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Indian Journal for the Practising Doctor

Morbidity profile and treatment pattern among the workers of diamond cutting and polishing industry at Ahmedabad City

Author(s): Harshvardhan Mehta H, Ribadiya G

Vol. 5, No. 5 (2008-11 - 2008-12)

ISSN: 0973-516X

Harshvardhan Mehta H, Ribadiya G

Dr.Harshvardhan Mehta, MD (Assistant Professor) and Dr.Girish Ribadiya, MD, (Resident), Department of Community Medicine, B.J. Medical College, New Civil Hospital Campus, Asarwa, Ahmedabad 380 016.

Correspondence: Dr. Harshvardhan Mehta, 1571, Shriramji’s Street, Opp.lakhia Street, Khadia, Ahmedabad 380 001 (Gujarat State). Phone: (079) 22 14 59 30; Mobile: 0-94275-22075;
Email: drharshvardhan (at) gmail.com

Abstract

Research question: What are the different health problems occurring among those working in diamond cutting and polishing industries in Ahmedabad city and what is the treatment seeking pattern among them?
Objectives: The study was aimed to identify

  1. the morbidity associated with diamond industry among the workers and the related epidemiological variables.
  2. the medical and health facilities available and health seeking behaviour pattern of the workers.
  3. the addictions among the workers of the iamond cutting and polishing industry.

Methodology: Study Design: cross-sectional study over one year period.
Participants and Setting: Workers of the diamond cutting and polishing units located at Bapunagar area of Ahmedabad city.
Statistical Analysis: Standard error of proportion (SEP)
Study Variables: Morbidity, treatment
Results: Majority of the studied workers were between 15-34 yr of age; 5% were children. The vast majority was literate; most secondary pass, but included graduates and postgraduates. More than 35% had refractive errors.
Key words: Morbidity, addiction, treatment

Introduction

Diamond, a highly desirable and precious jewellery, has been known since 4th Century BC. Since ancient times India was well known for diamond producing trade and innovations in cutting and polishing of diamond. There is also mention of the diamonds in the ancient Indian manuscripts like “Sukraniti”, “Shushruti”, “Kamsutra”, “Mahabharata”, “Rigved”, etc. Many well known diamonds (‘Kohinoor’,’ Great Mughal’, etc) were mined in India.

In the beginning of the 2othe Century, Banaras and Panna were the main centres for diamond cutting and polishing. In 1920, few Jari traders from Surat and Navsari, trading with Banaras, learnt the trade and brought it to Gujarat. At that time few goldsmiths and silversmiths developed the art and were engaged in trade. However, the diamond cutting trade grew very rapidly because it was a promising and lucrative type of vocation, easy to learn in a short period of 3-4 months, did not require any education, and was suitable for all ages. Accordingly, migration took place in thousands and many younger people got inducted into the trade. These people wherever they migrated took the art with them and spread to develop the trade in a big way in Ahmedabad during mid 70’s in and around Bapunagar area. Earlier the workers who migrated were from different area of Gujarat. But now, the workers are a mixture of the subsequent generations of the earlier workers and of the people who have migrated from states other than Gujarat.

Diamond cutting industry, in India is a small cottage industry, where workers are exposed to multifarious problems like dust, heat, poor illumination, poor hygiene, etc. Although some articles regarding the poor health and nutrition of diamond workers have appeared in local news papers, no scientific study has been published till now. Hence this study was planned to assess the morbidity profile and treatment pattern of the workers in diamond cutting and polishing industry in Ahmedabad, Gujarat.

Materials and Method

An estimated 2000 diamond cutting and polishing units, employing around 2 lakh employees, are located in and around Bapunagar area of Ahmedabad; 1% of these units (appro. 21 units) were selected randomly for this cross-sectional study.

A pre-designed and pre-tested performa was used for interviewing the workers of the studied units. For morbidity data clinical examination was done and enquiry was made about illnesses at the time of survey and during the last one year; documents of previous treatment were also received where available.

Information about the working conditions was collected by visiting the unit during working hours and simultaneously interviewing the workers were taken.

The information thus collected, was compiled and analyzed and appropriate statistical tests were applied for statistical inference.

Results

The age and sex distribution of the 866 surveyed workers is given in table 1; 709 (81.87%) were males and 157 (18.13%) female. Majority (612; 86.32%) of the males, were in the age group of 15-34 years with maximum number (222; 31.31%) 20-24 yr old. Of the females, 140 (89.17%) were 15-34 years of age with the highest proportion (53; 33.75%) 25-29 year old. Remarkably, 37 (5.22%) males were below 14 years of age, who can be considered child labourers; none of females, however, was in that age group.

