Ocular morbidity patterns among metal workers from an unorganized sector: A cross-sectional study

Introduction and Aim: The metal working process has many hazards that the metal workers are exposed to resulting in several health disorders and diseases. However, there is a lack of documented information regarding the prevalence of ophthalmic safety practices and the factors influencing them among metal workers in the Moradabad region or the study area. The aim of the present study is to assess ocular morbidity patterns among the metal workers from an unorganized sector. Methods: We conducted this study to find out the morbidity patterns among the metal workers working in Northwestern Uttar Pradesh, district Moradabad. A cross-sectional study was conducted among 100 metal workers using a pre-validated structured questionnaire. Results: All the metal workers working, without any formal eye health and safety training. Eye Injury was the most common problem at work. The age of the metal workers, duration of employment & welding hours per day were associated with ocular morbidities among the metal workers. In this study, among 100 metal workers, 18% of workers were suffering from an occupational eye injury. 98% metal workers population don’t have any personal protective eye device.86% of them feel this protective eye device is not so necessary. Conclusion: There is a need for occupational health safety awareness services for metal workers in Moradabad as well as in Uttar Pradesh. While further research may be required to make policy recommendations, the current study provides a baseline morbidity burden among these mental workers to look for interventions to promote health and safety at work for this neglected unorganized group.


INTRODUCTION
etalworking is a type of hazardous job.Commonly Metal workers are exposed to heat, burns, radiation, noise, fumes, and toxic gases.Moreover, due to different workplaces and working methods employed as well as the surrounding environment.Noxious agents can enter the body through various body routes.
Several researchers reported that Common health effects such as eye itching, irritation, lung disease, and fertility issues among metal workers worldwide.However, implementing safety measures and using personal protective equipment can help reduce the risks of morbidity and mortality.Unfortunately, though, there exists low awareness of hazards and use of protection among metal workers around India (1), including those in Northwestern Uttar Pradesh district Moradabad (2).
According to the factories (amendment) Bill, 2016 health safety statutes in the workplace normally exist only in four sectors like mining, factories, ports, and construction for regulating the Occupational Health and Safety (OH&S) of workers.The Factories Act of 1948 and the Mines Act have legal provisions to protect the occupational health and safety of the working populations in India.It was found that the Factories Act of 1948 was amended in 1954,1990,1976, and 1987 and a special chapter was added after the Bhopal gas disaster (3).There are very limited studies conducted on occupational health among metal workers in Northwestern Uttar Pradesh, district of Moradabad.Occupational health and safety is a recent idea and very few industrial sectors applied and associated with ideal occupational standards, even in the oldest industry like the metallic article-producing industry of Northwestern Uttar Pradesh, Brass city Moradabad.
As per studies, metal workers face hazardous working conditions and the usage of safety measures is low.Therefore, it is important to establish and investigate the current eye health issues among these metal workers.In the Northwestern region of Uttar Pradesh, Moradabad district is known as the brass city of India.There are various metal-working workplaces typically established in domestic workshops, local public markets, and along the main highways inside the city.It was found that Uttar Pradesh is the hub of several industries, industrial organizations, and sectors that are part of the Indian economy.The total population of Uttar Pradesh is 20.42 crores.According to the M Census of India (2011), there are a total 47,72,006 people living in the Moradabad district.There are 29.71percent of people who are workers among this 47, 72,006 population (4).After providing a detailed explanation of the study purpose, informed consent was obtained from each participant.Although the awareness about eye health and ophthalmic conditions of metal workers have been assessed and investigated in various regions of the world as well as India, there is still a lack of knowledge and awareness when it comes to their well-being within Northwestern Uttar Pradesh, Moradabad district.Therefore, we conducted this study to investigate the ophthalmic disorder profile of metal workers in this region, as well as create a platform to support future research and safety policy.

