The level of significance at 5%, (alpha 0.05), Power (1-β) 80%, Design effect 1.5, the calculated total sample size was 542 respectively and so that, 271 participants were selected from each of the cement dust exposed and non- exposed communities.
Sampling procedures
A multi stage random sampling method was used to select participants. Hosabettu is located at greater than 5 km away from the cement factory. The area apparently does not receive any cement dust from the factory or any other pollution so it was taken as a comparison site. To collect sample, the localities were each divided in to twelve geographical clusters (5 clusters from exposed and 7 clusters from comparison group) each containing a number of households based on distance located from cement factory and crossing of roads. From these geographical clusters six of them were selected systematically and a sub-sample of households per cluster were obtained randomly. Finally, all participants from member of the household who meets the inclusion criteria were selected and interviewed (Figure 1).
Figure 1. Sampling flow.
Variables and operational definitions
The dependent (outcome) variable was self-reported experience of one or anyone of the following symptoms; chronic cough, chronic phlegm, chronic wheezing, chronic chest pain and chronic shortness of breath. The predictor (independent) variables were; socio demographic factors (sex, age, educational status, marital status annual household income), environmental factors (duration (length) of exposure, indoor air pollutants), and behavioral factors (smoking habit). The operational definitions; chronic respiratory symptoms is development of one or more of the symptom/s of chronic cough, chronic phlegm, chronic wheezing, chronic shortness of breath and chronic chest tightness which last/s at least three months in one year. Chronic Cough is an experience of coughing as much as 4–6 times per day occurring for most days of the week (≥4 days) for at least three months in one year. Chronic Phlegm: It is sputum expectoration as much as twice a day for most days of the week (≥4 days) for at least three months in one year. Chronic Wheezing: A condition of causing a wheezy or whistling sound during inspiration/expiration at least three months in a year occasionally apart from that caused by a cold or acute upper respiratory infection. Chronic Chest stiffness/pain: In the past one year, chest stiffness/pain that kept off work with phlegm. Chronic shortness of breath is experiencing breathlessness when hurrying on the level ground or walking up a slight hill at least three months in a year or walking slower because of breathlessness or stopping for breath after walking some distance at least three months in a year or breathlessness while doing activities of daily living (American Thoracic Society).28
Data collection procedure
Interviewer administered modified standard questionnaire from American Thoracic Society on respiratory symptoms was used. The questionnaire (Extended Data file 1)35 comprises quantitative questions about demographic and socioeconomic characteristics, personal behavior, environmental factors, residential history, chronic respiratory disease and the occurrence of chronic respiratory health symptoms mainly cough, phlegm, shortness of breath, wheezing and duration of respiratory symptoms. The physiotherapy graduation students (n = 3) were involved in data collection and they were trained for 1 day on the data collection procedure by HR and KSS. Both the authors (HR and KSS) supervised the data collections process. A multistage random sampling technique was designed to reach the required sample size in both exposed and unexposed cluster group. The list of administrative zones of the study area and households were obtained from the local administrative office. Streets were selected from randomly selected strata and from the selected streets the households were proportionately allocated for each street. From the list of house numbers (ascending order) a systematic random sampling method was used by computing Kth (sampling interval; number of households/required proportionate sample). In the case of more than one eligible individual in a household, a lottery method was used to decide participation (Figure 1). To ensure de-identification of participant’s information, the direct and indirect identifiers were de-identified from the dataset and only the principal investigator had access to the consent and assent forms.
Data processing and analysis
The filled questionnaire was checked for completeness, coded and entered into EPI-data version 3.1 and exported to the IBM Statistical package for Social Sciences (SPSS) IBM version 24 for Windows (RRID: SCR_016479), Armonk, NY, USA. Sample characteristics were described as frequency, percentages, and mean with standard deviation for the exposed and unexposed groups. Independent factors related with respiratory symptoms at a P-value < 0.2 were identified by bivariate logistic regression analysis. To account for potential confounding and investigate the relationship between various independent factors, variables that demonstrated statistical significance at a p-value of less than 0.2 were included in the final multivariate logistic regression model. Factors deemed statistically significant in multivariate analysis were those having p-values less than 0.05 and 95% confidence intervals. Examining the variability in the correlation, potential confounding variables were added to the model as covariates. Significance tests and logistic regression modeling were carried out for suitably sized subgroups where there were distinct subgroups within each category in the data. Finally, the variables which had significant association were identified on the basis of AOR with 95% CI and p < 0.05.
