Health implications of poor housing ventilation

Introduction

Ventilation can be defined as the intentional movement of air from outside a building to the inside. It can also be defined as the free flow of fresh air into a building and the exit of vitiated air from the same building (Fabuwa, 2002).

Stanke (2007) described ventilation as an important factor for human survival in a house. But despite its importance adequate relevance is not given to it in the construction of houses thereby resulting to serious health problems both in rural and urban to be tremendously harmful to man’s health. Therefore, it is widely acknowledged that adequate ventilation is essential for good life and a key requirement for an effective living.

Proper ventilation in houses is a globally accepted phenomenon. And in addition one fourth of the world’s population is living in abject poverty (ASHRAE, 2013). This is an indication of poverty level and socio-economic standard of developing nations like Nigeria this affects the health of its inhabitants

One aspect that constitutes grievous problem in proper ventilation of houses in the affordability of adequate and efficient building material to construct good houses by the low income class which forms a large percentage of many nations particularly developing countries e.g. Nigeria (World Health Organization (WHO), 2008). The problem of adequate ventilation in rural areas is generally at the peak which includes lack of adequate planning of houses; attempt to maximize land use, inability to consult the appropriate quarters for approval of building plans and construction. Low socio-economic class are more at risk.

Aibor and Olorunda (2006) defined housing as a building constructed within the laid down building regulations to occupy persons and their personnel effects which possesses all the necessary sanitary conveniences, comfort, shelter, privacy, protecting lives and preventing disease associated with it. A suitable building for human inhabitation must be in accordance with the building regulation which includes the adequate provision of ventilation.

Paramount recognition of housing standard in human development made several international bodies including the United Nations to make a declaration on its place among other issues. According to Stanke (2007) Article 25C of the United Nations Law on Human Rights of 2006 stated that every individual has the right to live in a well ventilated and standard building to improve his/her health and well being.

Types of ventilation

Sherman (2012) classified ventilation in three (3) categories:

• Natural ventilation
• Artificial ventilation
• Hybrid/mixed mode ventilation

Natural ventilation

This is the type of ventilation that occurs naturally i.e. from natural sources (e.g. winds, and thermal buoyancy force due to indoor and outdoor air, density differences) which drive air through ventilating building opening. Ventilating openings includes windows, doors, solar chumming, wind tower and trickle ventilators. This ventilation of building depends on climate building design and human behaviour (Sherman, 2012).

Cross ventilation is a type of natural ventilation which occurs where there are pressure difference between one side of a building and the other. Typically, this wind driven effect in which air is drawn into the building on the high pressure leeward side. Wind can also drive singled sided ventilation and vertical ventilation.

Back – to – Back ventilation is an example of a poorly ventilated environment in which buildings are densely situated whereby three to four walls of the houses are shared with other buildings. In this environment natural ventilation is usually of low standard or absent. The environment with back –to-back ventilation is usually associated with poor air quality, unpleasant and musty odour (Kennedy, 2004)

Mechanical ventilation

Mechanical ventilation is referred to as ventilation that occurs artificially through the installation of mechanical equipment or machines e.g. fans installed directly on window or walls or installed in air dust for supplying air into or exhausting air from a room. This is usually depended on climate for example in warm and humid climate, infiltration may need to be minimized or prevented to reduce intestinal condensation (which occurs when warm, moist air from inside a building penetrates a wall, roof or floor and meets a cold surface). In this case, a positive pressure ventilating system is used conversely in cold climate. Air filtration needs to be prevented to reduce intestinal condensation for a room with locally generated pollutant such as bathroom, toilet or kitchen, the negative pressure system is often used. A balanced mechanical ventilation system refers to the system where air supply and exhaust have been tested and adjusted to meet designed specification. A minimum negative pressure of 2.5p is often maintained relative to the corridor in an airborne precaution room for infection (Hess, 2011)

Mechanical or artificial ventilation according to Hess (2011) can be classified into:

1. Exhaust ventilation
2. Plenum ventilation
3. Balanced ventilation
4. Air conditioning

1. Exhaust ventilation: in this system, air is extracted or exhausted to the outside by exhaust fans usually driven by electricity. As air is exhausted, a vacuum is created which induces fresh air to enter the room through windows, doors and other inlets. Exhausted ventilation is usually provided in large halls and auditoria for removal of air. The exhaust fans are housed in the external walls high up near the roof which facilitate removal of the upper layer of the heated air.
2. Plenum: in this system, fresh air is blown into the room by fans so as to create a positive pressure and displace heat air. Plenum or propulsion system is used for supplying air to air-conditioned buildings and factories.
3. Balanced ventilation: this is a combination of the exhaust and plenum systems of ventilation. The blowing fan must balance the exhaust fan.
4. Air-conditioning: Air-conditioning is defined as the “simultaneous control of all or at least the first three of those factors affecting the physical and chemical conditions of the atmosphere within any structure. These factors include temperature, humidity, air movement, distribution, dust, bacteria, odour and toxic gases most of which affect in greater or lesser degree human health and comfort”. In air-conditioning, the air is first filtered and then saturated with water vapours. The excess of moisture is removed and the air is heated to the desired temperature before it is supplied.

