Participants Profile and demographics
Twenty-four individuals agreed to participate; 23 in three focus groups (A: n=3, B: n=6, C: n=14) and one individual interview(D). Three volunteers did not show up during the first focus group due to other competing assignments. Age ranged from 29 to 72years with females in the majority (16 out of 24). The majority (20 out of 24) were from one tribe; 19 of the participants were married and 18 had at least primary level of education. Table 1 shows the participants’ profile.
TABLE 1: Participant socio-demographic characteristics
Participant characteristics
|
Focus Group A
N=3
|
Focus Group B
N=6
|
Focus Group C
N=14
|
Interview D
N=1
|
Total
N=24
|
Gender
Male
Female
|
1
2
|
6
0
|
0
14
|
1
0
|
8
16
|
Age group (yr)
18-39
40-59
60-79
|
3
0
0
|
3
3
0
|
1
5
8
|
1
0
0
|
8
8
8
|
Tribe
Tribe 1
Tribe 2
Tribe 3
Tribe 4
|
1
0
2
0
|
4
1
0
1
|
14
0
0
0
|
1
0
0
0
|
20
1
2
1
|
Marital Status
Married
Single
Widow
Widower
|
3
0
0
0
|
4
2
0
0
|
11
1
2
0
|
1
0
0
0
|
19
3
2
0
|
Children?
Yes
No
|
3
0
|
5
1
|
13
1
|
1
0
|
22
2
|
Educational attainment
Primary
Secondary
Tertiary
None
|
0
0
3
0
|
0
1
5
0
|
6
1
1
6
|
0
1
0
0
|
6
3
9
6
|
Occupation
*Employed
**Self-employed
Unemployed
|
0
3
0
|
2
4
0
|
0
13
1
|
0
1
0
|
2
21
1
|
Perception of air environment
Very good
Good
Fair
Poor
Very Poor
|
1
1
0
1
0
|
1
0
2
3
0
|
0
0
0
3
11
|
0
0
0
1
0
|
2
1
2
8
11
|
Previous research participation
Yes
No
|
0
3
|
2
4
|
0
14
|
0
1
|
2
22
|
*Civil servant, health worker. ** trading, business, artisan, farming, fishing
THEMES AND SUB-THEMES
The themes, sub-themes and selected quotes are presented on Supplementary File 2 and Figure 1. Six themes were formed from the data as follows 1) Negative perception of the environment, 2) The refinery is to blame, 3) Air pollution is seen or smelt, 4) Air pollution is associated with health and non-health risks, 5) Poor response to air pollution: everyone is to blame, and 6) Government is primarily responsible for healthy air quality.
Negative perception of the environment.
Perception of Air quality.
In the questionnaires administered to participants before the focus group commenced, the majority (21 out of 24) selected the terms ‘fair’, ‘poor’ or ‘very poor’ when asked about their opinion of the ambient air; only three of the participants reported that their air environment was ‘good’(n=1) or ‘very good’ (n=2). However, during the focus group the participants described their ambient air using the following terms: polluted, not good, bad, not perfect, not ideal to live in, amongst others. One of the male participants describes it as follows:
‘To me the environment is not good. It is not too safe for our human health. There’s a lot of pollution mostly this flare and tankers. They are risky to people…. to lives and properties... so that’s the way I see the environment’- B1
When presented with the WHO classification for air quality, the majority perceived their environment as ‘unhealthy’; a few persons described the environment as ‘hazardous’, while one person chose the ‘unhealthy for sensitive groups’. None of the participants described their air environment as ‘good’.
The moderator asked the participants which was the most worrisome pollution in their environment, and here is the response of one participant.
Moderator: Among all of the environmental problems, meaning water, land, air. Which do you think is most worrisome?
D1: Well, mere looking at it.. the air is most worrisome. Because this is what we breathe in.
One of the participants thought that the ambient air had reduced compared to when the refinery was in full operation.
‘The environment is bad, but lately because the refinery has not been working, the level of pollution has reduced. But when it was working, when you wake up in the morning, you see this soot on vehicles everywhere. That’s to tell you the amount of pollution’-B2
Water pollution.
