Journal of Health Innovation and Environmental Education Vol.
No.
June 2026, pp.
ISSN: 3062-9632.
DOI: 10.
37251/jhiee.
Examining the Relationship Between Environmental Health Conditions and the Incidence of Acute Respiratory Tract Infections (ARI) Among Students at San Roque Elementary School Vinh Nguyen Hoang1.
Ellen Tsholofelo2 1Department of Science Education.
Ubon Ratchathani University.
Ubon Ratchathani & Udonthani.
Thailand 2Department of Health Promotion and Education.
School of Public Health.
Boitekanelo College.
Gaborone.
Botswana
Article Info
ABSTRACT
Article history:
Purpose of the study: This study aimed to examine the relationship between environmental health conditions and the incidence of ARI among elementary school students.
Received Dec 14, 2025 Revised Jan 15, 2026 Accepted Feb 20, 2026 Online First Marc 13, 2026 Keywords:
Acute Respiratory Tract Public Elementary Students Environmental Health Health Epidemiology Ventilation 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 A significant association was identified between environmental health status and ARI incidence .
= 0.
Students exposed to inadequate environmental conditions had 4.
12 times higher odds of developing ARI (AOR = 95% CI: 1.
68Ae10.
p = 0.
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 contextspecific empirical evidence linking structural environmental exposure to respiratory morbidity.
This is an open access article under the CC BY license Corresponding Author:
Vinh Nguyen Hoang.
Department of Science Education.
Ubon Ratchathani University.
Warin Chamrap District.
Ubon Ratchathani Province.
Thailand.
Email: vinhnguyemh33@gmail.
INTRODUCTION
Acute respiratory tract infections (ARI) remain one of the leading causes of morbidity among schoolaged children globally, particularly in low- and middle-income countries where environmental health conditions are often suboptimal .
According to the World Health Organization, respiratory infections continue to contribute substantially to preventable illness and school absenteeism among children, with environmental exposures playing a critical role in transmission and severity .
Schools, as high-density social environments, represent critical micro-settings where children are simultaneously exposed to indoor air pollutants, inadequate ventilation, poor sanitation, and overcrowding factors known to increase respiratory vulnerability .
, .
Journal homepage: http://cahaya-ic.
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php/JHIEE A ISSN: 3062-9632 In the Philippine context, public elementary schools frequently operate under infrastructural constraints, including limited classroom space, inconsistent water supply, and variable waste management systems.
While national public health initiatives emphasize immunization and clinical management, comparatively less attention has been directed toward environmental determinants within school settings as upstream risk factors for ARI .
, .
This imbalance reflects a broader public health challenge: interventions often target treatment rather than structural environmental prevention.
Existing literature has documented associations between household air pollution, ambient particulate matter, and childhood respiratory outcomes .
However, much of this evidence is derived from household-based or community-wide environmental assessments rather than institution-specific analyses .
Studies focusing on schools have largely concentrated on indoor air quality parameters in high-income countries, leaving a contextual gap in low-resource educational environments .
Moreover, previous research typically isolates single environmental variables such as ventilation or humidity without integrating a multidimensional environmental health framework that includes sanitation, waste management, classroom density, and hygiene infrastructure simultaneously.
This fragmentation highlights a critical research gap limited empirical evidence examining how composite environmental health conditions within public elementary schools in developing settings influence ARI incidence among students .
There is insufficient localized data to inform evidence-based school health policies, particularly in semi-urban public schools such as San Roque Elementary School .
Without such context-specific analysis, policy responses risk being generalized, reactive, and insufficiently targeted.
The present study addresses this gap by systematically examining the relationship between environmental health conditions and the incidence of ARI among students within a real-world public elementary school setting.
Unlike prior studies that emphasize isolated exposures or rely solely on secondary health records, this research adopts an integrated environmental health perspective, assessing multiple structural and hygienic dimensions concurrently.
This multidimensional approach enables a more comprehensive understanding of how school-based environmental risks interact to influence respiratory outcomes .
The novelty of this study lies in three key contributions.
First, it contextualizes environmental health within a public elementary school environment in the Philippines an underrepresented setting in global ARI Second, it operationalizes environmental health as a composite construct rather than a single-factor exposure, allowing for a more ecologically valid assessment of risk.
