1

HEALTH RISK ASSESSMENT OF FACTORY WORKERS IN THE BOTTLING

AND BREWING INDUSTRIES IN BENIN CITY, EDO STATE-A COMPARATIVE

STUDY

BY

DR. NYEMIKE SIMEON AWUNOR

DEPARTMENT OF COMMUNITY HEALTH

UNIVERSITY OF BENIN TEACHING HOSPITAL

BENIN CITY, EDO STATE

A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENTS FOR THE PART II FELLOWSHIP EXAMINATION

IN THE

FACULTY OF PUBLIC HEALTH

THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA

MAY, 2011

2

DECLARATION

I, Dr Nyemike Simeon Awunor, hereby declare that I have written this dissertation titled

HEALTH RISK ASSESSMENT OF FACTORY WORKERS IN THE BOTTLING

AND BREWING INDUSTRIES IN BENIN CITY, EDO STATE – A

COMPARATIVE STUDY being presented under appropriate supervision and that it has

not been submitted in part or in full for any other examination.

________________________________

Dr NYEMIKE SIMEON AWUNOR

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CERTIFICATION

I testify that the dissertation titled HEALTH RISK ASSESSMENT OF FACTORY

WORKERS IN THE BOTTLING AND BREWING INDUSTRIES IN BENIN

CITY, EDO STATE – A COMPARATIVE STUDY was written by the candidate

under my supervision.

_____________________________

Supervisor

PROFESSOR (MRS) E.C ISAH

MBBS, M.Sc., FMCPH, FWACP

PROFESSOR/CONSULTANT

DEPARTMENT OF COMMUNITY HEALTH

UNIVERSITY OF BENIN/ UNIVERSITY OF BENIN TEACHING HOSPITAL

____________________________________

Head of department

DR (MRS) V.O OMUEMU

MBBS, MPH, FMCPH

SENIOR LECTURER/ CONSULTANT

DEPARTMENT OF COMMUNITY HEALTH

UNIVERSITY OF BENIN/ UNIVERSITY OF BENIN TEACHING HOSPITAL

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DEDICATION

Firstly, this work is dedicated to the immortal, invincible and only wise God who makes

all things beautiful in His time.

Secondly, this work is dedicated to factory workers in all industries in Nigeria who

represent a silent majority and whose powers if effectively harnessed could leapfrog our

nation from a third world to a first world country and achieve the much vaunted vision

20:20:20.

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ACKNOWLEDGEMENTS

I thank my supervisor, Prof. (Mrs) E.C. Isah for her time and painstaking attention to

detail in supervising this work, I remain grateful for the mentorship, ma. I thank my head

of department Dr (Mrs) V.O. Omuemu for her subtle guidance, steady concern and

uncommon concessions during the course of this work.

I am very grateful for the direction shown to me by Prof. (Mrs) Obehi H. Okojie

especially with regards to health risk assessments and mentorship through the years. I

sincerely appreciate my teachers Dr J.C. Chiwuzie, Dr (Mrs) A.N. Ofili, Dr A.O.

Adeleye, Prof. V. Wagbatsoma, Chief (Dr) S.U. Ighedosa for the training I have received

and have continued to receive from them.

I thank Dr A.R. Isara and Dr V.Y. Adam for their continued insistence on adherence to

time lines and standards. I thank them for their incisive comments and ready critique at

every stage of this research. I appreciate the contribution of Drs A. Okoh, E. Tobin, G.

Eze, S. Rotifa, R. Ibekwe, P. Okeowo and all the resident doctors in the Department of

Community Health UBTH, Benin City to this work.

I thank Dr Bright Oniovokurkor, Dr Richard Agabielesin, Mr Mathew Aigbukor and Mr

Ogaga Ajakpovi for their ready assistance on the field. To my industrial hygienist Mr

Greg Onaiwu of the Edo Environmental Laboratory and my research assistants Messrs Y.

Adeboye, S. Adebayo, A. Awoyomi, I. Ogunboye and S. Amodu, thank you for the co

- operation in getting things done, properly.

To my parents Engr. and Mrs E.S.O. Awunor, my in – laws Prof. and Mrs E.U. Nwa, I

thank you for the heritage of a good education. To my wife, Ido and daughter, Faith, I

thank you both for the understanding and support through this project.

Finally and most importantly to God be the glory for granting me the grace to conduct

this research.

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TABLE OF CONTENTS

Declaration ii

Certification iii

Dedication iv

Acknowledgements v

Table of Contents vi

List of Tables vii

List of Figures ix

List of Appendices x

List of Abbreviations xi

Definition of Terms xii

Abstract xiv

CHAPTER ONE

Introduction 1

CHAPTER TWO

Literature Review 8

CHAPTER THREE

Materials and methods 21

CHAPTER FOUR

Results 34

CHAPTER FIVE

Discussion, conclusion and recommendations 77

References 91

Appendices

7

LIST OF TABLES

Table 1: Socio-demographic characteristics of respondents 34

Table 2: Qualitative risk assessment in the beverage industries 37

Table 3: Environmental monitoring of noise and particulate concentration in

air

39

Table 4: Self reported occupational injuries among respondents in the past 12

months

41

Table 5: Prevalence and frequency of occupational injuries among

respondents

42

Table 6: Self reported notifiable injury among injured respondents 47

Table 7: Cigarette smoking among respondents 48

Table 8: Alcohol habit of respondents 49

Table 9: Frequency of intake of alcohol by respondents 50

Table 10: Respondents’ involvement in sporting activity 51

Table 11: Pre – employment medical examination 52

Table 12: Periodic medical examination 53

Table 13: Respondent who were being treated for hypertension or diabetes

mellitus

54

Table 14: Body mass index (BMI) of respondents 55

Table 15: Blood pressure of respondents 56

Table 16: Random blood glucose of respondents 57

Table 17: Multiple correlations of age, BMI, BP (systolic), BP (diastolic) and

random blood glucose of respondent in the bottling industry

58

Table 18: Multiple correlations of age, BMI, BP (systolic), BP (diastolic) and

random blood glucose of respondent in the brewing industry

59

Table 19: Knowledge and practice of personal protective equipment use by

respondents

60

Table 20: Training in correct use of personal protective equipments by

respondents

62

Table 21: Difficulty using personal protective equipments by respondents 63

Table 22: Frequency of use of personal protective equipments by respondents 64

Table 23: Respondents opinion on the use of personal protective equipments as

necessary

65

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Table 24: Responsibility for prevention of accidents in the workplace 66

Table 25: Health and safety training at work 67

Table 26: Frequency of health and safety trining for respondents at work 68

Table 27: Knowledge of health and safety committee in the industry by

respondents

69

Table 28: Practices of occupation health and safety by respondents 70

Table 29: Socio demographic characteristics and practice of occupational

health and safety among respondents in the bottling industry.

71

Table 30: Socio demographic characteristics and practice of occupational

health and safety among respondents in the brewing industry.

72

Table 31: Satisfaction with presently assigned job 73

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LIST OF FIGURES

Figure 1: Part of the body where injury occurred to respondents 43

Figure 2: Type of injury to respondents 44

Figure 3: Cause of injury to respondents 45

Figure 4: Period of the day when injury occured to respondents 46

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LIST OF APPENDICES

Appendix I: Questionnaire

Appendix II: Observational checklist

Appendix III: In depth interview guide

Appendix IV: Ethical clearance certificate

Appendix V: Letters of introduction to the industries

Appendix VI: Reminder letters to the industries

Appendix VII: Health screening slip

Appendix VIII: Result of noise and Particulate in air survey

Appendix IX: Occupational injury prevalence and frequency rates

Appendix X: Instruments used in the study

Appendix XI: Pictures of environmental monitoring

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LIST OF ABBREVIATIONS

BLS- Bureau of Labor Statistics

BOHS- Basic Occupational Health Services

FMOH- Federal Ministry of Health

HSE- Health and Safety Executive

ILO- International Labour Organisation

NIOSH- National Institute for Occupational Safety and Health

OHS- Occupational Health and Safety

OR – Odd’s ratio

OSHA- Occupational Health and Safety Administration

PET- Polyethylene terephthalate

PPE- Personal Protective Equipment

WHO- World Health Organisation

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DEFINITION OF TERMS

Accident: an unplanned, unexpected event in a sequence of events that occur through a

combination of causes. It results in physical harm (injury or disease) to an individual,

damage to property, a near miss, a loss, business interruption or any combination of these

effects.

Beverage: any type of drink except water.

Factory: any premises in which or within the close or cartilage or precincts of which one

person is or more persons are employed in any process for or incidental to any of the

following purposes namely;

(a) The making of any article or part of an article; or

(b) The altering, repairing, ornamenting, finishing, cleaning, or washing, or the breaking

up or demolition of any article; or

(c) The adapting for sale of any article16.

Hazard: a substance, agent or physical situation with a potential for harm in terms of

injury or ill health, damage to property, damage to the environment or a combination of

these.

Large scale industry: an industry comprised of greater than 1000 employees4.

Medium scale industry: an Industry comprised of 51-1000 employees

Notifiable accidents: accidents that result in loss of working capacity of at least one

worker for three days or more.

Occupational disease: is a disease contracted as a result of an exposure over a period of

time to risk factors arising from work activity.

Occupational health: is the discipline that promotes the physical, mental and social

well being of man in the work place by ensuring anticipation, evaluation and control.

Occupational injury: any personal injury resulting from an occupational accident.

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Risk: it is the probability that a particular adverse event occurs during a stated period of

time.

Risk assessment: is the qualitative and quantitative assessment of the likelihood of

adverse effects that may result from exposure to specified health hazards.

Safety: is to be free from danger or situations that can cause harm or injury.

Small scale industry: an industry comprised of 50 employees or less.

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ABSTRACT

INTRODUCTION: The International Labour Organisation states that 80% of

occupational injuries worldwide are largely preventable if available health and safety

interventions are carried out. Factory workers in the beverage industries are particularly

exposed to occupational hazards, injuries and work related diseases.

OBJECTIVE: The objective of this study was to assess the health risk of factory

workers and compare between the bottling and brewing industries in Benin City, Edo

State.

MATERIALS AND METHOD: A comparative cross sectional analytical study was

carried out in Benin City, Edo State. Two hundred and one respondents in the bottling

industry and 148 respondents in the brewing industry participated. This study was

conducted using researcher administered questionnaires, an observational checklist for

the workplace and an in-depth interview guide for the human resources officers. Data

was analysed using SPSS version 16.0, STATCALC and PEPI software version 4.4.

RESULT: The mean age of respondents was 30.2 ± 7.9 years in the bottling industry and

39.8 ± 12.2 years in the brewing industry (t = 8.91, p = 0.000, 95% CI = 7.48 – 11.71). A

majority of respondents in the bottling ( 94.7%) and brewing industries ( 90.5%) were

male, while the mean duration of employment was 4.8 ± 3.4 and 11.31 ± 9.6 years (t =

8.89, p = 0.000, 95% CI = 5.07 - 7.95) in the bottling and brewing industries respectively.

Mechanical hazards were the major hazard identified in both Industries. The mean level

of noise was within the permissible exposure limit of < 90dBA at 75.5 ± 12.1 dBA in the

bottling industry and 72.2 ± 12.1 dBA in the brewing industry, the mean particulate

concentration in air was within the permissible exposure limit of < 0.25mg/m3 at 0.01 ±

0.01mg/m3 in the bottling industry and 0.02 ± 0.01mg/m3 in the brewing industry. The

prevalence of self reported occupational injuries in the industries per 1000 workers per

15

year was 263 in the bottling and 506 in the brewing industries. The prevalence of

hypertension, diabetes mellitus and obesity were 26.4%, 0.01% and 5.5% respectively in

the bottling industry, and 30.4%, 2.7% and 12.1% in the brewing industry. The

proportion of respondents with a good practice of occupational health and safety ( OHS

) was 74.1% in the bottling industry compared to 16.9% in the brewing industry.

Generally, while the practice of OHS in the brewing industry was poor, it improved with

increasing age, being married, increasing duration of employment and increasing level of

education of respondents. There were no such associations seen in the bottling industry.

Workers in the brewing industry did not receive safety training in the preceding 12

months unlike workers in the bottling company. The use of PPEs was better among

workers in the bottling industry and most respondents in the bottling industry had a pre –

employment medical examination (OR = 1.99, 95%CI =1.26 – 3.13).

CONCLUSION: Hazards identified, mainly mechanical hazards, were similar in both

Industries even though the mean level of noise and particulate concentration in air were

within the permissible exposure limits. The prevalence of self reported occupational

injuries was higher in the brewing industry so also was the prevalence of hypertension,

diabetes mellitus and obesity. The practice of OHS was good in the bottling industry but

poor in the brewing industry.

RECOMMENDATIONS: Regular safety programmes and training should be instituted,

health risk assessments and medical examinations should be the norm, adequate PPEs

should be provided for workers especially in the brewing Industry and regular inspection

carried out by the factories inspectorate of the Ministry of Labour and Productivity.

Key words: Risk assessment, beverage industries, health, safety.

CHAPTER ONE

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INTRODUCTION

A landmark in the field of occupational health was achieved in 1950 by the report of the

first joint WHO/ILO committee on occupational health in which the purpose of

occupational health and its definition was stated as follows1:

“Occupational health should aim at the promotion and maintenance of the highest degree

of physical, mental and social well being of the workers in all occupations; the prevention

among workers of departures from health caused by their employment, from risks resulting

from factors adverse to health: the placing and maintenance of the worker in an

occupational environment adapted to his physiological equipment and, to summarise; the

adaptation of work to man and each man to his work. The main focus in occupational

health is on three different objectives;(1) the maintenance and promotion of workers’

health and working capacity, (2) the improvement of working environment and work to

become conducive to safety and health and (3) development of work organizations and

working cultures in a direction which supports health and safety at work and in doing so

also promotes a positive social climate and smooth operation and may enhance productivity

of the undertakings. The concept of working cultures is intended in this context to mean a

reflection of the essential value systems adopted by the undertaking concerned. Such a

culture is reflected in practice in the managerial systems, personnel policy, principles for

participation, training policies and quality management of the undertaking”1.

The practice of occupational health remains grateful to such notables as Bernadino

Ramazzini (1633-1714), the Italian physician who is regarded as the father of occupational

health. He wrote the famous treatise “De Morbis Artificum Diatriba” which was the first

systematic study of trade diseases2. He also stated the need to elicit the occupation of

patients when taking a good history stating that a doctor treating commoners should

enquire about their jobs. Percival Pott, a Briton, established the link between chimney

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sweeping and cancer of the scrotum in these sweeps. Lord Anthony Ashley Cooper (1801-

1885) who as a member of the British parliament helped to promote legislation which

reduced the hours of work and improved the conditions of work of women and young

persons employed in mines, factories and other workplaces. Sir Thomas Morrison Legge

(1863-1932) was an English physician who introduced the idea of notifying occupational

diseases especially lead. He also stressed a number of preventive aspects of occupational

health practice known as the Legge’s aphorisms3 and which are still relevant today namely:

1. “Unless and until the employer has done everything – and everything means a great deal -

the workman can do next to nothing to protect himself, although he is naturally willing

enough to do his share”.