All participants were concerned that rain water was no longer useful to them, since it was blackened by soot from the refinery which settles on their roofs (Suppl. File 2: subtheme-contamination of water bodies). The all-women group specifically spoke passionately about the water pollution as a result of oil-contamination of their rivers, which they ascribed to the presence of the oil refinery and oil spills. They were particularly concerned about the fish scarcity as a result of the contaminated rivers which threatens their main source of livelihood (fishing).
Air Pollution is seen or smelt
The participants identified air pollution mainly through their visual and olfactory senses. Black discoloration of rainwater, clothing, household furniture and floors caused by soot were some of the evidences of air pollution identified. Other visual evidence of air pollution included soot on cars and in their nostrils; one participant (A2) recounted how during the COVID-19 pandemic, she needed to change her face masks frequently because it was often stained black.
Some participants described perceiving a strong odour as another evidence of poor air quality, and this was sometimes associated with difficulty with breathing at night. Others mentioned pepperish sensation in their eyes, nostrils, chest and skin as signs of air pollution. One participant (B4) described how he would wash more frequently because of soot on his skin.
We observed that besides carbon black or soot, no other specific air pollutant was mentioned or described by the participants.
The refinery is to blame.
The perceived sources of air pollution included the petrochemical refinery and natural gas plant, illegal oil bunkering, vehicle emissions from tankers commuting to and from the oil depot; outdoor smoking and cooking; poor environmental hygiene (Suppl. File 2). The participants perceived the oil and gas refinery as the main source of outdoor air pollution. While some claimed the refinery was no longer functional and only emits the carbon black which is stored; others strongly claimed that the refinery was operational especially at night. Here are some quotes from the interview with one participant representing the community executives.
Moderator: In your opinion, do you think there is a heavy burden of trailers on your roads.
D1: Yes, there is, but the carbon from the refinery is worse. Because whenever they pump it out, that’s when you know that we have a problem
Moderator: Are they still pumping it out until now? I thought the refinery was shut down.
D1: They work only at night. ‘There is a company inside the refinery burning chemicals inside. It is not closed. Operations are still ongoing inside producing the chemical and gas. The odours, the smoke is a major worry’
An elderly female (C1) who resides close to the refinery corroborated this claim that the refinery was functional, but a few participants suggested that the refinery was not functional, while one of them claimed the stored carbon is still emitted even though the refinery was not producing.
Two young male participants (A1 and B5) hinted on the contributory role of illegal oil-bunkering (artisanal refineries) in the community while two young ladies (A2 and A3) lamented about dust and smoke from petroleum tankers driven to and from the oil depot in the community; in addition, they complained about the tanker drivers and young community boys smoking openly. Another male participant corroborated their complaints about tankers but interestingly, none of the males complained about outdoor smoking.
A number of the participants felt that odour from dirty drainages contributed to air pollution, as one of the male traders who owns a store in the community put it-
‘Yes, like lack of proper environmental sanitation. You know errr... our streets, the gutters, there is no proper clean up. The drainage is not flowing well, there are those containers you see in there that add to blocking the drainage’.-B1
None of the women from the all-women focus group raised the issue about poor environmental hygiene, smoking or diesel tankers; could this be an attempt to project the refinery as the only cause while deliberately de-emphasising other sources of air pollution? Or were these women truly unaware of other sources of air pollution in their community?
Mid-way through the focus group, the moderator presented information about air pollution (as mentioned earlier) to the participants using PowerPoint visuals, and interestingly one of the female participants showed surprise at the information that cooking could contribute to air pollution.
‘Cooking? I am surprised that it can lead to pollution. I know that sometimes when cooking, it makes us cough and we have to move away from the smoke. I thought that was just a normal thing, never knew it contributes to air pollution’. - C3
Air pollution is associated with health and non-health risks.
Health Risks associated with Air Pollution.
The participants were asked about symptoms or diseases prevalent in their community, and this was followed by a question to ascertain which they perceive are due to air pollution. Prevailing diseases mentioned included malaria, fevers, cough, catarrh, heart failure, kidney disease, liver disease, hypertension, and diarrhoea in children. The symptoms/diseases participants ascribed to air pollution were mainly respiratory including cough, catarrh, difficulty with breathing, and chest pain. Other symptoms were eye irritation and skin irritation. (Suppl file 2)
Two participants volunteered that anaemia, heart, liver and kidney failure were prevalent and may be due to air pollution exposure. An elderly woman had this to say when asked about prevailing illnesses in the community and then asked to specify which she ascribes to air pollution.
