Public Health Research 2015, 5(5): 129-134

DOI: 10.5923/j.phr.20150505.01

Effect of Exposure to Cement Dust on Pulmonary

Function among Cement Plants Workers in the Middle
Governorate, Gaza, Palestine
Yousef Aljeesh1, Wesam Al Madhoun2,3, Suliman El Jabaly4,*

1
Associate Professor in Public Health, Islamic University, Gaza Strip, Palestine
2
Assistant Professor of Environmental Engineering, Islamic University, Gaza Strip, Palestine
3
MIT-UTM program on Sustainable cities, Universiti Teknologi Malaysia, Johor Bharu, Malaysia
4
Clinical Instructor in Nursing, Al Quds Hospital, Gaza strip, Palestine

Abstract This study was conducted to investigate the level of PM air pollution in cement plants, and their impacts on
respiratory system health and pulmonary function for cement plants workers. Case-control study was conducted on all
cement plants at Middle Gaza Governorates. 100 individuals participated, case (exposed) and control (non exposed) groups
contain 50, 50 respectively. All participants were subjected to questionnaire, lung function measuring by electronic
spirometery. The findings of this study showed that an average particulate matter from 106.3 to 143.3, which is about more
than 4 times higher than the particulate matter (PM2.5) existing standard of 35 μg/m3 also an average particulate matter from
615 to 656, which is about more than 4 times higher than the particulate matter (PM10) existing standard of 150 μg/m3. As
well as, it showed clear links between PM exposure and respiratory health and pulmonary function. Cough, dyspnea and
sputum buildup were more common among the exposed group, Furthermore, the mean of FEV1/ FVC (%) for control group
is significantly greater than that for FEV1/ FVC (%) for case group. Among other recommendations, this paper infers that
Environmental and engineering control of cement dust emissions, protective techniques, procedures, measures and
equipment and periodic medical examinations.
Keywords PM2.5, Respiratory symptoms, Pulmonary function, Cement plants

1. Introduction Cement is one of the most important building materials in

the world. A cement plant can be a significant source of air
The worldwide community, especially the people in pollutants, and cement dust can affect respiratory symptoms
developing countries, are facing increasing risks of and lung function. Previous studies indicate reduced lung
respiratory diseases due to production of smoke and dust in function [4].
different occupational and industrial sectors [1]. Particulate matter (PM) has been found to be a major
It is impossible to envisage a modern life without cement. threat to human health. Health impact is caused by
Cement is an extremely important construction material used concentrations of PM in ambient air to PM standards, the
for housing and infrastructure development and a key to size of the particles and spatial planning [5].
economic growth. Cement demand is directly associated to The number of plants concrete operating in the Gaza Strip,
economic growth and many growing economies are striving 32 plants, according to the Ministry of National Economy,
for rapid infrastructure development which underlines the while the number of plants granted certification by the
tremendous growth in cement production [2]. Ministry of Public Works and Housing 11 plants only after
The cement industry plays a major role in improving compliance with regulations quality control approved by the
living standard all over the world by creating direct ministry, This means that there are a large number of plants
employment and providing multiple cascading economic pose a danger to the environment and the health of their
benefits to associated industries. Despite its popularity and workers.
profitability, the cement industry faces many challenges due Cement industry in Palestine has a specific importance in
to environmental concerns and sustainability issues [3]. this time in particular where the Palestinian society passes in
construction stage and a populating of what increases the
* Corresponding author:
elhelal88@hotmail.com (Suliman El Jabaly)
demand size on the cement, and this is what gives an extreme
Published online at http://journal.sapub.org/phr importance to establish local factory on the market
Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved compliance from the cement material by the specifications
130 Yousef Aljeesh et al.: Effect of Exposure to Cement Dust on Pulmonary Function
among Cement Plants Workers in the Middle Governorate, Gaza, Palestine

