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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 26  |  Issue : 4  |  Page : 199-204

Ocular morbidity and utilisation of protective eyewear among carpenters in Mushin local government, Lagos, Nigeria


1 Department of Ophthalmology, Guinness Eye Centre, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Ophthalmology, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
4 Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ontario, Canada

Date of Web Publication4-Oct-2019

Correspondence Address:
Dr. Onyinyechukwu Mary-Angela Onyekwelu
Department of Ophthalmology, Guinness Eye Centre, Lagos University Teaching Hospital, PMB 12003, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_51_19

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  Abstract 


Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury. Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace. Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses. Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint. Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW.

Keywords: Carpenters, Nigeria, ocular morbidity, protective eyewear, utilisation


How to cite this article:
Onyekwelu OM, Aribaba OT, Musa KO, Idowu OO, Salami MO, Odiaka YN. Ocular morbidity and utilisation of protective eyewear among carpenters in Mushin local government, Lagos, Nigeria. Niger Postgrad Med J 2019;26:199-204

How to cite this URL:
Onyekwelu OM, Aribaba OT, Musa KO, Idowu OO, Salami MO, Odiaka YN. Ocular morbidity and utilisation of protective eyewear among carpenters in Mushin local government, Lagos, Nigeria. Niger Postgrad Med J [serial online] 2019 [cited 2019 Nov 12];26:199-204. Available from: http://www.npmj.org/text.asp?2019/26/4/199/268595




  Introduction Top


Ocular trauma accounts for a significant proportion of occupational injury and is more prevalent in young males at their prime.[1],[2] Work-related eye injury can result in visual morbidity, economic loss, reduced productivity and psychological burden.[3] A significant proportion of work-related eye injury occurs in the construction industry and carpentry has been majorly implicated in developing countries.[1] These can be prevented by applying safety precautions like using the right machinery, proper safety training and the use of adequate protective eyewear (PEW).[3] The use of PEW can prevent up to 90% of work-related eye injuries.[1] Compliance with safety precautions is usually guided by safety regulations. However, most artisans in developing countries like Nigeria lack safety work regulations and training. This work assessed the prevalence of ocular morbidity and utilisation of PEW among carpenters in Mushin, Lagos, with a view to promoting ocular health and safety in the workplace.


  Subjects and Methods Top


The study was a descriptive cross-sectional study carried out among carpenters registered with the Professional Carpenters Association of Mushin Local Government Area (LGA) of Lagos State. Ethical clearance was obtained from the Health Research Ethics Committee of Lagos University Teaching Hospital (LUTH) located at Room 107, 1st Floor, LUTH Administrative Block, LUTH, Idi-Araba, Lagos, with protocol number ADM/DCST/HREC/APP/1488. The date of approval was 31st March, 2017 and data collection was carried out between 7th April, 2017 and 15th May, 2017. The study adhered to the tenets of the Declaration of Helsinki. Permission was obtained from the Chairman of the Professional Carpenters Association. The study rationale was explained to the participants, and written informed consents were obtained.

The Professional Carpenters Association in Mushin Local Government Area (LGA) is divided into seven geographical zones based on workshop address. Each zone comprises about 20–25 members with an estimated total population of 150. All consenting registered carpenters were enrolled in the study.

The sample size for this study was calculated using the sample size formula for the finite population in descriptive studies.[4]



n = Desired minimum sample size.

N = Population size which is 150.

Z = Statistic for level of confidence. For a confidence interval (CI) of 95%, this corresponds to 1.96.

P = expected proportion. For this study, proportion of 50% (0.5) was used

d = level of precision. For 5%, this was 0.05.



n = 108.08

Hence, the minimum sample size for this study was 108.

Adding 10% attrition rate for this study; (10/100) × 108 = 10.8.

108 + 10.8 = 118.8.

Therefore, the calculated sample size was 119 carpenters.

Data were collected using qualitative and quantitative methods. The quantitative methods included interviewer-administered questionnaires and ocular examination conducted at their meeting place(s). The qualitative probes comprised in-depth interviews of selected participants.

The questionnaire was in four parts. The first part focussed on the socio-demographic data of the respondents, the second and third parts of the questionnaire covered work and ocular history, respectively, whereas the fourth part assessed the awareness and use of protective eye devices. The questionnaires were administered in the English language and Yoruba (the native language).

The ocular examination included visual acuity assessment, anterior segment examination (using pen-torch and Keeler ® portable slit lamp) and posterior segment examination (using Welch-Allyn ® hand-held ophthalmoscope through dilated pupils). Health education was given, and free safety glasses were distributed to all participants at the end of the survey.

In-depth interviews of 14 randomly selected members from different zones were conducted at their individual workplaces using a guided interview approach and open-ended questions. Questions explored the utilisation level and barriers to utilisation. Responses were obtained using an audio recorder and transcribed.