‘They have cough. At times, when they test some have kidney, some liver. Most of them. Even as I am talking to you now, my husband…. I lost my husband last year. Kidney too….the whole leg got swollen and before you know it the person is dead’.C1
‘ I told you before that because of this pollution exposure, those who have died had a similar kind of disease – Kidney, Liver, starts with chest symptoms in the hospital it is confirmed to be kidney or liver’. C1
While these participants associate air-pollution with major organ failures among members in their community, we admit that there may be other contributory risk factors. For instance, we observed that regular intake of alcohol was a common social habit among community members (male and female); and this may also contribute to the burden of liver disease. In addition, majority of the participants opined that persistent exposure to air pollution was associated with chronic fatigue, reduced life span and premature death in their community. Two aggrieved women had this to say:
(upset) I no see my body carry! I no see my body carry!! (meaning ‘My body is not strong anymore’). Chest pain, body aches. I cannot go out to hustle as I should’-C3
‘I have been here for 35 years so I know what is really happening. Like most of my age group, some have not lived up to. Because of this(pollution) they lost their lives. Why do I say so, because I can just say we are living by the Grace (of God). Those that do not have strong genes, they die as a result. We cannot count. If you want to count the indigenes of this community, we are not much; it is only strangers. Because many die at early age. 40, just like that’- C1
This participant opines those good genes and God’s Grace are protective of environmental health risks, an opinion shared by other participants. Although the participants did not mention any psychological or emotional symptoms; we observed expressions of annoyance, frustration, and apathy particularly among the female participants which could result in significant stress and distress. The males on the other hand, expressed less emotions although their complaints were similar.
Non-health Impacts of Air Pollution.
Some participants complained about other impacts of air pollution including physical damage to properties such as clothing, zinc roofing sheets, and wares in their stores caused by soot; homes covered in soot and requiring repeated cleaning. Some participants mentioned the economic impacts of poor air pollution including: businesses relocating from their community and the high cost of accessing health care. One participant (A3) reported that outdoor relaxation was no longer enjoyable due to the odour and irritative symptoms.
After the participants discussed health risks associated with air pollution the moderator gave a brief talk (10mins) to educate each group on the sources and possible health impacts of air pollution; following this, the moderator noticed quietness in the room and expressions of surprise among the participants. Specifically, they were surprised at the extent of the potential health risks associated with air pollution.
‘If you did not say so, I would not have known that air pollution can contribute to causing cancer. But I believe you, because you wouldn’t say it if it is not in the books’- C2
‘I never thought air pollution can be responsible for kidney problem. We talk about not drinking enough water, stones, but not air pollution…. No’- B2
‘The childhood deformities. It was surprising’-C1
(In a low tone) ‘They are all disturbing madam; they are all disturbing. But the one I find most disturbing should be the cancer. I have been to the hospital and seen patients with cancer, I didn’t like what I saw’- A1.
‘The kidney disease. I have seen some around’-A2.
‘The mental disorder. I don’t know what is actually the cause’.- A3
Next, the participants were asked to share their perceptions about stake-holders’ response to air pollution, barriers to effective response and suggestions for effective air pollution control (Suppl file 2 ). Two themes were generated as detailed below.
Poor response to air pollution: everyone is to blame
The participants perceived that response to their environmental challenges was poor overall and that the community was being ignored by the government. Interestingly, although all participants were unanimous in their negative perception of existing government response, we noticed that all non-indigenes and some indigenes of the community strongly believed that their leaders were contributory to the ineffective government response and were vocal about it. On the other hand, majority of the indigenes were either silent about this contributory role of their leaders, while the only community executive interviewed appeared shocked at the revelation.
The sub-themes generated included ‘unsatisfactory response by stakeholders, distrust and lack of confidence in community leaders and government; lack of environmental health information and poor health literacy’ and will be described in the sections that follow.
Unsatisfactory response by Stakeholders.
