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SHORT COMMUNICATION
Year : 2022 | Volume
: 26
| Issue : 4 | Page : 281-284
Occupational health hazards of rickshaw pullers in lower middle income Country, India
Panna Lal1, Mohit Batra2, Madan M Majhi1, Pragya Ahuja3, Nidhi Bhatnagar1
1 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Department of Integrated Real World Evidence and Solutions, IQVIA, London, UK
3 Department of Anaesthetics, Frimley Park Hospital, Surrey, UK
Correspondence Address:
Dr. Nidhi Bhatnagar
Department of Community Medicine, Maulana Azad Medical College, New Delhi
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijoem.ijoem_113_21
Background: Rickshaw pullers work in unorganized sector. Ignorance, poverty, and strenuous physical exertion make them vulnerable to ill health and disease. Objectives: To assess the magnitude and pattern of morbidity, associated sociodemographic factors, and health-seeking behavior of the participants. Materials and Methods: A cross-sectional study was conducted on 305 participants. Predesigned, pretested questionnaire was used for data collection. Statistical Package for the Social Sciences (SPSS) 16 version was used for data analysis. Results: About 61% of the participants had morbidity in their lifetime and 49.5% fell sick in the last 15 days. Substance abuse in any form was reported by 73.1%. Grade-1 hypertension was reported in 28.2% and 7.5% was having grade-2 hypertension. Age, monthly income, substance abuse, and availing of health services were significantly associated with the development of health problems. Conclusion: Need to devise interventions that will focus on health awareness and early health-seeking behavior among the participants.
Keywords: Morbidity, occupational health hazards, rickshaw pullers
The majority of the workforce in India is in the unorganized sector with poor health determinants. Rickshaw pullers also belong to the unorganized sector. Ignorance, poverty, and strenuous physical exertion in an overtly polluted environment with occupational susceptibility to accidents and injuries make these rickshaw pullers vulnerable to ill health and disease.[1],[2],[3],[4],[5] The present study was undertaken to assess the magnitude and pattern of morbidity, associated sociodemographic factors, and health-seeking behavior of cycle rickshaw pullers working in Delhi.
Materials and MethodsStudy design
This cross-sectional study was conducted over 12 months. The study population comprised of rickshaw pullers working at various sites around two health centers (Delhi gate and Gokalpuri) of the Department of Community Medicine, Maulana Azad Medical College, New Delhi.
Study participants
Only male rickshaw pullers aged 20–50 years residing in Delhi for a minimum of 6 months were included in the study. Taking 95% confidence level and the overall prevalence of morbidity among rickshaw pullers to 30%[1] and with a relative error of 20%, the sample size comes out to be 234. The sample was rounded off to 300 after considering a 20% dropout. Finally, 305 rickshaw pullers were included. Within a 5 km radius of both the health centers, six to ten sites were identified (where 30–50 rickshaw pullers were found waiting for their passengers). Out of these sites, five sites around each center were selected by lottery method (total ten sites). Participants were enrolled by systematic random sampling method.
Study tools
The subjects were interviewed using a predesigned and pretested questionnaire. Morbidity profile was assessed and sickness was analyzed in two sections: (a) Spell of sickness in the last 15 days and (b) chronic illnesses involving different body systems. Anthropometric measurements, namely height and weight were recorded according to the standard protocol and body mass index (BMI), was computed and classified according to the World Health Organization (WHO) classification. The blood pressure of the study subjects was also measured using an aneroid sphygmomanometer and classified based on JNC-VII.
Statistical analysis
The data were analyzed using Statistical Package for the Social Sciences (SPSS) 16 version. The Chi-square test or Fischer's exact test was applied for inferential purposes and a P value of ≤0.05 has been considered for declaring the difference statistically significant.
Ethical approval
Informed written consent was obtained from the study participants. The study was approved by the institutional ethics committee, Maulana Azad Medical College, New Delhi.
ResultsAmong all, the majority (73.1%) reported some kind of substance abuse. Tobacco use was either in the form of smoking (65.9%) or chewable tobacco (50.6%). Alcohol consumption (29.5%) and other substances, predominantly cannabis (18.3%) were also reported. Morbidity patterns among study subjects are given in [Table 1]. Age of the rickshaw pullers, monthly income, substance abuse, and availing of health services were found to be significantly associated with the presence of morbidity [Table 2].
Table 2: Risk factors responsible for health problems/disease among study subjects (n=305)The majority (73.4%) of the study subjects had BMI within the normal range, 24.6% of the subjects were underweight, and 2.0% were overweight. None of the subjects were obese. Following JNC-VII criteria, 50.2% were having prehypertension. Grade-1, hypertension was present in 28.2%, and 7.5% having grade-2 hypertension. Age of rickshaw pullers and substance used were found to be significantly associated with the development of hypertension among the study subjects.
