University of Nigeria Research Publications

ALOH, Henry E. A

utho

r

PG/MPH/98/20822

Title

Appraisal of Occupational Health Hazard Among Quarry (Stone) Industry Workers in Ebonyi State of Nigeria with

Special Reference to Respiratory Diseases

Facu

lty

Medicine

Dep

artm

ent

Community Medicine

Dat

e February, 2004

Sign

atur

e

UNIVERSITY OF NIGERIA

KEENLOC BINDERS 3 OSADEBE STR., OGUl N/LAYOUT, ENUGU Your Sttistjetion k our eonearn.

-

MPII RESEARCH PROJECT

'I'OPIC: APPRIASAL OF OCCUPATIONAL IIEALTII IIAZAItD

AMON<; QllARItY (STONE) INDIJSTRY WOIIKERS IN I<DONYI

SI'A'I'E 01; NlGERlA Wl'TlI SPEClAL REFERENC:K '('0

RESPIRATORY DISEASES.

APPRIASAL O F

A DISSERTION SUBMITTED T O DEPT O F COMMUNITY

MEDICINE U.N.N. ENUGU CAMPIIS IN PART FIJLFII,I,MENT OF

THE REQUIREMENTS FOR THE AWARD O F THE DEGREE O F

MASTER O F PUBLIC HEALTH (MPH).

\

. BY: DR. HENRY E. ALOH

, DEPT. O F COMMUNITY MEDICINE

UNIVERSITY OF NIGERIA, ENUGU CAMPUS

SLJPERVISOK: PROF. R.A.N. NWAKOBY

DEPT O F COMMUNITY MEDICINE

UNIVERSITY O F NIGERIA ENUGU CAMPUS

MPI-I RESEARCH PROJECT

STUDENT NAME: DR HENRY E. ALOH.

REG. NO.

PROJECT TOPIC:

APPRAISAL OF OCCUPATIONAL HEALTH HAZARDS AMONG QlJARRY WORKERS IN EBONI'I STATE O F NIGERIA, WITH

SPECIAL REFERENCE T O RESPIRATORY DISEASES.

DECLARATION

I hereby declare that the study reported herein was done by me

and any assistance received is also acknowledged. That I l~ave not

previously subn~itted this dissertation in part or in fill1 for any

examination or publication.

DR. H.E. ALOI-I

DEPARTMENT OF COMMUNITY MEDICINE

LJNIVERSITY OF NIGERIA, ENUGU CAMPUS.

DEDICATION

This work is dedicated to the Mighty Jesus in whose rnercy arid

guidance I thrive.

To my wife M s . Gertrude Obianuju Aloh, and our children, Edinund,

William, Henry (Jnr .) and Soimacl~~ikwi .

ATTESTATION

I certify that the work for this dissertation topic.

DR. HENRY E. ALON

Was supervised by me.

ACKNOWLEDGEMENT

I wish to express my sincere appreciation to all the people who

contributed in one way or the other to the ,writing of this dissertation.

My heartfelt gratitude goes to Dr. B. S. C. Uzorcliukwu, Prof'.

B.A.N. Nwakoby, D. R. Nwagbo and Dr. (Mrs) C.N. Onwasigwe

who guided and supervised this work throughout the study period.

i express immense thanks to Ebonyi State Free Grassroots

Mobile Clinic Team that assisted a great deal in collection of the data.

My thanlcs also goes to the State Ministry of Health who permitted the

study in the state.

Finally, I wish to thank the Staff of Ebonyi State I-ISDP-I1 and

also EBRANS Computers, No 82 Zik Avenue Uwani Enugu for

assisting in the production of this work.

vii

TABLE OF CONTENT

l'itle page

Declaration

Dedication

Attestation

Contents

List of Tables

List of Figures

List of Acronyms

Abstract

CHAPTER ONE: Introduction

1.1 Introduction

1.2 Aims and Objective

1.3 Justification of Study

CHAPTER TWO: Brief Literature ~ e i i e w

2.1 SituationOverview t

2.2 Crystallille Silica (S and Silicosis

2.3 Concerns (or Statements of Problem)

2.4 Preventive Measures

CHAPTER THREE: Study Design and Methodology

3.1 Description of the Population under Study

3.2 Sample Size

3.3 Study Design

viii

v1

vi i . . .

Vl l l

X1

xii . . .

Xll l

xiv

3.4 Methodology and Data Collection 28

3.5 Data Analysis 30

CIIAPTER FOUR: Study Rcsults and Analysis

4.1 De~nog-aphic Result 32

4.2 Awareness Assessment 35

4.3 Hazard Assessment 37

4.4 Lung Function Assessment

CHAPTER FIVE: Discussion

5.1 Demographic Characteristics

5.2 Medical History

5.3 Lung Function Assessment 56

5.4 Limitation of the study 59

CHAPTER SIX: Conclusion and Recommendation

6.2 Conclusion 1

6.2 Recoinmendation

REFRENCE: 62

APPENDIX 1 : Permission of the study by the Ebonyi State Ministry

of Health. 74

APPENDIX 1 1 : Letter of acceptance, to participate in the study, from

Ebonyi State Association of Q~lai-ry Industry Owners 75

APPENDIX 11 1 : Consent to participate in the Study

APPENDIX 1 V: Study Questionnaire

APPENDIX V: Control Questionnaire

Table 1:

Table 2:

Table 3:

Table 4:

Table 5:

Table 6:

Table 7:

Table 8:

Table 9:

Table 10:

Table 1 1 :

Table 12:

Table 1 3 :

Table 14.

LIST OF TABLES.

Pages

Age Distribution of Quarry Workers. 32

Sex Ratio of Quarry Workers. 33

Years of Exposure to Silica (Quany Dust) 33

Job Description of the Workers 34

Level of Awareness. 36

Common Hazard Experienced at Work Site. 37

Common Symptoms and Signs among Quany Workers.39

FEVl Distribution for the 392 Quarry Workers, as

compared to that of the control population. 41

FEVl and Years of Exposure. 4 3

FEVlfor Workers with Less than 5Years Exposure.45

FEVlfor Workers with 5-10 years of Exposure. 46 .

FEV 1 for of Workers with more than 10 years

Exposure 47

FEVlof Workers who Snuff or Smoke Tobacco. 49

Urinalysis Result of the 392 Quany Workers. 50

LIST OF FIGURES

Pages ,

Figure 1 : Illustration of coinmon Hazard. 38

Figure 2: Illustration of FEVl for the T h e e Categories. 44

Figure 3: Illustration of Mean FEVl for the Three Categories.4S

xii

FEVI

CV

PLE

NlOSH

ILO

S 1 0 2

PAS

IARC

PACE

OSHA

ATSICDC

PYLL

PYWL

LGA

LIST OF ACRONYMS

Forced Expiratory Volume in one second

Calculated Value

Pennissible Limit of gxposure

National Institute of Occupational Safety and

Health

International Labour Office

Ciystalline Silica

Personal Air Sampling

Intemational Agency for Research on Cancer 4

Prevention and Control Exchange

Occupatioi~al Sal'ety and I-lealtl~ Adminis~r~rl io11

American Thoracic Society and Centers for

Diseases

Potential Years of Life Lost

Potential years of Work Lost

Local Government Area

xiii

ABSTRACT

To appraise the occupational health hazard among quarry workers in

Ebonyi State of Nigeria, a cross sectional study was carried out at

Abakaliki quarry site along the Old and New Enugu road. 130 Quarry

sites in Ebonyi State fonned the sample frame; out of which 49 sites

were selected using simple random sampling. All the 392 quarry

workers from the 49 sites participated in ,the study and this fonned the

study population. This population was grouped into 3 categories

depending on the duration or years of exposure. Assessinent of these

people were carried out on the basis of clinical history, physical

examination and lung ftinction assessment using Forced Expiratory

Volume in one second (FEVI) as measured with a Peak-flow meter.

The study shows that 38.8% had mild dough, 6.6% severe persistent I

cough and 4.1 % hea~noptysis. 48.2% had FEV 1 less than that of the

control population. The average FEVl of the studied population is

306.91111 and that of healthy control group (selected from the same (, area) is 3 l9.41n1, showing a difference of 12.5in1. When this is tested

at 95% confidence level (t=10.59; C.V. = 1.96; P10.05) there is

CHAPTER ONE

1.1 INTRODUCTION

I11 recent years there is growing concern for preventive health than it

was the case sdkie decades ago. There is now a greater concern for

prevention ~f~infectious w d parasitic diseases in developing co~mtries

than ever before, but with .little or no ~~~~~~~~~~n to prevention of I .

occupational diseases. With increased industrialization in the

developing countries there is need to pay attention to the resultirig

increase in occupational health hazards, so as to put safety ineasilres

in place.

The public, in particular the working class, are grossly LIII-informed

about the health hazard of their various occupations. Many suffer and

even die from one form pf occupational disease or the other, without

knowledge of the cause. Generally, there is poor awareness about

occ~~pational hazards, to the extent that only few medical practitioners

give attention to it while taking inedical history from patients.