Results
Socio-demographic and behavioral characteristics of study participants
A 100% response rate was achieved with 542 eligible respondents in this survey. Half (50%) were exposed to cement dust (dwelling near 1km of the cement mill) while the other half were not. The study included people aged 15-70, with mean (SD) ages of 36.74(±15.99) for exposed and 37.77(±15.13) for non-exposed. The majority of exposed respondents were under 25 (36.2%), while non-exposed respondents were 25–34 (20.8%) (Table 1).34 Most exposed respondents had less than 15000 INR (Indian rupee) monthly income (37.3%), compared to 41.0% of non-exposed respondents.
Table 1. Socio-demographic and behavioral characteristics of study subjects by their exposure status to cement dust air pollution from cement factory in Dakshina Kannada, Karnataka.
Only 38 participants in both the groups reported to have smoked, of whom 17 were current smokers and 21 ex-smokers. The majority (98%) lived in the house with a separate kitchen. One in nine participants (87.8%) lived in biomass-cooking households (Table 1). Exposed and non-exposed study volunteers had similar ages and sexes. Exposure and non-exposure had similar marriage rates (49.8% vs 52.8%). Illiteracy rates were similar for exposed (57.2%) and non-exposed (52.4%) participants. Farmers dominated exposed (46.1%) and non-exposed (55.7%) research respondents (Table 1).
Prevalence of chronic respiratory symptoms among exposed and non-exposed groups
A total of 309 (57.0%) of the individuals in the research experienced the development of at least one chronic respiratory symptom, including chronic cough, chronic phlegm, chronic wheezing, chronic shortness of breath, and chronic chest discomfort. The incidence of respiratory symptoms was substantially higher in the exposed group (n=224; 82.7%) compared to the non-exposed group (n=85; 31.4%) (P-value=0.001). Similarly, the percentage of individuals who had each respiratory symptom was substantially greater in the exposed group compared to the non-exposed group (p-value < 0.001) (Table 2).
Table 2. Prevalence of chronic respiratory symptoms among communities living proximate to the cement factories (n = 542).
| Symptoms | Total n (%) | Exposure status | p-value a | |
|---|---|---|---|---|
| Exposed (n=271) n (%) | Non-exposed (n=271) n (%) | |||
| Chronic cough | 226(41.7) | 184(67.9) | 42(15.5) | <0.001 |
| Chronic phlegm | 188(34.7) | 155(57.2) | 33(12.2) | <0.001 |
| Chronic wheezing | 196(36.2) | 147(54.2) | 49(18.1) | <0.001 |
| Chronic SoB | 174(32.1) | 137(50.6) | 37(13.7) | <0.001 |
| Chronic chest pain | 176(32.5) | 138(50.9) | 38(14.0) | <0.001 |
| Had respiratory symptomb | 309(57.0) | 224(82.7) | 85(31.4) | <0.001 |
Predictors of chronic respiratory symptoms among exposed and non-exposed group
Using bivariate logistic analysis, a subset of variables were examined for their individual contribution to chronic respiratory symptoms. Five predictors were found to be significant at p<0.2. Then these predictors were entered together to examine their effect on the outcome variable (chronic respiratory symptoms) by logistic regression model. All of the chronic respiratory health complaints were found to have a substantial correlation with exposure status in the final model. Furthermore, it was discovered that the outcome variable was substantially correlated with the primary causes of lighting and smoking status for chronic cough, occupation for chronic wheeze, and marital status for chronic shortness of breath, respectively. Table 3 displays the results of the bivariate and multivariate analyses.
Table 3. Bivariate and Multivariate logistic regression analysis; predictors associated with chronic respiratory symptoms among exposed and non-exposed communities living around Cement Factory.
