Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 27  |  Issue : 1  |  Page : 33-40

Risk Factors For Work-Related Eye Injuries Among Stone Quarry Workers: A Field Report


Department of Ophthalmology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Date of Web Publication4-Jul-2019

Correspondence Address:
Chinyelu N Ezisi
Department of Ophthalmology, Federal Teaching Hospital, Abakaliki, Ebonyi State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njo.njo_34_18

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  Abstract 


Objectives: To determine the prevalence, types, and risk factors for work-related eye injuries in a Nigerian population of stone quarry workers. Materials and Methods: The study was a questionnaire-based cross-sectional ophthalmic survey of stone quarry and stone processing industry workers in Abakaliki, south-eastern Nigeria. Data on participants’ socio-demographics, job characteristics, clinical ophthalmic symptoms and previous work-related eye injuries were collected and analyzed using descriptive and comparative statistics. Statistical significance was indicated by P < 0.05. Results: The participants (n = 384; males 158, females 226) were aged 32 ± 11.8 SD years (range, 14–68 years). Of them, 140 (36.5%) reported previous work-associated eye injury. Industrial injuries accounted for uniocular loss of vision in 2 (0.52%) of these workers. The most common eye injury was Blunt ocular trauma 106 (58.2%). The majority 379 (98.7%) of the workers did not use eye protective devices. Risk factors for work-related eye injury included unprotected eye exposure 85 (46.2%) for quarry sites and 117 (62.2%) for stone processing plant sites, following nonuse of eye protective devices, time of the day: 99 (53.8%) quarry site and 103(57.2%) stone processing site, occurred in the afternoon representing the highest time of occurrence. Occurrence of eye injury was found to be higher in the younger age group, male gender working in the stone processing plant, being a nontechnical worker, afternoon duty, and nonutilization of personal protective eye device (PPED). Conclusion: Adequate health education, emphasizing these risk factors, should be mandatory while comfortable and standard eye protective devices should be enforced for prevention of work-related eye accidents and work environment should be modified to ensure safety of workers.

Keywords: eye injuries, risk factors, stone quarry, work-related


How to cite this article:
Ezisi CN. Risk Factors For Work-Related Eye Injuries Among Stone Quarry Workers: A Field Report. Niger J Ophthalmol 2019;27:33-40

How to cite this URL:
Ezisi CN. Risk Factors For Work-Related Eye Injuries Among Stone Quarry Workers: A Field Report. Niger J Ophthalmol [serial online] 2019 [cited 2019 Nov 13];27:33-40. Available from: http://www.nigerianjournalofophthalmology.com/text.asp?2019/27/1/33/262064




