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JOURNAL OF COMMUNITY MEDICINE |
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INDIAN ASSOCIATION OF PREVENTIVE AND SOCIAL MEDICINE ORISSA CHAPTER |
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Asst. Professor, ** Lecturer, *** Assoc. Professor, **** Professor, ***** P.G, ****** Asst. Surgeon. Department of Community Medicine, M.K.C.G.Medical College, Brahmapur |
D.M.Satapathy, T.R. Behera, R.M.Tripathy, .T.Sahu S.K.Palo, S.R.Haldar |
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Introduction Occupation is one of the most important extrinsic factors, which has a major bearing on health. Ignorance, poverty, strenuous physical exertion in an overtly polluted environment, life-style especially substance abuse and sexual promiscuity are some of the other factors which influence the health status of an individual.
The rickshaw pullers act as the main mode of transportation for short distances in the urban areas. The strenuous work under the harsh urban environment, competition from other modes of public transport, lack of proper diet & rest, indulgence in harmful substances with a belief of physical relaxation and recreation etc. pose as health risks to this section of the population. Still not much has been done for the up-liftment of healt of rickshaw pullers.
Keeping this in view, present study was conducted with an aim to assess the health status of rickshaw pullers, to find out the various personal, social and environmental factors related to their health and to suggest measures for improvement of health status in study population. Material and Method The Berhampur municipality has a population of 3, 07,792 with 1, 60,354 males and 1, 47,438 females as per 2001 census, distributed among 27 wards. It has 1840 registered Rickshaw pullers mainly working under 147 rickshaw owners though few have their own rickshaw. 184 (10 % of registered) rickshaw pullers were randomly selected from 39 rickshaw owners. In each “owner point” the numbers of study subjects were randomly selected based on the proportion of the rickshaw puller present at that point. Verbal consent was taken before assessment of the health status. Socio-demographic, anthropometric & clinical examination was done .Body weight in Kg and Height in cm .were taken in standardized weighing machine and tape respectively and body mass index (BMI) was calculated. Data were collected over a pre designed and pre tested schedule between 15th August to 15th October of 2005 and analyzed in the department of community medicine, MKCG Medical College, Berhampur. Analysis was done by calculating proportion and using Chi-square test when ever required.
Result and Discussion Out of 184 rickshaw pullers, 144 (78.26 %) had migrated from rural areas. 53(28.8 %), 46(25 %), 53 (28.8 %) and 19 (10.32 %) were in the age groups of 21-30 yr, 31-40 yr, 41-50 yr and 51-60 yr of age respectively. Only 11 (5.97 %) were more than 60 years of age & 2 (1.38 %) were below 20 years of age.
145 (79 %) belonged to SC caste, 15 (8 %) to ST, 17 (9 %) to OBC and only 7 (4 %) belonged to General caste.
Out of total 184 rickshaw pullers 88 (48 %) were non-literates, 74 (40 %) had primary level education and only 22 (12 %) had above primary level of education.
Majority 142 (77 %) had a household size of 4 –7 and 22 (12 %) had household size of <4 and rest 11 % had household size >7 members.
After doing BMI study of all the cases majority 143 (78 %) were having BMI 18-24, in 39 (21 %) cases Body mass index( BMI) was found to be < 18, only 2 (1 %) are Overweight i.e. BMI 25-30 and no one was found to be obese.
Table- I: Morbidity pattern among cases
Musculoskeletal problem was the major (91.76 %) morbidity detected among the study subjects. GI problems accounted for 55.9 % of the study population and were mainly manifested as features of Acid Peptic Disease (APD). Ophthalmic problem as impaired vision was present in 51 % and degenerative lesions like pterygium, and pinguecula was present in 10.1 %. Dental problem like caries tooth, missing tooth, gingivitis etc accounted for 35.86 % of clinical morbidity. Similarly ear problem like impaired hearing, acute suppurative otitis media, wax in ear etc. were detected in 39.13 % of the study population. 19 % of the rickshaw pullers had inguinal lymphadenopathy and 14.13 % of the rickshaw pullers had varicose veins. Respiratory diseases were present in 11.95 % of the rickshaw pullers and 10.86 % of rickshaw pullers had diarrhoeal disorder. Genito-Urinary (GU) problems were present in 12 % of the study subjects. 15 % of the rickshaw pullers had dermatological disorders of which dermatitis was present in 7 %, 4.8 % had scabies and 3.8 % had eczematous lesions. 3.8 % of rickshaw pullers had elephantiasis of lower limbs and 2.1 % had unilateral or bilateral hydrocele of tunica vaginalis testes(TVT) sac.
