Examining the Relationship between Environmental Health Conditions and the Incidence of Acute Respiratory Tract Infections (ARI) Among Students at San Roque Elementary School
Abstract
Purpose of the study: This study aimed to examine the relationship between environmental health conditions and the incidence of ARI among elementary school students.
Methodology: An analytic observational study with a cross-sectional design was conducted among 80 students at San Roque Elementary School. Environmental health conditions were assessed using a structured observational checklist covering ventilation, sanitation, classroom density, waste management, and water availability. ARI incidence was determined through school health records and parental confirmation. Data were analyzed using Chi-square tests and multivariate logistic regression at a 95% confidence level.
Main Findings: Of the observed classrooms, 40.0% were classified as having inadequate environmental health conditions. ARI prevalence among students was 36.3%. A significant association was identified between environmental health status and ARI incidence (p = 0.001). Students exposed to inadequate environmental conditions had 4.12 times higher odds of developing ARI (AOR = 4.12; 95% CI: 1.68–10.09; p = 0.002).
Novelty/Originality of this study: This study advances prior research by operationalizing environmental health as a multidimensional composite construct within a real-world public elementary school setting, thereby generating context-specific empirical evidence linking structural environmental exposure to respiratory morbidity.
References
X. Wang, Y. Li, X. Mei, E. Bushe, H. Campbell, and H. Nair, “Global hospital admissions and in-hospital mortality associated with all-cause and virus-specific acute lower respiratory infections in children and adolescents aged 5–19 years between 1995 and 2019: A systematic review and modelling study,” BMJ Glob. Heal., vol. 6, no. 7, pp. 14–25, Jul. 2021, doi: 10.1136/bmjgh-2021-006014.
M. T. Saadi and P. Junadi, “Understanding outpatients’ intention to revisit a hospital: A study using theory of planned behavior and satisfaction in an Indonesian hospital,” Int. J. Pharm. Healthc. Mark., vol. 19, no. 4, Sep. 2025, doi: 10.1108/IJPHM-01-2025-0003.
S. L. McGuinness et al., “Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low‐ and middle‐income countries: a systematic review,” Trop. Med. Int. Heal., vol. 23, no. 8, pp. 816–833, Aug. 2018, doi: 10.1111/tmi.13080.
A. Razzaque, L. Nahar, M. Akter Khanam, and P. Kim Streatfield, “Socio-demographic differentials of adult health indicators in matlab, Bangladesh: Self-rated health, health state, quality of life and disability level,” Glob. Health Action, vol. 3, no. 1, p. 4618, 2010, doi: 10.3402/gha.v3i0.4618.
B. O’Rourke, W. Oortwijn, and T. Schuller, “The new definition of health technology assessment: A milestone in international collaboration,” Int. J. Technol. Assess. Health Care, vol. 36, no. 3, pp. 187–190, 2020, doi: 10.1017/S0266462320000215.
E. Sacks, M. Schleiff, M. Were, A. M. Chowdhury, and H. B. Perry, “Communities, universal health coverage and primary health care,” Bull. World Health Organ., vol. 98, no. 11, pp. 773–780, Nov. 2020, doi: 10.2471/BLT.20.252445.
L. Kano, E. W. K. Tsang, and H. W. chung Yeung, “Global value chains: A review of the multi-disciplinary literature,” J. Int. Bus. Stud., vol. 51, no. 4, pp. 577–622, 2020, doi: 10.1057/s41267-020-00304-2.
V. Czok, M. Krug, S. Müller, J. Huwer, and H. Weitzel, “Learning effects of augmented reality and game-based learning for science teaching in higher education in the context of education for sustainable development,” Sustain., vol. 15, no. 21, 2023, doi: 10.3390/su152115313.
Y. K.M and S. P. Gudur, “Strategic approaches to managing respiratory tract infection risk factors: a comprehensive review,” Asian J. Hosp. Pharm., vol. 4, no. 1, pp. 1–8, Mar. 2024, doi: 10.38022/ajhp.v4i1.80.
E. Moran, J. Kubale, G. Noppert, R. Malosh, and J. Zelner, “Inequality in acute respiratory infection outcomes in the United States: A review of the literature and its implications for public health policy and practice,” Apr. 26, 2020. doi: 10.1101/2020.04.22.20069781.
H. Jary, “Household air pollution and acute lower respiratory infections in adults: A systematic review,” PLoS One, vol. 11, no. 12, pp. 656–664, Dec. 2016, doi: 10.1371/journal.pone.0167656.
