Prevalence and risk factors for allergic rhinitis in bakers in Douala, Cameroon

Occupational rhinitis and asthma in bakers: a cross-sectional study in the former Katanga province of DR Congo

OBJECTIVE

Bakers are at high risk of rhinitis and asthma, but the prevalence of these occupational diseases is not well known in Sub-Saharan Africa. We investigated the prevalence of occupational rhinitis and asthma among industrial bakers in the former province of Katanga.

METHODS

In a cross-sectional study conducted in eight towns from October 2018 to September 2019, we included 276 male workers from 18 industrial bakeries and 113 male controls (35 butchers and 78 bread sellers), all nonsmokers. Participants replied to a validated questionnaire (European Community of Respiratory Health Survey II), administered face to face, and performed spirometry at the work place. In 15 bakers with symptoms of work-related asthma, records of self-measured peak expiratory flow (PEF) 4 times per day during 4 weeks were analyzed by the OASYS (Occupational Asthma System) protocol.

RESULTS

The bakers and controls did not differ by age (32.2 ± 7.3 y vs 32.8 ± 10.3 y). According to the questionnaire, work-related rhinitis and asthma were significantly more prevalent among bakers (31% and 5%, respectively) than among controls (2% and 0%, respectively). However, the groups did not differ significantly with regard to spirometric parameters. Based on PEF records, 10 out of 15 were positive for occupational asthma (OASYS score > 2.5), so the rate of occupational asthma was 3.6% in this study.

CONCLUSION

This first study in DR Congo demonstrates the existence of occupational rhinitis and asthma among industrial bakers in Katanga. Further epidemiological studies are needed to clarify the extent and risk factors of baker's asthma in the area. In the meantime, advocacy and implementation of appropriate occupational hygiene measures are warranted to protect bakery workers in DR Congo.

Heat Stress-Related Symptoms among Bakery Workers in Lebanon: A National Cross-Sectional Study

Heat exposure is linked to a range of heat-related illnesses and injuries. This study assessed the association between workers’ perceptions of the work environment and reports of heat stress-related health symptoms in bakery workers in Lebanon. A national cross-sectional survey of workers was carried out in 504 bakeries in Lebanon. One worker in each bakery was interviewed using questions relating to the workplace environment and heat stress-related health symptoms. Heat and humidity measurements were recorded in bakeries. Descriptive analyses were performed, and logistic regression assessed relationships between the workplace environment, worker perceptions, and reports of heat stress-related health symptoms. In total, 47.2% of workers experienced heat stress-related symptoms, 83% perceived workplace temperatures as hot, and 48% perceived these temperatures as affecting their health. Humidex readings showed that 49% of bakeries had conditions unsafe for routine work tasks. Working under pressure (AOR = 1.65; 95% CI = 1.12-2.43), job dissatisfaction (AOR = 1.76; 95% CI = 1.12-2.79), and perceptions that high temperatures negatively affected health (AOR = 2.73; 95% CI = 1.87-3.99) were all significantly correlated to reports of heat stress-related symptoms. Females were more likely to experience heat stress-related symptoms (AOR = 1.96; 95% CI = 1.13-3.39). Workers who reported low levels of water consumption at work were also more likely to experience heat stress-related health symptoms. We conclude that heat exposure potentially impacts workers’ health in Lebanese bakeries. Improvements in workplace conditions, adequate infrastructure, and workers’ training are key interventions for maintaining workers’ health.

Longitudinal predictors of bronchial hyperresponsiveness and FEV1 decline in bakers

OBJECTIVE

To determine long-term predictors of bronchial hyperresponsiveness (BHR) and forced expiratory volume in one second (FEV₁) decline.

METHODS

A longitudinal study in 110 bakers in 4 industrial bakeries and 38 non-exposed workers was conducted at the workplace with a mean of 3.3 visits per subject over a period of 13 years and a mean duration of follow-up of 6 years in bakers and 8 years in non-exposed subjects. A respiratory health questionnaire was administered; occupational allergen skin prick tests, spirometry and a methacholine bronchial challenge test were performed at each visit. In each bakery, full-shift dust samples of the inhalable fraction were obtained in order to assess the exposure of each job assignment. The repeated measurements of BHR and FEV₁ were analyzed using mixed effects logistic and linear regression models in subjects seen at least twice.

RESULTS

BHR, respiratory symptoms and their simultaneous occurrence depended on the duration of exposure. FEV₁ significantly decreased with duration of exposure and BHR at a preceding visit. This result persisted when adjusting for the effect of BHR at the current visit. The measured exposure levels were not a significant predictor for any outcome. Occupational sensitization was only a predictor of a decline in FEV₁ when duration of exposure was not included.

