A survey on the occupational health status of gardeners in bhopal, India.

BACKGROUND: Occupational gardeners are exposed to various risk factors like dust, allergens, sharp tools, and pesticides, which make them vulnerable to many diseases. This study was designed to survey the health status of this occupational group.
OBJECTIVES: The objective was to collectsociodemographic and health status information of occupational gardeners.
MATERIALS AND METHODS: The study group comprised 75 male occupational gardeners of the Bhopal city and suburb. A pretested proforma questionnaire was used to record the necessary information like medical history, sociodemographic factors, and findings of clinical investigations. RESULT AND DISCUSSION: This survey reveals that 50% of gardeners are underweight, 31.99% with high normal to high blood pressure, and none with diabetes. The prevalence of vision disturbance (26.66%), eye inflammation (29.33%), stiff nose (21.33%), joint pain, swelling and muscle stiffness (29.33%), and accidental injury (28%) was significantly high among gardeners. Gardeners should be educated to use protective clothing, quit smoking and tobacco consumption, adopt proper body posture, and ensure vaccination.

Introduction

Health care sector in India has witnessed a significant growth during the last few years, both in quality and capacity. Relatively lower cost of health care, as compared to developed countries, coupled with international quality has positioned India as a major destination for health care services. In spite of such developments, heath care facilities in the country remain inadequate to meet the needs of the citizens.(1) India is a vast country and variation occurs in the disease pattern due to the socioeconomic pattern and other factors. There is a lack of health information in many subpopulations like community gardeners in India, which needs to be explored for public health policy needs.(2)

Gardening is the practice of growing ornamental or useful plants. There are so many health-related benefits of gardening like access to food, improved nutrition, increased physical activity, and good mental health.(3) The occupational gardeners have a hectic physical work profile. They have to work in the afternoons of summer and early morning in winters and also in rainy seasons. Gardeners are very prone to skin sensitivity, asthma, musculoskeletal problems, and hypertension.(4) An estimated 160 million people suffer from work-related diseases and there are an estimated 270 million fatal and nonfatal work-related accidents per year. Some two million people die every year from work-related accidents and diseases.(5) This fact is also important for the personnel engaged in gardening as they have to undergo physical strain in an environment polluted by pesticides, dust, excessive sunlight, severe cold, and different allergic weeds affecting health and well-being of gardeners. This study was thereby conducted to assess the health status of the gardeners of the Bhopal city and suburbs to find out the related risk factors so that appropriate preventive measures can be recommended for safe guarding the health.

Materials and Methods

The study was conducted on 75 gardeners randomly selected from work place. Data were collected by person-to-person visits. They were assured of the confidentiality of the data and their informed consent was obtained. Sociodemographic information like age, sex, educational level, occupation status, and behavioral characteristics like use of tobacco, bidi, and alcohol were collected using a predesigned and pretested questionnaire. Health status was assessed by conducting appropriate anthropometrical, clinical, and laboratory examination of each subject following standard clinical methods. Blood sugar was estimated by using Glucometer (Accu-chek) after taking the gardeners′ blood samples in the early hours of morning before joining the duty. During personal interviews, the subjects were asked specific questions regarding the use of personal protective devices like shoes, gloves, goggles, face masks, etc. Similarly, they were asked whether the employer organized any health education session or were given any personal advice regarding the use of personal protective devices and quitting habits such as smoking and tobacco chewing.

Statistical analysis

The results were expressed in terms of mean ± SEM. Experimental data were analyzed using one-way ANOVA.

Results

A total of 75 gardeners with the age ranging from 20 to 65 years were surveyed during this project between February and March 2009. A total of 41 subjects were in the age group of 20-35, 28 in the age group of 35-50, and 6 in the age group of 50-65.

Among the study subjects 38.66% were underweight with a mean BMI of 17.59 and further 12% persons were severely underweight with 15.48 mean BMI. In this survey, 48% subjects were found to be overweight with a mean BMI 25.63 as represented in Table 1. High blood pressure was found in 14.66% subjects and high normal in 17.33%. Normal blood pressure was observed in 23% subjects and low normal in 28%. Blood sugar levels of study subjects were moderately high in 41.33% and normal in 57.33% as stated in Table 2.