A. R. Sherris, “Associations between ambient fine particulate matter and child respiratory infection: The role of particulate matter source composition in Dhaka, Bangladesh,” Environ. Pollut., vol. 290, no. 12, pp. 1–11, Dec. 2021, doi: 10.1016/j.envpol.2021.118073.
W. Zhang, R. Ma, Y. Wang, N. Jiang, Y. Zhang, and T. Li, “The relationship between particulate matter and lung function of children: A systematic review and meta-analysis,” Environ. Pollut., vol. 309, no. 127, p. 119, Sep. 2022, doi: 10.1016/j.envpol.2022.119735.
K. Saxena, “Association between maternal prenatal exposure to household air pollution and child respiratory health: a systematic review and meta-analysis,” Yale J. Biol. Med., vol. 97, no. 1, pp. 29–40, Mar. 2024, doi: 10.59249/TAVR4964.
A. J. Kroopnick and E. C. Miller, “Approach to altered mental status in pregnancy and postpartum,” Semin. Neurol., vol. 44, no. 06, pp. 695–706, Dec. 2024, doi: 10.1055/s-0044-1788977.
I. V. Roche, M. Ubalde-Lopez, C. Daher, M. Nieuwenhuijsen, and M. Gascon, “The health-related and learning performance effects of air pollution and other urban-related environmental factors on school-age children and adolescents a scoping review of systematic reviews,” Curr. Environ. Heal. Reports, vol. 11, no. 2, pp. 300–316, Feb. 2024, doi: 10.1007/s40572-024-00431-0.
I. Demchenko, B. Maksymchuk, V. Bilan, I. Maksymchuk, and I. Kalynovska, “Training future physical education teachers for professional activities under the conditions of inclusive education,” Brain. Broad Res. Artif. Intell. Neurosci., vol. 12, no. 3, pp. 191–213, 2021, doi: 10.18662/brain/12.3/227.
A. M. N. Azmi et al., “The impact of leg width on muscle activation and performance during push-up exercise,” Int. J. Hum. Mov. Sport. Sci., vol. 11, no. 6, pp. 1238–1243, 2023, doi: 10.13189/saj.2023.110607.
J. L. Roque, “Revisiting the level of school-based management in public elementary schools of Santiago City, Isabela, Philippines,” J. Educ. Teach. Trainers, vol. 14, no. 1, pp. 1–12, Jan. 2023, doi: 10.47750/jett.2023.14.01.012.
H. KOĞAR, “Which scale short form development method is better? A comparison of ACO, TS, and SCOFA,” Int. J. Assess. Tools Educ., vol. 9, no. 3, pp. 583–592, 2022, doi: 10.21449/ijate.946231.
N. Kesorn, P. Junpeng, M. Marwiang, K. Pongboriboon, K. N. Tang, and M. Wilson, “Development of an assessment tool for mathematical reading, analytical thinking and mathematical writing,” Int. J. Eval. Res. Educ., vol. 9, no. 4, p. 955, Dec. 2020, doi: 10.11591/ijere.v9i4.20505.
E. Kiel, A. Braun, M. Muckenthaler, U. Heimlich, and S. Weiss, “Self-efficacy of teachers in inclusive classes. How do teachers with different self-efficacy beliefs differ in implementing inclusion?,” Eur. J. Spec. Needs Educ., vol. 35, no. 3, pp. 333–349, 2020, doi: 10.1080/08856257.2019.1683685.
D. Madigan, P. B. Ryan, and M. Schuemie, “Does design matter? systematic evaluation of the impact of analytical choices on effect estimates in observational studies,” Ther. Adv. Drug Saf., vol. 4, no. 2, pp. 53–62, Apr. 2013, doi: 10.1177/2042098613477445.
W. Sauerbrei, M. Abrahamowicz, D. G. Altman, S. le Cessie, and J. Carpenter, “Strengthening analytical thinking for observational studies: The stratos initiative,” Stat. Med., vol. 33, no. 30, pp. 5413–5432, Dec. 2014, doi: 10.1002/sim.6265.
M. Stoto, M. Oakes, E. Stuart, E. L. Priest, and L. Savitz, “Analytical methods for a learning health system: Design of observational studies,” eGEMs (Generating Evid. Methods to Improv. patient outcomes), vol. 5, no. 1, p. 29, Dec. 2017, doi: 10.5334/egems.251.
N. A. Quarderer et al., “Fostering the development of earth data science skills in a diverse community of online learners: A case study of the earth data science corps,” J. Stat. Data Sci. Educ., vol. 0, no. 0, pp. 1–22, 2024, doi: 10.1080/26939169.2024.2362886.
