Abstract
Background:
Avian diseases should be known to people who raise birds as pets or for commercial purposes. Exposure to high levels of airborne dust and endotoxins is known to cause allergies. This study, therefore, intends to assess avian allergy and its associated factors among poultry workers and bird fanciers in urban Mysuru.
Methods:
A cross-sectional study was done over three months among 60 poultry workers and 60 bird fanciers in a selected rural population of the Mysuru district. The participants were selected by simple random sampling method and their data were obtained by interview method using a pre-tested semi-structured questionnaire. Chi-square test/Fisher’s exact test was used to check the associations between the demographic variables’ avian allergy.
Results:
The survey revealed that 31.67% of poultry workers and 53.33% of bird fanciers had symptoms. The majority of the study participants were illiterate and were not using personal protective equipment (PPE) regularly. The results showed a significant association between education (P = 0.013) and the use of PPE (P = 0.020) with avian allergy. Observing the health hazards, 42.10% had respiratory problems, 42.10% had skin problems, and 26.31% had eye problems. Further, a significant association was also found between education and knowledge about diseases (P = 0.001).
Conclusion:
The avian allergy among the bird fanciers was higher when compared to poultry workers. It is necessary to organize routine counseling, awareness, and training programs about diseases and prevention strategies related to their work and living environments and keep them updated.
Keywords: Allergy, avian diseases, bird fanciers, personal protective equipment (PPE), poultry worker, zoonosis
INTRODUCTION
Poultry is one of the fastest-growing agricultural industries in India. In the last two decades, India’s poultry industry has seen substantial structural and operational changes.[1,2] While agricultural crop output has been increasing at a pace of 1.5 to 2% per year, egg and broiler production has been increasing at a rate of 8 to 10% per year. As a result, India is presently the fifth-greatest producer of eggs and the eighth largest producer of broilers in the world.[3]
Poultry dust, pathogens, endotoxins, as well as NH3 and carbon dioxide (CO2), are all present in poultry production and hatcheries as a result of excreta decomposition, poultry respiration, and other operations in animal confinement buildings. These and other components, such as animal manure, waste, feathers, fragments, and skin, have been linked to negative environmental and health effects.[4,5] Prolonged exposure to airborne contaminants can cause respiratory problems such as allergic responses, asthma, and hypersensitivities, as well as pneumonitis and organic dust toxic syndrome (ODTS).
Similar to the poultry industry, the population of pet birds in India increased from 143,000 to 157,000 in 2019 and this figure is expected to reach around 170,000 by the end of 2023.[6] Professional birdkeepers are at a higher risk of developing health problems due to exposure to numerous occupational agents. Airborne contaminants in birds’ cages include a variety of aerosolized agents, such as organic dust, skin debris, broken feather barbules, insect remains, birds’ excreta, ammonia, and a variety of viable bacteria, as well as airborne gram-negative bacteria and endotoxins, similar to those found in the poultry industry. As a result, occupational allergies are a significant health issue for birdkeepers, and workers in this industry are also at a high risk of developing respiratory problems.[7,8,9]
The present study aims to identify and compare the frequency of occupational allergies among poultry workers and bird fanciers and to assess the risk factors and knowledge associated with the development of these occupational allergies.
METHODOLOGY
A cross-sectional study was conducted in the rural field practice area of the Department of Community Medicine, JSS Medical College, Mysuru (Hadinaru Primary Health Centre) for a period of three months (August to October 2022). The study protocol was approved by the Institutional Ethics Committee (JSSMC/IEC/260822/34 NCT/2022-23) and informed consent was obtained from the participants after explaining the purpose and procedure of the study. All subjects aged more than or equal to 18 years and willing to participate were included and subjects with exposure of less than 1 year were excluded from this study.
A pilot study conducted from August 5th to August 15th, 2021 showed avian allergy prevalence as 30% and 10% in bird fanciers and poultry workers, respectively. Assuming a power of 80% an alpha error of 5% and a confidence interval of 95% sample size of about 59 rounds to 60 subjects in each group needs to be studied.
