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Indian Journal of Community Medicine

Health Status and Health Seeking Behaviour of Male Workers in Delhi

Author(s): Jugal Kishore, TK Joshi*

Vol. 26, No. 4 (2001-10 - 2001-12)

Department of Community Medicine, Maulana Azad Medical College, New Delhi - 110002 *Centre for Occupational & Environmental Health, L.N. Hospital, New Delhi 110002

Abstract:

Research question: What is the health profile of male population engaged in various occupations in Delhi?

Objective: To study the health status and health seeking behaviour of male workers.

Study design: Descriptive study.

Setting: Ten clusters of residential areas from five zones of Delhi.

Participants: Randomly selected 744 adult male workers living in these areas.

Study variables: Working class, body mass index, blood pressure, PEFR, common diseases, health seeking behaviour.

Statistical analysis: Data was analyzed with the help of Epi-Info software package and to get the significant results with 95% confidence limit, non parametric test like Kruskal Wallis test and *2 test were applied.

Results: There were statistically significant differences in age (KW=10.24, p=0.0001), systolic (KW=23.63, p=0.00009) and diastolic (KW=25.52, p=0.00003) blood pressure and peak expiratory flow rate (PEFR, KW=25.36, p=0.00004) of different categories of workers. Unskilled and skilled workers (mean 3.75 4.84 and mean 4.65 5.95) had more disease symptoms on the day of survey as compared to businessmen (mean 1.59 3.07) and professionals (mean 1.83 2.52). Prevalence of chronic illnesses, i.e., asthma, heart disease and diabetes in businessmen and professionals was higher than other categories of workers. Current tobacco, alcohol use and non-vegetarian diet was more prevalent in unskilled (41.61%, 36.02%, 61.09%), semiskilled (42.57%, 37.62%, 64.34%) and skilled (44.75%, 36.96% and 61.09%) workers. For the common illnesses, professionals preferred to go to specialist (35.71%) and had relatively more faith in Ayurvedic system of medicine (32.14%) than other categories.

Conclusion: Behaviour modification programme regarding tobacco and alcohol in unskilled and semiskilled workers and regular check-up of blood pressure in businessmen, professionals and maintaining normal BMI in all categories of workers are urgently required.

Keywords: Male workers, Health status, Health seeking behaviour

Introduction:

Occupational health problems are important components of the total morbidity, disability and mortality. More rates of occupational illness and injuries are found in developing countries, where the resources available for investigating these problems are often limited1-3. The World Bank has estimated a burden of 36 million Disability Adjusted Life Years (DALYs) Lost or 3% of the global burden of disease, is caused each year by preventive injuries and deaths mainly due to high risk occupational exposure to toxic chemicals, noise, stress and physical debilitating work pattern4. Identification of risks and diseases is prerequisite for the prevention and control of occupational health problems that lead to improvement of working conditions and implementation of preventive occupational practices. Both the measures have the potential to magnify economic benefit of industrial development in third world countries, including India.

Large industries are reluctant to call outsiders for undertaking an assessment of working conditions and environment. However, many studies indicated that workers in large public sector industries suffered more injuries, respiratory and liver diseases and malignancies. Heat, dust, noise, and lifting load were the principal hazards identified in many industries5-8. Dust seemed to bother the workers most. Surprisingly, heat, radiation and cold were not perceived to be a threat to health and safety as also the noise, which was perceived as a nuisance. Correspondingly, noise induced hearing loss, diseases like tuberculosis, asthma, dermatoses, neurological, mental and musculoskeletal disorders and coronary artery diseases are prevalent in different categories of workers912. The workers did not appreciate other physical hazards and risks emanating from hand arm vibration and general body vibration. In addition, one more situation specific for Delhi is that large number of migrant workers come to Delhi in search of work and use the factory for living. They do not appreciate the risk involved in doing so13. Because of these factors it is very important to assess the health of the workers in Delhi at different points of time and data should be utilized for the occupational health programmes.

To avoid difficulties observed in the industrial surveys, usually created by the factory owners, managers and labour departments, community survey was designed to assess health status of workers in areas where different categories of workers formed largest groups. Their habits and health seeking behaviour were also assessed so that at risk groups could be identified for further investigations and to formulate preventive strategies.

Material and Methods:

Area: This paper presents the portion of big project carried out to assess the environmental and occupational health of Delhi's working population. Delhi was divided in five zones. In each zone, a broad outline of the areas was drawn and at least two areas were chosen for the sample. In these selected areas a sample of population from the most approachable houses or clusters, community or colony was contacted and interviewed in detail.

Sample: Analysis of 743 adult male workers from a total of 1077 adult population is presented in this paper. Housewives were excluded from the analysis. These workers were engaged in various occupations like Delhi Fire Service, DTC workers, managers, clerks, parking attendants, shop keepers, rickshaw pullers, labourers etc. and they were grouped according to their skills involved in the work.

