|Year : 2014 | Volume
| Issue : 1 | Page : 9-12
A study on morbidity among automobile service and repair workers in an urban area of South India
Mathew Philip, Reginald G. Alex, Soumya S. Sunny, Anand Alwan, Deepak Guzzula, Rajan Srinivasan
Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Web Publication||21-Jun-2014|
Reginald G. Alex
Department of Community Health, Christian Medical College, Vellore 632 002, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: Service sector in Indian industrial growth has obtained significant numbers. Automobile service industry is one of the largest in the world with a majority of the workers in unorganized sector of the industry. This study was carried out among auto service industry workers in Vellore urban area to assess possible occupation related morbidity. Materials and Methods: A cross-sectional observation study was carried out among 106 automobile repair shop workers. Results: Half (47%) suffered work related stress, 32 (30.2%) reported exposure to dust, 81 (76%) to heat, and 50 (17%) to hazardous chemicals and heavy metals. More than 90% reported over exposure to petroleum products. A third reported cough for more than 2 weeks, more than a quarter reported gastrointestinal symptoms associated with work. Half of them reported musculoskeletal complaints associated with work with a quarter reporting un-intentional work place injuries. A tenth of them were found to have reduced pulmonary function on testing and nearly half had impaired sensory functions in peripheries. Reduced pulmonary function was found to be significantly associated with heavy metal exposure (P = 0.001). Peripheral neuropathy was significantly associated with years of occupation (P = 0.001), exposure to petroleum products (P = 0.03) and exposure to heavy metals (P = 0.018). Discussion: Half of the workers were unaware of health problems associated with their occupational exposures and thereby the use of personal protection is abysmally low. A very high proportion of workers had symptoms of cough, breathlessness, abdominal pain, abdominal discomfort and muscle aches. Almost a quarter of the workers had un-intentional occupational injuries in the last 6 months. Though they work in a high-risk environment with chances of fire hazard, falls and chemical exposures, none of the workshops had fire-extinguishers, first aid kits or any such safety devices.
Keywords: Occupational health, automobile workers, morbidity, personal protection equipment
|How to cite this article:|
Philip M, Alex RG, Sunny SS, Alwan A, Guzzula D, Srinivasan R. A study on morbidity among automobile service and repair workers in an urban area of South India. Indian J Occup Environ Med 2014;18:9-12
|How to cite this URL:|
Philip M, Alex RG, Sunny SS, Alwan A, Guzzula D, Srinivasan R. A study on morbidity among automobile service and repair workers in an urban area of South India. Indian J Occup Environ Med [serial online] 2014 [cited 2020 Jan 21];18:9-12. Available from: http://www.ijoem.com/text.asp?2014/18/1/9/134946
| Introduction|| |
The service sector of industry also known as the tertiary sector is one of the three major sectors in the industry. The service sector emerged as the major sector of the economy both in growth and share in gross domestic product (GDP) in the 1990s. This sector has shown uniform growth and has shown that it is resilient even to the economic adversities even during down turn of the industry.
The global automotive repair and maintenance services industry is expected to be worth almost $306 billion by 2015.  The Indian automotive aftermarket is currently estimated at Rs. 33,000 contributing 2.3% of India's GDP.  The automotive aftermarket for parts in India is a large and growing market that spans manufacturers, distributors, retailers, service providers, and garages. The size of the automotive service market in India is estimated at 8-10 billion USD. It is estimated that 50% of this sector is unorganized.  The auto services sector currently employs an estimated manpower of 787, 7702 and increasing at the rate of 12% p.a.  This service sector is more prevalent in the rural areas when compared to the urban areas due to lower penetration of the organized sector into this areas.
Studies among this sector has shown employees suffer long working hours combined with poor remuneration and little social security, in the event of disease, disability, or death. The owners of such small workplaces are generally found to discount the health hazards and leave it to the workers themselves to manage their health problems.  Occupational risk among technicians working in these places range from exposure to various chemicals such as gasoline, benzene, lead, asbestos, exhaust fumes to work related accidents, musculo-skeletal trauma due to poor ergonomics at work places and psycho social problems like alcohol and nicotine dependence.  A study done in France to identify risk factors of laryngeal and hypo pharyngeal cancers showed that there was an excess risk among auto service workers (odds ratio-2.2, 95% confidence intervals-1.3-3.9)  Another study done among automobile radiator repair workers in New York city revealed that 67% of workers had blood lead levels in excess of permitted hazard levels.  A similar study assessing lead exposure in automobile workers in India showed a significant increase in levels of lead and an associated significant reduction in levels of zinc.  A 10 years followup study among automobile repair workers in The Netherlands, to assess cause specific mortality showed an increased mortality due to mesothelioma, urinary tract cancer, pancreatic cancer and ischemic heart disease.  A proportionate mortality ratio analysis of deaths in New Hampshire state of the United States of America among automobile mechanics, revealed increases in mortality from leukemia, lymphoma, oral, lung, and bladder cancers apart from an increased mortality due to cirrhosis of liver and suicide.  A cross-sectional study done in Egypt, to study contact dermatitis in automobile repair workers, showed the prevalence of contact dermatitis to be 18.4% against 3.9% prevalence among the control group which involved book sellers.  In a study to assess the lung function among automobile repair workers in Kolkata city, spirometry of the participants showed that 25.8% had obstructive impairment, with battery workers and spray painters at a higher risk. 
