Utilization of personal protective equipment and associated ......Textile industry, Workers How to cite this article Zegeorgous KG, Gebru HT, Demssie AF, Mekonnen TH, Aregawi BG, Woldegebriel

Edorium Journal of Public Health, Vol. 7; 2020.

Edorium J Public Health 2020;7:100025P16KZ2020. www.ejpublichealth.com

Zegeorgous et al. 1

CASE REPORT OPEN ACCESS

Utilization of personal protective equipment and associated factors among Kombolcha Textile Factory workers,

Kombolcha, Ethiopia: A cross-sectional study

Kifle G Zegeorgous, Hafte T Gebru, Amsalu F Demssie, Tesfaye H Mekonnen, Berihu G Aregawi, Manay K Woldegebriel

ABSTRACT

Aim: Personal protective equipment (PPE) utilization in the manufacturing industry is an important issue because one of the top ten deaths is due to lack of protective equipment utilization among all industries worldwide and millions of workers are suffered from non-fatal injuries and illnesses. This study is aimed to assess personal protective equipment utilization and factors associated among Kombolcha textile workers in Kombolcha town, Ethiopia. Methods: An institution-based quantitative cross-sectional study was conducted among 404 production workers. Stratified sampling technique was used to select the study participants. A pretested structured questionnaire was used to collect the data. We used Epi Info version 3.5.4 for data entry and SPSS version 20.0 for analysis. Odds ratio (OR) with 95% confidence interval (CI) was calculated to check the association between independent variables and utilization of PPE. Independent variables (cut

Kifle G Zegeorgous1, Hafte T Gebru2, Amsalu F Dems-sie3, Tesfaye H Mekonnen4, Berihu G Aregawi5, Manay K Woldegebriel5

Affiliations: 1Staff in Department of Labor and Social Affairs, Southern Wollo, Amhara Region, Ethiopia; 2Department of Biomedical Sciences, College of Health Sciences and Re-ferral Hospital, Aksum University, Aksum, Ethiopia; 3Depart-ment of Health Service Management, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Ethiopia; 4Department of Environmental and Oc-cupational Health and Safety, Institute of Public Health, Col-lege of Medicine and Health Sciences, University of Gondar, Ethiopia; 5Department of Public Health, College of Health Sciences and Referral Hospital, Aksum University, Aksum, Ethiopia.Corresponding Author: Hafte T Gebru, Aksum, Tigray, P.O. Box: 298, Ethiopia; Email: [email protected]

Received: 05 January 2020Accepted: 03 March 2020Published: 22 May 2020

RESEARCH ARTICLE PEER REVIEWED | OPEN ACCESS

off point, p-value < 0.20) in the binary logistic regression were analyzed by multivariable logistic regression at significance level of p-value < 0.05 to control confounders. Results: The magnitude of PPE utilization was 58.2%. Work regulation [adjusted odds ratio (AOR): 3.0, 95% CI:(1.04, 4.90)], safety training [AOR: 5.10, 95% CI: (3.14, 8.28)], drinking alcohol [AOR: 2.85, 95% CI: (1.73, 4.67)], spinning work section [AOR: 4.27, 95% CI: (1.52, 12.08)] were factors significantly associated with utilization of personal protective equipment. Conclusion: Utilization of PPE was low among production workers. Work regulation, work section, safety training, and drinking alcohol had statistically significant association with utilization of personal protective equipment.

Keywords: Kombolcha, Personal protective equipment, Textile industry, Workers

How to cite this article

Zegeorgous KG, Gebru HT, Demssie AF, Mekonnen TH, Aregawi BG, Woldegebriel MK. Utilization of personal protective equipment and associated factors among Kombolcha Textile Factory workers, Kombolcha, Ethiopia: A cross-sectional study. Edorium J Public Health 2020;7:100025P16KZ2020.

Article ID: 100025P16KZ2020

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doi: 10.5348/100025P16KZ2020RA

INTRODUCTION

Personal protective equipment (PPE) is defined as an equipment that will protect the user against health or safety risks at work and includes items such as safety



Zegeorgous et al. 2

helmets, hard hats, face masks, gloves, eye protection, boots, ear plugs, high-visibility clothing, safety footwear, and safety harnesses. It plays a significant role to safeguard workers from exposure to work hazards [1, 2].