The majority of the participants reported that there were no visible efforts by the government or industry management to address the issue of air pollution and the effects in their community. The problems participants discussed included unresponsive government, poor enforcement of protection laws, lack of incentives for community members, and unaffordable health care. (Suppl file 2: subtheme-unsatisfactory stake-holder response)
One participant (A1) repeatedly suggested that the focus group should have been held within the community to involve the ‘community executives’ who he claimed should be privy to more information. We sensed this was a subtle way of referring us to those perceived as ‘custodians of information’ and distancing himself from deeper revelations; he was re-assured that his suggestion will be addressed in subsequent sessions. Conversely, the other two participants in the same group session who were non-indigenes, spoke more freely expressing their dissatisfactions and frustrations with the government but more so, with the community leaders. The location of that particular session outside the community must have provided some safety and allowed them to express their views without fear; in addition, the participants did not know one another.
Concerning community response recurring codes included protests for solution, helplessness and apathy due to fear of oppression, and perseverance due to community attachment. Some persons have also responded by relocating away from the community. Some of the participants cited instances where groups have organised peaceful protests directed at the refinery management, but got disappointing responses (Suppl. file 2). An elderly woman describes the experience of an all-women group protest.
‘Over time, we have noticed that our health is not optimal. Particularly women. We have tried to go to refinery to peacefully explain what we are going through. They oppressed us! it was a serious matter. We were beaten and driven away’. - C1
Distrust and lack of confidence in community leaders and Government
Some of the participants expressed distrust in their community leaders whom they referred to using the term ‘community’ or ‘community boys’. Some codes generated here included ‘feeling of oppression and voicelessness; leaders as saboteurs of community efforts, corruption and selfishness, leadership not inclusive, and unaccountable leadership’. Some participants claimed that their leaders received incentives from the refinery management but did not extend this to the community members; others claimed that their leaders were not concerned about their welfare (Suppl. File 2). A lady who expressed frustrations and felt oppressed as an ethnic minority had this to say:
‘The community leaders. If you do not belong to their tribe, you are seen as an outsider. You do not have any right to intervene or complain… they give you instructions and you follow. You cannot even try it (i.e., complain), they will tell you, you are an outsider’- A3
Interestingly, a member of the community executive who was individually interviewed had this to say when asked to comment on the views of some of the participants about community leadership.
(Appearing surprised and upset) ‘Instantly I disagree. Nobody will see something bad happening and want to engage in it. As a leader, we are for the people and for all. So that is something to look into. Because every human being will always talk, some will be true and some will be lies’ – D1
Lack of environmental health information and poor health literacy.
The participants were not aware of the extent of health risks that may be associated with air pollution as mentioned earlier; they however expressed concerns when educated about the subject. In addition, some participants misinterpreted symptoms and aetiology of certain ailments as is exemplified by the quotes below:
‘Apart from catarrh, I still think infection too (referring to urinary tract infection). As a lady, you know it is not right to urinate anywhere, and you can contact infection easily that way from the dirty and unkept environment.’- A3
‘Looking at the issue, I want to say the heart failure (is associated with air pollution). Because when people breathe in the carbon it is difficult for them to breathe’.- D1
The majority of participants were not aware of where to obtaining environmental health information or where their concerns can be addressed; a few mentioned that an office existed in the Local Government Council premises, although they had never accessed it. One participant (A2) mentioned that the social media may be the source of such information.
Government is primarily responsible for healthy air quality
The participants perceive that effective air pollution control in their community is primarily the government’s task but would also involve all stakeholders including the refinery management (also reports to the Government), community leaders, community members and the research community (Figure 2).
Their suggestions include: providing incentives for community members, stopping gas flaring (alternative disposal of gas), regulating tanker drivers and illegal refineries, banning outdoor smoking and cooking with fossil fuel, public health education and empowerment in partnership with community, disseminating research findings to all Stake-holders, improving environmental hygiene and wearing protective face masks. These suggestions are summarised in a multi-level framework presented in Table 2.
Table 2: Multi-level framework for air pollution control in communities near petrochemical plants in disadvantaged communities.
LEVELS
|
RECOMMENDATIONS
|
LEVEL 1: Government/Systems
|
• Enforce environmental protection laws and policies.
• Provide accessible health care including health surveillance.
• Address unemployment and economic impact of environmental pollution.
- Job creation
- Cater for the vulnerable (elderly, children).
• Monitoring and evaluation in partnership with community members.
• Demand accountability from community leaders
|
LEVEL 2: Industries
|
• Adhere to remediation policies to control gas flaring and carbon emissions.