| Variables | Respiratory symptoms | COR 95% (CI) | AOR 95% (CI) | |
|---|---|---|---|---|
| No: n (%) | Yes: n (%) | |||
| Chronic cough | ||||
| Exposed to pollution | ||||
| No | 229 (84.5) | 42 (15.5) | 1 ref | 1 ref |
| Yes | 87 (32.1) | 184 (67.9) | 11.5 (7.6, 17.5)*** | 15.4 (9.24, 25.8)** |
| Main source of energy for cooking | ||||
| Gas/Electricity | 45 (68.1) | 21 (31.8) | 1 ref | 1 ref |
| Biomass | 271 (56.9) | 205 (43.1) | 1.62 (0.94, 2.81) | 0.73 (0.32, 1.66) |
| Smoking status | ||||
| Past smoker | 15 (39.5) | 23 (60.5) | 1 ref | 1 ref |
| Never smoker | 301 (59.7) | 203 (40.3) | 0.44 (0.22, 0.86)* | 0.27 (0.12, 0.62)** |
| Chronic phlegm | ||||
| Exposed to pollution | ||||
| No | 238 (87.8) | 33 (12.2) | 1 ref | |
| Yes | 116 (42.8) | 155 (57.2) | 9.6 (6.23, 14.9)*** | 11.5 (6.8, 19.4)*** |
| Main source of energy for cooking | ||||
| Gas/Electricity | 49 (74.2) | 17 (25.8) | 1 ref | 1 ref |
| Biomass | 305 (64.1) | 171 (35.9) | 1.62 (0.9, 2.89) | 0.92 (0.41, 2.06) |
| Smoking status | ||||
| Past smoker | 19 (50.0) | 19 (50.0) | 1 ref | 1 ref |
| Never smoker | 335 (66.5) | 169 (33.5) | 0.5 (0.26, 0.98)* | 0.5 (0.23, 1.09) |
| Chronic wheezing | ||||
| Exposed to pollution | ||||
| No | 222 (81.9) | 49 (18.1) | 1 ref | 1 ref |
| Yes | 124 (45.8) | 147 (54.2) | 5.4 (3.6, 7.94)*** | 5.3 (3.35, 8.4)*** |
| Occupation | ||||
| Farmer | 179 (64.9) | 97 (35.1) | 1 ref | 1 ref |
| Merchant | 52 (70.3) | 22 (29.7) | 0.78 (0.45, 1.36) | 1.38 (0.61, 3.1) |
| Government employee | 48 (63.2) | 28 (36.8) | 1.08 (0.64, 1.82) | 3.20 (1.2, 8.7)* |
| Daily laborer | 10 (38.5) | 16 (61.5) | 2.95 (1.29, 6.76)* | 3.99 (1.3, 12.62)* |
| Have no work | 57 (63.3) | 33 (36.7) | 1.07 (0.65, 1.75) | 2.71 (0.97, 7.57) |
| Chronic shortness of breath | ||||
| Exposed to pollution | ||||
| No | 234 (86.3) | 37 (13.7) | 1 ref | 1 ref |
| Yes | 134 (49.4) | 137 (50.6) | 6.47 (4.25, 9.85)*** | 8.4 (5.06, 14.0)*** |
| Marital status | ||||
| Single | 155 (72.1) | 60 (27.9) | 1 ref | 1 ref |
| Married | 179 (64.4) | 99 (35.6) | 1.43 (0.97, 2.1) | 1.7 (1.11, 2.62)* |
| Divorced | 17 (58.6) | 12 (41.4) | 1.82 (0.82, 4.05) | 3.81 (1.54, 9.45)** |
| Widowed | 17 (85.0) | 3 (15.0) | 0.46 (0.13, 1.61) | 0.77 (0.19, 2.99) |
| Main source of energy for cooking | ||||
| Gas/Electricity | 51 (77.3) | 15 (22.7) | 1 ref | 1 ref |
| Biomass | 317 (66.6) | 159 (33.4) | 1.71 (0.93, 3.13) | 1.14 (0.51, 2.55) |
| Chronic chest pain | ||||
| Exposed to pollution | ||||
| No | 233 (86.0) | 38 (14.0) | 1 ref | 1 ref |
| Yes | 133 (49.1) | 138 (50.9) | 6.36 (4.19, 9.66)*** | 6.4 (3.96, 10.4)*** |
| Smoking status | ||||
| Past smoker | 23 (60.5) | 15 (39.5) | 1 ref | 1 ref |
| Never smoker | 343 (68.1) | 161 (31.9) | 0.72 (0.37, 1.42) | 0.44 (0.18, 1.04) |
Exposure residents in this study had 15.4 times [AOR (95% C.I.) = 15.4 (9.24, 25.8)]. The odds of developing chronic cough, chronic phlegm, chronic wheezing, chronic shortness of breath, and chronic chest pain were, respectively, 11.5 times [AOR (95% C.I.) = 11.5 (6.8, 19.4)], 5.3 times [AOR (95% C.I.) = 5.3(3.35, 8.4)], 8.4 times [AOR (95% C.I.) = 8.4(5.06, 14.0)], and 6.4 times [AOR (95% C.I.) = 6.4(3.96, 10.4)] higher than non-exposed. Compared to households using gas or electricity, those using fuel gas as their primary source of lighting had 2.2 times [AOR (95% C.I.) = 2.2(1.16, 4.2)] greater risks of getting a chronic cough. Compared to smokers or former smokers, non-smokers had a 73% [AOR (95% C.I.) = 0.27(0.12, 0.62)] reduced chance of acquiring a chronic cough. The logistic analysis also showed that the risks of developing chronic wheezing were higher for government officials and daily laborers than for farmers, at 3.2 times [AOR (95% C.I.) = 3.2(1.2, 8.7)] and 3.99 times [AOR (95% C.I.) = 3.99 (1.3, 12.62)], respectively. Additionally, compared to single participants, married and divorced subjects had, respectively, .7 times [AOR (95% C.I.) = 1.7(1.11, 2.62)] and 3.8 times [AOR (95% C.I.) = 3.81(1.54, 9.45)] higher odds of experiencing dyspnea (Table 3).
