BMJ Open · 4 authors, 2 centres
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This cross-sectional study of 822 teachers in Gondar, Ethiopia found a 31.14% prevalence of chronic respiratory symptoms. Key modifiable risk factors included secondhand smoke exposure at home (AOR=9.85), chalk use (AOR=1.97), and failure to open windows during class (AOR=2.15). The findings highlight the need for smoking bans, improved classroom ventilation, and chalk dust control in Ethiopian schools.
**Background:** Chronic respiratory diseases affect hundreds of millions globally and are a major cause of morbidity and mortality. School teachers are an occupationally at-risk group due to exposure to chalk dust, poor indoor air quality, crowded classrooms, and other environmental hazards. In developing countries like Ethiopia, where chalk and blackboard instruction predominates, data on respiratory health among teachers are limited. This study aimed to investigate the prevalence and risk factors of chronic respiratory symptoms among school teachers in Gondar city, north-western Ethiopia.
**Methods:** A school-based cross-sectional study was conducted from April to May 2019 among primary and secondary school teachers in Gondar city. A multistage sampling technique was used: 13 of 66 elementary schools (20%) and 3 of 15 secondary schools (20%) were selected using simple random sampling, and the calculated sample was proportionally allocated. Study participants were selected using computer-generated random numbers. Data were collected using a pretested, self-administered Amharic version of the British Medical Research Council (BMRC) Questionnaire. Chronic respiratory symptoms were defined as one or more symptoms (chronic cough, chronic phlegm, chronic wheezing, chronic shortness of breath, or chronic chest tightness) lasting at least 3 months in the past year. Data were entered into Epi Info V.7 and analyzed using SPSS V.20. Bivariable and multivariable binary logistic regression were performed; variables with p<0.2 in bivariable analysis were entered into the multivariable model. Statistical significance was set at p<0.05.
**Key Results:** A total of 822 completed questionnaires were analyzed (response rate 97.4%). The majority were male (64.7%), with a mean age of 36.69 years (SD ±6.93). Most had a bachelor's degree (75.9%) and 40.2% had 6-10 years of teaching experience. The overall prevalence of chronic respiratory symptoms in the previous 12 months was 31.14% (n=256; 95% CI 27.99% to 34.43%). The most frequently reported symptoms were chronic shortness of breath (20.1%; 95% CI 17.4% to 23.0%), chronic cough (18.7%; 95% CI 16.1% to 21.6%), chronic wheezing (13.3%; 95% CI 11.0% to 15.8%), chronic chest tightness (11.20%; 95% CI 9.1% to 13.5%), and chronic phlegm (10%; 95% CI 8.6% to 12.3%). In the multivariable analysis, five factors were significantly associated with chronic respiratory symptoms: family history of respiratory problems (AOR=1.90; 95% CI 1.07 to 3.37; p=0.029), overweight BMI (AOR=2.57; 95% CI 1.57 to 4.21; p<0.001), exposure to secondhand cigarette smoke at home (AOR=9.85; 95% CI 4.77 to 20.33; p<0.001), use of chalk for teaching (AOR=1.97; 95% CI 1.25 to 3.09; p=0.003), and failure to open windows during class (AOR=2.15; 95% CI 1.02 to 4.52; p=0.043). The Hosmer-Lemeshow test indicated good model fit (p=0.7380).
**Clinical Implications:** This study demonstrates a high burden of chronic respiratory symptoms among Ethiopian school teachers, with a prevalence of 31.14%. The strong association with secondhand smoke exposure at home (nearly 10-fold increased risk) underscores the urgent need for smoke-free home environments and enforcement of public smoking bans. The finding that chalk use doubles the risk of respiratory symptoms supports transitioning to dust-free markers in classrooms. The protective effect of opening windows highlights the importance of natural ventilation as a low-cost intervention. Overweight teachers were at 2.57 times higher risk, suggesting that weight management could have respiratory benefits. These findings are particularly relevant for low-resource settings where chalk and crowded classrooms remain common. Limitations include the cross-sectional design (precluding causal inference), reliance on self-reported symptoms without pulmonary function testing or air sampling, and potential recall bias. Future research should incorporate objective lung function measurements and workplace air sampling.