Occupational health in small scale and household industries in Nepal: A situation analysis

Occupational health in small scale and household industries in Nepal: A situation analysis
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  1 52 Kathmandu University Medical Journal (2008), Vol. 6, No. 2, Issue 22, 1 52 - 160 Original Article  Occupational health in small scale and household industries inNepal: A situation analysis Joshi SK 1,3 , Dahal P 2 1 Principal Investigator, 2 Co Principal Investigator, Nepal Health Research Council, Ram Shah Path, Kathmandu, Nepal, 3 Asst. Professor, Kathmandu Medical College AbstractIntroduction: Making working conditions safe and healthy is the interest of workers, employers and the Government.Although it seems simple and obvious, this idea has not yet gained meaningful recognition in Nepal. Methods: The study was conducted in ten small scale industries of Kathmandu valley. Altogether 545 questionnaires onsocioeconomic and occupational history were fi lled up. Similarly, Workplace Occupational Health Assessment was donein all ten industries. A thorough medical examination of 135 child workers was done using a structured questionnaire to fi nd out the health effects due to occupational hazards. Results: Out of the total 545 workers present in the industries under study, 135 (24.8%) were child workers. Higherproportion of child workers (97%) was illiterate compared to 3% of children with primary level education. Among thechild workers, 23 (17%) were girls. The majority of the child labourers were suffering from conditions like otitis externa,otitis media, scabies, anaemia, upper respiratory diseases, nasal problems, abdominal pain etc. Conclusion: The occupational health and safety practices in small scale industries in Kathmandu have been found to beunsatisfactory. Child labour is a serious problem. Out of ten industries, six have employed child workers and the workingconditions range from bad to terrible. Health and welfare of the child workers was also not satisfactory. Key words: Situation Analysis, Occupational Hazards, Occupational Health and Safety, Small Scale and HouseholdIndustries, Child Labour, Kathmandu, Nepal T he industrial revolution paved a new highway forcharting newer territories and de fi ning developmentin a newer perspective. The mechanization of work andhuman inputs requirements enabled human to explorenewer horizons and newer dimensions. Although,human cherished desire has been fruitful to an extentthe back log of industrialization, altered work behaviourand changing trends have resulted in newer phenomenaof occupation related hazards. The sustainability andcontinued development of industrialization requiresincreased production and enhanced productivity,which also requires safe work and working conditions.Though these factors should have been a prerequisite,they are often neglected in our contemporary society. Itspertinent effects make human work force susceptible tovarious work related adversities. The situation is worsein the small scale and household industries.Small scale and household industries (SSHI) employon average nearly 40% of the workforce in theindustrialized countries and up to 60% of the workforcein developing and newly industrialized countries. 1 SSHI are gaining importance in national economies.They are employment-intensive, fl exible in adaptingto rapidly changing market situations, and provide job opportunities for many who would otherwise beunemployed. Their capital requirements are often lowand they can produce goods and services near theconsumer or client.The workforce of SSHI is characterized by itsdiversity. SSHI provide entry to the world of work for young people and meaningful activities to elderlyand redundant workers who have been separated fromlarger enterprises. As a result, they often expose suchvulnerable groups as children, pregnant women and theelderly to occupational health risks. Further, since manySSHI are carried out in or near the home, they oftenexpose family members and neighbours to the physicaland chemical hazards of their workplaces. Like all otheraspects of SSHI, their working conditions vary widelydepending on the general nature of the enterprise, thetype of production, the ownership and location. Correspondence Dr. Sunil Kumar Joshi,Occupational & Environmental Medicine SpecialistAsst. Professor, Department of Community MedicineKathmandu Medical College, SinamangalE-mail:  15 3 In general, the occupational hazards are much the sameas those encountered in larger enterprises, but as notedabove, the exposures to them are often substantiallyhigher than in large enterprises.Although very few studies have been reported, it isnot surprising that surveys of the health of workers inSSHI in such industrialized countries as Finland 2 andGermany 3 have disclosed a relatively high incidence of health problems, many of which were associated withlowered capacity for work and/or were work-relatedin srcin. In the SSHI in developing countries an evenhigher prevalence of occupational diseases and work-related health problems has been reported. 