Study setting and design
In northwestern Uttar Pradesh, district of Moradabad, we conducted a prospective, cross-sectional study.Metal workers are typically found in organized as well as unorganized sectors located in cities (Industrial area), along with beside main roads and residential places.

Sample size and sampling technique
This research was conducted to assess the eye health status of metal workers in Northwestern Uttar Pradesh, District Moradabad.This study was conducted in November 2022 to June 2023 .We enrolled 100 metal workers working in Northwestern Uttar Pradesh; district Moradabad, through a systematic random sampling method.In this study, metal workers between the ages of 14 and 60 were included and if they did not consent, they were considered non-respondents.We divided metal workers into three groups as per their job category like metal casting, scraping, polishing, and welding.

Ethics, consent, and permissions
The study was approved by the Institute Ethics Committee and followed the principles of the Declaration of Helsinki.The approval for this study (Ref: TMU/ IEC/ 2021-22/67) was taken from the Teerthanker Mahaveer University, Moradabad.

Data collection
We used pre-validated questionnaires and clinical performance to collect data [5].Participants were asked questions about their demographic data like age, gender, marital status, education, monthly income, duration of employment, hazardous exposure, and eye symptoms.The hazardous working exposure was measured in hours per day.

Statistical analysis
Data were entered into Microsoft Excel.Microsoft Excel was used to analyze the data.Descriptive statistics were calculated by using frequency distribution tables, central tendency, and percentage in consideration with variables like duration of employment, working hours with different hazardous conditions.Inferential statistical tests like chi square were used to correlate the age of metal workers of participants with conditions depending on the type of data.The probability of significance was set at a 5% level with a 95% confidence limit.through a random sampling method.In this study, metal workers between the ages of 14 and 60 were included and if they did not consent, they were considered nonrespondents.We divided metal workers into three groups as per their job category like metal casting, scraping, polishing, and welding.

RESULTS
In this study, 100 metal workers in Uttar Pradesh's district Moradabad participated.Table 1 shows the socio demographic characteristics of the metal workers.Table 2 shows ophthalmic safety practice among metal workers.Table 3 shows the age distribution among metal workers.Table 4 shows ocular sign and symptoms distribution among metal workers.

Socio-demographic characteristics of the metal workers
In this study, among 100 metal workers, the female was 74 percent, and the male was 26 percent.It was seen that most metal workers (37%) were aged between 40 to 49 years and (22%) were aged between 30 to 39 years.The mean age of metal workers was Mean ± SD (40.98±11.37)years.The education level attainment of the metal workers shows 13% of the respondents have completed up to Secondary school, followed by 20% up to the primary level education and showing that 64 % of the metal workers in this study were literate.The mean working experience of metal workers was Mean ± SD (17.04 ± 12.56) years.Marital status of metal workers shows more than 80% of the respondents were married, 3% were divorced and 8% were unmarried.64% of metal workers were illiterate.77% working population were Muslim and 23% working population were Hindu.We have classified the metal workers population based on Kuppaswamy's socioeconomic classification.As per that classification, 44% of metal workers are in Lower and 56% of metal workers are in Upper lower socioeconomic class.In this study, among 100 metal workers, 39% were metal casting, 24% were scraping, 29% polishing, and 8% welding.Among 8% welders, 3% were electric/arc welders and 5% were gas welders.In this study, 52% of workers had a work duration of 8-10 hours.The study revealed 48% of workers' monthly income was 5000-10,000/-.97% of workers had not followed any eye PPE policy.The study revealed 93% of workers had not taken any training and 87% of workers had not used eye PPE during work(Fig.1).98% of workers do not have eye PPE.Among them, 86% of workers feel eye PPE is not necessary.The study also revealed 69% of metal workers' working experience was more than 9 years.There were 36% of metal casting, 19% of scraping, 21% of polishing, and 5% of welding workers complaining that blurring of vision in distance and near.Study revealed 92% of workers had visual acuity 6/18-6/12.Among them, 46% of workers had presbyopia, 13 % cataracts, 6% color vision defect,10% distance refractive error, and 2% corneal opacity (Fig. 2).

