|Year : 2017 | Volume
| Issue : 1 | Page : 11-17
Impact of occupational health hazards prevention messages on perceptions among rural clients in India: The outcomes of a panel study
Sanjeev Davey1, Chaitanya Maheshwari1, Santosh Kumar Raghav1, Jai Vir Singh1, Nirankar Singh1, Anuradha Davey2
1 Department of Community Medicine, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India
2 Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India
|Date of Web Publication||21-Mar-2017|
B-197, 3rd Floor, Prashant Vihar, Sector 14 Rohini, New Delhi - 110 085
Source of Support: None, Conflict of Interest: None
Background: Clients engaged in various occupations in rural areas of India, especially from Uttar Pradesh, lack information regarding health hazards associated with their occupations. Therefore, the impact of prevention strategies on perceptions of clients regarding occupational health hazards (OHDs) carries its importance. Materials and Methods: A cross-sectional cum panel study was done for 6 months duration (from July 1, 2016, to December 31, 2016) on 389 clients (above 20 years) engaged in any kind of occupations, in a randomly selected Village, Makhiyali (under Rural Health Training Centre [RHTC] catchment area) of a Medical College in district Muzaffarnagar. Both quantitative and qualitative data were collected and results were analyzed by appropriate statistical software's such as Epi Info and Atlas.ti. Results: The prevalence of overall OHDs was 65.2%; being dominated by respiratory disorders (47.3%). The adults' perceptions in comparison to elderly were significantly better in respiratory disorders category (P < 0.05). In the first 3 months of cross-sectional study on clients, their understanding of occupational health (OH) messages was statistically significantly associated with both the types of occupation and literacy status of clients (P < 0.0001 each). Next half of 3 months of panel study revealed that, after having received health messages for their OHDs from RHTC or Primary Health Centre (PHC) staff, adults were statistically significantly (P < 0.0001) better able to appreciate the OHD prevention messages as compared to elderly. Conclusion: Rural clients' perceptions need regular improvement by occupational health education sessions for augmenting their understanding of OHDS. However, further more studies on this issue are required, so as to give a more clarified picture on this area.
Keywords: Health hazards, health prevention messages, India, occupational health, panel study, perceptions, rural clients
|How to cite this article:|
Davey S, Maheshwari C, Raghav SK, Singh JV, Singh N, Davey A. Impact of occupational health hazards prevention messages on perceptions among rural clients in India: The outcomes of a panel study. Int J Health Syst Disaster Manage 2017;5:11-7
|How to cite this URL:|
Davey S, Maheshwari C, Raghav SK, Singh JV, Singh N, Davey A. Impact of occupational health hazards prevention messages on perceptions among rural clients in India: The outcomes of a panel study. Int J Health Syst Disaster Manage [serial online] 2017 [cited 2017 Dec 17];5:11-7. Available from: http://www.ijhsdm.org/text.asp?2017/5/1/11/202652
| Introduction|| |
In the current era of sustainable development goals to be achieved, what is required is creation of more healthy societies in terms of workforce for a country and healthy workers are important for both governments and business sectors productivity of a developing country like India. The occupational health hazards (OHHs) associated with many occupations are on rise not only in the organized sector but also in unorganized sector such as agriculture, fishery, and horticulture which is an emerging threat in era of an occupational and environmental health in India.
There is no doubt on a global scale that, people are living longer and are healthier than they were decades ago. However, industrialization has also gifted adverse health consequences not only for workforces but also for the general population as well. These effects are caused either directly by exposure to safety hazards and harmful agents or indirectly through environmental degradation locally and globally. Environmental health hazards, like OHHs, may be biological, chemical, physical, biomechanical, or psychosocial in nature. Environmental health hazards also encompass traditional hazards of poor sanitation and shelter, as well as agricultural and industrial contamination of air, water, food, and land.
