• Users Online: 201
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 86-89

A research study on morbidity including silicotuberculosis among the mine workers of Rajasthan


1 Executive Director, GRAVIS, India
2 Prof & Head, Dept of Community Medicine, GMERS Medical College, Valsad, Gujarat, India

Date of Web Publication21-Aug-2018

Correspondence Address:
Rajesh Mehta
Prof & Head, Dept of Community Medicine, GMERS Medical College, Valsad, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.239500

Rights and Permissions
  Abstract 


Background: Stone mines of Western Rajasthan are famous worldwide for its sandstone and white marble. In the drought-stricken state of Rajasthan (in particular in its Western part) mining provides essential support to livelihood generation to more than 2 million people. Mineworkers in these mines work in unsafe conditions, are underpaid, undernourished and suffer with various health problems like silicosis and tuberculosis. This inspired us to estimate the morbidity profile of the mine workers in Jodhpur district of Rajasthan.
Material and methods: Using purposive sampling, 221 workers who responded to an appeal for health check up at the various mines and/or at the residential habitats were selected and conducted between August 2009 and April 2010. The collected data was analyzed by using Epi Info3.4.1.
Results: Age group of the workers was from 15 to 84 years. 28.6 % of workers were below the age of 30 years. 80 % and 52% of workers were addicted to tobacco and alcohol respectively. 25.33% of workers had past history of tuberculosis treatment. The various complaints of the workers were breathlessness (32.1%), chest pain (24.4%), cough (31.7%) etc. The miners were suffering from chronic respiratory tract infection (21.3%), silico-tuberculosis (11.3%), had digestive tract problem (24.4%), joint problems (23.3%) etc.
Conclusions: Looking at poverty, lack of opportunity for other employment for livelihood, lack of health & legal monitoring, absence of treatment for silicosis etc., enormous efforts are required to prevent silicosis in new generation and handle the old cases in a humane manner. But preventable nature of conditions along with huge support of NRHM, voluntary organizations and research together can make a difference in these long lasting problems

Keywords: silico-tuberculosis, miners, health profile, Jodhpur


How to cite this article:
Tyagi P, Mehta R. A research study on morbidity including silicotuberculosis among the mine workers of Rajasthan. J Integr Health Sci 2013;1:86-9

How to cite this URL:
Tyagi P, Mehta R. A research study on morbidity including silicotuberculosis among the mine workers of Rajasthan. J Integr Health Sci [serial online] 2013 [cited 2021 Dec 3];1:86-9. Available from: https://www.jihs.in/text.asp?2013/1/2/86/239500




  Introduction Top


Stone mines of Western Rajasthan are famous worldwide for their sandstone and white marble. In the drought-stricken state of Rajasthan, and particularly in its Western part, mining provides essential support to livelihood generation. Thousands of mines employ a large number of people with overall estimate for the state exceeding 2 million people. Mineworkers in these mines work in unsafe conditions, are underpaid and undernourished, and suffer from various health problems.

Silicosis and tuberculosis are two commonly found respiratory diseases that mineworkers suffer from. The risk of developing pulmonary tuberculosis is reported to be 2.8 to 39 times higher in patients with silicosis than for healthy controls.[1],[2],[3] The risk of a patient with silicosis developing extra-pulmonary tuberculosis is also as much as 3.7 times higher than in healthy controls.[4],[5] The pleural form is most common, accounting for 61% of the cases,[5] followed by the pericardial form and the lymph node form.[4] Silicosis is a dust-borne disease that causes irreversible and fatal changes in the lung tissue. Tuberculosis is infectious and caused by mycobacterium tuberculosis. Both silicosis and tuberculosis are potentially life threatening diseases. While TB can be cured completely with adequate medication, silicosis can only be provided palliative support. Mineworkers suffering from either of these diseases, have a great risk of developing the other disease. Co-existence of silicosis and tuberculosis is known as silico-tuberculosis, prevalence of which is high in stone miners of Rajasthan. Silico-tuberculosis over the years has affected mining community profoundly causing significant social and economic loss. Therefore, we decided to document the extent of problem along with recommendation to solve the same.


  Methods Top


Study design:

The study was cross sectional study. The study was started after institutional ethics committee clearance form Gravis.

