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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES ACADEMY OF MEDICINE FACULTY OF PUBLIC HEALTH DEPARTMENT OF ENVIRONMENTAL AND OCCUPATIONAL MEDICINE

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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES

ACADEMY OF MEDICINE

FACULTY OF PUBLIC HEALTH

DEPARTMENT OF ENVIRONMENTAL AND OCCUPATIONAL

MEDICINE

Author

Sagar Bhalala

PEOPLE WORK IN CHEMICAL MANUFACTURING COMPANIES AND

SUBJECTIVE HEALTH PROBLEMS

GUJARAT, INDIA

Master thesis (Public Health)

Student

Sagar Bhalala

Supervisor

Prof. Rūta Ustinavičienė

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INDEX

1. Summary………..4

2. Acknowledgment………...5

3. List of abbreviation……….…….6

4. Aim and objectives………..…7

4.1 Aim ………...7

4.2 Objectives………..…..7

5. Introduction………...8

6. Review of literature………...10

6.1 Chemicals and their effect of human body parts/systems……….10

6.2 Particular chemicals which capable to induce health problems………12

7. Methodology of a research……….…22

7.1 Research method………...22

7.2 Data collection……….…..22

7.3 Data analysis……….….23

8. Results ………...…...25

8.1 Characteristic of the respondents………...……25

8.2 Analysis of working hours among respondents………...…….26

8.3 Effect of chemicals on different health problems……….…….28

8.3.1 Effect of chemicals on general Health problems………...28

8.3.2 Effect of chemicals on respiratory related health problems……….…...33

8.3.3 Effect of chemicals on skin related health problems……….…..35

8.4 Relation of health problems with working hours with chemicals in the work environment……….….38

8.4.1 Relation between working hours with general health problems……….….39

8.4.2 Relation between working hours with respiratory related health problems………40

8.4.3 Relation between working hours with skin related health problems………...41

8.5 Relation between work experience with health problems……….42

8.6 Correlation matrix of variables (age and health problems)………..….44

9. Conclusion……….46

10. Discussion………..49

11. Limitations of the study……….50

12. Practical recommendation………..51

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3 14. References……….54 15. Annex 1………...58 16. Annex 2……….60

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1. Summary

The researcher: Sagar Kishorbhai Bhalala

Topic: People work in chemical manufacturing companies and subjective health problems, Gujarat,

India.

Aim: To assess the subjective health problems of people who are working in chemical manufacturing

companies in Gujarat, India.

This thesis is an initial attempt to evaluate workers' health problems as a result of the chemical industry's work. The study examined health problems caused by various chemicals in epidemiological research. Multiple health problems were caused by chemical factors. Work experience and working hours with chemical repercussions on the health condition of the selected population workers.

This study involved participants and an original questionnaire was first provided. Once our survey has been completed, the data input has been analyzed. Upon input, further research was performed with calculations and other methodologies. Frequencies and comparisons were calculated and demonstrated between different variables in line with the objectives and the study needed for research objectives was carried out. Different chemicals have caused different health conditions. Age is also at some point a major factor in high health risk.

The highlights of the study was ‘effect of working hours with chemical leads to more health problems’. Work experience was also one of the spotlight of major findings in this research. Results were constructive in case of many health problems from general, respiratory and skin related health problems.

However this study was mainly focus on effect of work pattern in relation to health problems among selected population. This can be questionable to research perspective. Safety measurements can be carry forward in this research as a future standpoint of this field. Overall results were to the expectations of researcher and demonstrate positive approach to the field of science.

Key words: chemical workers, health problems, working hours with chemical,

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ACKNOWLEDGEMENT

It is time of gratification and pride to look back with a sense of satisfaction on this long journey; with all my heart I want to thank each one of them. Many people have played a role in allowing me to give my thesis a concrete form. Time and space constraints prevent all of them here from being mentioned. First and foremost I give thanks to the all-knowing, all-present, all-powerful, GOD who has always sponsored myself with controversy and love.

Words are insufficient to convey my profound sense of thankfulness. I sincerely feel that my Father Mr. Kishorbhai N. Bhalala must have all credits for his consistent prayer, loving blessing, self-satisfaction and an unending trust in me. I sincerely believe that I would never have arrived at the stage of writing this recognition without my family's support. I am grateful to the honorable mother Mrs. Nitaben K. Bhalala who always gives me strength and inspiration and sincerely aspires to see me pursue higher education. I am grateful for this opportunity wholehearted.

Friendship is always a good thing and never a chance. My deepest feeling of debt towards my best friends is difficult for me. Thanks for always listening, supporting and encouraging me. I thank you all, my best friends Vishal, Krishna, Arzoo, Maitri, Parth, Hiren, Anjali, Ravi and Haritha. As a friend of yours, my life has added bright spots.

