Rajnarayan R Tiwari

INJURY PATTERN AMONG NON-FATAL ROAD TRAFFIC ACCIDENT CASES: A CROSS-SECTIONAL STUDY IN CENTRAL INDIA

RESEARCH QUESTION What is the pattern of injuries among non-fatal cases of road traffic accidents? OBJECTIVE To study the pattern of injuries among non-fatal cases of road traffic accidents. STUDY DESIGN Cross-sectional study. SETTING Nagpur, a city in central India. PARTICIPANTS 423 non-fatal cases of road traffic accidents reporting for treatment to Indira Gandhi Medical College, Nagpur during 1999-2000. STUDY VARIABLES Demographic characteristics, accident characteristics. STATISTICAL ANALYSIS Percentages, proportions, Chi-square test. RESULTS Out of total 423 subjects, 363 (85.8%) were male while only 60 (14.2%) were female subjects. Majority of the victims (75%) were in the age group 18- 37 years. Sideways collision was the most common type of accident seen in 269 (63.59%) cases. Two wheelers and LMV were the common vehicle being involved in accidents (69.97%) and these accidents were almost equally distributed in both half of the day. Fracture of the bones was the common injury afflicted to the victims followed by multiple injuries like blunt injury, abrasions and lacerations. Lower extremity was involved in 192 (45.39%) cases while multiple sites were affected in 114 (26.95%) cases. CONCLUSIONS In the present study, the fractures were the commonest injury among the victims of non-fatal road traffic accidents.

Gender differentials in the social and family life of leprosy patients.

A study was carried out at the Leprosy Control Unit, Government Medical College, Nagpur, India, to investigate gender differentials in the social and family life of leprosy patients. The study included 486 (268 males and 218 females) leprosy patients, who were diagnosed and registered at least 1 year prior to the data collection. It was observed that leprosy patients were isolated and refrained from various activities in the family. However, the effect of disease on this isolation was significantly greater in females as compared to males. Similarly, although, men and women were both affected in terms of their social life, women suffered more isolation and rejection from the society. The current study describes the gender differentials in the social and family life of leprosy patients in Central India.

Occupational health hazards in sewage and sanitary workers

An estimated 1.2 million scavengers in the country are involved in the sanitation of our surroundings. The working conditions of these sanitary workers have remained virtually unchanged for over a century. Apart from the social atrocities that these workers face, they are exposed to certain health problems by virtue of their occupation. These health hazards include exposure to harmful gases such as methane and hydrogen sulfide, cardiovascular degeneration, musculoskeletal disorders like osteoarthritic changes and intervertebral disc herniation, infections like hepatitis, leptospirosis and helicobacter, skin problems, respiratory system problems and altered pulmonary function parameters. This can be prevented through engineering, medical and legislative measures. While the engineering measures will help in protecting against exposures, the medical measures will help in early detection of the effects of these exposures. This can be partly achieved by developing an effective occupational health service for this group of workers. Also, regular awareness programs should be conducted to impart education regarding safer work procedures and use of personal protective devices.

