|Year : 2014 | Volume
| Issue : 3 | Page : 122-128
A study of morbidity pattern among iron and steel workers from an industry in central India
Manish J Biswas, Anil R Koparkar, Mohan P Joshi, Shilpa T Hajare, Nandakishor B Kasturwar
Department of Community Medicine, Narendra Kumar Prasad Salve Institute of Medical Sciences and Research Centre, Nagpur, Maharashtra, India
|Date of Web Publication||12-Dec-2014|
Anil R Koparkar
Department of Community Medicine, NKP Salve Institute of Medical Sciences and Research Center, Nagpur - 440 019, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Iron is the world's most commonly used metal and can usually be found with other elements in the form of steel. In this era of machines, it is the inevitable part in production of various materials like eyeglass frames, jet aircraft, the space shuttle, automobiles, and surgical instruments. Occupational factors make an important contribution to the global burden of disease, but the reliable data on occupational disease are much more difficult to obtain. Hence, the current study was carried out to find out the morbidity pattern among iron and steel workers Materials and Methods: A cross-sectional study. was carried out after obtaining permission from Institutional Ethics Committee in an iron and steel factory. Worker's detailed information regarding profile was taken in pretested questionnaire format after obtaining the informed written consent and explaining the purpose of study. Workers were also interviewed regarding their years of job, job satisfaction, usage of protective devices, and history of injuries during work. Worker's detailed general and systemic examination was conducted. Results: The overall prevalence of morbidities among the workers was 60%. It was observed that commonest morbidity in the workers was lumbago (musculoskeletal pain), that is, 33.25%which was more in Group B (49.73%) than Group A (18.78%), followed by occupational dermatitis (27%) which more common in Group A (33.33%) than Group B (19.79%). It was seen that occupation-related morbidities were more prevalent in Group A, i.e. Exposed group (P < 0.001). Conclusion: It was observed that occupation-related morbidities were more common in exposed group (EG) than that of nonexposed group (NEG) and the difference was found to be statistically significant (P < 0.001).
Keywords: Exposure, morbidities, steel factory
|How to cite this article:|
Biswas MJ, Koparkar AR, Joshi MP, Hajare ST, Kasturwar NB. A study of morbidity pattern among iron and steel workers from an industry in central India. Indian J Occup Environ Med 2014;18:122-8
|How to cite this URL:|
Biswas MJ, Koparkar AR, Joshi MP, Hajare ST, Kasturwar NB. A study of morbidity pattern among iron and steel workers from an industry in central India. Indian J Occup Environ Med [serial online] 2014 [cited 2020 Jan 18];18:122-8. Available from: http://www.ijoem.com/text.asp?2014/18/3/122/146909
| Introduction|| |
Iron is the world's most commonly used metal and can usually be found with other elements in the form of steel.  In this era of machines it is the inevitable part in production of various materials like eyeglass frames, jet aircraft, the space shuttle, automobiles, and surgical instruments.  The total production of steel in the world in 2012 was 121,293 thousand tons and that of India was estimated to be 6,600 thousand tons. 
The iron and steel industries have foundries consisting of oven and furnaces; which involve heat, noise, vibration, and dusty environments. Therefore, iron and steel workers are especially prone to occupational health problems and experience more sickness absenteeism.  The work-related morbidity and mortality not only results in suffering and hardship for the worker and his or her family, but it also adds to the overall cost to society through lost productivity and increased use of medical and welfare services. 
Occupational factors make an important contribution to the global burden of disease, but the reliable data on occupational disease are much more difficult to obtain. 
Leigh et al., has given the estimate of global burden of occupational disease. He has reported annual incidence of occupational morbidity as 4,240,700-10,010,800 cases per year and annual mortality of 583,700-704,200 per year. 
According to the data of year 2009 for National Programme for Control and Treatment of Occupational Diseases there are 100 million occupational injuries in India causing 0.1 million deaths. It is also estimated that in India, 17 million occupational nonfatal injuries (17% of the world) and 45,000 fatal injuries (45% of the total deaths due to occupational injuries in world) occur each year. Out of 11 million cases of occupational diseases in the world, 1.9 million (17%) are contributed by India; and out of 0.7 million deaths in the world, 0.12 million (17%) is contributed by India.  In 1986, the workforce in our country was 6 million, which now is 62 million due to the tremendous mushrooming of industries. 
The most common morbidities in occupational health reported by WHO are back pains, hearing loss, chronic obstructive lungs disease, asthma, injuries, lung cancer, and leukemia. 
