Responsiveness of Occupational Health Risk and Preventive Measures Practice by the Workers Employed in Tannery Occupation in Kanpur, India


 Background: Occupational health covers all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. There are several health risks, such as respiratory problems, injuries/accidents, musculoskeletal disorders, cancers, mental health disorders, skin ailments, infectious diseases, and many more involved in the occupation, which exclusively depends on workplace conditions. Objectives: The objective of the study was to understand the extent of awareness about occupational health risks involved in tannery occupation and adopted preventive measures by the tannery workers of Kanpur, India. Methods: Information for the present research was strained from a cross-sectional household study of tannery workers in the Jajmau area of Kanpur, India. The survey was piloted through the period January-June 2015, and 284 samples were collected. This study has adopted a three-stage sampling design. The frequency distribution and cross-tabulation were used. The difference in the awareness of various morbidities was tested using the chi-square test. A logistic regression analysis was used to identify individual risk factors. Results: The prevalence of awareness of tannery work is very hazardous in nature varies from 73% to 93% among the tannery workers. Tannery workers having a middle-school level of education were 3.01 times more likely to be aware of the hazards as compared to the illiterate workers. Tannery workers aged 36 and above were 0.34 times were 0.58 times less likely to aware of a hazardous work environment. Tannery workers who belong to the younger cohort (16-24 years) reported a higher awareness of respiratory problems (38%), skin complaints (59%), and gastrointestinal issues (21%) than those aged 36 years and above. About one-third of Beamhouse workers (33%) and over a quarter (26%) of the wet finishing had moderate to high dermal contact with the chemicals. The highest use of gloves and masks is seen in Beamhouse work (12 & 13%). Conclusions: The outcomes of the study give a clear indication of the effect of the workstation environment on the health status of workers and require the use of adequate measures to improve the facilities and thereby the health status of tannery workers.

Conclusions: The outcomes of the study give a clear indication of the effect of the workstation environment on the health status of workers and require the use of adequate measures to improve the facilities and thereby the health status of tannery workers.

Background
The enormous burden of poor working conditions stated by several studies and with the latest estimates provided by the International Labour Organization (ILO) that somewhere 2.3 million working people around the world capitulate to work-related accidents or diseases every year; this links to over 6000 deaths every single day. Worldwide, there are around 340 million occupational accidents and 160 million fatalities of work-related illnesses annually [1]. While Improved and harmless workplaces can avoid at least 1.2 million deaths every year, according to 2018 world health organization (WHO) study.
Many causalities can be prevented through addressing significant health dangers, which is directly associated with the workplace, and the exposures such as stress, long working hours and shift work, prolonged sitting at work, work-related climate-sensitive diseases, such as heat and cold stress, as well as workplace air pollution [2,3,4,5].
Occupational health covers all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. Depending on workplace conditions, there are several health risks: cancers, injuries/accidents, musculoskeletal disorders, respiratory problems, mental health disorders, skin ailments, infectious diseases, etc. Employment conditions in both formal and informal sectors are also significant factors: working hours, salary, and policies that cover such aspects as maternity leave, and provisions for protecting and promoting employee health [6]. Occupational health is a grave concern in developing countries, but there have been few studies of health issues faced by tannery workers because of which the problems are largely unknown. Further, the workers' health issues have not received sufficient attention from employers. The place and work environment are crucial influences on the extent of health risks faced by tannery workers.
According to WHO, occupational health problems accounted for about 1.5 percent of the total burden of disease regarding disability adjusted life years (DALYs), particularly in occupational health, which included work-related injuries, and exposure to risks such as carcinogens, airborne particulates, ergonomic stressors, and noise [7].
Tannery workers are susceptible to multiple chemical and physical hazards in their work.
Direct exposure to hazardous materials significantly increases health risks. The workers are exposed to chromium during the tanning process, leather dust, and various chemical agents. There are also ergonomic stressors that increase susceptibility to numerous health issues. Workers involved in multiple operations like material transfer, wet finishing, dry finishing, etc. are particularly vulnerable to harm. The risks associated with the tanning work is included in the proposed research paper examines the health hazards of tannery work Kanpur (India), and the preventive actions that are taken.
As mentioned earlier, there have been a limited number of studies of perceived health risks and preventive measures among tannery workers in the developing world. This research work investigates the work experience, working hours, type of job contract, and the type of work the tannery employees are usually engaged in. At the same time, it also examines their awareness of the hazardous work environment, the effect of exposure to chemicals, dangerous tissues involved in the tanning process. It also studies their perceptions of the effects of exposure to chemicals and contact with them, airborne dust, and ergonomic stressor. The objective of the study was to understand the extent of awareness about occupational health risks and adopted preventive measures during working hours among male tannery workers of Kanpur, India.