Third, it generates empirical evidence directly relevant to school-level policy formulation, bridging the gap between environmental health theory and actionable educational infrastructure planning.
The urgency of this research is underscored by the dual burden of communicable diseases and infrastructural limitations in public schools.
ARI not only affects child health but also disrupts educational attainment through absenteeism and reduced cognitive performance during illness episodes.
In settings where health systems are already strained, preventive strategies grounded in environmental improvement represent a cost-effective and sustainable intervention pathway.
By identifying specific environmental health factors associated with ARI incidence, this study seeks to inform targeted, school-based public health interventions that move beyond clinical management toward structural disease prevention.
RESEARCH METHOD
Study Design This study employed an analytic observational design, a quantitative approach aimed at examining the relationship between exposure variables and health outcomes without manipulating the study environment.
analytic observational research, investigators observe naturally occurring conditions and statistically assess associations between risk factors and outcomes .
This design is particularly appropriate for public health investigations where experimental manipulation of environmental conditions is neither ethical nor feasible .
In the context of this study, environmental health conditions were observed as exposure variables, while the incidence of Acute Respiratory Tract Infections (ARI) among students served as the outcome variable.
The research was conducted at San Roque Elementary School, a public elementary school representing a typical semi-urban educational setting in the Philippines.
A cross-sectional framework was applied, meaning that measurement of environmental conditions and ARI incidence occurred within the same period of observation .
This approach allows for assessment of statistical association while acknowledging that causal inference remains limited to correlational interpretation.
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Study Population and Sampling The study population consisted of all registered students enrolled during the academic year of data Inclusion criteria comprised active enrollment and parental consent for participation.
Students with incomplete health records were excluded to maintain data integrity.
Sampling was conducted using proportional stratified random sampling to ensure representation across grade levels.
This approach minimized selection bias and increased internal validity by ensuring that different classroom environments were proportionally included in the analysis.
The final sample size was determined based on minimum requirements for analytic observational studies to detect moderate effect sizes with adequate statistical power (Ou80%) and a 95% confidence level.
3 Research Variables Prior to presenting the operational structure of the variables, it is essential to clarify how environmental health was conceptualized.
Rather than treating environmental exposure as a single factor, this study operationalized environmental health as a multidimensional construct encompassing physical, sanitation, and hygiene-related components within the school setting.
The table below presents the operational definitions of the study variables, including measurement indicators and data sources.
Variable Environmental Health Conditions ARI Incidence Table 1.
Operational Definition of Study Variables Type Operational Definition Measurement Method Independent Composite of Direct classroom ventilation, lighting, checklist based on occupancy density, sanitation school environmental facilities, waste management, health standards and water availability Dependent Occurrence symptoms Health record review Acute and Respiratory Tract Infection confirmation within the last 3 months .
ough, questionnaire sore throat, fever, runny nos.
Scale Ordinal/Score Index Binary (Yes/N.
As shown in Table 1, environmental health conditions were measured using a structured observational checklist aligned with public health environmental standards.
Each component was scored and aggregated into an environmental health index.
ARI incidence was determined through documented school health records, supported by parental confirmation to reduce misclassification bias.
4 Data Collection Procedures Data collection was conducted in three integrated stages to ensure methodological rigor and Before concluding the methods section, it is important to clarify the conceptual structure guiding the study.
The analytical model assumes that environmental health conditions function as exposure variables influencing the likelihood of ARI incidence among students.
Figure 1.
Conceptual Framework of the Study Figure 1 illustrates the analytical pathway examined in this study.
Environmental health components are conceptualized as cumulative exposures within the school setting that may increase or decrease the probability of Examining the Relationship Between Environmental Health Conditions and the A (Vinh Nguyen Hoan.
A ISSN: 3062-9632 ARI occurrence among students.
This structured framework guided both variable operationalization and statistical modeling.
Data Analysis Data were analyzed using statistical software .
Descriptive statistics were first applied to summarize environmental health conditions and ARI prevalence.
Environmental health scores were categorized into AuadequateAy and AuinadequateAy based on established cut-off points.
Inferential analysis was conducted using the Chi-square test to examine the association between environmental health conditions and ARI incidence.
When necessary, logistic regression analysis was performed to estimate adjusted odds ratios (AOR) and control for potential confounding variables such as age and grade level.
Statistical significance was determined at p < 0.
05 with a 95% confidence interval.
