Abstract for Poster 1

 

 

Dermal Injuries in Hands Among Women in Fish Processing Works

A. Nag*¹, K. Elgstrand², A. Saha¹, P.K. Nag^1
1National Institute of Occupational Health, Ahmedabad 380 016, India
²National Institute for Working Life, Stockholm, Sweden

Background

In the sea-coast provinces of India, the sea fish processing is a promising export-oriented business with annual growth of about 7-8%. Data from some countries show that the work stress in fish processing activities is considerably high due to the productivity demands and partly to the varieties of manual tasks performed to ensure the products' values. The issues concerning the working conditions cover a range of aspects, including cold and wet working, exposure of hands to ice cold chlorinated water, fish protein related allergens through inhalation and skin contacts, use of unsafe hand tools, sustained standing work with unregulated working hours, etc. Prevalence of skin rashes and allergies (Jeebhay et al. 2000), protein contact dermatitis (Jeebhay et.al. 2001), eczema (Veien et al. 1983), Raynaud’s phenomena in hands (Mackiewicz and Piskorz 1977), warts (Kilkenny and Marks, 1996) and occupational asthma (Rodriguez et al. 1997) have been reported among the fish processing workers. There are reports of musculo-skeletal discomfort (Olafsdottir and Rafnsson, 2000) among the workers. The present investigation elucidates the work related hazards associated with fish processing activities with special reference to dermal injuries on hands and the possible preventive measures to reduce the hazards.

Methods

Approximately 0.2 million women are engaged in fish processing activities in the sea coast provinces of India and they outnumber men in the sector. A survey was conducted in four fish processing units in the sea coast of Gujarat, the western province of India. Usually, the catchments of fishes from the deep sea are brought in to the industrial units, where the processing work starts. Following washing of fishes in chlorinated water, the women stand in a row near the work desk, where the final sorting of the fishes are done with bare hands (Figure 1). The ice is constantly poured on the work desk to maintain quality of fishes. The floor of the processing area is abundant with water. Once the sorting is over, processing is undertaken for three activities — (1) the whole fishes are packed in boxes, (2) for prawn and squid, shells and skins are peeled, tentacles and heads are removed, and packed in different sizes, and (3) squids are cuts into rings, hardened and packed. The packed fishes are then transferred to cold storage and subsequently dispatched.

One hundred and eighty five women engaged in fish processing work were assessed to find out the hazards and the complaints associated with their work with reference to skin problems and symptoms in hands. In order to examine the skin temperature profile of the hand areas, the initial and after 2-hour work exposure, the skin temperatures of the fingers, palms, and lower arm were measured. The palms of the women were examined for any sign of Raynaud’s phenomena, blanching and numbness, after 2-hour of fish processing work.

An intervention program was implemented for hand protection against exposure to ice-cold water, direct contact with fish protein allergens and the sharp thorns of the sea fish. Only 47 women, who complained of pain and numbness, and manifested blanching and Raynaud’s phenomena in hands, were asked to wear rubberised hand gloves and undergo their usual routine work for similar duration in the first half of the morning shift. Therefore, the women served as their own control in the experiment. The women were advised to continue using the gloves for the remaining workday to monitor the symptoms at the end of the workday. The gloves were chosen considering the size of the hand and rubberised material that may be suitable for the tasks to be performed.

 

 

Figure 1. Fish processing activity

 

Results and discussion

The women involved in fish processing work are the young workers, with average age being 24.4 ± 7.4 years, and about 80% of the women belonged to the age range between 15 and 30 years. They were socio-economically poor and had work experience of 3-11 years.

The inclement working conditions of the fish processing industries pose health hazards to the women workers. The hands and fingers of the women were worst affected due to handling of ice-cold water and sea fish (Figure 2) in course of cleaning, sorting, peeling, deveining, cutting, slicing and packing of fishes. The blanching of fingers (72%), hand numbness (30%), repeated cut injury (50%) and dermatitis in hands and feet (10%) were prevalent among these women. The skin injury (Raynaud’s phenomena) in palm was observed among 61% of the women (Figure 3).

 

 

 

Figure 2. Dermal injuries in hand

 

 

 

 

Figure 3. Dermal and cut injuries in hands of women

 

 

The average palm and finger temperatures of the women during work were 25.6 ± 3.0 and 20.0 ± 1.5°C respectively (Table 1), which were about 5°C less than the pre-exposure values. On the other hand, the temperatures of the finger (front and back) during work exposure were as low as 20 ± 1.5 and 20.3 ± 1.4°C respectively, i.e., about 9°C less than the pre-exposure values. Such a significantly large skin temperature drops of the hand area by itself manifested in cold-induced dermal symptoms such as numbness of fingers, blanching and Raynaud’s like phenomena in hands. Based on study on Danish fish processing workers, Sorensen and Pedersen (1991) reported low skin temperature, low transepidermal water loss and low skin blood flow during work. It is likely that the damage to the skin caused by the irritants and allergens makes the skin vulnerable to thermal injuries, and vice versa.

 

 

 

The wearing of gloves substantially improved the skin temperatures of the hands and fingers. While the wearing of gloves for duration of 2-hour exposure could not bring the hand skin temperatures to the initial resting level, the improvements were found to be statistically significant at 1 percent level. This observation was further substantiated by a remarkable improvement in the onset of Raynaud’s phenomena, blanching and numbness of hands. As large as 84% of the women did not show any blanching of fingers and other cold induced symptoms with the wearing of gloves. With the continuing use of the gloves for the rest of the workday, all the women, including 16% of them who had still developed the cold-induced symptoms in spite of wearing the gloves, expressed satisfaction in their voting in comfort scale in wearing of the gloves and there was no reduction in their work performance and productivity. 

Conclusion

The dermal injuries of hand among women associated with the fish processing work poses a great health concern. It is likely that the combined effects of exposure of bare hands with the ice-cold water and other irritants manifest skin symptoms. A simple work intervention of advocating wearing of gloves might bring effective changes in the safety and health of women in the sector.

References

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Jeebhay MF, Robins M, Lehrer SB, and lopata AL, Occupational seafood allergy: a review, Occup Environ Med, 58: 553-562, 2001

Halkier-Sorensen L and Thestrup-Pedersen K, Skin Physiological Changes in smployees in the fish processing industry immediately following work. A field study, Contact Dermatitis, 25: 19-24, 1991

Kilkenny M and Marks R, The descriptive epidemiology of warts in the community, Australas J Dermatol, 37: 80-6, 1996

Mackiewicz Z and Piskorz A, Raynaud’s phenomenon following long-term repeated action of great differences of temperature, J Cardiovasc Surg 18: 151-154, 1977

Olafsdottir H and Rafnsson V, Musculoskeletal symptoms among women currently and formerly working in fish- filleting plants, Int J Occup Environ Health, 6: 44-49, 2000

Rodriguez J, Reano M, Vives R, Canto G, Daroca P, crespo JF, Vila C, Villarreal O, and Bensabat Z, Occupational asthma caused by fish inhalation, Allergy, 52: 866-869, 1997

Veien NK, Hattel T, Justesen O, Norholm A, Causes of eczema in food industry, Derm Beruf Umwelt, 31: 84-86, 1983

 

Content last modified: 15 May 2005