Morbidity pattern among stainless steel industry workers of Tamil Nadu: A cross sectional study

Introduction

Occupational health aims at the enhancement of the physical, mental and social well-being of workers and support for the development and maintenance of their working capacity, as well as professional and social development at work. In developing countries, where work is being increasingly mechanised, a number of work processes have been developed that treat workers as tools in production, putting their health and lives at risk.1 Occupational hazards may result in occupational diseases and it depends on the type of industry and duration of exposure to a substance. Stainless steel industry is one such industry where employees are exposed to various occupational hazard.2 It is a type of metal product that is more resistant to rust, staining and corrosion than regular steel. The elements which are present in stainless steel are chromium, nickel, molybdenum, silicon, aluminium and carbon.3 Most of the household articles which we use in our day today life are made up of stainless steel. Workers employed in stainless steel manufacturing units are exposed to the elements present in these products which results in various health hazards.4 Important health problems among them are mechanical injuries from machineries, occupational asthma, musculoskeletal problems and skin problems.5 Long term exposure to steel dust causes health effects on humans such as genetic damages, damage to nerves and endocrine system.6

These disabilities may have an irreversible impact on well being of an individual, One DALY (Disability-Adjusted Life Year) can be thought of as one lost year of ‘healthy’ life. The sum of these DALY across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.7 Another important aspect is Years of potential life lost, the total YLL’s by certain etiological factor such as non-communicable diseases by WHO GHE was 46 and injury was 12.8 These morbidities may also cause Sickness absenteeism which results in a major economic loss. Sickness absenteeism is defined by the Labour department in India as the total man shifts lost because of absences as a percentage of the total number of man-shifts scheduled.9 According to ILO 2008, 317 million accidents and diseases occurred on job annually; and about two thirds them caused employees away from work for four working days resulting in economic effects and loss of labour time in both developed and developing countries.10 As stated earlier in the study Stainless steel industry products are being widely used by the consumers but the industrial hazards arising out of these industries are often neglected and also only few studies are available for identifying the morbidity pattern among these employees. This study will help to identify morbidity pattern among steel industry workers and also to determine the relationship between morbidities and other associated factors such as PPE, sex, age etc.

Materials and Methods

Results

Total number of workers employed in the industry for more than a year were 165, male workers employed were 119 and female workers were 46. All the employees were permanently employed in the Industry and there were no contract workers. Male workers were made to work in Pressing, cutting, powdering and polishing section and female workers worked in Beading and packing section. Out of 165 permanent employees, 143 gave consent to participate and were included in the study and those who were suffering from some illness even before joining in the Industry were automatically excluded. These employees were provided with basic protective equipment like face mask, gloves, ear plugs and safety boots however few employees did not show interest to use them. The total number of workers employed in pressing and cutting section was 30.8%, powdering and polishing was 23.8%, beading and packing was 45.5%. Among these workers 15.4% of them had working experience of more than a year and 84.6% had experience of more than 2 years. Mean height of the employees was 157 + 0.013, weight was 59 + 1.92 and waist circumference was 88 + 1.86. 31.2% of workers used basic protective equipment like face mask, gloves, ear plugs and safety boots and remaining 68.8% did not use any form of protective equipment. Out of 143 employees 136 were suffering from either one of the occupational disease mentioned above. The overall prevalence of workers with morbidity pattern as per this study was estimated to be 95.1%. Nearly 10.5% suffered from non-communicable diseases, 25.9% had Bronchial Asthma, 30.8% had hard of hearing, 19.6% had various forms of skin diseases, 50.3% of them suffered from myalgia and 49.7% sustained mechanical injuries.

Among the study participants having experience of more than a year nearly 25.9% was suffering from bronchial Asthma and this association was said to be statistically significant. Among the employees not using personal protective equipment 15.2% of them developed bronchial asthma, 29.3% developed hearing loss, 21.2% developed skin manifestation and 42.4% had injuries. 65.9% employees using PPE gave history of mechanical injuries and this suggested that workers using PPE were also in risk of mechanical injuries. It was estimated that nearly 18.6% in the age group of 41-50 years gave history of non communicable disease like diabetes, hypertension and dyslipidemia. On estimating association between nature of work and morbidity 59% working in polishing and powder coating gave history of mechanical injuries, 38.2% of employees in polishing and powder coating section developed hearing loss.