  Introduction Top


Work-related injuries are injuries and illnesses resulting from events or exposures occurring in the workplace. It contributes significantly to the global burden of disease and disability, and mortality among the working age group.[1],[2] The occurrence of injury and frequency of occurrence are determined by several factors. These include the degree of exposure of workers to occupational hazards, inexperience, overconfidence, lack or underutilization of protective devices, poor work/equipment interaction, and suitability of instruments to physical and physiological characteristics of workers, psycho-social and environmental factors.[3] When the risk factors are appropriately modified, these injuries are preventable. Worldwide statistics show that visual impairment and blindness resulting from work-related eye injuries are common, with the causes varying in different countries.[4],[5],[6] World Health Organization (WHO) program for the prevention of blindness estimates that 55 million eye injuries that restrict normal activity occur each year and that 1.6 million cases of trauma result in total blindness.[4] The WHO statistics in 2007 showed that low- and middle-income countries had higher rates of work-related eye injuries, particularly in agriculture and unregulated industries.[5] Findings from the Nigerian national blindness survey reported 84% of blindness being due to avoidable causes. Within the preventable causes, ocular trauma was responsible for 1.1%.[6] This includes work-related ocular trauma. In Kaduna state Nigeria, occupational eye injuries in the quarry industry accounted for 11.7% of injuries sustained.[7] Nigeria is a signatory to VISION 2020 and has already drawn up a national plan for achieving its goal in line with the resolution of the 56th World Health Assembly.[3] This goal to eliminate the avoidable causes of blindness by the year 2020 will go a long way in reducing the burden of visual impairment and blindness of the general population of which quarry workers are a part of. Prevention of eye injuries at the workplace will entail proper identification of the risk factors, assessment, development of injury prevention protocols peculiar to that environment, and implementing and enforcing preventive measures. Due to limited resources in developing countries, cost-effective preventive measures are key to achieving success. These legislations were patterned after British style, who were the colonial power during its early development. However, Nigeria’s industrial legislative development suffered an implementation setback resulting from the comparative difference in the stages of industrial development in two countries; Nigerian being a developing country in contrast to Britain.[8],[9] Since independence, only limited amendments have been made to these colonial legislations. The Factories Act was enacted in 1958 and has been reviewed twice. The Factories Act and Mineral Act of 1958laid down the general terms, of minimum standards for safety, health, and welfare of factory workers and miners. In spite of these legislations, surveys of factories have shown that even these minimum standards are not being met in many Nigerian factories.[8],[10] The Quarries Decree 1969 was promulgated to control quarry operations as well as safeguard the health safety and welfare of quarry workers in Nigeria.[8],[11]

The supervision of quarries is carried out in Nigeria by the Federal Ministry of Mines and Steel Development, with the country divided into different zones for this purpose.

Several legislative measures have been put in place to regulate, monitor, and enforce healthy and safety measures in industries. This is to ensure optimal working conditions and the best achievable health for the workers in the industry. Several of these measures are enforced and reviewed periodically in developed countries in accordance with emerging occupational challenges in the industry. The quarry industries in developed countries are not left out. However, in developing countries like Nigeria, compliance to these legislations is largely suboptimal. A recent review of the Nigerian mining act was done in 2007.[12]; However, acceptance, enforcement, awareness of the eye health benefits, and compliance by workers is grossly suboptimal. Therefore, the risk of sustaining work-related eye injury remains high. Recently, problems of the Boko Haram insurgencies in Northern Nigeria, the frequent insurgent attacks by Fulani herdsmen, has made these open mining activities unsteady and practices unregulated. Workers perceive the work environment as unsafe harboring potential weapons of attack in the wake of an insurgent attack. Thus, work is suspended frequently until such attacks are controlled.

Lack of progress in occupational safety is partly as a result of outdated policies, lack of enforcement in addition to high cost of creating safe work environments. Company owners and operators perceive safety and health laws as expensive and unnecessary meddling by the government. Sometimes even the workers themselves resist health and safety regulations because they seem overcautious and may interfere with comfort. There is also the aspect of inexperience of workers with these modern methods of industrialization and thus ignorant of its attendant risks.[13]

In developing countries, high unemployment, and high emigration of the skilled and educated workforce, governments may be challenged to prioritize safety.[5]

Knowledge about the burden of occupational injuries may be helpful in advocating for increased attention to safety.[5]

Work-related eye injury is a neglected part of research in Africa especially in the Nigerian quarry industry with few studies discussing the risk factors to injury occurrence; hence, the reason for this study.


  Materials and Methods Top


Background: Abakaliki is the capital city of the present-day Ebonyi State in Southeastern Nigeria. It has estimated population of 141,438, according to the 2006 census.[14] The rainy season lasts from April–October and dry season from November– March. Annual rainfall is 1,600–2,200 mm. Humidity during the rainy season is as high as 82%. Mean temperature during the hottest period of February to April is 44.8°C. Its geographic terrain is rocky and mildly undulating; Hence, the existence of huge deposits of granite stone and limestone in the locality is seen.