Table-1 Distribution of the workers according to age and sex

Sr. No. Age Group (in years) Male Female Total
1 10-14 037 (05.22) 000 (00.00) 037 (04.27)
2 15-19 163 (22.99) 021 (13.38) 184 (21.25)
3 20-24 222 (31.31) 037 (23.57) 259 (29.91)
4 25-29 150 (21.16) 053 (33.75) 203 (23.44)
5 30-34 077 (10.86) 029 (18.47) 106 (12.24)
6 35-39 040 (05.64) 017 (10.83) 057 (06.58)
7 40-44 013 (01.83) 000 (00.00) 013 (01.50)
8 45-49 007 (00.99) 000 (00.00) 007 (00.81)
Total   709 (100) 157 (100) 866 (100)

Majority of the males (461; 65.02%) were educated up to the secondary level followed by 118 (16.64%) up to the primary and 81 (11.43%) up to the higher secondary level. Majority of the females (71; 45.23%) had studied up to the primary level followed by 55 (35.04%) up to the secondary level and 18 (11.46%) up to the higher secondary level. In total, majority of the workers 516 (59.59%) had studied up to the secondary level (Table 2)

Table-2 Educational status of the workers

Sr. No. Type of education Male Female Total
1 Primary 118 (16.64) 071 (45.23) 189 (21.82)
2 Secondary 461 (65.02) 055 (35.04 516 (59.59)
3 Higher Secondary 081 (11.43) 018 (11.46) 099 (11.43)
4 Technical 010 (01.41) 000 (00.00) 010 (01.15 )
5 Graduate 020 (02.82) 006 (03.82) 026 (03.01)
6 Post Graduate 008 (01.13) 002 (01.27) 010 (01.15)
7 Illiterate 011 (01.55) 005 (03.18) 016 (01.85)
Total   709 (100) 157 (100) 866 (100)

Majority of the workers (47.58%) were in the industry for less than 5 years, followed by 22.29% working for 6-10 years, and 16.28% for 11-15 years. Only 6.58% of the workers were continuing in the industry for more than 20 years. All the female workers were engaged for less than 15 years with the diamond industry.

Table 3 Duration of work by the workers in the diamond industry

Sr. No. Period (years) Male Female Total
1 <05 338 (47.67) 074 (47.13) 412 (47.58)
2 06-10 140 (19.75) 053 (33.76) 193 (22.29)
3 11-15 111 (15.66) 030 (19.11) 141 (16.28)
4 16-20 063 (08.88) 000 (00.00) 063 (07.28)
5 21-25 026 (03.68) 000 (00.00) 026 (03.00)
6 26-30 021 (02.95) 000 (00.00) 021 (02.42)
7 >30 010 (01.41) 000 (00.00) 010 (01.15)
Total   709 (100) 157 (100) 866 (100)

Table 4 shows that 115 (9.25%) workers (97.4% males; 2.61% females) were smoking either bidi or cigarette; 48.85% workers (92.2% males; 7.8% females) had a habit of chewing tobacco in any form. Only 4.85% workers (all males) admitted to be drinking alcohol. Majority (663; 76.56%) of workers (78.6% males; 21.4% females) habitually took tea/coffee. 76 males and 2 females had quit taking tea/coffee. Many workers were having more than one addiction, i.e. tea/coffee and smoking; Tea/coffee and tobacco chewing.

Table 4 Addictions among workers (Multi-Coding)

Sr. No. Type of Addiction Male 709 (100%) Female 157 (100%) _. Total 866 (100%)
1 Smoking 112 (10.38) 003 (01.83) 115 (9.25)
2 Tobacco Chewing 404 (37.44) 019 (11.58) 423 (34.03)
3 Alcohol 042 (3.89) 000 (00.00) 042 (3.38)
4 Tea/coffee 521 (48.29) 142 (86.59) 663 (53.33)
Total 1079 (100) 164 (100) 1243 (100)

More than one third 104 (35.49%) of the workers had refractive errors in the form of myopia and hypermetropia.(12.01%); of them nearly 90% were males. Out of the total workers with eye problems, one third (104/293, 35.49%) were having problems with near vision due to presbiopia or cataract. More than 32% worker reported eye fatigue or strain and 1.71% was having ocular ulcers due to foreign bodies. (Table 5)

Table 5 workers having Eye conditions

Sr. No. Type of eye problem Male (709) Female (157) Total (866)
1 Refractive Error 093 (36.47) 011 (28.95) 104 (35.49)
2 Difficulty in Near Vision 077 (30.2) 011 (28.95) 088 (30.03)
3 Eye Ache /Fatigue 081 (31.76) 015 (39.47) 096 (32.76)
4 Occular Ulcers 04 (1.57) 001 (2.63) 005 (1.71)
Total 255 (100) 38 (100) 293(100)

