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http://www.iaeme.com/IJM/index.asp 35 [email protected] International Journal of Management (IJM) Volume 6, Issue 10, Oct 2015, pp. 35-47, Article ID: IJM_06_10_006 Available online at http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=6&IType=10 ISSN Print: 0976-6502 and ISSN Online: 0976-6510 © IAEME Publication ___________________________________________________________________________ SEAFARERS FATIGUE MANAGEMENT AN EMPIRICAL STUDY ON INDIAN SEAFARERS Col. Dr .G. Thiruvasagam Vice-Chancellor AMET University (AMET-Academy of Maritime Education & Training) Chennai, India Dr. J. Rengamani Associate Professor AMET Business School, AMET University Chennai, India ABSTRACT Human fatigue is a common phenomenon that exists in most of the industries an outcome of the influence exerted due to continuous and rigorous work executed without any break. However one could see that the fatigue factor is excessively prevalent only among the seafarers in the shipping industry, as the lifestyle of the seafarers is something different from other professions in as much as they have to spend most of their time in mid sea, by enduring their services for months together in the absence of all their due domestic pleasure to rejoice and to rejuvenate their mind. Researchers on this field have time and again established that it is a proven fact that fatigue is one of the reasons for lack of concentration while attending to their routine work and even led to occurrence of accidents of ships nowadays. Several factors could be attributed to fatigue of seafarers, which include psychological, physiological and environmental factors; are the main reasons for their intermittent distraction, resulting in their poor on board performance and ultimately lead to spoil the physical and mental aspects as well. The fatigue factors among Indian Seafarers have been addressed in proper perspectives so as to find out a needy solution to overcome the same, by identifying the actual root cause and to take suitable remedial measures to relief from such a kind of stress, thereby to make them, all time fit, to execute their responsibilities. Moreover, adequate counseling and appropriate training are to be imparted to seafarers to overcome the fatigue factors, an environment conducive to execute the work in a perfect mindset, free from all their mental agonies. The research study has been concluded with pragmatic conclusions supported with the research oriented discussions on the factors of fatigue of Indian seafarers

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Page 1: Ijm 06 10_006

http://www.iaeme.com/IJM/index.asp 35 [email protected]

International Journal of Management (IJM)

Volume 6, Issue 10, Oct 2015, pp. 35-47, Article ID: IJM_06_10_006

Available online at

http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=6&IType=10

ISSN Print: 0976-6502 and ISSN Online: 0976-6510

© IAEME Publication

___________________________________________________________________________

SEAFARERS FATIGUE MANAGEMENT –

AN EMPIRICAL STUDY ON INDIAN

SEAFARERS

Col. Dr .G. Thiruvasagam

Vice-Chancellor

AMET University (AMET-Academy of Maritime Education & Training)

Chennai, India

Dr. J. Rengamani

Associate Professor

AMET Business School, AMET University

Chennai, India

ABSTRACT

Human fatigue is a common phenomenon that exists in most of the

industries an outcome of the influence exerted due to continuous and rigorous

work executed without any break. However one could see that the fatigue

factor is excessively prevalent only among the seafarers in the shipping

industry, as the lifestyle of the seafarers is something different from other

professions in as much as they have to spend most of their time in mid sea, by

enduring their services for months together in the absence of all their due

domestic pleasure to rejoice and to rejuvenate their mind. Researchers on this

field have time and again established that it is a proven fact that fatigue is one

of the reasons for lack of concentration while attending to their routine work

and even led to occurrence of accidents of ships nowadays. Several factors

could be attributed to fatigue of seafarers, which include psychological,

physiological and environmental factors; are the main reasons for their

intermittent distraction, resulting in their poor on board performance and

ultimately lead to spoil the physical and mental aspects as well. The fatigue

factors among Indian Seafarers have been addressed in proper perspectives so

as to find out a needy solution to overcome the same, by identifying the actual

root cause and to take suitable remedial measures to relief from such a kind of

stress, thereby to make them, all time fit, to execute their responsibilities.