I am indebted to the deep inspirer my esteemed guide Dr. Prof. Rūta Ustinavičienė, department of environment and occupational medicine. Her words of advice have been etched in my heart and I will always endeavor to hold up her ideas. Her simplicity, untiring and meticulous guidance, caring attitude be cherished in all walks of my life. I thank for bringing out the besting me.

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3. Abbreviations:

HCL- Hydrochloric acid H2SO4- Sulfuric acid HNO3- Nitric acid H3PO4- Phosphoric acid

WHO - World Health Organization

IARC - The International Agency for Research on Cancer BTXE - benzene, toluene, xylene and ethylbenzene Mn - manganese

CI - confidence interval

SMR - standardized mortality ratio UK - The United kingdom

U.S.A. - United states of America DMF - dimethylformamide

TCDD - 2,3,7,8- tetrachlorodibenzo-p-dioxin OR - odds ratio

RR - risk ratio

SIR - standard incidence ratio ATS - American Thoracic Society AML - acute myeloid leukemia

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4. Aim and objectives

4.1

Aim:

To assess the subjective health problems of people who are working in chemical manufacturing companies in Gujarat, India.

4.2

Objectives:

• To assess average amount of time they work with chemical materials.

• To evaluate health complaints in relation by different kind of chemicals and materials. • To evaluate effect of working hours with chemical leads to increase health problems.

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5. Introduction

India is the world’s largest democracy and second most densely populated country. Industrialization can solve economic development problems as its main goals are to reduce income i nequalities, increase national income, and alleviate poverty. As per the Census 2001, the Indian workforce is over 400 million strong, which constitutes 39.1 % of the total population of the country. In respect to this “Manufacturing Industries” employed about 42 million (13.4%) of the total working population. It becomes very indispensable for the country that all these workers should work in safe and healthy environment. It is the responsibility of every worker to well aware of their rights for environmental health and safety policies. A safe and healthy work environment is right of every worker in the industry. Workers are the back bone of any industries, if workers are fit and healthy (mentally and physically) then it will help any industries to grow swiftly. Surat is the one of the growing city of chemical industries of Gujarat state of India. Industries in Surat are emerging as key foundation for employment in the city. Apart from knowledge based industries it has witnessed the growth of many manufacturing industries of chemical.

WHO (World Health Organization) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. According to the WHO Study Group on Early detection of Health Impairment in Occupational Exposure to Health Hazards: Health connotes rather a way of functioning within one's environment (work, recreation, living). It not only means freedom from pain or disease, but also freedom to develop and maintain one's functional capacities. Health develops and maintained through interaction between the genotype and the total environment. The work environment constitutes an important part of people's total environment, so health is to a large extent affected by work conditions. (WHO, 1975).

Chemicals have become an indispensable part of human life, All living and non-living material is made up of chemicals and practically every manufactured product involves the use of chemicals. Many chemicals can, when appropriately used, suggestively contribute to the enhancement of our quality of life, supporting activities and development, preventing and controlling many diseases, and increasing agricultural productivity, health and well-being. In the face of their benefits, chemicals may, particularly when misused, cause adverse effects on human health and environmental integrity. Widespread submission of chemicals all over the world increases the probable of adverse effects. Evolution of chemical industries, both in emerging and in developed countries, is predicted to increase.

As new industries develop, existing industries expand, and new technology is introduced, the environment is progressively placed at risk and hazards to human health arise. History has shown that

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9 industrial revolution is rarely matched in speed with equivalent protection of the community and its environment. It is estimated by the International Labor Organization that some 200,000 work-related deaths occur each year all over the world. In addition, a large number of workers are victims of work-related accidents and illnesses.

Chemical (industrial) hazards are short in frequency but are significant in terms of potential loss of lives, injuries, environmental impacts, property damage, and socioeconomic implications. The frequency and severity of chemical hazards have increased in recent years due to the rapid development of the largest chemical industries - production and formulation, petrochemicals, pharmaceuticals, agrochemicals, industrial chemicals, and hazardous chemicals-oil deposits, exploration/extraction and reclamation sites, and so on. Increasing the size of plants, deposits, and conveyors, especially in tightly populated areas, represented the greatest risk and vulnerability to these dangers.

According to WHO (World Health Organization) Further information on the 10 chemicals or groups of chemicals of major public health concern can be found from the following: Air pollution, Arsenic, Asbestos, Benzene, Cadmium, Dioxin and dioxin-like substances, Inadequate or excess fluoride, Lead, Mercury, Highly hazardous pesticides.

In the chemical industry, emerging approaches to assess the health risks associated with dermal exposure and skin penetration of chemicals has typically received less emphasis that other exposure scenarios, especially inhalation. With improved controls of inhalation exposures, the relative contribution of dermal exposure and subsequent skin penetration to potential health risks has become higher (1,2,3).

