Journal of Advances in Medicine and Medical Research

Volume 35, Issue 24, Page 281-290, 2023; Article no.JAMMR.110622

RESPIRATORY TRACT INFECTIONS AND ASSOCIATED ENVIRONMENTAL

FACTORS IN PORT HARCOURT METROPOLIS
aAina O. C., aZike K. E., bOkoli D. C.
a
School of Public Health, University of Port Harcourt, Rivers State, Nigeria
b
Department of Medical Microbiology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria
correspondence: [email protected]

ABSTRACT
Background: This study assesses indoor air quality (IAQ), housing conditions, and their
impact on respiratory tract infections (RTIs). Key IAQ indicators include acceptable CO2
levels, but concerning temperature and humidity, potentially promoting microbial growth.
Additionally, PM2.5 and PM10 concentrations suggest respiratory hazards.
Aim: To investigate the complex interplay between IAQ, housing conditions, and prevalent
RTIs among residents of Port Harcourt Metropolis
Methods: A comprehensive analysis encompassing CO2 levels, temperature, humidity, PM
concentrations, and RTI prevalence, considering Pneumonia, Bronchitis, Flu, and
Tuberculosis. Associations with IAQ and housing conditions were explored.
Results: Significant associations were found between housing conditions and RTIs, with
wooden/zinc structures showing an 84.1% prevalence. Non-statistically significant IAQ-
respiratory illness association, but a higher likelihood (1.3) in persons with unhealthy IAQ,
suggests a potential trend. Overall RTI prevalence is 56.2%, indicating a significant public
health challenge.
Conclusion: The intricate relationship between IAQ, housing conditions, and RTI prevalence
calls for multifaceted interventions. Addressing poor ventilation, dampness, and specific
pollutants in IAQ indices is crucial. Targeted efforts, including improved ventilation, housing
infrastructure, and public health campaigns, are needed to mitigate respiratory morbidity in the
studied population.
Keywords: Respiratory tract infections, Environmental factors, Port Harcourt, Air pollution, Indoor air quality, Respiratory health

1.0 INTRODUCTION
Respiratory tract infections (RTIs) represent a significant public health concern globally,
contributing to substantial morbidity and mortality. In urban settings, environmental factors
play a pivotal role in the prevalence and severity of RTIs, posing a multifaceted challenge for
densely populated areas[1–3]. This study focuses on Port Harcourt Metropolis, a vibrant urban
center in Nigeria, to explore the intricate interplay between respiratory health and
environmental conditions. Port Harcourt, as an expanding metropolis, experiences rapid
urbanization and industrialization, leading to heightened environmental stressors. The urban
environment is characterized by increased vehicular emissions, industrial pollutants, and
construction activities, all of which contribute to the complex mixture of airborne
contaminants[4, 5]. Understanding the impact of these environmental factors on respiratory
health is crucial for designing effective preventive strategies and interventions.
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Air pollution, a prominent environmental factor in urban centers, has been identified as a
significant contributor to RTIs. Particulate matter (PM), volatile organic compounds (VOCs),
and other air pollutants can irritate the respiratory system, leading to respiratory symptoms and
exacerbating existing conditions[6, 7]. The high population density in Port Harcourt Metropolis
intensifies exposure to these pollutants, making it imperative to investigate their association
with RTIs[8]. Indoor air quality, often overlooked in urban health studies, is a critical
determinant of respiratory health, especially in densely populated areas. Factors such as
household cooking practices, use of biomass fuels, and building materials can significantly
impact indoor air quality[9, 10]. Examining these aspects is vital for understanding the
comprehensive environmental context influencing RTIs in Port Harcourt Metropolis.
The urban landscape itself, with its infrastructure, green spaces, and planning, contributes to
the overall environmental health. Urban planning that prioritizes green spaces and minimizes
environmental hazards can positively influence respiratory health outcomes. Conversely,
inadequate planning may lead to localized environmental stressors, affecting vulnerable
populations disproportionately[11–13]. Epidemiological studies investigating the prevalence
and patterns of RTIs in Port Harcourt Metropolis are scarce, necessitating a comprehensive
examination of the local context. This study seeks to fill this gap by employing a robust
epidemiological approach to analyze the association between RTIs and various environmental
factors. The research aims to identify specific pollutants, sources, and spatial patterns that may
contribute to respiratory health disparities within the metropolis.
The potential implications of this study extend beyond academic research, offering valuable
insights for public health interventions and policy formulation. Identifying modifiable
environmental factors associated with RTIs can inform targeted interventions to mitigate
exposure risks and improve respiratory health outcomes in the community. This study
emphasizes the critical need to investigate the relationship between respiratory tract infections
and environmental factors in Port Harcourt Metropolis. The unique urban challenges, coupled
with the pressing need for evidence-based interventions, underscore the importance of this
study in contributing to both academic knowledge and public health practices.
2.0 METHODS
2.1 Study Design
The study design was cross-sectional study, where the assessment of housing conditions and
its association with the respiratory health of the residents was carried out. The cross-sectional
approach was based on the assessment of the housing conditions, history of respiratory illness
across residents of the study area, within different genders, age-groups, diverse backgrounds
and beliefs.
2.2 Study Population
The study was carried out in the Obio-Akpor Local Government Area (LGA) of Rivers State,
Nigeria. The study population include residents of Obio/Akpor LGA. The study participants
were selected based on the following criteria;
Inclusion criteria
Individuals that have lived in Obio/Akpor for at least 12 months
The sample size for proportions formula by Kirkwood et al.[14] was used to determine the
minimum sample size required for the study.
n = z2pq/e2
where z = standard derivate at a 95% confidence interval,
p = 16% (0.16) reported prevalence of respiratory illness from a similar study[5]
q = 1 – p = 1 – 0.16 = 0.84
e = 5% (0.05) error rate.
Hence, the sample size n = (1.96)2 x (0.16 x0.84)/(0.05)2
n = 245 + 10% estimated incomplete response rate