CONCLUSION

In flour-exposed industrial bakers, length of exposure and smoking are long-term determinants of BHR and of the decrease in FEV₁. BHR at a preceding visit predicted lower FEV₁ even when accounting for the effect of BHR at the current visit.

Non-allergic rhinitis and associated risk factors among the elderly in communities close to gold mine dumps in Gauteng and North West provinces in South Africa: a cross-sectional study

PURPOSE

To investigate whether non-allergic rhinitis among the elderly was associated with living close to mine dumps METHODS: Elderly persons (n = 2397) residing in communities 1-2 km (exposed) and ≥ 5 km (unexposed) from five preselected mine dumps in Gauteng and North West provinces in South Africa were included in the cross-sectional study, using a previously validated modified ATS-DLD-78 questionnaire from the British Medical Research Council.

RESULTS

The overall prevalence of non-allergic rhinitis in this study was 23.99%. In the unexposed, it was found to be 18.82% and 27.08% exposed communities. Multiple logistic regression analysis indicated that having non-allergic rhinitis was significantly associated with living in exposed communities (OR 1.73; 95% CI 1.37-2.17), being an ex-smoker (OR 1.75; 95 CI 1.35-2.26), being a smoker (OR 1.24; 95% CI 1.02-1.62), history of occupational exposure to dust/chemical fumes (OR 1.58; 1.30-1.93) and use of gas as the main residential heating/cooking fuel type (OR 1.61; 1.01-2.57).

CONCLUSION

A high prevalence of non-allergic rhinitis was observed in the elderly living in exposed communities. The adverse association was observed between residing in communities close to mine dumps and non-allergic rhinitis.

Association of urinary sodium excretion with blood pressure and risk factors associated with hypertension among Cameroonian pygmies and bantus: a cross-sectional study

Background

High salt intake increases blood pressure (BP) and hypertension risk. This study aimed to examine association of urinary sodium excretion with BP and hypertension correlates among Cameroonian pygmies under hunter-gatherer subsistence mode and Bantus, living in urban area under unhealthy behavioral habits.

Methods

In this cross-sectional cluster sampling study, we randomly enrolled rural pygmies living in Lolodorf and urban Bantus living in Douala. The World Health Organization steps questionnaire was used to collect socio-demographic and lifestyle data. Height, weight, BP and single overnight spot urine samples were obtained in all participants. BP was measured in triplicate. Urinary sodium and potassium excretion was determined by flame photometry. Data were recorded and analyzed using SPSS 16.0.

Results

We included 150 Pygmies and 150 Bantus aged 38 ± 12 years and 33 ± 11 years, respectively (p <  0.0001). Compare to Bantus, pygmy’s height and weight were respectively: 1.54 ± 0.09 m vs 1.72 ± 0.12 m; and 54.4 ± 9.2 kg vs 77.2 ± 14.8 kg, all p <  0.0001. Age-standardized prevalence of hypertension was 3.3% among Pygmies and 28% among Bantus (p <  0.0001). Age-adjusted systolic and diastolic BP were lower in Pygmies than in Bantus (107 ± 12 vs 119 ± 17 mmHg and 71 ± 11 vs 78 ± 13 mmHg respectively, all P <  0.0001). BP increased with age but to a lesser extent in Pygmies (all p <  0.01). Urinary sodium excretion was lower in Pygmies than in Bantus (46.9 ± 32.4 vs 121.5 ± 61.0 mmol/l, p <  0.0001). Systolic and diastolic BP were positively associated with urinary sodium excretion in Bantus (all p <  0.05). In the two groups, urinary potassium excretion was similar, and was not related to blood pressure. In the total study group and in Bantus taken separately, urinary sodium excretion was higher in hypertensive than in normotensive subjects. Multivariable logistic regression showed that urinary sodium excretion, Bantu status and age emerged as independent determinants of hypertension in the whole study group (OR (95%CI): 1.012 (1.005–1.018); 11.408 (3.599–36.165); 1.095 (1.057–1.135) respectively, p <  0.0001).

Conclusion

Hunter-gatherer pygmies exhibit low level of urinary sodium excretion related to low rate of hypertension and slower BP increase with age. Salt intake was a major driver of hypertension in our study population. Our findings highlight the need of efforts to implement nationwide prevention programs promoting risk factor screening and healthier lifestyles including reduction of dietary salt intake in Cameroonian.

Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation

BACKGROUND

Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic.

OBJECTIVE

To develop diagnostic models predicting baker's asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic.

METHODS

As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker's asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure.

RESULTS

The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (≥10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients.

CONCLUSION

The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history.