• Partner with government to provide preventive health services.
• Partner with government and community to alleviate hardship in exposed communities
• Demand accountability from community leaders
• Show tolerance and discourage oppression of community members
|
LEVEL 3: Community Leaders
|
• Transparent, accountable and accessible leadership
• Inclusiveness in all community development projects
• Leaders should be advocates of the community
• Encourage regular community meetings
• Partner with other stakeholders to alleviate community hardship
• Co-produce health information with researchers for wide dissemination.
|
LEVEL 4: Individual members
|
• Behavioural changes
Use of protective masks and clothing
Improve environmental hygiene
Replace wood or coal with safer cooking fuels
Improved health-seeking behaviour
• Explore opportunities to gain health information
• Volunteer in research to be educated and empowered.
• Channel grievances peacefully through leadership and avoid forms of aggression.
|
LEVEL 5: Research Community
|
• More inclusive participatory research to co-produce evidence with community members
• Ensure accurate information is disseminated to all relevant stakeholders
• Educate and empower the public and advocate for health protective policies and measures.
• Follow-up visits to communities.
|
Public education was a favoured intervention among the participants and some suggestions are presented below:
‘To add to it, most of them are not aware, they don’t know the effect of what they are doing. If there were aware, they will not just pocket whatever the industries give to them, because they are endangering their lives’- B2
‘Continue proper and adequate awareness. Definitely one day people will listen. Let the people know the dangers’-A3
‘Maybe the research will help. maybe people will be hearing about this (air pollution and disease) for the first time. They don’t even know what is air pollution. Awareness is needed’- A2
‘People tend to believe what they see (smiles) You know we (mentions specific world region), we don’t want to hear. Doesn’t mean we don’t listen, but we are doubting Thomas, we prefer to see. So, creating that awareness I believe is key and to add to it, if you (your organisation) can bring physical evidence to say ‘see, it has happened to someone’ any physical evidence for them to see… it will make the awareness greater than just educating them.’-B5
‘Partner with the community leaders, because that’s where it starts from.
For instance, there is nothing in the community that doesn’t go through them. Give them the awareness, once they buy into it, I think things will improve’- B3.
Interestingly, none of the participants suggested a relocation of the refinery due to perceived benefits; according to D1
‘There is no person on the earth, who has a company in their land, and will want it to go. Because one day it will be useful. So, we are not praying for companies to come and go but rather stay and reap all the benefits. So that is what we wish.’
This parting plea by the 70year old woman-group leader captures the expectation of the women succinctly:
‘Are we rounding up? I have something else to say. You see in those days when we did not have this air pollution in our community. We remember that this crude will enter into our waters, and I know that it costs a lot to clean it up. Companies will come in too. I am almost 70years now, I still recall that government then brings aids in the form of money, health care to support the community. We want to speak as women and urge you to ensure your findings reach the government and let them help us like they used to in the past. Because I saw somebody two days ago, who is having difficulty purchasing medicines prescribed for him; Instead, he goes to buy paracetamol. I advised him that paracetamol will not treat his ailment as he was clearly getting worse. I know he may end up dying. We are suffering, we cannot afford medications, our staple food (fish) is no longer accessible. We hope the government will come to our aid’. C1
At the end of each session, the participants were informed that they would receive feedback on the outcome of the current study and asked to suggest other persons, groups or organisations who should receive information generated from the research. Here are some of their responses:
‘First of all, send it back to the community, then stakeholders…...those companies, those in the heath sectors. Share it with them, so that they will know that whatever they are currently doing should be intensified’ -B2.
‘Yes, the community is under the kingdom, so through the king, you will be able to get across to the people.’ -B3
‘Apart from the Kings and Industries, the communities are under a LGA and then State, so the LGA Chairman, the Secretary, MOH, Members of House of Assembly’- B6.
‘Since it is research you can put it online so everybody will see it’. -A2
‘Well, as many as are ready to help the community’, The Government, National and International – D1
A summary of our findings using the Pressure, State, Impact and Response (PSIR) framework (15) is show on Figure 3, where Pressure refers to the sources of air pollution, State refers to the state of the biosphere, Impact refers to impacts of pollution, and Response covers the efforts towards controlling air pollution. In addition, we developed a conceptual framework describing the determinants of air pollution health risk perception in the study community (Figure 4).