Moreover, adequate counseling and appropriate training are to be imparted

to seafarers to overcome the fatigue factors, an environment conducive to

execute the work in a perfect mindset, free from all their mental agonies. The

research study has been concluded with pragmatic conclusions supported with

the research oriented discussions on the factors of fatigue of Indian seafarers

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Col. Dr .G. Thiruvasagam and Dr. J. Rengamani

http://www.iaeme.com/IJM/index.asp 36 [email protected]

such as the long working hours of seafarers, irregular sleep patterns, frequent

changes in the maritime industry, environmental hardships of seafarers,

improper exercise and nutrition.

Key words: Seafarer, Fatigue, Stress, Stressors, Extent of fatigue, Causes of

fatigue, Effects of fatigue, IMO.

Cite this Article: Col. Dr .G. Thiruvasagam and Dr. J. Rengamani. Seafarers

Fatigue Management – An Empirical Study on Indian Seafarers, International

Journal of Management, 6(10), 2015, pp. 35-47.

http://www.iaeme.com/IJM/issues.asp?JType=IJM&VType=6&IType=10

1. INTRODUCTION

“Shipping is perhaps the most international of all the world's great industries, and

also one of the most dangerous” (International Maritime Organisations [IMO], 2011).

A range of approaches have been introduced to enhance maritime transport safety,

such as developing new methods of transportation, introducing numerous technical

innovations, increasing traffic surveillance and control, etc. Nevertheless, accidents

with catastrophic consequences still happen, which implies that all these measures are

not sufficiently effective.

There are risk factors in the marine industry, which degrade the seafarers

endurance especially their safety and performance. Seafarers endurance is a function

of operational risk factors such as physical conditioning, threshold of motion

discomfort, duration of sleep, quality of diet and other related aspects. Generally

organizations pay attention to improve overall quality enhancement, updating with

latest equipments and wires more than on training of staff. But many organizations do

not give importance to improve the individual performance of their staff, which alone

facilitate them to deliver knowledge and effective decision makings which are

essential for the successful operation of any organization. The International Maritime

Organisation (IMO) guidelines on Fatigue Mitigation and management are

comprehensive and practical advice to all the various stakeholders and how to combat

it. The United State Coast Guard’s crew endurance management programme

identified various operational, psychological, physiological and environmental

programme factors that can affect crew endurance and address the specific endurance

risks related to ship operations.

Maritime Industry does not have prescribed maximum hours of work and

minimum hours of rest like other transportation sectors. Whereas there is a necessity

to ensure that all the crew members are fit for duty when keeping a watch by the

mariners. Fitness can be made possible provided Fatigue Management programme are

being given adequately to the seafarers. IMO guidelines stresses that all vessel

operators should implement fatigue management plan but it is not practically

implemented. In the maritime Industry many factors are present which may cause

work related fatigue. For example, it is suggested that long and unsociable working

hours, lack of training, poor communication between office staff and sea personnel,

job insecurity, and physical health problems may all cause work related fatigue. If a

number of these factors are presented in combination, as they frequently are for those

working onboard vessels, the likelihood of individual suffering from work related

stress is greatly increased.

Although many companies as part of their health and safety policies do try and

take measures to reduce work related fatigue, evidence suggests that such measures

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are frequently not taken seriously, often being seen only as a paper exercise. Work–

related fatigue may also effect productivity. Workers who are stressed are also more

likely to be unhealthy, poorly motivated, less productive and less safe at work. This

has implications not only for the wellbeing of the seafarer, but also for the

competitiveness, and ultimately successes of the company. Despite the strong a priori

case for fatigue at sea, historically there has been relatively little research on

seafarers’ fatigue compared to other transport sectors. In recent years, examples of

fatigue at sea, and its consequences, have been more formally documented, not least

due to the high profile pollution and accident cases linked to fatigue. Examination of

this type of information supports the view that fatigue is a major health and safety

issue in the shipping industry with potentially severe environmental and economic

consequences.

2. LITERATURE REVIEW

In the first systematic review of work hours, stress and safety at sea, Brown (1989)

found little objective evidence of the effects of stress, although he did find anecdotal

evidence regarding personal stress experiences. Seafarers reported that they were

often expected to work continuously, under conditions of task-induced or

environmental stress for excessive (in relation to other industries) periods of time.

Respondents attributed a number of stress symptoms to their working arrangements

that were in general agreement with research into stress effects. Thus early research

on seafarers’ stress was largely based on Brown’s (1989) assertion that long hours are

a major contributor to stress and accidents at sea. Eleven years later a review focused

on the British offshore oil support industry found a similar picture to Brown,

concluding that stress has been noticeably under-investigated in the maritime domain

(Collins, Mathews and McNamara 2011).

