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ORIGINAL ARTICLE
Year : 2022 | Volume
: 29
| Issue : 4 | Page : 303-309
Non-COVID-19 uptake of personal protective equipment and rules compliance amongst industrial workers in Kano, Nigeria
Muhammad Garba Rayyan1, Usman Muhammad Ibrahim1, Usman Sunusi Usman2, Karibullah Idris Muhammad1
1 Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Community Medicine, Federal University Dutse, Dutse, Jigawa, Nigeria
Correspondence Address:
Usman Muhammad Ibrahim
Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, PMB 3452, Kano State
Nigeria
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/npmj.npmj_214_22
Background: Every workplace has got hazards in many different forms, ranging from sharps, falling objects, chemicals, infections, noise and a lot of other potentially dangerous situations. The occupational safety and health administration mandates employers to protect their employees from such potentially dangerous workplace hazards. Personal protective equipment (PPE) plays an important role in preventing and ensuring health safety amongst industrial workers. This study aimed to determine the use of PPE and rules compliance amongst Industrial Workers in Kano State. Methods: A cross-sectional study design was used to assess 150 workers selected from the Sharada Industrial Estate, Kano, Nigeria, using a multistage sampling technique. Data were obtained using semi-structured interviewer-administered questionnaires and analysed using SPSS version 22.0. Results: The response rate was 88.2%, and the mean age of respondents was 28.1 ± 7.4. About 72% were male, 74.7% had secondary education and 16.4% reported ever having a child with a congenital anomaly. Up to 25% reported using PPE always, 62% used PPE occasionally and 12% never used PPE. Factors significantly associated with the use of PPE at bivariate level were: Gender, 'provision of statutory regulation by the management', 'provision of PPE on worksite' and 'provision of training to staff' respectively. However, on multivariable regression analysis, only 'provision of statutory regulation by the management' and 'provision of PPE on worksite' were found to be independent (intrinsic) predictors of the use of PPE. Conclusions: Training alone does not necessarily increase the uptake of PPE amongst industrial workers. There is a need to ensure the availability of PPE at the worksite, as well as statutory regulations by industries.
Keywords: Compliance, industrial workers, Kano, Nigeria, personal protective equipment
Every workplace has got hazards in many different forms, ranging from sharps, falling objects, chemicals, infections, noise and a lot of other potentially dangerous situations. The Occupational Safety and Health Administration (OSHA) mandates employers to protect their employees from such potentially dangerous workplace hazards. Personal protective equipment (PPE) plays an important role in preventing and ensuring health safety amongst industrial workers.[1] Both employers and employees are required to work together in maintaining a healthy work environment. This will ensure the assessment of hazards, availability of PPE, training of employees on how to use PPEs and evaluating of the effectiveness of the PPE.[1]
Industrial workers are exposed to various hazards such as physical (e.g. noise), chemical (e.g. solvents, cement and dust), mechanical (e.g. slips, heavy tools and falls) and ergonomic (e.g. repetitive tasks, using wrong tools for the job or using tools improperly) that makes them vulnerable to many occupational diseases and injuries resulting in absenteeism at work.[2] The 'PPE' is therefore worn by industrial workers to minimise exposure to a variety of hazards, for example, eye and face protection (safety glasses, goggles or face shields), foot protection (safety shoes), hand protection (gloves), head protection (hard hats) and hearing protection (earplugs/earmuffs) amongst others.[2] On the other hand, there are different types of PPEs that are essential for the prevention and control of COVID-19 infection, including eye protection, gowns, gloves, surgical face masks, non-powered filtering facepiece respirators and powered air-purifying respirators. The PPEs needed for COVID 19 is designed to protect the individuals by considering the biology of the virus which is significantly small as evidenced by the diameter of 82–94 nm and spikes of 19 nm.[3]
Workers' awareness of their worksite SOP, the type of hazards they are exposed to at workplace, can significantly influence their effort for self protection and prevention from exposure to work place hazards.[4] An evaluation of six workplace safety programmes on injury reduction found that proactive practices (fixing problems as they occurred) reliably reduce injury rates and that the volume of training alone does not reduce accidents.[5]
To increase uptake, safety and effectiveness of PPE, there is a need to emphasise on their design, quality and comfort. In an automobile encapsulating plant, only 8% of the workers rated their respirators as comfortable, 30% tolerated their respirators and 62% felt they were uncomfortable. The proportion of workers who rated their PPE (apart from a respirator) as comfortable ranged from 32% to 52%. Comfort for other PPEs was rated as follows: coveralls/aprons – 52%, safety glasses – 51%, rubber gloves – 42% and hearing protectors – 36%. PPE was tolerated by only about 30% of the employees. Overall, about 96% of the workers used one or a combination of PPE.[6]
