|Year : 2014 | Volume
| Issue : 2 | Page : 89-94
Health profile of workers in a ship building and repair industry
Vaishali R Lokhande
Department of Medicine, Terna Medical College, Nerul, Navi Mumbai and Central Labour Institute, Sion, Mumbai, India
|Date of Web Publication||12-Dec-2014|
Vaishali R Lokhande
Department of Medicine, Terna Medical College, Nerul, Navi Mumbai - 400 706, and Central Labour Institute, Sion, Mumbai
Source of Support: None, Conflict of Interest: None
Background: The modern ship building industry, which encompasses the ship yards and marine equipment manufacturing, is an important and strategic industry. The various activities in modern ship building, maintenance, and repair have to be carried out at heights, or in closed confined spaces along with the added risk of exposure to chemicals and metal fumes. These activities expose the workers to various health hazards. Aims: This study was carried out with an aim to assess the health profile of workers in the ship building industry and to assess the occupational health issues related to ship building. Settings and Design: It was a cross-sectional study carried out on 100 randomly selected workers in a ship building yard in Mumbai, and their health profile was studied. Materials and Methods: The workers were enquired for history of co-morbidities, addictions and personal protective equipment use, health-related complaints, and were examined systemically as well as for bedside tests for hearing and detailed systemic examination as per the history or co-morbidity. Results: The important observations were those of prevalence of addictions (69%), irregular use of personal protective equipments (PPEs) among 50% of paint workers, presence of hypertension (20%), overweight (53%), osteoarthritis (10%), hearing loss (25%), and poor self-care. Conclusions: Health education to the workers regarding occupational hazards and lifestyle diseases along with more emphasis on the use of PPEs with regular health examination needs reinforcement.
Keywords: Health education, occupational health hazards, personal protective equipments, shipbuilding workers
|How to cite this article:|
Lokhande VR. Health profile of workers in a ship building and repair industry. Indian J Occup Environ Med 2014;18:89-94
| Introduction|| |
The modern ship building and repair industry is a very important industry. The various activities carried out include: Dry docking, and launching, fabricating and repairing large structural components, handling large materials, outfitting, surface preparation and scaling, electrical maintenance and repair, welding, electroplating, loading and unloading, and painting. These are fraught with hazards as most of these are carried out in closed spaces. Injuries, fatalities, electrocution, paint fumes inhalation and asbestos exposure-related respiratory problems, fires and explosions from welding, noise-induced hearing loss, and lead intoxication are few of the many health hazards that the workers are exposed to.
The study was planned with an aim of assessing the general health profile of these workers, any health issues, habits regarding personal protective equipment (PPE) use, to look for specific occupational health hazards, and to undertake or suggest appropriate measures or make recommendations to minimize the hazards, if any.
| Materials and methods|| |
The study was conducted at a shipbuilding yard in Mumbai. The data were collected in the general shift of workers around the lunch hours so as to cause minimum inconvenience to work. It was a cross-sectional study of 100 workers selected randomly from the ship yard. There were no exclusion criteria as the primary aim was to assess the health profile and health problems. The workers were enquired about their number of working years, previous occupations, previous hospitalizations as a result of work-related problems, comorbidities, addictions, use of PPEs, and any health-related complaints in particular. They were subjected to a detailed physical examination including blood pressure (BP), body mass index (BMI), hearing by absolute bone conduction (ABC) test, and systemic examination. The medical records of workers who had prior illnesses were examined too.
The findings were tabulated and analyzed for mean/average values and mode for frequency distribution. The workers were categorized according to the nature of work performed and the data were analyzed accordingly for any peculiar/predominant observations as per the worker groups to detect patterns.
| Results|| |
Of the 100 workers examined, the predominant group was that of painters (38%) and electricians (31%) [Figure 1]. The rest were electroplaters, welders, carpenters, fabricators, loaders, manual laborers, supervisors, and still workers.
The average age of the sample was 51.8 years with majority in the 46-50 years age group and the average years of working were 27.2 years. Seven percent of the workers had a history of fracture and hospitalization following accidental injury while at work; most were cases of forearm bone fractures (3/7), the rest were rib fractures, spine fracture, and metatarsal bone fracture. Two out of the eight welders, that is, 25% had sustained burns while welding. Two out of the 38 paint-shop workers (5%) had developed occupation-induced asthma; - they were on inhaled bronchodilators and 5% of the painters had developed skin reactions to paints. There was a history of diminished hearing in one worker. Alcohol addiction was present in 28% of the workers, most of them were painters (26.3%) and electricians (29%). Smoking and tobacco consumption was more common among painters (23%) and electricians (32%) [Figure 2].