Utilisation level was classified as no utilisation, poor utilisation and good utilisation. No utilisation referred to carpenters who have never used a protective eye device at work; poor utilisation referred to carpenters who use protective eye device at work but not all the time; whereas good utilisation referred to carpenters who use protective eye device at work all the time.

Work duration was categorised as short duration when years of experience was <10 years, while work experience of 10 years and above was categorised as long duration.

Data analysis was performed using the IBM Statistical Package for the Social Sciences version 20 (IBM Corp. Armonk, NY, USA). Descriptive statistics were presented as frequencies and percentages. Chi-square test and logistic regressions were used to test for associations between categorical variables. A value of P < 0.05 was considered statistically significant.

Qualitative analysis was performed using content analysis of data. Coding and indexing of responses into themes were done to categorise the responses using iterative/thematic responses.


  Results Top


One hundred and fourteen (114) respondents were analysed out of 117 enrolled for the study. This accounted for 97.4% study completion rate. Three participants were excluded due to incomplete data.

All (100%) the respondents were male. The age distribution is shown in [Figure 1]. The age range was 18–75 years with a mean age of 46.03 ± 15.51 years. The socio-demographic and occupational characteristics are summarised in [Table 1]. The mean work experience was 21.96 ± 13.70 years (0.2–49 years).
Figure 1: Age distribution of respondents

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Table 1: Socio-demographic and occupational characteristics of 114 respondents

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Thirty-five (30.7%) respondents reported eye injury at work in the previous year, whereas 37 (32.5%) respondents had work-related eye complaints. Details of the work-related eye history are shown in [Table 2].
Table 2: Work-related eye history of the respondents

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Two hundred and twenty-eight eyes of the 114 respondents were examined. One hundred and twelve (98.2%) respondents had a best-corrected visual acuity of 6/18 or better in the better eye. None of the respondents had visual acuity worse than 3/60 in the better eye. There were two cases of monocular blindness, one from open globe injury (sustained at work) and the other was due to optic atrophy. Eighty-five (74.6%) respondents had abnormal ocular findings, some of which had multiple pathologies. The pattern of ocular diseases among respondents is shown in [Figure 2].
Figure 2: Pattern of ocular diseases among 85 respondents

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Thirty-seven respondents (32.5%) had no knowledge of PEW. Among the 77 (67.5%) respondents who were aware, the most popularly known PEW was eye goggles (53.5%). Others were dark spectacles (20.2%), prescription glasses (8.8%) and helmets (7.0%). Some of the respondents had multiple responses.

Eighty-four (73.7%) respondents had never used any PEW device at work in the previous year, whereas 30 (26.3%) respondents used PEW occasionally. None of the respondents reported using PEW at work always. The reasons for poor utilisation of PEW among a multiple response set were lack of possession (52.6%), lack of felt-need (31.6%), forgetfulness (8.8%), uncomfortable (9.6%), poor visibility (2.6%) and poor cosmetic appearance (0.9%).

On logistic regression, previous eye injury and work-related eye complaint were significantly associated with the use of PEW as shown in [Table 3]. Respondents with previous eye injury (odds ratio [OR] =2.842, CI = 1.05–7.69; P = 0.040) and eye complaint (OR = 3.306, CI = 1.14–9.57; P = 0.027) were almost three times and three times more likely to use PEW, respectively.
Table 3: Logistic regression of variables for use of protective eye wear

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The mean age of the respondents for the in-depth interview was 45.42 ± 10.27 years (28–57 years), whereas the mean work experience was 22 ± 11.48 years (8–37 years). Most participants had good knowledge of PEW device and agreed that they were important. However, a few of the participants felt that PEW devices were not necessary as they felt they had no risk from their jobs. Some participants were aware of risks of eye injury from carpentry tasks and reported that some of their colleagues had lost vision following nail injury. Majority of the participants reported that sawdust and spray fumes regularly irritated their eyes, but they said that they had adopted it as a way of life since the redness often subsided within a few days.

Some of the reasons given for poor use of protective eyewear were ignorance, unfamiliarity and cloudy vision with PEW. The cost was not a predominant barrier. The prevalent feeling was that creating awareness most especially among the newer generation of carpenters will improve the use of PEW among carpenters. Some of the responses of the participants are summarised under key themes as shown below:

Ignorance and denial

'I don't use it because I have never used it all this while and I have not had any eye injury. Some people can have injury o, but me, I have not had any so I don't see the need'… 36-year-old furniture expert.

'For someone who is just learning, hitting 'tornado' nails is very difficult and sometimes it can bounce and enter the eye… but the problem is that we don't know where to buy that type of eyeglass from'… 29-year-old apprentice.

Unfamiliarity and dissatisfaction with protective eyewear

'I know that it is important and useful, but the fact is that I am not used to it. I was not trained with it'… 56-year-old furniture and roof expert.

