In-depth Analysis of Pattern of Occupational Injuries and Utilization of Safety Measures among Workers of Railway Wagon Repair Workshop in Jhansi (U.P.).

CONTEXT: Occupational injuries constitute a global health challenge, yet they receive comparatively modest scientific attention. Pattern of occupational injuries and its safety precautions among wagon repair workers is an important health issue, especially in developing countries like India. AIMS: To assess the pattern of occupational injuries and utilization of safety measures among railway wagon repair workshop workers in Jhansi (U.P.). SETTINGS AND
DESIGN: Railway wagon repair workshop urban area, Jhansi (U.P). Occupation-based cross-sectional study. PATIENTS AND METHODS: A cross-sectional study was conducted among 309 workers of railway workshop in Jhansi (U.P.) who were all injured during the study period of 1 year from July 2015 to June 2016. Baseline characteristics, pattern of occupational injuries, safety measures, and their availability to and utilization by the participants were assessed using a pretested structured questionnaire. STATISTICAL ANALYSIS USED: Data obtained were collected and analyzed statistically by simple proportions and Chi-square test.
RESULTS: The majority of studied workers aged between 38 and 47 years (n = 93, 30.6%) followed by 28-37 years (n = 79, 26%). Among the pattern of occupational injuries, laceration (28.7%) was most common followed by abrasion/scratch (21%). Safety shoes and hat were utilized 100% by all workers. Many of them had more than 5 years of experience (n = 237, 78%). Age group, education level, and utilization of safety measures were significantly associated with pattern of occupational injuries in univariate analysis (P < 0.05).
CONCLUSIONS: Occupational injuries are high and utilization of safety measures is low among workers on railway wagon repair workshop, which highlights the importance of strengthening safety regulatory services toward this group of workers. Younger age group workers show a significant association with open wounds and surface wounds. As the education level of workers increases, the incidence of injuries decreases. Apart from shoes, hat, and gloves, regular utilization of other personal protective equipment was not seen.

INTRODUCTION

Occupational or work-related injuries became more common after the industrial revolution. According to the International Labor Organization (ILO), occupational injuries and diseases represented 4% of total gross national product.[12] Occupational injuries constitute a major portion of the global injury burden, comprising almost 30% of all medically treated injuries to adults aged 18 to 64 years.[3] Occupational accidents, although definitions vary widely, are those occurring at the place of work; the prevalence rate of accidents ranges from 7.8 to 27.7%, depending on the type of work performed.[4] A workplace injury is defined in the legislation as an injury “relating in space, time and causality to performing his/her work, based on which he/she is insured, caused by an immediate and momentary mechanical, physical or chemical impact/exposure, a sudden change in body position, a sudden and unexpected exertion of the body, or other changes in the physiological condition of the body” (Article 22 of ILO constitution).[5] In the context of legislation, the major legal provision for protection of health and safety at workplace are Factories Act and Mines Act. However, greater than 90% of Indian labor forces does not work in factories, hence they fall outside the preview of Factories Act-1948, the only act that deals with occupational health and safety accidents. Some safety measures include wearing eye goggles, face masks, gloves, ear plug, apron, and air filter. The main reasons would include low level of education of workers, inadequate knowledge of health hazards, and unavailability of preventive measure. So, the rationale behind the study is to determine the pattern of occupational injuries among railway workers and utilization of safety measures by them.

PATIENTS AND METHODS

It was an occupational-based cross-sectional study conducted in urban area at railway wagon repair workshop of district Jhansi in Uttar Pradesh among 309 railway workers for a period of one year (July 2015 to June 2016). All the accidental injuries reported by railway wagon repair workers during their work in workshop will be considered as a sampling unit and each sampling unit is separately interviewed regarding occupational injuries and with their associated factors and safety measures adopted. A semi-structured interviewer administered questionnaire was used as a study tool. Questionnaire had two main sections:

Section-1: Sociodemographic details included age, sex, education, occupation, socioeconomic status (SES), etc. SES was assessed using the modified Kuppuswamy classification

Section-2: This includes details of department of workshop, pattern of injuries, and safety measures.