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6. Literature review

In 2017 (Rajasthan, India ), a recent overview was on chemical hazards in pharmaceutical industry: an overview by Princy agarwal, Anju goyal, Rajat vaishnav suggested that The manufacturing of active pharmaceutical ingredients (APIs) and formulation processes involves the use of various chemicals which includes various corrosive and irritant agents such as acids, bases, oxidizing and reducing agents, solvents, and many more which can be found sometimes at very high concentrations and are hazardous to health of persons performing the various processes during manufacturing and formulation of API and medicines. The effective management of the chemical risks linked to the handling of these agents is mandatory for the safety of the workers in the industry, ethically and also legally as per the rules and guidelines of various acts regulating the functioning of the pharma industry. Hazardous materials are chemicals that, if released or abused, can pose a threat to the environment or health. They include industrial chemicals, pesticides, agricultural chemicals, pharmaceuticals, cosmetics, and food chemicals that may be present at the workplace and “have a negative effect on a worker’s health as a result of direct contact or exposure to the chemical substance” (4).

A literature review by National Network on Environments and Women’s Health by Robert DE Matteo December 2011 reviewed that, A Night shift workers in plastic industries were found to have elevated levels of breast cancer in several studies. Exposure to light at night is thought to suppress the hormone melatonin which regulates circadian rhythms and normally suppresses the production of estrogen. The International Agency for Research on Cancer (IARC) has concluded that, “shift work that involves circadian disruption is probably carcinogenic to humans” The Danish workers’ compensation system now recognizes the association between work at night and breast cancer (5).

6.1 Chemicals and their effect of human body parts/systems

Clinical symptoms in affected body part and their causative chemicals, according to study in 2017 Rajasthan, India (4).

Table 1. Clinical symptoms in affected body part and their causative chemicals

Affected

body

organs/parts

Symptoms

Chemicals

Head Dizziness, headache Solvents, paint, ozone,

smoke Eyes Red, watery, irritated, grainy feeling

Corneal and conjunctival disturbances Lens, iris, and anterior chamber disturbances Posterior segment and

Smoke, gases, various dusts, vapors from paint, and cleaners Sulfur dioxide, dimethyl sulfate, hydrogen

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11 optic nerve disturbances Intra-ocular

pressure elevation

sulfide Anticholinesterase agents, copper, phenylmercuric salts Carbon disulfide, ethylene glycol, warfarin Formaldehyde, ammonia

Nose Sneezing, coughing, rhinitis, perforated septum

Smoke, ozone, solvents, various dusts, vapors, and fumes from paint and cleaners, acetic acid, acetic anhydride

Mouth/throat Green tongue, salivation, sore throat Vanadium, mercury, arsenic Chest and lungs Wheezing, coughing, shortness of

breath, lung cancer

Metal fumes, various dusts, smoke, solvents, vapors from paint and cleaners

Breast Gynecomastia Estrogens

Stomach Nausea, vomiting, stomach ache, diarrhea

Some metal fumes, solvents, paint vapors, long-term lead exposure

Skin Redness, dryness, rash, itching, skin cancer

Solvents, chromium, nickel, detergents and cleaners, paint on skin

Nervous system Nervousness, irritability, tremors, loss of coordination Drowsiness, disorientation

Long-term solvent exposure, long-term lead exposure CNS depressants CNS depressants, convulsant Reproductive system Men: Low sperm count, damage to

sperm.

Women: Menstrual irregularities, miscarriage, damage to egg/fetus

Lead, toluene, some other solvents, ethylene oxide gas

Pulmonary system Pneumonia Asthma Fibrosis

Ammonia, chlorine, oxides of N2

Phthalic anhydride, platinum salts Asbestos, kaolin, silica, talc Cardiovascular system Hypotension Hypertension Arrhythmia CNS depressants, nitrites Diphenyl Trichloroethane, carbon tetrachloride

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12 Digestive system Nausea, vomiting Jaundice CNS depressants,

anticholinesterases Hydrazine, chloroform Genitourinary system Skin Toxic nephrosis

Yellow stains Acute eczematous dermatitis

Nephrotoxin (dioxane), oxalic acid, picric acid Picric acid Acetaldehyde, barium compounds, benzyl chloride, copper dust, epoxy resins

Toxic chemicals are defined in terms of effect, The National Transport Commission has defined toxic chemicals as “substances that can cause death or serious injury or damage to human health if ingested or inhaled or in contact with the skin.”

A review in 2017 reviewed that The effects of toxic chemicals on the body can be categorized as acute or chronic.

Acute (short-term) effects Appears immediately or soon after chemical exposure. They can be minor, such as irritation of the nose or throat, or can be severe, such as eye damage or chemical vapors. The only thing that is common with these effects is that they happen instantly.

Chronic (long-term) effects they are usually caused by continuous or long-term exposure to harmful substances. These effects are generally irreversible.

Some chemicals can cause both acute and chronic effects. For example, solvents vapor inhalation may cause immediate dizziness (acute effect). However, breathing the same vapors all the time for many years could cause liver damage (4).