Population and sampling:

All mine workers of desert districts of Rajasthan in general and stone mines situated in vicinity of Jodhpur city in particular were considered as the population for sampling. (This included retired mine workers meaning workers who had to stop working because of illness or incapacity to work.) Due to inbuilt resistance of mine owners & pressing need of workers to work, it was not possible to take systematic random sample from a ready sampling frame. Also list of all workers was not available as, often, it is rotating short term work assignments in particular mines. It is estimated that around 100,000 workers are working in mines in study area. Therefore it was decided to go ahead with self selected sample of mine workers who responded to an appeal for health check up at various mines and/or at the residential habitats by workers of GRAVIS. However it was decided to include all major areas where mines are located. Following mining areas were visited for the study: Mandor, Kaliberi, Sursagar, Keru, Balesar, Gagari, 11 Mil, Bhat Basti, Belclor Basti and Ambedkarnagar. There are all chances that either cooperative workers came forward or workers who felt need of check up came forward. Overall, 221 mine workers underwent medical check-up. Though there was no invasive intervention, oral consent was taken from each subject under study after explanation in local language. As this is not strictly representative population based study of mine workers , word prevalence will be difficult to use in its strict scientific meaning , however as there is no systemic bias, with its due limitation, in this study, we will use the term prevalence of various morbidity among the population of the workers who had undergone the study.

Period of the study

The study was conducted between August 2009 and April 2010.

The team

The doctor, medical students and paramedical staff - all were well trained, they were oriented by the community health expert, and special additional training was given for respiratory function test to team of two persons. One of the team members was local resident who had knowledge of local language & had postgraduate qualification and other team member was having medical background with more than 10 years of experience. Both were working in a team at the time of respiratory function tests. Proper explanation was given to mine workers before each test. In case of unsatisfactory results repeat test was carried out. The instrument used for respiratory function test was a computerized machine (Med Spiror – made by a company having research department approved by Department of Science & Technology of Government of India)

Tools of data collection: Detailed tools were developed and were pretested.

  1. Medical check-up by doctor with help of medical students- Medical check-up of 221 mine workers.
  2. Respiratory function test by trained medical persons - Respiratory function tests were carried out in 77 workers out of 221 workers examined by medical team. It was possible to carry out respiratory test only in month of November as instrument was available only during that period. In addition to examination at site, as per the necessity, patients were advised referral to nearby government or charitable health care facility. Appropriate advice for follow up was given. Patients were also advised for necessary investigations, but it was not possible to collect and incorporate additional findings in analysis. For diagnosis, judgment was made based on the symptoms and clinical signs and mainly it was classified according to the system affected when it was not the focus of study. For respiratory diseases, help of X-ray findings, sputum for AFB and other investigations were used if already patient had report of the same. Support of respiratory function test was taken as additional tool for making judgment. Case records were also used for obtaining past history, when available, particularly for Tuberculosis.


Data-Analysis

The data collected was entered in excel and data was verified in minimum 10% of subjects and then final analysis was carried out on that data-set by EPI INFO - software prepared by the WHO. As the interest was mainly to document morbidity, frequency analysis was largely used.


  Result Top


The work was done in two phases. In September, health check up of 124 (56.1%) workers was carried out and in November, health check up of 97 (43.9 %) workers was carried out. Mean age of the workers was 40.7 years. Youngest person was aged 15 years & eldest worker was having age 84 years. Almost 28.6 % of workers were below the age of 30 years. Addiction was highly prevalent in mine workers, 80 % were having addiction of tobacco & 52 % were having addiction of alcohol. Past history of treatment of tuberculosis was available in 56 (45%) cases of mine workers. Out of that, 47 (83.92%) patients had completed treatment or they have taken treatment for more than or equal to six months. About 9(16.08%) patients had taken treatment for less than 5 months. 88 (74.6 %) workers out of 118 had poor hygiene. Average pulse rate was 82. (Out of 215, 8% had pulse rate more than 100 which suggested poor health). Average BMI was 20.9. 57 % workers were having BMI < 20. Out of 158 workers examined, 16(10.2%) had cataract & 64(40.51%) had refractory error. Out of 114 workers examined for deafness, 1 (0.9%) worker had total deafness & 8(7.0%)workers had mild deafness. Out of 135 workers examined for dental problems 114 (84 %) had discoloration of teeth, mainly due to tobacco habits, 55 (40.7 %) had dental caries and 1 worker had bleeding gums. Out of 117, 14(12%) workers had enlargement of cervical lymph node & 1(0.8%) had cold abscess on right side of neck. Out of 126, 25(20%) workers had pain in upper limb and 35 (27.7 %) had pain in lower limbs. Out of 119 workers, 4(3.4%) had varicose vein. On examination of respiratory system, crepitation, rhonchi or reduced air entry were found in 80(36.2 %) patients. Total 69 patients were referred for x-ray investigation. Out of these, 53 (76.8 %) patients required x-ray chest and rest of the patients mainly required x-ray of various joints. 39 patients were referred to undergo investigations for sputum AFB. Breathlessness (32.1%) was the most common symptom, followed by cough (31.7 %) and chest pain (24.4 %). All these indicate mainly respiratory system involvement. Headache (14 %) and fever (13.6 %) are also among the commoner symptoms. Most of the workers had respiratory system related symptoms (58.8 %).

