Pulmonary function and respiratory symptoms among petrol station workers in debre tabor town, northwest ethiopia, 2023 Authors:Deribew Abebaw Abuhay Int J Biol Med Res. 2024; 15(1): 7724-7730 https://www.biomedscidirect.com/2853/pulmonary-function-and-respiratory-symptoms-among-petrol-station-workers-in-debre-tabor-town-northwest-ethiopia-2023

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International Journal of Biological & Medical Research
Int J Biol Med Res. 2024; 15(1): 7724-7730
A R T I C L E I N F O A B S T R A C T
keywords
Petrol station workers
pulmonary function impairments
respiratory symptoms
Introduction: Petrol station workers are prone to pulmonary function impairment and respiratory
symptoms acquired during filling fuels and to the gases from vehicular exhaust. Decreased
pulmonary function parameters and abnormal respiratory symptoms such as cough, wheezing, and
breathlessness were reported among petrol station workers. Objective: The study was aimed to
assess pulmonary function and respiratory symptoms; and identify associated factors among petrol
station workers in Debre Tabor town.Methods and Materials: A comparative cross-sectional study
design was conducted among 66 petrol station workers and 66 Debre Tabor University workers
(controls) between March and May, 2023. Data on socio-demographics, occupational history,
utilization of personal protective equipment and respiratory symptoms were collected using an
interviewer- administered questionnaire. A digital Spirometer (Model Contec SP10) was used to
assess pulmonary function impairments. An independent sample t-test was used to compare
spirometerresultsoftheexposedandcontrols.Levelofsignificancewassetatp<0.05.Results:From
petrol station workers, the mean± SD of Forced Vital Capacity (FVC), Forced Expiratory Volume in
the first second (FEV1), FEV1/FVC%, Forced Mid-Expiratory Flow (FEF25-75%) and Forced
Expiratory Flow Rate (FEFR) were 3.72±0.64, 3.14±0.53, 81.16±10.44, 3.85±0.97 and 6.87±1.53
respectively. There was a significant decrease in these pulmonary function test scores as compared
withcontrols.Respiratorysymptomssuchascough,phlegm,wheezingandshortnessofbreathwere
developed in 41.4%, 26.7%, 30.4% and 16.7% petrol station study participants respectively.
Exposure to petrol fumes for more than 10 years was 3.18 times (AOR= 3.18; 95%CI=1.62- 9.73)
more prone to develop lung function impairment compared with those worked for <5 years.
Conclusion: Exposure to petrol fumes causes a significant reduction in pulmonary function among
petrol station workers. Respiratory symptoms were higher among petrol station study participants
comparedwiththecontrols.
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Int J Biol Med Res
Pulmonary Function and Respiratory Symptoms among Petrol Station workers in
Debre Tabor Town, Northwest Ethiopia, 2023.
Deribew Abebaw Abuhay*
Department of Biomedical Science, Human Physiology unit, College of Medicine and Health Science, Debre Tabor University, Ethiopia
Original article
Introduction
Copyright 2023 BioMedSciDirect Publications IJBMR - All rights reserved.
ISSN: 0976:6685.
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A petrol station, also known as a gas station sells fuel and
lubricant. Currently, regular gasoline, gasoil, kerosene, heavy fuel oil,
light fuel oil and JTA-1 are imported in to Ethiopian Petroleum
Supplies. Heavy and light fueloilsare imported for industrialuse, and
JTA-1 for aviation purposes. Gasoil and gasoline are used for
transportation, construction, industry, power generation,
agriculture,householdcookingandlightinginruralareas.
With the expansion of urbanization and increasing number of
automobiles in Ethiopia, a number of petrol stations are currently
found in most towns. Petrol, also known as gasoline is a complex
combination of hydrocarbons, additives, and blending agents . The
composition of gasoline varies widely, depending on the crude oils
used, refinery processes available, overall balance of product
demand, and product specifications. Its typical composition
includes hydrocarbons (alkanes and alkenes) and aromatic
compounds,suchasbenzene.
Petrol station workers dispense gasoline, diesel, and others
intotankswithinvehiclesandcalculatethefinancialcostofthefuel
transferred to the vehicle . These workers are exposed to such
products through inhalation of vapors, contamination of fume
particles during eating and drinking, skin contact from petrol
vapor, and vehicular exhaust. Occupational exposure to petrol
vapor affects the normal function of different body systems,
includingtherespiratory,liver,andrenalsystems().