4  Thousands of toxic chemicals used in SSHI pose serioushealth threats potentially causing cancer, respiratory andskin diseases as well as adverse effects on reproductivefunction. 4,5 Workers are exposed to hazardous chemicalagents such as solvents, pesticides and metal as well asvegetable and mineral dusts. 6,7 The risk of cancer fromworkplace exposure is of particular concern. The mostcommon occupational cancers include lung, bladder,skin and bone cancer, leukaemia and sarcomas. Thoughit is very dif  fi cult to achieve information about detailsconcerning carcinogens in the industries in Nepal, thereseems to be a large number of workers who are exposedto different carcinogens in a large number of industriesand the incidence of cancer is thought to be increasingevery year. 8 In a case control study done in Nepal, ahigh risk (OR 4.2 CI: 1.4, 12) for lung cancer was foundamong the workers, who have worked in the exposedoccupations like agriculture, construction of buildings,construction of roads and bridges, manufacturing, andtransport. 9 This study is a pioneering event in analysis of Occupational Health and Safety (OHS) in the industriesin Nepal. The concept of OHS is new even to theoldest industries of Nepal. Though there have beensome studies in relation to different industrial aspectsspeci fi c studies on working conditions, occupationalhealth and safety have not been conducted, except inthe jute industry of Nepal. Thus many industries, whichare prone to health hazard or many problems of OHSis yet to be studied. The lack of Procedural Guidelinesto analyze occupational health risks in the industries isanother setback in the fi eld of occupational health risksmanagement in Nepal.The objectives of the study were to assess occupationalhealth risks focusing more towards children in theselected SSHI in Kathmandu valley and identi fi cationof procedural guidelines to analyze occupational healthrisks in SSHI. Materials and methods This study was conducted in ten SSHI of Kathmanduvalley; the industries were randomly selected from thelist of the industries prepared by the researchers duringthe preliminary survey. The preliminary list containedthe name of the registered SSHI located inside as wellas outside the industrial estates. All industries wereassigned numbers and ten numbers were randomlypicked up by a person not related to the study.The respondents (545) were given a brief orientationon the nature and purpose of study; the informationseeking procedures were initiated by receiving priorconsent from the respondents and assuring them thattheir personal details would be concealed. However,they consented to publish their photographs in thearticle. The procedures and methods used for study werelimited to personal interviews, health examination of thechild workers and occupational health risk assessmentusing an assessment form developed by Harrington JMet al. 10 The health check up for 135 children less than 16 years of age was performed by a quali fi ed physician to diagnosethe ailments of child workers. The questionnaire used forhealth check up was a modi fi cation of the questionnaireby Shukla and Trivedi 11 which was used by them todetermine the exposure assessment to environmentalpollutants in Delhi. During health check up, generalvital indicators, skin, eyes, ENT organs, chest, abdomenand extremities were examined thoroughly. Similarly,information was gathered on subjective complaints of the child workers associated with different psychologicaland physical effects possibly induced by the work processes.The information collected was recorded and analyzedusing SPSS 10.0 version. The procedural guidelinesdeveloped to analyze occupational health risks werebased on the trends established around the globe inassessing OHS. Intense discussion was carried out withthe managers of those industries and other resourcepersons on OHS to design the guidelines that fi t thelocal conditions. The study has been conducted fromDecember 2004 to December 2005. Result The result of this study was based on the fi ndings from545 respondents including 135 child workers from10 different small scale/household industries. Theindustries selected for study were as follows:1. Metal industry2. Paint (Coating) Industry3. Tent industry4. Drinking water bottling plant  1 54 5. Brick kiln6. Stone crusher plant7. Construction industry8. Embroidery industry9. Instant noodle industry10. Carpet industryResults on occupational health risk assessments of thestudied SSHI are not presented here in detail.  