Hazards in rural areas also prevail from many occupations such as farming. It has been seen even in Canada that recognizing of farmers' hazards helps the family physicians to care more for farmers and their families. Agricultural workers therefore even in most developed country such as the US are also exposed to the broadest and most extensive exposure to injury and disease of any occupational group., It has also been seen even in the US that, farm workers often went ill and got affected by psychological illness, injuries, parasites, skin diseases, and exposed to the dangers of agrichemicals, so what can be a scenario of developing country such as India, where around 68% people live in rural areas, it is not imaginable.
Even in India, globalization and rapid industrial growth in the last decades have caused emergence of many occupational health-related issues., Agriculture owners and agriculture laborers, which is still the main occupation in India, giving employment to about 60% of the people, is not untouched from OHHs., The major occupational diseases/morbidity of concern in India as evident from literature are silicosis, musculoskeletal injuries, coal workers' pneumoconiosis, chronic obstructive lung diseases, asbestosis, byssinosis, pesticide poisoning, and noise-induced hearing loss., Moreover, inadequate information about occupational hazards since many decades has also created major obstacles in effective prevention of occupational diseases in many developing countries such as India.,, The problem is so grave that in Indian scenario even 33% of health-care workers have even failed to recognize work-related health hazards as found in an Indian study, so what we can expect for lay people in rural area.
One such kind of studies  also emphasizes the need for revision of work practices, increased protective measures, and development of indigenous work safety standards for workers in heat exposure environments in Indian context. Therefore the irony is that, despite the well-known existence of such kind of issues, there is a little awareness among rural clients on occupational diseases and this area of rural clients' perceptions has also not been a key agenda among policymakers and health system researchers in India. Although many quantitative studies ,,,,,,,, in past have shown some light on this issue, better elucidation of this area by inclusion of panel study approach is so far lacking in literature. Panel study is based on the principle of an investigation of attitude changes using a constant set of people and comparing each individual's opinions at different times. Moreover, this kind of our panel study may help to improve the occupational health status of people engaged in various occupations in rural area in long run in India. This was the prime reason for selecting this research area by authors in this article.
| Materials and Methods|| |
What are the impacts on clients' perceptions toward OHHs after giving OHHs prevention messages (OHHPM) in field catchment area of a health-care training center in Muzaffarnagar District, Uttar Pradesh of India by the way a panel study approach?
First, approval of Ethical Committee of the institution was sought by submitting the proposal to International Electrotechnical Commission Committee, and their consequent approval was obtained from them. This was followed by clients consent for their participation in this study – after explaining the purpose of this study.
Type of study
This study is a cross-sectional cum panel study.
Duration of study
The duration of the study is from July 1, 2016, to December 31, 2016 (6 months).
Place of study
The study was carried out in the field practice area of a Rural Health Training Centre (RHTC which averagely caters to a population of 43,261) in a randomly selected Village, Makhiyali (under RHTC catchment area) of a medical college in district Muzaffarnagar in state Uttar Pradesh of India. In RHTC area, various health and family welfare training programs were regularly organized in terms of outpatient department (OPD) activity, inpatient department services, specialist services, health days celebration activities, health camps as well as separate visits by medical social workers, and health educators in which various occupational health-related information were passed to all clients above 20 years till 80 years. The occupational health-related information was also passed sporadically to clients from time to time by the field staff of RHTC since the inception of health training center-RHTC in 2012. Hence, it was presumed that the clients had some knowledge regarding OHHs before the study.
The study was carried out on all age group of clients above 20 years whether they were adult and elderly (male and female both) whosoever came in sampling irrespective of any bias in study (based on simple random selection criteria).
The study was carried out on clients residing in RHTC from a simple random sample of 400 clients for 6 months duration by adopting a cross-sectional cum panel study method (however due to death/attrition or loss in follow-up from RHTC, 11 clients were finally discarded, so finally 389 clients were available for this cohort study - this also nearly corresponds to the sample size calculation criteria as suggested by the World Health Organization (WHO) that at least 50% clients may be having knowledge on this area by assuming P = 50% n = 4PQ/L 2 = 400, at 10% relative level of error) out of 5000 patients seen on half-yearly basis from RHTC.