Exposure to harmful substances is a major cause of pulmonary
function impairments and death worldwide. The International
Labor Organization indicates that 13,000 deaths worldwide were
caused by exposure to different chemicals, fuel vapor and dust in
* Corresponding Author : Dr. Deribew Abebaw Abuhay
Department of Biomedical Science, Human Physiology unit, College of Medicine and
Health Science, Debre Tabor University, Ethiopia
E-mail: amendere23@gmail.com
Copyright 2023 BioMedSciDirect Publications. All rights reserved.
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2. Deribew Abebaw Abuhay et al. Int J Biol Med Res. 2024; 15(1): 7724-7730
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the work place. Workers involved in petrol filling, mining,
construction, and dust generation are at high risk of developing
work- related respiratory illnesses . Consequently, occupational
respiratory diseases lead to premature mortality, loss of
productivity and disability . In India, respiratory diseases account
for 17% of the 11 million occupational diseases, and obstructive
lung diseases are responsible for 87% of work- related respiratory
diseasesmortality.
Petrol station workers typically work under unhygienic
conditions and perform hazardous tasks. They are prone to
pulmonary function impairment and respiratory symptoms
resulting from occupational inhalation exposure . Decreased
pulmonary function parameters such as Forced Expiratory Volume
in the first second (FEV1), Forced Vital capacity (FVC), Forced
Expiratory Volume in the first second to Forced Vital capacity
(FEV1/FVC %), and Forced Expiratory Flow Rate (FEFR) have been
reported in several studies. Dry cough, cough with phlegm,
wheezing and breathlessness are common occupation- related
diseasesamongpetrolfillingworkers.
Respiratory diseases are the sixth most common causes of
death in developing countries is more prevalent in developing
countries, especially Sub-Saharan Africa. In addition, petrol station
workers do not take any measures for occupational safety because
of limited resources, skills, and training of employers, technologies,
lowsocio-economicstatusandloweducationallevel .
Despite these health problems, a significant number of studies
have not been conducted on pulmonary function impairments and
respiratory symptoms among petrol station workers in Ethiopia.
Thisstudyaimedtofillthisinformationgapbyassessingpulmonary
function status and respiratory symptoms among petrol station
workersinDebreTabortown.
Pathogenesisofobstructiveandrestrictivelungdiseases
During the dispensing process, fuel vapor enters and is
deposited in different parts of the respiratory airways according to
their aerodynamic diameter, airway dimensions and breathing
patterns . Large dust particles (>5 μm) are deposited in the
conducting zone of the respiratory tract, including the nose and
trachea. Medium- sized dust particles (1-5 μm) are deposited in
smaller airways, including the terminal bronchioles, while smaller
particles(<0.1μm)aredepositedinthealveolithroughdiffusion.
Once inhaled fuel vapor particles are deposited in the
respiratory tract, they activate epithelial cells, including natural
killer cells and mast cells. Respiratory epithelial cells act as a
physical barrier in the lungs and play an important role in the
immune response to dust. These cells express different receptors
such as TOLL- like receptors, c- type lecitin receptors, and protease-
activated receptors, which can be triggered by environmental
allergensandmicrobialcomponents.
After receptor- mediated activation, epithelial cells produce
pro-inflammatory cytokines such as IL-6 and IL-8 in response to
allergens . This mechanism stimulates the lymphocytes, dendritic
cells,andgranulocytes.Activationofthesecellsreleasesproteases
that irritate the airway, prostaglandins that cause bronchospasm,
increased mucus secretion, and oxygen radicals that destroy the
alveolar wall and exacerbate inflammation . Finally, it leads to
mucus exudates (edema), lung parenchymal destruction (fibrosis),
bronchospasm, impaired muco-cilliary function, and air-flow
limitation.
Fig. 1: A conceptual framework of pulmonary function status
and respiratory symptoms and the associated factors among
studyparticipants.
MethodsandMaterials
Studydesign
Acomparativecross-sectionalstudydesignwasemployedfrom
MarchtoMay,2023atDebreTabortown.
