Prevalence and Risk Factor of Occupational Skin Complaints among Male Tannery Workers of Kanpur, India.

BACKGROUND: Occupational skin illnesses are the second most common occupational health hazard following musculoskeletal disorders. Tannery workers have frequent and prolonged exposure to skin irritants and allergens and may have a higher risk of developing occupational dermatitis. AIMS AND
OBJECTIVES: The aim of this study is to examine the extent of skin problems and their determinants among male tannery workers.
MATERIALS AND METHODS: The data for the present research was drawn from a cross-sectional household study of tannery and nontannery workers in the Jajmau area of Kanpur, Uttar Pradesh. A total of 284 tannery and 289 nontannery workers were interviewed using purposive sampling technique. Descriptive statistics and multivariate techniques have been used.
RESULTS: Tannery workers experienced itching hands or fingers with fissures (21%), scaling of hands or fingers with fissures (18%), red and swollen hands or fingers (11%), and vesicles on the hands or between the fingers (11%). The workers who had moderate/high dermal exposure to chemicals were 35(P < 0.001), and they were 31 (P < 0.001) times more likely to experience vesicles on scaling hands or fingers with fissures, and itching hands or fingers with fissures. The tannery workers engaged in wet finishing work were significantly 3.9 (P < 0.1) times more likely to experienced scaling on hands or fingers with fissures.
CONCLUSION: The study acclaims the mechanization of tannery activities at workplaces, so that risk of skin complaints can be minimized among tannery workers. As the risk of skin complaints is very high with the dermal exposure to chemicals, personal protective equipment must be provided and their use should be included in the curriculum of the ternary workers. Copyright:

Introduction

Leather production is one of the world's oldest trades, consisting of a chemical process that turns animal hides into much fewer perishable materials. The worker who works in the tanneries is liable to be affected by his exposure to lots of hazardous materials and processes during tanning. In this process, infection is a constant hazard as the hide serves as a medium for numerous microorganisms. Skin disorders such as eczema and contact dermatitis have been diagnosed among leather tanners exposed to chemicals during tanning and finishing process.[1] Most work-related dermatoses are subtypes of contact dermatitis. Skin contact with irritants or allergens is the leading cause of contact dermatitis. According to Kanerva et al., 2004, occupational skin diseases are the second most common occupational disease, following musculoskeletal disorders.[2]

It is important to mention that developing countries mostly have inadequate effective occupational health programs and inadequately developed and implementation laws and ordinances than those in the developed countries.[3] Therefore, complaint caused by occupation is less likely to be noticed in the developing countries somewhat as a result of poor occupational health services.[4] Toxic exposure of chemicals in tanneries workers is the main reason for health and safety violations. Skin and respiratory diseases are very common health problems among tannery workers due to the hazardous uses of chemicals.[5] These chemicals are potential irritants and sensitizers in workers who are frequently exposed to these for prolonged periods.[6] A study conducted in Kanpur among tannery workers found that 23 percent of tannery workers had dermatitis.[7] A Korean study on occupational skin diseases revealed that contact dermatitis was the most common (74.1%) among occupational skin diseases.[8] Chromium sulfate is often practiced in leather activities as a prime tanning means.[91011] Apart from this, many studies have accessed occupational skin diseases using a different method in different settings,[121314] but none of the studies has given the exclusive focus on the prevalence of skin complaints and its determinants among tannery workers. Therefore, this study is exclusive in this sense with the objective of determining the skin problems and their determinants among tannery workers using the empirical data set.

Materials and Methods

This study used the primary data from a cross-sectional household study of tannery and nontannery workers in the Jajmau area of Kanpur City in the state of Uttar Pradesh, India. The data collection operation was done during January-June 2015. The study has covered a total of 284 tannery and 289 nontannery workers from the study area, and they were interviewed using the pretested structured interview questionnaire. The three-stage sampling design was implemented for this study. Three areas, namely Budhiyaghat, Tadbagiya, and Asharfabad, were carefully chosen with the help of probability proportional to size (PPS) sampling procedure. Further, univariate, bivariate, and logistics regression analysis was used to explain the result of the study.