the competition price and to putting limit in front of the 2. Materials and Methods
subjection of the Palestinian market to the Israeli economy in
this side. Case-control study was conducted on all cement plants at
In a previous study, occupational exposure to cement dust Middle Gaza Governorates. 100 individuals participated,
is known to be an important factor in the causation of the case (exposed) and control (non exposed) groups contain 50,
chronic respiratory health effects [6]. 50 respectively.
In recent times. There were many problems affecting the All cement plant workers in the Middle governorate
respiratory system in the human body and there are many included in the current study. There are (6) cement plants
factors that cause various diseases and serious respiratory and the total number of workers in is (80) and excluded (30)
infections such as: crisis, lung fibrosis, acute and chronic people who do not work in the middle governorate, and
infections, asthma ... Etc. May be a cement dust affecting on who are under the age of 18 years or more than 40, and
the pulmonary function by causing some of these disease [7]. have past history. At the same time, The researcher used
Therefore, there are many problems and lack of awareness control group as a comparison consist of (50) participants,
as a result of wrongful conduct to work in the plants of who are not working in cement plants, and the case to
concrete, where the impact of the non-use of protective control group selected 1:1 described simply and matching
supplies negatively on the respiratory health of workers in with age, residence, gender and had not any past medical
the plants and on the quality of the air in the around area [8]. history.
Pulmonary functional measurements reveal significantly Data was collected in August till November 2014 using
increased lung resistance, transpulmonary pressures, and structured questionnaire in a face-to-face interview and
functional residual capacity with decreased dynamic lung measuring parameter of lung function by electronic
compliance and arterial oxygen tension and accompanying spirometer from each individual and measuring PM in each
chronic respiratory acidosis [9]. cement plant. Detailed information about the study was
These emissions are not only deteriorating air quality but given to the individuals, Both verbal and written consent was
also degrading human health. Emissions have local and obtained from each individual included in the study. The
global environment impact resulting in global warming, reason for selecting the middle governorate is the location of
ozone depletion, acid rain, biodiversity loss, reduced crop the plants which are in very populated areas.
productivity etc [10]. In those with evidence of airway obstruction and an
Results of several studies showed that these emissions are intermediate probability of asthma, arrange reversibility
adversely affecting human health in a variety of ways, like testing and/or a treatment trial for a defined period, NICE
itchy eyes, respiratory diseases like tuberculosis, chest guidance suggests that reversibility testing should not be
discomfort, chronic bronchitis, asthma attacks, routine if clinical features and spirometry are strongly
cardio-vascular diseases and even premature death [11]. suggestive of COPD [12].
NOTE A spirometer is a device that monitors the flow of
Summary of Literature Review air in and out of a person's lungs. The device can be used for
Air pollution has many negative effects on human health diagnosis and monitoring of pulmonary diseases, particularly
and it is recognized as a serious health hazard. There seems Asthma and COPD. Spirometers are divided into two classes
to be an association of air pollution with an increased risk of (manual and electronic) which have different specifications
decrease pulmonary function and acute respiratory
infections.
Following this, cement dust air pollution and its specific 3. Results
clinical effects on the human body were examined and
discussed. Health endpoints associated with both short and 3.1. PM Level in Cement Plants
long term exposure to cement dust were analyzed thoroughly PM2.5 and PM10 emission monitoring was carried out in six
with findings from numerous studies presented. Further, the cement plants.
health impacts of cement dust in Palestine and history of Figure 1 clarified the emission of PM2.5 by the cement
particulate air pollution regulations were discussed. Finally, plants varies widely from 82 to 196 μg/m3, with an average
more than fifteen similar previous studies of short and long particulate matter from 106.3 to 143.3, which is about more
term exposure to cement dust and its findings was mentioned, than 4 times higher than the particulate matter (PM2.5)
its findings are with line and consistent with our results and existing standard of 35 μg/m3.
findings. Figure 2 explained the emission of PM10 by the cement
From the above comprehensive literature review, it can be plants varies widely from 501 to 808 μg/m3, with an average
concluded that there is a correlation between particulate particulate matter from 521.4 to 656, which is about more
matters and alterations in pulmonary function and than 4 times higher than the particulate matter (PM10)
Exacerbation of respiratory symptoms. existing standard of 150 μg/m3.
 Public Health Research 2015, 5(5): 129-134 131

Table 1. Result of independent sample T-Test for pulmonary function

Parameters of
pulmonary Groups N Mean SD Test value P-value
function
control 50 74.61 5.15
FEV1/ FVC (%) 22.952 0.000*
case 50 53.93 3.74
control 50 3.52 0.53
FEV1 ( liter) 11.366 0.000*
case 50 2.61 0.21
control 50 4.70 0.48
Figure 1. The average of emission of PM2.5 by the cement plants FVC (liter) -1.559 0.122
case 50 4.86 0.55