First, the knowledge regarding various OHHs was assessed from 389 random samples of clients in RHTC area. They were divided in such a way that, clients in each category were randomly sampled above 20 years from adults and elderly category in 6 months duration to maintain the representativeness of sample from population. Then, all these clients in each category were assessed for their perceived benefits and utility of the health messages received by them for OHHs. All these data were taken by three kinds of investigators such as field staff, PG students, and authors for analyzing the findings. The results were then complied and appropriate statistical test was applied to find the significance of these findings.
Panel study approach
Panel studies are a type of particular design of longitudinal study in which the unit of analysis is followed at specified intervals over a long period. The key feature of panel studies is that they collect repeated measures from the same sample at different points in time. Panel studies often use cross-sectional data and compare the same group of individuals at intervals through time, but the sample is not necessarily a cohort as it can be a group of people that do not share a common event.
First, the participants of both categories, i.e., adults (aged 20–60 years) and elderly (between 60 and 80 years) were made, and they were studied in their cross-sectional area for their knowledge, attitude, and practices for their OHHs and previous understanding of OHHPM for the first 3 months between January 1, 2016, and March 31, 2016. Then, OHHPM were given later on in next 3 months from April 1, 2016, to June 30, 2016, in their panel study for assessing the impact of OHHPM on them individually among adults and elderly.
The following types of clients were used in study. All clients residing in the area of RHTC are above the age of 19 years till 80 years, i.e., from 20 to 80 years irrespective of any bias of sex, religion, caste, or socioeconomic status. The diagnosis for occupational health disease (OHD) was made as per the WHO criteria of OHD, and it was confirmed by a medical officer of health in the area, with the final laboratory as well as radiological confirmation received from medical officer of health for that particular client. However, only four major categories of OHD were included in study such as respiratory OHDs (including silicosis, coal workers' pneumoconiosis, asbestosis, byssinosis, and chronic obstructive lung diseases), muscular OHDs (including musculoskeletal injuries/trauma, etc.), ENT disorders (including noise-induced hearing loss, chronic suppurative otitis media, chronic laryngitis, etc.), and skin disorders (including, chronic allergic dermatitis, pesticide poisoning, etc.), assuming their possibility of higher existence in rural area of Muzaffarnagar district as indicated in literature. Hence, they were finally included in the study.
Moreover, children and adolescents were also excluded from this study due to the questionable quality of their responses and lesser chances of OHDs understanding among them due to their less exposure to OHDs.
As per the objectives of the study, the collected data were analyzed with using appropriate statistical package Epi Info and Atlas More Details.ti software. The qualitative data were analyzed by Chi-square test.
| Results|| |
In our study area, the adults in 40–59 years age group were maximum (55.1%), majority being Muslims (64.8%) belonged to general category (74.5%) and were farmers in their occupation (49.9%) and their overall illiteracy rate was 25.1% [Table 1].
|Table 1: Profile of study participants engaged in any kind of occupations in Makhiyali|
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The overall prevalence of OHDs was 65.2% and it was more among adults (59.3%). Most prevalent OHD among all clients were respiratory disorders (47.3%), whereas skin disorders were affecting least clients (3.6%). The respiratory disorders prevalence among clients were more among adults (46%) as compared to elderly (1.3%), and only skin disorders were slightly higher among elderly (2.0% vs. 1.1%) [Table 2].
|Table 2: Profile of prevalence of occupational health diseases among clients (n=389)|
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From cross-sectional study, it emerged that the overall 65% of clients in different occupations were unable to understand OHHPM given any time earlier, especially the farmers and laborers (59.2%) as compared to those engaged even in service and business category (5.4%) and this was statistically significant (P < 0.0001) [Table 3]. However, 61.9% clients with even some literacy were able to appreciate the OHHPMs, and this was statistically significant (P < 0.0001) [Table 3].