Child labour in footwear industry: Possible occupational health hazards

The constitution of India, as a part of the fundamental rights, has laid down that the State shall direct its policy towards protection of childhood and youth against exploitation and shall not be employed to work in any factory or mine or engaged in any hazardous employment. India has the largest number of urban and rural child workers in the world. The Government of India acknowledges at least 17.5 million working children.2 Footwear industry is also one of the major export oriented industry employing a large number of children. The Footwear Industry is a significant segment of the Leather Industry in India. India ranks second among the footwear producing countries next to China. The industry is labour intensive and is concentrated in the small and cottage industry sectors. While leather shoes and uppers are concentrated in large-scale units, the sandals and Chappals are produced in the household and cottage sector. The major production centers India are Chennai, Ranipet, Ambur in Tamil Nadu, Mumbai in Maharashtra, Kanpur and Agra in Uttar Pradesh, Jalandhar in Punjab and Delhi. The processes in the footwear making include last making, pattern cutting, clicking, Sewing, Assembling and Finishing. Children between 10 and 15 years old are mainly employed in assembling shoes. Some 80 percent of the children work for contractors at home. Children work on soling (fixing upper portions of shoes to leather or rubber soles) with glue. Children in cramped poorly lit rooms suffer from continuous skin contact with industrial adhesives and breathing vapors from glues. The children working in the footwear industry are exposed to physical factors like poor illumination, noise and poor ventilation, and chemicals like leather dust, benzene that is used as a solvent in glues and p-tert butyl phenols, which is used in neoprene adhesives. Thus most children suffer from respiratory problems, lung diseases and skin infections through constant exposure to glue and fumes. They are also exposed to risk of nasal cancer, neurotoxicity and adverse physical factors. It is recommended to stop child labour and let the child be bread eater rather than bread earner.

Tuberculosis among workers exposed to free silica dust

Tuberculosis (TB) is a global emergency. Poverty, increasing migration, homelessness and the compulsions to live and work in high-risk environments are making people increasingly susceptible to the disease. Those working in mines, construction work, stone-crushing and in other similar occupations where there is a greater level of exposure to silica dust are specially vulnerable. Though the association between TB and silicosis has been firmly established by the results of epidemiologic studies no attempts have been made to study the epidemiological features of radiologically active TB among free silica exposed workers. Thus the cross sectional study was carried out among slate pencil workers and quartz stone crushers to assess the prevalence of TB and some associated epidemiological factors. It included 253 quartz workers and 102 slate pencil workers. Clinical history and chest radiographs were used for labeling the subjects as tuberculotic. The pulmonary functions of the subjects were measured using Spirovit SP- 10. Statistical analysis was carried out using statistical software package Epi Info 3.3.2. Among stone crushers the prevalence of TB was found to be 10.7% while among slate pencil workers it was as high as 22.5%. Among the quartz stone-crushers the workers aged ≥35 years, those exposed for ≥3 years and those who were smokers had higher risk TB while among the slate pencil workers, only those exposed for ≥10 years had higher risk. Though the FVC and FEV1 values of the workers having TB were lower than those having normal radiographs, the differences were found to statistically non-significant.

Tobacco use and cardiovascular disease: a knowledge, attitude and practice study in rural Kerala.

BACKGROUND Tobacco consumption, either in smokeless form or as smoking, is reported to be responsible for major non-communicable diseases, namely, cardiovascular diseases, chronic obstructive pulmonary diseases and cancers. Whatsoever control strategy is being used, the community participation is of utmost importance, which will depend largely on the level of the knowledge in the community. AIM To assess the knowledge and attitude of a rural community towards the harmful effects of tobacco use. SETTING AND DESIGN Venganoor Gram Panchayat of Thiruvananthapuram district of Kerala; cross-sectional study. MATERIALS AND METHODS Interview schedule was used to collect the information on pre-designed and pre-tested proforma. The information recorded, included the demographic characteristics and socio-economic characteristics. The awareness regarding tobacco use and the attitude towards its non-usage was done, by putting forward, open and closed-ended questions. STATISTICAL ANALYSIS Percentages and proportions; t-test; chi-square test. RESULTS The present study included 302 (64.7%) females and 165 (35.3%) males. Among the males, 44 (38.5%) were ever smokers. Though 451 (96.6%) of the subjects knew that tobacco use is harmful for health, only 101 (22.5%) of the subjects knew that it causes cardiovascular diseases. Electronic and print media were the common source of such knowledge being reported by 265 (58.7%) and 202 (44.7%) subjects, respectively. CONCLUSIONS The subjects were aware about the harmful effects of tobacco use. However, more efforts are needed to make them aware about the role of tobacco smoking and chewing, in causing cardiac problems.