3.3.1. Forced Expiratory Volume in One Second (FEV1)

The mean for FEV1 for case group equals 2.61, with SD of
0.21. For control group, the mean for FEV1 equals 3.52, with
SD of 0.53. The value of the T-test equals 11.366, with
p-value equals 0.000. This implies that there is sufficient
evidence to conclude that mean of FEV1 is significantly
different between case group and control group. Since the
sign of the T-test is positive, then mean of FEV1 for control
group is significantly greater than that for FEV1 for case
Figure 2. The average of emission of PM10 by the cement plants
group.
3.2. Appearance of Respiratory System Symptoms 3.3.2. Forced Vital Capacity (FVC)
Respiratory tract symptoms reported in this study among The mean for FVC for case group equals 4.86, with SD of
the exposed workers to PM were cough, sputum build-up and 0.55. For control group, the mean for FVC equals 4.70, with
dyspnea. These symptoms were found to be related to SD of 0.48. The value of the T-test equals -1.559, with
exposure of PM. p-value equals 0.122. This implies that there is insufficient
Cough reported significantly among exposed workers to evidence to conclude that mean of FVC is insignificantly
PM and data analysis shows that 88% of the case group different between case group and control group. In other
suffer from cough, but 94% of the control group do not suffer words, there is insignificant difference in the mean FVC
from cough. between case group and control group.
Also showed that the presence percentage of exaggerated
cough among cases and control. That confirmed 86.4% of 3.3.3. FEV1/ FVC (ratio)
case that have cough increased or exaggerated during
exposed cement dust.
And 79.5% of case that have cough show that they have
sputum buildup, but do not buildup in the control group.
Also identified the presence percentage of dyspnea that
86% of the case group suffer from dyspnea, but 92% of the
control group do not suffer from dyspnea and the rest of the
same group (8%) suffer from dyspnea.

3.3. Parameters of Pulmonary Function

The result of electronic spirometer for lung function that
Figure 3. Shows that the correlation between group and diagnosis
statistically explained that mean of FEV1 is significantly
different between case group and control group which show: The mean for FEV1/ FVC (%) for case group equals 53.93,
The mean of FEV1 for control group is significantly with SD of 3.74. For control group, the mean for FEV1/ FVC
greater than that for FEV1 for case group and there is (%) equals 74.61, with SD of 5.15. The value of the T-test
insufficient evidence to conclude that mean of FVC is equals 22.952, with p-value equals 0.000. This implies that
insignificantly different between case group and control there is sufficient evidence to conclude that mean of FEV1/
group. In other words, there is insignificant difference in the FVC (%) is significantly different between case group and
mean FVC between case group and control group. In control group. Since the sign of the T-test is positive, then
addition to findings confirmed that mean of FEV1/ FVC (%) mean of FEV1/ FVC (%) for control group is significantly
for control group is significantly greater than that for FEV1/ greater than that for FEV1/ FVC (%) for case group.
FVC (%) for case group (Table 1). Figure 3 explained 92% of case group have moderate
132 Yousef Aljeesh et al.: Effect of Exposure to Cement Dust on Pulmonary Function
among Cement Plants Workers in the Middle Governorate, Gaza, Palestine