Table 6 depicts various common symptoms/ health problems experienced by the workers. The most common symptoms (found in 13.6%) were visual/ocular. The observed difference in visual/ocular problems among male and female workers is highly significant. [SEP=1.53, Z=10.37 (P<0.05)]. Many workers had ocular foreign bodies or ocular ulcers suffered during the last one year of work with diamond cutting and polishing. These were followed by headache (10.74%) , body ache (10.16%) and respiratory tract infections (10.16%). Some 2.42% of workers had developed asthma and 1.96% workers skin problems due to working conditions during the last one year of work.

Table 6 Health conditions during last one year to workers working with diamond polishing units

Sr. No. Condition Male Female Total
1 Respiratory Tract infection 072 (10.16) 016 (10.19) 088 (10.16)
2 Asthma 015 (2.12) 006 (3.82) 021 (2.42)
3 Fever 068 (9.59) 013 (8.28) 081 (9.35)
4 Throat pain 029 (4.09) 010 (6.37) 039 (4.50)
5 Common cold 034 (4.80) 009 (5.73) 043 (4.97)
6 Diarrhoea 034 (4.80) 013 (8.28) 047 (5.43)
7 Constipation 049 (6.91) 001(0.64) 050 (5.77)
8 Vision/Ocular problems٭ 117 (16.50) 001 (0.64) 118 (13.63)
9 Hypertension 041 (5.78) 016 (10.19) 057 (6.58)
10 Abdominal pain 086 (12.13) 011 (7.01) 097 (11.20)
11 Headache 074 (10.44) 019 (12.10) 093 (10.74)
12 Body ache/joint pain 068 (9.59) 020 (12.74) 088 (10.16)
13 Skin diseases 012 (1.69) 005 (3.18) 017 (1.96)
14 Generalised weakness 004 (0.56) 010 (0.64) 014 (1.62)
15 No complains 006 (0.85) 007 (4.46) 013 (1.50)
Total 709 (100) 157 (100) 866 (100)

٭SEP=1.53, Z=10.37 (P<0.05)

Health conditions among workers

larger image here

The most common health condition was some eye problem; nearly one third of the workers (33.83%) were having dome or the other eye condition at the time of survey. This was followed by other pre-existing conditions like hypertension (6.58%) and bodyache/backache/joint pain (6.24%). Almost 2.5 % of workers were having allergic asthma due to working environment; 0.80% of the workers reported psychological problems due to the working environment.

Table 7: Workers suffering from different health conditions at the time of study

Sr. No. Health condition prevailing Male Female Total
1. Hypertension 041(5.78) 016(10.19) 57 (6.58)
2. Hearing Problem 004(0.56) 003(1.91) 007 (0.81)
3. Asthma 015(2.12) 006(3.82) 21 (2.42)
4. Eye problem 255(35.97) 038(24.20) 293 (33.83)
5. Headache 028(3.95) 009(5.73) 37 (4.27)
6. Body ache/backache/joint pain 023(3.24) 31(19.75) 54 (6.24)
7. Weakness 008(1.13) 03(1.91) 11 (1.27)
8. Injuries 002(0.28) 000(0.00) 002 (0.23)
9. Psychological Problems 002(0.28) 005(3.18) 007 (0.80)
10. No complains 331 (46.69) 46 (29.30) 377(43.53)
Total 709 (100) 157 (100) 866(100)

Most of the workers (63.80%) were seeking treatment for their health conditions from either a private practitioner or private hospital. Only 7.77% workers reached corporate hospitals for treatment. Nearly 20.25% were seeking treatment from NGO/Trust hospitals for their health problems and 7.57% approached hospital for their problem. Only 0.61% workers were trying ayurvedic remedies for their health conditions. The observed difference between treatment seeking from the private practitioner/hospital and other outlets was highly significant. (I.e. SEP= 3.07 and Z= 8.99 at P<0.05)

Table 8 Health seeking behaviour of the workers

;_. Sr. No. Type of Health facility Male Female No. of workers
1 Private practitioner 159 (42.06) 030(27.03) 189(38.65)
2 Private Hospital 091(24.07) 032(28.83) 123(25.15)
3 Corporate Hospitals 029(7.67) 009(8.12) 038(7.77)
4 NGO/Trust Hospitals 076(20.21) 023(20.72) 099(20.25)
5 Government 022(5.82) 015(13.51) 037(7.57)
6 Ayurvedic Doctor 001(0.26) 002(1.80) 003(0.61)
Total 378(100) 111(100) 489(100)

SEP=3.07, Z=8.99 (P<0.05)
For calculation of SEP private practitioner and private hospitals were murged (i.e. 1+2) and other was merged (i.e. 3+4+5+6).