Discussion
Due to the rapid development of industry and the growing population, especially in Asian nations, people are living closer to these industries and are therefore exposed to harmful pollutants. A range of lung illnesses, from minor symptoms to cancer, have been linked to respirable cement dust exposure.29,30 Unsurprisingly, this study results indicated that residents exposed to cement dust reported respiratory symptoms at significantly higher rates than those who were not, highlighting the necessity of clearly delineating boundaries to permit habitation in close proximity to these industries. According to a study conducted in Midlothian, Texas, the results are in line with a survey of symptoms conducted on both the study group and a reference community. According to the investigations, those who live near a cement business have more respiratory effects.31,32
Compared to the non-exposed group, which reported 31.4% of respiratory symptoms, the exposed group in this study self-reported having at least one respiratory symptom, as defined by the American Thoracic Society (ATS).28 The prevalence of long-term respiratory issues in the exposed study area was comparable to research findings from Ethiopia and India.11,29 The Ethiopian study revealed the prevalence of chronic respiratory symptoms among cement industry personnel, whereas the Indian study focused on the locals residing near the cement plant. Interestingly, the study’s claimed prevalence is rather greater than the findings of studies conducted in Ethiopia (66.6%) and India (54.4%). There could be a variety of reasons for this, including variations in the operational definition of respiratory symptoms, the degree of dust exposure, and the multifactorial elements that influence respiratory health.
The comparative study in North Showa, Ethiopia reported 31.2% of non-exposed persons developed respiratory symptoms. Exposure to cement dust was observed to significantly increase chronic respiratory symptoms, including cough (41.6%), phlegm (34.7%), wheezing (36.2%), shortness of breath (32.1%), and chest discomfort (14.0%), compared to non-exposed individuals. A comparative research in North Showa, Oromia Regional State, Ethiopia, found that exposed and non-exposed groups had similar rates of cough (32% vs. 13.8%), phlegm (30.5% vs. 16.7%), wheeze (38% vs. 10.4), dyspnea (44% vs. 13.4%), and chest discomfort (20.3% In another Indian cement mill study, exposed and non-exposed adults had reduced rates of respiratory symptoms such cough (96% vs. 15%), shortness of breath (96% vs. 10%), wheeze (96% vs. 21%), and chest.26 Given that both age and maleness are positively correlated with respiratory symptoms,17,24,30 the discrepancy could perhaps be explained by the participant background characteristics from earlier research. Living in the exposed community increased the odds of chronic cough, phlegm, wheezing, shortness of breath, and chest pain by 15.4, 11.5, 5.3, 8.4, and 6.4 times, respectively, according to the logistic regression analysis, which also reveals that living in the exposed community was the most prevalent and significant determinant of all types of chronic respiratory health symptoms in this study. Pollution from cement production poses a threat to residents in communities that are already at risk. Since earlier studies have demonstrated considerable levels of PM, NOX, and CO in ambient air in communities near cement producers,31,32 residency in this community was regarded an adequate proxy measure of exposure. On the other hand, these results might have been influenced by other aspects of the home microenvironment that were not covered in this study. Further, the non-smokers had a decreased risk of chronic cough than smokers or ex-smokers. This conclusion is similar with studies done in India, Ethiopia, and Italy,11,24,29,30 while another Ethiopian and Iranian research found no difference in respiratory symptoms between smokers and nonsmokers.17,33 The quantity, frequency, and duration of cigarette smoking may account for this discrepancy. In the multivariable model, the only factor other than exposure status that was linked to persistent wheeze was occupation. Researchers found that regular workers were more likely than farmers to experience chronic wheeze. Daily exposure to excessive dust may cause respiratory health issues at work. Compared to single people, married or divorced people are more likely to develop chronic dyspnea. To support their family, married and divorced people may both work as dust workers. The duration, source of light energy at home, occupational status, and exposure to cement dust pollution were found to be significantly correlated with chronic respiratory difficulties in this study. Among residents without cement dust, only smoking status and sex was statistically significant (Extended Data 2).35 The main factor impacting respiratory symptoms in exposed groups was their work. Compared to farmers, day laborers and government employees were more likely to experience enduring respiratory symptoms. Therefore, both daily laborers and government employees may be exposed to dust and PMs. This study found a significant correlation between the level of cement dust pollution and respiratory symptoms. Compared to those who lived within one kilometer of a cement mill for fewer than five years, those who lived there for more than fifteen years were more likely to experience chronic respiratory issues. Studies conducted in India, Zambia, and Ethiopia found likely sex association with the self-reported respiratory problems.8,11,24,25 Particularly, the Zambian study indicated increased