2. “If you can bring an influence to bear external to the workman - that is one over which he

has no control - you will be successful; and if you cannot or do not you will never be

wholly successful”.

3. “Practically all industrial lead poisoning is due to the inhalation of dust and fume, and if

you stop their inhalation you stop their poisoning”.

4. “All workmen should be told something of the danger of the material with which they

come into contact, and not be left to find it out for themselves - sometimes at the cost of

their lives”3 .

He was appointed the first British medical factory inspector in 1898.

Industrialization is a significant marker of development from an agrarian society to a

developed society. The 18th century was marked by remarkable progress in inventions and

innovations to improve remarkably the productive forces of western nations and

developments in occupational health followed this trend of Industrialization4. The

expansion of multinationals and the need for sustainable development has led to the

establishment of industries in the developing nations like Nigeria to further reduce the cost

18

of production and serve as a source of employment for the indigenes. This is particularly so

for the bottling and brewing industries. The transfer of technology has contributed to an

increase in machinery and productivity which has also introduced new hazards; dangerous

processes, continuing use of chemicals of which the toxicity is not fully known, heat, noise,

and vibration, paced or repetitive work, night and shift work and occupational stress 4.

Though a number of developing countries are rapidly industrializing, occupational health

and safety facilities are often very limited and in some cases nonexistent. The World Health

Organisation (WHO) states that of the total 3 billion workers in the world more than 80%

work and live without having access to occupational health services5,6. Developing

countries are often recipients of technology transfer from developed countries and some

multinationals which are well established in developed economies have large factories in

developing countries expected to follow international standards of occupational safety and

health. Some of these industries which have difficulties operating in countries with

stringent occupational health and safety legislation may “export” quite hazardous

operations to developing countries with weak legislation and enforcement, thus

occupational hazards, injuries and illnesses remain a concern in the bottling and brewing

industry7.

1.1 STATEMENT OF THE PROBLEM

Occupational injuries and illnesses though largely preventable, unnecessarily affect the

health of the working population and have effects on the work productivity, economic and

social well being of workers, their families, and society8.

The beverage industry is a substantial employer of labour, with a number of bottling and

brewing industries located in Nigeria, there is currently no published data on injury and

illness rates specific to the beverage industry, there is also a paucity of research literature

19

published on the beverage industry in Nigeria. Data from the United Kingdom (Health

and Safety Executive) and United States of America (Bureau of Labor Statistics), however,

show a high level of reported injuries in the bottling and brewing industries. In the United

Kingdom the incidence rates of reported injuries per 100 000 employees for 1996/97 were

3521 in the brewing industry and 1166 in the bottling industry9-12 . In the United States, the

bottling industry’s 1990 injury and illness rate of 21.5% was well above the 13.2% in

manufacturing as a whole13.

Surveillance of workers’ health in developing countries like Nigeria should not be limited

to occupational diseases but also the general diseases of the working population3,6. This is

because the main health problems of the workers may not be occupational but the general

communicable and non communicable diseases of the populace5. The workplace, by

ensuring early detection and treatment for these diseases, can thus be seen as an avenue to

promote workers’ health.

The presence of occupational health and safety legislation without adequate enforcement

and penalties guarantees neither safe work practices nor proper work environment in these

factories. In spite of the existence of the 2004 factories act and labour laws14-17 with

seemingly appropriate legislative provisions, they do not appear to have had made much

impact primarily due to the shortage of trained factory inspectors thereby making

enforcement of the law impracticable. In 2006 there were 5,888 registered factories in the

country, but only 39 inspectors for the Factories Inspectorate of the Ministry of Labour and

Productivity. This number is grossly inadequate to cope with the demands of the job18. In

the Ministry of Health, the occupational health unit, formerly a full division, is presently

lumped with the Non Communicable Disease (NCD) and Neglected Tropical Disease

(NTD) programmes to form a division, and is ill equipped to carry out effective

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occupational health duties. There is little synergy between the Ministry of Health and the

Ministry of Labour and Productivity on occupational health and safety matters. This lack of

co-operation and use of available competencies further lowers the level of occupational

health and safety regulation and enforcement in the country. Nigeria is yet to have a clear

health and safety policy produced and widely circulated like developed countries such as

the United Kingdom12 and Australia19. An occupational health and safety bill has not yet

been passed by the legislative houses even when Industry regulation is inadequate.

Presently in Edo State, there is only one factory inspector covering the entire state18.

Most government owned Industries are not as effectively run as privately owned, multi

national, industries delivering similar products. A reason for this could be the ”for –

profit” motive of privately owned companies and competition in the marketplace to deliver

world class products. The need for International Organisation for Standardisation (ISO)

certification in some industries would demand meeting up to best practices in health and

safety. Bureaucratic bottlenecks with a sometimes poor response to competition by

government owned industries could also have an effect on establishing effective health and

safety programmes for the workers. Indeed a major reason accounting for differences in

outcome on productivity and safety could be the type of ownership of these industries4.

1.2 JUSTIFICATION OF THE STUDY

Occupational hazards, injuries and illnesses are a significant health problem and there is a

paucity of studies in Nigeria specific to beverage industry20 - 22. This study will help to

determine the prevalence of occupational injuries among the factory workers and the injury

prevention strategies available to them, thus providing baseline data for further research.

With the prevalence of diabetes mellitus as 2.2%23and the prevalence of hypertension at

10-12%24 of the general population in Nigeria; the level of awareness, screening and

control of these non communicable diseases among workers is an important health

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promotional activity25. A health risk assessment in the beverage industry will help to

establish the prevalence of these work related diseases and serve as a guide in designing a

relevant workplace health promotion programme where none is currently available7.

This study will also help to determine the level of practice of factory workers towards

occupational health and safety in order to ascertain the determinants of safety behaviour

among them26, Information collected could then be useful in planning and allocation of

healthcare resources for the promotion of the health of the working population.

A study of this nature can facilitate in ascertaining the level of compliance in the industry

with the provisions of the 2004 factories Act in the area of health, safety and welfare17 , It

can also help in developing an appropriate protocol for workplace hazard control and

Basic Occupational Health Services (BOHS) in the beverage industries5.

1.3 RESEARCH QUESTIONS

This study will attempt to answer the following questions

1. What are the Identified hazards in the beverage industries? Is the mean level of noise (<

90dBA) and particulate in air (<0.25mg/m3) within the permissible exposure limit of the

Federal Ministry of Environment?

2. What is the prevalence of occupational injuries and illnesses in the bottling and brewing

industries in Benin City, Edo State? What factors are responsible for any observed

difference? Could it be attributable to the type of ownership of the industries or differences

in socio – demographic characteristics of respondents?

3. Is there any difference in practice of occupational health and safety among workers in the

bottling and the brewing industries in Edo State? What factors are responsible for any

observed difference? Could it be attributable to the type of ownership of the industries or

differences in socio – demographic characteristics of respondents?

1.4 OBJECTIVES OF THE STUDY

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1.4.1 GENERAL OBJECTIVE

To compare the health risks to which factory workers are exposed in the bottling and

brewing Industries in Benin City, Edo state.

1.4.2 SPECIFIC OBJECTIVES

1. To determine and compare the magnitude of occupational hazards, injuries and illnesses in

the bottling and brewing industries.

2. To determine and compare the level of noise and particulate in the air that factory workers

are exposed to in the bottling and brewing industries.

3. To compare the practice of occupational health and safety among the factory workers in the

bottling and brewing industries.

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CHAPTER TWO

LITERATURE REVIEW

The beverage industry is made up of two broad categories and eight subgroups7. The non

alcoholic beverages make up the first category which comprise soft drink syrup

manufacture, soft drink and water bottling and canning, fruit juices bottling, canning and

boxing, the coffee industry and the tea industry. The alcoholic beverages which are the

second category include distilled spirits, wine and brewing. The workforce in this industry

range from low income unskilled individuals involved in the process of harvesting raw

materials to skilled educated individuals involved in automated and mechanized processes.

2.1 OCCUPATIONAL HAZARDS IN THE BEVERAGE INDUSTRY

Occupational hazards in the bottling and brewing industry are encountered from the point

of production, during storage or following distribution of the product. The bottling and

brewing industries are largely dependent on automation with some level of manual

handling and coupling of highly mechanized processes with repetitive motion of the

workers. Workers are thus exposed to ergonomic, mechanical, physical, chemical,

biological and psychosocial hazards 27-28. These increased workplace hazards predispose

factory workers to increased workplace morbidities and mortalities.

Mechanical hazards in the beverage industries would include falls from slippery floors with

water and other liquids, cuts, bruises and punctures from splinters of wood, broken glass

and flying glass by workers on the factory floor during production. Injuries from confined

spaces which could occur during cleaning and maintenance functions, crushing injuries

from forklift and loading accidents, repetitive motion injuries which can occur among

palletizers, sorters, crushers and driver - sales workers. Workers on the factory floor are at

24

risk of burns, electric shock and fire hazard. Eye strain could also occur among empty and

full sighters11.

Physical hazards in the beverage industries would include noise, being a highly automated

industry a lot of noise is generated by machinery along the production line, this is

irrespective of efforts at damping and sound proofing. The use of metallic cask in the

brewing industry can cause some noise in such casks and boilers. A challenge for

manufacturers in Nigeria, of which the beverage industries are not exempt, is to provide

alternative sources of power due to inadequate supply from the Power Holding Company of

Nigeria. A lot of noise arises from such industrial generating plants and in most cases it is

the highest single source of noise in the industry. Noise is one of the most common of

occupational hazards in the brewing and bottling industry which could arise from

generating plants and the production processes such as casking/ kegging, decrating and

washing, bottling, canning and packaging machinery29,30. Modern automated bottling plants

generate a considerable volume of noise and the effect of noise exposure can range fom

being annoying, to fatiguing and to downright damaging to the ear. This noise can be

reduced by the introduction of mechanical handling by pallets. It is important that noise is

controlled to reduce the incidence of noise induced hearing loss amongst the workers in the

industry. Nations have their permissible exposure limits (PEL) that have been set for noise

in an eight hour work period. In the United Kingdom it is 85 dBA, in the United States of

America it is 90dBA, in Nigeria it is 90dBA31-33. Noise levels in many work area in the

beverage industry range from 85 to over 90 dBA. The major potential hazard associated

with exposure to noise lies in the possibility of producing noise induced hearing loss.

Noise induced hearing loss is the most well known effect of noise, other detrimental effects

of noise include tinnitus (ringing in the ears), interference with speech communication and

25

with the perception of warning signals, disruption of work performance, annoyance and

extra-auditory effects. The severity of hearing loss is thus dependent on the noise levels in

the workplace, duration of exposure and the individual’s personal susceptibility. Noise

induced hearing impairment is very common but it is often under reported because there

are no visible effect and in most cases no pain. Protecting the workers hearing under most

circumstances should protect against most other health effects of noise32.

The permissible exposure limit (PEL) of noise define the threshold over which workers

are required to be provided with and to wear hearing protection such as ear plugs and ear

muffs while at work. Environmental monitoring entails the measurement of air borne

concentration of working substances in the air. Environmental monitoring of noise can thus

be achieved by a sound survey using a sound level meter or by personal monitoring of the

workers using dosimeters. This gives an estimate of the background exposure of workers

to the hazard in the atmosphere, the location in which the noise hazard is at its highest and

with time help to evaluate the environmental control measures put in place in the industry.

Ear plugs (inserted into the ear canal) and ear muffs (covering the external ear) are personal

protective equipment that can be useful in reducing the impact of excessive noise in the

workplaces. Audiometry is the medical test used to identify and characterize workers with

various degrees of hearing loss and should be part of test to be done for susceptible

workers in a periodic medical examination30.

In a study33 on industrial employees exposure to noise in sundry processing and

manufacturing industries in Ilorin metropolis Nigeria a mineral crushing mill, a soft drink

manufacturing industry, a beer brewing and bottling industry, a tobacco making industry

and a mattress manufacturing Industry were studied. Emphasis was on the noise emitted by

individual machinery from the selected industries. Findings showed that hammer mill

26

machine from mineral crushing mill produced the highest average noise 98.4dB(A), electric

generator from beer brewing and bottling industry 97.7dB(A), electric generator from soft

drink bottling industry 95.6dB(A), electric generator from mattress making industry

94.1dB(A) and vacuum pump from tobacco making industry 93.1dB(A). the highest and

lowest average noise exposure levels were recorded in the mineral crushing mill

93.16dB(A) and mattress making industry 84.69dB(A) respectively. There was a

significant difference (p<0.05) in noise levels in the industries surveyed. The percentages

of machines emitting noise above FEPA and OSHA recommendation (90 dB(A)) were:

minerals crushing mills (87.5%), soft drink bottling industry (83.3%), tobacco making

industry (71.4%), beer brewing and bottling industry (42.9%), and mattress making

industry (11.1%). In the past 20 years, the noise levels in soft drink bottling industry

reduced by 0.58 dB(A) and that of beer brewing and bottling industry reduced by 9.66

dB(A). But that of mattress making industry increased by 2.69 dB(A). On the average, the

noise level in these industries had reduced by 2.52 dB(A). Temperature variation in the

factory floor can also be a problem as excessive heat can be generated in some lines such as

the PET line if there is inadequate air conditioning giving rise to discomfort, increased

irritability and fatigue to the worker. Where the factory floor is poorly lit there is an

increased need for workers to strain their eyes and they are thus prone to more accidents.

Chemical hazards arise from carbon dioxide and other refrigerant gasses such as ammonia.

Workers involved in cleaning and equipment maintenance working in confined spaces are

particularly exposed to such hazards. Inhalation of grain dust especially in the brewing

industry could also be a hazard. Fumes and sprays from cleaning solvents, acids or alkalis

could lead to burns and inhalational injuries to factory floor workers especially those

involved in maintenance and cleaning. Organic dust can be a problem to workers in the

mills or store in the brewing industry. Occupational lung disease from exposure to grain

27

and malt dust is an important occupational ill health risk in the brewing industry. Mill

worker’s asthma (malt fever), extrinsic allergic alveolitis (Aspergillus clavatus), allergic

response to grain weevil (Sitophilus granaries), barley itch, organic dust toxic syndrome are

some of the reported lung diseases particular to the brewing industry29.