Figure 1

Percentage of employees using Personal Protective equipment

Discussion

In conducting field investigation for occupational illness one of the critical step is identification and engagement of the stakeholders. Workplace management, labor and government are the three basic stakeholder groups. In any small scale industry, owner may be main contact of operation, health, safety issues and human resources. The owner will provide epidemiologist with key information in the form of describing the work process, safety data sheets, recorded injury and illness and employee rosters.10 A small scale industry was selected for our study and basic face to face interview was done with the owner of the industry and above mentioned information was obtained. The main aim of this study was to identify morbidity pattern among stainless steel industry workers and for better understanding of morbidities the workers were categorised based on the nature of work. There were three sections in the small scale industry and workers were employed in various sections depending on their age, experience and physical ability to work. Male workers were employed in areas which requires manual work like section with machineries like hydraulic press, foaming, bending and polishing motors. Most of the female workers were employed in packing section. Workers were provided with health check-ups on regular intervals and awareness program for safe working environment was also provided. Protective equipment like gloves, mask and cap were provided to workers but few workers were not willing to use them. In our study overall morbidity pattern was 95% and major morbidity was myalgia and mechanical injuries. In a study done by Manish J. Biswas, Anil R. Koparkar et al,4 the overall prevalence of morbidities among the workers was 60% and the commonest morbidity in the workers was lumbago (musculoskeletal pain) 33.25% followed by occupational dermatitis (27%). Bjørn Hilt, Torgunn Qvenild og Olve Rømyhr11 studied the prevalence of ischemic heart disease in workers at a stainless steel welding factory. By using multiple logistic regression analysis with control for potential confounding factors, the odds ratios for the study group as compared to the control group, were 2.6 (95% CI 1.3–5.3) for "chest pain on exercise", 2.5 (95% CI 1.1–5.8) for"angina pectoris", and 2.4 (95% CI 1.1–4.9) for myocardial infarction. In our study prevalence of non-communicable disease was studied and only 10.4% had NCD like diabetes and hypertension and duration of illness as compared to their working experience was not significant. James S.House in his review article on occupational stress and coronary heart disease has mentioned certain factors like low job satisfaction, job pressure such as work overload, status inconsistency and job mobility as factors related heart diseases.12 In present study workers in the age group of 41-50 years have history of non communicable disease which may be associated with job stress indirectly.

In this study major morbidities like NCD, bronchial asthma, skin diseases, hard of hearing, myalgia and mechanical injuries related to stainless steel industry were given importance. History of duration of each of illness was obtained which was compared with years of experience. Major skin manifestion was contact dermatitis followed by fungal infection. Whispered voice test was used for screening hearing impairment in workers. Musculoskeletal pain was the commonest complaint by workers and injuries ranged from simple abrasion to major cuts or laceration. As mentioned earlier in the study 317 million accidents and deaths occurred in job annually worldwide hence new measures as discussed in review article by Lesley Rushton like disease proportions, number of deaths, incidence and prevalence of diseases and quality of life measures provide decision makers with data to facilitate prioritisation of risk reduction strategies.13

Conclusion

This study suggested overall prevalence of morbidities to be 95% and commonest among them was musculoskeletal pain. Pre-employment investigation, health check-up at regular intervals and making protective equipment mandatory are some of the preventive measures which can be followed to reduce prevalence of these occupational diseases.

Recommendation

Every industry should follow working guidelines proposed by central government like adequate bathing places, separate rest rooms for males and females, locker rooms, sitting arrangement for all workers obliged to work in a standing position, temporary living accommodation, adequate standard of canteen or canteens and medical examination of workers thereof in an establishment employing one hundred or more workers, creche under the age of six years, first aid boxes and other welfare measures required for decent life of workers.14 A supervisor must be available in small scale industries to monitor the working condition. Government should focus more on occupational health by expanding present legislations and facilities to workers of unorganised sector and periodic reviews should be done for improving the health of such worker.

Source of Funding

None.

Conflict of Interest

None.