Respiratory findings in chemical workers exposed to low concentrations of organic and inorganic air pollutants in 2000 found that, they studied 567 male and 135 female workers employed in two chemical plants in Zagreb, Croatia. Measurements of the ambient concentrations of air pollutants were performed. Occupational asthma was recorded in three (0.5%) of the men and in two (1.5%) of the women workers. Additionally, there were high prevalence of acute symptoms during the work shift. Among the chemical workers these were greatest for eye irritation (male: 43.9%; female: 51.9%), dryness of the throat (male: 43.4%; female: 57.0%) and irritation of the throat (male: 37.4%; female: 56.6%) (6).

6.2 Particular chemicals which capable to induce health problems

In 2015, According to Anderson AR, The toxic substances control act chemical substance inventory lists >84,000 chemicals used in commerce. With chemicals having a multitude of uses,

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13 persons are potentially at risk daily for exposure to chemicals as a result of an acute chemical incident. Depending on the level of exposure and the type of chemical, exposure can result in morbidity and, in some cases, mortality. The 57,975 incidents that were reported, 54,989 (95%) involved the release chemicals among them hydrochloric acid (326), and sulfuric acid (318) (7).

A group of researcher from china in 2016, their study concluded that, This study documents the epidemiology of chemical burns in the region using burn data from a local specialized hospital. A total of 690 patients (619 males, 71 females; average age: 30.6±12.4 years) were admitted to the department for chemical burns. Over the 10-year period, the incidence of chemical burns showed an increasing tendency. Chemical burns occurred most frequently in patients aged 20-59 years (94.79%). With regard to burns caused by chemicals, most were caused by acids (72.01%), with hydrofluoric acid and sulfuric acid causing 51.45% (8).

In 2017, a study was conducted in Poland by group of researchers on the research purpose was to analyze data concerning chemical incidents in Poland collected in 1999-2009 in terms of health hazards. The number of analyzed chemical incidents in 1999-2009 was 2930 with more than 200 different substances released. The substances were classified into 13 groups of substances and mixtures posing analogous risks. Most common releases were connected with non-flammable corrosive liquids, including: hydrochloric acid (199 cases), sulfuric acid (131) (9).

This study examines by Tuominen M in 1991, suggested that the possible effect of exposure to aerosols and gases on lung function in a fertilizer plant in Norway. Dynamic lung volumes of 383 workers were measured in 2007 and 2010. During the follow-up period, most workers performed tasks with low exposure levels of acid aerosols and inorganic gases. A questionnaire on respiratory symptoms was provided. The respiratory symptoms score was low during follow-up. Work in this fertilizer industry may lead to an excessive lung function decline (10).

According to group of Chinese researchers in 2018, purpose of this study was to ascertain whether (or not) exposure to benzene, toluene, xylene and ethylbenzene (BTXE), under normal working conditions, was associated with any health effects. Occupational health examination were investigated on 764 employees who exposed. Occupational exposure to low concentrations of BTXE had a certain impact on the blood system and liver and kidney function of the employees, occupational health surveillance for such people should be strengthened (11).

Occupational hazard risk assessment of workers exposed to benzene in a petrochemical enterprise in Shanghai, China, in 2016, To investigate the exposure to benzene, methylbenzene, and dimethylbenzene in workers in a petrochemical enterprise in Shanghai, China, and to

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14 conduct occupational hazard risk assessment. The results showed that benzene had a high carcinogenic risk (12).

Study of the cardiovascular effects of occupational exposure to organic solvents in 1998. A case-control study was used. they studied 345 workers (250 men) aged between 20 and 60 years at a petrochemical factory, and 345 age- and sex-matched controls with no occupational contact with chemical and physical factors. According to the main chemical pollutants in the working environment, the exposed subjects were divided into three groups: group 1, exposed to benzene; group 2, exposed to xylene and benzene, and group 3, exposed to phenol. The study show that those workers occupationally exposed to high concentrations of benzene and xylene. There was no convincing evidence of increased cardiovascular risk associated with occupational exposure to phenol (13).

Seppalainene and Harkonene 1976 also reported that workers exposed to high-level styrene had higher prevalence of cardiovascular disorder than workers with low level styrene exposure or normal population (14).

Epidemiological survey among workers exposed to manganese: Effects on lung, central nervous system, and some biological indices in 1987. A cross‐sectional epidemiological study was carried out among 141 male subjects exposed to inorganic manganese (Mn) in a Mn oxide and salt producing plant. A significantly higher prevalence of cough in cold season, dyspnea during exercise, and recent episodes of acute bronchitis was found in the Mn group (15).

In 2017 a group of German researchers conduct a cohort study among workers working with aromatic amines. Aromatic amines can cause bladder cancer. A long latency can still increase the risk of former exposed workers. In this study, a cohort of chemical workers with earlier use of aromatic amines compared to the general population. In the prospective cohort study UroScreen, 1800 former chemical workers exposed to aromatic amines were offered to participate in an early detection of bladder cancer by means of tumor markers. In 2003–10, 1609 people were examined at least once. The observed bladder cancer incidence was compared with the expected incidence in the general population. Bladder cancer risk was estimated as standardized incidence ratio. Resulted that Nine incidence urinary bladder carcinoma occurred during the study. Eight cases were ex-smokers and one case was non-smoker. All cases were exposed for at least 10 years, including six cases longer than 20 years. Compared to the general population, the risk of bladder cancer was high (16).