Grain dust is the dust produced during harvesting, drying, handling, storage or processing

of wheat, oats, barley, maize or rye. It is a complex mixture of fragments of grain,

inorganic soil particles, and associated organic contaminants. These contaminants may

include plant cell debris, insect parts and mites as well as viable and non viable micro-

organisms (vegetative cells and spores of fungi, actinomyces and bacteria, and their

components such as endotoxins and myco toxins). This complicated mixture makes the

effect of grain dust on the lungs difficult to determine.

When grain is handled clouds of grain dust, which is a complex mixture, are dispersed in

the air. In sensitized individuals, inhalation of allergens (fungal spores or avian proteins)

provokes a hypersensitivity reaction34,35. In the acute phase, the alveoli are infiltrated with

acute inflammatory cells. With chronic exposure granuloma formation and obliterative

bronchiolitis occur. Acute symptoms include fevers, rigors, myalgia, dry cough, dyspneoa

and crackles (no wheeze). Chronic symptoms include increased dyspneoa, weight loss,

exertional dyspneoa, type II respiratory failure and cor pulmonale. In the United Kingdom

the maximum exposure unit (MEL) is an average of 10mg/m3 of total respirable dust in the

air over an 8 hour period. This is a maximum and not a target, dust level must be reduced

as far below the MEL as reasonably possible. Higher concentrations can be permitted if

exposure levels are shorter but the maximum dust level should never exceed 30mg/m3

measured over a 10 minute period.

28

A study by Carveilhero et al36 of organic dust containing high level of endotoxin in two

breweries in Portugal found the prevalence of symptoms of organic dust syndrome to be

18% among brewery workers. Mucous membrane irritation was found among 39% brewery

workers. In an exposed population the incidence of the disease is about 5% but with the

introduction of automated malting in factories, where workers are not exposed, this disease

has been largely eliminated.

Biological hazards are of concern to workers involved in harvesting, milling and storage of

the barley and hops used in the brewing industry. These hazards include mill worker’s

asthma (malt fever) extrinsic allergic alveolitis (Aspergillus clavatus), allergic response to

grain weevil (Sitophilus granarius), barley itch, organic dust toxic syndrome, rodents and

insects28.

Psychosocial hazards to factory workers often occur with 8 – hour work shifts in 40 hour

work weeks for at least 50 weeks a year. In a situation where there is little job security,

wages are poor, employee benefits are minimal with little or no opportunity for

advancement, job dissatisfaction, depression and anxiety may arise in meeting production

demands especially under difficult work condition. This could have a bearing on the level

of OHS practice of the workers in particular and the level of productivity in the industries

in general2.

2.2 PREVALENCE OF OCCUPATIONAL INJURIES IN THE BEVERAGE

INDUSTRIES

Most of the published data on occupational injuries are derived from record reviews carried

out by regulatory agencies like the Health and Safety Executive (of the United Kingdom)

and the Bereau of Labor Statistics (of the United States of America). There are little or no

studies worldwide to provide substantive evidence. In the United Kingdom the incidence

29

rates of reported injuries per 100 000 employees for 1996/97 were 3521 in the brewing

industry and 1166 in the bottling industry9-11. The average for all manufacturing industries

in the period under review was 1210. The brewing industry has consistently had a high

injury incidence rate primarily because of the high level of manual handling. Still in the

UK an estimated 1.1 million people suffered from work related musculo-skeletal disorders

(WRMSD)14 and there were an estimated 265 000 new cases of stress, anxiety and

depression made worse by work which resulted in an estimated 13.5 million working days

lost due to stress, anxiety and depression in 2001/2002. In the same year there were 69 fatal

injuries from falling from a height, these facts are adverse to the optimum performance of

the worker.

In the United States, the bottling industry’s 1990 injury and illness rate of 21.5% was well

above the 13.2% in manufacturing as a whole and more than double the private industry

rate, which was 8.8%13. Still in the United States, the total corporate health and safety cost

in 1997 were estimated to be $418 billion in direct cost, and over $837 billion in indirect

cost14.

Differences also occur in the methods of calculating the various injury and illness rates

showing some national variations in criteria for recording these rates. The World Health

Organisation uses the number of accidents or injuries over a specified period divided by the

number of workers at risk in the Industry × 100037. The Health and Safety Executive (HSE)

of UK uses the number of injuries over a specified period divided by the number of

workers × 100 000 9. The Bureau of Labor Statistics (BLS) of the United States of America

uses the incidence of injury and illness per 10 000 full time workers 38, while in Australia

(Australia Bureau of Statistics) it is the number of injured workers in the previous twelve

months divided by the number of people employed in the Industry × 1000 39.

30

The Bureau of Labor Statistics (BLS) in 1997 stated that over 50% of all occupational

illnesses worldwide were associated with repetitive motion injuries40. The three most

common repetitive motion injuries were the muscle, tendon and nerve injuries. Repetitive

motion injuries, back pain and other musculoskeletal injuries occur in this industry

following the coupling of highly mechanized processes20 in the beverage industry.

Repetitive motion injury is not an acute or short term result of a onetime accident, but

instead, the chronic result of gradual repeated trauma. The main causes of injuries in the

beverage industry according to the HSE include slips and trips, being struck by falling

objects such as barrels, boxes and equipment, falls from heights, machinery mainly

conveyors, exposure to harmful substances such as cleaning chemicals and hot liquids and

transport accidents. Ergonomic considerations, inappropriate matching of workers with

tasks may cause or exacerbate occupational injuries and illnesses.

In the United States, the bottling industry’s 1990 injury and illness rate of 21.5% was well

above the 14.1% in the malt brewing industry, 13.25% in manufacturing as a whole and

more than double the private industry rate, which was 8.8%. In 1990 nearly three fifths of

the injury and illness cases in soft drink industry were serious enough to require workers to

take time off from their jobs or be assigned duties restricted to light work or a shortened

schedule13.

Occupational health concerns can be linked with specific jobs carried out in the Industry.

The common jobs seen in the industry include packaging and filling machine operators,

mechanic and manual labourers whose training for the position is completed on site with

extensive on the job instruction. The injuries are related primarily to manual material

handling activities such as unloading trucks filled with soda cans and bottles, and carting

and stacking of containers on customers’ premises. By repeatedly maneuvering heavy

31

loads, many soft drink drivers eventually sustain serious sprains and strains due to over

extension of their trunk and limbs.

The nature of injury included contusion, crushing and bruise, cut, laceration and fracture.

The back and other portions of the trunk (abdomen and shoulders) were the major parts of

the body affected by injuries and illnesses, accounting for one half of the soft drink cases

recorded by the supplementary data system. Another two fifths of the industry’s cases were

divided evenly between two other major body parts; the lower extremities (especially the

legs and knees) and the upper extremities (particularly the fingers)13.

Studies on occupational injuries in various industries have shown that work conditions 41,

shift of work42, speed of work43, education status and safety training44, alcohol and other

psychosocial factors 45 have effect on occupational injury causation. Sex, age, length of

service and occupation of the injured or ill worker and other case characteristic have also

helped analysts identify workers sharing risks commonly associated with workplace

injury46-51.

A study done to assess the association of job and some individual factors with occupational

injuries in northeastern France indicated job category (60.8%), sex (16.2%), regular

psychotropic drug use (8.5%), age groups (7.5%) and presence of disease were significant

contributing factors for occupational injuries46. Several studies on injuries at work in the

US adult population revealed more work related injury rates for males than females39,40. In

a study on construction workers in the United States, permanent (union) workers were

more likely than temporary (non union) workers to: perceive their supervisors as caring

about their safety, be made aware of dangerous work practices, have received safety

instructions when hired, have regular job safety meetings and perceive that taking risks was

not a part of their job52.

32

2.3 PREVALENCE OF HYPERTENSION, DIABETES MELLITUS AND

OBESITY: THE CONCEPT OF HEALTH RISK ASSESSMENT

According to the Centers for Disease Control and Prevention, a health risk assessment is “a

systematic approach to collecting information from individuals that identifies risk factors,

provides an individualised feedback and links with at least one intervention to promote

health, sustain function and/ or prevent disease53 .

Industries have reasons for initiating health promotion programmes which could include

cost containment, staff welfare improvement, positive corporate image and increased

productivity54. The broad components of worksite health promotion include medical care

with early detection and control of conditions that represent illness or are biological

precursors to illnesses such as diabetes mellitus or hypertension screening. Modification of

high risk behavior55-57 with known or suspected negative health effects such as smoking,

inactivity and poor nutrition. Methods to bring about successful behaviour modification

would include health information, education, counselling and incentives58.

In Nigeria, there is an awareness of the increasing importance of chronic diseases like

hypertension, diabetes mellitus and obesity as a cause of morbidity and mortality amongst

the populace. Reports of clinical research show that Nigeria is apparently at the early stage

of an epidemic rise in the frequency of non – communicable diseases. The epidemiological

and demographic transitions both demand appropriate response from the health system with

a need to adapt national health policy to the changing realities of disease profile and

population dynamics 59. Early diagnosis and treatment will reduce the risk of complications

from hypertension, diabetes mellitus and obesity. A study by Carel et al60 following a

multiphasic screening on prevalence and control of hypertension in a mixture of employed

populations showed that 8% of the 15 000 examinees were classified as hypertensives,

33

most of the hypertensives were unaware of their condition. Of those that were aware of

having hypertension (541 persons), about 75% were taking anti hypertensives and in about

67% of them the blood pressure was adequately controlled. A study in Zaria61, Kaduna

State among 3250 civil servants between the ages 25 – 65yrs) showed that the prevalence

of obesity was 13.5% among males and 16.1% among the females. The beverage industries

can serve as a place for initiating health promotion programmes to screen and control for

these diseases. Pre – employment medical examination provides a baseline on the health

status of the workers. Health risk assessments can thus serve for periodic medical

examination of the workforce.

2.4 PRACTICE OF OCCUPATIONAL HEALTH AND SAFETY

The basic principle of control of occupational hazards apply in the bottling and brewing

industries namely elimination, containment and adjunct measures2.

Elimination by substitution or change of process in production have helped to reduce the

incidence of injuries. The use of PETs instead of reusable glass bottles has helped to reduce

the incidence of glass cuts in the factory. The use of raised crates instead of half cut crates

for re usable glass bottles where in use has reduced the incidence of breakages and falls of

crates when moving them on pallets and forklifts as they are made to fit and grove

effectively to the crate above or beneath.

Containment of hazards at source can be done using total enclosing machinery or by partial

enclosures through the appropriate use of machine guards and reduction in the frequency of

man machine interface. Time limited exposure through 8 hour shift duties and days off as

appropriate help to contain the level of exposure of factory workers to hazards even when

their levels are below permissible exposure limits e.g noise . The use of personal protective

equipment by employees where provided by the employer can be an indicator to the safety

34

behaviour of the individual worker and adherence to safety rules in the organization. The

proper use of PPE’s, observance of safety rules, identification and proper application of

safety signs in the workplace by employees all help to guarantee safety as adjunct

prevention and control measures in the Industry28.

A study on occupational health hazards in manufacturing industries in Nigeria62 showed

that the attitude of workers towards the use of protective equipment was poor, since in

96.7% of all the industries studied these equipment were not in use despite having been

provided by management. There is a critical need for supervisors to alert workers to

dangerous work practices and conditions more frequently, and express concern, and praise

workers on safe work in a manner that is culturally acceptable.

A study in the United Arab Emirates among farm workers showed that protective

equipment was worn by a minority of farm workers while handling pesticides- gloves by

35%, work coveralls by 36%, a scarf to cover to the nose and mouth 39%, shoes at work by

79%. Acetylcholinesterase depletion was then found to be negatively associated with the

use of gloves, of work coveralls, and of a scarf to cover the nose and the mouth and with

the implementation of safety and hygiene procedures on the farm63.

Some studies have adduced reasons for non use of personal protective equipment to include

such factors as discomfort due to weather conditions, wrong size and ill fitting PPE and

payment for PPE by the individual worker. Other reasons include a lack of safety training

and ignorance on the importance of the PPEs. The measures to ensure effective use of

personal protective equipment would include education on the importance of proper use of

PPE to enhance safety in the workplace and to protect the worker, inclusion of proper use

of PPE’s as a condition for employment ab initio, provision of PPE’s free of charge to

35

employees and allowing employees to choose from a variety of styles of PPE’s provided to

ensure fitting59.

Safety professionals have increasingly turned their attention to social science for insight

into the causation of industrial accidents. Safety culture is defined as “ the product of

individual values, attitudes and beliefs, competencies and pattern of behaviour that

determine the commitment to, and the style and proficiency of, an organisation’s health

and safety management.” A social construct, safety climate, has been examined by several

researchers and it measures workers’ perception of organizational factors related to

occupational health and safety such as managements’ commitment to risk prevention or

priorities of safety versus production. Researchers have developed instruments for

measuring safety climate and have established some degree of psychometric reliability and

validity64. There is an empirical link between safety climate perceptions and objective

injury data65-67.

Adjunct measures would include good housekeeping practices, appropriate provision and

use of personal protective equipment (PPE), biological monitoring, environmental

monitoring, health promotional activities (disease screening programmes, incentive

programmes et al) and use of safety committees in the industry amongst others2.

36

CHAPTER THREE

MATERIALS AND METHODS

3.1 STUDY AREA

The study was carried out in Benin City the capital of Edo State in the south south

geopolitical zone of Nigeria. Edo State is bounded by Kogi State to the north, Delta State to

the south which also form the eastern border, Ondo State forms the southwest border. The

State was created on the 27th of August 1991 with Delta from the defunct Bendel State. It is

located in the heart of the tropical rainforest and it lies between longitude 50E and 60 42”E

and latitude 50 45”N and 70 35”N of the equator. Benin City is comprised of three Local

government areas namely Egor, Ikpoba Okha and Oredo with a total population of one

million eighty five thousand six hundred and seventy people (1 085 670)68. Majority of the

dwellers are of Benin tribe, the others are non indigenes and include the Esan, Igbo, Etsako,

Owan, Urhobo and Yoruba.

There is the presence of four medium scale beverage industries particularly involved in the

bottling and brewing of alcoholic and non alcoholic beverages in Benin City, two of which

participated in this study.