An enquiry into the pattern of PPE use revealed an alarming fact: 33% of the supervisory staff and 13% of the electricians did not use PPEs at all. Fifty percent of the painters used PPEs irregularly. All of the electroplating workers, manual laborers, fabricators, and loaders used essential PPEs regularly [Figure 3].
|Figure 3: Relevant personal protective equipment use among various worker groups|
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Thirty-five percent of the workers studied were hypertensive detected at the time of examination or were on medications for hypertension, of these 5% had uncontrolled hypertension with BP > 180/100 mmHg, 6% were diabetic. The prevalence rate of hypertension was highest among painters and electroplaters [Figure 4]. This group also had higher numbers of overweight workers [Figure 5]. Fifty-seven percent of the workers were found to be overweight with BMI > 25 [Table 1] and [Figure 5]
Osteoarthritis knee was observed in 43% (3/7) electroplaters, 50% (1/2) welders, and 19% (6/31) electricians. One loader complained of neck pain with sensory symptoms in both the arms in the form of tingling. Neurological examination revealed no gross deficit suggesting early cervical spondylosis. Fifteen workers reported pain in and around the shoulder region; 10 of them reported pain specifically near the acromioclavicular area. The shoulder joint movements were free.
Six percent of the workers were asthmatic, one had gout, one had cataract, two had ischemic heart disease, one had renal calculi, five had hernia who were all loaders, and one had hydrocele.
Absolute bone conduction (ABC) test using 256 and 512 Hz tuning fork revealed that 45% (14/31) electricians and 57% (4/7) electroplaters had reduced ABC as compared with the examiner whose hearing was normal [Figure 6]. All those with reduced hearing by ABC test could not confirm regular use of ear protection.
Dermatitis was found in 25% fabricators, 5% painters, and 3% electricians. Bronchospasm was observed in 11% painters and 13% welders. None of the workers had any eye complaints. Eye examination using a torch revealed cataract in one worker in both eyes and he was suggested to see an ophthalmologist.
The study revealed several health problems predominantly, addictions, overweight issues, across all class of workers with general apathy toward the use of PPEs and poor self-care.
| Discussion|| |
The shipbuilding industry is involved in several activities carried out in confined spaces and therefore exposing the workers to several health hazards.  Many of these operations produce emissions, which may cause detrimental effects on humans, such as cancer and lead poisoning. Pollutants may also be mutagenic or teratogenic. 
The process of docking is associated with hazards such as injuries following overturning of the ship during dry docking and launching if safety measures are inadequate.  Fabricating and repair of large structural components involves cutting, welding, and so on, using metal saws, oxy-acetylene and oxy-propane cutting torches, automatic welding equipment, and aluminum oxy-acetylene arc. These processes are fraught with hazards of respiratory irritation and systemic poisoning from exposure to toxic fumes and particles along with thermal burns from welding. Artificial ultraviolet radiation from welding increases the risk of cortical cataract, conjunctival neoplasms, and ocular melanoma.  Welding can produce metal fumes responsible for metal fume fever, bronchial asthma, chronic obstructive airway disease, pneumoconiosis, and lung cancer. , According to a study on the effects of ultraviolet radiation produced during welding operations, the radiation also affected the auxiliary workers involved in other operations.  In this study, 13% of the welders had bronchospasm needing inhaled bronchodilators, and two of them had sustained burns while welding.
Asbestos is used in insulating piping and fireproofing, thereby exposing the workers to potential hazards of respiratory damage. Significant excess all-cause mortality, increased incidence of lung cancer, and mesothelioma, have been reported related to asbestos exposure.  Painting is usually performed in confined spaces and tanks, thereby releasing particles leading to lead poisoning. Most of the paint-shop workers in this study reported showering prior to leaving work shift, although irregularly and not very reliably. In a study involving boatyard workers, the blood lead levels of workers were significantly related to the job and level of education, with high potential for "take-home" contamination; and simple habits such as showering or changing clothes prior to leaving shift influenced the risk of contamination.  Increased airway inflammation in atopic, nonsmokers exposed to isocyanates as seen in spray painters indicates hyper-responsiveness.  In this study, bronchospasm was observed in 11% of painters and 13% of welders underlining the increased risk of bronchial hyper-responsiveness on exposure to isocyanates and metal fumes. ,
Workers involved in drilling operations using hand-held vibrating tools may suffer from the hand arm vibration syndrome (HAVS) with definite increased mean vibration perception threshold (VPT) as compared with controls.  In this study, none of the workers dealing with drilling operations such as carpenter, electricians complained of arm vibration symptoms.
Dermatitis is a common problem among boat-building industry workers with as many as 25% reporting dermatitis.  Skin irritation along with respiratory symptoms as a result of chronic intoxication by fumigants is seen especially in workers involved in loading and unloading of containers.  One of the fabricators, two painters and one electrician in this study were found to have dermatitis.