Thus, industrial workers show high level of morbidities. In order to improve the quality of life of the industrial workers, it is essential that the burden of diseases among them be reduced. Depending upon the pattern and the magnitude of the morbidity, one could focus primary healthcare services to suit the local conditions. Hence, the current study was carried out to find out the morbidity pattern among iron and steel workers and to recommend corrective measures based on finding of study
| Materials and methods|| |
A cross-sectional study was carried out after obtaining permission from Institutional Ethics Committee.
Study area and study population
Study was conducted in an iron and steel factory situated 7 km away from tertiary care teaching hospital. The unit was involved in manufacturing of carbon alloy and stainless steel. The factory has five divisions as follows:
• Steel melting section (SMS): where the continuous casting of molten metal with complete stream shrouding is done. Solidification of the melted material and the testing of material is done in blooming section
• Rolling mill section (RMS): In this section, solid material from SMS is passed through hot rolling mill. Workers working here are mold operator, concast fitter, helper, mason, hand operator, tongsman, shaperman, roller attendant, fireman, water man, and table operator
• Quality control department (QCD): Here the product is inspected, metallurgically tested, and then put in the peeling bed of sulfuric acid to remove rust and clear the small holes. The workers working here are welders, gas cutters, lab assistants, crane operators, fitters, peeling machine operator, color coder, fireman, water man, and helper
• Maintenance department (MD): All materials including mechanical and electrical machineries are kept here. Workers in this section are store boy and electrician
• Administration department (AD): All administrative functions of the factory are done here. Subsidized canteen facility is also available in the factory.
For analysis and internal comparison; SMS, RMS, and QCD were taken together as exposed group (EG); as they were involved in production and direct exposure to factory hazards, which included a total of 239 workers, out of which 213 participated in the study, as workers working in these sections were exposed to working environment continuously during their working hours. While MD and AD were taken as nonexposed group (NEG); which had 197 workers working in this section, out of which 187 were included in the study. The factory works continuously round the clock in three shifts of 8 h each (6 am-2 pm, 2pm-10 pm, and 10 pm-6 am). Posting of worker in particular section was of permanent nature. The shifts of workers were changed in rotation at the interval of 1 month.
Sample size and sampling technique
Total number of workers working in the factory was 436. Out of this, the eight female workers from administrative area were excluded from the study, as there was no comparative group in productive area. The temporary or contractual workers, (22 in number), were also excluded from the study. Two workers were employed for less than 1 year and four workers did not consent for the study, hence excluded. Hence, a total of 400 workers were included in the study.
Out of these sections, first three sections were involved in production and direct exposure to factory hazards, so considered as EG) with - Out of all sections, three sections (SMS, RMS AND QCD) were involved in production and direct exposure to factory hazards, so considered as EG (Exposed Group). Total number of workers included from these sections was 88, 79, and 46 from the total of 98, 89, and 52, respectively. The MD and administrative department were not involved in production and so included in Non Exposed Group (NEG). A total of 103 and 84 workers were included from these MD and administrative department from total workers of 110 and 87, respectively.
All the permanent workers working in the factory for more than 1 year and gave consent for the study were included in the study.
Workers employed on contractual/temporary basis, workers working for less than 1 year, and female workers; (as there was no female workers in the EG), they were excluded from the study.
The study was conducted for a period of December, 2011 to May 2013. After obtaining the consent from institute's ethics committee, a written permission for the study was obtained from the concerned authority of factory. Workers' detailed information regarding profile was taken in pretested questionnaire format after obtaining the informed consent and explaining the purpose of study. Approximately, five to seven workers were examined daily in a separate room allotted by the management. Workers were also interviewed regarding their years of job, job satisfaction, usage of protective devices, and history of injuries during work. Workers' detailed general and systemic examination was conducted.
Blood pressure (BP) was measured indirectly using a mercury sphygmomanometer and the auscultatory method. Before the BP measurement, the industrial workers were made to sit (3-5 min) quietly in the examination room, preferably on a chair that supports the back comfortably. The arm muscles were relaxed and the forearm supported with the cubital fossa at heart level. A cuff was applied evenly to the exposed upper arm. The cuff was rapidly inflated until the manometer reading reached about 30 mm above the level at which the pulse disappear, and then slowly deflated at approximately 2 mmHg/s. During this time, the Kortkoff sounds were monitored using a stethoscope placed over the brachial artery. 
Systolic BP: The pressure at which the Kortkoff sounds first heard.
Diastolic BP: The pressure at which the Kortkoff sounds first disappear.