The Nigerian Bottling Company (NBC) PLC is a multinational public liability company

with a production plant located in Eyaen in Ikpoba Okha LGA along the Benin–Auchi

road, Benin City. NBC was established in Nigeria in 1953 at Ebute Meta, Lagos Nigeria

and was listed in the Nigeria stock exchange in 1972. It presently has 13 plants with over

80 depots to reach consumers at their doorstep. The Benin plant of the NBC was

established in the year 2000 and is the second largest in Nigeria, In April 2008 an incident

of fire occurred which led to the complete burning down of the factory. The plant re-

opened to production in 2009 following reconstruction. The products of the company

37

include soft drinks like Coca cola, Sprite, Fanta, Krest and Schweppes. Fruit juices such as

Five Alive and Cappy are also produced by the NBC. The Benin plant has 245 factory

workers. The factory workers work three shifts of eight hour per shift, NBC has various

departments namely human resources, finance, logistics, information, commercial, quality

assurance, fleet, plant, production, maintenance and safety. The factory has three

production lines namely the re-usable glass bottles (RGB) line, the polyethylene terephtate

(PET) line and the Juice line. The Benin plant has an effluent treatment plant and

discharges the treated effluent into the Ikpoba river. Staff of the NBC are covered by health

insurance under a health maintenance organization (Clearline HMO) in Benin City. There

is a factory clinic with an on - site doctor and nurses for treatment of minor ailments and

injuries. For more serious cases, staff of the plant are managed at the Faith Mediplex and

The Central Hospital Benin City.

The Bendel Breweries Limited which is located along the Benin-Agbor road, in Ikpoba

Okha Local Government Area, Benin City was founded in 1974 and commissioned by

Colonel Yakubu Gowon. It is fully owned by the Edo State Government. Bendel Breweries

has an administrative section and a factory which comprise the following units namely

brewing, fermentation, bottling, quality control and water treatment. The factory has a

production line that produces re-usable glass bottles (RGB); the products of the company

include Crystal malt and Crystal beer. The company discharges its effluent into the Ikpoba

river. It has a staff strength of 193 factory workers, with factory workers working shifts.

The company maintains retainership with some private hospitals in Benin City and the

Central Hospital Benin City. It has an on - site clinic managed by a nurse and a health

assistant.

38

Benin City has many health facilities both public and private ranging the three tiers of

primary, secondary and tertiary health care. It has numerous educational institutions,

religious institutions and other social amenities. There is also the presence of various other

industries such as agro-allied industries, construction and civil works, woodwork and

numerous small scale industries.

3.2 STUDY POPULATION

The study population comprised factory workers and relevant administrative staff in the

Nigeria Bottling Company PLC and Bendel Breweries Limited in Benin City, Edo State.

3.2.1 Inclusion criteria

All workers and their supervisors involved in the production process, storage and

distribution of the finished products who had been in employment for at least 6 months in

the industry were included in this study. A duration of at least 6 months from date of

employment was allowed for the assumption that the worker would have undergone a pre-

employment medical examination and would have received some safety training and

supervision, if available, in the industry within that period.

Key administrative staff in the human resources department of the respective industries

were included for an in-depth interview.

3.3 SCOPE OF THE STUDY

This study focused on a health risk assessment of the beverage industries in Benin City,

Edo state. Two industries, a bottling and a brewing industry in Benin City agreed to

participate in this study as examples of the non-alcoholic ( NBC PLC) and alcoholic

beverage (Bendel Breweries Ltd) industries, while NBC is a public liability company

Bendel Breweries Ltd. is a state government owned industry. The 7-Up bottling company

39

PLC and Guinness Nigeria PLC, however, did not participate in this study despite

correspondences and requests by the researcher (Appendix VI).

This study sought to examine the work environment in the two beverage industries in line

with the health, safety and welfare provisions of the 2004 Factories Act and HSE

guidelines for the bottling and brewing industries.

3.4 STUDY DESIGN

A comparative cross-sectional, analytical study design was used.

3.5 SAMPLE SIZE DETERMINATION

The minimum sample size for this study was calculated using the formula to compare two

proportions in two independent study samples considering alpha and beta errors69.

N= (Zα +Zβ)2

.2.p(1-p) 69

(d)2

Data sets: Inter-factory comparison, bottling (p1) and brewing (p2) industries

Variable: Injury rate

Where p= p1+p2 , Injury rate in bottling industry (p1 ) = 0.211

2 Injury rate in brewing industry (p2) = 0.141

P (1-p) : p=0.824, (1-p) =0.176

Zα =1.96, α = 0.05, therefore 95% confidence desired

Zβ = 0.84, β = 0.2, therefore 80% power desired

Difference to be detected (d) = 0.14 which is the difference in injury and illness rate

between the bottling and brewing industries15.

N= (Zα +Zβ)2

.2.p(1-p)

(d)2

N= (1.96+0.84)2.2. (0.824)(0.176)

(0.14)2

40

=116

Allowing for a non-response rate of 10%

11.6, approximately 12

Therefore N=116+ 12= 128

Subjects per group (minimum) = 128

Subjects in total (minimum) =256

3.6 SAMPLING METHOD

A total population survey was conducted in the two industries studied. One hundred and

forty eight respondents out of a total of 178 factory workers who participated met the

inclusion criteria in the Bendel Breweries Limited while 201 out of a total of 210

respondents who participated in the NBC met the inclusion criteria for the study.

3.7 STUDY DURATION

The study was conducted between July and December 2010.

3.8 DATA COLLECTION

Qualitative and quantitative data were collected using the following instruments.

3.8.1 Questionnaire:

A structured 60 - item questionnaire which consisted of both open and closed ended

questions was administered by the researcher and 5 trained research assistants who were

final year medical students of the University of Benin. The research assistants were trained

for two days on the proper use of the research tools to ensure uniformity in eliciting

information from respondents. The questionnaire (Appendix 1) was divided into sections

and information was sought on:

A: Socio-demographic and occupational characteristics

41

B: Injury and illness characteristics

C: Practice of occupational health and safety

C: Health screening

Twenty five questionnaires were pre-tested in a beverage industry in Ovia North East Local

Government Edo State owned by the Nigeria Institute for Oil Palm Research (NIFOR)

involved in Palm wine Production. The questionnaires were pre - tested to determine the

average duration of administration, comprehensibility, sensitivity, validity and reliability of

questions to respondents. Corrections to the questionnaires were effected before the

commencement of the study.

Interviews were conducted in batches with the assistance of the human resources

department of the two factories that circulated internal memoranda and worked out a

schedule with the various unit heads so as not to adversely affect production.

Occupational injury prevalence rate and frequency rate were calculated for both Industries

using the formulae adopted from the WHO module for primary health care workers

(Appendix IX), total number of injuries per worker was calculated summing up the number

of injuries suffered by respondents in the last 12 months. Period prevalence was thus

calculated37.

Occupational Injury

Prevalence rate = Total number of occupational injuries × 1000

Total number of workers exposed

Frequency rate = Total number of occupational injuries × 1000

Total number of work hours worked

The health screening70 included;

1. Anthropometric measurements namely height and weight measurements from which the

body mass index (BMI) was computed.

42

Height measurement: The height in metres was measured with the subject standing as tall

as possible, looking ahead, barefooted with the feet together and against a portable

lightweight taxiometer with a measuring range as 6 - 78 inches and graduations in 1/8 inch

(207cm x 1mm).

Weight measurement: The body weight of respondents was measured in kilograms using

a weighing scale with maximum capacity of 150 kg in divisions of 100 grams with the

respondents standing upright without shoes and in light clothing71.

The body mass index (BMI) was computed from the weight of respondents (kg) divided by

the square of their height (m2) 72

Body mass index (BMI) = weight(kg)

Height2 (m2)

The respondents were classified according to their BMI thus:

Underweight <18.5

Normal 18.5 – 24.9

Overweight 25 – 29.9

Obese I 30 – 34.9

Obese II 35 – 39.9

Obese III ≥ 40

respondents were finally categorized as underweight, normal, overweight and obese

1. Blood pressure measurement: Blood pressure was measured using an OMRON M2 basic

digital automatic blood pressure monitor with an accuracy of calibration at +3mmHg and a

range of measurement of 0 – 299 mmHg (Appendix 10). The respondent was made to sit in

a chair with the feet flat on the floor and the left arm placed on the table with the air tube

made to run down the medial side of the forearm and be in line with the middle finger. The

lower cuff was approximately 2cm above the elbow, measurement was taken with the cuff

43

covering about three quarters of the left arm and the respondent seated for at least five

minutes before taking measurement. The respondent was directed to keep still and not talk

during measurement. Two blood pressure readings were taken at an interval of 15 minutes

and the mean of the two readings taken as the individual’s blood pressure measurement.

Respondents were classified using the WHO – ISH criteria for grading blood pressure 73.

Normal <130 / <85 mmHg

High normal 130 – 139/ 85 -89 mmHg

Hypertension Grade I 140 – 159 / 90 -99 mmHg

Hypertension Grade II 160 -179 /100 -109 mmHg

Hypertension Grade III ≥180 / ≥110 mmHg

Blood pressure readings were recoded as normal blood pressure ( < 140/90mmHg),

elevated blood pressure ( >140/ >90 mmHg), isolated systolic elevated blood pressure (

≥140/ 90 mmHg) and isolated diastolic elevated blood pressure ( <140/ ≥ 90 mmHg)

following the American Heart Association74 recommendation to determine prevalence.

2. Random blood glucose measurements: was taken using an ACCU - CHEKR Active blood

glucose monitoring system (Appendix 10) with a measuring range from 10 – 600mg/dl (0.6

– 33.3mmol/L) in the following procedure; The test strip was inserted with the silver -

coloured bars facing up and towards the meter (meter will turn on automatically). The

researcher wore disposable latex hand gloves then verified that the code on the meter

display matched the code on the test strip vial. A blood sample was obtained by pricking

the side of the finger tip, after cleaning the site with methylated spirit and cotton wool,

gently with a lancet using standard precautions until a drop of blood formed. When the

blood drop symbol flashed on the display the drop of blood was touched and held to the

edge of test strip (to make sure all of the yellow area was filled). The result was then read75.

The sharps were disposed in a safety box and disposable hand glove and spirit swab was

44

disposed in a lined plastic bin. Respondents were then classified using the WHO criteria

into normal ( <140 mg/dL), impaired glucose tolerance (141 – 199mg/dL) and diabetes

mellitus (≥ 200mg/ dL).

The questionnaires and measurements were administered from 5th - 8th October, 2010 at

the Bendel Breweries Ltd. and 12th - 15th October, 2010 at the Nigeria Bottling Company

Plc.

3.8.2 In-depth interview guide

This was used to conduct interviews with the respective human resource managers in the

industries studied following their consent to get a management perspective on occupational

health and safety.

3.8.3 Observational checklist:

This was used to inspect and assess the bottling and brewing industry (walk through

survey) on their compliance with recommended international code of practice (HSE

guidelines) and their compliance to the 2004 Factories Act of Nigeria on health, safety and

welfare. Relevant aspects of the job load and hazard analysis checklist by Mattila and the

WHO training module on occupational health and safety were adapted for this purpose56,57.

3.9 ENVIRONMENTAL MONITORING

1. Noise survey

Environmental monitoring of noise was done using a BK precision sound level meter with

measures taken at 12 sites in each Industry. The instrument had been calibrated at the Edo

Environmental Laboratory using a standard acoustic calibrator (94dB, 110 Hz sine wave).

A- weighting for general noise sound level was chosen. The instrument was comfortably

held in the hand of the recorder and the microphone pointed at the suspected noise source.

45

The MAX MIN (maximum, minimum) mode was chosen and held, the sound pressure

level was displayed at their maximum and minimum readings. The average reading was

then taken for each of the twelve sites in both industries77.

2. Particulate in air survey

Air sampling of suspended particulate measurement was done using the haze dust monitor

1000 with readings taken from 12 sites in each industry studied. The HAZ DUST uses the

principle of near forward light scattering to measure dust concentration. Inside the

instrument an infra red light source is positioned at 900 degree angle to a photo detector. As

air borne particles enter the infra red beam they scatter the light. The amount of light

received by the photo detector is directly proportional to the aerosol concentration. No

filter or gravimetric analysis is required. The HAZ DUST is factory calibrated for

respirable particulate mass (size range 0.1 to 50 um) which falls under the

ACGIH/ISO/CEW criteria calibration for thoracic particulate mass. It had a sensing range

of 0.01 to 200mg/m3 and a particulate size range 0.1 to 50 um78. These measurements were

carried out with the assistance of an industrial hygienist from the Edo State Environmental

Laboratory Services on 18th November, 2010 at the Bendel Breweries Ltd. and 21st

December, 2010 at the Nigerian Bottling Company Plc

3.10 METHOD OF DATA ANALYSIS

Statistical Package for Scientific Solutions (SPSS) version 16.0 Software, PEPI version 4.4

and STATCALC were used for analysis of data. The mean, standard deviation and

proportion of the variables was calculated. Statistical test of association and test of

significance were carried out where applicable. The level of significance was set at p <

0.05. Odds ratio (OR) was calculated for comparison of parameters between the bottling

and brewing Industries and this was significant if the 95% Confidence Interval ( 95% CI )

46

was not inclusive of 1.0. The data was presented in statements, frequency distribution

tables, cross-tables and figures .

Practice of occupational health and safety by respondents was determined by their response

to five questions. An appropriate response to each question on OHS was given a score of 2,

an inappropriate response was given a score of 0. The least possible score per respondent

was 2 the highest possible score was 10. A total score of 0-4 (< 40%)was graded as poor

practice, 5-6 (50-60%) was graded as fair practice while a score of 7-10 ( 70-100%) was

graded as good practice.

The number of PPEs used routinely at work by respondent

Three or more items used routinely was taken as a good practice and scored as 2.

Two items or less used routinely was taken as a poor practice and scored as 0.

Received any training in the correct use of PPEs

Yes was given a score of 2 while no was given a score of 0.

Frequency of use of PPEs by respondent

A response of only when available and always when working was scored as 2.

A response of only when my supervisor is present and below was scored as 0.

Frequency of wash of work clothes by respondent

A response of daily, thrice weekly or weekly was scored as 2.

A response of rarely was scored as 0, where rarely was less than weekly.

Ever received health and safety training at work and frequency of health and safety

training at work

A response of yes, with a frequency of training not less than yearly was scored as 2

A response of yes and with a frequency of training more than yearly was scored as 0

A response of no training was scored as 0

47

3.11 ETHICAL CONSIDERATION

1. Individual consent: A written informed consent form was attached to each of the

questionnaires which was signed by the respondents after full explanation of the purpose

for the study by the researcher and research assistants (Appendix 1). Respondents were

duly informed of the voluntary nature of participation in the study. No token or inducement

was given to respondents who agreed to take part in the study.

2. Establishment consent: Permission was sought and obtained from the management of the

respective bottling or brewing industries that were used for the study ( Appendix V ).

3. Institutional ethical clearance: This was obtained from the University of Benin Teaching

Hospital Ethical Committee. The study proposal was submitted to the committee for

approval before the commencement of actual fieldwork (Appendix IV).

All respondents voluntarily agreed to participate in the health screening for hypertension,

diabetes mellitus and obesity. While the questionnaires were administered anonymously,

Respondents were given a screening slip (Appendix VII) recording their measurement in a

simple format to ease understanding and for their personal record and this was signed by

the researcher as evidence of the test and measurements carried out after which a brief

counseling session was given. Respondents with abnormal readings were counseled and

promptly referred to a nearby health facility or the University of Benin Teaching Hospital

as appropriate for further medical care. The health screening was done at the on - site clinic

and with the co-operation of the health personnel in both industries.

