Abstract
High exposure to hazards and unsafe behaviors are the most important factors contributing to ocular injuries and visual problems at the workplace. Evidence show high prevalence of ocular injuries in Asian countries. However, in Malaysia, very little is known about the ocular injuries and visual problems of workers in construction industries. A cross-sectional study was conducted on 385 workers (770 eyes, 378 males and 7 females). A comprehensive ocular assessment was done by using Reichert Portable Slit Lamp and a questionnaire was designed to assess the environmental hazards, behavior factors as well as the awareness. The prevalence of ocular injuries is 66.2% (n=255 eyes). Environmental factors were the major causes of ocular injuries and visual problems to the construction workers. There were significant differences found between the occurrence of ocular injuries to dust (70.4%, n=271, p=0.000), chemical (75.8%, n= 292, p=0.000), excessive heat (68.1%, n=262, p=0.000), equipment (60.5%, n= 233, p=0.001), fall (54.8%, n= 211, p=0.000) and limited working space (52.7%, n=203, p=0.002). Lack of knowledge (78.7%, n=303), inadequate training (69.3%, n=267) and low compliancy (62.3%, n=240) were observed. The awareness towards the environment (71.7%, n=276), behavioral awareness (65.7%, n=253) and their stress level (67.5%, n=260) were considered low. The findings indicate high prevalence of ocular injuries among construction workers, poor behavior and awareness among construction workers in Malaysia. Eye safety assessments, training and monitoring are required to improve the eye safety and health at the the workplace.
Introduction
Construction workers are bound to face unpredictable and dangerous situations at the construction sites. Lately, the ophthalmic emergencies departments has experienced a rise in patients, particularly construction workers, as they intensely suffer from ocular injuries. Whether these ocular injuries are treated or left untreated, it can impair their quality of life and their working capabilities. In fact, the ocular injuries may show a substantial loss of working days and show a cost for the health system (Gobba et al., 2017).
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The work environment is the main setting that affects a vital part of an individual’s wellbeing. The surroundings of the work area in any field can impact the medical state and productivity of workers (Chauhan et al., 2014). When comparing work environments, the most physically challenging and hazardous environment is in the construction sites. Construction workers are exposed to all kinds of environmental hazards, which arise due to manual handling, tools, small areas, work handled from high heights, excavations, irregular working hours and exposed to different weather conditions. Exposure to these environmental factors may cause industrial accidents to occur (Mock et al., 2017).
Construction workers that revealed unacceptable behaviors at work such as poor knowledge and refusing to wear personal protective equipment strongly increased the chances of developing eye injuries. It was found that these factors contributed to health consequences 10-20 times more in economically developing countries than those in developed countries (Jazari et al., 2018).
The construction workers are being thrown into the sites instead of getting proper training during their probation phase. This can contribute to the occurrence of ocular injuries as the construction workers lack a sense of awareness in terms of the environmental hazards as well as practicing unsafe behaviors (Shamsudin et al., 2015).
In Malaysia, it was found that out of 935 cases with ocular injuries, 440 of them were of work-related ocular injuries, majorly from workers in the construction industry. This was due to environmental factors and their behavioral compliancy towards wearing personal protective eyewear. A total of 86.59% of the workers did not wear personal protective eyewear (Min et al., 2016). Studies have shown that the workers who have a higher possibility of getting injured are immigrants, rather than native-born laborers. Immigrants are currently over-populated in construction work (Adhikary et al., 2017). The construction laborers are essentially bounded in exploitative conditions, restraining them with policies that does not offer much protection (Dutta, 2017). The existing knowledge and awareness about the safety of the surroundings at work is insufficient. It is imperative to increase one’s understanding through applying safe working practices to avoid industrial accidents from occurring (Netto & Hamedon, 2017).
The eye injuries such as subconjunctival hemorrhage, penetrating intraocular foreign body, chemical burns and lacerations, commonly occurred due to environmental hazard exposure and workers’ behaviors in terms of ignorance and compliancy towards wearing personal protective equipment (Almoosa et al., 2017). Despite extensive efforts that have been made to reduce the possibility of getting injuries in the construction industry, many studies are not comprehensive in this respect (Soltanzadeh et al., 2016). Hence, it is imperative to find the root causes so that safety measures can be done to avoid or prevent the occurrence of the ocular injury (Kumari & Daigavane, 2017).
Methods
Study Design
The research is a quantitative method, whereby the data collected from the questionnaire was more towards numerical approach. A cross-sectional survey was done using purposive sampling technique. Workers were evaluated using a validated structured questionnaire and an ocular observation using the appropriate equipment to determine the ocular health status of construction workers who were exposed to occupational hazards at a point of time, between June 2018 to February 2019.
Unit of Analysis
As the research was intended to determine the environmental factors, behavioral factors as well as awareness that is causing the ocular injuries and visual problems, data was collected from each construction worker and hence, the unit of analysis is the individual.
