Knowledge of Respiratory Disorders among Petrol Pump Workers in Erbil City

Introduction

The work setting creates an important part of man’s total environment, so health to a large extent is influenced by work conditions. Though some types of environments exist, it is the physical environment that plays an important bearing in health. Air, noise, heat, and radiation are the chief sites of environmental pollution and this is more so in urban regions (Nnaemeka, 2020). The number of gasoline and gas vehicles in the country is increasing each day, which in turn causes the expansion of gas stations and enhances the amount of fuel supply per day (Latif et al., 2019). Therefore, the air of cities is becoming directly and indirectly more polluted. This is an environmental problem in developing countries that has dangerous consequences for human health and the environment (Kerchich and Kerbachi, 2012).

Exposure to gases and vapors of volatile organic compounds is one of the factors affecting the health of workers in the oil industry. Benzene, toluene, ethylbenzene and xylene (BTEX) are among these volatile compounds and can expose workers in petrochemical and petroleum products such as gas station workers (Mehta et al., 2017; Dacherngkhao and Chaiklieng, 2019). Xylene (dimethyl benzene) is a clear and sweet solvent and its vapors can be very irritating to the eyes, nose, throat, skin and mucous membranes and can also affect the respiratory system and reduce Forced expiratory volume in one second (FEV1) and Forced vital capacity (FVC) levels in functional indicators of the lung (Baer, 2020).Toluene (methyl benzene) may cause fatigue, headache, anxiety, confusion and respiratory problems (Abdel Rasoul et al., 2017; PARK, 2021). Inhalation exposure to low levels of toluene vapors also causes changes in airway diameter, inflammation of the upper respiratory tract, and a decrease in FEV1 (PARK, 2021).

Petrol is a combination of volatile hydrocarbons, while diesel fuel contains paraffin’s, alkenes and aromatics. Petrol and diesel are the most commonly used automobile fuels in Zambia. A long term exposure to the air contaminants may lead to ill health on the respiratory functions (Shonga and Siziya, 2015).The International Agency for Research on Cancer (IARC) and the American Conference of Governmental Industrial Hygienists (ACGIH) place benzene in Group 1 (definitely carcinogenic to humans) (Megahed and Ghoneim, 2021, Yang et al., 2020).

Constant exposure of gas station workers to gasoline and diesel vapors affects lung function. The severity of respiratory distress depends on the duration of exposure (Rattanajongjitrakorn and Prueksasit, 2014). Identification of risks and diseases is a prerequisite for the prevention and control of occupational health problems that lead to improved working conditions and the implementation of occupational preventive measures (Nwanjo and Ojiako, 2010).

Although researchers have conducted numerous studies in this regard in different countries, but in relation to the proposed subject, according to the researcher's internet and library searches, there is little researches on gas station among workers in Iraq, and especially in the Kurdistan region. Therefore, with considering the importance of the subject, this study was conducted to determine the level of awareness of respiratory disorders in gas station workers in the city of Erbil, Iraq.

 Material and method

This research is a cross-sectional descriptive design. This study was conducted in all (146) gas stations under the management of the Ministry of Natural Resources in Erbil city. This study was conducted between 2021 and 2023. The target community includes employees of gas stations under the management of the Ministry of Natural Resources of Erbil. According to the lists obtained from the Presidency of the Council of Ministers of the Kurdistan Region/Ministry of Natural Resources/Directorate of Oil and Minerals a total of (568) Pump workers were present in the Fuel full station. The entire popular staff of Pump workers in Fuel full station in Erbil city was considered for the study.