Systolic and diastolic BP was measured thrice over a period of 10 min and the average reading was recorded. The BP was measured in the right arm using appropriate size cuff (covering at least 40% of arm circumference).  Hypertension was classified using The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) criteria. 
Data entry and statistical analysis
The data was entered and analyzed on computer using software Epi Info version 6.04. Percentages were used to describe sociodemographic profile and morbidities. Odds ratios were calculated to study the association and P < 0.05 was taken as significant.
| Results|| |
0Study participant's characteristics
A cross-sectional study was conducted in an iron and steel industry among 400 workers. Out of the total, 213 (53.25%) were included in Group A, that is EG, which included workers from SMS (88), RMS (79), and QCD (46). In other group, that is, in Group B (NEG group), 187 (46.75%) workers were included, which include workers from MD (103) and AD (84) [Figure 1].
[Table 1] shows age-wise distribution of workers. Majority of workers 170 (42.5%) belonged to age group of 35-44 years, of which 86 (50.59%) were in Group A, while 84 (49.41%) were in Group B. The minimum number of workers were in the age group 18-24 years (16,4.00%); out of them 15 (93.75%) were in Group A, while 1 (6.25%) was in Group B. All the workers were male.
[Table 2] shows education-wise distribution of workers. It has been observed that maximum number of workers had education of middle school level, that is, 30%, out of them 76 (63.33%) were in Group A, while 44 (36.67%) were in Group B; followed by education up to high school (24.25%). Only 2.5% were postgraduate. Majority of the workers (48%) were educated up to middle school and thus, were ignorant about the disadvantages of their occupational environment to which they were exposed.
[Table 3] shows distribution of the workers according to length of service. It has been observed from this table that maximum workers had work experience of more than 20 years, that is, 38.75%, out of which 52.90% were in Group A, while 47.10% were in Group B; followed by experience of 10-15 years (24.25%), of which 47.42% were in Group A, while 52.58% were in Group B.
|Table 3: Distribution of workers according to length of service (n=400) |
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Majority of the study population were in the EG for more than 20 years, making them prone to disadvantages of occupational exposure for a prolonged period. [Table 3].
According to Modified Prasad classification of socio-economic status, maximum workers belong to class III 47%, of which 53.19% belonged to Group A and 46.81% belonged to Group B, followed by class IV, that is, 37%. None of the workers belonged to lower class, that is, class V [Table 4].
|Table 4: Distribution of workers according to socioeconomic status (n=400) |
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[Table 5] shows that distribution of workers according to type of morbidity they are suffering from.It was seen that all the morbidities were more prevalent in EG, that is, Group A and the difference of prevalence of morbidities between Group A and B was found to be statistically highly significant (P < 0.001), except the musculoskeletal disorders in which difference in prevalence was not statistically significant. It was observed that commonest morbidity in the workers was lumbago (musculoskeletal pain), that is, 33.25%, which was more in Group B (69.93%) than Group A (30.07%); followed by occupational dermatitis (27%), which was more common in Group A (65.74%) than Group B (34.26%). It was observed that occupation-related morbidities were more common in Group A like occupational dermatitis (65.74%; Group B-34.26%), bronchial asthma (91.66%; Group B- 8.34%), tuberculosis (75%; Group B- 25%), chronic bronchitis (88.75%; Group B- 11.25%), folliculitis (100%; Group B-0%), injuries (94.66%; Group B-5.34%), heat stress (90%; Group B- 10%), chronic conjunctivitis (95.45%;Group B- 4.55%). Hypertension was seen in 92 (23%) workers.
|Table 5: Distribution of workers according to type of morbidity (n=400) |
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| Discussion|| |
This cross-sectional study was conducted in an iron and steel Industry among 400 workers. These workers were divided into two groups. Group A consisted of workers who were exposed to risk factors and Group B consist of workers not exposed to risk factors. Out of total study participants, Group A consisted of 213 (53.25%) workers; whereas, Group B consisted of 187 (46.75%) workers.
Present study shows majority (42.5%) of workers were in the age group of 35-40 years, followed by 25-34 and 45-54 years. Lower age group (18-24 years) was having majority (93.75%) of Group A workers. This was in accordance with age distribution pattern in other studies. 
Present study shows majority (30%) of workers were having education up to middle school followed by up to high school (24.25%). Education of workers in two groups was not similar. In Group A, majority of workers were having education up to middle school; whereas in Group B, majority was having education up to high school. Overall Group B was having higher education level. This might be due to inclusion of administrative group in Group B.
