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ORIGINAL ARTICLE  
Year : 2019  |  Volume : 44  |  Issue : 3  |  Page : 225-227
 

Study of noncommunicable diseases among the street sweepers of Muster Station, Ahmedabad municipal corporation


1 Department of Community Medicine, Smt. NHL MMC, Ahmedabad, Gujarat, India
2 Department of Community Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India

Date of Submission24-Oct-2018
Date of Acceptance20-Jun-2019
Date of Web Publication20-Sep-2019

Correspondence Address:
Dr. Anand Shah
B-1 Shravaknagar Flats, Usmanpura, Ahmedabad - 380 014, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcm.IJCM_322_18

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   Abstract 


Introduction: Today we all are talking for “Swatch Bharat”, but street workers are the real fighters who are working for this. Street working environment exposes to lot of organic and inorganic dust and chronic inhalation of dust during street sweeping which may increases respiratory health symptoms among them. This study was planned to study the effect of work on health of street workers primarily respiration function. Materials and Methods: A cross sectional study was carried out among muster station of Ahmedabad Municipal corporation area during a period of April 2013 to November 2014. For the study total 762 Safai Kamdar (street sweepers) and 41 administrative staff were included after taking consent. The participants were examined for hypertension, Peak expiratory flow rate (PEFR), lab investigations like hemoglobin and blood glucose. Results: Mean age of Street Sweeper was 39.2 + 10.02 years and admin staff was 38.2 + 6.92 years. Street Sweeper were found to be significantly underweight as compared to admin staff. Hypertension in administrative group (51.1%) was higher but not significant than Street Sweeper (45.03%). only 12.3 % of Safai Kamdar were using any kind of personal protective equipment (PPE). 52.1% of Street Sweeper had low PEFR was as compared to 20% of Administrative group. Conclusion: Street sweeping had a significant impact on health of street sweepers. They should be made aware about use of PPE.


Keywords: Hypertension, peak expiratory flow rate, sweeper


How to cite this article:
Parikh S, Shah A, Davda B, Bala D V. Study of noncommunicable diseases among the street sweepers of Muster Station, Ahmedabad municipal corporation. Indian J Community Med 2019;44:225-7

How to cite this URL:
Parikh S, Shah A, Davda B, Bala D V. Study of noncommunicable diseases among the street sweepers of Muster Station, Ahmedabad municipal corporation. Indian J Community Med [serial online] 2019 [cited 2019 Oct 22];44:225-7. Available from: http://www.ijcm.org.in/text.asp?2019/44/3/225/267350





   Introduction Top


Adequate sanitation, together with good hygiene and safe water, is fundamental to good health and social and economic development.[1] Street sweepers are exposed to a variety of risk factors (dust, bio-aerosols, volatile organic matter, and mechanical stress), making them susceptible to certain occupational diseases.[2] Very few studies have been conducted on the health hazards among such workers; the present study was aimed to study the prevalence of noncommunicable diseases, especially hypertension (HTN) among street sweepers, and to identify various factors affecting lung functions.

A cross-sectional study was carried among Muster Stations of Ahmedabad Municipal Corporation from April 2013 to November 2014. The city is divided into six administrative zones which are further divided into 64 municipal wards. Each ward has a muster station through which sanitation activities are carried out. A total of six muster stations (one from each administrative zone) were selected by purposive sampling to have better operational feasibility and for laboratory investigations. The employee who did not give consent for the study and those who remain absent were excluded. After exclusion, 762 street sweepers (of 814) and 41 administrative employees (out of 49) were evaluated for their health status.

Street sweeper is the worker who carries all the sanitation activities, mainly street sweeping and solid waste management. Employees other than street sweeper such as public health supervisor, sanitary inspector, and subsanitary inspector had similar kind of job profile (supervision, monitoring, and administration), so they were clubbed and named as administrative group and their health status was compared with street sweeper group.

A semi-structured pretested pro forma was used to record information about sociodemographic profile, use of personal protective measure, clinical history, as well as laboratory report. HTN was classified on the basis of JNC-7 classification.[1] Hemoglobin estimation [2] and random blood sugar (RBS) tests were carried out by the laboratory technician of respective urban health center. For peak expiratory flow rate (PEFR), Wright's portable PEFR instrument was used. Chisquare test, unpaired ttest, binary logistic regression and multivariate analysis were used to comment statistical significance.


   Results Top


A total of 762 street sweepers and 41 administrative staff were included in the study. The mean age of street sweepers was 39.22 ± 10.02 years and of admin staff was 38.2 ± 10.02 years; 64.4% among sweepers were males, whereas all the administrative staff were male. Among the education profile, majority had primary education (66.01%).