Studyareaandperiod
The study was conducted in Debre Tabor town, located in South
Gondar Zone of Amhara National Regional State, Northwest
Ethiopia. It is 97 kms from Bahir Dar, the capital of the region, and
665 km away from Addis Ababa, the capital of Ethiopia. Currently, it
has ten petrol stations owned by private companies, comprising
morethan72workers.
Source population: All petrol station workers working at
DebreTabortown.
Study group: Petrol station workers in Debre Tabor town who
fulfilledtheinclusioncriteria.
Control group: Residents of Debre Tabor University who had
similar baseline characteristics (age, sex, weight and height) as the
study groups; did not live, and had never worked in petrol stations
inthepast.
Inclusioncriteria
· Apparently healthy workers daily working in the petrol station
forsixmonthsormore
· Petrol station workers present at their working site during data
collectionperiod
· Petrol station workers who were willing to participate and
signedconsent.
Conceptual Framework

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Predictorvariables
·Socio-demographic parameters (sex, age, marital status,
religion,levelofeducation,monthlyincome)
·Workingduration
·Historyofpastexposuretogasolinefumes
·Trainingsgivenonthehealthimpactofpetrolexposure
·Availabilityofpersonalprotectiveequipment
·Useofpersonalprotectiveequipment
Operationaldefinition
FVC: Maximum volume of air forcefully expired after deep
inhalation. The person should continue expiring for a minimum of
sixseconds.
FEV1: The volume of air forcefully expired in the first one
secondofmaneuver.
FEV1/FVC%: Percentage of vital capacity expired forcefully
withinonesecondofdeepinspiration.
Forced mid-expiratory flow (FEF25-75%): the mean forced
expiratoryflowduringthemiddlehalfoftheFVC.
Peak Expiratory Flow Rate: Maximum air-flow rate during
FVCmaneuveratL/min.
Obstructive lung disease: FEV1/FVC ratio < 70% and percent
predicted FEV1<80%, (FEV1 much lower than FVC), however, FVC
valuesarenormalorincreased.
Restrictive lung disease: FVC and FEV1 are reduced in
proportion, however, FEV1/FVC ratio may be normal (80%) or
increased .
Respiratory symptoms: the presence of one or more
symptoms of cough, phlegm, wheezing, shortness of breath, and
chestpain .
Cough: occurring more than 4-6 times per day, >4 days in a
week,andatleastthreemonthsinayear.
Chestpain:Inthepastyear,chestpainpersistedduringworkor
dailyactivities.
Phlegm is classified as sputum expectoration twice a day, 4 days
aweek,andatleastthreemonthsinayear.
Wheezing:chestsoundwhistlingonexpiration.
Dyspnea:shortnessofbreathatrestoratexertion.
· Debre Tabor University workers with similar demographic and
socioeconomic characteristics to petrol station workers, except for
theriskofexposure.
Exclusioncriteria
Petrol station workers and Debre Tabor University workers
whosmokedtobacco,khatchewers,knownTuberculosiscases.
After adding a 10% non-response rate, 66 study participants
from each group were included making the total number of study
participants 132. Every petrol station worker was sampled until a
sample size was reached. Control groups were selected at their
officeusinglotterymethod.
Variablesofthestudy
Outcomevariable
· Pulmonaryfunctionparametersandrespiratorysymptoms
Double- population proportion formula with 95% confidence
intervaland80%powerwasusedtoselectstudyparticipants
n=(Za/2+Zß)2P(1-P)(r+1)
r(P1-P2)2
Wheren=samplesizerequiredforeachgroup
Zα/2=thecriticalvalueat95%confidenceinterval=1.96
Zβ=power=0.84.
P1=prevalenceofrespiratorysymptomsamongexposedgroups
P2= prevalence of respiratory symptoms among non- exposed
groups
P=average=(P1+P2)/2betweenthetwogroup
r = ratio of exposed to non- exposed =1 because equal number were
used
A similar study in Jimma Town, Ethiopia pulmonary function
impairment was found among 37.9% petrol filling workers and
15.2%controlgroups.Therefore,
P1=0.379 P2=0.152
P=(0.379+0.152)/2=0.2655
n=(1.96+0.84)20.2655(0.7345)(1+1)=60
(0.379-0.152)2
Sample size determination and sampling techniques
Deribew Abebaw Abuhay et al. Int J Biol Med Res. 2024; 15(1): 7724-7730

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Data collection instruments and procedures
Three Nurses were used to collect the data with close
supervision by the researcher. Two day training with practical
demonstrations on the interview techniques and measurement
procedures was provided to the data collectors. An interviewer-
administered structured questionnaire based on the American
Thoracic Society was used to collect data on socio-demography,
occupational history, use of personal protective equipment, and
respiratorysymptoms.
