Correlates of Stone Quarry Workers' Awareness of Work-related Ocular Health Hazards and Utilization of Protective Eye Devices: Findings in Southeastern Nigeria.

OBJECTIVE: To assess the awareness of work-related ocular health hazards and utilization of personal protective eye devices (PPEDs) among stone quarry workers in Abakaliki, southeastern Nigeria.
MATERIALS AND METHODS: In a cross-sectional survey of stone quarry industry workers in Abakiliki, conducted between March and April, 2012, data on participants' socio-demographics, job characteristics, PPED awareness, and utilization were collected. Descriptive and analytical statistics were performed. For intergroup comparisons, P < 0.05 was considered statistically significant.
RESULTS: All workers were aware of the need for utilization of eye protective devices; however, 98.7% declined its use for various reasons. About 74.6% attributed nonutilization to nonavailability while 10.4% attributed it to high cost and 10.2% declined its utilization due to discomfort associated with its use. DISCUSSION: Usage of PPEDs was associated with job specification, educational level, duration of work experience, awareness of work hazards, and knowledge about the purpose of PPEDs. Nonusage was associated with unavailability, high cost of procurement, and ocular discomfort from poor fitting and misty/cloudy vision with use. Users were more numerous among blasters and crushers whose jobs were most predisposed to work related accidents and workers with formal education.
CONCLUSIONS: Findings from the study reveal high level of awareness yet nonutilization of eye protection. Barriers to the utilization of these eye protective devices should be addressed to ensure greater compliance of its use.

INTRODUCTION

Work-related eye injury, especially in the quarry industry,[123] remains an important cause of ocular morbidity and vision loss in the working age group, in both low and middle income countries (LMICs) and the developed economies. With reported prevalence ranging from 2% to 4%,[4] and often involving the ocular surface and anterior segment, work-related eye injury is more common among industry workers in LMICS than in the industrialized countries.[4] Common injuries include destabilization of the pre-corneal tear film, radiation-induced conjunctival degeneration and lens changes, superficial ocular surface abrasions and foreign bodies, and occasionally, penetrating eye injuries.[5] Work-related eye injury leads to blindness, visual impairment, with work absenteeism, suboptimal work output, and injury-related compensation claims.[6] Predisposing factors to work-related eye injury include work exhaustion, tool malfunction, domestic tension, inattention, and lack of expertise.[7]

Despite the promulgation of safety measures against work-associated hazards,[8910111213] and their established protective efficacy,[5] the utilization of personal protective eye devices (PPEDs), goggles, helmet and face shields, and machine-incorporated devices has remained low, especially in developing countries. This has been variously attributed to workers' poor awareness of their protective benefits or employers' failure to provide them and enforce their use.[14]

To ensure compliance with use and optimize its protective effectiveness, PPED must be job-appropriate, user friendly, and devoid of user discomfort.[15]

There is dearth of both industry-wide and quarry-specific data on awareness and utilization of PPED use in developing countries. Consequently, we performed a cross-sectional survey of stone quarry industry workers in Abakiliki, southeastern Nigeria, to assess their awareness of, barriers and incentives to utilization of PPEDs, and the associated socio-demographic and job characteristics. The generated data will provide an evidence base to inform industrial health policy changes aimed at optimizing eye health and prevention of work-related eye injuries among stone industry workers in the study area and under similar settings elsewhere in LMICs.

MATERIALS AND METHODS

Background

There are several stone quarries located at various spots within Abakaliki, Ebonyi state. There is a central mine simply referred to as the mines located at the outskirts of Abakiliki and other smaller privately-owned ones referred to as the small scale minors. The central mine is the major producer of stones and have various privately-owned companies under its umbrella. It has an administrative head who is the manager of the biggest private company at the mines. The mine is leased to these private individuals who obtain and renew their licenses annually from the Federal Ministry of Mines and Power. There is a central processing plant at the Stone Crushers Enterprise zone located about 5 km from the heart of the town. At this site, different private owners group together under this umbrella. Each private owner has its own workers directly under its employment but all owners are registered under the state government who has an administrative head representative of the government. It is an open space polluted by dust from the plants and noise from the working machinery where each company is allotted space by the administrative head. Each private owner displays its stones and fine dust crushed by the plant for prospective buyers.

This study was conducted between February and April 2011 in Abakaliki, Ebonyi state, southeastern Nigeria.

Eligibility

All consenting technical workers actively involved in stone extraction and processing and laborers working in the stone industries located in the study area. Nontechnical workers were excluded from participation.

Ethics

Ethics clearance for the study was obtained from the Medical and Health Research Ethics Committee (Institutional Review Board) of the University of Nigeria Teaching Hospital, Ituku-ozalla, Enugu. Additionally, permission for the study was obtained from the management of central mines and the stone processing industry in Abakaliki. Also, informed written consent was obtained from each respondent.