Industrial accidents have been major contributors to morbidities and mortalities worldwide, with about 3.2 million disabilities and 9000 deaths occurring annually and costing over $110 billion in the USA. Training, regular and appropriate uses of PPEs, as well as compliance with the training procedures, are essential to reducing this burden. It is therefore critical to put a system in place for monitoring and ensuring adherence to workplace guidelines; perhaps, carrot and stick approach is essential in decreasing workplace hazards. However, there is a need to strike a balance between incentives on safety measures and incentives on productivity.[7]
The COVID-19 pandemic has generally increased the use of PPEs amongst the general population, especially face mask, which is part of the holistic strategy to suppress transmission. Even though the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.[8] The emphasis of this study is not on COVID-19 prevention; however, the uptake of face masks, and possibly other PPEs, could be influenced by the ongoing COVID-19 pandemic. This study assessed the non-COVID-19 use of PPE and rules compliance amongst industrial workers in Kano State, Northern Nigeria.
MethodsEthical approval
Approval to conduct the study was obtained from the Kano State Health Research Ethics Committee with the following reference number SHREC/2022/3337 and approval number of NHREC/17/03/2018 dated 29 April 2022. All the principles of research ethics were respected in accordance with the Helsinki Declaration throughout the study.
Study area and population
This study was conducted between 1 May and 29 June 2022 at the Sharada Industrial Estate, which is the largest industrial estate in Kano State, Northern Nigeria. Kano State is cosmopolitan in nature, with an estimated population of 13,076,892, who are predominantly Hausa–Fulani by tribe, with a significant proportion of other Nigerian tribes and foreigners.[9] The Industrial Estate consists of about 15 streets consisting of about 100 different industries: Rice Processing, Insecticides, Shoes, Rubber, Plates Producing, Oil Processing, Sacks Producing and Metallic Rods, amongst others. Significant numbers of the industries were closed and not functional at the time of conducting this study. The estimated total population of industrial workers is 50,000, and the study population comprised adult industrial workers (men and women), who were at least 18 years, and had been working in the selected industries for at least 12 months. Workers who were absent during the study period, for whatever reason, security men, drivers and administrative staff were excluded from the study.
Study design, sample size and sampling
The study was cross-sectional in design and conducted at the Sharada industrial estate, Kano, Nigeria, which was randomly selected from a list of all industrial estates in the state using balloting. Cochran's formula[10] was used to obtain a minimum sample size of 170.
Where n = minimum sample size, Standard normal deviate (z) 1.96 at 95% confidence interval (CI) and margin of error (d) 0.05, with the proportion (p) of PPE use as 87.3% obtained from a previous study conducted in Lagos, Nigeria, and q (1-p) representing complementary probability.[11]
A multistage sampling method was used to study the eligible respondents. Industrial workers who were directly involved in the process of production were selected for this study, while industrial workers who were absent for whatever reason during data collection, security men, drivers and administrative staff respectively were not selected. In stage one, the street in the industrial estate was mapped and 15 different streets were identified, from which four streets were randomly selected by balloting. In stage two, all the functional industries in the selected street were mapped, from which 25% of the total functional industries (Rice Processing, Insecticides Producing, Shoes Producing and Oil Producing Industries) were selected by simple random sampling. Respondents to be studied from the production unit/department from the selected industries in each street were proportionately allocated. In stage three, the register of the eligible respondents in each of the selected streets was obtained from the individual management of the functional industries and a single register was formed for each street, making up the sampling frame of that selected street. Systematic sampling was used to study the proportionately allocated number of respondents. The sampling interval was obtained in each of the selected streets as the ratio of the sampling frame of the selected street to the proportionately allocated sample size, with the first person selected using simple random sampling, between 1 and the sampling interval. Subsequent participants were selected by adding the sampling intervals to the preceding selected participant's serial number in the register until the proportionately allocated sample size was selected.