The study was a cross-sectional survey of stone quarry and stone processing industry workers conducted in Abakiliki, Southeastern Nigeria

Ethics: Prior to commencement of the survey, ethics clearance compliant with the 1964 Helsinki declaration, as amended in London in 2000, on research involving human subjects was obtained from the Medical and Health Research Ethics Committee (IRB institutional review board) of the University of Nigeria Teaching Hospital, Enugu. Permission to carry out the study was obtained from the administrative head of each stone industry. Informed consent to participation was obtained from each respondent prior to recruitment into the survey.

Study participants: All eligible and consenting technical (crushers, stone breakers, blaster, and drillers) and nontechnical (laborers) workers in the stone quarry and stone processing industries in the study area. Excluded were administrative and support staff that are not involved in stone extraction and processing and workers with employment duration of less than one year in the industry. This was to allow time for chronic exposure to risk factors and for mastery of the job.

Sample Size and Sampling: Using a 50% prevalence of eye injuries among stone industry workers, due to lack of related previous report, and error band of 5% a minimum sample size of 384 was calculated using the formula n = [z2 (1−P) P] / d2 where n = minimum sample size; d (precision or error band) = 5%; z = standard normal deviation of 1.96, at confidence level of 95%, P = 50% ; d is the desired precision (error band) due to random sampling error of 5% = 0.05,

n = [1.96 × 1.96 (1−0.5) 0.5] / {0.05}2 = 384

Sampling Technique: The stratified sampling technique was used with a two-stage stratification based on job specification. The first sub-stratification delineated workers in the quarry and in the processing sub-sectors. This was followed by further sub stratification of each sub-sector, based on job specification i.e. workers in the quarry sector were sub-stratified into blasters, drillers, breakers, and laborers while workers in the processing sector were sub-stratified into crushers, breakers, and laborers. Each sub-classification based on job specification was adequately sampled.

A register containing the names of all the eligible workers was compiled to serve as a sampling frame. The sampling interval (k) or skip interval was obtained by dividing the population size (2600) by the sample size (384). After a random start, and using systematic random sampling, every kth name in the register was selected for recruitment until the modified sample size was obtained.

At the central mine which is the quarry site, 50 companies operate. Each company has under its employ 2 blasters, 2 breakers, 5 drillers and 10 laborers. There are 50 companies at the stone processing plant. Each company has 1 crusher, 1 breaker and hire laborers depending on turn out per day.

Thus about 100 blasters: 50 × 2 ; 100 breakers: 50 × 2; 250 drillers: 50 × 5; 500 laborers: 50 × 10 work at the mines. At the stone processing plant, about 50 crushers: 1 × 50; 50 breakers: 1 × 50; 1700 laborers work at the site.

At the Central Mines which is the quarrying site,

Using probability proportionate to size, 15 Blasters were drawn out of a sample size of 384(using simple random sampling) by using the following calculation:

Blasters: 100 × 384 = 14.76 ∼ 15 2600

Drillers: 250 × 384 = 36.92 ∼ 37 2600

Breakers: 100 × 384 = 14.76 ∼ 15

Laborers: 500 × 384 = 73.84 ∼ 74 2600

At the Stone processing plant

Crushers: 50 × 384 = 7.38 ∼ 7 2600

Breakers: 50 × 384 = 7.38 ∼ 7 2600

Laborers: 1550 × 384 = 228.92 ∼ 229 2600

Study Instrument

This was a researcher-administered open- and close-ended questionnaire with fields on participants’ socio-demographics, job characteristics, awareness and utilization of protective eye devices, and history, type, timing and number of work-place eye injuries. Prior to deployment for final survey, the instrument was pretested on stone quarry and stone processing workers at Izzimagu stone industry, outside the study area but share similar characteristics as the study quarries and the processing plants. Critical feedbacks from the pretest informed modifications in instrument design to enhance its face, flow, and interpretation. Participants in the pretest were excluded from the final survey.