This research project is born out of the desire to increase awareness on

occupational health hazard among qliarry workers, q~lany industries

owners and the general public in Ebonyi State. This is important

because quar~ying has become a major ind~~stry, hence source of

income for many in the state. Few studies have been conducted in the

area of occ~~pational health in this part of the world. A study by Okcke

in 1997 show that occupational hazard such as low back pain among

coal-miners in Enugu was as high as 80 %[I]. Study conducted by

Isah et a1 in EdoDelta State of Nigefia revealed that about 96.7% of

all industries studied, no worker use protective device [2]. A very

related study to the present one was carried among an unselected

group of 126 stone-cutters in Kano Nigeria, where racliographic

evidence shows silicosis rate of 35%[3].

1.2 AIMS AND OBJECTIVE

General: The general aim of this study is to ascertain the types and

level of health hazard posed by exposure to quarry dust among workers

of quarry indi~st~y in Ebonyi State, with a special emphasis on respiratory

diseases including silicosis, This will form the basis for future study on

environmental and health impact of quarry dust in Ebonyi State.

Specific Obiective:

To asses type of hazards resulting fro111 quarrying.

To fmd out' the prevalence rate of each of these health

hazards or diseases among quarry workers.

To establish factors predisposing to these hcalth hazards

To asses level of knowledge the workers have about the

hazards of their occupation

To evaluate existing measures, if any, the

industrieslgovemnent are adopting to reduce the

occupational hazard orland to treat/rehabilitate affected

persons.

To make recoin~nendations to the Governinelit and

Quarry Owners Union on various way to seduce

occupational hazard of the industry.

1.3 JUSTIFICATION OF STUDYIINTRODUCTION

(a) lt is a known fact that people who are exposed to high earth dust

concentrations have higller chances of suffering from lung disease

3

especially silicosis. To what extend does tliis apply to quany

workers in Ebonyi State? In other words, what is the prevalent rate

of respiratory disease among qliarry workers? What can the

workers, quarry operator /owners or the Gover~~~nent do to protect

the workers? These are the questions this study is going to provide

answers to.

CHAPTER TWO:

2. BRIEF LITERATURE REVIEW I

2.1 SITUATION OVERVIEW

With the gndual quest of industrialization of the developing co~intries

and the prevalent level of unemployment, a situation has risen where a

sinall state like Ebonyi has qulanying as a inajor.industry and alnlost

the only source of employment for unskilled poor women and

children. This can be compared to what happened in Britain during

the industrial revolution of the eighteenth century. This trend is

accompanied by huge ill-effect, since both the quany operators and

the workers lack adequate knowledge of the occupational hazard and

the preventive measures that are essential with quarrying or stone

. Owing to the abmdance of sedimenta~y rock in the state, about 110

small and medium scale quarrying iiidustries are currently operating

in the state, employing about 2000 or more workers.

The Quarrying Industry involves various processes and operations

including:

1. blasting of rock or stones,

2. manual crushing of quartz stones,

3, inecbanical crushing and g- indi~ i~ ,

4. sieving and screening,

5. bagging, and

6. transportation to construction sites.

A study in Mumbai, India shows that each of these operations

generates high concentrations of airborne "total" dust and I

respirable dust, which contain very high percentage (>75%) of bee

silica. These give operators estimated average exposure to

airborne total dust of 22.5ing/m3 and respirable dust of 2.93inghn3

as against recoinmended level of permissible limit of exposure

(PLE) of 1 .08mg/m3 and 0.36ingirn3 respectively [4].

In developed countries like United State of America, the National

Institute of Occupational Safety and Health (NIOSI-I) recommended

exposure limit of 0.lingirn3 is even considered high [ 5 ] . Thus, the

present n~ethod of quarrying in Ebonyi State poses a serious health

risk to the workers, the public and the environment and therefore

requires suitable preventive and control measures.

Many of these hazardous exposures result from inadequacies in access

to information, occupational health services measurement teclmology,

safety facility, educatiodtraining of workers, absence or lack of

federal or state regulation on effective worker's compensation law [6].

In order to address concern about exposure risks to dust in American

the National Institute for Occupational Safety and Health (NIOSI-I),

from 1979 to 1982, conducted a cross-sectional exposure assessment

and mortality study of selected cnlshed stone facilities in the United

States. Crystalline silica was at 17 but of the 19 surveyed crushed

stone operations, and over exposures to this substance were measured

at 16 of the crushed stone operation [7]. Stone-grinding industry is / I

t . well known to place its work force at risk for silicosis. A study \

conducted in 1995 among workers in 37 factories in 3 sub districts of

Saraburi, Thailand showed a radiologic pattern indicating that 9% of I

the workers had silicosis and 1.8% pulmonary tuberculosis. The

respiratory damage is related to level and duration of exposure; thus 4

higher exposilre resulted in more serious diseases [8]. 'The present

study is born out of concern for health of the numerous quany

workers in Ebonyi State.

In this study, it is necessary to review methodological issues pertiiient

to the application of epidemiology in risk assessment. According to

Nurinem, the assessnient. of the healtl~ risk associated with

occupational and environmental exposures involves four phases:

1. Hazard identification: the detection of the potentials for agents to

cause adverse effects in exposed populations.

2. Exposure assessment: the quantification of e.>;pus~ll-es and

estimation of characteristic and sizes of the exposed population.

3. Dose response assessment.

4. Risk clzaracterization: the evaluation of the impact of a change in

exposure levels on public health effects [9].

For the purpose of this and fi~ture work, emphasis will be on the first

phase -that is hazard identification and the effects of these hazards on the

health of workers especially as it concern their respiratoiy system.

Preliminary review orland assumption is that the quarry workers are

faced with numerous occupational hazards ranging from:

- Physical injury froin machinery and other

equipment used for stone crushing and even froin

stone it self

- Noise pollution leading to impaired hearing.

- ~ohalation of tdtal respirable dust (crystalline

silica dust).

Among all these the most coininon hazard and most significant is the

illhalation of dust.

2.2 CRYSTALLINE SILICA (SIOz) AND SILICOSIS I

Crystalline Silica, also known as quartz, is a natural colnpoimd in the

eartll's crust and is the basic component of sand and stones or granite.

1 Thus, crystalline silica is associated with many types of rock and 1 therefore constitutes the major part of dust generated from quarry.

The most common procedures that expose workers to respirable

, , crystalline silica include the following activities: t

- Chipping, hammering and drilling of rock

- Cnishing, loading, hauling and dumping of rock.

The three type of crystalline silica are

(a) Quartz which is the most coinmon silica

(b) Cristobalite and

(c) Tridymite

Exposure to crystalline silica as particles in workplace remains the most

important public health concern worldwide [10,11] and the biggest ,/

problem is- in the developing world [12]. This exposure residts in \,

silicosis, which remains the most prevalent occupational lung disease

I worldwide [13].

The primary determinants of silica toxicity are concentration and

duration of d~ist exposure; particles size distribution and the presence of'

a freshly fractured surface (fractured hithin 6 hours or less). The

particles size of interest is 5nln or less. Silicosis is not apparent until 10

to 20 years or more after the first exposure to silica but acute silicosis

may occur within 3 years following exposure ' to extremely high

concentration of silica dust [13]. Cumulative dose is expressed as level

of exposure in ing/in3 x years of exposure and this is measured as

cumulative dose in ~ng/m'-~ear.

I

At its earliest stage silicosis can be seen as a nodular appearance on the

upper lobes of the lungs; on X-ray this is seen as round opacity

chal-acteristically visible in the upper lung fields.

.

There are four types of silicosis

- Simple silicosis: characterized by isolated roimd I I

opacities.

- Chronic nodular or conglomerative silicosis

characterized by confluence of opacities on the

chest x-ray

- Accelerated silicosis: very rare and arises from

intense short-tenp exposure to silica particles. It

is difft~sed and rapidly progressive ibsm of

nodular silicosis.

- Acute silicosis: occur with short tenn exposure to

very high concentration of silica dust and i t

appears in a chest x-ray like a slowly evolving

pullnonay edema.

!

2.2.1 Associated Diseases:

Apart fioin complications from' silicosis such as pneumonia, emphysema,

cor pulmonale and heart attack there are other diseases that are associated

with silicosis and/or result from exposure to silica. These include

tuberculosis, lung cancer, nepllrotoxicity (nephritis), systemic sclerosis

[14] and opportunistic infection of the lung such as atypical I 4

mycobacteri~m, acinetobacter spp and deep fungal infection [ 1 51.

Several studies have demonstrated that patients with silicosis have a

greatly increased risk of developing and dying fiom tuberculosis [16j.

The prevalence of tuberculosis increased with radiological severity of

silicosis in a study done in India [17]. Other studies have also revealed

that the prevalence of silicosis and piillnonary tuberculosis was

significantly associated with ,years of exposure [I 81 and that 'sil~cotics' I t

have increased mortality fiom tuberculosis [19].