Data collection
Data were collected using a validated structured questionnaire adapted from previous studies.[1] The industries specific standard operating procedures (SOP) on the use of PPE by industrial workers was obtained from the management of the selected industries and was used to assess utilisation. The first section assessed the socio-demographic characteristics of respondents; the second section assessed subjective compliance to PPE amongst industrial workers involved in the production process in Rice Processing, Insecticides Producing, Shoes Producing and Oil Producing Industries. The complete use of safety glasses and/or goggles, ear plugs/muffs, hand gloves, safety boots/shoes, face masks, apron, and knee/joint protecting mats was considered compliant (with always, occasionally and never as the options) based on the SOP of the selected industries; the third section obtained information on rules compliance (with yes, no and cannot say as the options); and the fourth section assessed respondents' perceptions on the effectiveness of PPE. About 10% of the calculated sample size (17) was used to pre-test the questionnaire and assess its psychometric properties at a different industrial estate (Bompai Industrial Estate). All the scales were reliable and consistent, with Cronbach's alpha of ≥0.80. Interviewer-administered questionnaires were used to study the eligible respondents. Research assistants were trained on the questionnaire (translated into the native Hausa Language) and study protocol (sampling procedures and eligibility criteria and informed consent).
Data management and analysis
Data obtained from the questionnaires were entered into two separate Microsoft Excel sheets by two separate clerical staff and subsequently checked for errors and (in) consistencies. The Statistical Package for the Social Sciences (SPSS) Version 22 (IBM Corp., Armonk, NY, USA) was used to analyse the data. Categorical variables were summarised as frequencies and percentages, presented in tables and compared using the Chi-squared test. While quantitative variables were summarised as means and standard deviations (SD), and compared using t-test (for normally distributed variables) or medians and ranges (for non-normally distributed variables). Factors considered as a priori confounders from majority of previous studies, as well as factors found to be significantly associated with uptake of PPE on bivariate analysis, were included in a logistic regression model to control for possible confounders. The level of statistical significance (Type I error) was set at <5% for all tests.[10] However, for the binary logistic regression model, independent variables with P < 0.10 at the bivariate level were included (parsimonious model).[12],[13] Adjusted odds ratios (AOR) and their corresponding 95% CI were used to measure the strength and direction of the effect of predictors. The goodness-of-fit was tested using the Hosmer–Lemeshow statistic (Chi-squared yielding a P > 0.05 considered a good fit).[14]
ResultsThe response rate was 150 (88.2%) out of 170. The non-responses were from the industrial workers who seek for an excuse during the interviews and effort to get them for completion of the interviews was not successful. The mean age of respondents was 28.1 ± 7.4. About 72% were male, 74.7% had secondary education only, 53.3% were single, 34.7% were married, 71.1% were Muslims by religion, 57.3% were Hausa by tribe and 10.7% were Fulani by tribe, as shown in [Table 1].
Majority of the respondents were involved in loom operation/extruding (45.6%), with about 64% occupying the operator/foreman position, while one respondent declined to respond to the question 1 (0.6%). In addition, out of the total 150 respondents interviewed, only 73 reported to have children, and up to 16% of the 73 who had children reported to have at least a child with congenital anomaly while in the current occupation, as shown in [Table 2].
Table 2: Type of work, position at work and the presence of a congenital anomalyAll the respondents (100%) believed the use of PPE is protective against work-related diseases and injuries based on the SOP of the industries. However, only 25% reported using complete PPE always, 62% used complete PPE occasionally and 12% never used complete PPE, as shown in [Table 3]. The main reason for non-uptake of PPE were: lack of time to wear it (53.3%), no need to use it at that time (18.7%), lack of comfort (10%);, not worthy for quick jobs (10%), it slows work (5.3%) and too long time to wear and take off (2%).
Table 3: Statutory regulations and compliance with personal protective equipment[Table 4] shows that the median hours of work in a day was 12 h (minimum of 8 and maximum of 12 h), with a median duration of work experience of 24 months (minimum of 12 and maximum of 108 months) and median monthly income of ₦16,500 (minimum of ₦9000 and maximum of ₦50,000).