Ethical Considerations Ethical clearance was obtained from the appropriate institutional review authority prior to data Written informed consent was secured from parents or guardians, and confidentiality of student data was strictly maintained.
All collected information was anonymized and used solely for research purposes.
RESULTS AND DISCUSSION
To provide an overview of the exposure variable, descriptive statistics were first conducted to assess the distribution of environmental health conditions across observed classrooms at san roque elementary school.
The composite environmental health index was categorized into adequate and inadequate based on the predefined scoring threshold.
Table 2.
Distribution of Environmental Health Conditions Environmental Health Category Frequency .
Percentage (%) Adequate Inadequate Total As presented in Table 2, the majority of classrooms .
0%) met the minimum environmental health standards, while 40.
0% were classified as inadequate.
Observational findings indicated that deficiencies were most frequently related to ventilation limitations and classroom occupancy density exceeding recommended The second descriptive analysis focused on the outcome variable, namely the incidence of ARI among students within the three-month observation period.
Table 3.
Prevalence of ARI Among Students ARI Incidence Frequency .
Percentage (%) Yes Total Table 3 shows that 36.
3% of students experienced at least one episode of ARI within the reference period, while 63.
7% did not report symptoms consistent with ARI.
This prevalence indicates that more than onethird of the student population was affected during the study window, underscoring the relevance of environmental determinants in this setting.
To test the primary hypothesis of this study, a Chi-square analysis was performed to examine the relationship between environmental health conditions and ARI incidence.
Table 4.
Association Between Environmental Health Conditions and ARI Incidence Environmental Health ARI (Ye.
n (%) ARI (N.
n (%) Total p-value Adequate 10 .
Inadequate 19 .
Total As shown in Table 4.
ARI incidence was markedly higher among students exposed to inadequate environmental health conditions .
4%) compared to those in adequate environments .
8%).
The Chi-square test indicated a statistically significant association between environmental health status and ARI incidence .
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These findings suggest that students in classrooms with substandard environmental conditions were significantly more likely to experience ARI episodes.
To further assess the strength of association and control for potential confounding variables .
ge and grade leve.
, logistic regression analysis was conducted.
Table 5.
Logistic Regression Analysis of Environmental Health Conditions and ARI Incidence Variable Adjusted Odds Ratio (AOR) 95% CI p-value Inadequate Environmental Health 4.
68Ae10.
Age 82Ae1.
Grade Level 71Ae1.
The logistic regression model demonstrates that students exposed to inadequate environmental health conditions had 4.
12 times higher odds of developing ARI compared to those in adequate environments (AOR = 95% CI: 1.
68Ae10.
p = 0.
, after adjusting for age and grade level.
Neither age nor grade level showed a statistically significant association with ARI incidence.
These findings confirm that environmental health conditions within the school setting function as an independent risk factor for ARI among students.
The strength of association observed in the adjusted model reinforces the central hypothesis of this study and highlights the structural nature of respiratory health risk in school This study demonstrates a statistically significant and robust association between environmental health conditions and the incidence of Acute Respiratory Tract Infections (ARI) among students at San Roque Elementary School.
Students exposed to inadequate environmental conditions exhibited more than fourfold increased odds of experiencing ARI compared to those in adequately maintained classrooms .
This finding confirms that environmental determinants within school settings are not peripheral contributors but constitute a central structural risk factor for respiratory morbidity among school-aged children.
The magnitude of association observed in the adjusted model underscores that environmental exposure operates independently of age and grade level, reinforcing its etiological relevance.
From an epidemiological standpoint, these results align with the broader framework advanced by the World Health Organization, which emphasizes environmental quality particularly ventilation, sanitation, and crowding as critical determinants of communicable respiratory diseases .
, .
However, while prior global reports predominantly synthesize macro-level or household-based environmental data, empirical studies focusing specifically on school-level environmental health in low and middle-income settings remain limited .
, .
Most existing literature examines indoor air pollution within domestic environments or urban ambient particulate matter exposure, often overlooking institutional micro-environments such as public elementary schools.
This imbalance creates a contextual blind spot in public health evidence, particularly in Southeast Asian educational The present findings contribute to closing this gap by situating environmental health assessment directly within a real-world public school environment and linking composite environmental indicators to verified ARI Previous studies have frequently examined isolated factors such as ventilation adequacy or humidity without integrating sanitation infrastructure, waste management systems, water access, and classroom density into a multidimensional exposure construct .