'I don't see well with it. Some of those special eyeglasses makes things to look bigger and so I can mistakenly hit myself with nail'… 53-year-old cabinet maker.

'I have never used it (PEW) because I have never seen anyone who used glasses for carpentry work'… 53-year-old furniture maker.

Forgetfulness

As for me, I know that it is very important because I even have eye problems. Most of other people are just ignorant of it. but sometimes, I forget to use it'… 35-year-old carpenter.

'I know it is useful, but sometimes, I forget to use it. Now, I have tied a strap around it so that I will not be forgetting'… 51-year-old furniture expert.


  Discussion Top


To the best of our knowledge, this is the first survey to evaluate the ocular health and safety among carpenters in Nigeria. Previous reports have either focussed on ocular morbidity, awareness and utilisation of protective eye devices among other set of artisans; or general work safety among carpenters.[5],[6],[7],[8],[9],[10],[11] Thus, our data add to the existing information on ocular safety at the workplace among artisans.

The mean age of the respondents in this study was slightly higher than the mean age of 31.75 and 39 years reported by Oduntan [5] as well as Ajayi and Omotoye [6] respectively, among welders in their studies. The older age group in this study may be a reflection of a changing trend of career choices in our society, with the youth engaging less in learning skilled trade but more in lucrative white-collar jobs or daily-income money-spinning jobs such as commercial bike riding or cab driving. This was reiterated by a higher number of masters when compared to apprentices in this study and was the opinion of a number of masters when discussing the challenges facing artisan apprenticeship. There was no female among the respondents in this study, which was similar to the studies by Edema et al.[7] and Eze et al.[12] This reiterates the fact that females in this environment rarely engage in technical artisan jobs.

The mean work experience in this study was higher than observed in other studies.[5],[8],[9],[11],[12] This difference may be due to the older age group in this study and may also reflect the paucity of apprentices with a change in the trend of career choices. Most of the respondents trained through apprenticeship. This was similar to other studies in Nigeria, in which majority of the respondents trained through apprenticeship.[10],[11],[12] Artisans in developing countries like Nigeria are more commonly trained via hands-on apprenticeship.[11] Technical and vocational education in Nigeria lacks adequate funding, personnel, facilities and staff motivation, which may deter potential trainees from enrolling.[13],[14] Furthermore, vocational schools require payment of tuition fees while apprenticeship may actually provide some pocket money for the trainees during the training period.

The prevalent eye disorders among the respondents in this study were uncorrected refractive errors, cataract and glaucoma suspect. Uncorrected refractive errors, cataract and glaucoma are common causes of visual impairment in our environment as reported in the Nigerian National Blindness and Visual Impairment Survey and thus, this finding is a reflection of the larger population.[15] In addition, the older mean age of the respondents in this study may account for age-related conditions like cataract. Pingueculum and pterygium were found in 15.8% and 9.2% of the respondents, respectively. Conjunctival degenerative diseases like pterygium have been thought to occur more frequently with exposure to ultraviolet radiation and irritants such as dust, wind and chemicals.[16] Since carpenters often work outdoors and are commonly exposed to ultraviolet rays, sawdust and spray fumes; these may increase the likelihood of degenerative conjunctival changes.

The level of awareness of PEW in this study was lower than 98.9% reported among steel workers [9] as well as 90.6%[6] and 99.4%[12] among welders. This may suggest that the concept of eye protection is less popular among carpenters when compared to other artisans as was deduced from the in-depth interview, in which some participants reported that PEW was not common practice among carpenters because they were not trained with PEW awareness. The most popularly known PEW among the respondents was eye goggles, which was a similar finding in other studies.[8],[9],[12]

This study showed low level of utilisation of PEW with only 26.3% of the respondents using PEW occasionally, which was similar to the observation made by Abu et al.[8] and Ademola-Popoola et al.[9] Higher levels were reported by Ajayi et al[6] and Oduntan [5] among welders. This may be due to reasons such as the obvious radiation exposure associated with welding or the projectile nature of the offending foreign body, thus prompting the use of PEW. There was a statistically significant positive relationship between previous eye injury, work-related eye complaint and the use of PEW. This finding was similar to that reported by Ajayi et al[6] in which a higher proportion of those who used eye protection always, had a previous ocular injury. This suggests a reactive approach as opposed to a proactive approach to job safety, in which individuals comply with safety precautions when they have had previous negative experience. In addition, those who had no prior eye injury may feel no need for eye protection as was reported and suggested by some respondents during the in-depth interview.

The reasons for poor utilisation of PEW in this study included the lack of possession, lack of felt-need, discomfort with PEW use, ugly designs and forgetfulness among others. These were also reported in other studies.[8],[11],[12],[17] This suggests that the availability and accessibility of ergonomic PEW may help to improve compliance. From the in-depth interview, some participants also reported that the lack of familiarity and not 'growing up' with PEW use also mitigated utilisation. Thus, training younger apprentices with emphasis on this safety precaution may help foster compliance over time.