Pulmonary function status of petrol station workers and controls
was assessed using a digital spirometer (Contec SP10) in a sitting
position, wearing a nose clip, and breathing through the mouth
piece. Before performing pulmonary function tests, study
participants were informed to avoid heavy exercise. Study
participants were asked to sit on a chair and asked to take a normal
3-4 breathes through the mouth piece. Inspire slowly and deeply,
and then breathe out forcefully and rapidly. Three consecutive
readings were taken with five minutes interval in between the
readings. The highest score of the three readings were taken as the
final readings for pulmonary function status parameters. Daily
calibration of the spirometer, and disinfection of the mouth piece
was done after every measurement and kept clean for the next
maneuver .
The quality of data was controlled through providing training
for data collectors, pre-testing the questionnaire, spirometric
measurements at a fixed time, calibration of the spirometer before
performing the test, and repeating the measurements. For
consistency,theEnglishversionofthequestionnairewastranslated
in Amharic, native language. All data from the study participants
werekeptconfidential.
Dataanalysis
Data was entered in to Epi-data version 4.6 then analyzed using
Stata-14. Descriptive statistical values (mean, proportion and
standard deviation) were computed, and the results are presented
in the tables and figures. Comparison of pulmonary function scores
(FVC, FEV1, FEV1%, FEF25-75% and PEFR) of the two groups was
done by independent sample t-test. Bivariable and multivariable
logistic regression analyses were employed to show any
association between independent and dependent variables using
oddsratio.Inallcases,statisticalsignificancewassetatp<0.05 .
Ethicalconsideration
Ethical approval was obtained from Ethical Review Board,
College of Medicine and Health Sciences, Debre Tabor University,
Ethiopia. Permission was obtained from the managers at each
petrol station. Written informed consent was obtained from every
study participant upon explaining the purpose and benefits of the
study.
Resultsofthestudy
Descriptiveanalysesofstudyparticipants
Onehundredthirtytwoparticipantswereenrolledinthisstudy.
Among petrol station workers, 62.1% were males. They were
between 22 - 47 years old (mean ± SD: 30.46 ± 7.31 and 28.71± 4.25
in petrol station workers and controls respectively). The majority
(68.2%)ofthepetrolstationworkersweremarried(Table1).
Noneofthepersonnelprotectiveequipmentwasavailableandused
by 91% of the petrol station workers. This increased the rate of
exposure to volatile products. Only six (9.1%) petrol station
workers occasionally used gloves during their life time. Almost half
(51.5%) of the study participants had worked in petrol stations for
five - ten years. None of the study participants had received training
or awareness regarding the hazardous effects of petrol fumes or
waystoreducetheirexposuretotheseproducts(Table2).
Table 2: Work related data of petrol station workers in Debre
Tabortown,NorthwestEthiopia,2023
Contec SP10 Spirometer
Mouse piece and nose clip
Fig. 2: Equipments for assessing pulmonary function
Data quality control and management
Table 1: Socio-demographic characteristics of petrol station
workers and controls at Debre Tabor, 2023.
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Pulmonary function impairments and Respiratory symptoms
among petrol station workers and controls in Debre Tabor,
2023.
Accordingly to the independent sample t-test output, the
mean±SDofFVC,FEV1,FEV1/FVC%,FEF25-75%,andPEFRamong
petrol station workers was 3.72±0.64, 3.14±0.53, 81.16±10.44,
3.85±0.97 and 6.87±1.53, respectively. The mean scores were
4.46±0.81, 3.95±0.27, 86.72±8.32, 4.16±2.05 and 7.94±1.19 among
controls; and the change was statistically significant (p<0.05)
(Table3).
Table 3: Spirometer measurements of petrol station workers
andtheircontrolsinDebre
Tabortown,NorthwestEthiopia,2023.
