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A Study of the Health Profile of Rubber Plantation Workers in Rural Kerala

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A Study of the Health Profile of Rubber Plantation Workers in Rural Kerala ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES A study of the health profile of rubber plantation workers in rural Kerala Tapas Sadasivan Nair1, Suneela Garg2, Mongjam Meghachandra Singh3 1Resident, 2Director-Professor, 3Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India Submitted: 29-08-2015 Revised: 28-10-2015 Published: 10-01-2015 ABSTRACT Background: The state of Kerala produces nearly 90% of India’s natural rubber output. Access this article online Rubber plantation workers are vulnerable to a variety of health hazards and being in the Website: unorganized sector, do not enjoy the benefits that their counterparts in organized sector enjoy. Hence, monitoring of their health needs to be done periodically. Aims and Objectives: http://nepjol.info/index.php/AJMS 1. To assess the health status and common illnesses of rubber plantation workers. 2. To DOI: 10.3126/ajms.v7i3.13288 detect the prevalence of non-communicable diseases like diabetes and hypertension among E-ISSN: 2091-0576 2467-9100 rubber plantation workers. Materials and Methods: A cross-sectional study was conducted P-ISSN: amongst 154 rubber plantation workers in Pathanamthitta District in the state of Kerala, India in September 2014. Data was collected using a predesigned pretested and semistructured questionnaire containing items to assess the socio-demographic profile, their medical history and individual hazard exposure. Data was analysed in SPSS Version 16. Results: Chemical exposure was the most common hazard reported by rubber plantation workers (70.1%). The most common health complaints were musculoskeletal (66.2%), respiratory (31.2%), dermatological (26.6%) and ophthalmological disorders (22.7%). 20.1% prevalence of diabetes and 29.9% prevalence of hypertension was detected among study subjects; awareness and treatment seeking behaviour was poor. Conclusions: Proper health and safety training of rubber plantation workers on workplace hazards and ergonomics is essential to reduce work-related morbidities. Efforts should be made to enhance their access to healthcare and provide periodic health checkups. Key words: Occupational health, Rubber plantation workers, Health hazards, Health profile INTRODUCTION of rubber trees to get the optimum output of latex as well as to later process the latex with formic acid in order to India is the fourth largest producer of natural rubber create rubber sheets. in the world. The cultivation of rubber trees (Hevea brasiliensis) as a cash crop in India was initiated by the Plantation workers all over the world are exposed to British in the 19th century mainly in Assam and Kerala. hazardous working conditions, such as exposure to As the tropical climatic conditions and hilly undulating pesticides, working long hours in hot humid climates, terrain of Kerala was extremely favourable for the growth and working with dangerous machinery. These working of rubber trees, rubber plantations flourished and Kerala conditions predispose them to a variety of health problems eventually became the dominant producer of natural like respiratory, dermatological and musculoskeletal rubber in the country, producing as much as 90% of disorders.2-4 The health risks associated are also determined India’s rubber output.1 Majority of the producing units by the length of time exposed, type of work engaged in, are small growers (with plantations less than 20 hectares) the work environment and the personal protective measures and hence the tapping of rubber trees for latex is mainly employed. In addition to this, they often suffer from a manpower intensive enterprise, depending on skilled yet various morbidities related to their environment like snake seasonal labourers to perform the ‘tapping’ of the trunks bites,5 nematode infections6 and vector borne diseases like Address for Correspondence: Dr. Tapas Sadasivan Nair, Flat 4B, Jomer Haven, Illom Road, Near TDM Hall, Kochi-682016, Kerala. E-mail: [email protected]. Mobile: (+91)9654082358. © Copyright AJMS Asian Journal of Medical Sciences | May-Jun 2016 | Vol 7 | Issue 3 103 Nair, et al.: Health profile of rubber plantation workers malaria,7 dengue8 and chikungunya.9 Non-communicable these questions while others were revised to ensure that diseases is also an emerging concern of late.10Aside from the participants would comprehend the meaning of the the direct impact on workers’ health, work-related ailments question. and illnesses may affect their productivity, job tenure and satisfaction. The schedule included questions pertaining to age, gender, state of origin, marital status, education, income and type Rubber plantation workers are a part of the informal of housing of the study participants. The schedule also occupational sector in India. Hence, they do not have included items for assessment of exposure to chemicals, any organized occupational health services. Further, very heat, fumes and noise on daily basis. Past history of diseases limited attempts have been made to study the