The total numbers of pump workers during data collection were (568) but (50) pump workers were excluded because of their participation in the pilot study and (10) pump workers refused to participate in the study and also (8) pump workers were unavailable during data collection because of their sick leaves. Finally, the sample size of the study became (501) pump workers. Since the entire population of pump workers staff was considered for the study, the sample estimation was not required. The sampling method is the census method. Inclusion criteria: Workers who have had service in this field over five years, working in petrol pumps in urban areas and Engaged in fuel filling and vehicle oil replacement work. Exclusion criteria: Workers who have served in this field under five years, Who are of age below 18 years, Who have a childhood history of respiratory diseases, Working in the petrol station as a gas station cashier, cleaner, clerk, customer service representative and supervisors, Unwillingness of workers to participate in this study. Smoking workers.

To collect data from pump employees and gas station employees, a checklist made by the researcher was used.

Section 1: Socio-demographical characteristics.

Section 2: Questionnaire to assess the knowledge of workers regarding respiratory morbidities. This part includes items to assess the knowledge of workers about respiratory disorders related to their occupations, which are divided into five sections such as: Causes of respiratory morbidities, Effects of environmental pollution and petroleum fumes on the respiratory system, Signs and symptoms and complications of respiratory morbidities, Diagnosis and treatment of respiratory morbidities and Prevention. Categorization of worker according to knowledge scores: Adequate knowledge: 70% - 100% (22 - 30), Moderate knowledge: 35% - 69.99% (11 - 21) and Inadequate knowledge: 0 – 34.99% (0 - 10).

Result

Table.1  show information about Socio-demographical characteristics of Petrol Pump Workers in the study a According to result the mean of age was 26.38 years, Most of the workers were in the age group of 23-27 years(54.1%) and most of them were single (65.5%). Most Economic status of the workers were Earnings equal to expenses (61.7) .52% of the workers had shift at night. 81.6% of workers had 6-7 years of work experience, most of them worked 40-60 hours a week.

Table.1. Socio-demographical characteristics of Petrol Pump Workers

Table.2. provides us with information about the knowledge of gas station employees about respiratory disorders about the causes of respiratory complications. According to the results of this table, gas station workers (65.1%) and street sweepers (34.9%) are more exposed to oil fumes and air pollutants than others. Therefore, according to the results, it makes them more prone to inhaling pollutants (56.3%) and lack of rest (30.9%). It was proved that overcrowding with (41.1%) has the greatest impact on aggravating the effects of air pollution. Environmental pollution and, most importantly, oil smoke with (42.5%) are the most predisposing factors in the lung function of gas station workers due to constant exposure to pollutants (76.6%). Along with the involvement of other body systems, the most involvement is in the respiratory system, which accounts for 81.2% of the share. The results showed that factors can accelerate this breathing disorder, the most important of which is smoking (97.4%).

Table.2. Knowledge regarding respiratory disorders among petrol pump workers about causes of respiratory morbidities

The results of the investigation of knowledge variables about respiratory disorders in gas station workers / the effects of environmental pollution and oil fumes on the respiratory system are listed in Table3. According to the results, exposure to these pollutants affects the lungs more, which in the long term affects the airway, which has the greatest effect on dilation (with 35.3%). Also, Bronchial asthma was the most common complication among gas station employees with 54.5%. It was proved that the most common symptoms of respiratory complications among employees are cough (56.1%), weakness (30.9%), headache (7.4%), and abdominal pain (5.6%). Long-term exposure to these pollutants has potential side effects, which were the most common, respectively, difficulty breathing (63.1%) and loss of appetite (29.3%). We also examined the time required for symptoms of respiratory disease to appear, which showed that people develop symptoms of respiratory disease within a few months (50.3%) and a few weeks (31.1%).

Table.3. knowledge regarding respiratory disorders among petrol pump workers/ effects of environmental pollution and petroleum fumes on respiratory system

In Table.4., the results of the examination of knowledge variables related to respiratory disorders among gas station workers regarding signs and symptoms and complications of respiratory are mentioned. According to the results, the first symptoms that a person shows include cough (39.3%), wheezing (30.9%), chest tightness (29.1%), and bloody sputum (0.6%), respectively. Most of the participants (56.9%) believed that if they experience coughing and difficulty in breathing, they should consult a doctor, and most (53.9%) believed that the lung function test is the best diagnostic method. According to the results, asthma (with 65.3%) was the most important complication that may occur in gas station workers due to their work environment.