Tool: An interview schedule was designed and pre-tested which mainly focused on worker's job, socio-economic and health status, body mass index (BMI-Weight in Kg/height in square meter), blood pressure, peak expiratory flow rate (PEFR- three readings on Wright portable Spirometer), personal habits like alcohol and tobacco use and health seeking behaviour. Alcohol and tobacco use was not graded and only history of current, past or no consumption was recorded. House to house survey was carried out in selected area till a sub-sample of 75-100 was achieved.

Results:

Table I: Characteristics of various categories of workers in Delhi.

  Unskilled Mean (SD) Semi-
skilled Mean
(SD) Skilled Mean (SD) Clerk/
Shopkeeper Mean
(SD) Professional Mean (SD) ANOVA/ Kruskal Wallis p value
Age 30.99 (11.39) 36.49 (9.89) 35.26 (9.89) 32.55 (11.97) 42.03 (13.45) 45.06 0.00001
Mean years of study 7.54 7.43 10.28 10.10 15.01 100.45 <0.0001
Income (Rs./month) 2247.13 (1376.63) 2715.73 (964.70) 3540.21 (2402.19) 3269.23 (3684.58) 6105.50 (3595.66) 142.85 <0.0001
Body Mass Index 21.39 (3.94) 22.19 (4.08) 23.17 (3.46) 22.76 (4.41) 24.33 (3.25) 7.83 0.00003

Age of the workers had direct association with their level of skills and professionalism. Unskilled workers belonged to low age group. Similarly, clerks and shopkeepers had average age lower than other workers. Professionals had highest mean age (42.03 13.45). A significant trend in their educational qualification could be observed with their skills. Similarly, their average monthly income also showed a significant trend i.e., workers were paid according to their skills. Professionals and skilled workers had higher body mass indices as compared to unskilled and semiskilled workers. This difference could be due to their significant differences in age and income. But it could be due to manual work that the unskilled and semiskilled workers do in industries.

Table II: Blood pressure, Peak expiratory flow rate (PEFR) and symptoms* experienced in last one year and on the day of survey.

  Unskilled Mean (SD) Semiskilled Mean (SD) Skilled Mean (SD) Clerk/Shopkeeper Mean (SD) Professional Mean (SD) ANOVA/ Kruskal Wallis p value
Systolic Pressure 119.48 (14.49) 121.82 (18.59) 123.40 (15.08) 123.1 (16.07) 130.96 (13.19) 23.63 0.00009
Diastolic Pressure 80.22 (10.32) 81.79 (12.77) 84.32 (10.88) 81.96 (10.07) 85.96 (10.07) 25.52 0.00003
PEFR 377.95 (103.96) 372.87 (106.45) 416.53 (97.91) 402.64 (95.33) 426.34 (100.91) 25.36 0.00004
Symptoms in last one year. 7.85 (5.79) 7.46 (4.93) 7.83 (5.53) 5.61 (4.74) 7.11 (5.66) 22.14 0.0001
Symptoms on the day of survey. 3.35 (4.89) 0.75 (2.33) 4.65 (5.95) 1.59 (3.07) 1.83 (2.52) 86.27 0.00001

*Symptoms= General, respiratory, digestive, mental, neurological, cardiac, toxicity symptoms.

Table II shows that blood pressure (systolic and diastolic) of professionals was much higher than other occupational groups. But this could be due to their higher age, economy and BMI. PEFR was higher in professionals and skilled workers, whereas, unskilled and semiskilled workers had low values. The difference of PEFR according to occupations was found to be significant. Although average of different types of symptoms experienced in last one year was higher in unskilled workers who were usually involved in construction work, labour in industries and rickshaw pullers but skilled workers and semiskilled workers also experienced high number of symptoms. Similarly, symptoms experienced on the day of survey were also common in unskilled and skilled workers. Clerks, shopkeepers and professionals experienced comparatively less symptoms in last one year and also on the day of survey. More symptoms and low PEFR values in unskilled workers may be due to their more exposure to pollutants at work places and poor BMIs.

Table III: Common diseases in workers in Delhi.

  Unskilled n=204(%) Semiskilled n=101(%) Skilled n=252(%) Clerk/ Shopkeeper n=160(%) Professional n=26(%) Total n=743 X2 test p value
Asthma 5(2.45) 1(0.99) 4(1.59) 7(4.37) 1(3.8) 18(2.4) 4.49 0.34
Heart Disease 1(0.49) 3(2.97) 9(3.57) 6(3.57) 2(7.69) 21(2.8) 8.24 0.08
Diabetes Mellitus 1(0.49) 0(0.00) 1(0.39) 2(1.25) 2(7.69) 6(0.8) 19.30 <0.001
Allergy/ Dermatitis 4(1.96) 6(5.94) 12(4.76) 5(3.12) 2(7.69) 29(3.9) 5.56 0.23
Tuberculosis 1(0.49) 1(0.99) 2(0.79) 1(0.62) 0(0.00) 5(0.6) 0.51 0.97

The number of diseases in each group was very low but when each disease was compared separately, significant differences were observed among different categories of workers (Table III). Unskilled, semiskilled and skilled workers were believed to be exposed more to air, industrial and vehicular pollution but asthma was not found higher in these groups when they were compared to professionals and clerks or shopkeepers. Overall prevalence of heart diseases in male workers was 2.83% and maximum were noted in professionals. Among them majority had sedentary work practices and belonged to high socio-economic status. Prevalence of tuberculosis was 0.7% which is slightly higher than the national average of 0.4%. Four percent of the population was suffering from skin diseases.