Sampling Frame and Sample Size
The sampling frame defines all elements in the population from which the samples are drawn. The sampling frame for this research were construction workers, in Malaysia. They were identified through phone calls and meetings with the site supervisor, project engineer or person-in-charge. The sample size was decided based on scientific table guidelines given by Krejcie and Morgan (1970). As the population of construction workers in Malaysia are beyond 100000, the sample size required to establish representativeness for generalizability was 384.
Inclusion Criteria
The target population falls under the inclusive criteria, whereby construction workers in the age range of 18-55 years, with no systemic disease, and have been working at the site for more than five months. The participants voluntarily agreed to participate in the study and were allowed to withdraw at any time. Prior to that, a consent form was given beforehand to the participants.
Exclusion Criteria
The exclusion criteria were participants suffering from any systemic disease such as diabetes mellitus, hypertension or atherosclerosis as it may alter the accuracy of the results. Besides that, participants who are not construction site workers were excluded from the study.
Reliability Testing
A questionnaire was given to assess the environmental, behavioral factors as well as the awareness contributing to the ocular injuries. Reliability test was used to measure the internal consistency of the environment, behavior and awareness of the construction workers. The environmental factors consisted of six questions. The scale showed a high level of internal consistency, in which the Cronbach's α was of 0.701. The behavioral factors which had 3 items had a cronbach’s α of 0.902 and awareness, which consisted of 3 items, had a cronbach’s α of 0.771.
Data Collection
The data collection for this research was conducted from June 2018 to February 2019. The participants are individuals exposed to any type of occupational hazards at the construction site, in the age range of 18 years old to 55 years old. A consent form was given to the participants prior to the examinations. The results were obtained by assessing the ocular health status of the individuals exposed to occupational hazards. Presence of any ocular injuries from the eyelids, lashes, cornea, conjunctiva and crystalline lens were assessed.
Data Analysis
The data collected was analyzed through the Statistical Package for Social Sciences (SPSS). It provided evidence on the environmental hazards, behavioral factors as well as awareness towards the ocular injuries and visual problems. Descriptive and Chi square analysis was made. The association between the ocular injuries and the factors was assessed. The conclusion was made based on the outcome of the data that was collected and analyzed. Hence, the correlation of the possibility of the occurrence of ocular injuries and the factors was determined.
Ethical Consideration
Ethical approval to conduct this study was obtained from the Postgraduate School in Management and Science University, Shah Alam. The consent to perform the assessments to the construction workers from the appropriate companies was obtained. Before conducting the assessments, the construction workers involved in this project were given a consent form.
Results
Out of the 385 construction workers, it was found majority of them were Bangladeshi’s (74.22%, n=285), followed by Indonesians (9.64%, n =37), Malaysians (8.33%, n=32), Pakistanis (4.17%, n=16), Myanmar’s (3.13%, n=12) and Nepal (0.52%, n=2). A total of 64.9% (n=250) of the construction workers did not wear personal protective eyewear. After the eye assessments, it was found that 66.2% (n=255) of the construction workers had ocular injuries. Among the 255 construction workers that had ocular injuries, majority of them had pterygium (54.60%, n=184 eyes), followed by foreign body (28.18%, n=95), subconjuctival hemorrhage (9.20%, n=31 eyes), corneal haze (4.74%, n=16 eyes), laceration (1.78%, n=6 eyes), corneal burn (1.20%, n=4 eyes) and traumatic cataract (0.30%, n=1 eye). When assessing their visual status, majority of the construction workers (83.76%, n=645) had a good visual acuity of less than 6/9. About (15.58%, n=129) had a visual acuity below 6/12. Only a small number of construction workers had poor visual acuity of worse than 6/18 (0.66%, n=5). The environmental exposures causing the ocular injuries to the construction workers had p values of less than 0.05. Hence, it is statistically significant to the occurrence of the ocular injuries. However, behavior and awareness were not statistically significant to the occurrence of the ocular injuries to the construction workers as the p value is above 0.05. The behavior in terms of the knowledge on personal protective eyewear, adequate training provided, compliancy towards wearing PPE and awareness of the hazards were assessed using Likert scale. It was found that the knowledge (78.7%, n=303), training (69.3%, n=267) and compliancy (62.3%, n=240) were low. When assessing the awareness, it was found that the construction workers had low awareness towards the surroundings at work (71.7%, n=276), poor behavioral awareness (65.7%, n=253) and had low pressure at work (67.5%, n=260).
Conclusion
The prevalence of ocular injuries and visual problems were determined through this research and environmental factors (dust, chemical, excessive heat, equipment, fall and limited working space) showed statistical significance to the occurrence of ocular injuries and visual problems, while the construction workers exhibited poor behavior and a lack of awareness. Hence, through this research, organizations as well as the government will determine the severity of the existing situation and hence, implement newer policies in Malaysia to lessen the occurrence of injuries. Not only will the newer policies reduce the occurrence of ocular conditions, but it will also reduce the overall injuries of the construction worker. As construction workers obtain more information regarding their ocular health status, they will take the appropriate steps to prevent injuries from occurring and be more aware of environmental hazards at the construction sites. Students will also benefit from this research as it will help them gain more insights in the body of knowledge.
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