As a result of exposure to chemical, biological, dust, fibers, and physical agents, as well as accidents there will be direct and indirect loss of cost. The direct cost includes compensation and treatment costs for injured workers whereas the indirect cost is related to loss of time spent by injured individuals and family members to take care of the injured workers and additional costs for training to the new workers. Occupational hazards are becoming important public health challenges mainly in the developing nations [3–5].

According to the International Labor Organization estimation, every 15 seconds, a worker dies from a work-related accident or disease and 153 workers have work-related accidents. More than 2.3 million deaths are occurred per year and 317 million workers have work-related accidents. Textile industry is labor intensive and technologically complex production industry where workers are often exposed to different safety hazards like cotton dust, excessive noise, accidents, and diseases [6, 7]. As a result of this exposure, workers, employers, and governments lost direct and indirect costs related to workplace injuries and illnesses, such as eye, nose, ear, skin, and throat diseases. A study showed that educational level of workers, duration of working in a certain factory, training regarding work-related hazards and prevention methods, and the medical checkups were associated with the development of skin disease among American adult factory workers. Workers do have neither access to occupational health services nor comprehensive occupational health safety and prevention plan in many nations [8–10].

The use of PPE to reduce different health risks and accidental injuries needs consistent availability of the equipment in the workplace and regular supervision and training to make sure workers use it properly [11, 12]. Though the utilization of PPE to minimize health risks and injuries in workplace is justifiable; its utility pattern is not well investigated so far particularly in the current study setting and in most of sub-Saharan African countries, like Ethiopia [12, 13]. As a result, there is no clear information about PPE usage and factors associated with its utilization among textile factory workers. The association of sociodemographic variables, behavioral variables, and workplace-related variables with utilization of PPE was evaluated.

The result of this study will be helpful for planners and policy makers to design appropriate intervention and control mechanism of work related hazards. Therefore, the study was aimed at assessing the utilization of PPE and associated factors among Kombolcha Textile Factory workers in Kombolcha town, Northeast Ethiopia.

MATERIALS AND METHODS

Study area and periodThe study was conducted in Kombolcha Textile

Factory, Kombolcha, Northeast Ethiopia from February 1, 2016 to March 30, 2016. Kombolcha Textile Factory was established in 1986 in Amhara Regional State and located at 380 km far from Addis Ababa. It is one of the largest private limited companies in the town which is engaged in the production of towels, bed sheets, and home fabrics using cotton. The factory has a total of 1525 workers.

Study designAn institution-based cross-sectional quantitative

study was employed.

PopulationAll workers in Kombolcha Textile Factory were

considered as the source population and the study populations were all selected Kombolcha Textile Factory production workers. All workers involved in the process of production at spinning, weaving, engineering, finishing, and garment departments were included in the study.

Sample size and sampling procedureSample size

The sample size was determined using a single population proportion formula by using with 95% CI, Z α/2 1.96, margin of error = 0.05, nonresponse rate = 10%, and prevalence of PPE utilization = 54% [14].

n = (Z α/2)2 P (1–P)

d2 = n =

(1.96)2 0.54(1–0.54)

0.052

n = 381 + 10% non-response rate =419

Sampling procedureStratified sampling technique was used to select

the study participants. The manufacturing units were stratified into four departments: spinning, weaving, engineering, and finishing and garment to each department. The total of 419 samples drawn from the factory’s list of workers using simple random sampling by computer generated method was proportionally allocated to each department (Figure 1).

Variables of the study

Dependent variable

• Utilization of PPE



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Independent variable

• Sociodemographic variable: Sex of workers, age of workers, marital status, religion, level of education, work experience and length of employment

• Work environmental factors: Occupational health and safety training, working section, occupational safety and health supervision, and work regulation

• Behavioral factors: Alcohol consumption, chat chewing, smoking habit

Operational definition1. PPE: It is any clothing or equipment used by

workers to protect them from occupational hazards.

2. Utilization of PPE: Use of all the necessary worker-specialized clothing or equipment by workers for protection against health and safety hazards in the workplace. Workers were classified as those who used PPE when they were observed wearing of all the PPE that were necessary to be worn during work in a particular working section. This includes:

• A respirator, gloves, eye protector, boot shoes, overall, ear plugs and mask at spinning section.

• A respirator, gloves, eye protector, boot shoes, ear plugs and overall at weaving section.

• A respirator, gloves, mask, boot shoes and overall at finishing and garment section.