Table IV: Personal Habits of the workers of Delhi.

  Unskilled n=204(%) Semiskilled n=101(%) Skilled n=252(%) Clerk/ Shopkeeper n=160(%) Professional n=26(%) X2 test p value
Tobacco*
Current 85(41.67) 43(42.57) 115(45.63) 65(40.63) 9(34.61) 2.12 0.71
Former 14(6.86) 5(4.95) 17(6.74) 7(4.38) 3(11.54)    
Never 105(51.47) 53(52.47) 120(47.62) 88(55.00) 14(53.84)    
Alcohol
Yes 74(36.2) 38(37.62) 93(36.96) 49(30.86) 7(25.00) 3.08 0.54
No 130(63.8) 63(62.38) 159(63.04) 111(69.14) 19(75.00)    
Food
Vegetarian 59(28.91) 36(35.64) 98(38.91) 72(45.14) 18(67.86) 22.42 0.0001
Non-Vegetarian 145(71.09) 65(64.36) 154(61.09) 88(54.86) 8(32.14)    
Fruits
Frequent 116(56.99) 63(62.07) 231(91.51) 137(85.71) 24(92.86) 42.03 <0.00001
Never/Hardly. 88(43.01) 38(37.93) 2(8.49) 23(14.29) 21(7.14)    

*Tobacco: Current versus never tobacco users analyzed.

Prevalence of tobacco use in different categories of workers was more or less same. However, professionals and clerks/shopkeepers had low rates. Similarly, alcohol use was also low in these two groups (Table IV). Vegetarian food and frequent fruit eating was significantly associated with occupations (p=0.0001). Majority of professionals were vegetarians (67.86%) as compared to other groups.

General physicians were preferred more for health consultation by all categories of workers except professionals. On the other hand specialists were preferred more by the professionals, which could be due to their higher educational and economic status. Surprisingly, professionals preferred alternative Indian medicine more. Self-medication was considered to be risk behaviour for the individual and it was observed that all categories of workers including professionals with similar proportions took medicine/drugs without the consultation of doctor.

Discussion:

Professionals and clerks/businessmen had high prevalence of chronic illnesses and consulted specialists and preferred Ayurvedic system of medicine. That could be due to their higher age, body mass indices and socio-economic status. Poor BMI and higher symptomatology in unskilled and skilled workers could be attributed to their poor socio-economic status, imbalanced diet, higher tobacco and alcohol use. Higher socio-economic status was associated with sedentary work practices. Both the factors are already established causes of heart disease particularly coronary artery disease9,15. In the present study the prevalence of heart disease was 3.57% each in clerks/shopkeepers and skilled workers but it was much higher in professionals (7.69%). Similar findings have been reported in sedentary workers with a prevalence of 5.2% of coronary heart disease in Nagpur9. Working class had slightly higher prevalence of tuberculosis (0.7% which is slightly higher than the national average of 0.4%) that could be due to their socio-economic status, diet and BMI. Skin diseases vary from place to place and in different occupational exposure sites. Chemical exposure may increase the prevalence of dermatoses. In petroleum workers it was as high as 6.8%16.

Prevalence of tobacco use in all categories of workers was high but it was similar to the national rates17. High prevalence of tobacco use among working people should be one of the major areas of concern. India does not have any effective smoke free workplace policy. In a review study, a decline was reported in cigarette smoking, mainly due to a ban on smoking in workplaces, public transport and in other public locations - such as theatres, cinemas and shopping malls in Australia and United States18. Similar policy of Delhi Government should be supported.

Numerous studies indicate a relationship between increased consumption of fruits and vegetables and lowered risk of certain cancers19, cardiovascular diseases and stroke20. It was also studied that the work-site and family interventions were more helpful in increasing fruit and vegetable consumption. Such programmes are more efficacious and cost effective in influencing health behaviour such as eating habits if implemented in the working community21. Consumption of fruits and vegetables was low in labour class which could be due to their poor socio-economic status in the present study. However, low cost fruits and green leafy vegetables may be advocated and employers may take initiatives to improve their workers' health, which would increase the productivity in return.

The study concluded that a regular checkup of BP in businessmen/clerks and professionals and maintaining normal BMI by practicing healthy lifestyle, for example, consumption of more vegetarian food and fruits particularly in unskilled, semiskilled and skilled workers was urgently required. Behaviour modification programmes regarding tobacco and alcohol use by workers is also recommended involving general physicians.

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