Table. 4. knowledge regarding respiratory disorders among petrol pump workers about signs and symptoms and complications of respiratory morbidities

Table.5. shows the results of the examination of the variables of knowledge related to respiratory disorders in gas station workers regarding signs and symptoms and respiratory complications. Based on the results of changing the worker's workplace (45.7%) and prevention of complications (41.9%), the biggest advantage is timely diagnosis and treatment. Based on this, workers must be medically examined at least monthly. The results showed that regular screening and use of protective masks (with 57.5%) is the most important step to prevent respiratory complications among workers. As mentioned, the best method of prevention is frequent washing of the face (57.3%) and the use of a mask (38.9%) was the easiest measure to minimize the entry of pollutants into the lungs in gas station workers. Workers did exercise to improve lung function, and deep breathing exercises (32.9%) and weight lifting (26.3%) were the most popular. Most people (55.1%) believed that exercising once a day is enough.

Table.5. knowledge regarding respiratory disorders among petrol pump workers about diagnosis and treatment of respiratory morbidities

Table.6. shows a questionnaire to assess the knowledge about the prevention of respiratory disorders in gas station workers. According to statistical estimates, most people (61.3%) believed that the face mask is the best mask that prevents the inhalation of oil fumes and air pollutants. In addition, 61.3% believed in using a mask during all working hours, and 36.7% believed in using a mask when there is heavy smoke. Most of the workers believed that the mask prevents dust particles from entering the lungs (56.7%) and some thought that the mask provides cool air for breathing (30.3%). In addition, 73.9% of the workers checked the tear and elastic band of the mask before wearing it. The most common consequences of not using a mask were cough and breathing problems (60.9%), headache (25.9%), vomiting (11.6%), and abdominal pain (1.6%). More investigations on the masks used by the workers showed that most workers (59.3%) believe that the mask should be well fixed on the nose and mouth. Also, changing it once a day (57.7%), and once in two days (39.7%) were the most frequently changing masks among the workers.

Table.6. knowledge regarding respiratory disorders among petrol pump workers about prevention

The result of examining the variables of leveles of knowledge among participants at gas station showed that 393 people (78.4%) had moderate knowledge and 102 (20.4) high knowledge and 6 (1.2) low knowledge(Figure 3-1).

Figure 3-1. Knowledge regarding respiratory disorders among petrol pump workers

 Discussion

The present study focuses on the evaluation of knowledge about respiratory problems among employees of gas stations under the management of the Erbil Ministry of Natural Resources.

This study's findings showed that the mean age of the workers was 26.38 years, which indicates that most of the population was working at gas stations at a young age. In the study of Desalegn Tetemke et al (2014) (D et al., 2014), the minimum and maximum age of the workers were 16 and 54 years, respectively, with an mean age of 24.45 years, which is close to our study. Similar to this study, the mean age in the study by Ajeet Jaiswal et al (2020), was 25.32 (Jaiswal, 2020).

The majority of respondents were single, according to the findings on their marital status. In the study of Desalegn Tetemke et al (2014), the number of single and married people was almost the same, and the number of single people was slightly more, which constituted 55.6% of the sample (D et al., 2014).  Examining the results of the age variable in the study of Moneim et al (2023) showed that 87% of the participants are married people, which is contrary to our study. Marriage is a personal decision and many factors can facilitate the conditions of marriage or prevent it. This is the only convincing reason for this conflict in the results because these studies were conducted in different geographical areas (Abdel Moneim et al., 2022).

