Environmental risk factors and the associated morbidity in a periurban area, Alexandria, Egypt Mayada R. Moussa a,b,c , Rim A. Hussein a and Hesham M. El-Naggar a,d a Environmental Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt, b Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates, c School of Health and Environmental Studies at Hamdan Bin Mohamed Smart University, Health Studies Department and d Faculty of Dentistry, King Abdul-Aziz University, Jeddah, Kingdom of Saudi Arabia Correspondence to Rim A. Hussein, DPH, Environmental Health Department, High Institute of Public Health, Alexandria University, 165 El Horreya Avenue, 21561 Alexandria, Egypt Tel: + 20 342 85575; fax: + 20 342 88436; e-mails: rimahamid@yahoo.com, reem.abdelhamid@alex-hiph.edu.eg Received 3 January 2016 Accepted 22 January 2016 Journal of the Egyptian Public Health Association 2016, 91:44–51 Background According to the WHO, nearly 24% of the global disease burden is attributable to environmental risk factors (RFs). People living in periurban areas are particularly at risk due to lack of basic sanitation requirements. Objective To investigate the possible association between environmental RFs and disease prevalence for a community living in a periurban area in Alexandria, Egypt. Materials and methods A cross-sectional study was conducted in 2012. The study sample consisted of 355 families. An interviewing questionnaire and an observation checklist were used for data collection. In addition, 10 drinking water samples were randomly collected for physical, chemical, and bacteriological analyses. The questionnaire included questions on indoor environmental RFs as well as morbidity in the study sample, and the observation checklist covered outdoor environmental RFs. The environmental risk was determined using a risk score whose calculation was based upon the presence/absence of 10 indoor and 12 outdoor environmental RFs. The association between risk scores and 14 morbidities was investigated using unconditional logistic regression analysis, expressed as odds ratio (OR) and 95% confidence interval (CI). Results A significant association was found between the total environmental risk score and respiratory diseases (OR = 2.298, 95% CI: 1.231–4.291), diarrhea (OR = 2.083, 95% CI: 1.102–3.939), liver diseases (OR = 2.491, 95% CI: 1.067–5.819), skin diseases (OR = 1.821, 95% CI: 1.012–3.310), and bronchial asthma (OR = 2.228, 95% CI: 1.066–4.565). Noncommunicable diseases such as cardiovascular diseases and musculoskeletal diseases did not show any significant association with environmental RFs. Conclusion and recommendations Environmental RFs have an adverse impact on health within communities living in periurban areas. It is recommended that sanitation be improved and various outdoor environmental RFs be addressed in these underprivileged areas, as well as health education campaigns be organized aiming at raising the awareness of residents on indoor environmental RFs and ways to prevent them. Keywords: communicable diseases, refuse disposal, sanitation, waste management J Egypt Public Health Assoc 91:44–51 & 2016 Egyptian Public Health Association 0013-2446 Introduction Risk factors (RFs) are any attributes, characteristics, or exposures that increase the likelihood of developing a disease or injury. They can be classified into behavioral RF (e.g. physical inactivity and excessive alcohol consumption), biomedical RF (e.g. high blood pressure and high cholesterol level), demographic RF (e.g. elderly), and environmental RF (e.g. unsafe water and poor sanitation) [1,2]. According to the WHO, nearly 24% of the disease burden and 23% of premature deaths are attributable to environmental RF [3]. A significant association has been reported between indoor environmental conditions (e.g. crowding, humidity at homes, and tobacco smoke) and increased risk for respiratory infections [4–6]. As for gastrointestinal infections, many environmental variables were found to be significantly associated with diarrhea. For example, unsafe water and the use of water storage containers at homes [7], number of people per house, inadequate solid waste management indoors and/or out- doors, presence of sewage in the streets nearby homes [8], and the presence of vectors in the surroundings [9]. With regard to eye infections, trachoma was detected in houses deprived of water supply and its prevalence was found to increase with increasing distance to the water source [10]. With regard to cardiovascular diseases, an exposure– 44 Original article 0013-2446 & 2016 Egyptian Public Health Association DOI: 10.1097/01.EPX.0000480930.70965.83 Copyright r 2016 Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.