3.13 STUDY LIMITATIONS

Audiometric testing for the factory workers was not carried out in this study due to

resource and logistic constraint even though environmental monitoring through a noise

survey was done using a sound level meter.

48

Information on injury and illnesses in the past one year elicited from the questionnaire were

self reported by respondents which could have had some recall bias. The researcher sought

to examine the injury and illness register in the Industry to know the level of incident

reporting in the workplace. There was none available in the brewing industry as at the time

of conducting this study, while there was an up to date register in the bottling industry, the

researcher however was not permitted to copy accident and injury records from the register

for use in this study.

For the screening of diabetes mellitus, random blood glucose measurement was used

instead of fasting blood glucose due to the inability of the researcher to guarantee a fast

among the study subjects.

49

CHAPTER FOUR

RESULTS

A total of 201 factory workers in the Bottling industry and 148 factory workers in the

Brewing industry who met the inclusion criteria were interviewed in this study

TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

Variable Industry

Bottling

Freq. (%) N=201

Brewing

Freq. (%) N=148

Age (years)

15-24

25-34

35-44

45-54

>55

49 (24.4)

113 (56.2)

22 (10.9)

15 ( 7.5)

2 ( 1.0)

20 (13.5)

30 (20.3)

43 (29.1)

31 (20.9)

24 (16.3)

Sex

Male

Female

190 (94.5)

11 ( 5.5)

134 (90.5)

14 ( 9.5)

Marital status

Single

Married

117 (58.2)

84 (41.8)

51 (34.5)

97 (65.5)

Religion

Christianity

Islam

African Traditional Rel.

184 (91.5)

16 ( 8.0)

1 ( 0.5)

144 (97.3)

2 ( 1.4)

2 (1.4)

Level of education

Primary

Secondary

Tertiary

12( 6.0)

54 (26.9)

135 (67.1)

22 (16.3)

66 (45.2)

58 (39.2)

50

TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS

CONTD.

Variable Industry

Bottling

Freq. (%) N=201

Brewing

Freq. (%) N=148

Ethnic group

Benin

Esan

Urhobo

Yoruba

Igbo

Owan

Etsako

Others

58 ( 28.9)

32 ( 15.9)

4 ( 2.0)

39 ( 19.4)

24 ( 11.9)

8 ( 4.0)

9 ( 4.5)

27 ( 13.4 )

54 (36.5)

42 (28.4)

5 ( 3.4)

1 ( 0.7)

27 ( 18.2)

3 ( 2.0 )

3 ( 2.0)

13 ( 8.8)

Department

Production

Engineering

Distribution

152 (75.6)

9 ( 4.5)

40 ( 19.9)

87 (58.2)

28 (18.9)

33 (22.3)

Schedule of work

Permanent day

Shift work

56(27.8)

145(72.2)

95(63.6)

53(36.4)

Duration of employment

(years)

0-5

6-10

>10

135 (67.3)

48 (23.8)

18 ( 8.8)

50 (33.8)

26 (17.6)

72 (48.6)

The mean age of respondents was 30.2 ± 7.9 years for the bottling industry and 39.8 ±

12.2 years for the brewing industry. The difference between the means of age in both

industries showed (t = 8.91, df = 347, p = 0.000, 95% CI = 7.48 – 11.72).

Majority of the respondents 190 (94.5%) in the bottling industry and 134 (90.5%) brewing

industry were male. Majority of respondents 117 (58.2%) in the bottling industry were

51

single while majority of respondents in the brewing industry 97 (65.5%) were married. In

both industries majority of the respondents 184 (91.5%) bottling and 144 (97.3%) brewing

were Christians. Majority of the respondents in the bottling industry 135 (67.1%) had

tertiary education while most of the respondents in the brewing industry 66 (45.2%) had

secondary education.

In both industries the Benin tribe represented the largest ethnic group with 58 (28.9%) in

the bottling industry and 54 (36.5%) in the brewing industry. In the bottling industry the

Yoruba ethnic group followed with 39 (19.4%) while in the brewing industry the Esan

ethnic goup followed with 48 (32.4%). The other ethnic groups represented in the study

include Igbo, Urhobo and Ijaw. With regard to the department of respondents, the

production department represented the largest category with 152 (75.6%) in the bottling

industry and 87 (58.2%) in the brewing industry.

Majority of respondents in the bottling Industry 145 (72.2%) did shift work while majority

in the brewing Industry 95 (63.3%) did Permanent day. The mean number of hours worked

by respondents per day in the industries studied were 7.8 ± 2.3 in the bottling industry and

8.16 ± 0.57 in the brewing industry. The mean duration of employment of respondents was

4.8 ± 3.4 years for the bottling industry and 11.31 ± 9.6 years for the brewing industry ( t

= 8.89, df = 347, p = 0.000, 95% CI = 5.07 – 7.95).

52

TABLE 2: QUALITATIVE RISK ASSESSMENT IN THE BEVERAGE

INDUSTRIES

Hazard identified

Risk of exposure in the industries

Bottling Brewing

Mechanical

i. Broken glass

ii. Slippery floor

iii. Repetitive motion

iv. Unguarded machinery/

moving machine parts

+

+

++

+

++

++

++

++

Physical

i. Noise

ii. Temperature variation

+

+

+

+

Chemical

i. Cleaning agent (e.g caustic

soda)

_

+

Psychosocial

i. Job dissatisfaction

+

++

Key

( +) Present

( ─) Absent

Broken glass was a hazard identified in the brewing and re usable glass bottle line in the

bottling Industries, Some workers were involved in manually crushing condemned glass

bottles for recycling as seen in the bottling company and were at increased risk of injuries

from broken glass.

The floor of both Industries was well drained except for some area in the re usable glass

bottle line where bottles were washed and the filling section which was wet and slippery.

The floor of the engineering workshop in the brewing industry was both greasy and

slippery. The Engineering section in the bottling Industry, however, was clean.

53

Repetitive motions and manual handling was seen among workers involved in loading and

unloading pallets in both Industries. Empty sighters involved in inspecting bottles were at

increased risk of eye strain, headaches and visual acuity problems in both industries. There

were well marked pedestrian walk ways in the bottling Industry but none in the brewing

Industry. Workers in the brewing industry were thus more exposed to accidents from

moving machine parts and forklifts.

The generator house in both Industries produced excessive noise, maintenance workers in

both industries were at risk of noise induced hearing loss. Noise was a hazard in the Quality

control room of the brewing Industry as it was located above the factory floor. The Quality

control room in the bottling Industry, however, was sound proofed and located adjacent to

the Polyethylene terephthalate (PET) line (Appendix VIII)

Excessive heat, evidenced by excessive sweating among workers in the factory floor was

not noticed except among the workers in the PET line in the bottling industry.

Some workers in the brewing Industry were manually involved in loading caustic soda into

the washer for washing the glass bottles and were at an inreased risk of sustaining chemical

burns.

More of the workers in the brewing industry expressed dissatisfaction with their presently

assigned job when compared with the bottling Industry (Table 31).

54

TABLE 3: ENVIRONMENTAL MONITORING OF NOISE AND

PARTICULATE CONCENTRATION IN AIR

Variable

Industry

Permissible

exposure limit

FMENV

Test statistic

t-test

Bottling

N =12

Brewing

N=12

Noise

Mean + SD

Range

Highest source

dBA

75.5 +12.1

56.8- 93.5

Generator house

(93.5)

dBA

72.19 +13.1

55.6 – 94.2

Generator house

(94.2)

dBA

< 90

< 90

< 90

t=0.64

df=22

p=0.527

Particulate in

air

Mean

Range

mg/m3

0.02+0.01

0.01-0.02

mg/m3

0.01+0.01

0.01-0.02

mg/m3

< 0.25mg/m3

< 0.25mg/m3

t=2.42

df=22

p=0.023

*** Detection limit for particulate in air is 0.01mg/m3

FMENV – Federal Ministry of Environment

The average noise levels in both industries fell below the permissible exposure limit of

90dBA in both industries with 75.5+ 12.1 dBA in the bottling industry and 72.2+ 13.1 in

the brewing industry. The highest source of noise in both industries came from the

generator house with 93.5dBA in the bottling industry and 94.2 dBA in the brewing

industry. There was no statistically significant difference in the mean noise levels in both

industries (p= 0.527).

55

The mean particulate in air levels of both industries was far below the 0.25 mg/m3

permissible exposure limit of the FMENV at 0.01mg/m3 in the bottling industry and

0.02mg/m3 in the brewing industry. It was barely at the detection limit of the HAZ DUST

monitor used at 0.01mg/m3 in both industries even though there was a statistically

significant difference in the particulate in air levels of both industries (p=0.023) studied.

56

TABLE 4: SELF REPORTED OCCUPATIONAL INJURIES AMONG

RESPONDENTS IN THE PAST 12 MONTHS

Injured

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

33 ( 16.4 )

136 ( 83.6 )

33 ( 22.3)

115 ( 77.7)

Total

201 (100.0)

148 (100.0)

X2 = 1.921, df = 1, p = 0.166 OR = 0.85, 95% CI = 0.57 - 1.35

The proportion of workers who had suffered at least 1 occupational injury in the bottling

industry was 33 (16.4%) while in the brewing industry it was 33 (22.3%). There was no

statistically significant difference (p = 0.166) among respondents in both industries studied.

57

TABLE 5: PREVALENCE AND FREQUENCY OF OCCUPATIONAL

INJURIES AMONG RESPONDENTS

Occupational

Injury

Bottling

Brewing

Prevalence rate

per 1000 workers per

year

263

506

Frequency rate

hours worked per

year

0.13

0.25

There were 53 injuries reported among 33 respondents in the bottling industry while there

were 75 injuries reported among 33 respondents in the brewing industry. This gave an

Injury prevalence rate of 263 per 1000 workers per year in the bottling Industry and 506

per 1000 workers per year in the brewing Industry. The prevalence of injury was more in

the brewing Industry.

The injury frequency rate per 1000 work hours per year was higher in the brewing industry

at 0.25 per 1000 compared to the bottling Industry at 0.13 per 1000.

58

FIGURE 1: PART OF THE BODY WHERE INJURY OCURRED TO

RESPONDENTS

Majority of the respondents in the bottling industry were injured in the hand (66%), most of

the respondents in the brewing industry were injured in the hand (33%) followed by the

upper limb (27.3%) and lower limb (27.3%).

0

10

20

30

40

50

60

70

Head &neck

Upperlimb

Hand Lowerlimb

Feet Trunk Back

9.1%12.1%

66.6%

0 0 0 00

27.3%

33.3%

27.3%

6.1%3% 3%

FREQ

UEN

CY

%

Part of the body affected

Bottling

Brewing

59

FIGURE 2: TYPE OF INJURY TO RESPONDENTS

Majority of the respondents in both industries sustained lacerations as the type of injury in

the bottling 22 (66.7%) and the brewing 28 (84%) industries.

0

10

20

30

40

50

60

70

80

90

Sprain Laceration Dislocation Crushing Burns

3%

66.7%

6.1% 6.1%

18.1%

6.1%

84.6%

03%

6.1%

FREQ

UEN

CY

%

TYPE OF INJURY

Bottling

Brewing

60

FIGURE 3: CAUSE OF INJURY TO RESPONDENTS

Being struck by/ against an object was the predominant cause of injury to respondents in

the bottling (66.7%) and brewing (60.6%) industries.

0

10

20

30

40

50

60

7066.7%

18.1%

3%6.1%

0

6.1%

0

60.6%

6.1%

15.1%

9.1%

3%0

6.1%

FREQ

UEN

CY

%

CAUSE OF INJURY

Bottling

Brewing

61

FIGURE 4: PERIOD OF THE DAY WHEN INJURY OCCURRED TO

RESPONDENTS

The afternoon 17 (58.7%) was the period of highest occurrence of injury in the brewing

industry even though morning and afternoon was equally shared among injured

respondents at 11 (33%) in the bottling company as the period the when most injuries

occurred to respondents.

0

10

20

30

40

50

60

Morning Afternoon Night Can't remember

33.3% 33.3%

24.3%

9.1%

21.2%

51.5%

15.2%12.1%

FREQ

UEN

CY

%

PERIOD OF THE DAY

Bottling

Brewing

62

TABLE 6: SELF REPORTED NOTIFIABLE INJURY AMONG RESPONDENTS

Notifable injury

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

8 (3.9)

193 (96.1)

4 (2.7)

144 ( 97.3)

Total

201 (100.0)

148 (100.0)

X2 = 1.630 , df = 1, p =0.202

Eight (3.9%) of the workers injured required to be absent from work for more than three

days in the bottling industry while 4 (2.7%) of the workers injured required to be absent

from work for more than 3 days There was no statistically significant difference (p= 0.202)

in the number of injured workers in both industries that were of work for more than three

days following injury. This finding, however, gave a prevalence of notifiable injury of 8

(3.7%) in the bottling industry and 4 (2.7%) in the brewing industry.

63

TABLE 7: CIGARETTE SMOKING AMONG RESPONDENTS

Smoking status

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Smoker

Non smoker

8 ( 4.0)

193 (96.0)

11 ( 7.4 )

137 (92.6)

Total

201 (100.0)

148 (100.0)

X2 = 1.974, df =1, p = 0.160

Majority of respondents in the bottling 193 ( 96.0% ) and brewing 137 ( 92.6% ) Industries

were non smokers. Eight (4.0%) in the bottling industry and 11 (7.4%) in the brewing

industry were smokers. There was no statistically significant difference amongst the

number of smokers in both industries ( p = 0.160).

64

TABLE 8: ALCOHOL HABIT OF RESPONDENTS

Alcohol intake

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

74 ( 36.8)

127 (63.2)

97 (66.9)

51 (33.1)

Total

201 (100.0)

148 (100.0)

X2 = 28.143, df =1, p =0.000 OR = 0.31, 95% CI = 0.19 -0.49

In the bottling industry 74 (36.8%) respondents took alcohol while in the brewing industry

97 (66.9) respondents took alcohol. There was a statistically significant difference (OR =

0.31, 95% CI = 0.19 -0.49) in the proportion of respondents that took alcohol in both

industries.