Several studies show the association between silicosis and I1111g cancer

either due to silicosis itself or due to a direct effect of the underlyiiig

exposure to silica [20, 211. They are convincing evidence to classjfL

crystalline silica as a hiunan carcinogen by the inhalation route [22].

Thus, radiogra,~hic abnormalities suggestive of exposure to silica dust are *

now regarded as markers for increased risk of lung cancer [23].

Silicotics have 3.9 times cliances higher than non-silicotics of

predilection to lung cancer [24] and lung cancer risk increases wit11

duration of occupational exposure [25].

F~rthemore, there have long been case reports linking silica exposure to

a variety of autoimmune or connective tissue diseases (systemic sclerosis,

\ rheumatoid arthritis; lupus) and evidence of this association in

epideiniological studies has been increasing in the last decade [I 1 , 26,

and 271. 111 a study in Switzerland, signs of liidncy dysr~ulctio~l

detectable in urinary protein excretion were searched for in a group of 86

silica - exposed workers who were compared to 86 control subjects

matched for age, body mass index and smoking status. The results

strongly suggest that occupationa ' :

clinical renal effect after less than

1 exposure to silica may lead to sub- #

2 and in the absence of silicosis

[28]. A study in Italy provides fi~rther evidence that exposure to silica

dust is associated with nephrotoxic effects [29].

2.2.2 Silicosis Rate:

The detection rates of silicosis among silica exposed persons varied

strongly with latency [30], with about 5.9% of workers exposed to *

crystalline silica eventually developing silicosis [31] In a 1939 study in

Great Britain, 5.4% of a population of sand blasters died froin silicosis or

from silicosis with t~iberc~~losis in a 3 - 5 year period [32]. The rate of

silicosis was higher among smokers than among non-smokers (rate ratio

= 134) [30]. In Viet Nain the cumulative number of diagnosed cases

constitutes 90% of all cases of occupational compensated diseases. In the

USA, it is estimated that more than one million workers are

occupationally exposed to free crystalline silica dust, of which some . 59,000 (i.e. 5.9%) will eventually develop silicosis [33].

In Singapore, a radiological survey of 1188 granite quarry workers in

1965 revealed that 8% had silicosis. A follow up survey of 1230 quarry

workers carried out in 1971 showed that 15% had silicosis [34]. A

similar survey done in 1990 on 219 workers currently employed in six

operating granite quarries showed that tlae prevalence of silicosis among

drilling and c~lshing workers was 12.5%, but 1n~1c1i less among

maintenance and transport workers, at 0.8% [ 3 5 ] .

2.3 CONCERNS (OR STATEMENTS OF PROBLEM)

1. Ebonyi State is a sinall state whose greater percentage of the

population is predominantly niral dweller, made up of peasant I

fanners and laborers with grosi or absolute lack of knowledge

I5

I

on health issues. Thus, there is a widespread lack of awareness

of effect of silica exposure ainong quarry workers and of the

environmental impact.

2. There is also lack of primary preventive measures such as:

(a)Inadequate engineering control of dust generation, dust

release and dust into the work place .

(b)Inadequate respiratory protection prograinme or measures I

ainong quarry workers or their employer.

3. Statistical and epidemiological data on silicosis or respiratory

disease from dust is absent in all small quarry enterprises and

construction industries. Neither does the hospitals keep mirch

record of occupational diseases.

4. Failure on the part of the Government orland industries to

conduct adequate medical surveillance programmes. Thus,

there is under-reporting and under-diagnosis of occupational

disease.

5. Lack of or inadequate legislation and lack of labour inspection

for enforcement of existing laws.

6. Silicosis is known to have the greatest mean Potential Years of

Life Lost (PYLL) of 22.1 years and Potential Years of Work

Lost (PYWL) of 21.5 years, thus placing it as the most serious

pneuinoconiosis [36]. The estimated rate of one-second Forced

Expiration Volume (FEVI) loss is 691nlJyear [37]. This shows

that the quarry workers are a highly endangered group of

people, but without the knowledge of their proposis.

2.4 PREVENTIVE MEASURES

, ".r: I,J

Silicosis is a disease that can be preventkd given sufficient education and

training, proper facilities and removal systems and adequate govei-nment

regulations and compliance to the regulations. Thus awareness and

planning are the kcy to preventing silicosis. There are five cardinal area

of focus t

1. Dust Control

2. Respjratoly Protection Programme

3. Personal Hygiene and Training

4. Medical Surveillance

. . 8 r .

5. ~el-Iabilffa~ion/com~ensation of workers and policy % * - .

2.4.1 DUST CONTROL ',

The key to preventing silicosis is to keep dust out of the air. This can be

I : achieved with provision of a watei- hose 9 to 'wet dust before it becomes

airborne. Quarrying with the addition of water in combination with

forced ventilation has been shown to be an effective means of d ~ ~ s t

control [38]. The wetting method is only necessary where the industries

fail to use equipment and inachineiy with dust collection [39]. The third

and the real ways to reduce occupational disease through dust control is

to cut the duration of contact with dust [40]. However, the use of the

: : engineering controls and containment: methods sl-~ould be routinely

applied. Lastly air monitoring, that is measuring of actual ainoiint of

crystalline silica in the air is useful. Sometimes this is done based on

indirect surrogates of exposure suc1-1 as measuring of concentrations of

silica in other environmental media such as water, food or soil [4 1 ]

2.4.2 RESPIRPITORY PROTECTION PROGRAMME

Employers are required to provide respiratory protection programme that

include but not limited to provision of respirators and protective clothing

to workers, proper training of workers on how to use and maintain these

respirators and evaluation of workers ability to p6rform the work while

wearing a respirator [42]. It, is important to note that respirators should I i 0

never be used as a primary means of safeguarding workers froin the

hazard of dust. More effective control such as :

(a) autoinatiol~, where manual labour is not required

(b) enclosed system, where dust is not allowed to leak

(c) local exhaust ventilation

(d) substitution, where other materials are used in constn~ction

industry in

place of stone

All these should be part of primary means of protecting workers.

2.4.3 PERSONAL HYGIENEITRAINING

There are many steps quarry workers can take to protect tl~einselves from

the dangers of crystalline dust pParticles:

The most ilnpoi-tailt of these is the awareness of the dangers of

silica dust and knowledge of the symptom of respiratory disease

especially silicosis. Thus, workers should. be encouraged to

illcrease their awareness and reporting of occupational diseases

I1431.

Personnel or workers should know the work or operations

where exposure to silica dust oc!ci~rs [44].

Workers should participate in all monitoring or training

programme offered by the employer or quarry association.

Thus, workers should receive safety training and education.

Dissemiilation o f research findings to concerned group of

workers may also result in reduction of occupational hazard

- t

In Bddition to wearing respirators, workers should wear

washable protective clothes at work site, shower and change

into clean clothes before leaving work site.

(e) Quarry workers should not eat, drink, use tobacco products or

apply cosmetics in dusty areas.

(f) They should wash their hands and face before eating or

drinking.

(g) They should curtail habits, such as smoking, that heightens the i

damage caused by inhaling silica dust.

2.4.4 MEDICAL SURVEILANCE

Proper Medical examination should be available to all workers who may

be exposed to crystalline silica. This should include the following:

a. Medical and occupational history to collect data on workers

exposure to silica and symptoins of respiratory diseases. This

may be in fonn of a standardized pdmonary questionnaire [46].

b. Pl~ysical examidation.

c. Chest X-ray. The report on such chest x-ray should be

according to International Labour Office (ILO) classification of

Radiographs of pneu~noconiosis [47]. According to Quebec's

Guidelines, chest x-ray is the only tool recoininended to screen

for silicosis. This is because i ~ d i n o n a r ~ lesions can be foimd

on chest x-ray before the presence of symptoms. For quarry

and mine workers pulmonary examination is to be carried out

before the start date of the job and then every 3 years. The

validity of pre-employment and periodic radiographic

examination cannot be over-emphasized with respect to control

of silicosis and t~~berculosis in quarry or pottering industry [17,

481. 1 ,

Chest x-ray schedule for silica-e~~osed'workers may also be based on

Exposure-Duration-Age X-ray Schedule or on Cumulative -Dose

concept.

The Exposure -Duration - Age X-ray schedule is as follow

Exposure period Age of worker (in yrs) X-ray Schedule Less than 10yrs All age Every 5yrs More than 10yrs Less than35 Every 5yrs More than 1 Oyrs ' 35-44 Every 2yrs

3 , More than I Oyrs 45 and abovk Every I yr

Another school of thought prefers using cumulative dose (level of

exposure X years of exposure) in scheduling chest radiography [49].

Cumulative Dose At lmg/m3 year

d. Pulmonary fimction test (Spirometry) especially FEVl (Forced

Expiratory Volume in the first ~econd). This is usefill because

silicosis have been shown to significantly cause decrease in the

parameters of pulmonary fimction ever before on set of obvious

symptoms and signs [50].

e. Urinalysis is also *needed to rule out earlier onset of renal

toxicity or dysfimction in silica exposed workers.

f. Annual evaluation for tuberculosis may be recommended in

Schedule 1 :' Chest x-ray

I

At 2mg/in3 year

AT 2.5mgiin3 year

And for eveiy increase by 0.5mg/m3

year

some workers based on previou& findings [5 1 ) .