  Study Definitions: Top


Work Related Injury: For the purpose of this study, it is defined as any accident occurring during the course of activity related to industrial work. It is therefore, the logical consequence of placing a fallible human being in potentially dangerous circumstances in the industrial workplace.[15] When the eyes are involved, they are referred to as work-related eye injury

Data Analysis: Data were entered and analyzed using the statistical package for social sciences (SPSS) software for windows, version 18 (SPSS Inc, Chicago, Illinois, USA). Descriptive statistics yielded percentages, frequencies, and proportions. Univariate statistical tests, for significance of observed inter-class differences, utilized the student-t test for metric/continuous variables and Chi square or Fishers exact test, as appropriate, for categorical variables. In all comparisons, statistical significance was indicated by P < 0.05, with the associated odds ratio and 95% CI. In cases of multiple co-linear variables, multivariate logistic regression was performed to determine independent effect of the variables on the outcome of interest, workplace eye injury.

The collected data were analyzed using SPSS software version. For categorical variables, means and standard deviation and other descriptive measures were determined. Frequency tables and graphs were constructed to represent quantitative data. A chi-square test was applied for comparison of proportions and evaluating associations of categorical variables in contingency tables and continuous variables using multi-regression analysis. Statistical significance was said to be achieved where P values were less than 0.005.

Study approval was obtained from the health research ethics committee of University of Nigeria Teaching Hospital. Ituku-Ozalla. Enugu State, Nigeria. Permission to carry out the study was obtained from the administrative head of the quarry while informed consent was obtained from the respondents before administering the questionnaire on them.


  Results Top


Participants’ Socio-Demographic and Job Characteristics: The participants (n = 384) comprised 158 males and 226 females, who were aged 32 ± 11.8 SD years, with age range of 14–68 years and modal age group of 21–40 years. Of them, 26 (6.8%) possessed formal education while 268 (69.8%) were married. Their distribution in work sector showed that 105 (27.3%) work in the quarry while 279 (72.7%) work in the processing sections of the stone industry. Overall, their cadre distribution showed: Laborers-291 (75.8%), Blasters-18 (4.7%), Breakers 22 (5.7%), Crushers 46 (12.0%), and Drillers 7 (1.8%). Their socio-demographic and job characteristics are shown in [Table 1].
Table 1 Socio-demographic and job characteristics of participants

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[Table 2] shows sector and job-specific frequencies of work-related eye injuries.
Table 2 Sector- and job-specific frequencies of eye injuries

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Work-Related Eye Injuries: Of the 246 (64.1%) workers with past history of work-related eye injury, the most common types of injuries reported were superficial ocular foreign body-170 (69.1%), blunt trauma-59 (24.0%), superficial ocular abrasion-12 (4.9%), burns-3 (1.2%), allergic peri-ocular skin peeling 1 (0.4%), and penetrating injury 1 (0.4%). Injury caused severe monocular visual impairment (DVA of <6/60–3/60) in 2 (0.8%) workers. Work-associated eye injuries were more frequent among processing workers compared with quarry workers. − Male gender (P = 0.001) and engagement in stone processing (P = 0.001) did, but age (P = 0.91), duration of work experience (P = 0.19) and distant visual acuity status (normal vs. sub-normal, P = 0.37) did not, significantly predict the occurrence of work-related eye injury among participants.

Age Distribution: Age distribution of workers with a past history of eye injury is presented in [Table 3].
Table 3 Age distribution of workers with a past history of eye injury sustained at work

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Duration of Work Experience: Duration of work experience of workers with past history of eye injury is presented in [Table 4].
Table 4 Duration of work experience of workers with a past history of eye injury sustained at work at the stone quarry and stone processing plant

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Time of Occurrence of Work Related Injuries: The timing (temporal profile) of the occurrence of eye injuries showed: morning (quarry, processing plant; 30–16.3%, 32–17.4%), afternoon (99–53.8%, 103–57.2%) and evening (54–29.3%, 30–16.7 P %) value 19.23(0.001).