65

TABLE 9: FREQUENCY OF INTAKE OF ALCOHOL BY RESPONDENTS

Frequency

Industry

Bottling

Freq. (%)

n=74

Brewing

Freq. (%)

n=97

Daily

Thrice weekly

Weekly

Monthly

Rarely

6 ( 8.1 )

8 ( 10.8)

21 (28.4)

15 (20.3)

24 (32.4)

22 (22.7 )

26 (26.8)

21 (21.6)

7 ( 7.2)

21 (21.6)

Total

74 (100.0)

97 (100.0)

X2 = 19.032, df = 4, p = 0.001

In the bottling industry 8 (10.8%) took alcohol thrice weekly compared to 26 (26.8%) of

the respondents in the brewing industry. There was a statistically significant difference in

the frequency of intake of alcohol among respondents (p = 0.001)

66

TABLE 10: RESPONDENTS’ INVOLVEMENT IN SPORTING ACTIVITY

Involved in sporting

activity

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

116 (57.7)

85 (42.3)

80 (54.0)

68 (46.0)

Total

201 (100.0)

148 (100.0)

X2 = 0.463, df = 1 , p = 0.496

One hundred and sixteen (57.7%) of the respondents were involved in sporting activity in

the previous week prior to the study in the bottling industry compared to 80 (54.0 %) of

respondents in the brewing industry studied. There was no statistically significant

difference (p = 0.496) in involvement in sporting activity among respondents in both

industries. The sporting activities included jogging, brisk walking and football.

67

TABLE 11: PRE- EMPLOYMENT MEDICAL EXAMINATION

Pre employment medical

examination

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

121 (60.2)

80 ( 39.8)

64 (43.2 )

84 ( 56.8)

Total

201 (100.0)

148 (100.0)

X2 = 9.838, df = 1, p = 0.002 OR = 1.99, 95% CI = 1.26 – 3.13

One hundred and twenty one (63.0%) of respondents in the bottling industry had a medical

examination in the past before starting work in the industry compared to 64 (44.0%) in the

brewing industry. There was a statistically significant difference (OR = 1.99, 95% CI =

1.26 – 3.13) in the proportion of respondents who had a medical examination before

starting work in both industries.

68

TABLE 12: PERIODIC MEDICAL EXAMINATION

Periodic medical

examination

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

126(62.7)

75 (37.3)

38 (25.7)

110 (74.3)

Total

201 (100.0)

148 (100.0)

X2 = 49.87, df = 1 , p = 0.000 OR = 4.86, 95% C.I = 2.97 – 7.98

One hundred and twenty six (62.7%) respondents in the bottling industry had a medical

examination in the past since starting work in the industry compared to 38 (25.7%) in the

brewing industry. There was a statistically significant difference (OR = 4.86, 95% C.I =

2.97 – 7.98) in the proportion of respondents who had a medical examination since starting

work in both industries.

69

TABLE 13: RESPONDENTS WHO WERE BEING TREATED FOR

HYPERTENSION OR DIABETES MELLITUS

On treatment

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

9 (4.5)

192 ( 95.5)

11 ( 7.4)

137 ( 92.6)

Total

201 (100.0)

148 (100.0)

X2 = 1.38, df = 1, p = 0.241 OR = 0.58, 95% = 0.22 – 1.57

Nine (4.5% ) of respondents in the bottling industry were being treated for a chronic illness

compared to 11 ( 7.4% ) in the brewing industry. Further data analysis showed that

Hypertension was the predominant chronic illness in the bottling 7 (87.5%) and brewing 9

(81.8%) respondents were receiving treatment for. There was no statistically significant

difference ( OR = 0.58, 95% = 0.22 – 1.57 ) in the distribution of respondents being

treated for a chronic illness in both industries studied.

70

TABLE 14: BODY MASS INDEX OF RESPONDENTS

BMI

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Underweight (< 18.5)

Normal ( 18.5 - 24.9)

Overweight (25- 29.9)

Obese I (30-34.9)

Obese II (35- 39.9)

Obese III ( ≥40)

6 (2.9)

125 (62.2)

59 (29.3)

8 ( 3.9)

2 (0.9 )

1 ( 0.5 )

0 ( 0.0)

67 (45.3 )

63 ( 42.5 )

17 (11.5 )

1 (0.7 )

0 (0.0)

Total

201 (100.0)

148 (100.0)

Fisher’s exact test, p = 0.0001

Sixty three (42.5%) of respondents in the brewing industry being overweight compared

with 59 (29.3%) of workers in the bottling industry. Prevalence of obesity was found to be

5.5% in the bottling industry and 12.1% in the brewing industry. There was a statistically

significant difference in the BMI of respondents in the bottling and brewing industries ( p =

0.0001)

71

TABLE 15: BLOOD PRESSURE OF RESPONDENTS

Blood pressure [mmHg]

Industry

Bottling Freq. (%)

Brewing Freq. (%)

Normal

[<130/ <85]

High normal

[130-139/ 85 - 89]

Mild Hypertension (Grade

I)

[140 – 159/ 90 - 99]

Moderate Hypertension

(Grade II)

[ 160 – 179/ 100 - 109]

Severe Hypertension

(Grade III)

[>180 / ≥110]

105 ( 52.2 )

43 (21.4 )

44 ( 21.9 )

6 ( 2.9)

3 (1.4)

78( 52.7 )

25 ( 16.9 )

20 (13.5 )

15 (10.2 )

10 ( 6.8 )

Total

201 ( 100.0 )

148 ( 100.0 )

X2 = 17.735, df = 4, p = 0.001

The prevalence of high blood pressure was found to be 26.4% in the bottling industry and

30.0% in the brewing industry. There was a statistically significant difference in the blood

pressure categories of respondents in the bottling and brewing industries studied (p

=0.002).

72

TABLE 16: RANDOM BLOOD GLUCOSE OF RESPONDENTS

Random blood glucose

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Normal

197 (98.0)

139 (93.9 )

Impaired glucose tolerance

3 (1.5)

5 ( 3.4)

Diabetes mellitus

1 (0.5) 4 ( 2.7 )

Total

201 (100.0)

148 (100.0)

Fisher’s exact, p=0.1319

[Normal < 139mg/dl, Impaired glucose tolerance 140-199mg/dl, Diabetes mellitus >

200mg/dl].

The prevalence of diabetes mellitus was 0.01% in the bottling industry and 2.7% in the

brewing industry studied. There was no statistically significant difference in the random

blood glucose measurements of respondents (p = 0.1319) in both industries.

73

TABLE 17: MULTIPLE CORRELATIONS OF AGE, BMI, BP (SYSTOLIC), BP

(DIASTOLIC) AND RBG OF RESPONDENTS IN THE BOTTLING

INDUSTRY

AGE BMI BP(SYSTOLIC) BP(DIASTOLIC) RBG

AGE

Pearson correlation

Sig.(2 tailed)

N

1

201

442**

.000

201

177*

.012

201

.392**

.000

201

.130

.067

201

BMI

Pearson correlation

Sig.(2 tailed)

N

442**

.000

201

1

201

.101

.154

201

.199**

.005

201

.024

.738

201

BP(SYSTOLIC)

Pearson correlation

Sig.(2 tailed)

N

.177*

.012

201

.101

.154

201

1

201

.

.661**

.000

201

.

297**

.000

201

BP(DIASTOLIC)

Pearson correlation

Sig.(2 tailed)

N

.392**

.000

201

.199**

.005

201

.661**

.000

201

1

201

235**

.001

201

RBG

Pearson correlation

Sig.(2 tailed)

N

.130

.067

201

.024

.738

201

.297**

.000

201

.235**

.001

201

1

201

** Correlation is significant at 0.01 level (2 – tailed)

*Correlation is significant at 0.05 level (2 – tailed)

Correlating the above variables with diastolic BP it is observed that that all the

correlations are significant at 0.01 level and range from .199 to .661. systolic and diastolic

blood pressure being, expectedly, moderately correlated (0.661), BMI (0.199) and random

blood glucose (0.235) having little, if any, correlation with BP(diastolic) . Age (0.392) had

a low correlation with the BP (diastolic) of respondents in the bottling industry.

74

TABLE 18: MULTIPLE CORRELATIONS OF AGE, BMI, BP (SYSTOLIC), BP

(DIASTOLIC) AND RBG OF RESPONDENTS IN THE BREWING INDUSTRY

** Correlation is significant at 0.01 level (2 – tailed)

*Correlation is significant at 0.05 level (2 – tailed)

Correlating the above variables with diastolic BP it is observed that the correlations of age

and BP (systolic) were significant at 0.01 level, while the correlations of BMI and RBG

were significant at 0.05 level with a range from. 208 to 731. systolic and diastolic blood

pressure being highly correlated (0.731), BMI (0.208) and random blood glucose (0.210)

and age (0.311) having a low correlation with BP (diastolic) of respondents studied in the

brewing industry.

AGE BMI BP(SYSTOLIC) BP(DIASTOLIC) RBG

AGE

Pearson correlation

Sig.(2 tailed)

N

1

148

.064

.436

148

.410**

.000

148

.311**

.000

148

.177*

.031

148

BMI

Pearson correlation

Sig.(2 tailed)

N

.064

.436

148

1

148

.159

.053

148

.208*

.011

148

.032

.702

148

BP(SYSTOLIC)

Pearson correlation

Sig.(2 tailed)

N

.410**

.000

148

.159

.053

148

1

148

731**

.000

148

.279**

.001

148

BP(DIASTOLIC)

Pearson correlation

Sig.(2 tailed)

N

.311**

.000

148

.208*

.011

148

.731**

.000

148

1

148

.210*

.010

148

RBG

Pearson correlation

Sig.(2 tailed)

N

.177*

.031

148

.032

.702

148

.279**

.001

148

.210*

.010

148

1

148

75

TABLE 19: KNOWLEDGE AND PRACTICE OF PERSONAL PROTECTIVE

EQUIPMENTS USE BY RESPONDENTS*

Type

Industry

Bottling (N =201) Brewing (N = 148)

Knowledge

Freq. (%)

Practice

Freq. (%)

Knowledge

Freq. (%)

Practice

Freq.(%)

Helmet

Face shield

Eye goggle

Earmuff/ earplug

Nose mask

Hand gloves

Safety shoes

Coveralls

185 (92.0)

161 (80.1)

193 (96.0)

194 (96.5)

180 (89.6)

195 (97.0)

194 ( 96.5)

192 (95.5)

54 (26.9)

39 (19.4)

105 (52.2)

117 (58.2)

82 (40.8)

140 (69.7)

184 (91.5)

178 (88.5)

128 (86.5)

111 (75.0)

139 (94.0)

126 (85.1)

35 (91.2)

143 (96.6)

139 (93.9)

137 (92.6)

21 (14.2)

20 (13.5)

63 (42.5)

27 (18.2)

49 (33.1)

77 (52.0)

65 (43.9)

71 (48.0)

* Multiple responses

Respondents in the bottling industry knew of the PPEs required in the industry in the

following order for the first four namely hand gloves 195 (97.0%), ear muff/ earplugs 194

(96.5 %), safety shoes 194 (96.5%), eye goggles 193 (96.0%) whereas respondents in the

brewing industry were aware of PPEs used in the industry in the following order for the

first four namely hand gloves 143 (96.6%), safety shoes 139 (93.9%), eye goggle 139

(94.0%), coveralls 137 (92.6%)

76

The four most frequently used PPEs by respondents in the bottling industry were safety

shoes 184 (91.5%), coveralls 178 (88.5%), hand gloves 140 (69.7%) and ear muff/ earplug

117 (58.2%) whereas the four most frequently used PPEs among respondents in the

brewing industry studied were coveralls hand gloves 77 (52.0%), 71 (48.0%), safety shoes

65 (43.9%) and eye goggle 63 (42.5%) respectively.

77

TABLE 20: TRAINING IN THE CORRECT USE OF PERSONAL PROTECTIVE

EQUIPMENT BY RESPONDENTS

Received training

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

150 (74.6)

51 (25.4)

61 (41.2 )

87 ( 58.8)

Total 201 (100.0) 148 (100.0)

X2 = 39.801 , df = 1, p = 0.000 OR = 4.19, 95% CI = 2.59 – 6.80

One hundred and fifty (74.6%) of respondents in the bottling industry had received training

on the correct use of PPEs compared to 61 (41.2%) in the brewing industry studied. There

was a statistically significant difference ( p= 0.000) in receiving training in the correct use

of PPES between respondents in both industries studied with proportionally more

respondents in the bottling industry having received training in the correct use of PPEs.

78

TABLE 21: DIFFICULTY USING PERSONAL PROTECTIVE EQUIPMENT BY

RESPONDENTS

Difficulty using PPEs

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

11 ( 5.5 )

190 ( 94.5)

11 ( 7.4)

137 (92.6 )

Total 201 (100.0) 148 (100.0)

X2 = 0.554 , df = 1 , p = 0.457 OR = 0.72, 95% CI = 0.28 – 1.85

Majority of respondents in the bottling industry 190 (94.3%) and brewing industry 137

(92.6%) had no difficulty in using the PPEs provided. There was no statistically significant

difference (p = 0.457) observed among respondents in both industries.

79

TABLE 22: FREQUENCY OF USE OF PERSONAL PROTECTIVE

EQUIPMENTS BY RESPONDENTS

Frequency of use

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Always, when working

Only when it is available

Sometimes when I feel like it

Never even when it is available

177 ( 88.1)

14 ( 7.0)

9 ( 4.5)

1 ( 0.5)

89 (60.1)

21 (14.2)

33 ( 22.3)

5 ( 3.4)

Total

201 (100.0)

148 (100.0)

X2 = 40.489 , df = 3, p =0.000

There was a statistically significant difference (p = 0.000) among respondents in both

industries with regard to the frequency of use of PPEs with 177 (88.1%) of respondents in

the bottling industry using their PPEs always when working compared to 89 (60.1%) in the

brewing industry.

80

TABLE 23: RESPONDENTS OPINION ON NECESSITY OF USE OF

PERSONAL PROTECTIVE EQUIPMENT

Necessary

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

198 (98.5 )

3 ( 1.5 )

142 (95.9)

6( 4.1)

Total

201 (100.0)

148 (100.0)

X2 = 2.205 , df = 1, p = 0.138 OR = 2.79, 95% CI = 0.61 – 14.32

Majority of respondents in both industries agreed that the use of PPEs was necessary

among workers in the bottling 198 (98.5%) and brewing 142 (95.9%) industries. There was

no statistically significant difference (p = 0.138) in the opinion of respondents in both

industries on the necessity for use of PPEs.