Results

Over one-fifth of the tannery workers (22%) reported skin complaints such as "itching hands or fingers, and fissures," while the same was experienced by 7.3 percent of the nontannery workers. The problems were diverse: vesicles on the hands or between fingers (11% and 2.4%); scaling on hands or fingers with fissures (18% and 3.8%); reddening and swelling of hands or figures (11% and 1.4%), and allergic dermatitis (9% and 2.4%) among tannery and nontannery workers [Table 1 and Figure 1].

Table 1

Percent distribution of workers having skin problems experienced in last 12 months preceding the survey reported by tannery and nontannery workers in Kanpur, India, 2015

Skin Complaints	n (%)
	Tannery workers	Nontannery workers
Red and swollen hands or fingers
Yes	32 (11)	4 (1)
No	252 (89)	285 (99)
Red hands/fingers and fissures
Yes	10 (4)	4 (1)
No	274 (96)	285 (99)
Vesicles on the hands or between the Fingers
Yes	32 (11)	7 (2)
No	252 (89)	282 (98)
Scaling hands or fingers with fissures
Yes	52 (18)	11 (4)
No	232 (82)	278 (96)
Itching hands or fingers with fissures
Yes	61 (22)	21 (7)
No	223 (78)	268 (93)
Have you experienced allergic dermatitis
Yes	25 (9)	7 (2)
No	259 (91)	282 (98)
Total	284 (100)	289 (100)

Figure 1

Skin cmplaints reported by the tannery workers in Kanpur, India, 2015

Tannery workers belong to the following categories: illiteracy, medium level of media exposure, 20 and more years of work experience, involvement in wet finishing work, works as a temporary worker, and a high level of dermal exposure to chemical had a higher prevalence of skin-related problems [Table 2].

Table 2

Prevalence of skin-related complaints reported by the tannery workers of Kanpur City, India, 2015

Background variables	Red and swollen hands or fingers	Vesicles on the hands or between the figures	Scaling hands or fingers with fissures	Itching hands or fingers with fissures	Number (n)
Age in years
16-24	3.5	3.5	0.0	0.0	29
25-35	6.8	8.7	20.4	20.4	103
36+	15.8	14.5	20.4	26.3	152
Education
Illiterate	15.5	14.4	22.5	28.9	187
Up to primary	5.3	13.2	21.1	15.79	38
Middle school	4.0	0.0	4.0	0.0	25
High school and above	0.0	0.0	3.0	3.0	33
Media exposure
Low exposure	10.8	9.2	15.4	24.6	65
Medium exposure	15.9	16.7	26.1	28.3	138
High exposure	3.7	3.7	7.4	7.4	81
Work experience
Up to 5 yr.	7.1	6.1	8.2	10.2	98
6 to 10 yr.	19.2	14.9	19.2	24.5	96
11 to 20 yr.	4.7	12.5	23.4	26.6	64
20 more yr.	14.3	14.3	39.3	39.3	28
Type of work
Beam housework	12.5	16.7	16.7	25	24
Wet finishing work	14.3	12.9	25.7	22.8	70
Dry finishing work	4.9	7.7	16.8	20.3	144
Miscellaneous work	25.5	17	12.8	21.3	48
Type of Job contract
Temporary job (daily wages)	11.9	12.3	20.2	23.3	255
Permanent job	6.5	3.2	3.2	6.5	31
Dermal exposure to chemicals
No exposure	2.5	5.1	3.8	6.3	80
Low exposure	16.2	12.3	10.8	11.5	149
Moderate/High exposure	10.5	17.5	57.9	68.4	57
	11.3	11.3	18.3	21.5	284

The model shows an elevated odds ratio, indicating that tannery workers belong to the upper age categories were 4.0 and 2.6 times more likely to have red and swollen hands or fingers, and vesicles on their hands or between the fingers. The workers having 20 or more years of experience were 10.4 (P < 0.01) and 3.2 times more likely to have scaling hands or fingers with fissures and itching hands or fingers with fissures. Further, the workers engaged in wet finishing work were significantly 3.9 (P < 0.1) times more likely to experience scaling on hands or fingers with fissures. Dermal exposures to chemicals resulted in significant odds for skin complaints [Table 3].