In 2010 Enrico Pira from university of Turin investigated that, bladder cancer risk in a cohort of dyestuff workers who were heavily exposed to aromatic amines from 1922 through 1972. they updated the follow-up by 14 years (through 2003) for 590 exposed workers to include more than 30

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15 years of follow-up since last exposure to aromatic amines. Expected numbers of deaths from bladder cancer and other causes were computed by use of national mortality rates from 1951 to 1980 and regional mortality rates subsequently. There were 394 deaths, compared with 262.7 expected. Overall, 56 deaths from bladder cancer were observed, compared with 3.4 expected. The standardized mortality ratio for bladder cancer increased with younger age at first exposure and increasing duration of exposure. Although the standardized mortality ratio for bladder cancer steadily decreased with time since exposure stopped, the absolute risk remained approximately constant at 3.5 deaths per 1000 man-years up to 29 years after exposure stopped. Excess risk was apparent 30 years or more after last exposure (17).

Silica is one of the most common occupational exposures worldwide. In 1997 the international agency for research on cancer (IARC) classified inhaled crystalline silica as a human carcinogen (group 1), but acknowledged limitations in the epidemiologic data, including in consistencies across studies and the lack of extensive response data. We have conducted a pooled exposure-response analysis of 10 silica-exposed cohort to investigate lung cancer. In that study, The pooled cohort included 65,980 workers (44,160 miners, 21,820 nominees), and 1072 lung cancer deaths (663 miners, 409 nonminers). Follow-up has been extended for five of these cohorts beyond published data. The estimated excess lifetime risk (through age 75) of lung cancer for a worker exposed from age 20 to 65 at 0.1 mg/m3 respirable crystalline silica (the permissible level in many countries) was 1.1-1.7%, above background risks of 3-6%. As a conclusion the study results support the decision by the IARC to classify inhaled silica in occupational settings as a carcinogen, and suggest that the current exposure limits in many countries may be inadequate. These data represent the first quantitative exposure-response analysis and risk assessment for silica using data from multiple studies (18).

In 2010 study by Luoping Zhang and team of University of California, Berkeley suggested that, There are concerns about the health effects of formaldehyde exposure, including carcinogenicity, in light of elevated indoor air levels in new homes and occupational exposures experienced by workers in health care, embalming, manufacturing, and other industries. Epidemiologic studies suggest that formaldehyde exposure is associated with an increased risk of leukemia. However, the biological plausibility of these findings has been questioned because limited information is available on the ability of formaldehyde to disrupt hematopoietic function. Their objective was to determine if formaldehyde exposure disrupts hematopoietic function and produces leukemia-related chromosome changes in exposed humans. We examined the ability of formaldehyde to disrupt hematopoiesis in a study of 94 workers in China (43 exposed to formaldehyde and 51 frequency-matched controls) by measuring complete blood counts and peripheral stem/progenitor cell colony formation.

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leukemia-16 specific chromosome changes were significantly elevated in myeloid blood progenitor cells. These findings suggest that formaldehyde exposure can have an adverse effect on the hematopoietic system and that leukemia induction by formaldehyde is biologically plausible, which heightens concerns about its leukemogenic potential from occupational and environmental exposures (19).

Michael Hauptmann, National Institutes of Health and team did a research in 2003 and suggested that, Many U.S. factory workers are exposed to formaldehyde. Although increased risks for leukemia have been found in medical workers and other professionals exposed to formaldehyde, studies in industrial workers, who are thought to have higher exposures, have shown inconsistent associations. We extended follow-up of a cohort of industrial workers to evaluate the association between formaldehyde exposure and lymphohematopoietic cancers. As a conclusion they found that Exposure to formaldehyde may cause leukemia, particularly myeloid leukemia, in humans. However, results from other investigations are mixed, suggesting caution in drawing definitive conclusions (20). Another study from National Institutes of Health in 1986, A historical cohort study evaluated the mortality experience of 26,561 workers employed in 10 formaldehyde-producing or -using facilities. Approximately 600,000 person-years of follow-up accrued as workers were followed to January 1, 1980. Estimates of historical exposure to formaldehyde by job were developed by project industrial hygienists using monitoring data available from participating plants, comments from long-term workers, and comprehensive monitoring data specifically collected for this study. Mortality from all causes combined was about as expected (standardized mortality ratio (SMR) = 96) based on mortality rates of the general U.S. population. Significantly fewer deaths occurred from infective and parasitic diseases (SMR = 51) and from accidents (SMR = 72) than expected. Cancer overall was not related to formaldehyde exposure. Workers exposed to formaldehyde had slight excesses for Hodgkin's disease and cancers of the lung and prostate gland, but these excesses were not consistently related to duration of or average, cumulative, or peak formaldehyde exposure levels. Although there was a deficit for cancer of the buccal cavity and pharynx, mortality from certain subsites, i.e., the nasopharynx and oropharynx, was elevated. These subsites did not, however, show a consistently rising risk with level of exposure. These data provide little evidence that mortality from cancer is associated with formaldehyde exposure at levels experienced by workers in this study (21).