By operationalizing environmental health as a composite index, this study advances a more ecologically valid and system-oriented analytical approach.
This multidimensionality constitutes a key novelty of the research, as it captures the cumulative exposure burden experienced by students rather than fragmenting environmental risk into disconnected variables .
, .
Another important contribution lies in the contextual specificity of the evidence.
Much of the literature on school environmental quality originates from high-income countries where infrastructural standards and regulatory enforcement differ substantially from those in resource-constrained public schools .
, .
The current findings provide localized empirical data from a semi-urban Philippine public school, thereby enriching the global evidence base with data from underrepresented contexts.
This contextualization enhances external validity for comparable educational systems facing similar infrastructural constraints and strengthens the relevance of environmental health research in Southeast Asia.
The implications of these findings are both theoretical and practical.
Theoretically, the results reinforce ecological models of health that conceptualize disease risk as a product of structural environmental exposure rather than solely individual susceptibility.
The significant association observed in this study supports the argument that ARI prevention strategies must extend beyond clinical treatment and immunization programs toward upstream environmental modification.
Practically, the fourfold increased risk associated with inadequate environmental conditions suggests that relatively modest infrastructural improvements such as optimizing ventilation, reducing classroom crowding, strengthening sanitation maintenance, and ensuring consistent access Examining the Relationship Between Environmental Health Conditions and the A (Vinh Nguyen Hoan.
A ISSN: 3062-9632 to clean water could substantially reduce ARI incidence and related absenteeism.
In resource-limited educational systems, structural environmental interventions may represent a cost-effective and sustainable disease prevention strategy compared to recurrent clinical management.
Despite these contributions, several limitations must be acknowledged.
First, the cross-sectional analytic observational design precludes causal inference.
Although a strong association was identified, temporal sequencing between exposure and outcome cannot be definitively established.
Second.
ARI incidence was based on recorded symptoms and parental confirmation rather than laboratory confirmation, introducing potential misclassification bias.
Third, the environmental health index, while multidimensional, relied partly on observational scoring, which may introduce measurement variability despite quality control efforts.
Finally, the study was conducted within a single institutional setting, limiting generalizability beyond comparable public elementary schools.
These limitations, however, also delineate directions for future research.
Longitudinal cohort designs could strengthen causal interpretation, while multi-school comparative studies would enhance external validity.
Incorporating objective indoor air quality measurements such as particulate matter concentration or COCC levels could further refine exposure assessment.
Nonetheless, within its methodological boundaries, this study provides compelling evidence that environmental health conditions within school settings constitute a significant and independent determinant of ARI among students.
CONCLUSION
This study aimed to examine the relationship between environmental health conditions and the incidence of Acute Respiratory Tract Infections (ARI) among students at San Roque Elementary School.
The findings demonstrate that 40.
0% of classrooms were categorized as having inadequate environmental health conditions, while 36.
3% of students experienced at least one ARI episode within the three-month observation Statistical analysis revealed a significant association between environmental health status and ARI incidence .
= 0.
Multivariate analysis further confirmed that students exposed to inadequate environmental conditions had 4.
12 times higher odds of developing ARI (AOR = 4.
95% CI: 1.
68Ae10.
p = 0.
independent of age and grade level.
These results affirm that environmental health conditions within school settings constitute an independent and structurally significant determinant of respiratory morbidity among elementary students.
Strengthening school-based environmental standards particularly ventilation, sanitation, and classroom density management should be prioritized as a preventive public health strategy.
Future research should employ longitudinal and multi-site designs to strengthen causal inference and expand generalizability across diverse educational contexts.
ACKNOWLEDGEMENTS
The authors express sincere gratitude to the school administration, teachers, parents, and students of san roque elementary school for their cooperation and participation in this study.
Appreciation is also extended to all research assistants who contributed to data collection and validation.
USE OF ARTIFICIAL INTELLIGENCE (AI)-ASSISTED TECHNOLOGY
The authors confirm that no artificial intelligence (AI) assisted technologies were utilized in the preparation, analysis, or writing of this manuscript.
All stages of the research process, including data collection, data interpretation, and the development of the manuscript, were conducted solely by the authors without any support from AI-based tools.
REFERENCES