Table 3

Adjusted Odds ratio of skin problem among tannery workers of Kanpur City, India, 2015

Variables	Red and swollen hands or fingers	Vesicles on the hands or between the fingers	Scaling hands or fingers with fissures	Itching hands or fingers with fissures
Age in years
16-24®
25-35	1.201	1.496	1.29	0.529
36+	4.058	2.628	1.08	1.02
Education
Illiterate®
Up to primary	0.317	1.053	1.977	0.615
Middle school	0.333	1.08	0.653	1.05
High school and above	1.021	1.01	0.213	0.101**
Media exposure
Low®
Medium	3.28**	2.40**	2.43**	1.15
High	1.36	1.30	1.20	0.69
Work experience in current tannery
Up to 5 yr.®
6 to 10 yr.	2.584*	1.893	1.452	1.263
11 to 20 yr.	0.351	1.467	2.688	1.309
20 more yr.	0.629	1.181	10.463***	3.225*
Type of work
Beam housework®
Wet finishing work	0.911	0.803	3.982*	1.198
Dry finishing work	0.324	0.571	3.391	2.139
Miscellaneous work	1.271	0.929	2.222	2.184
Type of Job contract
Temporary job (daily wages)®
Permanent job	0.814	0.413	0.287	0.638
Dermal exposure to chemicals
No exposure®
Low exposure	6.083**	2.368	3.541*	1.89
Moderate/High exposure	3.334	2.52	35.154***	30.915***

®Reference category; ***P<0.001, **P<0.05, *P<0.01

Discussion

Itching hands or fingers with fissures was the more common problem among the tannery and nontannery workers, followed by scaling hands or fingers with fissures. Moreover, older and illiterate workers were more prone to skin disease. Our result is in the line of previous studies, which show that the linkage of the worker and developing the skin disease.[7] The odds of having a red shawling hand or finger and vesicle on hand and between the finger are higher among the workers aged 65 years or more. It may be because of the higher number of years spent by these workers in the tannery work.

The workers having more than 11 years of experience working as a tannery worker have reported higher skin complaints. The study conducted in other places also confirms this result.[1516] More experience of working is linked with the higher exposure to harmful chemicals and other toxicants which is responsible for skin disease or complaints. Our study found that the risk of developing scaling hands or fingers with fissures and the itching hand of fingers with fissures is higher among those tannery workers who were associated with wet finishing work, dry finishing work, and miscellaneous work compared to beam housework. This is because in this section, workers are directly involved and exposed to harmful chemicals. Interestingly, the risk of skin complaints is less among permanent workers than a temporary worker (wage labors). Moreover, as expected, dermal exposure to the chemical is highly significantly associated with skin problems among tannery workers. It is obvious because at the time of animal hide process, many chemicals (such as chromium, benzene, formaldehyde, etc.) have been used, which is very detrimental for human skin. Some of the studiesl have also shown the association of dermal exposure to chemicals and skin problems,[1116171819] and our study is also affirming the previous findings.

In conclusion, the prevalence of skin complaints is higher among tannery workers. The results depict the statistically significant association of skin complaints with the work experience, type of work, type of job, and dermal exposure to the chemical. However, work-related problems can affect the quality of work and unpleasantly affect the efficiency of daily life. Tannery workers are exposed to chemicals in hot and humid environmental conditions. Due to a lack of awareness and unavailability, tannery workers do not use PPE, especially those engaged in dry and wet finishing work. By using personal protective gear, tannery workers can minimize the risk of skin irritants and complaints. Further, advanced research needs to be conducted on the occupational hazards for Indian tannery; therefore, the authority must take adequate steps to eliminate the risk factors associated with it.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.