Methods
Information for the present research was strained from a cross-sectional household study of tannery workers in the Jajmau area of Kanpur, India. The survey was piloted through the period January-June, 2015, and was a portion of a Ph.D. database. All total of 286 tannery workers from the study area were questioned. Rigorous pre-testing was completed with the tannery workers of the Jajmau area for testing the internal uniformity of schedule.
Beforehand starting the interviews, we have clarified the tenacity of the survey and requested to contribute to the study by giving the proper information. After that, face-toface discussions were piloted among those who agreed to participate in the study by using a structured pre-tested questionnaire on the tannery workers. Appropriate statistical methods were used to meet the objectives of the study.

Sampling Design
This study has adopted a three-stage sampling design. At the first stage, seven localities in the Jajmau area, namely Tadbagiya, Kailash Nagar, J.K. colony, Asharfabad, Motinagar, Chabeelepurwa, and Budhiyaghat, were selected based on a higher concentration of leather tannery worker's population in these areas as reported by various stakeholders in the city. In the second stage, three out of the seven localities, namely Budhiyaghat, Tadbagiya, and Asharfabad, were selected by probability proportional to size (PPS) sampling technique after arranging them in increasing order of estimated number of HHs of leather tannery workers. Subsequently, a comprehensive household listing and mapping were completed in each of the three localities, and all the household were classified into three groups-households having at least one tannery worker, irrespective of having or not having any non-tannery worker, households having non-tannery worker (s) and households having no worker. The first two groups of households constituted two independent sampling frame in each of the three selected localities. While the third group of households was excluded from the study. Once the updated and comprehensive sampling frames were developed in each of the three areas included in the study, a circular systematic random sampling was used for the selection of households at the third and the last stage. In case, if more than one worker were in a household, the target respondent was selected using KISH table. In each of the three selected areas, 100 households were selected for each of the two categories i.e., a tannery as well as non-tannery workers, using a circular systematic random sampling procedure. Thus, a total of 600 HHs were selected for the interview, and a total of 284 HHs having at least tannery workers, and 289 HHs of non-tannery workers (s) were interviewed successively. In the paper, we have tried to understand the level of awareness among the leather tannery workers. Bivariate analysis and logistic regression analysis is performed.

Work related characteristics of tannery workers
The work-related characteristics of tannery workers are presented in Table 1. Tannery operations can be categorized into four broad categories: Beamhouse work (8% of workers in a tannery unit), wet finishing (25%), dry finishing (50%), and miscellaneous work (17%). We collected information on total work experience (in the present job and previous ones) in tanneries. Around 15 percent of the tannery workers surveyed were engaged in the occupation for more than 20 years, and about one-third of workers were involved for 20 years in the tannery occupation. Most of the workers (89%) were working as daily wage laborers, while only 11 percent were permanent employees. Over one-fourth (27%) worked for 11 to 12 hours a day, and 52 percent reported that they worked for all seven days in the week.
The nature of the work done is shown in Figure 1. For this study, the job contract was divided into two categories-temporary (daily wages) and permanent. Most workers were engaged in works on a temporary basis. In the beam house, where the work is particularly hazardous, 96 percent of the workers were employed temporarily, with permanent employees making up the remainder. The nature of the job contract was heavily skewed in the other sections also: wet finishing work (84% and 16 percent respectively of temporary and permanent workers), dry finishing (89% and 11%), and miscellaneous work (94% and 6%).

Awareness about the exposure of hazardous chemicals and work environment
Workers' awareness of hazards involve in tannery operation is presented in Table 2. About 79 percent of the workers in the age group of 16-24 years agreed with the statement that "tannery work is very hazardous in nature" found to be highest. Awareness of the above statement varies from 73 to 93 percent for the educational attainment, religion, caste, media exposure, and standard of living index among the tannery workers. It was found that tannery workers having a middle-school level of education were 3.01 times more likely to be aware of the hazards as compared to the illiterate or less educated ones.
Those with a comparatively higher standard of living were 2.08 times more likely to agree that "tannery work is very hazardous in nature" than those having a lower standard of living. Agreement with the statement that "tannery workers work in the very hazardous work environment" ranges from 55-79 percent for the predictors such as age, education, religion, caste, media exposure, and standard of living index. Tannery workers aged 36 and above were 0.34 times, and those who had a medium level of media exposure were 0.58 times less likely to aware of a hazardous work environment. We also examined the perceptions about exposure to hazardous chemicals in tanning processes. The awareness varied between 40 and 69 percent according to selected background variables. Odds ratio show that workers having a middle level of education were 0.43 times, and those with a medium level of media exposure are 0.54 times less likely to aware of the exposure of hazardous chemicals used in the tanning process. We also tried to understand the awareness of exposure to hazardous tissues involved in the tanning process. It was found that awareness ranged from 40 to 65 percent, depending on age, education, religion, caste, media exposure, and standard of living index. The odds ratio shows that tannery workers aged 36 years and above were 0.44 times less likely to aware of the hazardous tissues involved in the tanning process. The awareness of potential health hazards involved in the tanning process by type of work is presented in Table 3. It is seen that 83 wet finishing and dry finishing (about 80%) workers were aware that the tannery work is hazardous. Similarly, 66 and 64 percent wet finishing and dry finishing workers engaged in tannery workers accepted that they worked in an unsafe work environment. Most of the workers (69%) in the wet finishing section reported that tannery workers were exposed to several hazardous chemicals during the tanning process, which was following by workers engaged in dry finishing (55%), Beamhouse work (50%), and workers engaged in miscellaneous work (49%). Around twothirds of the workers involved in wet finishing were agreed that hazardous tissue engaged in the tanning process.