81

TABLE 24: RESPONSIBILITY FOR PREVENTION OF ACCIDENTS IN THE

WORKPLACE

Responsibility

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Management

Supervisors

Workers

Everybody

30 (14.9 )

10 (4.9 )

4 ( 2.0)

157 ( 78.1)

45 (30.4 )

3 ( 2.0 )

14 ( 9.5 )

86 ( 58.1)

Total

201 (100.0)

148 (100.0)

X2 = 25.851 , df = 3, p = 0.000

One hundred and fifty three (78.1%) respondents in the bottling industry stated that

everybody was responsible for prevention of accidents in the workplace compared to 83

(58.1%) in the brewing industry. There was a statistically significant difference (p = 0.000 )

in the opinion of respondents in the bottling and brewing industries on who was responsible

for prevention of accidents in the workplace with

82

TABLE 25: HEALTH AND SAFETY TRAINING AT WORK

Received training

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

152 (75.6)

49 (24.4)

62 ( 41.9)

86 (58.1 )

Total

201 (100.0)

148 (100.0)

X2 = 40.885 , df = 1, p = 0.000 OR = 4.30, 95% = 2.65 – 6.99

One hundred and fifty two (75.6%) of respondents in the bottling industry had received

health and safety training at work compared to 62 (41.9%) of respondents in the brewing

industry. There was a statistically significant difference (p= 0.000) in receiving health and

safety training among respondents in both industries studied.

83

TABLE 26: FREQUENCY OF HEALTH AND SAFETY TRAINING FOR

RESPONDENTS AT WORK

Frequency

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Monthly

Quarterly

Half yearly

Yearly

Rarely

60 (29.8 )

32 ( 15.9 )

11 ( 5.5 )

26 (12.9 )

49 (35.8 )

1 (0.6 )

3 (2.0 )

3 (2.0)

9 (6.1)

132 (89.2)

Total

201 (100.0)

148 (100.0)

X2 = 125.711 , df = 4 , p = 0.000

One hundred and thirty two (89.1%) of respondents in the brewing industry reported as not

receiving any health and safety training compared with 49 (35.8%) in the bottling industry

studied. There was a statistically significant difference in the frequency of health and

safety training to respondents in the bottling and brewing industries (p= 0.000) with

84

TABLE 27: KNOWLEDGE OF A HEALTH AND SAFETY COMMITTEE IN

THE INDUSTRY BY RESPONDENTS

Knowledge

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Correct

Incorrect

162 (80.6 )

39 ( 19.4)

39 ( 26.3)

109 ( 73.6)

Total

201 (100.0)

148 (100.0)

X2 = 102.696 , df = 1 , p = 0.000 OR = 11.61, 95% CI = 6.80 – 19.93

One hundred and sixty two (80.6%) of respondents in the bottling industry had a correct

knowledge of a health and safety committee in the industry compared to 39 (26.3%) of

respondents in the brewing industry. There was a statistically significant difference (p =

0.000) in the knowledge of respondents on a health and safety committee in the industry.

85

TABLE 28: PRACTICE OF OCCUPATIONAL HEALTH AND SAFETY BY

RESPONDENTS

Level of practice

Industry

Bottling

Freq. (%)

Brewing

Freq. (%)

Poor

Fair

Good

18 ( 9.0 )

34 (16.9)

149 (74.1)

78 (52.7 )

45 ( 30.4)

25 (16.9)

Total

201 (100.0)

148 (100.0)

X2 = 122.168 , df = 2 , p = 0.000

One hundred and forty nine (74.1%) in the bottling industry had a good practice while 78

(52.7%) in the brewing industry had a poor practice of occupational health and safety.

There was a statistically significant difference (p= 0.000) in the practice of occupational

health and safety by respondents in both industries.

86

TABLE 29: SOCIO DEMOGRAPHIC CHARACTERISTICS AND PRACTICE

OF OCCUPATIONAL HEALTH AND SAFETY AMONG

RESPONDENTS IN THE BOTTLING INDUSTRY

Variable

Practice of Occupational Health and

Safety

Total

Freq. (%)

N=201

Test statistic Poor

Freq. (%)

n=18

Fair

Freq. (%)

n=34

Good Freq.

(%)

n=149

Age group

15 – 24

25 -34

35 - 44

45 – 54

>55

7 (14.3)

7 ( 6.2)

2 (9.1)

2 (13.3)

0 (0.0)

10 (20.4)

17 (15.0)

4 (18.2)

2 (20.0)

0 ( 0.0)

32 (65.3)

89 (78.8)

16 (72.7)

10 (66.7)

2 (100.0)

49(100.0)

113(100.0)

22(100.0)

15(100.0)

2(100.0)

X2 =5.524

df= 8

p=0.700

Marital status

Single

Married

12 (10.3 )

6 (7.1)

20 ( 17.2)

14 (16.7)

85 (73.2 )

64 ( 76.2 )

116(100.0)

84 (100.0)

X2 =0.617

df= 2

p=0.734

Level of education

Primary

Secondary

Tertiary

1 (9.1)

4 (7.4)

13(9.6)

1(9.1)

9(16.7)

24(17.8)

10(81.8)

41(75.9)

99(72.6)

12(100.0)

54(100.0)

135(100.0)

X2 =1.088

df= 4

p=0.896

Duration of

employment

(years)

0.5 – 5

6 – 10

>10

13 ( 7.8 )

4 (8.2)

1 (14.3)

22 (14.9)

10 (20.4)

2 (28.6)

110 ( 74.3)

35 (71.4)

4 (57.1)

148(100.0)

49(100.0)

79100.0)

X2 =1.692

df= 4

p=0.792

There was no statistically significant association between the age (p=0.700), marital status

(p=0.734), level of education (p=0.896) and the duration of employment of respondents

with their practice of occupational health and safety.

87

TABLE 30: SOCIO DEMOGRAPHIC CHARACTERISTICS AND PRACTICE

OF OCCUPATIONAL HEALTH AND SAFETY AMONG

RESPONDENTS IN THE BREWING INDUSTRY

Variable

Practice of Occupational Health and

Safety

Total

Freq. (%)

N=148

Test

statistic Poor

Freq. (%)

n=28

Fair

Freq. (%)

n=45

Good

Freq. (%)

n=25

Age group

15 – 24

25 -34

35 - 44

45 – 54

>55

17(85.0)

16(53.3)

23(53.5)

10(32.3)

12(50.0)

3(15.0)

11(36.7)

14(32.6)

14(45.2)

3(12.5)

0( 0.0)

3(10.0)

6(14.0)

7(22.6)

9(37.5)

20(100.0)

30(100.0)

43(100.0)

31(100.0)

24(100.0)

X2

=26.751

df= 8

p=0.001

Marital status

Single

Married

33(67.3)

45(46.4)

14(28.6)

31(32.0)

3( 6.1)

22(22.6)

49(100.0)

97(100.0)

X2 =8.896

df= 2

p=0.012

Level of education

Primary

Secondary

Tertiary

15(66.7)

27(40.3)

36(61.0)

6(28.6)

23(34.3)

16(27.1)

1(4.8)

17(25.4)

7(11.9)

22(100.0)

67(100.0)

59(100.0)

X2

=10.071

df= 4

p=0.039

Duration of employment

(years)

0.5 – 5

6 – 10

>10

37(74.0)

12(46.2)

29(40.3)

11(22.0)

10(38.5)

24(33.3)

2(4.0)

4(15.4)

19(26.4)

50(100.0)

26(100.0)

72(100.0)

X2

=17.342

df= 4

p=0.002

The practice of occupational health and safety improved with the age of respondents,

married respondents had a better practice of occupational health and safety, respondents

with secondary education and respondents that had a longer duration of employment had a

better practice of occupational health and safety in the brewing industry studied.

There was a statistically significant association between age (p=0.001), marital status

(p=0.012), level of education (p=0.039) and duration of employment (p=0.002) with the

practice of occupational health and safety among respondents.

88

TABLE 31: SATISFACTION WITH PRESENTLY ASSIGNED JOB

Satisfied Bottling

Freq. (%)

Brewing

Freq. (%)

Yes

No

150 (74.6)

51 (25.4)

80 (54.0)

68 (46.0)

Total

201 (100.0)

148 (100.0)

X2 = 16.054 , df = 1 , p = 0.000 OR = 2.50, 95% C.I = 1.55 – 4.04

Majority of the respondents in the bottling company 150 (74.6%) were satisfied with their

job compared with 80 (54.0%) in the brewing industry studied. There was a statistically

significant difference (OR = 2.50, 95% C.I = 1.55 – 4.04) in the satisfaction of

respondents with their jobs in both industries.

89

IN - DEPTH INTERVIEW

In depth interviews were conducted with the human resources officers in the two industries

following their informed consent. Below is a report of both interviews using the in-depth

interview guide.

1. What in your opinion is occupational health and safety in this industry

Bottling: Occupational health and safety is balancing the burden of work and the health of

staff so that over time they are still as effective as expected.

Brewing: It is working with the axiom “safety first and safety always”, the need to protect

the staff from injuries and industrial accidents.

2. Who in your opinion is responsible for health and safety in the workplace:

management, supervisors, workers or all the above.

Bottling: Everybody, your safety is your responsibility

Brewing: Safety is everybody’s responsibility though management has a heavier burden to

ensure safety.

3. Is there a specific officer in charge of health and safety in the workplace

Bottling: Yes, the safety manager.

Brewing: Yes, there is a safety officer in this factory.

4. Is there a health and safety committee in this industry

Bottling: Yes, they are known in this factory as the “emergency response team”

Brewing: No

5. If yes, what are the duties of the health and safety committee

Bottling: They investigate injuries and accidents thoroughly, they supervise periodic pep

talks on health and safety to employees, they ensure staff and contractors are PPE

compliant and ensure that plant safety rules and code of conduct are kept by staff and

contractors.

90

6. If no, will it be necessary to set up a health and safety committee in this

industry

Brewing: It won’t be necessary as the safety officer takes care of that.

7. Is there a need for training of factory workers in occupational safety

Bottling: Yes there is a need for safety training and it is done periodically in the year in

this factory. Every new staff or visitor to the plant goes through a brief induction

programme (10 minutes HSE video) the first time he enters the factory. A more elaborate

training is given subsequently employees are provided free copies of the “Staff safety

induction handbook” and “Employees health and safety at work handbook”.

Brewing: Yes there is a need for safety training but none has been done in the past year.

8. Can you mention some of the personal protective equipment provided for

workers in this industry

Bottling: Safety shoes, coveralls, ear plugs/ ear muffs, eye goggles

Brewing: Helmet, glove, nose mask, safety shoes, coveralls.

9. In your opinion are workers compliant with the use of personal protective

equipment and in the practice of safety in the Industry

Bottling: Yes, spot check show an average of 75% compliance every month

Brewing: Yes, there are sanctions for unsafe acts in the factory such as query and

suspension to erring workers.

10. Are there incentives to workers on good occupational health and safety

practices

Bottling: Yes there are, such as commendations, distribution of promotional gift items

such as T-shirts, fez caps, insecticide treated nets and mugs.

Brewing: None presently in the factory.

11. If, no will you consider incentives as necessary.

91

Brewing: Yes, they would be necessary to encourage staff. Awards can be given.

12. Are health promotional activities appropriate in this industry viz health

education, health screening, incentive programme, recreational activities etc. (kindly

state them).

Bottling: Yes but there is room for improvement as we just concluded a heath week in

December comprising health talks, free health screening and a walk for life

programme. There is presently no area delineated for recreational activities in the factory.

Brewing: More still needs to be done.

13. What would you suggest to improve occupational health and safety in this

industry.

Bottling: Continuous education of workers on health and safety, improvement in

observations already made in the factory. There has been strong emphasis on OHS in the

workplace since the unfortunate fire incident of 2008. A lot of improvement has however

happened since then such as the establishment of an emergency response team, provision of

fire hydrants in various points in the factory, first aid training and the annual health week

for employees. Even at that there is still room for improvement following observations you

might have made in this factory.

Brewing: Increase in the number of PPEs provided, increased training of workers on health

and safety, prompt payment of health retainers for the care of workers and improved

equipping and stocking of staff clinic.

92

CHAPTER FIVE

DISCUSSION

The mean age of respondents and the mean duration of employment of workers in the

bottling industry were 30 ± 7.9 and 4.8 ± 5.4 years respectively, this was lower than the

mean age and duration of employment of respondents in the brewing industry at 39.8 ±

12.2 and 11.3 ± 9.6 years. A possible reason could be the relative difference in the date of

establishment of these industries in Benin City. The Brewing industry was established in

1974 while the bottling industry began production in Benin City in 2000 even though it was

established in Nigeria in 1952.

Expectedly the Benin Ethnic group comprised the majority in both industries studied at

28.9% in the bottling industry and 36.5% in the brewing industry. This was followed by the

Yoruba (19.4%) and the Esan (28.4%) ethnic groups in the bottling and brewing industries

respectively. While the brewing industry represented the order of distribution of an Edo

state owned industry, the Bottling company, headquartered in Lagos, reflected a

cosmopolitan distribution of its employees in Benin City as staff can be transferred from

factories in other locations to work in Benin City. The majority of respondents in both

industries were male 94.5% in the bottling industry and 90.5% in the brewing industry

which is expected in a manufacturing Industry going by estimates from National Bureau of

Statistics79.

While most of the respondents in the bottling industry were single (58.2%), most of the

respondents in the brewing industry were married (65.5%). The relative difference in age

and duration of employment of respondents could explain this difference (p =0.000) in

marital status in the industries. Age and employment status determine significantly

preparedness for marriage in various ethnic groups in Nigeria. In both industries majority

93

of respondents were Christians which was in keeping with the predominant religion in Edo

state.

The beverage Industries employ people of varied academic qualifications ranging from

illiterate and semi literate involved in farming and harvesting raw materials to semi –

skilled and highly skilled professionals involved in the highly automated processes6 of

production of the beverages. Edo state provides a rich pool of such academically qualified

manpower having the second largest adult literacy rate (91.1%) in Nigeria after Lagos state

and having an unemployment rate as at 2005 of 8.0% when the national average was

11.9%85. Majority of respondents in the bottling industry (67.1%) had tertiary education

while most of the respondents in the brewing industry had secondary education (45.2%).

The production department employed the largest proportion of respondents in both

industries with (75.6%) bottling and (58.2%) in the brewing industry respectively, this was

expected of a factory46,50.

The risk assessment showed that workers in the bottling and brewing Industries were

mainly exposed to mechanical hazards such as broken glass, slippery floor, repetitive

motion and unguarded machinery/ moving machine parts especially in the re usable glass

bottle section of both industries. This was similar to the reports of the HSE on the beverage

industries. Interventions to reduce occupational injuries should be targeted at those

production lines as they contribute to a large proportion of the injury burden. The mean

level of noise and particulate in air in both industries was within the permissible exposure

limit of the Federal Ministry of Environment. The highest level of noise occurred in the

Generator houses of both Industries. This was in keeping with the finding in an earlier

study33 on Industrial employees exposure to noise in five industries including a bottling

and a brewing factory in Ilorin metropolis, where it was observed that there has been a drop

94

in the mean noise levels in bottling and brewing Industries in the last 20 years which could

have been due to change of processes in the factories. It was stated that over all, the

average noise levels in these industries had reduced. A pre – employment and periodic

audiometry however would give the incidence of noise induced hearing loss among

workers as this is usually insidious in onset45. High levels of particulate in air have ceased

to be a problem in the brewing Industry due to the highly automated milling processes

present in most breweries, thus eliminating dust production50.