 Hybrid/mixed mode ventilation

Hybrid (mixed mode) ventilation relies on natural driving forces to provide the design flow rate it uses mechanical ventilation when the natural ventilation flow rate is low. This type of ventilation uses both naturally and mechanical ventilation process. The natural and mechanical component may be used in conjunction with each other or separately at different times on the importance of proper ventilating opening such as windows and doors (Schild, 2002).

 Factors that lead to poor ventilation

According to Clark et al., (2002) poor ventilation can be, caused by the following factors

• High level of illiteracy
• Lack of a good housing plan
• Lack of skillful personnel and manpower
• Poor government policies and regulatory framework
• Lack of sufficient land.
• Poverty-low income level and unemployment.

 High level of illiteracy

Due to ignorance on the importance of living in a well ventilation building, people tend to live in houses that are not properly ventilated thus leading to problems associated with poor ventilation which includes Tuberculosis, pneumonia, common cold, catarrh etc.

Lack of good housing plan

Most houses constructed in the rural areas and even in the urban areas are constructed without a good house plan thereby leading to negligence on the importance of proper ventilating openings such as windows and doors.

Lack of skilful personnel

When personnel’s employed to carry out the planning and construction of a building are not skilful in doing their work, the work is done casually without adequate consideration to ventilating opening and even they are considered they are not properly constructed thereby leading to poor ventilation of the building.

Lack of sufficient funds

Lack of sufficient funds (insufficient funds) is a key factor in the increase of poor ventilation because; when there is insufficient  funds one tends to maximize capital thereby creating very limited consideration to proper ventilation.

Poverty

Poverty is a very crucial factor that influences the type of house inhabited by an individual. The absence or presence of insufficient funds or money leads to a choiceless situation where one cannot choose whether or not to dwell in a well or poorly ventilated apartment because his/her finance cannot afford a good house.

 Effects of poor ventilation to health and social care

Some of the effects of poor ventilation as highlighted by Shaw (2004) include:

• high prevalence of disease attack
• exacerbation of mental stress
• accident (home accident)
• excessive heat and cold

In addition, Health Council of The Netherlands (2010) in accessing indoor air qualities in The Netherlands stated that poor indoor air quality lead to:

• poor educational attainment and deprivation
• occurrence of indoor pollutant
• easy spread of communicable disease
• airborne and contact borne diseases such as tuberculosis, measles, cholera, scabies’ etc.
• It deteriorates and conveys a sense of discomfort which could lead to headache, sweating, dizziness etc.

High prevalence of disease attack

Poor ventilation caused by inadequate ventilating openings and overcrowding of a room causes ill ventilation which serves as a route in the transmission of respiratory disease such as tuberculosis, asthma, influenza, etc. this result in an increase in the disease burden with the population, it also affects productivity thus perpetuating the cycle of poverty (Singh et al., 2005).

 Exacerbates mental illness

Poor ventilation caused by overcrowding and poorly constructed ventilating opening result in the disturbance of the brain cells thereby leading to irritation, intimidation and further complication such as mental disorder (Israeli & Pardo, 2011).

Accident

Overcrowding in a building with various materials, furniture or facilities due to lack of adequate space would result to accidents especially among children thus causing injuries and probably infections and diseases.

Excessive cold or heat

Poor ventilation or inadequate ventilation in a house would cause excessive heat during the dry season thereby making the building uncomfortable for human inhabitation the presence of excessive heat also gives an irritating feeling.

Poor educational attainment and deprivation

The poor design of a house and its lack of ventilating opening often renders the leaving environment unconducive for learning especially during extreme whether condition. These factors have serious health implication with attendant social and economic consequences including school absenteeism.

Airborne disease transmission

Poor ventilation which does not allow adequate free flow of air increase the rate of air borne disease transmission from person to person present in a particular place, e.g. tuberculosis, cholera, cough, etc (American Academy of Orthopaedic Surgeons (AAOS), 2011).

Hazards associated with poor ventilation

According to Singh et al., (2005), the hazards associated with poor ventilation can have direct or indirect impact on health and they have the potential of causing injuries and damages to individual expose to them.

Those hazards are not restricted to contamination and they include

• Physical hazard
• Social hazard
• Biological hazard

Physical hazard

This hazard includes heat, cold, inadequate energy, efficiency, poisoning (carbon monoxide, lead) and similar physical hazards are caused as a result of poor ventilation in a house and maintenance of equitable temperature by cooling during dry season and wet season is also conducive to good health examples of physical hazard are:

1. Heat: Buildings that are constructed without adequate consideration to ventilation e.g. lack of adequate large windows or windows constructed facing the south are likely to develop higher indoor temperature and they carry greater risk to health. It can also as a result of climate change and the inadequate provision of windows and doors in a house.
2. Damp and mould: This types of housing related hazard tends to be worst in overcrowded dwelling often occupied by families of low socio-economic states however damp and mould have repeatedly been linked to a number of health outcome including respiratory system, nausea, vomiting and general ill health.
3. Carbon monoxide (poisoning): Poisoning by carbon monoxide occurs as a result of poorly ventilated and maintained combustion sources (gas boilers, fire etc.) which causes irritation of the eye and nose this making the entry disease germs easy.
4. Random: Radioactive gas which enters building from underlying soil and rock when random and its decay products are inhaled they eradicate tissues in the body with the largest dose being delivered to the lungs.