Exposure to nickel compounds during welding and electroplating can cause skin irritation, lung fibrosis, and cancer.  The process of electroplating may release hexavalent chromium, which may cause DNA damage leading eventually to neoplastic transformation. , Therefore the potential for workplace hazards for ship workers is high if adequate precautionary measures including the use of PPEs are not taken. In this study, the electroplating workers and fabricators were compliant with PPE use, whereas the electricians (13%) and supervisor staff were noncompliant. Fifty percent of the painters used relevant PPEs regularly.
A history of addictions elicited from the workers revealed that 28% of those consumed alcohol and most of them took it regularly with the average intake of two pegs per day. Alcohol consumption was the highest among electricians (29%) and painters (26%). Seventeen percent of the workers smoked cigarettes or bidis with an average consumption of 1.69 packs per day. Thirteen percent consumed tobacco in other forms. Tobacco use was observed the most in electricians (32%) and painters (23%). Psychoactive substance use remains a major health concern among workers.  Substance abuse may compound the risk of lung problems and accidents as well. A study has also revealed increased incidence of stomach, liver, and lung cancers among production workers probably related to occupational exposure, although the study did not comment on the causative factors.  The added effect of smoking and alcohol to occupational exposure to hazardous chemicals in the setting of noncompliance to PPE use may contribute toward increased cancer risk.
The study revealed that 7% of the workers suffered workplace-related falls, fracture, and hospitalizations; most of these could not confirm the use of PPE at the time of fall. There were no head injuries reported though. A study revealed that the main contributing factors for workplace fatalities were hazardous conditions; an error of judgment; unsafe work practices; and failure to wear a personal protective device, which could have been lifesaving. 
Noise is prevalent in a ship yard and engineering controls are difficult to implement as the workstations are not fixed leading to noise-induced hearing loss. It is a definite hazard in workplaces involving major operations such as drilling and outfitting, descaling, and electroplating. This may get magnified if the noise levels are compounded by exposure to solvents such as toluene, styrene, xylene as observed in shipping, paint and, laquer industry.  Chronic and intensive styrene exposure that occurs in boat-building workers involved in lamination process increases the hearing threshold with improvements of hearing thresholds during work- and exposure-free period suggesting a direct correlation. , Forty-five percent of the electricians and 57% electroplaters in this study had decreased absolute bone conduction when examined by tuning forks of 256 and 512 Hz frequency as compared with normal. These will need detailed ear examination and pure tone audiometry for dip in hearing at 4000 Hz to detect noise-induced hearing loss. More importantly, the reinforcement of using PPEs for ear protection is necessary.
Ten workers reported knee pain and they had features suggestive of osteoarthritis knee. Six of them were electricians, three electroplaters, and one welder. All of them had BMI above 25 kg/m 2 and none could recollect any history of specific trauma to the knees. One loader complained of neck pain with sensory symptoms in both arms in the form of tingling but no neurological deficit suggesting cervical spondylosis. Fifteen workers reported pain in and around the shoulder region; 10 of them reported pain specifically near the acromioclavicular area. The shoulder joint movements were free. Occupation-related musculoskeletal disorders are fairly common in ship workers, and ergonomic intervention can prevent these disorders. 
Fifty-three percent of the workers were overweight and this was prevalent across all worker classes. Thirty-five percent workers were hypertensive, detected at the time of examination or were on medications. The prevalence rate of hypertension was highest among painters and electroplaters in this study as noted in other studies. , The study also found high incidence of hearing impairment as detected by absolute bone conduction test (25%) along with hypertension (35%), although there was no overlap observed as noted in another study. 
The possibilities of a number of hazards during shipbuilding work imply that workplace practice and attitudes toward ensuring safe environment will prevent and reduce occupational health hazards. Knowledge, attitudes, and safe practice patterns among the workers will definitely improve after proper training and this may even encourage active participation from the workers in suggesting or planning workplace safety modifications.  Automation of production processes that involve hazardous processes along with prevention policies, including education of workers and surveillance, will minimize work-related injuries. 
The workers in shipbuilding industry suffer from a number of issues, notably, addictions; apathy regarding PPE use; occupation-related hazards, such as asthma, dermatitis, hearing deficits, musculoskeletal disorders; and lifestyle diseases, such as overweight, obesity, and hypertension. Health education to the workers to emphasize on the prevailing health problems and potential occupation-related health hazards is essential. Emphasis on the proper and timely use of relevant personal protective equipments with additional legislative disciplinary measures may be needed. Periodic medical examination for all worker classes to detect lifestyle diseases and timely intervention will reduce work absenteeism and morbidity, mortality among workers. Regular hearing tests with audiometry will be useful as most of these workers are exposed to high levels of noise for most part of the shift. Finally, regular counseling and feedback regarding addiction hazards, healthy lifestyle measures to reduce cardiovascular risk, and emphasis on PPE use are recommended.
| Acknowledgment|| |
The authors acknowledge the Ship yard, Mazagaon Dock Limited, Mumbai, where the study was carried out and thank Dr. Prashant Lanjewar, Director, Central Labour Institute, Sion, Mumbai, for his guidance on the project.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]