Table 1

Body mass index of study subjects in relation to body weight

Table 2

Distribution of study subjects according to the blood sugar range

All the subjects were surveyed for their general health status concerning different organ systems as depicted in Table 3. Smoking behavior was found in 50.66% subjects and alcohol consumption in 41.33%. The most common health problems are vision disturbance (26.66%), eye inflammation (29.33%), stiff nose (21.33%), joint pain swelling and muscle stiffness (29.33%), and accidental injury (28%). Most rarely found health issues are constipation (1.33%), weight loss (2.66%), varicose veins (1.33%), and poor sleep (1.33%).

Table 3

General health status surveillance of study subjects

Discussion

The study populations of gardeners were mostly literate. Most of the gardeners were permanent employees getting a monthly salary and some of them were on a contract basis with daily/weekly wages. They resided in overcrowed and unhygienic conditions of the slum areas, making them susceptible to vulnerable diseases.

Gardening burns on an average about 5 calories a minute or about 300 calories an hour in the case of light working hobby gardeners.(6) In the case of occupational gardeners, about 15 min of gardening uses up about 140 calories. Over 12 months of daily gardening workout uses up a total of 51,100 calories per year, equivalent of 14.6 pounds of body weight. The survey data showed that 12% subjects are severely underweight and 38.66% are relatively underweight which, is a matter of serious concern. The professional gardeners in the concerned area can hardly earn Rs. 2000-5000 per month. The physical work is strenuous, so a proper nutritional food supply is must to meet the need of sufficient calories. Cardio and weightlifting aspects of gardening include tasks like pushing a mower, raking, lifting bags of soil, pushing the wheel barrel, turning compost, shoveling, tiling, and more. Gardening has been shown to be a relaxing active activity that can significantly lower blood pressure in people with hypertension and prehypertension. Our survey showed that 14.66% of study subjects were having high blood pressure and 17.33% subjects showed high normal blood pressures which contrast the normal assumption. The hectic work schedules of occupational gardeners affect the blood pressure of the subjects. This implies that one-third of gardeners are prone to be hypertensive in future if they ignore it.

Physical activity is an important part of diabetes management plan. At the time of exercise, muscles use sugar (glucose) for energy and regular physical activity also improves body's response to insulin. These factors work together to lower the blood sugar level. Normal blood glucose levels were found in 57.33% of study subjects. It implies that none of the studied subjects were diabetic in primary screening.

A significant number of studied subjects were having vision problem (26.66%) and eye inflammation (29.33%). The gardeners are exposed to intense sunlight, chemicals, and pesticides which cause inflammation and irritation in eyes. Long-term exposure to sunlight especially ultraviolet (UV) rays and chronic eye irritation from dry dusty conditions seem to play an important role.(7) Some pesticides can cause skin rashes itching and watery blisters may form. A total of 13.33% gardeners complain of skin allergies owing to constant exposure to mud and pesticides. Respiratory system problems are common in gardeners due to exposure to different allergic weeds. The way to avoid such problems is to educate them about allergic plants and detail precaution while handling such plants.

The gardeners have to work in different postures continuously for long durations which results in joints pain, swelling, muscle stiffness, and back pain. The gardeners use different agricultural tools which have sharp edges so there is a risk of accident while using such tools. Most gardening tools are old-fashioned and need more physical labor to operate. The percentage of accidental injury was found to be 28%. This can be reduced by proper training.

Conclusion

Based on the finding, we are suggesting some safety tips to improve the working conditions of occupational gardeners not only in the Bhopal region but also in the whole country.

Gardeners should be motivated to use safety goggles, sturdy shoes or high rubber boots, and long pants when using lawn mowers, and other machinery. The gardeners should be encouraged to wear gloves, long sleeves, and sunshades to lower risk of skin irritation, sunburn, and skin cancer.

Instructions and warning labels on chemical, lawn and garden equipment should be followed carefully.

Tetanus lives in the soil and enters the body through cuts in the skin. Because gardeners use sharp tools, dig in the dirt and handle plants with sharp points, they are particularly prone to tetanus infections. Ensure tetanus/diphtheria vaccination.

As far as our literature survey, this study is the first reported health surveillance on occupational gardeners in India. Although the study was conducted on a limited number of subjects, the outcome is interestingly revealing some facts about the working condition and health status of gardeners. These types of studies in a large number of subjects from different geographical and economic regions can explore the real picture of occupational gardeners, which will definitely help in the betterment of their socioeconomic conditions.