Awareness about the health hazard due to work in tannery occupation
This research work examined awareness of health problems that may occur in tannery work. Various health issues like respiratory trouble, skin complaints, eye-related, and gastrointestinal issues were observed, which are presented in Table 4. Tannery workers who belong to the younger cohort (16-24 years) reported a higher awareness of respiratory problems (38%), skin complaints (59%), and gastrointestinal issues (21%) than those aged 36 years and above. There is an increasing awareness of educational attainment. Workers with high school education and more showed higher awareness of respiratory problems (52%), skin complaints (67%) in comparison to illiterate Similarly, other caste group workers were also more aware of respiratory problems (29%), eye-related issues (46%), and the gastrointestinal problem (19%) compared to the schedule caste and other caste group workers.

Qualitative measure of environmental exposure by type of work
The chemicals used in tanning processes are not consumed but discharged into the environment as effluents. Effluents organic matter, chromium, sulphides, and solid waste. Qualitative assessment of exposure at the workplace may be a usefu evaluating hazardous working conditions.

Preventive measure and experiencing the different working condition
The preventive and safety measures appropriate for the work are presented in Table   6. The highest use of gloves and masks is seen in Beamhouse work (12 & 13% respectively), wet finishing ( Most tannery workers also reported that exhaust fans (88-99%).

Discussion
The results from this study of male tannery workers in Kanpur, Uttar Pradesh demonstrated that the workers were exposed to chemicals, leather dust, which contains chromium, and physical hazards. A substantial proportion of the tannery workers reported awareness of the health risks of the various tanning processes. The physical and cognitive difficulty levels of the job in tanneries were similar to previous studies [8,9,10]. It is essential to mention here that there are very few studies conducted on tannery workers in the Indian context.
The results of our study validate the need for further efforts to minimize hazardous occupational health risks among tannery workers. However, findings depict tannery workers aged 36 years & above are less likely to be aware of the hazardous work environment, and malignant tissues involved in the tanning process, lack of protective equipment and safety devices showed a significant double risk for occupational health and injuries [11,12,13,14]. Previous findings agree with a study on salt workers found that there is a considerable gap between their knowledge and practices, along with protective measures [15]. A study conducted on chronic conditions, workplace safety, and job demands in Colorado revealed that non-provision of workplace safety led to employees' chronic health conditions and contributed to absenteeism and poor job performance. It also influences the physical and cognitive difficulties of the workers associated with the work [16]. Other factors also significantly affect perceptions of health risks: age, education, religion, caste, media exposure, and standard of living index. Workers reported that they are aware that they have the chance of getting respiratory problems, skin complaints, eye-related, and gastrointestinal problems from the tannery. A substantial proportion of workers experienced severe conditions, such as humidity (69-88% of those surveyed), heat (69-84%), noise (78-87%); they had also got used to the smell of hides (51-63%). Comparable outcomes found by a study led in some developing countries concentrating on the upshot of work-related acquaintance to noise and heat on the health of the workers. Results portray that those who worked in the foundry had high thermal stress, high noise levels, high visual defects, high muscle cramps problem, high visual disability and also describe non-use of protective equipment and poor occupational hygiene and safety measures were also affected the health problem among workers [17,18,19,20]. Our study recommended that leather dust exposure be reduced by providing gloves and masks and by installing a hood duct to provide better ventilation and removal of leather dust from the work area as also recommended by previous researches [21].
This research also suggested risks should be assessed for their potential consequences on health. Liquid effluents contain organic matter, chromium, sulfides, and solid wastes. A qualitative assessment of exposure showed that moderate to high exposure to chemicals and also contacted them. It has been reported from the literature that the workers on exposure to leather dust, which contains chromium in the protein-bound form, exhibited a higher mean concentration of urinary and blood chromium [8].  Figure 1 Percent distribution of job contract by their type of work they usually do in tannery reported by tannery workers