2"\11est x-ray

Another chest x-ray

Another chest x-ray

g. General medical surveillance through encouraging pllysiciails

and paihologist, as well as other health care providers to repoll

11. all diagnosed cases of silicosis to relevant state or federal health

department. These reports should include persons with a

physician's provisional diagnosis of silicosis based on exposure

setting and clinical symptoms and signs [52] or a chest x-ray

consistent with silicosis or a pathologic finding consistent with

silicosis.

2.4.5 REHABILITATION/COMPENSATION AND POLICY

The employers of quarry workers are expected to maintain responsibility

for l~ealtl~care expenses and lost income that res~rlt from occupational

injury and illness either directly or through the workers compensation

insurailce system[53]. At present this is far from being the case in the * 9

qtlarry industries. Thus, there is need for effort towards bringing all the

stake-holder includini the policy makers (Govenunent), workers, quarry

industry owllers and insurance companies together for a detailed

discussion on hazards associated with exposure to crystalline silica,

p-eveniion and compensation issues. The major challenge is to ensure \

that the final policy is scientifically and legally supportable and

acceptable to both workers and'einployer~ [54].

24

CHAPTER THREE

STUDY DESIGN AND METHODOLOGY.

3.1 DESCRIPTION OF THE POPULATION UNDER STUDY

The area that is today known as Ebonyi State was part of the old E n u p

and Abia State of Nigeria until October 1996, when it was created into a

separate state. The creation of Ebonyi State translated to the

reunification of the people of old Abakaliki province.

I , I . Ebonyi State of Nigeria situates in the SouthEastern part of Nigeria and

has a pop~ilation of about 2 million people (projected from the 1991

National Population Census). The 'state occupies a landmass of

approximately 5,93 5km2, and lies on approximately latitude 7' 3 0 ' ~ to

8'30'~ and longitudes 5'40% to 6 ' 4 5 ' ~ . The State is bounded to the

East by Cross River State, to the West by Enugu State, to the South by ' , I

Abia State and to the North by Benue ~ t a i e of Nigeria [ 5 5 ) .

In the past Ebonyi people were mainly agrarians being predominately

peasant fanners. Thus, the main stay of the economy was agricult~ire.

However, in the past twenty years quarrying started to g o w into a major

type of industry in the state. The towns where these industries are

located include Abakaliki, the state capital and Ishiagu in Ivo Local I

Govenment Area; the quarrying reserve at Okpoto in Isheilu East LGA

and Ngbo in Ohaukwi LGA are yet to go into full production

The type of quarrying industries present in Ebonyi State ranges froin

manuallindividual stone quarrying to small and medium scale quarry

industries that \tses heavy machinery for stone cnishing. The number of

the industries is estimated at 130 and they are located close to residential *

buildings all over Abakaliki and Ishiagu, because of absence of a

fi~nctional indmtrial layout. These industries constitute the major

supplier of panitelstone clippings in the southern part of Nigeria. *

Individuals and various limited liability companies own the qw-rying

industries. The work force is between 1 and 80 per establishinent (an

average of 8 personne, depending on the size and capacity of the

industry. The employees are lnainly non-skilled workers comprising of

men and women in the ratios of 3:7 (men: women). This is an estimated

value based on a preliminary study.

3.2 SAMPLE SIZE

This study was carried out on 392 Quarry workers who are employed in

s~nall and medium scale quarry industries in Ebonyi State. The workers

comprise largely of women between the age of l6yrs and 6Oyrs of age

plus fewer numbers of men between the age of 20yrs and 60yrs. Few +

truck drivers who transport this crushed stone to various destinations

were included.

The population size is derived from the fonnula for calculation of ininiinum sample size:

Where 11 = Sample Size f'$. c,."

Where 2 =1.96; p = 0.09 and q = 0.9 1 ; Sample error = 5%

Thus, expected minilnuin sample size, q =I26

' : A control population of 392 healthy people was selected, ~natched for age

I

and sex, from the same area. ,-

" ' 3 ,I' 3.3 STUDY DESIGN: Cross-Sectional

The study design is a cross-sectional study and it is aimed at assessing

the health hazard confronting quarry workers in Ebonyi State with special

attention to respiratory function and lung diseases. . Other diseases or

injury such as trauma, deafness etc were also noted.

I *

The study is aimed at verifying the finding that silicosis is one of the

most prevalent occupational disease among people exposed to silica dust.

Tt is going to describe as well as examine factors associated with the

occurrence of respiratory disease among cnlsh (quarry) stone workers.

3.4 METHODOLOGY *AND DATA COLLECTION

1 ,

The 130 Quarry industries, located in ~bakaliki , fonn the sample frame.

Out of these 49 sites were selected using simple random sampling. All

the workers, totaling 392, from these 49 sites were included in the study.

The 392 workers were grouped into 3 categories based on years of

exposure (that is number of years the person has spent working in quarry

industry):

(A) Less than 5 years exposure

+ (B) 5-1 0 years exposure

(C) More than 10 years exposure.

Five types of assessinent were carried out for the respective category of

workers:

(a) Questionnaire: For the 3 categories A, B and C and it include

background variable (bio-data) and questions that were aimed at I

providing answers to the objective of the study. The questionnaire was

structured and interviewer administered. A pre-test of the questionnaire

was carried out.

(b) Clinical examination: For category A, B and C. Two physicians in

the company of four nurses and two ward orderlies conducted a

comprehensive clinical examination of each quarry worker, including 9

I:

chest auscultation. I ,

(c) Spiroinetry with peak flow metre was used to measure FEV1: for

category A, B and to assess pulmonary function.

(d) Urinalysis was carried out using combi-9 to determine presence of

proteinuria and hae~natilria for category A, B and C.

(e) Chest X-ray for only category C and were read by a radiologist.

A control g-oup of 392 nonnal people selected from the same area with

the study population was assessed using assessment (a) to (c) above.

f I

, Prior to the above steps a letter was written to the Association of Quany

Industry Owners, Ebonyi State, requesting for their permission to allow

their workers participate in this exercise. Permission was granted (see

appendix iv) and the workers were enthusiastic to get involved in the

study.

,

3.5 DATA ANALYSIS

The questionnaire (appe'ndix iv) was analysed using Epi-info analysis

software version 6.

/

The resuli of the assessment incliiding spiromet~y (i .s. FEV I ) and \

urinalysis were matched to the n~lmber of years of exposure:

(a) Workers with less than 5.years exposure

I ! (b) Workers with 5 - 10 years exposure +

O Workers with more than 10 years exposure

The radiological examinatio~i and analysis was focused on workers with

more than 10 years exposure to quarry dust. This is because the

indiiction period between initial silica exposure and development of

radiographically detectable nodular silicosis is usually > 10 years.

Shorter induction periods are associated with heavy exposures and acute

I , silicosis may manifest within 6'months to 2 years following sucli massive

exposure to silica dust [57] .

The demographic data and the result of the clinical assessment was

analysed using Epi-info.

Data obtained were tabulated and Mean FEVI calculated for various

group. The mean FEVI of the study population was compared with that

of the control group usihg student t-test at 95% confidence inter-val.

CHAPTER FOUR

RESULTS AND ANALYSIS:

L

These results einanate froin clinical assessment of 392 granite workers ! $

who had spent a minimum of 1-year working in quany indust~y. A

control population of the same number was also assessed with specific

emphasis on their lung fiinction (Forced Expiratory Volume in one

second -FEV 1 ).

4.1 Demographic Result

The age distribution of the workers is shown below.

I I TABLE 1: AGE DTSTRTBI!TTQ)N OF QUARRY WORKERS

Percent

0.5

Age

(years )

<9 -

10-19

20-29

Frequency

( f)

2

76

32

30-39 44

Total 3 92 100

The mean age of the quany workers is 40.3years. T he Sex Ratio of the workers, shown below, revealed that most of the

workers are females (ratio of 6: 1).

60.7% of the population (238) are employee while 39.3% (1 54) are self-

Sex Male

Female

TOTAL

employed as owner of small quarry industrious. Duration of exposure and

type work is shown in table 3 and 4 respectively

Frequency 60

232

392

I 1

TABLE 3: YEARS OF EXPOSURE: TO SILICA (QLARRY DI'S'T)

Duration of Exposure

Percent :15.3

84.7

100%

/ 5-10 years

- Ratio 1

6

More than 10 years

1 TOTAL

No of worlters (freq) 1 Percent

Among the 392 workers, the majority (7q.5%) had spent less than 5 years

working in quarry industry. Only 68 had spent 5-loyeass and very few

had spent a period of more than 10 years, a duration, which is necessary

for silicosis or any serious pneumoconiosis to occui-.

