Selected aspects of occupational health and safety practices in small scale factories in the area of Medical Officer Health, Kotte

Objectives The objective of this study was to describe the health hazards, welfare facilities and health and safety related practices in small-scale factories in a selected MOH area. Methodology A descriptive cross sectional study was conducted among small scale factories in the MOH area Kotte. The entire population of 82 factories with less than SO workers was studied. The occupiers were interviewed using an interviewer administered questionnaire to identify the health related practices, and an observation schedule was used to assess the health hazards and welfare facilities. Results Availability of sanitary conveniences (94%), drinking water (84%) and washing facilities (99%) was satisfactory. The availability and adequacy of dining rooms, rest rooms and first aid facilities were extremely poor. The workers were exposed to multiple health hazards in the workplaces. The commonest hazards identified were poor house keeping (90%), electrical hazards (88%}, excessive noise (80%), unguarded machinery (73%), ergonomic hazards (70%) and poor cleanliness (57% }. Only 25% of factories trained the workers on safe use of machinery. Welders' eye guards were provided in all the factories that carried out welding but no other personal protective devices were provided to the workers were exposed to multiple hazards like dust, chemicals and fumes. Provision of health services was limited to taking the patient to the hospital in an emergency. Only 10% of the factory managers were aware of the accident notification system and almost all the fact.ories did not comply with it.


Introduction
Small and medium-sized enterprises are a critical factor in economic development and creation of jobs throughout the world ( 1 ). They employ a significant pan of the global labour force. These employees belong to the under-served working population who do not fully benefit from available knowledge and experience related to health and safety at work (2).
The number of small scale industries in Sri Lanka has increased with the growth of the population and rapid urbanization. In 2004, there were 12 I ,426 establishments with less than 10 workers with a total labour force of nearly 300,000 (3).
Available findings on occupational health status in small-scale industries (SSls) in Sri Lanka reveal unsatisfactory health and safety conditions with exposure to multiple hazards (4). SSis are subject to numerous workplace hazards like dust, heat stress, toxic substances, noise, vibration and poor hygiene (5). The Factories Ordinance No.45 of I 942 provides the legal framework for occupational health of factory workers in Sri Lanka. The small scale factories are covered by this legislation which specifies provisions for the health, safety and welfare of factory workers.
The working condition of these establishments is a strong determinant of the productivity as well as the health of their work force. Therefore, improving the occupational health status of these under-served workplaces has become a priority. The objective of this study was to describe the health hazards, welfare facilities and health and safety related practices in small-scale factories in the Kotte MOH area with a view of making suggestions for improvement.

Methodology
The study design was a descriptive cross sectional study which was conducted in two steps.
• Preliminary survey to identify the small scale factories in the area. • Descriptive cross sectional study of the workplaces co identify health hazards.health related facilities and practices in small scale factories.
The study was conducted in the Medical Officer of Health area Kotte. All the small scale facto1ies (employing 50 or less workers) were identified using the information available with the Public

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Health Inspectors and the Public Health Midwives. Completeness was achieved by a house to house survey. Two study instruments, an observation schedule and an interviewer administered questionnaire, were utilized. The interviewer administered questionnaire was targeted for the occupiers/managers of the factories. It was intended to identify heailh and safety related practices in the factories. The questionnaire was prepared in English and translated to Sinhala. The questionnaire consisted of four parts-basic information about the factory and the workers, safety related practices, first-aid and health facilities and accidents and related practices. The observation schedule was designed to assess the health hazards and welfare facilities. It covered the following areas-physical environment, electrical safety, cleanliness and housekeeping, machinery and moving parts, ergonomic hazards, chemicals, fumes and gases and welfare facilities. It was completed by the chief investigator by observing the work area and welfare facilities of each factory. In the situations where there were more than one work room the average condition of all rooms was considered. When setting the standards for observing the work envirorunent, the requirements specified in the Factories Ordinance were used (6). Noise levels were measured objectively using a standard CR: 303 noise level meter. The study instn11nents were pre-tested and necessary changes were made. Ethical clearance for the study was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo.