On examination, more important findings were pairing of pulmonary tuberculosis and silicosis (11.3 %). Absolute percentages of tuberculosis ( 17.2 % ) and silicosis ( 14. 9 % ) are likely to raise if we do further follow up and investigate all cases of chronic and asymptomatic respiratory tract problem. Digestive system problems (24.4 %), joint problems (23.1 %) and Hepatomegaly (10.9 %) are also major problems. Respiratory function tests were carried out in all workers when it was feasible during second phase of medical check-up irrespective of symptoms or findings of patients. Computerized value of Forced Vital Capacity and FEV1/FVC were used to draw inference. It was clear that respiratory functions were normal in 29 % of workers having other complains, while it was normal only in 18 % of workers having respiratory problems. Indirectly this is suggestive of possibility of good validity of respiratory function test. Most striking difference was seen in severe restrictive pattern which was present in 15% workers having respiratory problems compared to 3% of workers having other problems.


  Discussion Top


Almost 24% of workers were above 50 years of age, but many of them were not working at present because of ill health. High prevalence of addiction among workers leads to increase in occurrence of silicosis as well as tuberculosis due to decrease in resistance and poor nutrition. About 26% had respiratory rate more than 20 per minute which is suggestive of poor respiratory system or general conditions like anemia, malnutrition etc. almost 57% workers were having BMI less than 20 which is suggestive of rampant malnutrition. Lack of sufficient calorie balance in diet leads to protein depletion as it is utilized for giving energy at the cost of its primary function of production of immunity and other vital functions. Among the various patterns of abnormal respiratory function tests, most common finding was restrictive pattern which suggests damage to lung tissues instead of simple obstruction. It was not possible to include more subjects which would have given more clarification. Almost all asymptomatic patients of respiratory tract problems (found to be so based on clinical ground) had abnormal respiratory function test. This is clear indication that such non-invasive test which is cheaper and feasible in such set up can be used more extensively.


  Conclusion Top


Morbidity in mine workers is unacceptably high. The current study has shown that with help of volunteers of medical colleges it is possible to document the problem. Next phase of solutions can also be tried out. The hope is definitely there because of existence of many positive observations like good rapport of voluntary organization with workers, mine workers have opportunity to work in united manner in a small or large groups , unions are already formed , some of the employers are ready to listen to newer changes required , technology for reduction of dust production is available, legal action are likely to take shape in near future , national health insurance scheme for BPL families by government is likely to take momentum etc.

Acknowledgement:

  • - Mine workers who underwent health check up & educational programme
  • - Mr. Mahitosh Bagoriya, Mr. Vinod Kumar and other GRAVIS staff for supporting study
  • - Students of Kesar SAL medical college
  • - PG students of community medicines of Medical college of Vaghodia, Baroda and PS Medical college, Karamsad.
  • - Mr. Jagdish Patel , occupational health expert for technical support
  • - HEDCON, Jaipur for technical support Financial support - MISEREOR, Germany




 
  References Top

1.
Calvert GM, Rice FL, Boiano JM, Sheehy JW, Sanderson WT. Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States. Occup Environ Med. 2003;60(2):122-9.  Back to cited text no. 1
    
2.
Hnizdo E, Murray J. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occup Environ Med. 1998;55(7):496-502. Erratum in: Occup Environ Med 1999;56(3):215-6  Back to cited text no. 2
    
3.
Corbett EL, Churchyard GJ, Clayton T, Herselman P, Williams B, Hayes R, et al. Risk factors for pulmonary mycobacterial disease in South African gold miners. A case-control study. Am J Respir Crit Care Med. 1999;159(1):94-9.  Back to cited text no. 3
    
4.
Cowie RL. The epidemiology of tuberculosis in gold miners with silicosis. Am J Respir Crit Care Med. 1994;150(5 Pt 1):1460-2.  Back to cited text no. 4
    
5.
A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council. Am Rev Respir Dis. 1992  Back to cited text no. 5
    



This article has been cited by
1 Silico-tuberculosis, silicosis and other respiratory morbidities among sandstone mine workers in Rajasthan- a cross-sectional study
Saranya Rajavel,Pankaja Raghav,Manoj Kumar Gupta,Venkiteswaran Muralidhar,Hans-Uwe Dahms
PLOS ONE. 2020; 15(4): e0230574
[Pubmed] | [DOI]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methods
Result
Discussion
Conclusion
References

 Article Access Statistics
    Viewed897    
    Printed60    
    Emailed0    
    PDF Downloaded94    
    Comments [Add]    
    Cited by others 1    

Recommend this journal