Working at sea is likely to be fatiguing for a number of reasons: fast port

turnarounds, demanding (often split) shift systems, regular periods of sustained

attention, physical exertion and harsh environmental conditions have all been

associated with interrupted sleep patterns and stress (Smith, Lane and Bloor, 2011,

2013; Allen et al., 2014).

Fatigue is a common problem in the general population (Bensing, et al, 1999;

David, et al, 1990). It is well known that stressful social events frequently lead to

acute mental fatigue and sometimes cause problems with mental health and chronic

fatigue, even resulting in death in the case of overwork (Amagasa, et al, 2005; Der-

Shin Ke, 2012; Iwasaki, et al, 2013).

Prevalence of fatigue in the general working population has been estimated to be

as high as 22% (Bültman et al., 2002). Considerable onshore studies on fatigue show

that as much as 20% of the working population experience extreme fatigue in their

life. In Japan, 60% of the general adult population complains of fatigue and one third

of the population suffers from chronic fatigue (Watanabe, 2008). Fatigue was

regarded as the first concern of seafarers in a study concerning ship manning

(National Research Council, 2012).

But such estimates were difficult because of the lack of systematic reporting

procedures (Gander, 2005). In a survey (Wadsworth et al., 2008) of over 1,800

professional seafarers, a quarter of respondents reported fatigue or sleep while on

watch and nearly half of the sample reported that fatigue leads to reduced collision

awareness. A great amount of research has shown that fatigue is still a major issue at

sea. However, estimates of the prevalence of fatigue will vary depending on the

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indicator of fatigue we choose. Different aspects of the fatigue process will lead to

different results. It is also suggested that seafarers may be unlikely to admit and report

their experience of fatigue in the investigations due to the worry of being derided

(Houtman, et al, 2005).

3. METHODOLOGY OF THE STUDY

The target population was considered as seafarers of Indian origin who were working

at various levels/job categories on the deck side and the engine side of foreign going

merchant vessels. The total sample size considered for the study was 150. The study

consists of five parts such as seafarer’s demography, extent of fatigue, causes of

fatigue, effects of fatigue and prevention of fatigue. The survey elicited the

demographic and job-related data, usual shipping routes, shipboard working hours,

type and size of the ships and fatigue levels of crew members on board. To assess the

fatigue due to long continuous working days, the occurrence of extremely long

working times was registered. Furthermore, the most stressful job activities such as

watch-keeping at sea (officer on watch on the bridge), district route of a seagoing

vessel (navigation through highly frequented routes), port clearance (loading and

unloading, safety techniques and hygiene control measures), port manoeuvres (arrival

and departure), administrative tasks, and routine activities during the voyage. The

work-related fatigue of the seafarers such as mental strain of accomplishing the set-

task, Lack of rewards for accomplishment, Lack of self-confidence to work, Social

relations, Feeling of threat, Physical oppressiveness, Unpleasant work conditions,

Lack of support & Sense of responsibility, were measured by using a structured

questionnaire. The questionnaire designed for the evaluation of subjective perception

of work and the individual feeling of work-related fatigue, allows the individual

estimation of the feeling of fatigue. The structured questionnaire followed a simple

model of fatigue which is presented below:

A simple model of Seafarers Fatigue

4. OBJECTIVES OF THE STUDY

The objectives of the study were to analyze the factors of fatigue as specified:

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To investigate the mean differences of the extent, causes & effects of seafarer’s

fatigue.

To study the relationship between the age, extent, causes & effects of fatigue

To study the relationship between the seagoing experience with the extent and effects

of fatigue.

To identify the prevention of seafarer’s fatigue

5. HYPOTHESES OF THE STUDY

This article is organized around the following working hypotheses:

There is a significant difference in the mean values of the extent of fatigue, causes of

fatigue and effects of fatigue.