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= 245+24.5 = 269.6 ~ 297
Therefore, 297 persons were selected for the study.

2.3 Data Collection

Every individual participating in the study was provided with a questionnaire to complete, and
their indoor air quality (IAQ) and housing circumstances were evaluated by trained research
assistants. The CO2 detection equipment from CASELLA and the relative humidity detection
tool from CASELLA were utilized to monitor levels of CO2 and relative humidity. The
ambient temperature of the interior environment was assessed by employing a mercury-in-glass
thermometer, while the levels of suspended particulate matter (2.5 and 10 micrometers) were
evaluated using a digital air quality monitor, following the guidelines provided by the
manufacturer (Wood's Tech, California, USA).

2.4 Data Analysis

The data analysis was conducted using version 25 of the Statistical Package for Social Sciences
(SPSS). The data were effectively presented utilizing descriptive statistics, including measures
such as mean, frequencies, and percentages. The study employed logistic regression analysis,
specifically utilizing chi-square tests and odds ratios, to examine the relationship between
housing conditions and the prevalence of respiratory infections. All analyses were run at a 95%
confidence level, and a p-value of 0.05 or less was considered statistically significant.

2.5 Ethical Considerations

The Rivers state ministry of health and the University of Port Harcourt's ethics committees
both gave their approval for the study. All participants had to give written informed consent
expressing their desire to participate prior to being included in the study. Personal identifiers
will be encoded with unique serial numbers throughout the trial to ensure that no identifiable
information about the subjects is combined or disclosed.
3.0 RESULTS
Table 4.1 shows the demographic characteristics of the study participants. The result showed
that 153(51.52%) are male and 144(48.48%) are female. It also showed that 29(9.76%) are
between 1 - 10 years, 50(16.84%) are between 11 - 20 years, 52(17.51%) are between 21 - 30
years, 47(15.82%) are between 31 - 40 years, 39(13.13%) are between 41 - 50 years,
38(12.79%) are between 51 - 60 years and 42(14.14%) were 60 and above.

Table 1: Demographic Data of Participants

Variable Frequency Percent

(n=297) (%)
Gender
Male 153 51.52
Female 144 48.48
Age groups
1 - 10y 29 9.76
11 - 20y 50 16.84
21 - 30y 52 17.51
31 - 40y 47 15.82
41 - 50y 39 13.13
51 - 60y 38 12.79
60 and above 42 14.14

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The results of an investigation into the indices of the indoor air quality in several different
household situations are detailed in Table 4.3. It was determined that the average concentration
of CO2 was 0.086 parts per million (ppm), with a margin of error of 0.01. The average
temperature was 27.6 degrees Celsius, with a standard deviation of 1.1 degrees. The relative
humidity was measured and found to be 63.9 plus or minus 3.9 percent on average. The typical
concentration of PM2.5 particles was 0.3 ppm, with a standard deviation of 0.1 ppm, while the
typical concentration of PM10 particles was similarly 0.3 ppm, with the same standard
deviation.