Following an official letter to the management of the central quarry mines and the stone processing plant in Abakaliki, permission was granted for the study to be carried out. This was a one site survey at the central mines and a one site survey at the stone processing plant where all mining operators were relocated to by the state government.

Sample size and sampling strategy

Based on the 9.6%[14] reported prevalence of PPED utilization in a related survey and an error band of 5%, a minimum sample size of 134 was envisaged. However, this was inflated to a modified sample size of 500 to compensate for possible refusal.

A register containing the names of all the eligible workers was compiled to serve as a sampling frame. The sampling interval (k) or skip interval was obtained by dividing the population size (2000) by the sample size (500). After a random start and using systematic random sampling, every kth name in the register was selected for recruitment until the modified sample size was obtained.

Study instrument

This was a pretested researcher-administered open- and close-ended questionnaire with subsections on participants' socio-demographics, job characteristics, and previous work related eye problem; and PPED: awareness, availability, types, utilization pattern, and barriers to utilization. In addition, it sought data on participants' history of pre-employment eye examination, official (arranged by the employer) or unofficial.

Survey administration

To ensure participation, the survey was administered on-site during the workers' break period (11 am to 12 noon) at the administrative office of each survey (quarry site).

Data analysis

Data was analyzed using the Epi Info™ statistical software, version 7 (Centre for Disease Control and Prevention, Atlanta, GA, USA). Data were examined using descriptive and comparative statistics. For intergroup comparisons, Chi-square test, student's t-test, and Fisher's exact tests were used as appropriate. In all comparisons, all P values < 0.05 and the associated odds ratios and 95% confidence intervals were considered statistically significant. In cases of multi-collinearity, in the univariate comparison, multivariate logistic regression was performed to assess the independent effect of the potential predictor variables on the outcome of interest, i.e., PPED utilization.

RESULTS

Participants' socio-demographic and job characteristics

The participants (n = 500) comprised 205 (41%) males and 295 (59%) females who were aged 34.38 ± 11.19 years (range, 10–60 years). Their age profile showed age groups of 21–30 years (Quarry) and 31–40 years (stone processing plant). Of them, 191 (38.2%) possessed formal education whereas 341 (68.2%) had work experience of 1–5 years. The participants' socio-demographic profile is reported in Table 1; their job characteristics are shown in Table 2.

Table 1

Participants' socio-demographic profile

Table 2

Job characteristics

Awareness of work-associated ocular hazards

Two hundred and sixty (52.0%) participants were aware of the potential ocular health hazards associated with working in the stone industry. The sources of hazard awareness were personal experience of eye injury at work 160 (32.0%), mass media 10 (2%), medical personnel 25 (5%), and co-workers 105 (21%). None (0.0%) obtained awareness from the quarry management as health talks on job-related ocular health hazards are not given to employees.

Awareness of PPEDS

Of the 500 participants, 500 (100%) were aware of use of goggles as a type of PPED; however, 0 (0.0%) were aware of eye shield, helmet, or machine-incorporated protective eye device.

Utilization of PPEDs

Of the 500 participants,' only 10 (2%) possessed and used PPED, i.e., eye goggles; none used (utilized) eye shield or helmet. Also, none of the participants used machine-incorporated protective eye device. Of the 10 (2%) who used goggles, none used it regularly. More participants in the stone processing group 12 (2.4%) than stone quarry workers group 7 (1.4%) utilized PPED (P = 0.34).

Of the participants who possessed eye goggles, all were irregular users despite their age, sex, educational status, duration of work experience, and history of job-related eye injury.

The leading barriers to utilization of PPEDs were nonavailability 373 (76.1%), cost 52 (10.6%), and user discomfort 51 (10.4%) [Table 3]. An overwhelming majority of the workers had no pre-employment eye test (98.70%). Among the workers who had pre-employment test, none underwent an official test: test enforced by employers (0%) while all (100%) had it in a private set-up for personal health reasons and kept their results.

Table 3

Barriers to PPED utilization

DISCUSSION

Socio-demographics

A greater proportion of the workers were married females with no form of education. This is not surprising because their work, being mainly laborers, required no expertise and received very little remuneration. Abakaliki being home to poor rural peasants, females rely on work at the Quarry site as a means of survival. This sharply contrasts with Okoye's work [5] where all workers examined were males. The job specification, type of industry, and location (rural/urban) may be contributory. However, being mostly an illiterate population, the need for adequate communication of information as regards to reading, understanding, and appreciating instruction manuals of machines including eye safety signs, devices, and posters become a big challenge. In South Africa,[16] in the 1990s, there was a massive retrenchment of uneducated workforce in the mining industry, compelling workers to get educated to maintain their jobs. Literacy should be encouraged as it has an inverse effect on the occurrence of work-related accidents.