There is a significant association between the age and the factors of the extent of

fatigue

There is a significant association between the age and the factors of the causes of

fatigue

There is a significant association between the age and the factors of the effects of

fatigue

There is a significant association between the seagoing experience and the factors of

the extent of fatigue

6. DATA ANALYSIS AND INTERPRETATIONS

6.1. Demographic Data Analysis

The study pertains to the management of seafarer’s fatigue and 39% of the

respondents fall under the age category of 30-40 years (Table-1). 32% of the

respondents have acquired the educational qualifications equivalent to under

graduation (Table-2) and 41% of them have the seagoing experience of 5-10 years

(Table-3). Equal percentage of master level ranks & chief engineer level ranks were

held by the respondents of the present study about the seafarer’s fatigue (Table-4).

55% of the seafarers have received training on mitigating the fatigue at work (Table-

5). The demographic details are specified in-detail.

Table 1 Age of Seafarers

Age Respondents Percentage

Below 30 28 19

30-40 59 39

40-50 38 25

50-60 18 12

Above 60 7 5

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Table 2 Educational Qualification of Seafarers

Education Respondents Percentage

Schooling 35 23

Diploma 48 32

Graduation 44 29

Post-graduation 11 7

Others 12 8

Table 3 Seagoing Experience of Seafarers

Table 4 Rank held by Seafarers

Sea experience Respondents Percentage

Below 5 yrs 19 13

5-10 yrs 62 41

10-15 yrs 39 26

15-20 yrs 21 14

Above 20 yrs 9 6

Rank Respondents Percentage

Master (Captain) 28 19

2nd

officer 14 9

3rd

officer 11 7

4th officer 16 11

Chief engineer 24 16

2nd

engineer 25 17

3rd

engineer 17 11

4th engineer 9 6

Other ranks 6 4

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Table-5 Training of Seafarers in Fatigue Management

7. MEASURE OF SEAFARER’S FATIGUE

Cronbach’s alpha is used to test the reliability and validity of the data collected. A

value more than .70 is significantly good measure for sufficient scale of reliability

(Cronbach, 1951, Nunnally, 1987). According to the Cronbach’s alpha test, the values

of alpha in this study for the factors of fatigue would be 0.792, 0.802 & 0.826

respectively, considering all the factors under investigation. A closer look at the

Cronbach’s alpha values of the individual constructs have yielded acceptable results.

It is evident from the Table-6 that the cronbach’s alpha values are reasonably high and

hence it can be inferred that the scales are consistent and reliable.

Table 6 Cronbach’s Alpha Values

Fatigue Factors Cronbach’s Alpha

Extent of fatigue 0.792

Causes of Fatigue 0.802

Effects of Fatigue 0.826

The result of the Questionnaire survey regarding the work-related fatigue of the

seafarers shows that the p-values of all the fatigue factors are less than 0.05 (Table-7).

This clearly indicates that the seafarers, irrespective of the deck-side seafarers or the

engine-side seafarers, have a sort of mental strain while accomplishing their tasks and

they are also incurred to the high levels of physical oppressiveness. In addition, the

seafarers have strong feeling towards the factors such as lack of sleep, insufficient

Training Respondents Percentage

Yes 82 55

No 68 45

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rest, lack of self-confidence to work, feeling of threat, unpleasant working conditions

and the lack of support from their peers or superiors. The stress level on ships

travelling worldwide was considered higher due to the separation from their family as

well. This is probably caused by the long distance from home as well as by missing

social contacts due to the fact that these ships only stop a few times in ports.

In spite of the levels of stress incurred by the seafarers on-board, the seafarers

with long period of service at sea subjectively estimated their work as less burdening

and stressing as compared to the new entrants. The seafarers were aware of their own

abilities of meeting job requirements, the seafarers work experience at sea reduced

uncertainty while solving problems, the seafarers were aware of the safety and health

related rules of work on vessels, the seafarers had gained and consolidated theoretical

and practical knowledge and skills of coping with difficult situations.

Table 7 Student's t-test of Fatigue factors (significance level = 0.05)