In 2003 a study was conducted by David Coggon and his team did research on formaldehyde is mutagenic and, when inhaled at high concentrations, carcinogenic in rats. Some epidemiologic studies have linked occupational exposure to formaldehyde with cancers of the nose, nasopharynx, and lung, but the evidence for human carcinogenicity has been inconsistent and requires clarify cation. They extended by 11 years the follow-up of an existing cohort of 14 014 men employed at six British

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17 factories where formaldehyde was produced or used. Standardized mortality ratios (SMRs) were derived using the person-years method and were compared with the expected numbers of deaths for the national population. As resulted mortality from lung cancer was increased among those who worked with formaldehyde, particularly in men in the highest of four estimated exposure categories, and the increase persisted after adjustment for local geographic variations in mortality. However, there was a statistically nonsignifying cant decrease in the risk of death from lung cancer with duration of high exposure, and this risk showed no trend with time since first high exposure (22).

The National Institute for Occupational Safety and Health previously conducted a retrospective cancer incidence and mortality study of workers employed at a rubber chemical manufacturing plant in 2012. Compared with New York State incidence, the bladder cancer risk was 6.5 times higher for workers considered to have definite exposure to ortho-toluidine and aniline, and 4 times higher for workers with possible exposure. Exposure characterization in the original study utilized a surrogate measure based only on departments in which each worker was ever employed (23).

Rendering to research in 2017, The purpose of this study was to classify hazards at an industrial level and evaluate the exposure risks of workers exposed to dimethylformamide (DMF) used as a solvent in the workplace A total of 63.8% of workplaces in the textile manufacturing sector had a hazard quotient higher than 1. The highest risk for exposure to dimethylformamide (DMF) is in the rubber and plastic manufacturing industry, and the lowest risk was in the medical materials and pharmaceutical manufacturing sector (24).

A team of researchers from university of Jordan investigated the prevalence and nature of oral health problems among workers exposed to acid fumes in two industries in Jordan in 2001. A case-control study was performed at Jordan's Phosphate Mining Company and a main private battery factory. Comparison of general and oral health conditions between workers exposed to acid fumes and control group from the same workplace. The sample consisted of 68 subjects from the phosphate industry (37 acid workers and 31 controls) drawn as a sample of convenience and 39 subjects from a battery factory (24 acid workers and 15 controls). Structured questionnaires on medical and dental histories were completed by interview. Clinical examinations were carried out to assess dental erosion, oral hygiene, and gingival health using the appropriate indices In both industries, acid workers showed significantly higher oral hygiene scores, obtained by adding the debris and calculus scores, and gingival index scores than their controls. The single most common complaint was tooth hypersensitivity (80%) followed by dry mouth (77%) on average. Exposure to acid fumes in the work place was significantly associated with dental erosion and deteriorated oral health status. Such exposure was also detrimental to general health (25).

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18 Exposure to hydrogen chloride can occur through inhalation, ingestion, and eye or skin contact (Sittig, 1991). Hydrogen chloride forms corrosive hydrochloric acid on contact with water found in body tissues. Inhalation of the fumes can cause coughing, choking, inflammation of the nose, throat, and upper respiratory tract. In severe case hydrogen chloride in high concentrations causes pulmonary edema, circulatory system failure, and death. Skin contact can cause redness, pain, and severe skin burns. Hydrogen chloride may cause severe burns of the eye and permanent eye damage (Kirsch and Drabke, 1982) (26).

Toluene chemicals had a high risk of harm, induce damage to major organs example the central nervous system, liver, kidneys, skin and others. Public Health Center Sememi in October 2013 reported at least 12 health complaints in the shoes craftsman at Oso Wilangun village Surabaya. This study was to analyze the level of health risks from exposure to toluene in workers craftsmen shoes. The population was 51 people by the sampling technique using total sampling. Data were collected using a questionnaires, checklist. Data was analyzed descriptively with the results: 87.5% toluene concentrations below threshold limit values (<188 mg/m3), the smallest value of 0.80 mg / m3 and the highest concentration of 520.81 mg/m3, the level of health risk at the work site 1 and 3 was above the threshold value (in an unsafe condition) (27).

This study was to determine the prevalence of respiratory health complaints, allergy symptom, lung functions, and the association between airborne concentrations of chromium and aluminum with respiratory health and allergy symptoms among machining industry workers in Selangor, Malaysia. The study design was a cross-sectional comparative study. The respiratory and allergy symptoms were obtained through the American Thoracic Society (ATS) Adult Respiratory modified questionnaire. The exposed group reported significantly higher prevalence of cough symptom, morning cough with sputum and health worries caused by metalworking fluids than the unexposed group (28).