Table 2: Summary of Air Quality Indices

Parameter Mean ±SD

CO2 (ppm) 0.086 ±0.01
o
Temperature ( C) 27.6 ±1.1
Relative Humidity (%) 63.9 ±3.9
P.M 2.5 (ppm) 0.3 ±0.1
P.M 10 (ppm) 0.3 ±0.1
AQI 149.7 ±50.7
AQI: Air quality index

Figure 1 shows the overall prevalence of respiratory infections among the residents in the study
area. It was observed that 167 (56.2%) of the residents had reported a respiratory
illness/symptom while 130 (43.8%) had not reported any respiratory symptom/illness.

130, 43.8%
167, 56.2%

Respiratory symptoms No respiratory symptoms

Figure 1: Distribution of Respiratory Illness in Participants

The types of respiratory tract infections considered in the study are listed in the table below.
There were 52 cases of Pneumonia, 38 cases of Bronchitis, 32 cases of Flu, 30 cases of Rhinitis,
and 15 cases of Tuberculosis. Pneumonia accounts for 31.14% of the total cases, Bronchitis for
22.75%, Flu for 19.16%, Rhinitis for 17.96%, and Tuberculosis for 8.98%.

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 Table 3: Distribution of Respiratory Tract Infection in residents

Respiratory Tract Infection Frequency (n) Percent (%)

Pneumonia 52 31.14
Bronchitis 38 22.75
Flu 32 19.16
Rhinitis 30 17.96
Tuberculosis 15 8.98
Total 167 100.0

Table 4 shows the association of the different indoor AQI and the presence of respiratory illness
among the children. The data shows that 60.5% of the residents with unhealthy indoor AQI had
a respiratory illness, while 53.8% of persons with good/moderate indoor AQI had respiratory
illness. The distribution of the respiratory illness by the indoor AQI category was not
statistically significant (p = 0.132). There was a 1.3 (0.3 – 4.5) likelihood of respiratory illness
among persons with unhealthy indoor AQI.

Table 4: AQI and risk of respiratory illness among residents

Respiratory illness No Respiratory illness Total Chi-square OR (95% C.I)

AQI category n (%) n (%) n (%) (p-value)
4.62 (0.031)* 1.5 (0.3 – 2.9)
Unhealthy 128(55.9) 101(44.1) 229(100.0)
Good/Moderate 39(57.4) 29(42.6) 68(100.0)
Table 5 shows the association of housing conditions and respiratory illnesses among the
residents. The table shows that 84.1% of the persons living in wooden/zinc buildings had a
respiratory illness, compared to 44.5% of persons living in block buildings which had
respiratory illness. The distribution of respiratory illness by the type of building was
statistically significant (p = 0.001). There was also a significant association between the type
of apartment and presence of respiratory illness (p = 0.002), it was shown that 45.9% of the
persons in the single rooms had respiratory illness, compared to 56.0% living in flats and 72.9%
living in duplexes. There was no significant association (p >0.05) between the reported
respiratory illness and factors such as living conditions, stationary water, drainages, smoke
sources, cross-ventilation, presence of plants and weed.

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 Table 5: Association between housing condition and respiratory illnesses

Respiratory No Respiratory Total Chi-square

illness illness n (%) (p-value)
Variable n (%) n (%)
Type of Building
Block 93(44.5) 116(55.5) 209(100.0) 39.43 (0.001)*
Wooden/Zinc 74(84.1) 14(15.9) 88(100.0)
Type Of Apartment
Single Room 51(45.9) 60(54.1) 111(100.0) 12.63 (0.002)*
Flats 65(56.0) 51(44.0) 116(100.0)
Duplex 51(72.9) 19(27.1) 70(100.0)
Living Conditions
Alone 44(55.7) 35(44.3) 79(100.0) 0.11 (0.942)
Living with a roommate 61(57.5) 45(42.5) 106(100.0)
Sharing a room with at least 2 persons 62(55.4) 50(44.6) 112(100.0)
Stationary water
Yes 92(61.3) 58(38.7) 150(100.0) 3.20 (0.073)
No 75(51.0) 72(49.0) 147(100.0)
Drainage (filled)
Yes 83(56.8) 63(43.2) 146(100.0) 0.05 (0.832)
No 84(55.6) 67(44.4) 151(100.0)
Smoke source (≤5m)
Yes 85(55.9) 67(44.1) 152(100.0) 0.01 (0.913)
No 82(56.6) 63(43.4) 145(100.0)
Cross-ventilation
Yes 81(57.4) 60(42.6) 141(100.0) 0.16 (0.688)
No 86(55.1) 70(44.9) 156(100.0)
Plants (trees, flowers)
Yes 88(56.1) 69(43.9) 157(100.0) 0.04 (0.948)
No 79(56.4) 61(43.6) 140(100.0)
Weeds
Yes 75(51.0) 72(49.0) 147(100.0) 3.21 (0.073)
No 92(61.3) 58(38.7) 150(100.0)