More than half (54.8%) of the participants never took medical advice for their problems. Among those who sought medical advice majority (71.0%) preferred allopathic medicine, followed by homeopathic (7.9%), and Ayurveda (3.7%). However, as many as 17.4% of the study subjects were still going to quacks for treatment. A small proportion of them (13.8%) visited government hospitals while the majority (86.2%) preferred private facility. For spending on treatment, the majority (67.4%) were spending up to ₹500, 18.8% of the subjects spent more than ₹500. The majority (87.61%) of the subjects were spending up to 10% of their monthly income on their treatment.
DiscussionAround three-fourth of the study subjects in the current study had the habit of substance abuse. Tobacco smoking (69.5%) and chewing (50.6%) were the most common habituation. This could be due to tobacco products being easily available at a lower cost and their use being socially acceptable. About one-third of study subjects were having the habit of alcohol drinking, while 18.3% of the study subjects were using cannabis. A study from Bangladesh also showed a high prevalence of smoking or substance abuse in rickshaw pullers.[6] In Ludhiana, India, tobacco was most frequently ever used by rickshaw pullers (92%) followed by alcohol.[7] The difference could be due to different workplace conditions, beliefs, and thinking.
Overall 61.0% of rickshaw pullers were suffering from either acute or chronic health problems during their lifetime and almost half (49.5%) of them had at least one spell of sickness in the last 15 days. Factors like the consumption of tobacco and alcohol, and the low socioeconomic status might be contributing to the health problems. The major acute health problem observed in our study had also been reported from Bangladesh.[8] The chronic illnesses, among study subjects, were found to be of dental origin (32.8%), vascular origin (31.1%) including varicose veins, and musculoskeletal problems (30.1%) including generalized body ache and leg pain. The possible attributes to these problems might be poor personal hygiene; a high rate of tobacco consumption; long hours spend on pedaling rickshaws. In a study from Odisha, India, musculoskeletal pain problem was found as the major morbidity (91.7%) among the study subjects followed by gastrointestinal problems (55.9%), ophthalmic problem as impaired vision (51.0%).[1] Aches and pains, and physical weakness constitute 43% of all chronic ailments, likely to be associated with rickshaw pulling itself, reported from Bangladesh.[8] The difference in observations may be due to the difference in the geographical area covered, the difference in the time of the studies. The majority of the study subjects (73.4%) in the present study had BMI within the normal limits. However, 24.6% of them were underweight and only 2.0% were overweight. Similar observations have been reported from Odisha and may be due to the nature of the job involving intense physical activity for prolonged durations.[1] The observations on blood pressure recordings among rickshaw pullers have not been reported in other studies.[6],[7],[8],[9],[10],[11]
More than half (54.8%) of the study subjects never took medical advice from health care providers. This is low as reported in the National Sample Survey Office (NSSO) sixtieth round, which reported 82% of the respondents reported their illnesses to the health care facility.[12]
The most cited reason for not taking treatment in the National Sample Survey Office (NSSO) sixtieth round[12] was that they thought the illness was “not serious” (32% in rural and 50% in urban areas) whereas, in the present study only 7.7% of the study subjects mentioned this reason and the major reason cited was the shortage of money (53.9%). The difference might be due to negligence and not being aware of government-run health facilities and the availability of free medicines. Among those seeking medical advice, a very small number (13.8%) went to government hospitals or dispensaries for treatment. Similar findings were reported from the NSSO sixieth round.[12] In the present study majority (87.61%) of the subjects were spending up to 10% of their monthly income on treatment. In another study from Delhi, 27.5% of the respondents spent their household savings on treatment, and 43% had to borrow funds.[13] More rickshaw pullers must be encouraged to use government-run health facilities to reduce the burden of health care costs.
Subjects more than 40 years were at increased odds of having health problems. Further, among those who had less income (<₹10,000) per month had health problems. Similarly, study subjects who were staying with their family had significantly more health problems as compared to those staying alone. Those who were living alone might have ignored their health problem, thus not seeking any medical advice and remain at increased odds of having a health problem. A study from Ranchi, India, reported that Rickshaw pullers cannot afford to give much importance to their health and suffer from a variety of occupational and other illnesses.[14] More than two-thirds (67.7%) of study subjects having substance abuse had health problems compared to those who do not have any substance abuse. Among study subjects who were availing health services, 91.3% had health problems as compared to those who were not approaching health care providers. Utilization of health services most probably would have led to early diagnosis of diseases among subjects which otherwise would have remained undetected, thus the presence of health problems more in those rickshaw pullers who are utilizing health services has been observed [Table 2].
ConclusionThe health status of the study participants is far from being satisfactory. Information, education and communication (IEC) campaign focusing on the risk factors is mandated. Health insurance schemes were identified as a felt need for this section of the population. Mobile out patient department (OPD) clinics at points of the congregation of rickshaws will support early health-seeking. Periodic health screening and necessary referrals can be done through these mobile clinics.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgements
Authors would like to acknowledge all the participants.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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