Prevalence of Chronic Respiratory Symptoms and Associated Factors among Kitchen Workers in Food and Drinking Service Establishments in Kellem Wollega Zone, Western Ethiopia, 2021

Background: Kitchen workers in Food and Drinking Service Establishments are at high risk while exposed to toxic compounds from burning fuel and fumes from cooking. However, there is inadequate Evidence on the issue in developing country like Ethiopia. Therefore, assessing this information was aimed to fill this gap.

Objective: To assess prevalence of chronic respiratory symptoms and associated factors among Kitchen workers in food and drinking service establishments in Kellem Wollega Zone, Western Ethiopia

Methods: An Institution based Cross-sectional study was conducted in Kellem Wollega Zone from August 30-September 15/2021. Six towns were selected from the zone using simple random sampling and total of 649 kitchen workers were selected using simple random sampling after proportional allocation. Interviewer administered structured questionnaires were used to collect the information and the data were entered in to Epi info version 7 and exported to SPSS Version 20 for further analysis. Bivariable and multivariable Binary logistic regression with 95% C.I was used to assess the factors. 

Result: The overall prevalence of chronic respiratory symptoms was 170(27.3%) with 95%CI (23.8-30.7). Average working hour per a day (AOR= 2.09, 95% CI: 1.30-3.37), being used firewood and charcoal as energy source (AOR= 2.23, 95% CI: 1.05-4.71), Separated kitchen room in work place (AOR=0.46, 95% CI:0.31-0.68), Windows in the home kitchen (AOR= 0.48, 95% CI: 0.33-0.71) and service years in kitchen (AOR=1.83,95% CI:1.04- 3.21) were significantly associated with chronic respiratory symptoms 

Conclusion and recommendation: The prevalence of Chronic Respiratory Symptoms was low. Average working hour per a day, being used firewood and charcoal as energy source, separated kitchen room in work place and Windows in the home kitchen were significantly associated with chronic respiratory symptoms. Therefore, efforts should be done to minimize Chronic Respiratory Symptoms through promoting limited work hours per a day, avoid using firewood and charcoal as energy source and using separated and ventilated kitchen.

Chronic respiratory symptoms such as chronic cough, chronic phlegm, wheezing, shortness of breath, and chest pain are manifestations of respiratory problems that are mainly developed as the result of occupational exposures [1]. Worldwide non-communicable diseases are the leading cause of mortality which accounts for 82%of deaths and among those non-communicable diseases, chronic respiratory diseases such as, asthma and chronic obstructive pulmonary diseases accounted for 4million or 10.7

Study Area and period

The study was carried out on Kitchen workers in food and drinking service establishments which were found in towns of Kellem Wollega Zone. Kellem Wollega Zone is one of Oromia Regional state Zones which is found at 652 km to the west From Addis Abeba, Capital of Ethiopia. The zone has eleven Districts and one zonal town and the total population of selected study areas were 552377 and there are 120 rural and 12 urban towns and 489 food and drinking service establishments. The study was conducted from August 30-September 15 /2021.

Study design

Institution based Cross-sectional study was conducted to assess the prevalence of chronic respiratory symptoms and associated factors among Kitchen workers in food and drinking service establishments.

Population

Source population. All Kitchen workers in food and drinking establishments in Kellem Wollega Zone.

Study Population 

All randomly selected Kitchen workers in food and drinking establishments of the selected towns 

Study Unit: Individual Kitchen worker.

Inclusion and Exclusion Criteria 

Inclusion Criteria

Individuals who had worked in kitchen of food and drinking establishments for more than one year. 

Exclusion Criteria 

Workers who recently had surgery of thorax, abdomen, and any acute illness.  Individuals who have known chronic respiratory disease such as asthma. Individuals who are smoking/has history of smoking. Sample size determination and sampling technique. Sample Size Determination for Specific Objective One.

The sample size was determined by using a single population proportion formula by assuming 5% (0.05%) marginal error and 95% confidence level. The prevalence of respiratory symptoms among Kitchen workers in Food and drinking establishments was taken from the study conducted in Gondar town which was 44 % (21).