In present study, majority (38.75%) of workers were having service for more than 20 years, followed by 10-15 years. This shows inclination of workers towards working for long period in this factory. This also shows that majority of workers had exposure of this factory for more than 10 years.
In current study, overall prevalence of morbidity was 60%. The percentage of morbidities was higher in Group A (62.08%) than Group B (37.92%), which was statistically significant (χ2 = 18.81, P < 0.001). In other studies, prevalence of overall morbidity was varying from 16 to 81%. ,, This might be due to different working conditions, different health facilities, assessment methods, etc.
In present study it was observed that commonest morbidity in the workers was lumbago (musculoskeletal pain), that is, 33.25%. Among total workers with musculoskeletal morbidity, majority were in Group B (69.93%) than Group A (30.07%). Study by Aghilinejad et al., (2012) showed that among workers, 46.3% in the past week and 61% in the last year claimed one of musculoskeletal disorders in their bodies. Lumbar, knee (s), and neck areas had the most common musculoskeletal disorders. Musculoskeletal disorders had significant association with the job time of work and body mass index (BMI).  Whereas, study by Bihari et al., (2011) showed that overall prevalence of musculoskeletal pain was found to be 25.9%. Pain was found to be more frequent among females (31.3%) as compared with males (20.9%). More than 50% of the subjects complained of backache.  In other study by Masset and Malchaire (1994), which is a cross-sectional study, mentioned that lumbar symptoms were 66, 53, and 25%, respectively, during the lifetime, 12 months, and 7 days before the interview.  Karnaukh et al., (1998) has also observed that the incidence rate of lumbosacral radiculities myalgias and myositis in drifters and drillers was 5:8 and 2:5 times as high, respectively than that of thoracic, lumbar, cervical osteochondrosis, epicondylities in drivers 3.9, 2.4, and 3.3 times high; a fact which might suggest an important role in the etiology of the above conditions. 
Our study showed that, among the respiratory problems, upper respiratory infection (21.00%) was most common problem, followed by Chronic Bronchitis (20.20%), bronchial asthma (6.00%) and pulmonary tuberculosis (2.00%). Obtulowicz et al., (2000) reported that 52% patients had allergic skin disease as contact dermatitis of the hand or generalized dermatitis. Nickel, chrome, iron, and copper metal's dust were the main allergic factors.  Whereas, Sarma (2009) in her study on construction workers in India showed that dermatitis affected exposed parts in 93.75% and covered areas in 62.5%. 
In present study, it was observed that hypertension was among 93 (23%) workers. Among total workers with hypertension, majority were in Group B (70.66%) than Group A (29.34%). Study by Deepalakshmi et al., in Coimbatore on industrial workers showed that prevalence of hypertension was 14.43%.  Whereas study by Manjunatha et al., (2011) on 353 iron and steel workers in Karnataka, South India showed hypertension in 24.4%.  Narlawar et al., in their cross-sectional study found that prevalence of hypertension among continuous exposure group (25.51%) was significantly higher than intermittent exposure group (14.05%; χ2 = 14.28, degrees of freedom (df) =1, P < 0.001). 
Our study showed that, among the respiratory problems, upper respiratory infection (21.00%) was most common problem, followed by Chronic Bronchitis (20.20%), bronchial asthma (6.00%) and pulmonary tuberculosis (2.00%). Study by Barhad et al., (1975) showed prevalence of chronic cough was 22%, dyspnea 20%, wheezing 20%, and chronic bronchitis as 20%.  Lowe (1968) showed prevalence of chronic bronchitis as 13-20%. 
Bradshaw et al., (1998) in their cross-sectional study of respiratory symptoms and lung function in welders was performed at eight New Zealand welding sites where Bradshaw symptoms of chronic bronchitis were more common in current welders (11.3%) than in non-welders (5.0%) in those workers with a cumulative exposure index <4 years (odds ratio (OR) =4.1, 95% confidence interval = 0.09-17.6). Workers with chronic bronchitis had significantly lower measure of baseline peak expiratory flow (PEF; P = 0.008) and forced expiratory volume/forced vital capacity (FEV/FVC) ratio (P = 0.001) than workers without chronic bronchitis.  Kolarzyk et al., (2000) has observed that 28.7% of the workers of the 'Sendzimir' Steel Mill, Cracow, Poland had chronic bronchitis. 