A retrospective cohort study in 2015 found that, benzene exposure has been causally linked with acute myeloid leukemia (AML), but inconsistently associated with other hematopoietic, lymphoproliferative and related disorders (HLD) or solid tumors in humans. Many neoplasms have been described in experimental animals exposed to benzene. We used Poisson regression to estimate adjusted relative risks (RR) and the likelihood ratio statistic to derive confidence intervals for cause‐ specific mortality and HLD incidence in 73,789 benzene‐exposed compared with 34,504 unexposed workers in a retrospective cohort study in 12 cities in China. respiratory diseases (RR = 1.7, 95% CI = 1.2, 2.3) (29).

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19 In 2017, Gihan, Mahmoud, Kamal conducted Analysis of risk perception using Kinney and Fine risk assessment method showed that 31.3% of the study group reported that benzene exposure has no risk at all, 36.7% reported the low degree of risk, 14% reported medium risk degree, 7.3% reported high risk and 10.7% reported very high risk (30).

Rubber tire manufacturing industry has a history of more than half a century in Iran. The old and semi-automated processes equipment, backward technology, and raw materials impurity lead to significant exposures to occupational carcinogens such as benzene. This study was conducted in 2014 to assessment of benzene exposures and evaluation the resulting cancer risk in two tire-manufacturing factories. The odds ratio of leukemia was 2.06 times the working population without benzene exposure, as well; the cancer incidence was 16.14 cases per 1000 workers (31).

A survey was conducted on 65 nail salon workers who were immigrants from Southeast Asia in Oregon, USA in 2015. More than 20% of the participants reported nose irritation and allergies as the most common health problems because of benzene and toluene inhalation during work (32).

Review was conducted in 2014 to find out risk of benzene on human health. The Manufacturing sector has the highest number of cases (26,000) and the second highest reported incidence (139 per 100,000) of occupational skin diseases among major industries. The aromatic hydrocarbon benzene has been used extensively over the years as a raw material in the manufacture of polymers, detergents, pesticides, dyes, plastics, and resins, and as a solvent for waxes, oils, natural rubber, and other compounds. Headaches, dizziness, nausea, and vomiting are all symptoms of benzene overexposure. Exposure to benzene at high concentration can lead to blurring of vision, unconsciousness, convulsions, ventricular irregularities, and respiratory failure. Death as a result of exposure to extremely high concentration of benzene may occur because of respiratory failure or cardiac arrhythmias (33).

According to WHO 2010, Acute occupational exposure to benzene may cause narcosis: headache, dizziness, drowsiness, confusion, tremors and loss of consciousness.2 Use of alcohol enhances the toxic effect. Benzene is a moderate eye irritant and a skin irritant. Benzene is a well-established cause of cancer in humans.1,3 The International Agency for Research on Cancer has classified benzene as carcinogenic to humans (Group 1).1,3 Benzene causes acute myeloid leukemia (acute non-lymphocytic leukemia), and there is limited evidence that benzene may also cause acute and chronic lymphocytic leukemia, non-Hodgkin's lymphoma and multiple myeloma. Individuals who have experienced benzene poisoning requiring treatment show a substantially increased risk of mortality from leukemia.

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20 Any worker exposed to toxins like hydrochloric acid should seek medical attention. Depending on the severity of exposure, a patient may need prolonged treatment. The poisoning treatment depends upon levels of the chemical exposed to, and the type of exposure-liquid contact, ingesting or inhalation. Symptoms from ingesting or inhaling hydrochloric acid can include: Abdominal pain, Inflammation of throat, Trouble breathing, Chest pain, Fever, Throat pain, Vomiting, Bluish color to lips, Chest tightness, Choking, Coughing, Dizziness, Low blood pressure.

There were 3,173 workers with complete data available within the study period for analyses in 2017. The cohort is predominantly male (93%) and White (78%). Over half of the workers were short-term with less than 1 year of employment duration (n = 1,711). Compared with only 176 (5.5%) workers known to be deceased in the original study, the current study observed 1,473 deaths (46%) with over 3 decades of extended follow-up (34).

White blood cells and platelet counts were significantly lower than 140 controls in a 2004 study of 250 workers exposed to benzene, even under 1 ppm air exposure. The formation of progenitor cells declined significantly with increased exposure to benzene and was more sensitive to the effects of benzene than the number of mature blood cells (35).

A recent study accompanied by abnormal hematological findings in 2019 was found among taxi drivers exposed to high concentrations of benzene, toluene, ethylbenzene, and xylene that exceeded the permitted levels. Exposed taxi drivers showed a variety of symptoms related to various systems, such as neurological, respiratory, gastrointestinal, cardiovascular and endocrine, and significant changes in blood components (36).