• A respirator, gloves, boot shoes, eye protector, overall, reflector, mask at the engineering section [13].

3. Drinking alcohol: a person who takes drinking alcohol for at least 3 days/week and one drink alcohol per day.

4. Smoking cigarette: a person who smokes one/single cigarette per day.

5. Chewing chat: a person who chews chat 50 grams/day and takes at least 3 days/week.

Data collection procedureFace to face interviewer was used to collect the required

quantitative information on utilization and availability of PPE. The questionnaire includes: sociodemographic characteristics of the workers, environmental factors, and behavioral factors. Three trained data collectors were recruited and two supervisors who are graduates of workplace health and safety and environmental sanitation were engaged.

Data quality controlThe quality of data was assured by proper designing

and pretesting of the questions in Bahir Dar Textile Factory among 21 production workers. In addition, training was given for the data collectors and supervisors. The principal investigator and supervisors were making day-to-day on-site supervision during the whole period of data collection. At the end of each day, the data were reviewed and checked for completeness, accuracy, and consistency and corrective discussion was held with all the research team members.

Data processing and analysisThe data were entered into Epi Info version 3.5.4 and

exported to SPSS version 20.0 for analysis. Descriptive statistics was done using standard statistical parameters: percentages, means, and standard deviations. All variables with p ≤ 0.2 in bivariable analysis were inserted in the multivariable logistic regression model to identify factors associated with utilization of PPE; then p < 0.05 was considered as significant.

Ethics approval and consent to participate

Ethical clearance was obtained from Ethical Review Board of University of Gondar and formal letter was sent to Amhara National Regional State South Wollo Labor and Social Affairs Bureau in order to get letter of cooperation for the factory. There were no potential risks that have any harm in any form to the study participants, after obtaining permission from factory directors and unit coordinators, written consent was obtained from the study participants. Information obtained from individuals was kept secured and confidential.

Figure 1: Schematic presentation of the sampling procedure at Kombolcha Textile Industry workers, Kombolcha town, Northeast Ethiopia, 2016.



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RESULTS

Sociodemographic characteristicsFour hundred four (404) textile factory workers

were involved in the study giving 96.4% response rate. The mean age of respondents was 36.8 ± 9.4. Out of the 404 workers, 290 (71.8%) were males. More than 33% of them belonged to the age group of 31–40 years. The majority of the participants 326 (80.6%) attended secondary education and above. More than three-fourth (75.7%) participants were married about same number of participants served for less than 10 years in the factory (Table 1).

Behavioral characteristics and environmental conditions

Most of the participants 238 (58.4%), 345 (85.4%), and 370 (91.6%) reported that they did not take alcohol, chat, and cigarette, respectively. Three hundred forty four (85.1%) participants revealed that they were supervised for their occupational safety and health in their respective working sections. Three-fourth of the participants were given occupational safety and health orientation and 227 (56.2%) took comprehensive occupational safety and health training (Table 2).

Table 1: Sociodemographic characteristics of Kombolcha Textile Factory workers at Kombolcha town, Northeast Ethiopia, 2016 (n = 404)

Variables Frequency Percent

Sex

Male 290 71.8

Female 114 28.2

Age (in year)

18–30 123 30.4

31–40 136 33.7

41–50 120 29.7

51–60 25 6.2

Educational status

Primary education 78 19.3

Secondary education 162 40.1

Diploma 130 32.2

Degree and above 34 8.4

Work experience (in years)

1–10 302 74.8

>10 102 25.2

Religion

Orthodox 151 37.4

Muslim 231 57.2

Protestant 22 5.4

Marital status

Marred 306 75.7

Single 98 24.3

Table 2: Behavioral characteristics and environmental conditions of Kombolcha Textile Factory workers at Kombolcha town, Northeast Ethiopia, 2016 (n = 404)

Variable Number Percent

Drinking alcohol

Yes 168 41.6

No 236 58.4

Chat chewing

Yes 59 14.6

No 345 85.4

Smoking cigarette

Yes 34 8.4

No 370 91.6

Get safety and health training

Yes 177 43.8

No 227 56.2

Follow work regulation

Yes 2355 58.2

No 169 41.8

OSH orientation

Yes 315 78

No 89 22

OSH supervision

Yes 344 85.1

No 60 14.9

Magnitude of PPE utilizationThe PPE utilization of workers in Kombolcha Textile

Factory is found to be 58.2%. Forty-three workers in the weaving section, 99 workers in the spinning section, 40 workers in the engineering section, and 53 workers in the processing section use all the available PPE in their respective sections. Hence, there were 235 (58.2%) workers who used PPE. In the weaving section, 68 (94.4%) of workers used boot shoes, 64 (88.9%) used ear plug, and 67 (93.1%) used an equipment covering the whole body. In the spinning section, most of (91.5%) workers used boot shoes. One hundred thirty-five (82.3%) of workers used respirator and the same number of workers used ear plug.