[Table 5] shows the types of injury sustained by different workers according to their job specification.
Table 5 Types of eye injury sustained by the workers according to job specification

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Agents of Injury: Pieces of broken stone representing (53–89.3%) and (75–84.1%) at the stone processing site and the stone quarry site constituted the most frequent object responsible for causing work-related accidents. Other agents causing eye injury included Explosive (5–7.9%); Dust (4–6.3%) Quarry, (5–6.0%) Processing; Machine (4–4.8%) Processing plant. P value 11.12(0.023).

Risk Factors for Eye Injury: Univariate and multivariate predictors of work-related eye injuries is presented in [Table 6] and [Table 7] respectively.
Table 6 Univariate associations of work-related eye injuries

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Table 7 Multivariate predictors of work-associated eye injuries

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  Discussion Top


Majority of the workers were married, uneducated, adult females working in the stone processing sector with minimal work experience. Although Okoye[15] et al. reported a male predominance industrial workers, the poor work remuneration and non requisition of pre-employment job experience portends the Nigerian quarry industry as ideal for unskilled housewives mainly employed as laborers to cater for their sources of livelihood. This was corroborated by Uwakwe in a related survey.[16]

A prevalence of work-related eye injury of 246(64.1%) was reported by the workers. Data on occurrence of work related eye injury was got through history as proper documentation of occurrence was not the practice. This was thus a study limitation. This high prevalence has been corroborated by studies from low- and middle-income countries such as India[17] 56%, Thailand[18] 50%, and Singapore[19] 56%. The reasons for this high prevalence are two-faced. On one hand is low level of industrialization with poor knowledge and provision of eye-safety measures and policies in addition to lack of enforcement of these regulations. This is the case in the index study. On the other hand, it must be observed that higher prevalence rates seen in some middle-income countries such as China has been attributed to rapid industrialization without a matching pace of advancement in occupational eye-safety regulations.

The most common types of injuries in descending order were foreign body 106 (58.2%), blunt trauma 59 (32.4%). This is consistent with Edema et al. who also identified foreign body as the most common type of eye injury in industrial workers, they studied.[20] This is not surprising as there were no environmental dust control measures in place to prevent occurrence of these work-related accidents. Most breakers, being the highest subgroup with work-related injury, suffered from Blunt trauma resulting from pieces of broken stones.

At the stone quarrying and stone processing site, stone dust was recognized as a potential occupational hazard, being the major agent of injury. Majority of the workers were exposed to varying degrees of atmospheric crushed stone dust and ocular irritation from dust, predisposing them to conjunctivitis. The crushers at the stone processing site were found to be exposed to the greatest risk of stone dusting. Uwakwe[16] in his study observed dust as a potential danger and probably the most difficult problem that the workers were facing at stone quarries. This finding agrees with observations made at the stone processing site in this survey. Most workers examined, were found to have a practice of copious irrigation of affected eyes with clean water following excessive contact.

Stone injuries were also common especially amongst breakers, drillers, crushers, and to a lesser extent the laborers. Fire or smoke from explosives and flying pieces of stone posed as potential hazard to the blasters. Drillers were exposed to fast moving particles of stone, smoke, or fire from explosives used to bore holes into rocks. The breakers were exposed mostly to flying pieces of stone, which majorly caused ocular foreign body and blunt trauma. Mine explosion accidents, operating machine accidents, trips over stones, and falls resulting from deep gulley created by continuous excavation, emission of noxious gases from operating machine, and drills were some of the hazards the workers were exposed to.

Risk Factors for Injury Occurrence:

Age: In the present study, age was not a significant risk factor for injury occurrence although more injuries occurred in the younger age group. There has been conflicting data from previous studies with some reporting higher risk for injury occurrence amongst the older age group mainly from inattention, easy fatigability[21],[22] while others reported same in the younger age group, mainly due to restlessness, carelessness, and more likelihood to take risks.[23]

In addition, Nigerian quarries being mainly private enterprises, though regulated by the Federal Ministry of Mines and Steel development, the private companies who employ these workers renew their contract on a monthly or quarterly basis and prefer young people who can cope with the demands of the job.