I Job Suecification I No of workers I Percent 1 Stone Blastering

Cnlshing Machine Operator Manual Crushing

6

18

Collection of Stone froin grinding machine Loading Section

Most of the workers are mainly untrained 'labourers' and therefore are

I .5

4.6 I

12

Total

engaged in collection of stone froin the cnlshing machine (234 or 59.7%)

3.1

234

122 I

59.7

31.1 i 392 100%

and loading of truck (122). Only small proportions of workers are

engaged in machine operation (4.6%) or in inanual ci-ushing (3.1%).

, , 4.2 AWARENESS ASSESSMENT :

The awareness level of the workers with respect to the use of protective

measures at job was assessed while their medical history was being

taken. This is considered very important due to the fact that the key to

reducing occupational health hazard is prevention. The result of this

assessment is shown in table 5 below.

TABLE 5: LEVEL OF AWARENESS (n = 392)

Preventive Measures

Use of Respirator

Use Nose/Mouth mask '

Bathing before leaving work site for home Change to clean cloth& before going home Wash hand before meal and/or before snuffing or smoking Any form of training

precautionary I Level of Awareness (No. of workers taking

Percent

The use of mask or respirator is not practiced among the workers. The

quarry owners don't provide thein. Tlk workers are practicing only

routine personal hygiene such as the wash of hands before meal and

changing into clean clothes. Only 2 workers received one form of

measures) 0

training or the other.

0

4.3 HAZARD ASSESSMENT t

Some hazards were specifically pointed out in the questioimaire as being

coilzlnonly experienced by workers. The assessment of these hazards as

complained or perceived by the workers is shown in table 6.

- ---

Occupational Hazard I Frequency I Percent of worker with]

Noise Pollution I 220

Physical Injury

Dust Inhalation I 320 Excessive Heat I 24

224 the comptiant 57.1

Fig. 1 : COMMON HAZARD EXPERIENCED A T WORK SITES

r-

Physical Injury

sw No~se Pollution

5 Dust Inhalation a Excessive Heat

WORKERS (n = 392)

Frequency population

42.9 SymptomsISign

Body pains 168

Loss of appetite

Fever

Weakness I I11

1 9 1

Occasioned cough

Persistent cough

Mild breathlessness on exertion Prolonged or severe bseathlessness on

Minor fatigue

Severe fatigue

W.eigl~t loss 102

Night sweat 50

Occasional chest pain 220

Persistent Chest Pain

Numbness of the extremities

Injury at workplace

Impaired hearing

Abnormal chest shape

Dec

reased air entry into the

lungs

Eye itching

Skin rashes

The study group (quany workers) manifested various symptoms and

signs of lung diseases, ranging from occasional cough in 38.8% of the

workers and mild breathlessness on exertion in 15.8% to persistent cougl~ b

in 6.6%, l~aeinoptysis in 4.1 %, severe breatl~lessi~ess in 0.5% and

decreased air entry in 5.1%. There were also numbness of the extremities

in 33.7% of the studied population and impaired hearing in 12.2%.

4.1 LUNG FUNCTION ASSESMENT:

An assessment of the lung fimction of the quarry workers was camed out

using spirometer to measure Forced Expiratory Volume within first 1 , ,

second (FEVI). The result of this is shown in table -8 and that of the

control in table-9.To understand the effect of duration of exposure further

analysis of the result obtained was done to classifL the study population

into thee depending on the number of years each worker had put in.

TABLE 8: FEVI DISTRIBUTION FOR TI1E 392 QIJARRY

WORKERS AND rf'HA'r OF CON'I'ROL POI'llrf'ION.

FEVI I Quarry Workers I Control population I Percentage /

(ML)

<200 -

(t calculated = 10.59; t critical value =1.976; P< 0.05) = significant

4 1

Frequency (0 23

Frequency (9 24

Percentage

6.1

Froin this table the Mean FEVI for study population is 306.9in1.

83.9% of the workers have FEVl of 200-400inl and only 6.1 %manifested

a FEVl of less than 200ml. When compared with the mean FEVI of the

control group, this gives a difference of 12.5ml. Using student t - test, the

significance of the different between mean FEVI for study populatioil 1 / I *

(306.91~11) and of the control population (319..4inl) was tested at 95%

confidence level, (t-calculated = 10.59; t-critical value = 1.97 and P=

This shows a significant difference between the lung functions of the two

i

I"?

The Population distribution of FEVl for various years of exposure is I : I

illustrated in table 9 bellow. The accompanied bar chart coinpares thc

. number of workers in the three groups of exposure for respective range of

FEVI.

TABLE 9: FEW AND YEARS OF EXPOSURES

FEVI Less than Syrs of exposure

Number (Oh)

5-10 yrs of exposures

TOTAL

More than 10 years of

Number ('A,) . exposure

Number (%)

300 68 24

fig. 2: 1~ISTR1131J'rION OFTHE 'I'HREE CATEGORIES O F WORKERS FOR VARIOUS VALUES O F FEVl

A larger proportion ( \ 62 .Yh ) of workers with more than 10 years

exposure exhibit low FEVI in the range of 201-300 1111. For the same

range of FEV I only 3724 of workers with less than 5 years exposure were . found to exhibit pulmonary function as low as that. On the other hand, as

much as 48% of workers with less than 5 years exposure shown FEVl of

30 1 -4OOmI, while only 29.4% of 5-1 0 years exposed workers were able

to achieve FEVl of that range. Thus, the number of years of exposure is

inversely proportional to the FEW of the workers. Workers with more

than 10 years exposure have FEVl of not more than 300m1, due to degree

of respiratory fimction iinpainnent.

'B'ABIJE 10: FEVI FOR WORKERS WITH IJ1?SS THAN 5 YE:\MS

FEVI

(ml)

1 TOTAL

Frequency Percent I

Mean FEVl for workers with less than Syears exposure is 320 .5~1 ; h i s

almost approximate the FEVl of the control population (3 19.4inl) and

show that there is no loss in their pulinonaiy fimction.

TARLE 11: FEVI FOR POPM,,\'TJON OF WORKERS \ \ ' l f l 7 1 5-10

FEVI (ml)

TOTAL

Frequency

( f )

Percent

Mean FEVI of worker with 5-10 years exposure period is 279.9inl

showing a pulmonary loss of 39.5m1 when compared with that of control

population (3 1 9.41111). I

TABLE 12: FEW FOR POPL1LATION OF WORKERS WITH MORE 'KHAN 10 17EAHS EXPOSURE

FEW (ml) I Frequency I Percent

Mean FEV 1 for quairy workers of more than 10 years exposure is 2 13inl;

TOTAL

this shows that this group of workers experienced pulmonary function

loss of 106.4ml when compared to that of control population.

24 100

FEW (ml)

Fig. 3: MEAN FEVl FOR THE THREE CATEGORIES OF 1 , I

WORKERS

The figure above clearly.illustrates the depreciating pulmonary function

of quarry ~ 'o rke r s as the number of years of exposure increases.

TOBACCO

TOTAL I 146

Percent

The mean FEVI for workers, who in addition to being exposed to quarry

dust, also smoke or snuff tobacco is 290.2ml. This value is less than the

average FEVl for the entire study population by 16.71111, showing that

smokingisnuffing accentu8tes the pulmonary function loss.

TABLE 14: URINALh'SIS RESULT OF THE 392 QLlARRh'

I Type Of test / Number of Workers I Percent

1 I I u An attempt to assess thc renal fu~xtion of the study popirlatio~l slmws that

Proteinuria

Haematuria

Normal Urine

Total

60 persons (15.3%) have a trace of protein in their urine, while 12

workers (3.1%) have haemat~uia (blood in the urine). The rest of the

60

12

320

392

workers, 81.6% of them, show 11011nal iirinalysis.

15.3

3.1

-

81.6

100

CHAPTER FIVE

DISCUSSION

5.1 Demographic Characteristics:

f I The study population is 392. Their working (or exposure) period is

usually 8.00ain to 6.00pin everyday of the week (Monday-Saturday) that

is 10 hours daily. Most of the workers are not educated and live in nearby

villages.

This study is aimed at assessing occupational-health hazards among

quarry workers in Ebonyi State using: clinical history, physical

examination, assessment of pulmonary function by spiroinetry (FEVl), I L

urinalysis and chest x-ray

The mean age of the quarry workers under study is 40.3 years (see table

I). It is alanning to note that 19.4% of the workers were within tlie age

range of 10-1 9 years. This raises a lot of socio-cultural questions that

may attract some sort of study and State Governinent attention. The

majority (49%) of the population is within age range of 40-59 years. The t \ I *

sex ratio (see table 2) of the study population is 6:l (female, male)

showing that the majority of tlie work forces are women. This brings to

focils the problem of labour distribution among the genders in quarry

industry. This might be due to the fact that women in our society often

work in positions with lower pay, less power and frequently little control

over their jobs or work functions. It is therefore important to integate

gender concerns in the policy measure of what may constitute an

occupational safety for the workers. I

The job specification of the study population shown in table 4 connotes

that most of the workers work in the loading section. Thus, their jobs

entail manual collection of crushed stone away fiom crushing macl~ine.