Fatigue factors t p

Extent of fatigue

1. Inability to stay awake 1.92 0.001*

2. Hand-eye coordination skills 1.89 0.004*

3. Speech difficulties 2.01 0.005*

4. Sluggish feeling 2.11 0.001*

5. Inability to exert force 2.12 0.001*

6. Slip of tools/equipment 1.23 0.001*

7. Physical discomfort 1.35 0.001*

8. Headaches 1.46 0.000*

9. Giddiness 1.24 0.000*

10. Heart palpitations 1.57 0.002*

11. Rapid breathing 1.23 0.003*

12. Loss of appetite 1.37 0.001*

13. Insomnia 1.58 0.008*

14. Sudden sweating 1.69 0.003*

15. Leg pains or cramps 1.23 0.007*

16. Digestion problems 1.77 0.012*

17. Risk taking 2.38 0.013*

18. Intolerance 2.43 0.001*

19. Needless worry 2.57 0.007*

20. Reduced motivation to work well 2.89 0.009*

21. Mood swings 2.24 0.015*

22. Poor judgement 2.57 0.004*

23. Inaccurate interpretation of a situation 2.36 0.003*

24. Failing to anticipate danger 2.32 0.002*

25. Slow response 2.37 0.003*

26. Reduced attention 2.68 0.004*

27. Difficulty in concentration 2.75 0.001*

28. Inability to pay attention 2.87 0.011*

Causes of Fatigue t p

1. Lack of sleep 2.62 0.019*

2. Poor quality of sleep 1.22 0.024*

3. Insufficient rest time 1.63 0.035*

4. Poor quality of rest 2.47 0.036*

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5. Stress 1.23 0.003*

6. Boring and repetitive work 1.39 0.001*

7. Noise or Vibration 2.48 0.013*

8. Ship movement 2.55 0.015*

9. Food 1.63 0.018*

10. Medical conditions 2.39 0.008*

11. Ingesting chemicals 1.64 0.003*

12. Jet-Lag 2.87 0.032*

13. Excessive work load 1.98 0.001*

Effects of Fatigue t p

1. Inability to concentrate 2.49 0.004*

2. Diminished decision making ability 1.58 0.000*

3. Poor memory 2.87 0.001*

4. Slow response 2.85 0.002*

5. Loss of bodily control 1.25 0.001*

6. Mood change 1.49 0.016*

7. Attitude change 2.66 0.009*

* p < 0.05.

The correlation between age of seafarers and the extent of fatigue is 0.819 (Table-

8). This shows that the age of seafarers and the extent of fatigue are positively

correlated. The two-tailed significance value (0.017) is less than the p-value (0.05). It

can be specified that the age of seafarers and the extent of fatigue are significantly

associated with each other. This clearly shows that as age increases, the extent of

fatigue also increases.

Table 8 Age and Extent of Fatigue

Age Extent of Fatigue

Age Pearson Correlation 1 0.819

Sig. (2-tailed)* 0.017

Extent of Fatigue Pearson Correlation 0.819 1

Sig. (2-tailed) 0.017

* p < 0.05.

To further establish that the age and the extent of fatigue are associated with each

other, the chi-square statistics has been calculated and presented in Table-9.

Table 9 Chi-Square Analysis: Age and Extent of Fatigue

Age/Extent of fatigue

Chi-square

df

Asymp.Sig*

53.67

27

0.001

* p < 0.05.

It is evident from the above table that there is a significant association between the

age and the extent of fatigue.

The correlation between age of seafarers and the causes of fatigue is 0.792 (Table-

10). This shows that the age of seafarers and the causes of fatigue are positively

correlated. The two-tailed significance value (0.013) is less than the p-value (0.05). It

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can be specified that the age of seafarers and the causes of fatigue are significantly

associated with each other.

Table 10 Age and Causes of Fatigue

Age Causes of Fatigue

Age Pearson Correlation 1 0.792

Sig. (2-tailed)* 0.013

Causes of Fatigue Pearson Correlation 0.792 1

Sig. (2-tailed) 0.013

* p < 0.05.

To further establish that the age and the causes of fatigue are associated with each

other, the chi-square statistics has been calculated and presented in Table-11:

Table 11 Chi-Square Analysis: Age and Causes of Fatigue

Age/Causes of fatigue

Chi-square

df

Asymp.Sig*

41.24

12

0.003

* p < 0.05.

It is evident from the above table that there is a significant association between the

age and the causes of fatigue.

The correlation between age of seafarers and the effects of fatigue is 0.846 (Table-

12). This shows that the age of seafarers and the effects of fatigue are positively

correlated. The two-tailed significance value (0.009) is less than the p-value (0.05). It

can be specified that the age of seafarers and the effects of fatigue are significantly

associated with each other.