Fig. 2: Ocular sign and symptoms distribution among metal workers
In this study, among 100 metal workers, 18% of workers were suffering from an occupational eye Use 13% Nonuse 87%

Usage of eye PPE while working
Yes 7% No 93% injury.Among them, 17% of workers had a history of eye injury more than a year ago.Study revealed that 13% injury happened in the morning, 2% in the afternoon, and 3% in the evening.13% of workers reported that injury was mild (no first aid needed), 2% cases reported that injury was moderate and there was a requirement of first aid, 3% worker reported that injury was serious, and they need immediate admit in Hospital/emergency clinic.The study revealed that 3% of workers reported that they need more than a month to recover from this injury and get back to his/her workplace and 15% of workers reported they need less than a month to recover from this injury.17 % of workers reported that their injury was in one eye and 1% of workers reported that their injury was in both eyes.Workers also reported that the nature of the injury was 16% mechanical, 1% chemical, and 1% electrical.87% metal workers population do not have any personal protective eye device.86% of them feel this protective eye device is not so necessary.87% of them never used a personal protective eye device during his/her hazardous work.28% among them sometimes used it near vision glass during work.93% of them had not received any technical or eye safety training to use protective eye devices (Fig. 1).

DISCUSSION
In this current study, the prevalence of favorable ophthalmic safety practices stood at 13% which was lower than the rates observed in similar investigations conducted in South Africa (89.0%) (6), Nigeria (96.6%) (7) and Uganda (89.0%) (8).This disparity could potentially be attributed to variations in the socioeconomic characteristics of the study, age of metal worker , duration of experience in metal work, daily working hours, and the size of the sample.
In our study, job training emerged as a significant factor associated with favorable ophthalmic safety practices.Our study revealed that 93% participants did not undergo eye safety training.This finding concurs with results from studies in India (10), Nigeria (11), and Ethiopia (12).Job training equips metal workers with foundational knowledge regarding the nature of their work, associated ocular hazards, and safety measures during their work shifts, ultimately fostering better ophthalmic safety practices among trained individuals.
Our study shows that 69% of participants have experience more than 9 years.Greater working experience tends to enhance metal workers' awareness of the ocular hazards associated with metal work and encourages consistent utilization of personal protective eye equipment.
Finally, our study revealed that 18% of workers had a history of ocular injuries.The findings from studies conducted in Canada (13), Alabama, USA (14), Nepal (15), and Nigeria (16) show that metal workers who had previously experienced ocular injuries were more likely to recognize the detrimental impact of their work on eye health and the preventive benefits of protective eyewear.

Limitations of the study
This study did not include any objective instruments to measure metalworking related to other systemic health disorders.Self-reported symptoms may have led to an under or overestimation of the impact of the hazard.When we screened their eye health and visited the location of the camp, we saw their working areas were very unhygienic and they were working in a very low illuminating area.It should be noted that a few metal workers are generally not involved in physical tasks regularly due to hazardous impacts on their health.

CONCLUSION
This study has found a high prevalence of various ocular morbidities among metal workers in Northwestern Uttar Pradesh's Moradabad district.More than half of the population suffered from vision defects.This study also demonstrates that their profession is hazardous.This research also revealed that over half of Moradabad metal workers' population demonstrated a negative attitude towards safety practices.Various international studies have already established the fact that metal working causes serious health conditions, making this possibly the first evidence of metalworking-associated ocular morbidities from this region.Various Factors like working as a metal worker, having received job training, work experience and history of ocular injury were found to be significantly linked to maintaining satisfactory ophthalmic safety practices.Further research is necessary to distribute personal protective equipment and traditional vision spectacle to metal workers, educate them about the occupational hazard which helps them to follow safety regulations and assess their safety compliance after the intervention.

Fig. 1 :
Fig. 1: Eye personal protective equipment uses and its training distribution among metal workers