FVC= Forced Vital Capacity, FEV1=Forced Expiratory Volume in
the first second, PEFR=Peak Expiratory Flow Rate, FEF25-75%=
Forced mid-expiratory flow, = Mean, SD= Standard Deviation, * =p <
0.05,**=p<0.001
Pulmonary function impairment among the study participants
was classified as obstructive or restrictive. Approximately,
29(43.9%), 17(25.75%), and 5(7.5%) petrol station workers
developed obstructive, restrictive and mixed pulmonary function
impairment, respectively (figure 4). Similarly, 10(15.15%) and 8
(12.12%) control groups developed restrictive and obstructive
pulmonaryimpairments,respectively.
Fig. 3: Obstructive, restrictive and mixed pulmonary function
impairmentsamongpetrolstationworkers,2023
The presence or absence of respiratory symptoms among study
participants was also analyzed. The result indicated that 41.4%,
26.7%, 30.4%, 16.7%, and 2.03% of petrol station workers
developed cough, phlegm, wheezing, shortness of breath, and chest
pain respectively. Similarly, the symptoms were found among
20.85%,11.62%,12.34%,and4.72%ofcontrols(Figure5).
Fig. 4: Respiratory symptoms of study participants at Debre
Tabortown,2023.
Factors associated with pulmonary function impairments and
Respiratorysymptomsamongstudyparticipants
Predictor variables with a statistically significant association (p
<0.25) in bivariable analyses were analyzed using multivariable
logistic regression to identify those factors statistically associated
withpulmonaryfunctionimpairments.
The findings showed that exposure to petrol fumes for five or
more years and the use of personnel protective equipment were
statistically associated with pulmonary function impairment
(p<0.05). Accordingtothisstudy,petrolstationworkersexposedto
petrol fumes for more than ten years were 3.18 times more prone to
pulmonary function impairments compared to those exposed for
less than 5 years (AOR= 3.18; 95%CI=1.62- 9.73). Similarly, study
participants working for 5-10 years were 2.56 times more prone to
pulmonary function impairments than to those working for less
thanfiveyears(AOR=2.56;95%CI=1.42-7.50).
The use of personnel protective equipment was also
statistically associated with pulmonary function status. Petrol
station workers who did not use these equipment were 2.3 times
more risky to develop pulmonary function impairments (AOR= 2.3;
95%CI=1.45-5.65)(Table4).
Table 4: Predictor variables associated with pulmonary
functionscoresinpetrolstationworkersinDebretabor,2023.
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Discussion
The findings of this study revealed that exposure of petrol
station workers to petrol vapors resulted in compromised
pulmonary function. This was consistent with similar studies
conducted in India , Malaysia , Nigeria , Khartoum City, Sudan ' and
Addis Ababa, Ethiopia . These findings could be because petrol
station workers are constantly exposed to petrol vapors that might
cause widespread peroxidation processes, decrease body
antioxidant defense system, and induce oxidative stress, resulting
in non-specific free radical attacks and inflammatory responses .
However, this was not in agreement with a study from Indonesia
where there was no significant difference on FVC, FEV1, and %FVC
scores of the two groups of study participants. The difference might
arise from the spirometric method used as well as socio-
demographicdifferencesamongthestudyparticipants.
In this study, higher number of petrol station participants
experienced respiratory symptoms of varies severity compared
with controls. This was in agreement with similar study conducted
in Pakistan and Nigeria' . However, this finding was contrary to
those of studies from Indonesia and Tanzania where the majority
of respondentsdidnotexperiencerespiratorycomplaints.
The logistic regression analyses also indicated that duration of
exposure and use of personnel protective equipments were
associated with pulmonary function impairments. Similar findings
were obtained from several studies . Exposure to petrol fumes for
longer periods may increase the risk of pulmonary impairment and
associatedrespiratorysymptoms.
Conclusion
People who work at petrol station areas were constantly
exposed to the hazardous toxin vapors of gasoline, kerosene, and
diesel during their daily activities. Exposure to such harmful
substances resulted in a significant reduction in the pulmonary
function test results. Pulmonary function impairments as well as
the development of respiratory symptoms was higher in petrol
station study participants compared with those in the control
groups. Exposure to petrol vapors for longer periods and the
absence of personnel protective equipments at the working site
were found to be statistically associated with impaired pulmonary
function.
Recommendations
The study suggested regular screening of petrol station
workers for pulmonary functions for early detection and
management of pulmonary diseases. Proper use of protective
equipment, such as face masks and gowns at work- places can
decreasetheriskofexposure.
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ISSN: 0976:6685.
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