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4.0 DISCUSSION
The assessment into indoor air quality (IAQ) and respiratory tract infections (RTIs) reveals
noteworthy implications for public health and clinical microbiology. From the findings of the
study, the acceptable CO2 concentration (0.086 ppm) indicates effective ventilation, reducing
the risk of respiratory issues related to poor air circulation. However, the elevated average
temperature (27.6°C) and humidity (63.9%) create favourable conditions for microbial growth.
Increased warmth supports the survival and proliferation of microorganisms, potentially
leading to respiratory infections[15–17]. The concentrations of PM2.5 and PM10 particles at
0.3 ppm suggest the presence of airborne particulate matter, posing potential respiratory
hazards. These particles, when inhaled, can irritate the respiratory tract, exacerbating pre-
existing conditions or triggering respiratory symptoms[18, 19]. The combination of elevated
temperature, high humidity, and particulate matter underscores the importance of
comprehensive indoor air quality management. Implementing measures to control temperature
and humidity levels, along with effective air filtration systems, can mitigate the risk of
microbial proliferation and reduce exposure to respiratory irritants, promoting a healthier
indoor environment[20, 21].

The high prevalence of respiratory infections (56.2%) in the study area may be explained by
various factors contributing to compromised respiratory health. Potential explanations as
reported in similar studies include environmental pollutants, poor indoor air quality,
overcrowded living conditions, inadequate ventilation, and a high burden of infectious
agents[22–24]. Additionally, socioeconomic factors, lifestyle choices, and limited access to
healthcare services might contribute to the overall public health challenge posed by respiratory
infections. Addressing these multifaceted issues through targeted interventions, public health
campaigns, and improved healthcare infrastructure could help mitigate the impact of
respiratory infections in the studied population[25, 26].

The high prevalence of Pneumonia, Bronchitis, and Flu in the population may be attributed to
various factors such as viral and bacterial infections, compromised immune systems, or
environmental exposures. Tuberculosis, with its infectious nature, contributes to the
complexity of respiratory infections. The non-significant IAQ-respiratory illness association
could be due to the limitations of general IAQ indices in capturing specific pollutants relevant
to respiratory health[18, 23, 27]. However, the higher likelihood of respiratory illness in
persons with unhealthy IAQ indicates a potential trend, emphasizing the need for a more
nuanced understanding of indoor air pollutants and their impact on respiratory health. Factors
like specific pollutants, allergens, or indoor contaminants not covered by general IAQ
assessments may play a role in respiratory morbidity among individuals with compromised
indoor air quality[20, 28].

The observed association between housing conditions and respiratory illnesses, particularly in
residents of wooden/zinc buildings, suggests that specific environmental factors within these
structures contribute to poor respiratory health as reported in similar studies in southern
Nigeria[16, 19, 20]. Inadequate ventilation and potential indoor pollutants, combined with poor
insulation in wooden/zinc buildings, may create conditions conducive to mold growth and
higher humidity levels. These environmental factors are known contributors to respiratory
issues. The varying associations based on the type of apartment highlight the complexity of
housing-related influences on respiratory health[16]. Additionally, the non-statistically
significant association between indoor air quality (IAQ) and respiratory illnesses indicates the
need for a more detailed examination of specific pollutants not covered by general IAQ indices,

287
emphasizing the importance of identifying and mitigating specific indoor air contaminants for
improved respiratory outcomes.

5.0 CONCLUSION
The study underscores the importance of indoor air quality (IAQ) and housing conditions in
respiratory tract infections (RTIs). While CO2 levels suggest adequate ventilation, elevated
temperature and humidity may promote microbial growth. RTIs like Pneumonia, Bronchitis,
and Flu contribute significantly, with Tuberculosis adding complexity. Though IAQ-
respiratory illness association is non-significant, the higher likelihood (1.3) in unhealthy IAQ
indicates a potential trend. Housing conditions, especially in wooden/zinc structures, show
significant associations with respiratory illnesses. The overall prevalence of 56.2% highlights
a substantial public health challenge. Interventions should target IAQ, housing, and public
awareness for effective respiratory morbidity reduction.

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