Some of the limitations of this study are the lack of a focussed group discussion which would have enriched the qualitative probe. However, the nature of their jobs made it difficult to gather the carpenters in groups. Furthermore, incentives like the distribution of free safety glasses may have biased their responses, but this was minimised by distributing the glasses at the end of the survey.


  Conclusions Top


This study revealed a low level of utilisation of PEW among carpenters in Mushin Local Government. It further demonstrated a significant association between PEW use and previous work-related eye injury as well as eye complaint. The main barriers to the use of PEW wear were lack of possession, lack of felt-need and ignorance.

We recommend regular eye health education with an emphasis on eye safety at work, availability of affordable, ergonomic PEW devices and advocacy for legislative enforcement of occupational and eye safety regulations. The monthly meetings of the carpenters' association provide a good avenue for regular sensitisation while the establishment of eye injury registers may form the basis for advocacy.

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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sukati VN. Workplace eye injuries: A literature review. Occup Health S Afr 2014;20:18-22.  Back to cited text no. 1
    
2.
Wong TY, Tielsch JM. Epidemiology of ocular trauma. In: Duanes TD, Tasman W, Jaeger EA, editors. Duanes Clinical Ophthalmology [DVD-ROM]. 2011 Edition. Philadelphia: Lippincott Williams and Wilkins; 2011.  Back to cited text no. 2
    
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Blais BR. Basic principles of occupational ophthalmology. In: Duane TD, Tasman W, Jaeger EA, editors. Duanes Clinical Ophthalmology [DVD-ROM]. 2011 Edition. Philadelphia: Lippincott Williams and Wilkins; 2011.  Back to cited text no. 3
    
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Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci 2006;1:9-14.  Back to cited text no. 4
    
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Oduntan AO. A survey of eye safety practices among welders in Nigeria. Clin Exp Optom 1998;81:29-33.  Back to cited text no. 5
    
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Ajayi Iyiade A, Omotoye Olusola J. Pattern of eye diseases among welders in a Nigeria community. Afr Health Sci 2012;12:210-6.  Back to cited text no. 6
    
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Abu EK, Boadi-Kusi SB, Opuni PQ, Kyei S, Owusu-Ansah A, Darko-Takyi C. Ocular health and safety assessment among mechanics of the Cape Coast Metropolis, Ghana. J Ophthalmic Vis Res 2016;11:78-83.  Back to cited text no. 8
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Ademola-Popoola DS, Akande T, Ayanniyi A. Ocular health status and practises among the workers of a steel rolling mill in Nigeria. Cent Eur J Occup Environ Med 2005;11:163-8.  Back to cited text no. 9
    
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Sabitu K, Iliyasu Z, Dauda MM. Awareness of occupational hazards and utilization of safety measures among welders in Kaduna Metropolis, Northern Nigeria. Ann Afr Med 2009;8:46-51.  Back to cited text no. 10
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Bolaji AO. Analytical study of carpenters attitude towards safety and occupational health practice in Oyo state of Nigeria. J Hum Ecol 2005;18:99-103.  Back to cited text no. 11
    
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Eze BI, Okoye O, Aguwa EN. Awareness and utilization of welders' personal protective eye devices and associated factors: Findings and lessons from a Nigerian population. Workplace Health Saf 2015;63:170-8.  Back to cited text no. 12
    
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Okoye R, Arimonu MO. Technical and vocational education in Nigeria: Issues, challenges and a way forward. J Educ Pract 2016;7:113-8.  Back to cited text no. 13
    
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Adewale P, Siyanbola A, Siyanbola S. Building craftsmanship skill development and Nigeria's vision 20: 2020: Imperatives and daunting challenges. Int J Vocat Tech Educ 2014;6:36-42.  Back to cited text no. 14
    
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Abdull MM, Sivasubramaniam S, Gudlavalleti MV, Gilbert C, Abubakar T, Ezelum C, et al. Causes of blindness and visuaaal impaairment in Nigeria: The Nigeria national blindness and visual impairment survey. S Afr Med J 2011;101:53-8.  Back to cited text no. 15
    
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Ginger-Eke HA, Ogbonnaya CE, Ezisi CN. Pterygium: Recent trends and persppectives – A review of pathogenesis and current management options. Niger J Ophthalmol 2018;26:89-98.  Back to cited text no. 16
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Ajayi IA, Adeoye AO, Bekibele CO, Onakpoya OH, Omotoye OJ. Awareness and utilization of protective eye device among welders in a Southwestern Nigeria community. Ann Afr Med 2011;10:294-9.  Back to cited text no. 17
[PUBMED]  [Full text]  


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