Pattern of morbidity among female textile workers in Puducherry , South India

Introduction: The Indian textile industry is one of the largest in the world and accounts for 21% of the total employment generated in the Indian economy.1 The current burden of occupational health diseases is estimated to be around 18 million cases.2 Objectives: To study the pattern of diseases which are common among textile workers. Methods: A descriptive study was conducted among 179 women working in a textile industry in Puducherry. After obtaining informed consent, data was collected using a structured questionnaire. This was followed by systemic examination of Sensory systems (visual acuity testing using Snellen’s chart, hearing tests using Tuning fork), Respiratory system (using Peak Expiratory Flow Meter) and Musculoskeletal system (Straight leg raising test and others). Data was analyzed using SPSS version 19:IBM. Results: 70% of the participants belonged to the age group 21-40 years and more than half of the women were employed for 5-9 yrs. One fourth of the subjects had complaints of musculoskeletal problems such as joint pain, myalgia and chronic low backache. Respiratory infections and other complaints were also reported. Nearly 40% of the study subjects had myopia, 3% had abnormality in hearing and Peak Expiratory Flow Rate was reduced in 53% of cases. Conclusion: The present study shows that myopia is common among the workers, along with abnormal lung function, which indicates a need for, preplacement and periodic medical examination to rule out ophthalmic and pulmonary morbidities.


INTRODUCTION
The Indian textile industry is one of the largest in the world with a massive raw material and textiles manufacturing base. 1 Indian economy is largely dependent on the textile manufacturing and trade in addition to other major industries.About 27% of the foreign exchange earnings are on account of export of textiles and clothing alone. 1he textile industry accounts for 21% of the total employment generated in the Indian economy.Around 35 million people are directly employed in the textile manufacturing activities.Indirect employment including the manpower engaged in agricultural based raw-material production like cotton and related trade and handling could be around another 60 million. 1he current burden of occupational health diseases is estimated to be around 18 million cases and among them, the annual incidence of chronic respiratory disorders is forty five lakhs, dermatitis is thirty lakhs and musculoskeletal disorders is seventy five thousand cases.Thirty percent of hospital admissions and twenty eight percent of limb injuries are related to occupation diseases morbidities. 2sick-leave-based case-control study, reported that the main morbidities among these workers are respiratory diseases, accidents and injuries, musculoskeletal and connective tissue disorders.The morbidities also increased with age and sex; morbidity among women was 1.5 higher than among men. 3Another case control study reported the that aches (19.4%), respiratory (12.1%) and fever (7.7%), was higher in textile workers than in the comparative group. 4 cross sectional study done at Wardha reported that chronic bronchitis, eosinophilia 19.8%, iron deficiency anemia, refractive errors, upper respiratory tract infection, low back pain were common in this group of workers. 5uducherry is a Union Territory with Legislature extending over an area of 479 Sq .kmslocated 160Kms south of Chennai, with the population of 950,289 of which male and female were 468,258 and 482,031 respectively.69.16% lives in urban regions and 30.84 % lives in rural areas of Pondicherry as per Govt of India Ministry of MSME 2012.Pondicherry has nearly 8708 small scale industries apart from 45 large scale and 80 medium scale industries.Taken together, these provide employment to more than 80,000 people.Some of the significant industries in Pondicherry are chemicals, textiles, light engineering, metals, and food processing.These were the industries which contribute to the economic growth of Pondicherry as well as overall health status of the community. 6s textile industry is one of the significant industries in Puducherry, that contribute to the economic growth and give employment to majority of people, a study on morbidity pattern in textile industry would help us to indentify the common morbidity prevailing among them, especially refractive error, hearing defect, musculoskeletal problems, infections related to respiratory system, reproductive system etc.Women workers, they contribute significantly to national development by performing both remunerated/paid and unremunerated/unpaid work.They also struggle to combine their roles to look after their families.Women household workers have a double burden as there is greater demand for their skills as care-givers and service workers outside home. 7ery few studies have been done to describe the morbidity status of women working in textile industry in southern India.It is in this context that the present study was carried out with an objective to assess the morbidity pattern among female textile workers in Puducherry.

MATERIALS AND METHODS
This descriptive study was conducted in the year 2011 from April-June.There were five large scale/Public sector and seven medium scale textile industries in Pondicherry, out of these textile industries this textile industry "x" was chosen by purposive sampling.This industry exclusively employs female workers.It produces cotton and jute products like bags and clothes.Calculated sample size was 170 subjects based on estimated 37% prevalence rate (prevalence of back pain), 5 precision of 20%.All subjects in the industrial unit were invited to participate in the medical evaluation.A structured questionnaire was prepared, piloted and pre tested.The questionnaire included socio-demographic details of the participant, nature of job, duration of employment, presenting complaints and symptoms pertaining to vision, hearing, respiratory ailments, skin problems, musculoskeletal disorders, etc. Modified Prasad's classification was used for calculating SES.The study was approved by the institute Scientific and Ethics committee.Administrative permissions were obtained from the management after explaining the purpose of the study.After obtaining the informed consent verbally, the participants were interviewed as per the questionnaire.Height in meters, weight in Kg and blood pressure measurement was done using stadiometer and weighing machine (Dr Gene bathroom weighing scale machine).Random Blood sugar estimation was done by using glucometer (Accu-chek Active Model:GU).This was followed by systemic examination of Sensory systems (visual acuity testing using Snellen's chart, hearing tests using Tuning fork-Aluminum Clinical Grade Nerve/Sensory Tuning Fork), Respiratory system (using Peak Expiratory Flow Meter) and Musculoskeletal system (Straight leg raising test and others).Subjects were also subjected to Spirometry test using Peak Expiratory Flow meter.A trained Technician from Pulmonary medicine collected data using Peak Expiratory Flow and an Optometrist collected data on vision using Snellen's chart.Predicted PEFR for each subject was calculated based on the formula: 3.310 x height (cms)-1.865x age (years)-81.0.(Ranga Rao et al, 2002). 8f the PEFR of the subject is <80% of the predicted value then that PEFR is considered as abnormal.