Social hazard

Overcrowded houses which reduce the free flow air prompt to higher risk of being involved in offences due to lack of improved occupant’s psychological and physiological needs.

Biological hazard

The risk of transmission of communicable disease is high in a house that has poor ventilation and overcrowding. Overcrowding and poor ventilation are problem commonly associated with insanitary dwelling. It is exacerbated by an under supply of larger dwelling and impair ventilation (inadequate windows and doors in the house). They are of great problems in all phases of public health this is because, a house overcrowded with people is bound to generate a lot of solid and liquid waste whose magnitude in most cases is beyond the available facilities which gives rise to biological hazard. A house is said to be over crowded when the vacant floor available for each adult is less than fifty square feet. Children above ten years are counted as adult in this case. A house is said to be poorly ventilated when the supply of air (natural and artificial) is inadequate.

Remedies to poor house ventilation

A good house must be well ventilated with adequate air openings. Such as windows, doors and other artificial ventilating equipment or materials such as fans, air condition etc (Shaw, 2004)

The building should have adequate space so as encourage the entrance and exit of fresh and still air respectively. The house should be built far from odour generation premises such as a waste collection site etc. to prevent the courage of bad odour into the premises.

Conclusion

From the above discussion, it is concluded that poor or inadequate ventilation leads to various occurrences of several diseases including tuberculosis, catarrh, pneumonia, etc. and it is therefore necessary that there should be adequate consideration of ventilating openings during building construction and there should be adequate artificial source of ventilation such as fans, air conditioners etc. this will aid proper ventilation in the absence of the natural ventilation.

Recommendations

The problem of poor ventilation can be solved through the adherence to the following recommendations:

1. There should be effective health education of the general public on the health implication of poor housing and the relevance of living in a well ventilated building by the environmental health officers.
2. The government should embark on programs that will help in arresting the problem of poor ventilating conditions of houses.
3. During construction of houses there should be adequate provision of ventilating openings such as windows and doors.
4. There should be provision and effective implementation of building adoptive by laws.
5. Efforts should be made by those involved in the inspection of houses (environmental health officers and local government engineers to ensure that all houses which will be built in the future possess an approved building plan.
6. House owners and possibly dwellers should effect repairs on damaged parts of their houses such as windows and doors.

References                                           

Aibor, M. S and Olorunda J. O (2006). A technical handbook of environmental health in the 21^st century for professional and students. Lagos: Divine Favour Publishers.

American Academy of Orthopaedic Surgeons (AAOS) (2011). Bloodborne and Airborne Pathogens. New York: Jones & Barlett Publishers.

ASHRAE (2013). Ventilation for acceptable indoor air quality, standard Atlanta: American Society of Heating, Refrigeration, and Air-Conditioning Engineers.

Clark, M., Riben, P., & Nowgesic, E. (2002). The association of housing density, isolation and tuberculosis in Canadian First Nations communities. Int J Epidemiol;31,940-43.

Fabuwa, A. I. (2002). Dwelling disparities/how poor housing leads to poor health. Environmental Health Prospects 12(2), 62-64

Health Council of The Netherlands (2010). Indoor air quality in primary schools. The Hague: Health Council of The Netherlands

Hess, D. R. (2011). “Approaches to conventional mechanical ventilation of the patient with acute respiratory distress syndrome”. Respir Care 56 (10), 1555–72.

Israeli, E. & Pardo, A. (2011). The sick building syndrome as a part of the autoimmune (auto-inflammatory) syndrome induced by adjuvants. Mod Rheumatol. 21(3),235-9.

Kennedy, L. (2004). Remaking Birmingham: The Visual Culture of Urban Regeneration. London: Routledge.

Schild, P. G. (2002) Hybrid ventilation of Jaer School: Results of Monitoring, Hybrid Ventilation 2002: 4^th International Forum, May 14-15, 2002, Montreal, Canada.

Shaw, M. (2004).  Housing and Public Health. Annual Review of Public Health 25,397-418.

Sherman, M. H. (2012) “ASHRAE’s First Residential Ventilation Standard” New York: Lawrence Berkeley National Laboratory.

Singh, M., Mynak, M. L. & Kumar, L.  (2005). Prevalence and risk factors for transmission of infection among children in household contact with adults having pulmonary tuberculosis. Archives of Disease in Childhood 90,624-28.

Stanke, D. A. (2007). “Standard 62.1-2004: Stricter or Not?” ASHRAE IAQ Applications, Spring 2006.

World Health Organization (2008). Closing the Gap in a Generation- Health equity through action and the social determinants of health. Geneva: World Health Organization.