Where: n= sample size 

Zα/2 = Z value at 95% CI [1.96] 

p = Proportion 

d = Margin of error tolerated is (0.05) 

n=1.962 *0.44(1-0.44)/0.052 =379, Adding non-response rate 10%, 416 study participants.

For Specific Objectives two (Associated Factors) 

Sample size was determined using double population proportion formula using Epi Info Version 7.2 software considering the following assumptions: P1: 56.3% of kitchen workers who worked for greater than five years developed chronic respiratory symptoms, and P2:43.7

Socio-demographic Characteristics

From 649 Kitchen workers projected for the study, 622 of them responded the questionnaires completely making response rate of 95.8%. Out of the total 622 respondents, 435(69.9%) were female and Majority of the study participants were married, 406(65.3%). Out of total interviewee, less than half of them 259(41.6%) attended primary school followed by secondary school 221(35.5%).

Occupational and Organizational characteristics

Among 622 study participants, 296(47.6%) were kitchen workers working in the restaurant followed by tea house 237(38.1%) and Hotel 74(11.7%). We found that 273(43.9%) of respondents had service years or work experience of 1-2 years and 112(18%) of them had service years of≥5 years in the current kitchen of food and drinking establishments. From total participants, 423(68%) of workers had worked in the kitchen for greater than or equal to 8(eight) working hours per day and 199(32%) of them had worked for less than 8(eight) working hours per day in the kitchen. Among 60(9.6%) of Kitchen workers who ever worked in environment where there is cooking fumes or dusty environment before joining current kitchen work, 25(4%) of them worked coble stone work, 23(3.7%) were worked as cleaners and 11(1.8%) of them worked in cement factory. Most commonly energy source used in the kitchen to cook food was fire wood and charcoal, fire wood and, Charcoal and electricity which was 233(37.5%), 190(30.5%) and 121(19.5%) respectively (Table 01). Regarding organizational characteristics, 397(63.8%) of kitchen workers has been working in separated kitchen room, and 255(41%) of them cook food in kitchen which had no windows.

Chronic Respiratory Symptoms

According to this study findings the most complaint respiratory symptoms by the kitchen workers in food and drinking service establishments in Kellem Wollega zone were Chronic cough, Breathlessness chest pain, Wheezing and Cough with sputum (Figure 01). Overall prevalence of Chronic Respiratory Symptoms was 170 (27.3%) with the 95%CI (23.8 – 30.7) (Figure 02)

Factors Associated with Chronic Respiratory Symptoms

In order to identify factors associated with Chronic Respiratory Symptom in the study area, we run binary logistic regression analysis at both bivariable and multivariable levels. Multivariable logistic analysis results have showed that there were six variables: Working hour per a day, Ever worked in environment where there is cooking fumes or in dusty environment before, Energy source mostly used in the kitchen, Absence of separated kitchen room in work place, Service years and Absence of windows in the home kitchen were significantly associated with chronic respiratory symptoms among kitchen workers in food and drinking service establishments at P-value less than 0.05.

The odds of having Chronic Respiratory Symptom among kitchen workers who work more than or equal to 8 hours per a day was 2.09 times more likely as compared to kitchen workers who work less than 8 hours per a day (AOR= 2.09, 95% CI: 1.30 –3.37). Kitchen workers who had greater than or equal to five years of work experience had odds of developing chronic respiratory symptoms about 1.83 times more likely than those workers with work experience of 1-2 years (AOR=1.83, 95% CI: 1.041.03-3.21). Table 02: Logistic regression analysis to identify factors associated with chronic respiratory symptoms among kitchen workers in food and drinking establishments in Kellem Wollega zone, 2021(Attached at the end of text file, page 23).

The study findings showed that the prevalence of respiratory symptoms by the kitchen workers in food and drinking establishments in Kellem Wollega zone were Chronic cough (13.7%), Breathlessness (12.9%), chest pain (11.6%), Wheezing (8.5%) and Cough with sputum (8.2%). Overall prevalence of Chronic Respiratory Symptoms was 170 (27.3%) with the 95%CI (23.8 – 30.7). The prevalence reported in this study was lower than the prevalence of respiratory symptoms among kitchen workers in Gondar town which was 44% [20]. The findings of this study was also lower than (Shortness of breath:12.9%, wheezing:8.5%) the findings of study done in Malaysian (shortness of breath:33.7%, wheezing:14%) and the study done in Iran which shortness of breath was 65% and wheezing was 20% [19,20]. This discrepancy might associate with amount of food cooked, cooking frequency and previous exposure to cooking fumes.