Hazard evaluations and field studies carried out in USA show that quartz

concentration varied significantly by plant and job [58]. In this study it 1 ,

was observed that the groups of workers !n loading section are exposed to

very high concentration of gr~anite dust.

It is iinportant to note that the study intended to do Chest X-ray on all 24

persons who qualified for it, having been exposed for more than 10 years.

However, only 3 persons timed up for the x-ray; the rest where not

around by their employers to leave their work site. The result of these x-

rays have been read by a radiologist and found to be norn~al. Literature I t

review, of previous studies, shows that analysis of chest radiog-aph of

exposed subjects using ILO international classification resulted in 15.8%

abnonnal films [59]. According to Symanski et al, a serial chest x-ray of

acceptable quality taking over a period of 5-loyears is necessary [60].

The emphasis of the study was therefore focirsed on the k t four

assessments.

5.2: Medical History

Awareness assessment (in table 5 ) shows the level of ignorance of the

quarry workers and their employer. Little protective measures were

observed by the workers as noted in Edo State of Nigeria by Isah et a1

[2], except for washing of hands and changing into clean clothes before . I

leaving for llome. Use of ~ o s e i m o u t l ~ mask and protective clothing

during working hours is almost non-existence. Most workers are without

any fonn of training with respect to their job. The clinical history as

shown in table 6, revealed that (fiom the workers perception) dust

inhalation is the commonest source of health hazard (81.6%), fbllowed

by physical injury (57.1%) and noise pollution (56.1 %). Figure-1 is the

accompanying pie chart of table-6 showing the 4 coininon health hazards

confronting the quarry workers., I I I

Measuring thc lcvcl of tllcsc Ilazards in the developing corlntries like

Nigeria requires human, financial and material resources. Hence, in this

study observation and interrogation of the workers were used [61]. Other

methods of measuring exposure are through:

(a) Personal air sampling (PAS) measurement of respiratioll dust. [62], t , I

(b) A computer-aided video-exposure mohitoring [63].

(c) Mathematical emission factor or prediction type of equation [64]

(d) The use of animals raised in polluted envirorzlnental condition as an

indicator for risks to human health [65]. t

The clinical history of the study population yielded about 22 symptonjs

and signs that were listed and scored using frequency or percentage of > 9

t

workers reporting with each ailment (see table 7). The table clearly \

illustrate that the coimnonest symptoms include minor fatigue (57.1 %),

occasional chest pain 56.1%), fever (50%) and cough (45.4%), unlike in

54

coal miners were low back pain constitute the major complaint [I].

Grouping of these symptoms points to various diseases entities. This is

not surprising since silica dust exposure is also associated with the

following diseases (either alone or in association with silicosis): Silico-

tt~berculosis or tuberculosis' [66-701, lung cancer [71-811, Idiopathic L

pulmonary fibrosis [82], Renal impairment and disease such as Weggner

granullomatosis [83], IgA nephropathy [84], Sclerodenna [W], aid

Rheumatoid arthritis [86,87]

Some stitdies have gone firrther to alert that silicosis is the most common

and most frequently seen t~~berculosis-complicated pne~unoconiosis [88].

Thus the second important illness associated with crystalline silica is

pulmonary tuberculosis., Some Teports from India say that up to 50% of

patients with silicosis has pulmonary TB [89].

In 1997, the International Agency for Research on Cancer (IARC)

upgraded its evaluation of crystalline silica to a human carcinogen [go].

The risk of lung cancer is associated with the year of and age at first /

/'

exposure to silica, duration of exposure and latency [9 1 1.

, , Symptoms of silicosis include dyspne!i (breathlessness), cough [92],

weight loss, fatigue, night sweat and occasional fever [93]. A stiidy done

here in Nigeria (in a village near Kano) using unselected group of 126

stone cutters revealed radiologic evidence of silicosis in 38.8% which is

unexpectedly high [94]

5.3 Lung Functions Assessment

Table 8 show a mean FEVI of 306.9ml for the study population, as v L I ,

compared to 319.4 ml for control population marched for age (see table

9).

Student t-test was used to test the significance of this different (12.51~1)

in the mean FEVI for the study group and the control population at 95%

confidence level. This confimed the fact that the differences in mean

FEVl of quarry workers and that of the control is statistically significant

Table 10-grouped FEVI for various years of exposure. This and figure 2

show that people with short duration of exposure have higher FEVI and

that the FEVl decreases with increased exposure period.

Analysis of the FEVI for workers that snuff or/and smoke tobacco show

a inean FEVI of 290.2ml. When compared with the mean FEVl of the

I ,

study population it shows that snuffink or smoking of tobacco also

enhances deterioration of lung function. This finding is siinilar to that of

Gupta in India [94].

A siinilar study to the present one, done by Institute for Risk Assessment

Science Environmental & Occupational Health group in Netherlands

show a significant association between exposures to concrete dust and ' I I

lung function loss [95]. This loss appears inost severe in the presence of

disease [96]. However, its presence is still independent of silicosis [97].

The highly exposed workers showed greater prevalence of chronic cough

and p h l e p and a inean reduction of 5% in FEVI [98]. Past studies have

shown that sand wo'rkers have FEVI that is significantly lower than that

of healthy adults from the study area [99]. This is because cumulative

I t exposure to respirable dust is. the most, $ important risk factor, (with or

withoilt disease) for manifestation of respiratory symptoms and impaired \

lung function [100,101]. The same apply to coal inhe dust exposure

[102]. In some studies average annual losses of FEVI were as muct~ as

301n1 [lO3].

On the contrary, in few studies on quarry employees, there is no

association between respiratory symptoi& or spiro~netric result and dust-

exposure [ I 041. A study done in Japan by Baba et a1 on 12 1 dust workers

whose chest x-rays were found to be "class 1" of the diagnostic criteria

for pneuinoconiosis indicated that all the pulmonary fimction variables

showed no correlation with smoking and total years of dust exposure,

rather aging was the most dominant factor for pulmonary dysfimction

[lO5].

To assess the renal f~iilction of the study population show that 6Opersons

(1 5.3%) have a trace of protein in the urine, while 12 workers (3.1 %)

have haematuria (blood in the urine). This gives a total of 18.4%

with renal pathology. Impairment of renal fimction due to prolonged /

exposure to dust has been reported by Lapiti et a1 about four years ago , .. \

[2 91. I

,

5.4 Limitation of the study:

Only 24 workers had spent more than 10 years in the quarry industry; and

out of this only 3 persons accepted to do chest x-ray. This small number

made it impossible for the study to establish exposure - response

relationships for the development of diseases such as silicosis or lung

cancer [l06].

CHAPTER SIX

6.1 : CONCLUSIONS

The FEVI of quarry workers decreases with years of exposure, rncaning

there is a gradual loss of lung function as years of exposure to respirable

dust increases.

The findings in this study show that there are evidences of decreased lung

fiinction and renal pathology and perhaps other diseases among quarry

4 5 workers. However, it is not possible tb confirm incidence of silicosis

because of the small number of worlcers with 10 or more years exposure

to silica dust in the study. Nevertheless, small airways obstruction may

still be present among silica-exposed workers in the absence of

radiological evidence of silicosis [ 1 071.

6.2: RECOMMENDATIONS

The following preventive measures are therefore recommended. ' I I

1. To keep dust out of the air tlu-ough h e use of wetting metbod. This I

entails the use of water hose to sprinkle water at the dusty area or \

s~te .

2. Reduction in duration of contact with dust.

60

3. Sufficient educatiodtraining of worker on coininon hazards posed by

their job and ways to prevent them.

4. Improved personal hygiene

5. Use of respirator orland masks plus p~otective clothing. t

6. Routine medical examination ofquany workers.

7. Rehabilitation of workers who are incapacitated as a result of

occupational illness.

8. More studies on the health hazard of quarry worker are essential.

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2. Isah, E.C. Asuzu, M.C. and Okojie, O.H. Occi~pational Health Hazards in Manufacturing Industries in Nigeria, Journal of Coimnunity Medicine & Primary Health Care 1997 Dec; vol 9:26-34.

' I 3. Warrel DA, Harrison BD, Fawcett IW, Keller . SD. Silicosis among g~indstone cutters in the north of Nigeria i'horax 1975 Aug;30(4):389-98

4. Fulekar MH. Occupational exposure to dust in quartz manufacturing industry. Ann Occupational Hygi. 1999 May; 43(4): 269 - 273.

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14. Zayk, Devine D. and Chu-g A. Quartz in inactivate alpha1 - activates alphal-antiproteinase: Possible role in mineral dust - induced emphysema. J Apply Physiol. 1995 Jan;78(1); 53-58

15. Owens hIW, Kinasewitz GT and Gonzalez E. Case Report: Sand Blaster's Lung with Mycobacterial ~nfectfon. Am J Med Sci. 1988: 295 (6): 554-557. 16. Sherson D and Lander F. Morbidity of Pulmonary Tuberculosis ainong Silicotic and non silicotic foundary workers in Demnark. J Occu Med. 1990; 2: 110 - 113.