occupational such as skin diseases such as contact dermatitis, allergies, exposure and health profile of this population in India. fungal infections, musculoskeletal disorders such as low Therefore, the present study was undertaken to assess their back pain, knee joint problems, pain in feet, respiratory health status and common illnesses, as well as to detect the symptoms such as breathlessness, cough, wheeze, etc., eye prevalence of non-communicable diseases like diabetes and related symptoms like irritation, watery eyes, etc, worm hypertension among them. infestations, vector borne diseases like malaria, dengue and chikungunya in the last one year were elicited from MATERIALS AND METHODS the participants. Study settings and participants Study methodology It was a community based cross-sectional study conducted Before the commencement of the study, a thorough survey among rubber plantation workers working in Kozhencherry of all rubber plantations was undertaken. After mapping Taluk (9.3388° N 76.7127° E) in Pathanamthitta District these places, the rubber plantation workers were located of the state of Kerala, India. Pathanamthitta District and contacted. A three-member team led by the investigator was chosen as it is the second most productive district interviewed the workers present on the day of survey. The in Kerala for natural rubber output and the taluk was objective of the study was explained to them and informed selected randomly. Kozhencherry Taluk covers an area of consent was obtained before the collection of data. The 8 square kilometres and has a population of 14,000 as per subjects were then interviewed regarding their socio- the Census of India 2011.11 There are numerous rubber demographic status and health profile. In addition to this, plantations in the area, and the workers are located in or their blood pressure and fasting blood sugar was measured around these plantations. Taking prevalence of morbidities as per JNC 8 and WHO guidelines respectively.12,13 among rubber plantation workers to be 50% (as there are no comprehensive studies in the Indian setting) with 95% The option to opt out of the study was kept open without confidence interval and precision of 10%, the sample size any clause. Confidentiality of data was ensured. The Ethics was estimated to be 96. However, 154 rubber plantation Committee of the institution approved the protocol of workers working in the area consented to participate. the study. Inclusion criteria Statistical analysis All workers involved in rubber plantations for at least 1 year The collected data was entered into Microsoft Excel and were included in the study. then analyzed using Statistical Package for the Social Sciences Version 16. Descriptive statistics, including mean and standard Study period deviation for quantitative data and proportions for qualitative The study was conducted over a period of two weeks in data were used to characterize the study population. September 2014. Study tool RESULTS A pre-tested, semi-structured interviewer based questionnaire was used for data collection. The questionnaire Socio-demographic profile of workers was prepared after a rigorous literature review.2-10 The Overall 154 male rubber plantation workers consented questions were then assessed for suitability, relevance and to participate. The mean age of study group was accuracy in the Indian context. The interview schedule 34.3±4.8 years with a range of 21-65 years. Majority of was pretested on 25 rubber plantation workers from the respondents were married (n=136; 88.3%). Nearly one- Thekkemala village in Pathanamthitta District of Kerala. third of the participants (n=48; 31.2%) were educated up As a result of this pretesting, some of the items on the to primary level, whereas 40.9% (n=63) were illiterate. 103 questionnaire were discarded mostly due to ambiguity of subjects (66.9%) were residing in rented accommodations 104 Asian Journal of Medical Sciences | May-Jun 2016 | Vol 7 | Issue 3 Nair, et al.: Health profile of rubber plantation workers near the plantations while 14.3% (n=22) were staying workers, followed by fumes (n=51; 33.1%), dust/smoke in quarters and 18.8% (n=29) in slum clusters. Only 59 (n=29; 18.8%) and heat (n=23; 14.9%). Noise was reported workers (38.3%) belonged to Kerala; the rest were from the least (n = 15; 9.7%) (Figure 1). other states like Tamil Nadu (22.1%), Andhra Pradesh (17.5%), Orissa (13.6%) and Bihar (8.4%). Mean income Self-reported health problems among welders during the rubber tapping season was Rs 400 per day. Musculoskeletal disorders were the most commonly reported A majority of workers had more than 3 years of working health problems by the workers such as neck pain, lower experience in rubber plantations (81.2%) (Table 1). back ache and knee joint problems (n=102; 66.2%) followed by respiratory problems (n=48; 31.2%), dermatological Exposure to occupational hazards problems (n=41; 26.6%) and ophthalmological problems Chemical exposure (n = 109; 70.1%) was reported to be (n=35; 22.7%) in the last year. A few cases of vector borne the most common hazard at the rubber plantation by the diseases and worm infestations were also reported (Table 2).
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