Statistical analysis
The collected data was entered and analyzed using SPSS version 19:IBM.(Statistical Package for Social Sciences).The findings were expressed in terms of proportions or percentages and Mean ± SD as appropriate.

RESULTS
There were totally 185 female workers in that industry.A total of 179 subjects participated in the study and the rest of the female workers left their job just before the start of the study.Mean age of the participants was 34.94 ± 8.9.Among the study subjects 126 (70%) were in the age group of 21-40, 141(79%) were married, 65 (36.3%) had higher education.More than fifty percent were in class IV SES ( Per capita income Rs:480-959), lived in semipucca house, and 75% were from nuclear family.Majority (85%) of the workers were from the urban area (Table 1).More than half of the women were employed for 5-9 yrs.Most (68.2%) of the study subjects were employed in stitching, while the other types of job profile included cutting (11.7%), packing (3.3%) and general assistance (Table 2).Around 40.8% were with normal weight, 39.1% pre-obese, 12.8% obese, 6.7% underweight and 0.6% overweight.Around 129 (72.1%) subjects were with normal blood pressure, 20.7% pre hypertensive and 7.3% were hypertensive.Around 2.2% had abnormal random blood sugar values of >140 mg %.One fourth of the subjects (27.4%) had complaints of musculoskeletal problems such as joint pain (9.5%), myalgia (8.9%) and chronic low backache (8.9%).Around 12.3% had respiratory tract infection and 7.3% had gastric problem like acid peptic disease.Problems of ear, nose and throat like sinusitis was observed in 5% of subjects.Other problems were related to reproductive system (leucorrhoea in 2.8%), dermatological (3.4%) and urinary tract infection (3.4%) (Figure 1).On clinical examination nearly 71 (40%) of the study subjects had myopia, 3% had abnormality in hearing (Table 3).Though subjects had complaints of low back ache there was no abnormality on detailed evaluation.The peak expiratory flow rate was abnormal in 53% of cases.

DISCUSSION
This study showed that 27% of the workers had musculoskeletal complaints of which myalgia; arthralgia and low back ache were common.This is similar to other studies. 4,6,8,17,18Present study showed respiratory tract infection 12.3% and acid peptic disease 7.3%, this was also in accordance with the study done in Rajasthan among textile workers males and females in 2005. 3n this study on examination, 40% of the study subjects had refractive error, which is higher compared to other studies.This has to be addressed at the earliest as most (68%) of the workers were involved in fine work (stitching).Unless this problem is addressed it may lead to injuries.Hearing abnormality was lower compared to other studies. 9This may be due to reduced noise exposure due to different levels of machinery involved in various processing and manufacturing.
The International Labour Organization estimates that 40% of all costs related to work-related injuries and diseases are due to musculoskeletal disorders.Among these, low back pain is the most common.Proper ergonomic measures has to be taken by the company to enable the worker to work comfortably and to prevent all the musculoskeletal complaints, and other health issues. 15,16s most (70%) of the study subjects were in the productive age group (21-40 yrs) their health problems like refractive error, musculoskeletal and abnormal PEFR has to be treated and followed up regularly.This not only affects their personal health and family but also the productivity of the company in the long run. 1,3ore than half of the study subjects had abnormal PEFR.This is high compared to the study done among textile workers in Karachi both genders in 2009. 10As all the study subjects were women; they are subject to the duel burden of indoor air pollution both at home and at the work place.(13)(14) However for detailed assessment of the pulmonary function; these subjects were referred to tertiary centre for further evaluation.
Occupational health studies are difficult to perform as there is an amount of fear and panic on the management side, due to issues related to morbidity of their workers and the associated legal issues.There may be some resistance from the industries sector, but as evident from this study, there is a need for regular pre-placement and periodic medical examination for this group of workers.

CONCLUSION
The present study found that most common problem was musculoskeletal and nearly 40% of the study subjects had myopia.This shows that the workers are unaware of ergonomic postures and medical evaluation.Hence, there is need for preplacement and periodic medical examination to be done by doctor in the industry clinic.This would help in early diagnosis and treatment of morbidities prevailing among the employees.

Table 1 : Socio-demographic details of the study subjects (n=179)
* Modified Prasad's classification.International Journal of Medicine and Public Health, Vol 6, Issue 3, Jul-Sep, 2016