Results
There were 82 small scale factories in Kotte and all of chem were included in the study. Out of those, 26 were not registered at the local government authorities. Sixty four out of 82 factories (78%) had 1 · 10 workers, 15 (18.3%) had 11 -20 workers and 3 (3.7%) had more than 20 workers. The 82 factories were involved in a diverse range of activities. Out of the total work force of 645 employed in the factories, 389 (61.l % ) were males. Table 2 gives the distribution of the employment status of the total workforce. When considering the manpower levels the work force was employed at, it was shown that a majority of 433 (67%) of the work force were employed as machine operators and that 16 l (25%) were employed as labourers. Table 3 shows the availability and adequacy of welfare facilities. Sanitary conveniences (94%), drinking water (84%) and washing facilities (99%) were available in most factories. On the other hand, availability and adequacy of dining rooms, rest rooms and first aid facilities were extremely poor. Provision of first aid facilities was grossly insufficient; only five factories had * As a percentage of the total no. of factories using electricity (n=66) which mainly consisted of blades of cutting equipmenL The prevalence of general, physical, housekeeping and ergonomic hazards in the 82 factories is summarized in Table 5. Poor ventilation was noticed in 29 (35%) factories. Tripping hazards were seen in 74 (90%) and workers were exposed to repetitive movements in 58 (70%) factories. Table 6 summarizes the findings on chemical hazards. In 20 (66.6%) out of 30 factories using Chemicals were stored in the work area itself in 27 (90.0%) of the factories. Labelling of the chemical containers was poor and in 64% of the factories the workers were unable to read the available labels. Chemical safety cards were not available in any of the 30 factories and none of the managers or occupiers was aware of those.
The managers / occupiers were questioned on the safety related activities carried out in their work places. It was noticed that safety was not recognized as a need in any of the factories. There were 67 factories which used machinery which had the potential to cause injuries to the workers. Out of those only 17 (25.4%) factories provided some form of training to the workers on the safe use of the machines. In the remaining 50 (74.6%) factories the new workers started using the machinery without any training to learn by trial and error.
Provision and use of personal protective devices (PPDs) was assessed by questioning the management regarding the provision of PPDs and observing their use by the workers. Although dust and fumes were a problem in 18 factories none of them had provided masks. None of the 30 factories where the workers hand led chemicals had provided them with gloves. Six out of the 13 factories with welding activities provided the workers with eye guards.
During the pre-test, it was noticed that the concept of occupational health services was totally unknown in this setting. Therefore the factory management was questioned on the curntive care that was provided to the workers in .in emergency during working hours. None of the factories had the ability to provide the services of a doctor, neither full time nor part time. The commonest practice was to take the patient to the nearest general practitioner (73.2%) or the government hospital (25.6%). Facilities to transport a patient were available in 22 (27%) of the factories.
Only 8 (9.8%) occupiers were aware of the accidents notifiable according to the Factories Ordinance. Therefore information about notifiable accidents had to be obtained after educating them about notification. There were I l factories where notifiable accidents had occurred in the past year. The number of notifiable accidents was 11 and accordingly the rate of notifiable accidents per 1000 workers was 17. Only one factory had notified the accident and recorded it in the general register. Tn all other 8 I factories a general register was not available. There were 35 factories where minor accidents had occurred during the past year. The number of minor accidents was 65 and the rate of minor accidents per I 000 workers was 100.8. Therefore, the total accident rate was 117.8 per 1000 workers.

Discussion
Occupational health is identified as a component of primary health care in Sri Lanka but there is no organized system to provide the services related to occupational health. The legislative framework regarding occupational health in Sri Lanka is limited mainly to the Factories Ordinance. Therefore, recommendations in the Factories