Estimation of sample size: Considering the prevalence of occupational injuries in previous studies was 25.42%.[6] The estimated sample size is calculated as follows:

The formula used for calculation of sample size (n) was:

n = z2pq/L2

Where z (at 95% confidence levels) =1.96–2;

P = 25.42;

q = 74.58; and

L = absolute error of 5%.

So sample size (n) =309 (303 plus 6 workers as dropout)

Inclusion criteria: All levels of workers who are ≥18 years of age and who were currently working in the workshop were included in this study.

Exclusion criteria: Those who reported injuries outside the working environment of workshop.

Those workers with preexisting medical conditions before the start of the study. These conditions are any cardiovascular disease, neurological and psychiatric disorders, and musculoskeletal disorders.

Those females who were pregnant at the time of study period.

Permission to conduct this research study was sought from Institutional Ethics Committee and from workshop manager and the safety officer. Informed consent was taken from every injured person with explaining the purpose of study.

Data analysis

The questionnaire responses were entered in Epi data software and the collected data were consolidated on Microsoft Excel sheets and further analyzed in Epi-info 7.1.3.0 version. The results were expressed as proportions and percentages. Chi-square test was used for qualitative variables to find association and P value <0.05 was considered statistically significant.

RESULTS

Table 1 shows that out of 309 respondents, 29.13% belonged to the age group of 38–47 years followed by 28–37 years, which comprises 26.21% with male preponderance (93.20%); 53.40% belonged to upper middle class followed by lower middle social class (43.69%) and only 3% of workers were from upper lower social class. All the respondents were permanent. Skilled workers (51.46%) were mostly exposed to injuries followed by semi-skilled workers (31.07%) and then unskilled workers (17.48%). Most of the respondents (78.64%) had been working for more than 5 years in the workshop. Majority had education up to junior high school (42%), which includes middle and primary school followed by intermediate level of education (32.04%) and around 6.80% respondents were graduates.

Table 1

Distribution of respondents by socio-demographic determinants

Table 2 shows that majority of workers belong to safety category department (69.90%). Among the safety category, most of the workers were welders (25.24%) followed by fitters (18.45%). In the essential category, painter and tool room workers were in equal proportion (5.83%) and 3.88% of workers were shunting master who belongs to nonsafety category.

Table 2

Distribution of respondents according to department of workshop

Table 3 shows pattern of injury among injured workers; the most common pattern of injuries among them are cuts or lacerations (29.13%) followed by abrasions (21.36%) and bruises (16.50%). Around 2.91% suffers from fractures and 0.97% suffered from burns, which are the cases of heat burns and 0.97% was suffered from welder's flash, 9.71% of workers shows eye foreign body, while 12.62% had sprains. Crushing head injury was seen in among 0.91% respondents and around 3% of workers suffered from heat stroke.

Table 3

Distribution of respondents on the basis of pattern of injuries

Table 4 shows a significant association between workers of age group 18–57 years with surface wounds (abrasions and contusions) and open wounds (cuts and lacerations), while age grouP ≥58 years shows a significant association with open wounds as the most common pattern of injury. Pertaining to the association between sex of the workers and the pattern of injuries, it revealed a significant association between male workers and surface wounds as the most common pattern of injury.

Table 4

Association of Age and Sex of workers with Pattern of injuries

Table 5 shows a significant association between workers with intermediate and high school level of education with surface wounds, while those with middle and primary school level of education shows a significant association with open wounds. Pertaining to the association between occupation and the pattern of injuries, both skilled and semi-skilled workers show surface wounds as the most common pattern of injury, but this association was not found to be statistically significant.

Table 5

Association between Education and Occupation of workers with Pattern of injuries

Table 6 depicts that though workers were aware of the availability of personal protective equipment (PPE) in workshop, they were not in their regular use. Only safety shoes, hard hat, and gloves were used regularly by all the workers (100%). Safety helmets and face shield were used regularly by 75.73% of workers. Safety goggles were used regularly by 66.02% of respondents. Full body safety suit (100%) and fire proximity suit (97.10%) were almost never used by the workers during their work in the workshop. 69.90% of workers never used ear plugs and 89.32% of workers never used ear muffs at the time of injury. 87.30% of workers were irregularly using face mask.