This study was done among automobile repair workers in November 2012 to assess the prevalence of health problems among these workers and their awareness about personal protection equipment (PPE). The study was done in Vellore urban area within corporation limits.
| Materials and methods|| |
A pilot survey was undertaken to gauge the prevalence of health problems in automobile repair workers and their awareness about PPE. A cross-sectional study was designed, involving 120 automobile repair workers from Vellore corporation limits. Recruitment was done after obtaining a written informed consent and the participants were administered a local language translation of a semi-structured, pilot tested questionnaire to find out exposure to potentially harmful environments, use of PPE and prevalence of health problems. Peripheral sensory neuropathy was assessed with 2 g monofilament and peak expiratory flow rates (PEFRs) were found out using a peak flow meter. Workers who had entered the profession in the last 1 year were excluded from the study. Data entry was done using Epi-info 7.0 (CDC, Atlanta, USA) and analyzed using SPSS 17.0 (IBM Inc, USA).
| Results|| |
The survey was done during the month of November 2012, and involved a total of 120 automobile repair shops of which 106 (88%) workers responded. The age of the respondents ranged from 17 to 67 with a mean age of 30.8 and a standard deviation of 9.9. Nearly, 75% of the participants were in continuous employment in the same industry for more than 10 years. Of the surveyed workers, only 24 (22.6%) had completed high school education, with the rest mostly discontinuing formal education early. Only 4 (3.7%) of the automobile repair workers had received formal training or certification. Work mostly learned through apprenticeship with various senior workers. About 17% of the surveyed automobile workers were owners of the establishment too with the rest being paid employees. A majority (84.9%) did multiple general work in repairing and servicing of the automobile, while 16 (15.1%) were specialized workers involved in complex works such as radiator servicing, battery repair, painting work, gearbox works, etc. The mean income of the workers surveyed was around INR 5350 a month.
All of the surveyed workers reported more than 40 h of working time per week with 3 (2.8%) worked in shifts. Nearly, half (45.3%) of the workers were not satisfied with their job, for reasons like low wages and strenuous work mentioned by most. Half (47.2%) of automobile workers reported stress at workplace and 26 (24.5%) said it adversely affected their family life in various ways. Seventy-seven (72.6%) workers did not have any social security while the rest had either provident fund or employees' state insurance scheme with only 7 (6.6%) having provision for paid sick leave. Thirty-three (31.1%) of the workers said PPE was available for use in the workshop, but only 9.4% of them use it regularly due to various reasons [Table 1].
Half (53) of the surveyed workers were unaware of any occupational diseases associated with their line of work, though 32 (30.2%) reported exposure to dust, 81 (76.4%) had exposure to heat, 50 (47.2%) mentioned exposure to chemicals which included battery acids, engine coolants, gear oil, engine oil, brake oil, lubricants, etc. Most (90.6%) of surveyed workers were exposed to petroleum products in some part of their work with 18 (17%) of the workers were involved in Battery servicing and electroplating works, which involved possible exposure to heavy metals.
Nineteen (17.9%) of the workers reported cough or breathlessness lasting for more than 2 weeks, in the last 6 months while 31 (29.2%) had dyspepsia or abdominal pain during the same period. Forty-seven (44.3%) participants reported muscle and joint pains in the last 6 months while only 6 (5.7%) had any skin rash or skin irritation. Twenty-six (24.5%) reported of un-intentional workplace injuries in the last 6 months. A focused clinical examination of the participants revealed that 10 (9.4%) had pallor, 11 (10.4%) had features suggestive of contact dermatitis, while 6 (5.7%) had wheeze or crackles on auscultation. Seventeen (16%) of the workers had an average peak flow, <300 L/min and 50 (46.2%) had impaired sensations in their feet, when tested with a 2 g monofilament [Table 2].