Discussion

Age and sex distribution of the surveyed population shows that 81.87% were male and that 31.3% of males were in the age group of 20-24 years whereas 33.7% of the females were in the age group of 25-29 years (33.75%). More than 4% of the males workers were child labourers.

Notably only 1.85% of the total workers were illiterate while majority of the male workers had studied up to the secondary level and majority of females up to the primary level. Interestingly 1.15, 3.01 and 1.15% of the workers, respectively, had studied up to technical, graduate and post graduate level respectively, which shows that even well-educated persons are attracted towards the diamond industry because of easy job availability, higher daily wages, and little or no training required, etc.

Traditionally the diamond industry has been male dominated since no females were working for more than 15 years; majority (47.13%) were working for less than 5 years and most of them might not be working regularly. Data shows that that males prefer to continue in the same profession.

During study it was observed that majority of the workers were living with their families probably because they are getting average or better facilities like residence, food, sanitary conditions, etc. While 21.71% and 9.01% were living alone or with relatives respectively, only 0.69% lived within the factory premises. It is important to note that about 9.25% workers were smoking either bidi or cigarette; of the smokers majority (97.39%) were males; only 2.61% were female. In addition, 48.85% workers were having habit of chewing tobacco in any form; again 92.24% were male and only 7.76% female. About 5% of males admitted of being hooked to alcohol. It was also found that workers were trying to hide the addictions like alcohol and smoking. Such substance abuse could be contributing to their ill health.

More than one third of the workers complained of developing refractive errors in (myopia or hyper-metropia) during the preceding one year. Out of which nearly 90% were males. However, these problems could well be present for a longer time. Out of the total workers with eye problems, 35.5% were having problems with near vision due to presbiopia or cataract. More than 32% worker had reported eye fatigue or strain and 1.71% was having ocular ulcers due to foreign bodies. Overall the majority complained of some eye problem; the nature of work, which entails focussing on a small area for long hours, might be putting unusual strain on their eyes, which could be made worse by the existing refractive errors or presbyopia. The data show that the commonest condition among workers was ocular injury. Nearly 13.7% had ocular foreign bodies which might have been associated with ocular ulcers.

Body aches, headache and respiratory tract infections (each accounting for more than 10% of the morbidity could be attributed, respectively, to bad posturing, eye-muscle strain and the dust emanating from cutting/polishing. Asthma and skin problems in about 2% of the workers could have been due to dust and vapours generated during cutting and polishing work. It is also notable that only 0.80% of workers reported psychological problems due to work environment; that implies that the vast majority find their working conditions good.

Majority of the workers (63.80%) sought treatment for their health conditions from either a private practitioner or a private hospital; 20.25% from NGO/Trust hospitals; and 7.8% from corporate hospitals. Only 7.6% approached a government hospital for their problem. This might reflect lack of trust in government outlets.

It is noteworthy that the workers were not using any type of personal protective devices and more important thing was that they were not aware of even existence of any such gear or devices. There was a dramatic lack of health education among the diamond polishing workers; all of them appeared ignorant about the health hazards pertaining to their occupation.

Recommendations

  • The diamond industry which employs lakhs of workers should be given more attention under the provisions of the Factories Act. The government should examine the possibility of simplifying the provisions of the Act and other labour laws, in consultation with entrepreneurs as well as the representatives of workers, keeping in view the nature of the industry.
  • Special teams of health care workers, with preventive and occupational health background, should be prepared and trained to visit both organised and unorganised units regularly, keep surveillance for the health hazards and impart necessary health education on regular basis.
  • Besides medical measures, engineering techniques should be employed to make the working environment hazard free.

References

  1. Park K. Environment and health. In: Park’s Textbook of Preventive and Social Medicine, 19 th ed, 2007.
  2. Ensure environmental sustainability, UN Millennium development goals. [cited on 2007 Dec 18].
  3. Nath KJ. Home hygiene and environmental sanitation: a country situation analysis for India. Int J Environ Health Res 2003;13:19-28.
  4. American Conference of Governmental Industrial Hygienists. 2003 TLVs and BEIs based on documentation of the threshold limit values for chemical substances and physical agents and biological exposure indices. ACGIH: Cincinnati; 2003.
  5. Hunter’s Diseases of Occupations, Occupations and its infections diseases – J. Heptonstall, C. Cockcroft (eds), 9th ed, page No. 489-490.
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