|Table 3: Profile of understanding of occupational health hazards prevention messages with occupations and literacy of clients from cross-sectional study|
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There was no significant difference in the perceptions of adults and elderly category in all kinds of OHDs studied (P > 0.05) except respiratory disorders where the difference of perceptions among adults and elderly were significant (P < 0.05) as per their prevalent OHDs found. Overall, the perceptions of adults, however, were better in all categories [Table 4].
|Table 4: Perceptions of clients with occupational health diseases toward possible occupational health diseases causation in their minds in area of rural health training center (n=254)|
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Clients those who received preventive, promotive, or curative cum rehabilitative health messages from either RHTC staff or PHC staff for their OHDs, they were better able to appreciate the OHDs among them and this finding across all types of OHDs were highly statistically significant (P < 0.0001) and this difference between adults and elderly responses also came out to be significant. The total mean health messages received were only 188 (48.3%), and the overall health messages received (HMR) effect on clients' perceptions was only 16.9% [Table 5].
|Table 5: Perceptions of total (all kinds) clients toward occupational health diseases in area of Rural Health Training Centre those who received health messages (HMR) irrespective of their occupational health disease status (n=389)|
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| Discussion|| |
In our present study, the overall prevalence of OHDs was quite high (65%) that too in adults (59%), which may be possible as higher percentage of farmers (49.9%) as dominant occupation was prevailing in our study area coupled with possibly high illiteracy rate among predominantly Muslim population and other weak social profile of clients in our study area. This was in unison to many studies ,,, across the globe including India. According to the WHO estimates also, occupational health risks are found to be the tenth leading cause of morbidity and mortality, and occupational risk factors are responsible for many morbid conditions found globally, such as 37% back pain, 16% hearing loss, 13% chronic obstructive lung disease, 11% asthma, 10% injuries, 9% cancer, and 2% leukemia.
If we look at the Indian epidemiological data about occupational health diseases, it has been seen that, in India, the annual incidence of occupational disease was found to be between 924,700 and 1,902,300 leading to over 121,000 deaths as found in few studies., According to another survey of injury incidence in agriculture conducted in Northern India, an annual incidence of 17 million injuries per year (2 million moderate to serious events), and 53,000 deaths per year have been found., This corroborates with the finding of higher prevalence of OHDs existing in population in our study. The possible reason for such a scenario is that, in India, the occupational health is a secondary issue among health policy and health-related programs which get reflected in the weakly implemented occupational health policy. This was also the probably one of the main reasons of finding higher respiratory disorders (47.3%) in our study.
The important issue which came out from our study is that, the adult clients engaged in various occupations suffered more from respiratory disorders (46%) possibly due to less occupational prevention strategies followed by either themselves or even advised less by their employers or PHC or RHTC staff. The reason might be that in India, occupational health is just a simple health issue, which includes child labor, poor industrial legislation, vast informal sector, less attention to industrial hygiene, and poor surveillance data., The higher prevalence of respiratory disorders as found in our study may also be occurring due to many other reasons such as less knowledge of OHDs among clients and poor perceptions regarding OHDs due to less organization of OHPs by PHC or RHTC Staff. In fact, in India, 72% of population lives in the rural area. Emerging occupational health problems needs be tackling along with the existing public health problems. Globalization and rapid industrial growth in the past few years have added further to complexities of occupational health-related issues. A report by the National Institute of Occupational Health, India (1999), also reports that more than 3 million people working in various type of mines, ceramics, potteries, foundries, metal grinding, stone crushing, agate grinding, slate pencil industry, etc. These workers are found to be occupationally exposed to free silica dust and are at potential risk of developing silicosis. This may explain the dominant OHD – respiratory disorders in our present study.