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pulmonary hiberculosis in Stone grinding factories in Sarabmi, Thailand. J Med Assoc Thai. 1995 Dec, 78 (12): 662-669.

I

19. Goldsmith DF, Beaumont JJ, Morrin i~ and Schenker MR. Respiratory Cancer and other Chronic Disease Mortality among silicotics in Califonia. Am J Ind Med. 1995 Oct; 28(4). 459 - 467.

20. Smith AH, Lipipero PA and Barroga VR. Meta-analysis of Studies of Lung Cancer ainong Silicotics. Epidemiology. 1995 Nov; 6(6): 67 1 - 624.

18. A~ingKasuvapala N, Juengprasert W and Obhasi N. Silicosis and

\

2 1. Dong D, Xu-G, Sun Y and Hu P. Lung Cancer among workers Exposed to Silica dust in Chinese Refractory Plant. Scand. J . work Environ Health. 1995; 21 Supl. 2: 69-72.

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I I

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I L

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Nov;5(11): 1044-50. . t

/ I

69. Corbett El, Churchyard GJ, Clayton ?J et al. Risk factors for pulinona~y myco bacterial in S. A. goldminers A case control study, Ann J. Respir Crit.Care.Med. 1999 J and 1 B ( l ) : 94-9.

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' , 2001 Sep 15;154(6): 538-43 . 1 I

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i 77. Hughes JM, Weill 1-1, Rando RJ, Shi R, McDonald AD, McDonald \ '. JC. Cohort mortality study of North American industrial sand workers. 1 I . Case-referent anakysis of lung cancer and silicosis deaths.,Ann Occup Hyg 2001 Apr;45(3):201-7

78. McDonald Ad, MCdONALD jc, Rando RJ, Hughes JM, Weill H., Cohort mortality study of North American industrial sand workers I. Mortality fiom lung cancer, silicosis and other causes.. Ann Occup Hyg

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80.Checkoway-H; Hughes-JM;Weill-H; Seixas-NS. Crystalline silica exposure, radiological silocosis, and lung cancer mortality in diatomaceous earth industry workers.; Thorax. 1 999 Jan;54( 1):56-9.

8 1. Carta P, Aru G, Manca P. Mortality fiom lung cancer among silicotic patients in Sardinia: an update study with 10 inore years of follow up.Occup Environ Med 2001 Dec;58(12):786-93

1 . I 3

82. Baumgrartner KB, Samet JM, Coultas-DB, Stdley CA, Hunt WC, Colby TV. Occupational and environmeal risk factors for idiopathic pulmonary fibrosis: a multicenter case-control study. Collaborating centres., Am-J-Epidemiol. 2000 Aug 15; lU(4): 307-1 5.

83. Straif-k; Keil-U; Taeger-D; Holthenroch-D; Sun-y; Bungers-M; Weiland-SK, Exposure to nitrosamines, carbon black, asbestos, and talc and mortality fioin stomach, lung and laryngeal cancer in a cohort of rubber workers.,Am-J-Epideinio1.2000 Aug 15; 152(4): 297-306.

84. Fujii Y, Ariinura Y, Waku M, F ~ ~ j i i A, Nakabayashi K, Nagasawa T. A case oSIgA nephropathy associated with silicosis. Nippon Jinzo Gakki

I I Shi 2001 ,0ct; 43(7): 61 3-8 . I

85. Bovenzi M, Barbone F, Pisa FE, FE, Betta A, Romeo L. Sclerodenna and occupational exposure to hand-transmitted vibration,Iiit Arch Occup Environ Health 2001 Oct; 74(8):579-82

86. Yang Y, Fujita J, Tokuda M, Bandoh S, Dobashi H, Okada T, Okahara M, Kishiinoto T, Ishida T, Takahara J. Clinical features of

polyinyositis/dermatoinyositis associated with silicosis and a review of the literature.,Rheumatol Int 2001 Aug;20(6):235-8

87.Tumer S, Cherry N. Rheumatoid arthritis in workers exposed to silica . in the pottery industry. Occup Environ Med 2000 Jul; 57(7): 443-7

88. Articles in Russsian. Silicosis is the most coinrnon and most

I L

frequently tuberculosis-complicated pneumoconiosis with poor prognosis.,Probl Tuberk.200 1 ;(6):22-3

89. Jindal SK, Aggaiwal AN, Gupta D. Dust-induced interstitial lung disease in the tropics.Curr Opin Pulin Med 2001 Sep;7(5):272-7

90. Cocco P. Multifactorial aetiology of lung cancer among silica- exposed workers. Ann Acad Med Singapore 2001 Sep;30(5):468-74

9 1. Ulin K, Waschulzik B, Elmes H, Silica dust and 11111g cancer in the German stone, quarrying and ceramic industries: results of a case-control study. Thorax. 1999 Apr;54(4):347-5 1.

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scientific judgment. Ann Occup Hyg 2000 Jan;44(1):3-14.

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94. Gupta P. Chaswal M, Saxena S. Ventilatory filnctions in stone quarry workers of Raj asthan.1ndian J Physiol 1999 Oct;43(4):496-500.

95. Meijer E, Kroinhout H, Heederik D. Respiratory effects of exposure to low levels of concrete dust containing crystalline silica. Am J Ind Med 2001 Aug;40(2):133-40

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97. Ng TP, Clian SL. Lung fiinction in relation to silicosis and silica exposure in granite workers.Eur Respir J 1992 Sep;5(8):986-9 1

98. Ng TP, Phoon, WH, Lee HS, Ng YL, Tan KT. An epidemiological survey of respiratory morbidity among granite quarry workers in Singapore: chronic bronchitis and lung fiinction impainnent.,Ann Acad Med Singapore 1992 May;2 1 (3):3 12-7.

99. Mathur ML, Dixit AK, Lakshminxayana J. Correlates of peak expiratory flow rate: a study of sand stone q ~ ~ a n y workers in desert .Indian J. Physiol Phannacol 1996 Oct;40(4):MO-4.

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103. Graham WG, Weaver SA, Shikaga TO, Grady RV. Longitudinal p~~linonary fiinction lossei in Vermont granite workers: A re-evaluation. Chest 1994 Jul; 106(1): 125-30

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the workers of pne~imoconiosis in Kitakyishu JUOEH 1983 Depl; 5(3): 351-8.

106. Zhuang 2, Hear1 FJ, Odencrantz J,; Estimating historical respirable crystalline siliea exposures for Chinese pottery worlccrs and iro~dcoppcr, tin and tungsten miners. Ann Occup Hyg 2001 Nov; 45(8): 631 -42.

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MINISTRY OF lIEr\I.TI t Ixinc: P. M. B. 061

y,,111 1 M . ABAKALIKI

I I : ~ 1 : ~ ~ . NlHIPHD/28/1 /T/189 Date: 9th hlarch, 2003

The Head, Department of Community Medicine, University of Nigeria, Enugu Campus.

Sir,

PERMISSION TO CONDUCT RESEARCH ON OCCUPATIONAL HEALTH IN ABAKALIKI

This is to inform you that the Ministry of Health, Abakaliki has received a application from Dr. Henry Alo, a student of your instituion requesting to carry out a research on "OCCUPATIONAL HEALTH HARZARDS AMONG QUARRY (STONE) INDUSTRY WORKERS IN ABAKALIKI, EBONY1 STATE WITH SPECIAL REFRENCE TO RESPIRATORY DISEASE". The Ministry has considered the application and permission granted for the study to be conducted.

We wish to request that the findings from the study be made available to the Ministry in other to see how it can assist in improving the Health status of our people.

-96-2 / - DR. I. N. ECH~EGU Director Public Health Services 174

ABAI<ALII<I STONE CRUSHER OWNERS LIMITED KILOMETER 176 ABAKALLKL~..ENUGU FEDERAL HIGHWAY

3 ABAKALIKI, EeONYl STATE. T ~ L : 043-201 56,20652,20683. BANKERS: UNION BANK OF (NIG.) PLC.

Our Re!: Your Rrj: ' 7 t h Nov, 2001 Dale:

ASCO LYD Abaka l ik i

Dr Henry E. Aloh I?Gl;!C C o o r d i l ~ a t o r Ebongi S t a t e H e a l t h Byetern Fund p r o j e c t 2 r e s c o Ju r l c t i on i ibakakik i

De~2.r S i r ,

;,'e arc: c x i t t i n g t o acknoa ledge Rece ip t of your l e t t e r

d a t c d 3 1 s t O c t . , 2301, on t h e above s u b j e c t metcer .

'.:e a r e t o inform you a l so t h a t t h e o r g a n i z a t i o n a f t e r

c o n s i d e r i j ! ~ t h e need f o r t h e p r o p o s e c i f r e e medics1 E v a l u e t i o n

and ?reetrnent t o i t s s t a f f / w o r k e r s , w i ? ~ ob l i ged f o r your

e f ~ o r t s i n t h i s d i r e c t i o n . $';

l i l e a s e be inQ$med t h a t t h e ; o r g $ n i o a t i o n has a l s o ,3:>, ?