Table 6

Distribution of respondents on the basis of their utilization of PPE

Figure 1 is an enquiry into the pattern of PPE use that revealed an alarming fact: Regular use of PPE is done by every worker of the workshop but the percentage of utilization is low except shunting master who is 100%. 30% of the painters and 70% of tool room workers used PPEs irregularly.

Figure 1

Personal Protective Equipment's use among various workers group

DISCUSSION

Out of 309 respondents, 29.13% belonged to the age group of 38–47 years followed by 28–37 years, which comprised 26.21% with male preponderance (93.2%) and all the respondents were permanently employed and working for more than 5 years in the workshop. In a similar study conducted by Kumar et al. among study subjects, 85.4% were male workers and 38.4% belonged to age group between 38 and 47 years. Around 86% had permanent employment pattern.[7] A study by Suparna et al.[8] also supported the similar results as compared to the age groups in the present study, but the results were contrasting in employment pattern of the workers in which 66.4% were permanently employed. According to Biswas et al.,[9] all the workers in the factory were on temporary basis as the factory is seasonal. Thakur et al.[10] also support the results of our study, where the factory had male preponderance.

In the present study, 53.40% belonged to upper middle class followed by lower middle social class (43.69%), and only 3% of workers were from upper lower social class. In a study conducted by Chauhan et al.,[11] among study subjects in terms of education level, similar results were supported that 26% had high school level of education followed by primary school (21%) and graduate (5%). In a study by Yerpude and Jogdand, out of 474 study participants, 37% had primary school level of education, 28.9% educated up to middle school, and 8.44% were graduate which is different as compared to the present study.[12] In a study conducted by Chauhan et al.,[11] all the workers were welders because it was a welding industry. In a similar study conducted by Tiwary et al.,[13] it was found that there were 47% welders, 29% fitters, 11% supervisors, and 4% painters. In the present study among injured workers, the most common pattern of injuries among them are cuts or lacerations (29.13%), followed by abrasions (21.36%) and bruises (16.50%). In a study conducted by Abbas et al.,[14] the results were similar to the present study where cuts or lacerations are seen in 30.9% of construction workers, 28.6% had contusions, and around 14.3% workers suffered from sprains. Harrison et al. in their study found 42.6% of aging women had sprains, contusions were seen in 11.2%, and around 7.5% suffered from fractures. Lacerations were seen in 4.2%, which is different from the present study.[15] Only safety shoes, hard hat, and gloves were used regularly by all the workers (100%). Safety helmets and face shield were used regularly by 75.73% of workers. Safety goggles were used regularly by 66.02% of respondents and 87.3% of workers were irregularly using face mask. In a study conducted by Adewoye et al.,[16] out of 285 workers around 77% of workers regularly used safety goggles and 41% regularly used safety shoes, 70% used hand gloves regularly though the awareness is low as compared to our study, but regular utilization of PPE was higher. A study by Nanthini and Karunagiri [17] concluded that only safety shoes were used regularly by the workers, which is similar to our study. In this study significant association was seen between workers of age group 18–57 years with surface wounds (abrasions and contusions) and open wounds (cuts and lacerations). With respect to education of the workers, the present study showed a significant association between workers with intermediate and high school level of education with surface wounds, while those with middle and primary school level of education showed a significant association with open wounds. According to Nearkasen Chau et al.,[18] the main lesions were sprain or dislocation (23.7%), contusion (23.6%), wound (20.3%), vertebral column traumatism (17.9%), muscle tearing (13.2%), fracture (9.5%), crushing (8.5%), foreign body (2.3%), burn (1.5%) which was significantly associated with age grouP <30 years and primary level of education. In a study conducted by Biswas et al.,[9] cuts/lacerations were common pattern of injuries followed by contusions, which were significantly associated with age group 30–50 years and with primary level of education. Abbas studied contusions were the common pattern of injury, which was significantly associated with age group up to 50 years. With respect to education of workers, low level of education shows a significant association with open wounds, which is similar to our study.[14]

CONCLUSIONS

Occupational injuries are high and utilization of safety measures is low among workers on railway wagon repair workshop, which highlights the importance of strengthening safety regulatory services toward this group of workers. Younger age group workers show a significant association with open wounds and surface wounds. As the education level of workers increases, the incidence of injuries decreases. Apart from shoes, hat, and gloves, regular utilization of other PPE was not seen.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.