Current study showed the prevalence of chronic conjunctivitis was 5.5% of which 95.45% belonged to Group A. Study by Omoti et al., (2009) showed the most common ocular disorders in industrial technical workers in the Delta state, Nigeria were pingueculum (215,21.5%), presbyopia (97,9.7%), refractive error (94,9.4%), pterygium (86,8.6%), and chronic conjunctivitis (45,4.5%)  Study by Dada et al., (1968) showed that prevalence of chronic conjunctivitis in machine operators, skilled workers, unskilled workers clerical, and administrative workers was 6, 2, 4, and 2.7%, respectively. 
In the present study, the prevalence of heat stress was 10% in the workers and of which majority (90%) were in Group A workers than Group B (10%). Pandit and Tiwari (2008) conducted a cross-sectional study on different morbid conditions among steel pipe producing workers. Results of study showed that, symptoms suggestive of heat stress such as prickly heat, dehydration, perspiration, and pyrexia were observed in 13% of the subjects. 
The prevalence of occupation-related injuries in the present study was 18.75% of which majority (94.66%) were in Group A. Agrawal (1990) showed that maximum number of cases were seen due to electric flash (78 cases or 28.9%) and slag burn (70 cases or 25.9%). Flame burn (39 cases or 14.4%), electrical contact (30 cases or 11.1%), gaseous burn (20 cases or 7.4%), scald (18 cases or 6.7%), and chemical burn (15 cases or 5.6%) were accounting for the rest.  Safe Work Australia (2009-2010) mentioned that out of 3,226 employees of construction site, 306 (9.5%) were suffering from injuries. Boilermakers and welders suffered 16.0% of construction eye injuries. In broader terms, being hit (by moving and falling objects) was the mechanism involved in 241 cases (78.7%).  Karnaukh et al., (1998) has also observed that over 60% (242) of deaths were due to work-related injuries. 
| Summary|| |
In the present study, workers were grouped as Exposed (Group A) and Non-Exposed (Group B). majority of workers (170,42.5%) belonged to age group of 35-44 years, of which 86 (50.59%) were in Group A, while 84 (49.41%) were in Group B, followed by 114 (28.5%) in the age group of 25-34 years. All the workers were male. Majority of the workers were educated upto middle school, that is, 120 (30%). Most of the workers were working for more than 20 years (155,38.75%) in the factory, in the same department without replacement and were exposed to hazards of industry for the long period. According to the classification of Modified Prasad's Scale, 188 (47%) workers belonged to class III, of which 100 (53.19%) belonged to Group A and 88 (46.81%) belonged to Group B, followed by class IV (37%), and only 2% workers belonged to class I.
The overall prevalence of morbidities in the factory workers was 60%, that is, 240 workers were suffering from some form of morbidity. The percentage of morbidities was higher in Group A (69.95%) than Group B (48.66%) and when statistically tested, it was found to be significant (P < 0.001).
In the present study, it was observed that commonest morbidity in the workers was lumbago (musculoskeletal pain) which was more in Group B (49.73%) than in Group A (18.78%), followed by occupational dermatitis (27.00%) which was more common in Group A (33.33%) than Group B (19.79%). It was observed that the occupation-related morbidities were more common in Group A; like contact dermatitis, bronchial asthma, tuberculosis, chronic bronchitis, folliculitis, injuries, heat stress, and chronic conjunctivitis; were more common in group A than that in Group B. It was seen that all the morbidities except musculoskeletal disorders were more prevalent in EG, that is, Group A and the difference of prevalence of morbidities between Group A and B was found to be statistically highly significant (P < 0.001).
| Conclusion|| |
Out of 400 workers, 213 (53.25%) workers were directly exposed to the hazards of iron and steel industry as they were working in production department and 187 (46.75%) were working in administrative department and so were unexposed or not directly exposed to the hazards of the factory. The prevalence of morbidities among the workers was 60%. The most common morbidity was musculoskeletal disorders. Other occupation-related morbidities like bronchial asthma, tuberculosis, chronic bronchitis, folliculitis, injuries, heat stress, and chronic conjunctivitis were more common in EG; and the difference between the groups was found to be statistically significant (P < 0.001).
| Recommendations|| |
A thorough preplacement medical examination should be conducted for all workers and then departments should be allotted accordingly. The records of the medical examination should be maintained and periodical examinations should also be done. Looking at prevalent morbidity pattern among Group A workers, they should be imparted necessary health education periodically for reducing prevalence of lumbago, dermatitis, workplace injuries, and chronic bronchitis. There should be regular shuffling and substitution of workers from higher exposure department to lower one. The workers should be taught about various protective devices and safety measures and importance of their use for prevention of occupational diseases. There should be strict laws laid down for the factory for usage of protective devices ergonomic guidelines.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]