Further, the literature also reveals that agriculture is the leading occupation in Uttar Pradesh and more small-scale industrial units are situated in Uttar Pradesh than in any other state, with 12% of over 2.3 million units. The most common occupation in our study was farming (49.9%), followed by laborers (25.7%), which was also in unison to other reports, which indicate that the Muzaffarnagar is well known for its agricultural prosperity with highest agricultural GDP in Uttar Pradesh. The Muzaffarnagar with a literacy rate of 70.11% and minority population of about 60% of the total population of the district as documented from many reports, indicates that appreciation of occupational health problems by clients may be an existing issue.,,, The development of occupational asthma and chronic obstructive pulmonary disease due to exposure to various chemicals in working atmosphere coupled with the impaired pulmonary function testing in the hairdressers has been seen in studies done in Muzaffarnagar. OHDs as found in our study many due to many risk factors exposures as found in many studies in India.,,,,
This type of above studies in literature may explain the no significant difference in perceptions of adults and elderly category in all kinds of OHDs studied except respiratory disorders as per their prevalent OHDs found (P > 0.05). However, perceptions of adults were better in all categories of OHDs found; this might be due to better adult literacy rate and possibly better social media exposure of adults, therefore showing better ability to understand the OHH risks in Muzaffarnagar district in Uttar Pradesh.
This picture may also be existing due to following factors found in many studies.,,, It has been seen that clients' perceptions are linked with satisfaction of their rehabilitation. It has also been seen from literature that the differences between younger and older participants in relation to occupational performance and subjective quality of life are different. One such study from South India also reveals that, the sawmill workers believe respiratory diseases were the common health problems among them but felt user-friendly personal protective equipment were not available to them. Hence, these factors as evident from studies in literature ,,, may explain the possible results obtained in our study.
Moreover, in our present study, clients those who received health messages in the form of prevention strategies based on preventive, promotive, or curative cum rehabilitative approaches from either RHTC staff or PHC staff for their OHDs, they were better able to appreciate the OHDs among them and this finding across all types of OHDs was highly statistically significant (P < 0.0001) and this difference between adults and elderly responses also came out to be significant and total mean health messages received were only 188 (48.3%). However, the overall HMR effect on clients' perceptions was only 16.9%.
As in our study, overall 54.4% of clients were unable to understand occupational health messages (OHM) and majority of them belonged to farmers (31.2%) and laborers (15.2%), and this was statistically significant (P < 0.0001). In our study, the farmers had least knowledge about OHDs, but they were ready to follow health messages (HM) from PHC or RHTC staff proved some kinds of structured OHDs messages are given to them from time to time. However, 61.9% of clients with even some literacy were able to appreciate the OHM, and this was statistically significant (P < 0.0001). This was in similarity to studies where it has been seen that the farmers are concerned with their occupational health and safety issues; they not only like access to an occupational health and safety service but they also must be provided any new farm health and safety programs including farmer input to ensure practicality, applicability, and acceptance.,,,
This means, what is required for primary health-care approach to delivery of occupational health, we must create awareness at multiple levels, for example, health personnel, nongovernmental organizations, women's organizations, and rural clients attending a PHC or RHTC this along with greater organization and empowerment of the agricultural workforce and small farmers are also needed and health-sector staff, must therefore manage occupational health problems and identify the greatest hazards prevention strategies for explaining it to clients in rural area, more frequently.,,, Therefore, focusing on recurrent occupational health outcomes among farmers is the need of hour to design more effective interventions in agriculture and other industries affecting their occupational health as also found in related studies in the literature.,,,
| Conclusion|| |
This panel study reveals that the rural clients have less understanding of health hazards associated with their occupations; which can be improved by opening either proper occupational health clinics or proper integration of occupational health education programs within the primary health-care system with utilization of RHTCs of budding medical colleges in India, probably then clients can better appreciate the OHHs. However, authors suggest that this aspect needs further detailed study in future, before jumping to a definite conclusion.
We would like to acknowledge all the Rural Health Training Centre (RHTC) and Primary Health Centre (PHC) – Makhiyali staff including medical officer of area as well as Medical Interns and PGs (Dr. Rama Shankar, Dr. Pradeep Choudhary, Dr. Sangeeta Jain Sharma, Dr. Tausif Alvi and Dr. Sana Siddique) from Department of Community Medicine, Muzaffarnagar Medical College who contributed in data collection to execution in management of this study at both RHTC and PHC.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]