Spirometric measurements among quartz stone ex-workers of Gujarat, India.

Spirometric Measurements among Quartz Stone Ex‐workers of Gujarat, India: Rajnarayan R Tiwari, et al. Occupational Medicine Division, National Institute of Occupational Health, Ahmedabad, India—The present cross sectional study was carried out among 134 ex‐workers from quartz stone crushing units. Using the interview technique as a tool for data collection, demographic and occupational details of the subjects were recorded on the predesigned proforma. Standard diagnostic criteria were used for diagnosing silicosis and silico‐tuberculosis. The pulmonary functions of the subjects were measured with Spirovit SP‐10. The mean age of the males was found to be 33.18 ± 10.39 yr and that of the females was 30.10 ± 9.3 yr and for the whole group was 31.77 ± 9.99 yr. Mean duration of exposure was 2.74 ± 1.65 yr. The study variables included age, sex, duration of exposure, smoking and respiratory morbidity. Forced Vital Capacity (FVC) which suggests lung parenchymal disorders was found to be significantly reduced with female sex, presence of smoking, increasing duration of exposure and presence of pneumoconiosis, whereas the lung function parameters indicating the status of airways were found to be significantly reduced with all the factors. Therefore, it was concluded that quartz stone workers exposed to approximately 100% free silica had deteriorated lung function which can be attributed mainly to respiratory disorders along with other epidemiological factors such as age, sex, duration of exposure and smoking.

Mapping ‘Occupational Health’ courses in India: A systematic review

The occupational health scenario is undergoing a paradigm shift in developing countries with rapid industrialization. Inadequate human resource is, however, a concern. The creation of Basic Occupational Health Services will demand a further increase in specialist manpower. The current training capacity of occupational health specialists has been mapped by a systematic review in India. Twenty-one institutes have been identified all across the country. They have an existing capacity for training about 460 specialists. This number is inadequate considering the population of Indias working class. A mixture of strategies must be urgently planned for addressing this issue.

Occupational skin problems in construction workers.

Background Construction workers handle cement which has constituents to produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients, such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients, such as chromium). Aim: The present study has been carried out among unorganized construction workers to find the prevalence of skin problems. Materials and Methods: The present cross-sectional study was conducted in 92 construction workers of Ahmedabad and Vadodara. Results and Discussion: All the workers were subjected to clinical examination after collection of information regarding demographic characteristics, occupational characteristics and clinical history on a predesigned proforma. Of them, 47.8% had morbid skin conditions. Frictional callosities in palm were observed in 18 (19.6%) subjects while 4 (4.3%) subjects had contact dermatitis. Other conditions included dry, fissured and scaly skin, infectious skin lesion, tinea cruris, lesion and ulcers on hands and/or soles. Conclusion The skin conditions were common in the age group of 20–25 years, males, those having ≥1 year exposure and those working for longer hours. Half of the workers not using personal protective equipment had reported skin-related symptoms.

Respiratory health of female stone grinders with free silica dust exposure in Gujarat, India.

Abstract Eighty-five female quartz mill stone-grinding workers belonging to the Naika, Rathwa and Damor tribes of Chhotaudepur village of the Godhra region of Gujarat, Western India were surveyed and examined to assess health effects related to free silica dust exposure. The mean age for the subjects was 28.2 ± 9.2 years, while the mean duration of exposure was 2.04 ± 1.7 years. Chest radiographs showed findings suggestive of silicosis in 14%, silico-tuberculosis in 11.6% and tuberculosis in 8.1% of the study subjects. Respiratory morbidity was significantly associated with duration of exposure (χ2 = 9.9, df = 2, p<0.007). On spirometry, obstructive, restrictive and combined (restrictive as well as obstructive) changes were found in 12.8%, 10.5% and 3.5% of the subjects, respectively. Overall, about one-third of subjects displayed abnormal pulmonary function and respiratory morbidity on chest radiographs.