risks of persistent respiratory problems among women. Similarly, taking into account Zambia’s comparable cultural background and increased usage of dirty fuels for cooking, the current study also discovered that participants were exposed to cement dust due to the compounding effects of using biomass and residing close to a cement plant particularly among women. This study’s comparative design between the exposed and unexposed groups of nearby inhabitants who share similar environment, socioeconomic level, cultural background, and ethnicity is its strongest feature. The following study limitations should be taken into account when interpreting the results and exercising caution when drawing conclusions: although the study showed differences in community respiratory health between the groups according to how far away they lived from the cement plant, the cross-sectional design may not have been sufficient to establish causality. Additionally, source apportionment, ambient air pollutants, medical history, and surgical history were not taken into account. Therefore, it is uncertain if the variations in chronic respiratory issues between the two groups were brought on by emissions from cement factories. The inquiry might have overlooked additional sources of contamination in the community that was exposed. Furthermore, self-reported symptoms were not supported by hospital data.
Conclusion
The findings of this study unequivocally imply that living within close proximity to a cement plant shows the extent of exposure to cement dust there is and may be associated with respiratory issues that the community’s citizens experience. As a greater percentage of those in the exposed group experienced respiratory symptoms, it is appropriate to limit restrictions to residential areas close to cement plants that are similar to this one. Furthermore, it’s critical to pinpoint contributing variables, reduce exposure to them, and minimize health issues.
Ethics and consent
The Alvas College of Physiotherapy and Research Centre, Dakshina Kannada, Karnataka, research ethics committee (REC) and institutional review board approved the study (ref no; ACP/OP/CL/2022/52; 22/02/2023). All interviewees were told of the survey’s goal, benefits, and harms, selection criteria to get permission, and their right to withdraw or reject the research participation. Participant’s data was de-identified prior to analysis and the findings of this study were not linked to any participant identifying records. Making the questionnaire anonymous protected participants’ commerce and confidentiality. Data was protected with a computer password and not shared with any parties. Scientific honesty was maintained by correctly referencing all book and journal authors and recognizing researchers, persons, and organizations that helped complete this thesis. Written informed consent was obtained from all the participants and from the parents or guardian of participants aged under 18 years. In addition, assent form was obtained from the participant’s under 18 years. As some of the participants were illiterate, if the participant was unable to read/write the informed consent form, an impartial witness from their neighbourhood or one of their family members who could read/write during the explanation of the contents in the informed consent form. Then the impartial witness signed the consent form and a left thumb impression was obtained from the participant.
Authors’ contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, data, analysis and interpretation. HR, and KS trained the data collectors, supervised data collection, and approved completed questionnaires. All the authors took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work".
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how to cite this article
Janakiraman B, Ravichandran H, Susheel Shetty K et al. Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:682 (https://doi.org/10.12688/f1000research.147324.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review
Current Reviewer Status:
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 24 Jun 2024
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6
How to cite this report:
Birgul A. Reviewer Report For: Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:682 (https://doi.org/10.5256/f1000research.161508.r394225)
The direct URL for this report is:
https://f1000research.com/articles/13-682/v1#referee-response-394225
https://f1000research.com/articles/13-682/v1#referee-response-394225
NOTE: it is important to ensure the information in square brackets after the title is included in this citation.
Reviewer Report 13 Aug 2025
Askin Birgul,
Bursa Technical University, Bursa, Turkey
Approved with Reservations
VIEWS 6
Major Comments
- Study Design and Inference
The cross-sectional nature of the study limits causal inference between cement dust exposure and respiratory symptoms. This limitation should be more clearly acknowledged in the abstract and
CITE
HOW TO CITE THIS REPORT
Birgul A. Reviewer Report For: Chronic respiratory health symptoms and associated factors among exposed and unexposed residents to cement dust, in Moodubidire, Dakshina Kannada, Karnataka; a comparative cross sectional study [version 1; peer review: 1 approved with reservations]. F1000Research 2024, 13:682 (https://doi.org/10.5256/f1000research.161508.r394225)
The direct URL for this report is:
https://f1000research.com/articles/13-682/v1#referee-response-394225
https://f1000research.com/articles/13-682/v1#referee-response-394225
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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