Journal of the Com,mmity physicilms of Sri Lanka
Ordinance were used as the standard against which the health, safety and welfare provisions in the factories were assessed.
The study instruments included an observation schedule and an interviewer administered questionnaire. Considering the immense diversity of the activities carried out at the small scale factories, the study instruments were directed to identify the general occupational health hazards common to all small scale factories rather than those specific to individual industries. In the observation schedule, the noise levels were measured objectively and the ventilation and space were assessed objectively according to the criteria specified in the Factories Ordinance (6). The presence of electrical, ergonomic, chemical and housekeeping hazards was assessed against a set of predetermined criteria formulated according to the opinion of a panel of experts.
The welfare facilities available in these small sea. le factories are seen to be far from the optimum and this situation seems to be a conunon finding in the small scale industries and the informal sector in other countries also (7,8). These unsatisfactory welfare facilities show that the workers of small scale factories are working in environments that do not effectively fulfill their basic amenities. These unsatisfactory working conditions could lead to adverse health conditions, both physical and psychological.
In 8.5% factories there was no clear demarcation between the work area and the living area. Industries like garments, making shoes and preparing food were housed in the living areas of the owners' houses exposing the family members including children to health hazards like dust, sharp instruments, unsafe electrical connections and smoke.
Excessive noise is found to be a common problem with 80% factories having more than the standard limit of 85 dBA. The high noise level was not continuous in most of these factories, therefore not all the factories with above 85 dBA can be considered as having harmful noise levels. None of those factories had made any attempt to control the noise exposure of the workers. Exposure to excessive noise levels places these workers in the risk of developing adverse health effects like increased blood pressure, fatigue, increased heart rate and most importantly noise induced hearing loss.
Poor electrical safety was observed in a majority of factories with conductors below head level (88% ), unsafe connections (85 % ) and exposed conductors (54% ). It was noticed that most of the

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occupiers were not aware of the electrical hazards present. Housekeeping hazards which could be avoided without any additional cost, was neglected in most fact0ries. Guarding of machinery was found to be unsatisfactory. Most factories used old machines without proper guards and che available guards were removed because they interfered with the work. The deficiencies observed in electrical safety, housekeeping and guarding of machinery makes these small scale factories highly unsafe work environments. This low priority given to work place safety in small scale workplaces is evident from other studies in Sri Lanka (4) as well as other countries (8)(9)(10)(11). This situation makes the employees prone to accidents and injuries in the work settings.
This study revealed a high prevalence of ergonomic hazards mostly caused by ill designed work stations and ill fitting furniture. Ergonomic hazards were found to be prevalent in small scale industries according to findings of other studies as well (8). Exposure to ergonomically unsound work postures makes the workers prone. to musculoskeletal problems and fatigue as well as leading to low productivity.
Chemical safety was found to be ptior in the 30 industries using chemicals and basic precautions with regard to chemical use were not adhered to in a majority of the places. Poor chcmicol safety places these workers at high risk of accidental ingestion of chemicals, chemical burns and lllJUnes. These findings agree with those conducted in other countries (8,9) which describe poor chemical safety in SMEs and the informal sector.
Safety related practices were lacking seriously with only 25% factories providing training to the workers on safe use of machinery. Provision of personal protective devices (PPDs) was extremely poor. Among the 82 factories which ex p osed the workers to a host of occupational hawrds, the provision of PPDs was limited to eye guards provided to welders. In all six factories where eye guards were provided the workers used them indicating that their enthusiasm to protect themselves was good whereas the lack of commitment was on the part of the employers.
Occupational Health Services (OHS) provided by th� Factory owners/ management was limited to actions taken during an illness or injury occurring during working hours in which case the patient was taken to the nearest general practitioner or government hospital. The occupational health services in the factories studied were for below and almost non comparable with the standards specified by U1e ILO Convention on Occupational

Jo11mal o f the Community physicians of Sri Lanka
Health Services 1985. The compliance with the Factories Ordinance requirement to notify major accidents and record in the general register was not practised in almost all the factories. Less than 10% factory managers were a ware about the notification system of industrial accidents or the notifiable accidents which shows that this lack of compliance could be mainly due to poor awareness.

Conclusious and Recommendations
Small scale factory workers are exposed to multiple health hazards in their workplaces. Welfare facilities were unsatisfactory in majority of factories where even the minimum requirements of the Factories Ordinance were not provided. Occupational Health Services were found to be virtually non existent. The employers were unaware of the industrial health legislations and the requirements they are bound to fulfill under that. Overall, the small scale factories were found to have highly unsatisfactory work environments which need immediate interventions. The coordinated action of the labour authorities, primary health care team and facLOry management is recommended to face this challenge.