Cross-tabulations and tests of proportions were done to find out association between different variables. Cough or breathlessness for more than 2 weeks was found to be significantly associated with age (P = 0.046) and exposure to chemicals (P = 0.032). Reduced peak flow was seen more with ages above 40 (P = 0.001) and exposure to heavy metals (P = 0.001). Peripheral sensory neuropathy was seen significantly associated with age (P = 0.001), years of service (P = 0.001), exposure to petroleum products (P = 0.03) and exposure to heavy metals (P = 0.018) [Table 3].
| Discussion|| |
The work environment observed during the course of the study painted a dismal picture with continuous working hours and no provision for rest, a very high proportion of workers reported work-related stress and poor job satisfaction. This is consistent with previous studies, which proves that blue-collar workers are more at risk of work-place stress than white collar workers.  Majority of the workers interviewed had no provision for social security when schemes like employees provident fund and employee state insurance coverage were available. ,
Half of the workers were unaware of any health problems due to their occupational exposures and thereby the use of personal protection is abysmally low. A very high proportion of workers had symptoms of cough, breathlessness, abdominal pain, abdominal discomfort and muscle aches, but only very few numbers has sought medical attention to the problems, main reason for which was poor finances coupled with high medical costs. The mean monthly income for the surveyed workers were INR 5350, which makes spending on healthcare a luxury, which most of them cannot access. The lack of paid sick leaves and any social security net can be read along with any data on poor health seeking behavior. Almost a quarter of the workers had un-intentional occupational injuries in the last 6 months. Though they work in a high-risk environment with chances of fire hazard, falls and chemical exposures, none of the workshops had fire-extinguishers, first-aid kits or any such safety devices. Furthermore, none of the workers had received any formal training in workplace safety or administration of first aid. The findings of high prevalence of peripheral sensory neuropathy in the surveyed workers, when examined using a 2 g monofilament may be due to the subjective nature of the test and poor foot hygiene, as the examination was done in the workplace itself which was recognized as a limitation of the study. Also the validity of PEFR measurements using peak flow meters is sub-optimal, as the techniques of measurements are difficult to teach and highly subjective in nature this was a limitation. This study was aimed as a pilot study in giving directions for future research in health problems affecting unorganized and marginalized occupational groups such as automobile repair and service workers. Further research employing advanced techniques like blood picture, heavy metal assays, nerve conduction studies, biothesiometry, pulmonary function tests etc., are needed.
| Acknowledgment|| |
The authors would like to thank Dr Kuryan George, Professor and Head, Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
| References|| |
|1.||Automotive Service Industry: Market Research Reports, Statistics and Analysis. Available from: http://www.reportlinker.com/ci02295/Automotive-Service.html. [Last accessed on 2013 Sep 26]. |
|2.||Auto Serve-2012. Available from: http://www.ciiautoserve.in/autoserve/indus.php. [Last accessed on 2013 Sep 25]. |
|3.||Skill Gaps in Indian Automotive Service Sector. Available from: http://www.kpmg.com/IN/en/IssuesAndInsights/ArticlesPublications/Documents/Skill%20Gaps%20In%20Indian%20Automotive%20Service%20 Sector.pdf. [Last accessed on 2013 Sep 25]. |
|4.||Bhasker VV. Indian auto component industry: A decade of growth and way forward. Res J Manage Sci 2013;2:19-27. Available from: http://www.isca.in/IJMS/Archive/v2i3/4.ISCA-RJMS-2013-014.pdf. [Last accessed on 2013 Sep 26]. |
|5.||Joan ME. Leaving it up to the workers: Sociological perspective on the management of health and safety in small workplaces. Occup Environ Med1997;54:477-82. |
|6.||Schwartz E. Proportionate mortality ratio analysis of automobile mechanics and gasoline service station workers in New Hampshire. Am J Ind Med 1987;12:91-9. |
|7.||Goldberg P, Leclerc A, Luce D, Morcet JF, Brugère J. Laryngeal and hypopharyngeal cancer and occupation: Results of a case control-study. Occup Environ Med 1997;54:477-82. |
|8.||Nunez CM, Klitzman S, Goodman A. Lead exposure among automobile radiator repair workers and their children in New York City. Am J Ind Med 1993;23:763-77. |
|9.||Singh B, Dhawan D, Nehru B, Garg ML, Mangal PC, Chand B, et al. Impact of lead pollution on the status of other trace metals in blood and alterations in hepatic functions. Biol Trace Elem Res 1994;40:21-9. |
|10.||Hansen ES. Mortality of auto mechanics. A ten-year follow-up. Scand J Work Environ Health 1989;15:43-6. |
|11.||Attwa E, el-Laithy N. Contact dermatitis in car repair workers. J Eur Acad Dermatol Venereol 2009;23:138-45. |
|12.||Chattopadhyay O. Pulmonary function in automobile repair workers. Indian J Community Med 2007;32:40-2. |
|13.||d'Errico A, Cardano M, Landriscina T, Marinacci C, Pasian S, Petrelli A, et al. Workplace stress and prescription of antidepressant medications: A prospective study on a sample of Italian workers. Int Arch Occup Environ Health 2011;84:413-24. |
|14.||The Employees' provident funds miscellaneous funds act, 1952. Available from: http://www.epfindia.gov.in/EPFAct1952.pdf [Last accessed on Oct 1, 2013] |
|15.||Employee State Insurance Act, 1948. Available from: http://www.labour.nic.in/upload/uploadfiles/files/ActsandRules/SocitySecurity/TheEmployeesAct1948.pdf [Last accessed on Oct 1, 2013] |
[Table 1], [Table 2], [Table 3]