14.4% of street sweepers and 2.4% of administrative group were underweight as per body mass index (BMI) classification,[3] the difference being statistically significant. 17.9% of male sweepers were underweight as compared to 8.10% of female sweepers, whereas 40.6% of female sweepers were in obese category as compared to 25.8% of male sweepers. This gender difference in BMI was statistically significant by Chi-square test. Waist-to-hip ratio was significantly abnormal (high) among 96.7% of female sweepers as compared to only 8.1% of male street sweepers.

Mean blood pressure among females was significantly higher as compared to males in street sweeper group, while the mean blood pressure among administrative group was higher but not significant than street sweeper. Proportion of HTN among females (49.8%) was higher as compared to males (42.8%) in street sweeper group, while proportion of HTN in administrative group was 51.1%. According to principle of “Rule of halves for HTN,” the proportion of HTN among sweepers was 45.01%, of which less than one-fifth (17.3%) of them were on antihypertensive medicine; of them only 3.3% of had controlled HTN. Proportion of HTN among administrative group (51.21%) was more (45.01% in sweepers group), whereas 40% of administrative group on treatment had controlled HTN as compared to only 3.3% of sweepers on anti-HTN drugs. Of those who were taking treatment of HTN, 96.7% of sweepers had uncontrolled HTN, while 60% of the administrative group had uncontrolled HTN. This indicates better health-seeking behavior among administrative group.


   Materials and Methods Top


A total of 127 employees did not consent for laboratory investigations and were excluded from the study. The mean hemoglobin level among female was 10.7 ± 1.2 gm% and among males was 11.6 ± 1.21 gm%. Proportion of anemia was significantly high among males (82.22%) as compared to females (77.31%). Of 676 employees, four employees had random blood sugar (RBS) >140 mg% and were referred to a physician.

None of the sweepers was using any “personal protective equipment (PPE),” but many were using handkerchief and dupattas. Hence, we have labeled them as unconventional PPE and compared its significance. Only 95 sweepers (12.3%) were using any kind of unconventional PPE) in the form of handkerchief and dupattas [Table 1]. Sweepers were classified on the basis of median peak expiratory flow rate PEFR into two groups above median (normal) and below median (low) PEFR. 50.4% of the employees had low PEFR. Higher proportion of street sweepers (52.1%) had low PEFR as compared to administrative (20%) group. Association of breathlessness among nonusers of unconventional PPE and smokers found highly significant, while it was not significant with anemia.
Table 1: Association of breathlessness with smoking and use of personal protective measure

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   Conclusion Top


In the present study, 45% and 80.3% of sweepers had HTN and anemia, which was higher than sweepers of Nagpur Municipal Corporation.[4] The prevalence of HTN among sweeper group was also higher than general population of the city (36.8%),[5] which clearly shows the attribute to occupational exposure. In this study, 80.3% of sweepers were anemic. In the Nagpur study,[4] 20.4% of sweepers had anemia which was lower than these study findings.

To identify the determinants (factors) affecting the PEFR among street sweepers, multivariate analysis was carried out [Figure 1]. According to the logistic regression, smoking tobacco (odds ratio [OR] = 4.8) was the most important factor determining the low PEFR, which was also found to be highly significant (P < 0.0001). With reference to administrative group, the street sweeper job had OR of 1.9 for having low PEFR and this was significant at P = 0.04, which indicates an occupational exposure as a risk factor for reduced lung function. Tobacco chewing (OR = 1.1), breathlessness (OR = 0.63), age (OR = 0.9), and gender (OR = 0.11) do not have any effect in reducing PEFR. However, the young age (OR = 0.9), female workers (OR = 0.74), and use of PPE (OR = 0.74) had negative but statistically no significant impact on low PEFR. The screening of HTN in the regular health checkup of the sweepers (done by respective UHC) which is already in existence should be strengthened. Both male and female street sweepers should be given iron-folic acid tablets. Street sweeper should be sensitized to use PPE such as mask, cap, apron, gumboots, and gloves.
Figure 1: Multivariate analysis of various factors and its impact on peak flow expiratory rate of study population

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560-72.  Back to cited text no. 1
    
2.
World Health Organization. Nutritional Anaemias. Report of a WHO Scientific Group. (WHO Technical Report Series, No. 405). Geneva: World Health Organization; 1968.  Back to cited text no. 2
    
3.
World Health Organization. BMI Classification. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. [Last accessed on 2019 Aug 27].  Back to cited text no. 3
    
4.
Sabde YD, Zodpey SP. A study of morbidity pattern in street sweepers: A cross-sectional study. Indian J Community Med 2008;33:224-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Parikh S. Assessment of cardiovascular disease risk by using Framingham risk equation amongst the residents of Ahmedabad city. Nat J Community Med 2013;4:392-7.  Back to cited text no. 5
    


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