M. T. Ho, P. Mantello, and Q. H. Vuong, “Emotional AI in education and toys: Investigating moral risk awareness in the acceptance of AI technologies from a cross-sectional survey of the Japanese population,” Heliyon, vol. 10, no. 16, p. e36251, 2024, doi: 10.1016/j.heliyon.2024.e36251.
L. Ashour, “A review of user-friendly freely-available statistical analysis software for medical researchers and biostatisticians,” Res. Stat., vol. 2, no. 1, pp. 1–13, 2024, doi: 10.1080/27684520.2024.2322630.
S. Bhambhani, K. R. Kondhare, and A. P. Giri, “Diversity in chemical structures and biological properties of plant alkaloids,” Molecules, vol. 26, no. 11, p. 3374, Jun. 2021, doi: 10.3390/molecules26113374.
B. Passaretti, C. Missiuna, A. J. Levinson, L. S. Turkstra, T. Gallagher, and W. Campbell, “Development and evaluation of an online professional development course to support delivery of tiered school-based rehabilitation services,” Disabil. Rehabil., vol. 10, no. 1, pp. 1–13, 2024, doi: 10.1080/09638288.2024.2417769.
V. Mohan, “Slowing the diabetes epidemic in the world health organization south-east asia region: The role of diet and physical activity,” WHO South-East Asia J. Public Heal., vol. 5, no. 1, pp. 5–15, 2016, doi: 10.4103/2224-3151.206554.
E. Ruoss, “Opportunities to leverage world heritage sites for local development in the alps,” Eco.mont, vol. 8, no. 1, pp. 53–61, 2016, doi: 10.1553/eco.mont-8-1s53.
M. A. S. Khasawneh, “Beyond digital platforms: Gamified skill development in real-world scenarios and environmental variables,” Int. J. Data Netw. Sci., vol. 8, pp. 213–220, 2024, doi: 10.5267/j.ijdns.2023.10.002.
A. M. Aljeboree et al., “Direct Dyes Derived from 4 , 4 -Diaminobenzanilide Synthesis , Characterization and Toxicity Evaluation of a Disazo Symmetric Direct Dye,” Bioresour. Technol., vol. 2, no. 3, pp. 1–12, 2014, doi: 10.1007/s12257-009-0199-4
E. U. Alum, E. I. Obeagu, and O. P.-C. Ugwu, “Enhancing quality water, good sanitation, and proper hygiene is the panacea to diarrhea control and the attainment of some related sustainable development goals: A review,” Medicine (Baltimore)., vol. 103, no. 38, p. e39578, Sep. 2024, doi: 10.1097/MD.0000000000039578.
C. Ai Tran, D. H. Van, T. Thuy Phuong Nguyen, T. Thi Thanh Nguyen, and T. Minh Nguyen, “Research in higher education quality assurance worldwide (2003–2023): A bibliometric analysis from the Scopus database,” Cogent Educ., vol. 12, no. 1, p., 2025, doi: 10.1080/2331186X.2025.2479405.
Q. Gao, S. Zhang, Z. Cai, K. Liu, N. Hui, and M. Tong, “Understanding student teachers’ collaborative problem solving competency: Insights from process data and multidimensional item response theory,” Think. Ski. Creat., vol. 45, p. 101097, 2022.
B. Y. Rizkiwati, S. U. M. Widjaja, A. Haryono, H. Wahyono, and M. Z. Majdi, “Financial literacy education models for 7–12 years old based on the local wisdom of sasak tribe Lombok Indonesia,” Pegem Egit. ve Ogr. Derg., vol. 12, no. 2, pp. 58–70, 2022, doi: 10.47750/pegegog.12.02.05.
N. A. Hidayati, H. J. Waluyo, R. Winarni, and Suyitno, “Exploring the implementation of local wisdom-based character education among indonesian higher education students,” Int. J. Instr., vol. 13, no. 2, pp. 179–198, 2020, doi: 10.29333/iji.2020.13213a.
Y. Narny, A. Muhajir, and R. Cribb, “Disaster history as a reflection of human–environment relations: An ecological approach to disaster studies in Indonesia,” E3S Web Conf., vol. 677, no. 7, pp. 110–123, Dec. 2025, doi: 10.1051/e3sconf/202567711003.
Copyright (c) 2026 Vinh Nguyen Hoang, Ellen Tsholofelo
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and acknowledge that the Journal of Health Innovation and Environmental Education is the first publisher licensed under a Creative Commons Attribution 4.0 International License.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges and earlier and greater citation of published work.
.png)
.png)