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Almost all workers in the engineering section used the available protective equipment. None of the workers in this section reported not using eye protectors and boot shoes and only 1, 2, and 3 workers reported that they did not use gloves, overall body coverage, and masks, respectively (Table 3).

The main reasons for not using PPE were lack of knowledge (43.2%) and negligence of the workers (19%). Moreover, lack of PPE in the textile factory (11.24%) and feeling discomfort (11.84%) while using them had comparable contribution for not using the PPE (Figure 2).

Factors associated with personal protective equipment

To control the possible confounders, multivariable logistic regression was utilized and work regulation, safety training, drinking alcohol, and spinning section were statically significant at 0.05 p-value.

Workers who followed work regulations were 3 times more likely to utilize PPE compared to those who did not follow regulations in their workplace [AOR: 3.04, 95% CI (1.04–4.90)]. Similarly, the odds of using PPE was 5 times higher among those who took formal safety training compared to those who did not take the training [AOR: 5.10, 95% CI (3.14–8.28)].

Participants who drink alcohol were 2.85 times more likely to utilize PPE than those who did not drink alcohol [AOR: 2.85, 95% CI (1.73–4.67)]. The odds of utilizing PPE among workers of the spinning section was 4 times higher than those who work in the processing and garment section [AOR: 4.27, 95% CI (1.52–12.08)] (Table 4).

DISCUSSION

In this cross-sectional study, the magnitude of PPE utilization was 58.2% which is relatively comparable with a report (54%) among textile factory workers in Adwa town [15]. The current magnitude of PPE utilization was higher than the study conducted in Addis Ababa 43.6% [16], industrial workers in Iran 41.7% [17], and small-scale garment enterprises in Botswana 9.3% [18] but far lower than textile workers in Hawassa 82.4% [13] and Zambia 77.33% [19]. The possible reason for differences in the utilization of PPE might be associated with local work-related safety culture, sample size differences in the study methods and context of the study settings.

According to the current study, workers being trained for health and safety had higher odds of using PPE compared to those who did not (AOR = 5.10, 95% CI: 3.14–8.28) which was in line with a study conducted in Hawassa [13] and another case control study from Amhara Region [11]. This might be due to the fact that

Table 3: Utilization of personal protective equipment in each section among Kombolcha Textile Factory workers in Kombolcha town, Northeast Ethiopia, 2016 (n = 404)

Sections and PPEs Use Do not use at all

Weaving section (n = 72)

Respirator 60 (83.3%) 12 (16.7%)

Eye protector 52 (72.2%) 20 (27.8%)

Glove 56 (77.8%) 16 (22.2%)

Boots shoes 68 (94.4%) 4 (5.6%)

Ear plug 64 (88.9%) 8 (11.1%)

Overall body cover 67 (93.1%) 5 (6.9%)

Spinning section (n =164)

Respirator 135 (82.3%) 29 (17.7%)

Eye protector 143 (87.2%) 21 (12.8%)

Glove 125 (76.2%) 39 (23.8%)

Boots shoes 150 (91.5%) 14 (8.5%)

Ear plug 135 (82.3%) 29 (17.7%)


Mask 143 (87.2%) 21 (12.8%)

Engineering section (n = 47)

Respirator 39 (83%) 8 (17%)

Glove 46 (97.9%) 1 (2.1%)

Eye protector 47 (100%) –

Mask 44 (93.6%) 3 (6.4%)

Boot shoes 47 (100%) –


Processing and garment (n = 121)

Respirator 95 (78.5%) 26 (21.5%)

Glove 88 (72.7%) 33 (27.3%)


Mask 87 (71.9%) 34 (28.1%)

Figure 2: Reasons of not using personal protective equipment of textile factory workers at Kombolcha town, Northeast Ethiopia, 2016 (n = 404).