Majority of the workers were aged 21–40 years (Quarry) and 31–40 years (stone processing plant). Most of these presently work as laborers. Being a private enterprise, though regulated by the Federal Ministry of Mines and Steel, the private companies who employ these workers renew their contract on a monthly or quarterly basis and prefer young able-bodied people who can cope with the demands of the job. Similar trend have been observed among coal workers.[17]

Job characteristics

Majority of the workers had a working experience of less than or equal to 5 years. This finding is similar to reports from Ghana,[18] but contrasts with report by Ilmarinen [19] where workers who had spent several years in the industry had less chances of encountering work-related accidents due to higher cognitive function in anticipating and avoiding work-related accidents.

Issues about lasting long on a job due to good incentives and remuneration thus employers exploiting job experience of old workers to minimize overhead costs and reduce occurrence of work related accidents is brought to fore.[20]

As collaborated in Okoye's survey,[5] an overwhelming majority did not undergo pre-employment test. The case for pre-employment test is justified to determine job capability and to document baseline information for reference in cases of work related accidents, especially in view of determination of extent of injury and in calculation of worker compensation claims. However, in developing countries, employers seemed unconcerned and are not aware of their rights, thus proper occupational safety practices are not implemented.

Awareness of job-associated ocular health hazards: prevalence and associated factors. A larger proportion of the workers drew their awareness of ocular health hazards in the industry from personal experiences at work related injury as earlier reported.[21] However, it seems that utilization uptake was still poor despite this. Possibly, the low occurrence of severe visual impairment and blindness following work-related accidents might be responsible.

PPED utilization: Associated factors and barriers

Despite 100% awareness of the use of protective eye goggles as a type of PPED, only 1.3% utilized and all utilized it irregularly.

Omolase et al.[22] found, that despite the fact that all the welders interviewed were aware of the ocular protective utility of the welders' goggle which was from personal experience from previous accidents, most (82.5%) did not wear goggles always. He also found that the majority of work-related eye injuries (among welders) were avoidable by correct use of eye protective devices. Peate observed that 90% of work-related accidents could be avoided with adequate eye protection.[23] Thus, the need for its enforcement cannot be overemphasized.

Nonuse of eye protective devices was reported in 98.7% of the worker. Thus, despite the potential hazards found in the quarrying industry, an overwhelming majority of the workers did not use eye protective devices. Quandt et al.[24] in their study of eye injuries of agricultural farmers found that 98.4% workers examined did not use eye protection at work. This finding agrees with findings in the current study. Most workers seen in the two studies had low enlightenment level; thus, the apparent unimportance attached to the use of eye protective devices.

In the present study, a good percentage of workers 200 (39.9%) who had work-related eye injury were aware of work-related hazards yet utilization was irregular. Few who utilized eye protective devices admitted to past history of trauma prior to the onset of its utilization and observed that such eye injuries never reoccurred following constant use of eye protective devices. Thus, utilization was based on personal appreciation of its need or drawn from lessons learnt from past occurrence of eye trauma. Omolase et al. observed similar findings.[24]

Several reasons have been adduced for not utilizing eye protective devices in the present study. An overwhelming majority laid claim on the unavailability of these devices. Another reason for underutilization was that it was very costly to procure individually as most of the workers were very poor peasants. For the few that utilized PPED, irregular use was attributed mainly to user discomfort from poor fitting and misty/cloudiness interfering with visibility as collaborated by Verma et al.[25]

Several workers, especially laborers, felt they did not run any risk of eye injury and thus did not need eye protection. This emphasizes the need for proper education of quarry workers on the benefits of using eye protective devices at all times during work as well designing protective devices that will suit the climatic conditions, and reduce discomfort of the workers.

The blasters and crushers had a higher utilization rate than the rest of the workers. This is probably because they are the most exposed to the most dangerous aspects of quarrying as reported by Bajpayee et al.[26] However, it was observed from the present study, that blasters were and crushers were most at risk of injury thus utilized PPED.

Study limitations

Inadequate availability of resources was an impediment limiting the extent of the research which would have involved studying other stone quarries in other localities in addition to the one specified. The study was therefore restricted to Abakaliki.

Information bias which may be recall or interviewer bias may affect some of the important variables such as industrial accident history. However, as no pre-employment eye tests were conducted on most workers, it was difficult or even impossible to determine their pre-employment ocular status which would have served as a baseline for comparison. Past reports of industrial accidents would have been verified if such records were available.

CONCLUSIONS

Awareness of work-related ocular hazards had an inverse relationship with formal education. Compliance with utilization of PPED was mainly from personal experiences of work-related accidents and was higher among the technical workers who had formal education and were exposed to the most dangerous aspects of quarrying. Barriers to use of PPED were mainly unavailability. Therefore, employers should be held culpable to provide and enforce the use of appropriate, job-adapted and comfortable PPED in a safe work environment where the promulgated laws enacted to ensure adequate eye protection are regularly reviewed, updated, and enforced.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.