. . < . ,, ,* r

endorsed your r equdh t ?for per&Lss$bp;$to c a r r y o u t f r e e n e d i c a l

i2v ; ) lux t ion ii iL'recttmen~~,!,tQ,,...~ts . -.i: sti+$$[@~rkers. ..*, . kc, 'lot( will t h e r e f o r e gieas@&ke,ep , . . us informed of t h e mood,

d a t e , T i m e anti venue of t h i s ' e x c e r e i s e t o enab l e us o r g z n i z e

o u r s t a f f /worke r s .

Thanks f o r con t inued coope ra t i on

Coqrade J , N. Nwagwu S e c r e t a r y (ASCO LfD).

I ) APPENDIX I11

CONSENT

I, Chief/Mr./Mrs./Miss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

do hereby give my consent to participate in the stildy titled:

Appraisal of occupational health hazard among Quarry (Slone)

Industry workers in Ebonyi State of Nigeria, with special reference

% , I I

to respiratory disease. 1 will. answer all question to the best of my I

knowledge and will subject inyself to comprehensive clinical

examination orland chest X-ray, where necessary.

Sign:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Site:.

7 6

APPENDIX 1V

TOPIC HEALTH ASSESSMENT OF QUARRY WORKERS

IN EBONY1 STATE SECTION A:

Tick or write in words for appropriate answer h

( 1 ) Agc last birth-day in years.. .

(2) Sex (1) Male [ I (2) Female [ 1

(3) Marital Status (a) Single [ 1 (b) Married [ 1 (c) Separated [ 1 (d) Divorced [ 1 (e) Widowed [ 1

(4) Rdigion (a) Christianity [ 1 (b) Traditional [ 1 0 ' Muslim I [ 1 (d) Others (Specify) . . . . . . . . . . . . . . . . . . . . . . . . .

(5) Employment Status (a) Self-employed [ 1 . (b) Employee [ 1

(6) (a) Part-time [ 1 (b) Full-time [ 1

(7) If part-time what other work(s) are you engaged in

(8) How many years have you worked in quany or stone cnlshing industry

(x) 5 yrs or less [ (y) 5-10yrs

I

77 II I

(z) 10 yrs or more 1 ' 1

(9) What type of duty are you engaged in, the quarry or stone crushing industry?

(a) Stone Blastering [ 1 (b) Machine Operator in the crushing section [ 1 0 hlanual C n ~ h i n g [ 1 (d) Collection of stone from ginding/cnlshing machine[ (e) Loading section [

I I

(f) Bagging section [ 1 (g) Transportation section [ 1

(10) Are your (a) Trained in your job [ 1 I , (b) , Untrained t I [ 1

SECTION B: Assessment of Level of Awareness

(1 1) What are occupational hazards associated with stone c n ~ h i n g (a) Injury [ 1 (b) Noise pollution [ 1 0 Inhalation of dust [ 1 (d) Exposure to excess heat and possible ill-effect [ ] (e) Others

..................................................... (specify).

(12) What protection measures do you adopt at work place? (a) Wear Respirator [ 1 (b) Wear Nose and Mouth Mask [ 1 0 . Protective clothing [ 1 (d) others

(speci&) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(13) Do you bath before leaving for home? ( 4 Yes [ I (b) No [ I

(14) Do you change to a clean clotlles before going home (a) Yes [ I (b) No C I

j I (1 5) Do you wash your hand before eatipg or snuff or smoke (a) Yes [ I (b) ~6 [ I

(1 6) Who provide you with the protective measures (a) Self [ 1 (b) Employer [ 1

(17) Have you had any training or talk on occupational hazards of your job

( 4 Yes [ I (b) No [ I

SECTION C: Medical Surveillance

' I (1 8) What are your commonest illnesses? (a) Malaria [ 1 (b) Coug11 [ 1 O Weakness [ 1 (d) Breathlessness [ (e) Others

I

(speci@) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1 9) How many times have you been to the hospital in the last 12 months as a result of illness ?

(a) Nil [ 1 (b) 1-2times [ 1 (c) 3-4times [ 1 (d) 5-6 times [ . ] I

(e) ->6 t imes [ 1

(20) Do you experience any of the following within the past 12 months? (a) Shortness of breath following physical exertion [ 1 (b) Occasional cough [ 1 O Minor Fatigue [ 1

(d) Occasional chest pain [ (e) Loss of appetite [

I I

(2 1) Do you experience worse conditions namely (a) Prolonged shortness of breath following mild

pl~ysical exertion [ 1 (b) Persistent cough [ 1 0 Severe fatigue [ 1 (d) Persistent Chest pain [ 1

I , (e) Weight loss [ . ] I

(f) Fever [ 1 (g) Night Sweat [ 1 (h) Cough out of blood [ 1 (i) Numbness of the extremities fingers, toes, hands & feet[ ]

(22) Do you have or have you had any of the following (a) Injury from work place [ 1 (b) Partial or complete deahess [ 1 0 Others

(specify). .............................................................

(23) Pllysical Examination by a doctor (a) Normal Chest shape on inspection [

I I

I (b) Abnormal Chest sl;ape on inkpection [ 1 O Decreased air entry [ 1 (d) Crepitation on Auscultation [ 1 (e) Others

........................................................... (specify).

(24) Forced Expiratory Volume in 1 second (FEVI) (a) < 2 0 0 [ 1 (b) 200 - 300 [ 1 0. 301-400 [ 1 (d) -101-500 [ 1 (e) > 500 [ 1

, , (25) Unalysis: (a) PH: .(i) <7, [ 1 (ii) >7 [ I

(b) , (i) 'Protein Urea [ ] (ii) Nil Protein [ I

0 (i) Blood (RBC) [ ] (ii) Nil Blood [ I

(d) Others

(26) Chest X-ray (a) Nodule upper lobe seen [ 1 (b) Fibrosis Seen [ 1 0 Normal [ 1 (d) Other Findings

(specify). ...................................................

APPENDIX V

! I

TOPIC HEALTH ASSESSMENT OF QUARRY WORKERS

I

IN ERONYISTATE: CONTROL QUESTlONNAlRE SECTION A:'

Tick or write in words for appropriate answer

. . . . . . . . . . . . . . . . . (1) Age last birth-day in years.

(2) Sex (1) Male [ 1 (2) Female [ 1

(3) Marital Status (a) Single (b) Married O . Separated (d) ' Divorced (e) Widowed

(4) Religion (a) Clvistianity [ 1 (b) Traditional [ 1 O Muslim [ 1

. . . . . . . . . . . . . . . . . . . . . . . . . (d) Others (Specify)

(5) Employment ~ t a t u i (a) Self-employed [ 1 (b) Employee [ I

(6) (a) Part-time [ 1 (b) Full-time [ 1

1 ,

(7) 1f p&-time what other work(s) are \ou engaged in . . . . . . . . . .

(8) Do you smoke or snuff tobacco (4 Yes [ I (b) No [ I

(9) If yes for how many years: (a) 5 yrs or less [ I 8 2

(b) 5 - 10 yrs I I ( 4 10 yrs or more [ 81

(10) Have you been exposed to any form of 'Excess Dust' 111 the past? If so for how long'?

(a) 5 yrs or less [ 1 (b) S - 10 yrs [ (c) 10 yrs or more [

I I

8 , t a

SECTION B: Medical Surveillance

(1 1) What zre your commonest illnesses? (a) Malaria [ 1 (b) Cough [ 1 43 Weakness [ 1 (d) Breathlessness [ 1 (e) Others

(specify). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(12) How many times have you been to the hospital as a result of illness in the last 12 months?

1 , (a) Nil [ I I t

(b) 1-2 times [ 1 (c) 3-4tiines [ 1 (d) 5-6 times , [ 1 (e) > 6 times [ 1

(13) Do you experience any of the following within the past 12 months? (a) Shortness of breath following physical exertion [ 1 1

(b) Occasional cough [ 1 O Minor Fatigue [ 1 \

(dj Occasional chest pain [ 1 \

(e) loss of appetite [ 1

, (14) Do you experience worse conditions namely? (b) Prolonged shortness of breath following mild

physical exertion . [ 1 : I - Persistent cough [

Severe fatigue [ 1 Persistent Chest pain [ 1 Weight loss [ Fever

I I

Night Sweat [ 1 Cough out of blood 1 Numbness of the extremities fingers, toes, hands & feet[ ]

(1 5) Physical Examination by a doctor (a) Normal chest shape on inspection [ ](b) Abnormal Chest shape on inspection 1

I O Decreased air entry [ 1 (d) Crepitation on usc cult at ion : [ (e) Others

1

(specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1 6) Forced EY oiratory Volume in 1 second (FEW) (a) <20O[ 1 (b) 200 - 300 [ 1 0 301-400 [ 1 (d) 401 - 500 [ 1 (e) >500 [ 1

(17) Unalysis: (a) PH: (i) <7 [ 1 ( i ) >7 [ I

(b) (i) .Protein Urea [ ] (ii) Nil Protein [ 1

0 (i) Blood (RBC) [ ] (ii) Nil Blood [ I

(d) Others