The study identified factors responsible for the developments of chronic respiratory symptoms. Working hours per day, Work experience/service years, ever worked in environment where there is cooking fumes or in dusty environment before, separated kitchen room from establishments, using fire wood and charcoal as main source of energy and Windows in the kitchen room were the factors identified for chronic respiratory symptoms of kitchen workers in food and drinking service establishments. This study showed that socio demographic characteristics such as sex, age, religion, marital status, educational status and monthly income of workers were not significantly associated with the development of chronic respiratory symptoms. Previous study has reported that sex and socio-economic status had significant association with chronic respiratory diseases [5,17,18]. This difference may account for existence of variation among countries culture, living and earning conditions.

Another finding from this study was that having longer years of service in the kitchen was significantly associated with risk of developing respiratory symptoms. This study has similarity with different other studies done in Thailand and Nigeria (18) which indicated having longer years of experience of working in kitchen had significant association with respiratory symptoms. Kitchen workers who mostly used firewood and Charcoal as energy source had higher odds of having Chronic Respiratory Symptom as compared with those who mostly used only charcoal. This study result was supported with other studies conducted in Cameroon in which using fire wood as energy source was factor for development of chronic respiratory symptoms [2,4). Regarding of having separated kitchen room in work place, kitchen workers who experienced working in the separated kitchen room were 54% less likely had CRS as compared to those who did not experienced working in the separated kitchen room from food and drinking establishment. This study result was different from study conducted in Thailand in which having separated kitchen work was not associated with chronic respiratory symptoms (23). The possible reason for this difference might be because of working environment and sociocultural difference.

Limitation of the study

Response to the Chronic Respiratory Symptoms was depend only on the participants compliant/self-report (lack of clinical confirmation for the diagnoses) 

This study findings showed that Chronic cough, Breathlessness, chest pain, Wheezing, and Cough with sputum were respectively the main chronic respiratory symptoms developed among kitchen workers in food and drinking service establishments in Kellem Wollega zone and Overall prevalence of Chronic Respiratory Symptoms was low in this study area.  Average working hour per a day, work experience, ever worked in environment where there is cooking fumes or in dusty environment before, Energy source mostly used in the kitchen, separated kitchen room in work place and Windows in the home kitchen were significantly associated with chronic respiratory symptoms among kitchen workers in food and drinking establishments.

Recommendations

Workplace health and safety measures providing greater health protection of the kitchen workers are needed and the issue should receive more public attention. Authorized body need to enforce food and drinking service establishments’ owners and managers to reduce working hours per day for kitchen workers, to have separated kitchen room from establishments and to have windows.

Follow up study is recommended to know level of exposure among the kitchen workers of different food and drinking establishments

Acknowledgments

The authors would like to thank all respondents for their willingness to participate in the study.

Competing interests

No conflicts of interest in this work among authors.

Ethics approval and consent to participate

All methods of this study were carried out under the Declaration of Helsinki’s ethical principle for medical research involving human subjects. Ethical approval to conduct this study was obtained from the ethical review board of Ambo University (Ref. No: DRE/004/21). An official letter was sent to the Kellam Wollega zonal health office. A permission letter was delivered to the Woreda health office. Then, the woreda health office sent supportive letters to respective public health facilities. For uneducated participants informed consent was obtained from their parents or friends and for educated participants it was taken from the participants themselves. Confidentiality and privacy of the information was maintained. The participants were informed that participation is voluntary

Publication consent

All authors of the study agreed to publish the study in Dove Press. Publication consent was obtained from the publication office of Dambi Dollo University after reviewing the mother document. 

Availability of Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Authors contribution

GF has been working on data analysis and writing up the final results, HM has been working on proposal preparation and AT has been working on overall activities.

Funding

No any source of Fund for this research.