Because the volatile pollutants generated in petrol stations are lipophilic and their absorption is proportional to BMI and fat mass, body mass index (BMI) is one of the most critical determinants for pollutant absorption (Rahimi Moghadam et al., 2019). the BMI of workers in the study of Mandal et al (2020) (Mandal and Mukherjee, 2020), and Belal Rahhal (2022) (Rahhal, 2022), was equal to 24.52, and 26.68 kg/m2, respectively. The BMI of the first study is similar to our study, but the BMI of the second study is higher than the mean of our study. In Adeniyi et al.'s study (2014), BMI was equal to 22.7 kg/m2, which is lower than the mean of our study (Adeniyi, 2014). The reason for the inconsistency of the mean BMI in the studies can be attributed to the number of participants, the ratio of male and female workers, and the lifestyle pattern of the people.

Ifeyinwa et al (2016), conducted a study to investigate the risk of respiratory disease among fuel pump operators. They found that most of the employees' shifts are more than 8 hours per day, which is consistent with our study. These long work shifts can expose people to more pollutants, which creates more challenges to minimizing these complications in employees. Therefore, the government and interested officials should act to solve these challenges (Ifeyinwa et al., 2016).

In this study, it was proved that 52% of people are night shift, which is contrary to the study of Muhammad Mohsin et al (2022). The reason for this is that in the study of Muhammad Mohsin et al., most of the participants were married. But in our study, most of the participants were single, and single people choose the night shift more often. Because fewer drivers visit gas stations at night and it gives them more time to rest (Mohsin et al., 2022). Also, the results showed that most of the workers had 6-7 years of work experience and most of them worked 40-60 hours per week, which is not consistent with the study of Shambharkar et al (2021) (Shambharkar, 2021). Because their work shifts and working hours were different during the week.

In this study, we measured the variables of cough, chest tightness, coughing attacks and airway mucus, shortness of breath, wheezing in situations that patients can experience. The results of the cough variable showed that most of the patients cough and the cough is present on most days for more than 3 consecutive months. Examining the chest tightness variable showed that 16.4% of the employees felt chest tightness while resting, walking and while working. Regarding the phlegm elimination variable, a small percentage of people removed phlegm from their chest and had little awareness. The variable of coughing attacks and airway mucus showed that a small percentage of people experience coughing attacks and excessive phlegm secretion more than three weeks a year. Also, regarding shortness of breath, 28.5% of patients stated that they experience shortness of breath when walking fast on a flat surface or when climbing a gentle slope. And less than half of the people also claimed that they feel wheezing in their chest every day when they breathe. There are limited studies with which to compare these results. But in a study by Neghab et al (2012), they investigated the prevalence of respiratory symptoms in gas station workers. The results of the comparison between the control group and the case showed that the incidence of cough, sputum, and both together for 3 consecutive months or more in a year has a significant difference. Also, the occurrence of wheezing most days and nights, shortness of breath compared to the same age group were among the statistically significant parameters which are consistent with the results of our study (Neghab and Habibi Mohraz, 2012).

Gas station workers may be impacted by a variety of health issues as a result of their employment; thus, they must be knowledgeable and aware of the impacts of gasoline and diesel. Knowledge is sometimes defined as an understanding of facts or practical abilities, but it may also refer to familiarity with items or circumstances. Workers who understand the effects of gasoline and diesel can protect themselves against sickness (Zins, 2007; Ebeid, 2021).

Statistical analysis showed that there is a statistically significant difference between the knowledge of gas station employees about the causes of respiratory complications, the effects of environmental pollution and oil fumes on the respiratory system, signs and symptoms and respiratory complications, and diagnosis and treatment of respiratory diseases with the age group.

These findings are not consistent with the study of Thomas et al (2020) (Thomas et al., 2020). Bhandari et al (2015) in their study, instead of comparing age groups, used the year of work as a criterion for comparison with the level of knowledge. They found that there is a statistically significant relationship between these two variables (Aryal Bhandari, Gautam, and Bhandari, 2015).