obstruction and the rest of the same group (8%) have mild of the cement plant workers and the control group. Fell et al,
obstruction. This abnormalities were found to be related to 2003 [18], selected 119 cement plant workers, from them
exposure of PM air pollution. only 19 were non smokers; remaining all were either
smokers or ex-smokers.
Similarly to our findings, Merenu et al. 2007 [6]
4. Discussion investigated the effect of cement dust exposure on 56 cement
Data in figure (1) reveals that the emission of PM2.5 by the factory workers with a mean of 10 years exposure to cement
cement plants varies widely from 82 to 196 μg/m3, with an dust on lung function. They found that the vital capacity and
average particulate matter from 106.3 to 143.3, which is forced expiratory volume in one second were significantly
about more than 4 times higher than the particulate matter lower in cement factory workers than in control subjects.
(PM2.5) existing standard of 35 μg/m3 [13]. Their results suggest that chronic cement dust exposure
Also, data in figure (1) reveals that the emission of PM10 impairs lung function. Similarly, El Badari and Saeed, 2008
by the cement plants varies widely from 501 to 808 μg/m3, [19] reported a significant reduction in FVC, FEV1 and
with an average particulate matter from 615 to 656, which is PEFR in cement dust exposed workers compared to control.
about more than 4 times higher than the particulate matter The lung function indices were found to be reduced with
(PM10) existing standard of 150 μg/m3 [13]. increasing duration of exposure to cement dust. Our results
Positive significant relationship is observed between are in conformity with these results.
cement dust air pollution exposure and appearance of In parallel to our findings Nordby et al. 2011 [20] reported
respiratory system symptom (cough, sputum build-up and that Forced Expiratory Volume in the first second (FEV1)
dyspnea). reduced with an exposure-response relationship in the
The results of the acute respiratory symptom scores are in highest compared with the lowest exposure level of cement
agreement with data reported by Mwaiselage et al, 2005, dust. Concurrently, Zelke et al. 2010 [17], found that FVC,
Meo et al, 2013, Zeyede, 2010 [14, 15]. Who found a high FEV1 were significantly reduced among the cement
prevalence of shortness of breath, stuffy nose and sneezing production workers but not among the controls. The
among exposed cement factory workers. reduction in lung function was probably associated with high
In parallel to our findings, Merenu et al, 2007 [6]. cement dust exposure.
investigated the effect of cement dust exposure on cement Also, Mwaiselage et al. 2004 [21] investigated ventilatory
factory workers with a mean of 10 years exposure to cement function in cement factory workers and reported that
dust on lung function. They found that the vital capacity and exposed workers had significantly lower FVC, FEV1, and
forced expiratory volume in one second were significantly PEF than controls. Nordby et al. 2011 [20] reported that
lower in cement factory workers than in control subjects. Forced Expiratory Volume in the first second (FEV1)
The statistical strength of these relationships are in line reduced with an exposure-response relationship in the
with review paper carried out by Mariammal T. et al, 2012 highest compared with the lowest exposure level of cement
[16], where several studies worldwide were reviewed, and dust. Concurrently, Zelke et al. 2010 [17] found that FVC,
observed that occupational respiratory diseases are usually FEV1 were significantly reduced among the cement
caused by extended exposure to irritating or toxic substances production workers but not among the controls. The
that may cause acute or chronic respiratory ailments. The reduction in lung function was probably associated with high
incidence depends upon the chemical composition of dust, cement dust exposure. Moreover, Sultan A Meo et al, 2002
size of the particles, duration of exposure and individual [22] In cement plant workers, showed a statistically
susceptibility. Dust originating from work operation like significant reduction was demonstrated in the mean values of
drilling, blasting and grinding becomes airborne and FVC, FEV1, PEF, and MVV. The mean value for FEV1/FVC
inhalation of particles may induce accelerated lung function ratio was significantly higher in cement plant workers.
decline. Beside that, Al-Neaimi et al. 2001 [23], demonstrated that
Moreover, results of this study are also in agreement with the ventilatory function (FVC, FEV1, and PEF) were
those in studies conducted in different geographic regions on significantly lower in the cement plant workers compared
sample of the general population. Zeleke et al. 2010 [17] with unexposed subjects.
found an association between acute respiratory symptoms In addition to Sultan A Meo et al, 2013 [14], explained
and acute ventilatory effects and exposure to PM in a that cement plant workers exposed for more than 10 years
combined cross-sectional and cross-shift study in study was showed a significant reduction in FVC, FEV1, MVV, and
conducted in Dire Dawa cement factory in Ethiopia. PEF relative to their matched controls.
At the differences, Fell et al, 2003 [18] found that the As well at differences, Fell et al, 2003[18] found that the
mean pulmonary function indices were similar for cement mean pulmonary function indices were similar for cement
plant workers and control group. There was no plant workers and control group. There was no
duration-response-related decrease in lung function indices. duration-response-related decrease in lung function indices.
However, in the present study we found a decline in lung However, in the present study we found a decline in lung
function parameters with period of exposure to cement dust. function parameters with period of exposure to cement dust.
The main reason for this difference is the selection protocol The main reason for this difference is the selection protocol
 Public Health Research 2015, 5(5): 129-134 133

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