Out of the 12 poultry farms in Hadinaru village, six farms were selected by lottery method and from each farm, 10 poultry workers were by simple random sampling method. Out of the 135 registered bird fanciers, 60 were selected by simple random sampling. The data were obtained through face-to-face interviews.
The data were collected from the respondents using a pre-tested, semi-structured questionnaire. The questionnaire includes details about the socio-demographic profile (age, gender, education, occupation), duration of exposure, working hours per day, smoking status, protective equipment used during work, type of fuel used for cooking, past medical illnesses, and symptoms related to avian diseases such as shortness of breath, coughing, wheezing, nasal discharge, phlegm, sore throat, eye itching, and redness, blurring of vision, skin itching and rashes, headache, earache, chest tightness, and abdominal pain. It also had questions to assess the knowledge of subjects regarding diseases and their mode of transmission.
Statistical analysis
The data collected were entered in Microsoft Excel 2019 spreadsheet followed by analysis using SPSS version 23 (Licensed to JSS AHER). The demographic characteristics such as age, gender, and education were represented using standard deviation and percentages. The associations between the selected demographic variables and avian allergy were found using the Chi-square test/Fisher’s exact test. The data distribution was represented using appropriate tables and figures. A P value of less than 0.05 was considered statistically significant.
RESULTS
The overall prevalence of avian allergy among poultry workers was 31.67% and bird fanciers were 53.33%, respectively. The mean age of poultry workers was 30.44% ± 12.077 years and bird fanciers were 30.44% ± 12.077 years. The association between education and symptoms was observed to be statistically significant in both groups [Table 1a and b].
Table 1a.
Characteristics of poultry workers
| Variables | Categories | Poultry workers | |||
|---|---|---|---|---|---|
|
| |||||
| Symptom present [n (%)] | Symptom absent [n (%)] | Chi-square value | P | ||
| Age | ≤20 | 4 (28.6%) | 10 (71.4%) | ||
| 21-40 | 11 (32.4%) | 23 (67.6%) | 7.064 | 0.055 | |
| 41-60 | 1 (11.1%) | 8 (88.9%) | |||
| 61-80 | 3 (100%) | 0 (0%) | |||
| Total | 19 (31.67%) | 41 (68.33%) | |||
| Gender | Male | 15 (31.3%) | 33 (68.8%) | ||
| Female | 4 (33.3%) | 8 (68.7%) | 0.019 | 0.890 | |
| Total | 19 (31.67%) | 41 (68.33%) | |||
| Education | Illiterate | 5 (20.8%) | 19 (79.2%) | ||
| Primary | 1 (16.7%) | 5 (83.3%) | 12.582 | 0.013# | |
| Middle school | 0 (0%) | 7 (100%) | |||
| High school | 9 (56.3%) | 7 (43.7%) | |||
| Post high school | 0 (0%) | 1 (100%) | |||
| Graduate | 4 (66.7%) | 2 (33.3%) | |||
| Total | 19 (31.67%) | 41 (68.33%) | |||
| Duration of exposure (in years) | ≤5 | 7 (25.9%) | 20 (74.1%) | 0.766 | 0.682 |
| 6-10 | 6 (35.3%) | 11 (64.7%) | |||
| >10 | 6 (37.5%) | 10 (62.5%) | |||
| Total | 19 (31.67%) | 41 (68.33%) | |||
| Smoking | Yes | 3 (27.3%) | 8 (72.7%) | 0.120 | 0.516 |
| No | 16 (32.7%) | 33 (67.3%) | |||
| Total | 19 (31.67%) | 41 (68.33%) | |||
#- Fisher’s exact test
Table 1b.