Results on socioeconomic survey Important baseline characteristics such as gender,education level, monthly income, alcohol drinking andsmoking habit of the overall workers in all ten industrieshave been compared.Table no. 1 shows the distribution of male and femaleworkers along with the number of child workers withinthem and their working period in different industries.A high proportion of the child workers (97%) wasilliterate and only 3% of the children had a primarylevel education. Among the child workers, 23 (17%)were girls. The monthly income of the workers wasless than fi ve thousand rupees in the majority of theindustries under study, except in the metal, paint,drinking water bottling plant and carpet industries. Themajority of the workers in brick kiln, stone crushing,construction, embroidery and carpet industries wereilliterate with higher number of workers with secondarylevel education in the drinking water bottling plant andinstant noodle industries.Alcohol drinking habits were habitual among a largeproportion of workers. The majority of the workerswere daily drinkers.  Results on health check up of the child workers The fi gure 7 shows the prevalence of different healthoutcomes / diseases among the child workers. Except forlower respiratory tract infection (LRI), the prevalence of all selected diseases was found to be high. The highestprevalence (53.3%) was found for ear problems, whereas49.6% were suffering from other diseases (e.g. scabies,anaemia, and pin worm infestation) and 38.5% fromupper respiratory tract infection (URI) respectively.Also 37% of the respondents had nose problems.The Table no. 2 shows the prevalence of differenthealth outcomes/diseases among the child workersfrom different SSHI. Subjective complaints of the childworkers related to different psychological and physicaleffects induced by the work processes are shown in theFig 8. The major health effects induced by the physicalwork were observed as fatigue, general body ache,headache, irritation, weakness, sleep disturbance anddepression.  Results on the preparation of procedural guidelines to analyze occupational health risks The procedural guidelines developed mainly focuseson situational analysis, and identi fi cation of hazards.The guidelines identi fi ed include followings sequentialanalysis as walk through survey, identi fi cation of hazards, sampling, health assessment, occupationalhistory recording, biological effect monitoring andreview of medical records. (Table 3) Table 1: Distribution of workers in the industries under study and their working period List of IndustriesNumber of adult workersNumber of childworkersExposure period   (in hours)MaleFemale Metal Industry282108 – 12Paint industry25008Tent industry322808Drinking water bottling Plant361208Brick Kilns 45333510Stone Crushing Plant35322510Construction Industry425158Embroidery Industry320188 – 18Instant Noodle Industry403208Carpet Factories30563210  1 55 Fig 1: Metal casting work without protection. Fig 5: A child worker carrying bricks. Fig 2: Grinding and polishing of metal. Fig 3: Chemical burn Fig 4: Stone crusher plant. Fig 6: Child workers doing embroidery work   1 56 Table 2: Cumulative Frequency Distribution of Health Outcomes/Diseases among child workers in different industries S.N.DiseasesFrequency (%) in different industries Metal(10)Brick Kiln(35)StoneCrusher(25)Construction(15)Embroidery(18)Carpet(32)Total(135)1Eye Problem3 (30%)16 (45.7%)12 (48%)07 (39%)7 (22%)452Ear Problem5 (50%)20 (57.1%)10 (40%)10 (66%)9 (50%)18 (56%)723Nose Problem5 (50%)22 (62.8%)12 (48%)7 (58%)04 (12.5%)504URI2 (20%)17 (48.6%)15 (60%)3 (20%)015 (47%)525LRI04 (11.4%)6 (24%)005 (16%)156Skin Problem7 (70%)18 (51.4%)6 (24%)4 (26%)00357AbdominalProblem1 (10%)7 (20%)9 (36%)015 (83%)10 (31%)428MusculoskeletalProblem2 (20%)10 (28.6%)12 (48%)5 (33%)016 (50%)459Other problems*( pallor, scabies)1P (10%)10 P(28.6%)12 P(48%)012 P (67%)7 P 25 S =32(100%)67 *P: Pallor (anaemia) S: Scabies   53.30%49.60%38.50%37%33.30% 33.30%31.10%26%11.10% 0%10%20%30%40%50%60%    E  a  r    P  r  o   b   l  e  m  O  t   h  e  r  s   (   p  a   l   l  o  r ,    s  c  a   b   i  e  s   )   U   R   I   N  o  s  e    P  r  o   b   l  e  m   M  u  s  c  u   l  o  s   k  e   l  e  t  a   l    P  r  o   b   l  e  m   E  y  e    P  r  o   b   l  e  m   A   b  d  o  m   i  n  a   l    P  r  o   b   l  e  m  S   k   i  n    P  r  o   b   l  e  m   L   R   I Disease       P     r     e    v     a      l     e     n     c     e Fig 7 : Overall prevalence of health problems among child workers in all industries
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