Predictors of personal protective equipment uptake
Sex, 'provision of statutory regulation by the management,' 'provision of PPE on worksite' and 'provision of training to staff' were found to be significantly associated with the use of PPE at bivariate level [Table 5]. However, in multivariable regression model, only 'provision of statutory regulation by the management' (P < 0.001; AOR = 0.028, 95% CI– 0.004, 0.184) and 'provision of PPE on worksite' (P < 0.001; AOR = 0.098, 95% CI– 0.030, 0.325) were found to be independent (intrinsic) predictors of the use of PPE. Workers in industries that provided statutory regulations were 97.2% less likely to 'never use' PPE, while workers in industries that provided PPEs on the worksite were 90.2% less likely to 'never use' PPE.
Table 5: Relationship between socio-demographic characteristics and uptake of personal protective equipment Discussions The very high response rate of 96.7% was not unexpected, as workers in organised formal settings, such as industries and hospitals, are more likely to participate in research compared to general community surveys.[15] The young age of the respondents (mean ± SD, 28.1 ± 7.4 years) may not be unrelated to the long working hours, unemployment, poverty and higher number of young population in Kano. This could also explain why majority of the respondents were males (72%) with only secondary education (74.7%). Our finding regarding the mean age of industrial workers of 28.1 is similar to the findings by studies conducted in Sri Lankan and Nigeria.[11],[16] The fact that more than half of the respondents were single (about 53%) could not be unrelated to their young age and possibly long working hours.
Even though, all the respondents (100%) believed the use of PPE is protective against work-related diseases and injuries, only 25% reported using PPE always, 62% used PPE occasionally and 12% never used PPE. This shows that knowledge and perception do not always translate into practice, despite the ongoing COVID-19 pandemic, which could have influenced the uptake of PPE. However, another finding which was higher than what we found and reported in this study related to the findings of OSHA in South Florida, which reported about 64% of workers frequently wear the correct protection.[1] Another Nigerian study also reported that over three-quarters of the respondents have used the PPE provided, and about 72% used the safety manual provided.[9] The difference in these findings may be related to the possibility of monitoring compliance with the use of PPEs by the designated authorities of the industries.
This study found the main reason for non-uptake of PPE to be 'lack of time to wear it' (53.3%), followed by 'perceived lack of need to use at that time' (18.7%), 'lack of comfort' (10%) and 'not worthy for quick jobs' (10%). This is similar to the findings of a qualitative Ethiopian study which found that non-availability of PPE, disharmonious work environment, low perceived susceptibility and belief about PPE were the major organisational and individual level barriers to uptake of PPE.[17] These findings, even though not exactly the same, further explain the survey of an automobile encapsulating plant, where only 8% of the workers rated their respirators as comfortable, 30% barely tolerated their respirators and 62% felt that they were uncomfortable.[6]
The findings of this study revealed that only 'provision of statutory regulation by the management' and 'provision of PPE on worksite' were found to be independent predictors of the use of PPE. Workers in industries that provided statutory regulations were 97.2% less likely to 'never use' PPE, while workers of industries that have PPEs on worksites were 90.2% less likely to 'never use' PPE. This is in agreement with findings from a Nigerian study amongst construction workers, which found that inadequate enforcement, lack of adequate regulations and lack of PPE provision by industries were associated with poor uptake of occupational health and safety measures.[18]
Limitation of the study
This study was limited by social desirability bias which was minimised by educating the respondents on the importance of reporting correct findings by this study in the areas of policy formulation and other areas towards improving safety and prevention of exposure to hazards amongst industrial workers. Similarly, this study was limited by the possibility of recall bias which can be minimised by conducting an observational study to assess the availability and use of PPE with an observation checklist. Similarly, the study was limited by the response rate of 88.2%, which may decrease the power of the study.
Conclusion and RecommendationKnowledge and training alone do not necessarily increase the uptake of PPE amongst industrial workers because all the respondents believed that PPEs are protective against hazards and diseases. There is a need to ensure the availability of PPE at worksite, as well as statutory regulations on PPE by industries, as they have been found to be independent predictors of the use of PPE amongst industrial workers.
Authors contribution
All the authors contributed equally in concept, design, definition of intellectual content, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing and manuscript review.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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