Statistical analysis showed that there is a statistically significant difference between the knowledge of gas station employees about the causes of respiratory complications, the effects of environmental pollution and oil fumes on the respiratory system, signs and symptoms and respiratory complications, and diagnosis and treatment of respiratory diseases with the age group.

These findings are not consistent with the study of Thomas et al (2020) (Thomas et al., 2020). Bhandari et al (2015) in their study, instead of comparing age groups, used the year of work as a criterion for comparison with the level of knowledge. They found that there is a statistically significant relationship between these two variables (Aryal Bhandari, Gautam, and Bhandari, 2015).

The comparison of the above parameters with the economic status, work shift, years of Education, working by years, and working hours per week of people showed that there is a statistically significant relationship. Thomas et al (2020), concluded that education, higher monthly salary (>Rs. 5000), and longer work experience (>10 years) lead to increased awareness of occupational respiratory issues (Thomas et al., 2020).

A descriptive-analytical study was conducted by Okafoagu et al (2017), to investigate the determinants of knowledge and occupational hazard safety measures of workers. Found that workers with formal education are more aware of workplace hazards. And training enables workers to avoid occupational hazards and without training, they cannot understand and adopt occupational health measures. These findings are consistent with our study (Okafoagu et al., 2017). But Moneim et al (2023), in their study, concluded that the knowledge level of workers is largely unaffected by their education, which contradicts our findings (Abdel Moneim et al., 2022).  The reason for this discrepancy can be that in the study of Moneim et al., most of the participants were poorly educated and did not have a university education. Because a professional degree is not required to be employed as a Petrol filler. This also depends on the policies of each gas station.

The Moneim et al (2023) (Abdel Moneim et al., 2022), investigation found that the majority of exposed individuals understood the name of the principal substance, despite the fact that only half of them had actual contact with it. Kaufman et al (2009) (Kaufman, Anderson, and Issaragrisil, 2009), discovered that 17% of the employees surveyed recognised gases originating from fuels, 20% recognised chemicals utilised in their industry, and 14% recognised vapours created by automobiles. These findings corroborated those of Abdel Monem et al (2010) (Mon et al., 2010), which found that staff were well-versed about the effects of gasoline on the environment and human health. However, the workers' level of knowledge was essentially unaffected by their schooling. This was reinforced by Abd ElAziz et al (2012) (E. A., M., and A.-E, 2012), who said that there was no significant relationship between worker knowledge and schooling. These findings are not consistent with our study.

We also compared these parameters with those before contracting covid-19 and the results showed that there is a significant statistical relationship. However, due to the fact that this disease became an epidemic in recent years, previous studies of Covid-19 were not used as a comparison criterion in order to identify similar and inconsistent studies with our study according to the available sources. Therefore, it can be said that this is another prominent point of our study.

Conclusion

Gas station workers in Erbil are exposed to gasoline and vapors produced while filling cars and smoke from cars. It was proved that the awareness of respiratory disorders among fuel-filling workers in gas stations are influenced by many factors including demographic and environmental variables. It was also proven that workers used poor protective measures despite their knowledge of the adverse health effects of gasoline. This means that knowledge does not have much effect on practice. Common self-reported symptoms among gas station workers were headache, nausea, and shortness of breath. The prevalence of self-reported symptoms increased significantly with increasing years of working at the gas station. In general, prevention, intervention, and training programs regarding the use of protective measures, monitoring the health status, and increasing the knowledge of gas station employees should be implemented.

Limitation: This study has a few restrictions. The survey participants may have been affected by the "healthy worker effect" since some employees may have quit their jobs due to developing a handicap or experiencing worse respiratory problems as a result of exposure to gasoline fumes. It may be believed that certain employees who have a delayed reaction to gasoline fumes have healthy lungs. Other limitations of this study include the researcher's time limit and the non-cooperation of some gas station operators

Disclosures: Authors have disclosed no conflicts of interest.