Table-II: Type of Morbidity & its relationship with different factors
Musculoskeletal Problems & Duration of Service Years of service Disorder present Disorder absent Inference < 5 yr 53 6 c2 = 0.002 > 5 yr 112 13 (p > 0.1)
Impaired hearing & Duration of Service Years of service < 5 yr 7 52 c2 = 18.91 > 5 yr 54 71 (p < 0.001)
GI problem & Tobacco addiction Tobacco addiction Present 81 68 c2 = 0.82 Absent 22 13 (p > 0.1)
Educational status & RTI \ STI * Educational status Non-literate 13 75 c2 = 1.31 Primary 6 68 (p > 0.1) Above primary 3 19
Marital status & RTI \ STI Marital status Married 15 158 c2 = 32.16 Unmarried 7 4 (p < 0.001) The duration of service was considered for the occurrence of musculoskeletal morbidity among the study subjects. 32 % had perused this occupation for more than 5 years of whom 89 % had musculoskeletal morbidity where as 68 % had worked for more than 5 years of whom 89 % had this form of morbidity. This indicates that the occupation itself is burdened with strenuous work and over exertion and it could be the cause of musculoskeletal morbidity. Nordin et al. (1) have also found that over exertion accounts for more than two thirds of the disorders of musculoskeletal system among industrial workers. This finding has also been found to be a cause of musculoskeletal disorders by Houtman IL et al. (2) and Skov T et al. (3)
Similarly among the 59 study subjects who had pursued this occupation for more than 5 years only 7 (11.8 %) had impaired hearing where as out of 125 subjects who had worked for more than 5 years 54 (43 %) had this form of morbidity, which was mainly sensory-neural in type. There was a significant (p < 0.001) relationship between impaired hearing and long duration of this type of occupation. It has been found by other authors Aage R. Moller (4) that prolonged exposure to loud noise can lead to sensory-neural type of deafness. The rickshaw pullers are also exposed to noise pollution especially by vehicular traffic and prolonged exposure to this form of noise pollution can be a possible cause of this form of morbidity among the study subjects.
81 % of the study subjects were addicted to tobacco, of which 54 % had features of APD. Similar form of morbidity as acid peptic diseases (APD) was also present in 63 % of the rest 35 study subjects who were not addicted to tobacco showing no significant difference (p > 0.1) in occurrence of APD and tobacco addiction. Though Freidman et al. 1974, Gugler et al. 1982 (5) have shown a relationship of occurrence of APD among tobacco users, the present study did not find any such relationship. More than half of the study subjects had APD, which could be due to their irregular dietary habits, work related physical as well as mental stress, lack of adequate rest etc, which are known predisposing factors for Acid Peptic Disease. (6, 7)
Signs and symptoms of respiratory tract infection (RTI) and sexually transmitted infection (STI) were present in 22 (12%) of the study subjects. This was significantly (p < 0.001) more among unmarried (63.6 % Vs 8.6 %) study subjects. The study did not reveal any significant (p > 0.1) relationship between literacy status and RTI \ STI. The prevalence of RTI \ STI of 12 % is similar to that of Laxmi et al. who had shown a prevalence ranging 10-15 % among rickshaw pullers & migrant laborers in their study. (8)
CONCLUSION Among the rickshaw pullers 78% have come from rural areas. Leading morbidities among them were found to be musculoskeletal disorders, acid peptic diseases and impaired hearing. Following measures have to be implemented to improve their health status. 1) Compulsory registration of the rickshaw pullers can have a definite impact in defining this population, so that appropriate health services can be suitably targeted for this community. 2) Regular health check-ups should be carried out with involvement of NGOs, Youth organizations, Social service agencies etc, for this downtrodden section of population. 3) Awareness generation activities especially on prevention of RTI \ STI, contraception and healthy life style should be imparted in a language, understandable & acceptable for this section of the community.
REFERENCES
1. Margareta Nordin & Carl Zetterberg. Work related Musculoskeletal Disorders excluding Back Pain. 65: 937-939. 2. Houtman IL, Bongers PM, Smulders PG. Psychological stressors at work and musculoskeletal problems, Scand J. Work Environ. Health, 1994; 20: 139-145. 3. Skov T, Borg V, Orhede E. Psychosocial and Physical risk factors for musculoskeletal disorders of the neck, shoulder & lower back in sales people. Occup. Environ Medicine., 1996; 53: 352-356. 4. Aage R. Moller. Noise as a Health hazard – Maxcy – Rosenau Public health and Preventive Medicine John M. Last. 12th Ed.: 750-753. 5. M.J.S. Langman and R.F.A- Logan Gastro Intestinal disease- Oxford Text book of Public Health. Vol – 4: 167-169. 6. F. R. Lambert- The stomach and Duodenum, Gastritis, Duodenitis and Peptic ulceration.- Diseases of Gastro-intestinal tract and Liver. 3rd Ed: 226, 233. 7. Stuart jon Spechler- Peptic ulcer disease and its complications- Sleisenger and Fordtran’s Gastrointastinal and Liver disease 7th Ed. Vol-1: 754-756. 8. Dr. Laxmi, Aditi Tandon. STI Cases highest among UT migrants. Tribune News Service, Chandigarh, September-24.
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E-mail: drdurgams@rediffmail.com |
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HEALTH STATUS OF RICKSHAW PULLERS OF BERHAMPUR TOWN, SOUTH ORISSA |