Gender: Male gender was a significant risk factor for sustaining eye injury. Local[15] and international studies[24] have reported higher prevalence of work-related eye injuries among men. The men were employed to perform the most dangerous aspects of quarrying thus they were more exposed and were more at risk.

Work Sector: Working in the stone processing plant was a significant risk factor for sustaining work-related eye injuries. Considering that the most common agent of injury was broken pieces of stone, it is not surprising that workers in the stone processing plant are more at risk. However, the stone processing plant accounts for majority of the work force. This may have influenced our findings. Okoye[15] et al. corroborated this.Job Specification: Paul[25] observed that non-technical mining workforce had to sustain work-related injury more than the technical workers. This was observed in this study, These uneducated part of the workforce were less informed about the technicalities of their job and lacked appropriate understanding of occupational health and safety, making them the least likely to be compliant with safety measures.

Duration of Work Experience: Majority of workers with less than ten years of work experience were found to sustain work related eye injuries but this was not statistically significant. Longer duration at work ensures mastery and reduces incidents of work-related eye injury.[15]

Time of Occurrence:

Most work-related injuries occurred in the late afternoon. This can be attributed to work exhaustion, reduced mental alertness with resulting poor concentration, especially under the hot sun. Open mining is practiced in most parts of Nigerian quarries.[16] Work-related injuries have been reported to occur more at night and mainly attributed to carelessness.[16] However, most Nigerian quarries do not run night shifts.[26]

Utilization of PPED:

It also appears that enforcement of PPED use is dependent on the industry, with more compliance reported in the coal industry. Ezepue and Nworah[27] demonstrated a low occurrence of mining related injuries in their study. They felt this may have been due to the wearing of head and eye protective devices by miners in the coal industry. PPED use in the current study was voluntary. This bothered workers doing the most dangerous aspects of quarrying such as blasting and lessons drawn from past incidents of accidents witnessed or told by eye witnesses. A blaster at the quarrying site admitted a past episode of chemical eye injury and facial burns.

Using the multivariate predictor of work-associated eye injuries, working in the stone quarry was a significant risk factor for sustaining work related eye injury. This is not surprising as the most dangerous aspects of quarrying occurred here involving the blasters and drillers. It is noteworthy to observe that methods of stone processing in this industry were still primitive, lacking due consideration for the workers involved. Breaking, for instance, was done manually with a sledge hammer; Drilling with outdated electric powered drills in the open. These drillers and breakers were exposed to high velocity fragments of broken stone. Thus with no form of eye protection, work-related accidents would be frequent in this subgroup. More blasters were found to use eye protection resulting in reduced occurrence of eye injury in this subgroup. These workers carried out blasting from a safe distance and ignited their explosives via a cord, which was lighted at one end.

Taking into cognizance all the potential hazards in the quarrying industry, it is obvious that at the end of any work day, most workers would run the risk of suffering harm to the eye directly or indirectly. Most workers must have been exposed to varying degrees of atmospheric stone dust, some to flying pieces of stone and others to fire or smoke from explosives. It is also important to note that the industrial eye injuries reported, represent only a small proportion of the total injuries actually occurring.


  Conclusion Top


Several risk factors for eye injuries were encountered at the work site by majority of the workers. There is need for use of eye protective devices, training, and retraining of workers to achieve mastery of job specification thus minimizing injuries and maintaining the work environment according to stipulated guideline with enforcement of regulations that are punishable, to make the workplace safe for all workers.

Acknowledgements

I acknowledge the support and co-operation of the staff of the Central mines stone quarry and the stone processing industry in Abakaliki, the resident doctors of Federal Tteaching Hhospital, Abakaliki and Mr. Chuma Oraedu − the statistician.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Uncited reference Top


[23].



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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