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training to the workers really ensures workers to remain enforced and motivated to follow the safety instructions by creating better cooperation between workers, managers, and safety committee of the factory.

Factory workers who follow work regulation in the workplace had higher odds of utilizing PPE than worker who did not comply with work regulations (AOR = 3.04, 95% CI: 1.04–4.90). This was supported by reports from the United States [12]. It might be because workers give due respect to the regulatory team and it is workers’ responsibility to value the workplace rules and regulations which are incorporated in the staff evaluation system. Workers regulation document was also available in each production section. In spinning section, workers utilized PPE were 4.23 times more than those working in the processing and garment section [AOR = 4.27, 95% CI (1.52, 12.08)]. This was congruent with a study conducted in Adwa [15]. The possible explanation for this might be due to the intimacy and cooperation of the staff members to respect the safety guidelines.

The odds of utilizing PPE among those who drink alcohol was higher compared to those who did not drink [AOR = 2.85, 95% CI (1.73, 4.67)] but this study was supported by none of the reports reviewed. This finding

was opposed by a study conducted in Hawassa textile workers [13] and a study conducted among solid waste collectors of Addis Ababa city, where alcohol users were related to work hazards [16]. Unfortunately, the current study participants who drink alcohol were found to take care about their practice of using protective equipment.

As this study was conducted using self-reported approach, there might be interviewer and social desirability bias due to the nature of data collection tool. Moreover, this study does not establish the cause and effect relationship between the variables.

CONCLUSION

The magnitude of utilizing PPE was 58.2% among textile production workers in Kombolcha town. Work section, safety training, drinking alcohol, and following work regulations showed statistically significant association with utilization of PPE. Hence, providing health and safety training, reducing alcohol consumption, and compliance with workplace regulations are recommended to utilize PPE to alleviate workplace-related injuries.

Table 4: Logistic regression analysis for factors associated with PPE utilization among textile factory workers in Kombolcha town, Northeast Ethiopia, 2016 (n = 404)

Variable Utilization of PPE COR (95% CI) AOR (95% CI)

Yes No

Work experience (in year)

1–10 182 120 1.00 1.00

10+ 53 49 1.14 (0.89–2.20) 0.80 (0.47–1.34)

Work regulation

Yes 168 67 3.14 (2.07–4.70) 3.04 (1.04–4.90)*

No 75 94 1.00 1.00

Safety training

Yes 177 70 4.32 (2.82–6.60) 5.10 (3.14–8.28)*

No 58 99 1.00 1.00

Drinking alcohol

Yes 122 46 2.88 (1.80–4.40) 2.85 (1.73–4.67)*

No 113 123 1.00 1.00

Work section

Weaving 43 29 1.90 (1.05–3.44) 1.32 (0.68–2.57)

Spinning 99 65 1.95 (1.21–3.15) 4.27 (1.52–12.08)*

Engineering 40 7 7.33 (3.04–17.67) 0.64 (0.32–1.30)

Processing and garment 53 68 1.00 1.00

*p < 0.05, reference = 1.00; COR: Crude odds ratio



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AcknowledgmentWe would like to acknowledge University of Gondar, Institute of Public Health, and the Labor and Social Affairs Bureau of Amhara National Regional state for their valuable support. Finally, our heartfelt thank goes to study participants, Kombolcha Textile Industry managers, safety officers, data collectors, and supervisors for their devotion to be involved in this study.

Author ContributionsKifle G Zegeorgous – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Hafte T Gebru – Design of the work, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Amsalu F Demssie – Analysis of data, Interpretation of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Tesfaye H Mekonnen – Design of the work, Acquisition of data, Interpretation of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Berihu G Aregawi – Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved



Zegeorgous et al. 8

Manay K Woldegebriel – Analysis of data, Interpretation of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Guarantor of SubmissionThe corresponding author is the guarantor of submission.

Source of SupportNone.

Consent StatementWritten informed consent was obtained from the patient for publication of this article.

Conflict of InterestAuthors declare no conflict of interest.

Data AvailabilityAll relevant data are within the paper and its Supporting Information files.

Copyright© 2020 Kifle G Zegeorgous et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.

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Utilization of personal protective equipment and associated ......Textile industry, Workers How to cite this article Zegeorgous KG, Gebru HT, Demssie AF, Mekonnen TH, Aregawi BG, Woldegebriel