Characteristics of bird fanciers
| Variables | Categories | Bird fanciers | |||
|---|---|---|---|---|---|
|
| |||||
| Symptom present [n (%)] | Symptom absent [n (%)] | Chi-square value | P | ||
| Age | ≤20 | 4 (44.4%) | 5 (55.6%) | 3.686 | 0.286 |
| 21-40 | 26 (55.3%) | 21 (44.7%) | |||
| 41-60 | 0 (0%) | 2 (100%) | |||
| 61-80 | 2 (100%) | 0 (0%) | |||
| Total | 32 (53.3%) | 28 (46.7%) | |||
| Gender | Male | 31 (52.5%) | 28 (47.5%) | 0.890 | 0.346 |
| Female | 1 (100%) | 0 (0%) | |||
| Total | 32 (53.3%) | 28 (46.7%) | |||
| Education | Illiterate | 0 (0%) | 2 (100%) | 14.375 | 0.009# |
| Primary | 5 (100%) | 0 (0%) | |||
| Middle school | 0 (0%) | 3 (100%) | |||
| High school | 7 (36.8%) | 12 (63.2%) | |||
| Post high school | 8 (53.3%) | 7 (46.7%) | |||
| Graduate | 12 (75%) | 4 (25%) | |||
| Total | 32 (53.3%) | 28 (46.7%) | |||
| Duration of exposure (in years) | ≤5 | 12 (52.2%) | 11 (47.8%) | 4.944 | 0.176 |
| 6-10 | 9 (81.8%) | 2 (18.2%) | |||
| >10 | 11 (42.3%) | 15 (57.7%) | |||
| Total | 32 (53.3%) | 28 (46.7%) | |||
| Smoking | Yes | 8 (40%) | 12 (60%) | 3.207 | 0.206 |
| No | 24 (60%) | 16 (40%) | |||
| Total | 32 (53.3%) | 28 (46.7%) | |||
#- Fisher’s exact test
In poultry workers, the prevalence of symptoms increased with an increase in the duration of exposure from 25.9% between 1 and 5 years to 37.5% for >15 years duration while no such change was seen in bird fanciers. Only 30% of poultry workers who worked for greater than eight hours per day experienced symptoms when compared to 33.8% of those who worked for less than eight hours [Figure 1].
Figure 1.
Total duration of exposure and symptoms
The majority of the study participants in both groups were either non-smokers or former smokers and a gas stove was used for cooking purposes in their homes.
Regarding PPE use, 22 (36.7%) poultry workers and 32 (53.3%) bird fanciers reported to be using PPE regularly and this was found to be significantly associated with symptoms in poultry workers [Table 2].
Table 2.
Association between PPE and symptoms among poultry workers and bird fanciers
| Variables | Categories | PPE | Chi-square value | P | |
|---|---|---|---|---|---|
|
| |||||
| Use regularly (%) | Do not use (%) | ||||
| Poultry workers | Symptoms present | 11 (50%) | 8 (21.1%) | 5.396 | 0.020* |
| Symptoms absent | 11 (50%) | 30 (78.9%) | |||
| Total(%) | 22 (36.7%) | 38 (63.3%) | |||
| Bird fanciers | Symptoms present | 20 (62.5%) | 12 (42.9%) | 2.315 | 0.128 |
| Symptoms absent | 12 (37.5%) | 16 (57.1%) | |||
| Total(%) | 32 (53.3%) | 28 (46.7%) | |||
*-significant P value (Chi-square test)
This study also showed a significant association between education and knowledge of diseases among poultry workers while no association was seen in bird fanciers [Table 3] [Figure 2].
Table 3.
Association between education and knowledge of diseases
| Education | Knowledge of diseases | Chi-square value | P | |
|---|---|---|---|---|
|
| ||||
| Yes (%) | No (%) | |||
| Illiterate | 0 (0%) | 24 (45.3%) | 16.803 | 0.001 # |
| Primary school | 3 (42.9%) | 3 (5.7%) | ||
| Middle school | 0 (0%) | 7 (13.2%) | ||
| High school | 1 (14.3%) | 15 (28.3%) | ||
| Post high school | 0 (0%) | 1 (1.9%) | ||
| Graduate | 3 (42.9%) | 3 (5.7%) | ||
| Total (%) | 7 (11.7%) | 53 (88.3%) | ||
#- Fisher’s Exact test
Figure 2.