The prevalence rate of occupational injuries was less in the bottling industry at 263 per

1000 workers compared to the brewing industry at 506 per 1000 workers ( OR = 0.52,

95%CI = 0.44 – 0.62). Though this was in keeping with findings from the United Kingdom

citing an increased incidence of injuries among workers in the brewing industry9 the

reverse was the case from the survey of BLS data in the United States of America which

showed an increased incidence of injuries and illnesses in the bottling industry when

compared with the brewing Industry15. The proportion of workers incurring injuries at work

was high in both Industries, this could have been due to the fact that the beverage industry

requires a lot of manual handling which predisposes workers to injuries. An observation

however is that workers in the brewing Industry were at an increased risk of sustaining

occupational injuries even though hazards in both Industries were similar. A study on tile

factories in India showed an overall prevalence rate for accidents as 185 per 1000 workers

80 which was lower than that found in these beverage industries. The Indian study was a 12

month record based cross sectional study of 416 workers in three tile factories whereas this

study relied on self reporting by respondents and was comparative of the bottling and

brewing Industries.

95

Individual analysis of injuries in this study showed that the hand followed by other parts of

the upper limb was the predominant part of the body affected by injury in both industries,

studies in manufacturing industries reported that majority of accidents affected the limbs

as the main part of the body usually involved in the production process9,11 . This was in

keeping with the observations from a study on the bottling plant in Ilorin which showed

that due to the coupling of workers with the highly mechanised processes such as

depalletising the upper limbs and hands were highly exposed to most injuries20. Lacerations

were the predominant type of injury to respondents in both industries with 66.7% in the

bottling industry and 84.8% in the brewing industry, these were mostly due to cuts from

glass bottles, poorly guarded equipment or dangerous processes like palletizing. The HSE

fact sheet reports a similar pattern 11.

The cause of injury to respondents was mainly struck by/ against an object most times such

objects include glass, machine parts and pallets. If the worker is not adequately protected

such loose objects from working sections could cause injuries49. In the brewing industry a

greater proportion of accident occurred during the afternoon shift though there was no

statistically significant difference in the occurrence of accidents according to shifts covered

by respondents51. A possible reason could be the rush to hand over to a later shift or

reduced supervision in the afternoon shift compared to the morning shift in the brewing

Industry. There was no such variation in the bottling Industry.

It would seem that even though the prevalence of injuries was more in the brewing

industry, the proportion of notifiable injuries/accidents requiring the injured worker to be

off work for three days or more was slightly higher in the bottling industry (3.9%) when

compared with the brewing industry (2.7%). Fatigue following the heavier schedule of

workers observed in the bottling industry as seen in a higher proportion of them running

96

shift could aggravate the severity of injuries necessitating the more days of work following

an injury compared to the brewing industry.

The health screening revealed that with regard to the social habits of respondents most of

the respondents in the brewing industry (66.9%) took alcohol compared to a few in the

bottling Industry (26.8%). A possible reason could be an easier access to alcoholic

beverage by workers in the brewing industry. A few of the respondents in both industries

smoked cigarettes, 4.0% in the bottling industry and 7.4% in the brewing industry. Alcohol

intake and smoking are modifiable risk factors for developing cardiovascular diseases and

diabetes mellitus. The ongoing concerted Federal Ministry of Health campaign against

tobacco smoking may be responsible for the low prevalence of tobacco smoking among the

workers.

Barely above half of the respondents in both industries were involved in sporting activities

(57.7%) in the bottling and (54.0%) in the brewing industry. The sporting activities

included brisk walking, jogging, football and table tennis. There were no recreational

facilities available for workers in both industries. Cigarette smoking, alcohol intake and

lack of physical activity are known risk factors in the development of chronic diseases like

hypertension, diabetes mellitus and obesity.

Most respondents in the bottling industry (60.2%) had a pre employment medical

examination done for them compared to (43.2%) in the brewing industry which was a

statistically significant (p=0.002).

Nine (4.5%) and 12 (8.1%) of respondents in the bottling and brewing industries studied

had been diagnosed with a chronic illness (hypertension and diabetes mellitus) in the past.

All the previously diagnosed respondents except one in the brewing industry were

97

presently receiving treatment for the chronic illnesses diagnosed. Majority of those

diagnosed with a chronic illness were receiving treatment for hypertension 7 (87.5%) in the

bottling industry and 9 (81.8%) in the brewing industry. Effective work site health

promotion programmes should include health education and periodic screening for non –

communicable diseases like hypertension and diabetes mellitus to ensure prompt treatment

of the affected worker.

The prevalence of high blood pressure following the screening exercise was 26.4% in the

bottling industry and 30.0% in the brewing industry. The cut off for hypertension was set at

> 140/90mmHg following the WHO/ISH criteria some previous studies of hypertension in

Nigeria used a cut off of >160/95mmHg and thus reporting a prevalence ranging from of

10-12%24. This difference in cut off for diagnosis could account for the higher yield

reported in this study. Risk factors such as age, intake of alcohol, smoking and level of

exercise would seem to favour a higher prevalence of HBP in the brewing industry when

compared with the bottling industry. The increased health awareness in the bottling

industry following the frequency and uptake of health and safety training would favour an

early detection and treatment of respondents with regard to hypertension and other chronic

illnesses. The relatively young age of respondents in the bottling Industry compared with

the respondents in the brewing industry could put the workers at a reduced risk of

developing hypertension. A similar study among bank workers in Benin City on the

knowledge and prevalence of factors for hypertension showed a prevalence of 17.7% for

hypertension81.

The health screening exercise for diabetes mellitus using random blood glucose

measurement of respondents gave a prevalence of 0.01% in the bottling industry and a

98

prevalence of 2.7% in the brewing industry. The prevalence in the brewing industry was

similar to the national prevalence of 2.2% 23.

With regards to the body mass index (BMI) of respondents, this study showed that majority

of respondents in the bottling industry (65.1%) were of normal weight, whereas 45% of

respondents in the brewing industry were of normal weight. This study showed a

prevalence of obesity of 5.5% in the bottling industry and 12.1% in the brewing industry.

This was lower than that recorded among Nigerian adults attending Family Medicine

Clinics as outpatients in Rivers state which gave a prevalence of 14% in an urban centre

and 16.3% in a rural centre82. A possible reason could be the relatively high level of work

activity among the factory workers and the healthy worker effect which would show a

reduced prevalence among the beverage workers compared with the general population.

Multiple correlations of systolic blood pressure, diastolic blood pressure, BMI, RBG and

age showed a similar pattern in both Industries. Age however was more strongly correlated

with the systolic blood pressure of respondents in the brewing industry (r = 0.410**)

compared to the bottling Industry (r = 0.177*). The relatively older population in the

brewing Industry could explain this difference.

This study found out that the workers knew of the personal protective equipment (PPEs)

that were necessary for operations in the beverage industries. A difference though was in

the use of these PPEs by respondents, this was determined by such factors as availability,

fit and enforcement. Literature has shown that in the beverage industries safety shoes,

coveralls, ear muff / ear plugs and eye goggles were the most commonly used PPEs 31. The

use of PPEs by workers is dependent on their adequate provision by the employer, good

safety practice, demands that such workers provided with PPEs use them. The level of use

of PPEs by workers could then be an indirect means to evaluate the level of compliance

99

with safety rules. This study found that the use of these PPEs was higher in the bottling

industry compared to the brewing industry. A possible reason could be the level of safety

awareness in both industries and a higher level of availability and enforcement of PPEs in

the bottling industry. Spot checks in the bottling industry revealed an average of 75%

compliance per month (reported in- depth interview) there was no similar measure in the

brewing industry. Studies have shown improved compliance with safety rules and measures

following an improved attitude of management towards safety i.e. safety culture61, 62. The

walk through survey revealed that most workers in the bottling industry were observed to

put on their safety shoes, coveralls and ear plugs in the least, few workers in the brewing

industry had coveralls, fewer still wore safety shoes and no earplug/ear muff was observed

among workers in the brewing industry. It was observed by the researcher that visitors were

not allowed into the bottling factory without covered shoes and workers were not allowed

into the factory without safety shoes. These enforcements encourage safe work practices.

The high prevalence and frequency of accidents and injuries in the brewing could be a

consequence of inadequate provision and enforcement of PPEs. It was observed in both

Industries that there was supervision on the production floor of workers by supervisors.

The response of workers with regard to training in correct use of PPEs revealed that more

workers in the bottling industry 74.6% compared to 41.2% in the brewing industry received

training in correct use of PPEs. This was reflected in the frequency of use of PPEs by

respondents as 88.1% of workers in the bottling industry compared to 60.9% of workers in

the brewing industry. It was interesting to note that majority of workers in the bottling

industry ( 98.5%) and brewing industry ( 95.9%) considered the use of PPEs as necessary.

The gap noticed in the opinion of workers and their actual use could stem from the level of

provision of these PPEs by management, frequency and adequacy of safety education, and

the safety culture in the industries which other studies have shown52,61,62.

100

The fire incident suffered by the bottling company in 2008 could also have induced an

improved awareness and practice of OHS. The need for ISO certification on HSE by most

multinational companies such as the bottling company study may also have improved the

level of health and safety. Predictive safety management as practiced in Japan and Finland

aims at being proactive to safety and not reactive as in most situations in Nigeria51. This

serves to reduce the direct and indirect cost of accidents to industries and individuals. A

positive observation however is that with the opinion of respondents in the brewing

industry that PPEs are necessary, with adequate provision, training and motivation, their

practice could improve. This study showed that the frequency of wash of work clothes

(thrice weekly) was higher among respondents in the bottling industry at (45.8%) compared

with the brewing industry (19.6%). The opinion of respondents on whose responsibility it

was to prevent accidents in the workplace showed that the workers believed it was

everybody’s responsibility at 78.1% in the bottling industry and 58.1% in the brewing

industry. Workers in the brewing industry (30.4%) indirectly expected their management to

do more when compared with workers in the bottling industry (14.9%). Thomas Legge

clearly stated in his first Aphorism that “Unless and until the employer has done everything

– and everything means a great deal - the workman can do next to nothing to protect

himself, although he is naturally willing enough to do his share”. This aphorism remains

relevant even to findings from this study.

Majority of respondents in the bottling industry had ever received health and safety training

(75.6%) compared to (41.9%) in the brewing industry (p=0.000). Majority of respondents

in the bottling industry (80.6%) were aware of a health and safety committee referred to as

the “emergency response team”. There was no such committee available in the brewing

industry. This study showed that overall the practice of OHS was good among respondents

in the bottling industry 149 (74.1%) but poor among respondents in the brewing industry

101

78 (52.7%). Earlier highlighted factors such as adequate and frequent health and safety

education, provision of safety equipment, proper enforcement of safety rules, accident

investigation, safety training and safety committees have a positive influence on the

practice of OHS in the industry32,59. The difference in prevalence and frequency rates in

both industries would seem to be more of institutional than due to personal characteristics

of respondents.

Even though, overall, the practice of OHS was poor in the brewing industry it would seem

that practice improved, however, with increasing age of respondents, being married,

having a secondary level of education and working more than ten years in the industry37.

Studies have shown that accidents are more common with the younger age group and less

experienced workers83. This study showed that no such difference or variation among

respondents in the bottling Industry with regard to their practice of safety, a possible

reason could be the level of management support for health and safety in the bottling

industry.

It would seem that more respondents in the bottling industry (74.6%) were satisfied with

their presently assigned job compared to 54.0% in the brewing which was statistically

significant (p= 0.000). Job satisfaction plays a positive role in reducing accidents in the

workplace while psycho social stressors increase them61.

Finally, the type of ownership of these companies could be the main factor accounting for

the observed differences in occupational health and safety. State owned industries are most

time run as parastatals of the state government with the ideology of a public concern and

not a business entity. Providing baseline services, employment and public utility by such

companies is usually at the expense of efficiency and competitiveness. Private concerns as

part of multinationals, however, have international standards to live up to and remuneration

102

and incentives for their workers are sometimes better than in the public sector. These

factors may have influenced the observed differences in occupational health and safety, as

Edward Deming, the advocate of Total Quality Management, aptly stated “ 85% of the

problems in any company are from the management, just 15% are from the workers84”.

The type of management, therefore, will largely influence the level of occupational health

and safety in any Industry.

103

CONCLUSION

Information from this study showed that mechanical hazards were the main hazard

affecting workers in both industries. The level of noise and particulate in air workers were

exposed to was within the recommended permissible exposure limits in an eight – hour

work period, it was observed however that the generator houses in both industries produced

the highest level of noise which was above the permissible exposure limit.

The prevalence of injuries was higher in the brewing industry when compared with the

bottling industry. The prevalence of hypertension, diabetes mellitus and obesity was also

higher in the brewing industry when compared to the bottling industry.

The practice of occupational health and safety among respondents was good in the bottling

industry but poor in the brewing industry. This was largely due to inadequate provision of

safety equipment, absence of health and safety training in the last 12 months and the

absence of a health and safety committee in the brewing industry. A fire incident engulfing

the bottling factory in 2008 could have however influenced its’ current emphasis on safety.

104

RECOMMENDATIONS

Based on the findings from this study and the conclusions reached, the following

recommendations are hereby made:

1 There should be improved health education, safety training and adequate provision of

safety equipment especially in the brewing industry.

2 A health and safety committee should be set up in the brewing industry as this would help

in the co-ordination of health and safety programmes across all cadre of staff as is already

being done in the bottling industry

3 Pre – employment and pre - placement medical examinations should be the norm in both

industries. Health risk assessments could also be done periodically to identify workers at

risk of developing or who have developed non communicable diseases like hypertension,

diabetes mellitus and obesity. The scope could be broadened to include communicable

diseases like HIV/ AIDS.

4 Recreational facilities could be set up in both Industries to encourage physical activity and

exercise among the workers. In addition, a worksite health promotion programme for

workers especially in the brewing industry should be initiated in order to effectively

manage identified work related diseases and thus reduce workplace morbidity and

morbidity.

5 Proper records of occupational accidents and injuries should be kept by the management of

both industries.

6 The Factories inspectorate of the Federal Ministry of Labour and Productivity should

endeavour employ and train more staff to enforce proper factory inspection for the health,

safety and welfare of the Nigerian worker.

7 The current power sector reform by the Federal Government should be expedited, if

successful, it will effectively eliminate noise as a hazard produced by the various industrial

105

generating plants with their consequent pollution of the environment. This will help

safeguard the workers health as the generating plants, in most instances, are the single

highest sources of noise in the Industries.

106

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