Table-12 Age and Effects of Fatigue

Age Effects of Fatigue

Age Pearson Correlation 1 0.846

Sig. (2-tailed)* 0.009

Effects of Fatigue Pearson Correlation 0.846 1

Sig. (2-tailed) 0.009

* p < 0.05.

To further establish that the age and the effects of fatigue are associated with each

other, the chi-square statistics has been calculated and presented in Table-13:

Table 13 Chi-Square Analysis: Age and Effects of Fatigue

Age/Effects of fatigue

Chi-square

df

Asymp.Sig*

58.61

30

0.007

* p < 0.05.

It is evident from the above table that there is a significant association between the

age and the effects of fatigue.

The correlation between seagoing experience of seafarers and the extent of fatigue

is 0.711 (Table-14). This shows that the seagoing experience of seafarers and

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the extent of fatigue are positively correlated. The two-tailed significance value

(0.002) is less than the p-value (0.05). It can be specified that the seagoing experience

of seafarers and the extent of fatigue are significantly associated with each other.

Table 14 Seagoing Experience and Extent of Fatigue

Seagoing Experience Extent of Fatigue

Seagoing Experience Pearson Correlation 1 0.711

Sig. (2-tailed)* 0.002

Extent of Fatigue Pearson Correlation 0.711 1

Sig. (2-tailed) 0.002

* p < 0.05.

To further establish that the seagoing experience and the extent of fatigue are

associated with each other, the chi-square statistics has been calculated and presented

in Table-15.

Table 15 Seagoing Experience and Extent of Fatigue

Seagoing experience /Extent of fatigue

Chi-square

df

Asymp.Sig*

49.77

27

0.001

* p < 0.05.

It is evident from the above table that there is a significant association between the

seagoing experience and the extent of fatigue.

8. CONCLUSION

The research study reveals that the factors related to the extent of fatigue such as long

working days, heat & vibration in work places, separation from their family, time

pressure / hectic activities, lack of rest, lack of sleep, excessive work load and

repetitive work are the most important fatigue related factors on board. The seafarers

with higher fatigue level due to heat in shipboard operations had shorter job duration

at sea. The stressors of heat and noise show that physical stressors on ships currently

are still very important in spite of the increasing mechanization in seafaring.

In the study, there are significant associations between the age of seafarers and the

factors of extent of fatigue. Especially the engine room personnel, permanently being

close to the heat-producing engines, stated a higher stress level due to heat &

vibration in their workplaces. Additionally, the time pressure aboard was regarded as

more stressful by less-than one third of the engine personnel, but by half of the deck-

side seafarers.

The deck-side officers stated a higher stress level due to time pressure and hectic

activities on board. This can be attributed to their frequently extremely long working

days due to unexpected situations and to the increasing amount of administrative

duties. Extremely high number of working hours over a lengthier period of time

combined with a lack of sleep can elicit chronic fatigue, health problems and safety

risks on the vessels. The study showed that engine room seafarers had a lower fatigue

level than deck side seafarers due to long working days and time pressure or hectic

activities. This indicates regular working hours and routine procedures in the engine

room, whereas especially the deck personnel has to react to permanently changing job

demands such as port clearance, navigation and watch-keeping at sea.

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The extended working hours including inappropriate rest between periods of duty,

are given high preference. This priority is based on the considerable weight of

evidence in the study relating to the impact of extended working hours on the factors

of fatigue of Indian Seafarers. It can be clearly understood that operating a 24-hour

industry in a hostile environment will result in additional work hours from time to

time. However, the Indian seafarers suggested that following major industry reform,

issues such as decreased crew sizes, increased commercial pressure, and extended

duties have contributed to both acute and chronic Fatigue. In some cases, particularly

during periods involving heavy traffic or bad weather, seafarers raised concern that

safety may be compromised as a result of persistent stress.

The study indicated the majority of the maritime sample (72%) reported poor to

very poor quality sleep, and half the workforce reported less than 6 hours of sleep per

day at sea. The seafarers experience considerable demands from broken rest including

being woken unexpectedly, being on call and unpredictable working hours. The sleep

quality was the highest ranked of the factors contributing to physical ill health among

seafarers. The suggestions for the prevention of Seafarers Fatigue is to improve the

Sleep time, Duration & continuity of sleep time, Quality of sleep time, Appropriate

rest between break time, provision of good working environment, Consumption of

nutitious food, Peer interaction and Job rotation.

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