Distribution of study subjects based on knowledge of diseases and their mode of transmission
Out of the 19 poultry workers who reported symptoms, eight (42.10%) suffered from respiratory problems, eight (42.10%) had skin problems followed by 5 (26.31) with eye problems while among the 32 bird fanciers with symptoms, 24 (75%) suffered from respiratory problems followed by 11 (34.37%) with eye problems and 10 (31.25%) with skin problems [Figure 3].
Figure 3.
Distribution of respondents based on different types of health problems
DISCUSSION
Contact with bird feathers, secretions, or droppings might expose you to allergens. Excreted serum protein antigens, bacterial endotoxin, and other biological non-specific compounds may be found in bird droppings. Since 1920, feathers have been recognized to be a source of allergies.[7,10]
The present study showed around 31.67% of poultry workers and 53.33% of bird fanciers had at least one or more symptoms. A cross-sectional study done in Ludhiana city of Punjab reported around 43.93% of poultry workers with symptoms which was more when compared to our study. The reason noted in this study was the workers with a longer duration of exposure had a significantly higher chance of getting the disease[11] Another study done on 177 poultry farm workers and 183 three workers of other occupation groups in Kerala showed that poultry farming as such is a risk factor for developing respiratory morbidity poultry workers. Almost 27% of farmers in that study reported to have experienced one or more respiratory symptoms with the majority suffering from allergies and rhinitis-related symptoms.[12]
In the present study, a higher frequency of symptoms was seen with increased duration of exposure in poultry workers while no such pattern was seen in bird fanciers. A study done by Sylwia Świderska-Kiełbik et al.[7] in Poland in birdkeepers also showed no correlation between symptoms and duration of exposure.
In this study, 36.7% of poultry workers and 53.3% of bird fanciers reported to be using PPE regularly and there was a significant association between the use of PPE and symptoms in poultry workers (P-0.020). This was lower when compared to another study done in Nigeria by Iwuala et al.,[13] where 75% of poultry workers were aware of PPE and were using it.
Only 11.7% of poultry workers and 38.3% of bird fanciers were aware of the diseases caused due to avian exposures. This was lower when compared to a study done in Ghana in 2017 by Matilda Ayim et al.,[14] where almost 76.5% of participants knew about at least one poultry disease. Another study done in Jaipur, Rajasthan, by Sihag Priyanka et al.,[15] showed that 70% of the poultry workers had a medium level of knowledge followed by 21.30% of participants with a high level of knowledge.
This study also showed a significant association between education and knowledge of disease among poultry workers (P < 0.001).
This study also has few limitations. Since the study was conducted during the COVID-19 pandemic period, the spirometry values of the patients were not assessed. The study could only involve a small portion of the population, and the cross-sectional design of the study based on participants’ self-reported data could also be a drawback. Further, the female respondents among both groups especially, the bird fanciers’ group, were fewer. Most of the poultry workers were migrant laborers who were a little reluctant to share their full history.
CONCLUSION
Work-related symptoms, both respiratory and non-respiratory, were more in bird fanciers (53.33%) when compared to the poultry farm workers (31.67%). The level of education was found to be a significant factor responsible for causing avian allergy in both poultry workers and bird fanciers while the usage of PPE was only associated with avian allergies in poultry workers. Further, there was also a significant association between knowledge of disease and education status among poultry workers. So, there is a need to educate the people having close contact with birds regarding the diseases, their mode of transmission, and the use of PPE which can help protect those involved in these fields.
Recommendations
Awareness and training programs about diseases and the use of PPE should be organized for poultry workers and bird fanciers to get updated with knowledge about diseases and prevention strategies related to their work and living environments. Hence, it is necessary to not only strengthen existing occupational health and safety laws but also to provide information and training to both owners, employees, and bird fanciers about the potential risks of organic dust exposure and the use of PPE to reduce the risk of exposure to workers in these facilities.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
The study was approved by the Institutional Ethics Committee. (JSSMC/IEC/260822/34 NCT/2022-23).
Conflicts of interest
There are no conflicts of interest.
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