Study by Pepe, Seidenari in 1993 found that patching 2% aqueous hydrogen chloride to the forearms of 16 volunteers (18–40 years old, 4 men and 12 women) resulted in positive results after 24 hours in 62.5% (10 volunteers). (37).

During the unloading of a container with commercial hydrogen chloride, nine workers were exposed to hydrogen chloride vapor for approximately 15 seconds. In four workers symptoms like headache, irritation of the eyes, tightness in the chest, dyspnea and burning in the throat disappeared after a period of 4 hours. Following an accident with hydrogen chloride, burning and watering eyes, burning throat, headache, chest pain, dyspnea and flu-like symptoms were seen in the persons exposed. Twenty months later the pulmonary function and the behavior of 45 exposed persons and 56 selected control persons were examined. The closer to the location of the accident the exposed person had been, the more restricted was the pulmonary function (38,39).

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21 The research was conducted among 250 workers from different printing houses of Dhaka city in 2016. From the result of this research, it was determined that the workers of the printing industry were suffering from various diseases. With gastritis (21.73%) and different kinds of skin diseases (15.65%) being the disease mostly suffered, the workers were also suffering from diseases such as high blood pressure (16.52%), eye irritations (32.80%), coughing (30.40%) (40).

Benzene and ethyl benzene risk analysis in painters in cancer. Fundamental and clinical investigation into cancer. The study results showed that toluene had the lowest concentration of all BTEX compounds in 2016. The average risk of cancer was estimated at 3.21 daily to 2 and 3.63 daily to 10-2 for workers exposed to benzene and ethyl benzene, respectively The risk of non-carcinogenic BTEX exposure was greater than that of the reference danger level. Statistical trials show that pollutant levels in the breathing area for workers of work age and duration of employment are significantly different (P<0.001) (41).

In 2014, a group of researchers in Kanpur City India suggested irritation of the eyes and exposed skin surfaces. It has long been known that the teeth of industrial workers exposed to inorganic acids are affected in varying degrees. On breathing an industrial acid mist, the irritant effects are localized to the nose, mouth and throat-coughing, nose running and upper respiratory tract. Irritation of the eyes and exposed skin surfaces also occurs. As compared to study group, in the control group the period of exposure was significantly lower (P < 0.001). It was seen that in the control group more than two third (69.5%) respondents had up to 5 years of experience whereas in study group the period of exposure was more than 5 years in 89.3% subjects (42).

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22

7. Methodology of research:

Ecological descriptive study was performed to find out the present work is related to the study of chemical industrial workers health related problems. For purposes of the study, subjects were randomly selected from the chemical industries of the Surat District’s Sachin industrial area. Based on the operation performed in these units, a questionnaire was designed to gather maximum and useful information. Under this study, 191 adult (male and female) samples were taken. The respondents were from labor class working in different chemical industries. Questionnaires were prepared to gather information about the industrial workers’ demographic profile and their current state of health.

7.1 Research method:

In order to satisfy research objectives, Quantitative research technique was used mostly to achieve the goal of research. Original questionnaire was prepared with all information units which will use for research fulfillment according to requirements of objectives and goal of research. Sociodemographic characteristics was totally within the guide lines of ethics and privacy of participant. Research schedule was designed according to plan as follows:

• Find research area where we can do this research as we found this problem regarding general health problems among chemical workers.

• According to need of research we decide three objectives to reach our goal. • Generate questionnaire to cover all aspects of research.

• Permission from respected organization and bioethics department of university. • Collection and analysis of data according to objectives.

• Results and conclusion. • Sample size and selection:

Sample size was 200 (male and female) anonyms adult participants from chemical industry whom were working with chemical. according to availability and by participant’s decision we collected 191 (male and female) adult participants.

7.2 Data collection:

Data collection was held by original questionnaire distribution in selected sample population from chemical industries. We explained all questions from questionnaire to selected participants. Most of participants were from labor class working so we had to fill questionnaires according to provided information by selected participants. It was time consuming for us to collect data as per information provided by selected participants.

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23 For assessing their work with chemical and health status of workers, the questionnaire consists of items which is based on working time with chemicals of the workers which leaded them to any general health problems due to working with that particular chemical or group of chemicals. There were total 8 items in that part which included:

• Sociodemographic characteristics • Experience with chemical work • Daily working hours with chemicals

• Number and name of chemicals they were working on daily basis • General health problems from that chemicals

• Nature of chemicals

• Any respiratory problems due to that particular chemicals • Any skin related problems due to that particular chemicals

It was designed in that way, so they can choose problems from the list according to three aspects which we designed. General health problems, respiratory problems and skin related health problems due to that particular chemical.

7.3 Data analysis

“IBM SPSS 20” statistics was used to analyze the data which was gathered from questionnaire. We made different variables according to objective to get simple and accurate results at the end of analysis.

We divided age into two groups 1st group is 20 to 30 years and 2nd group is 31 to 50. We decided these two groups because we had youngest age is 20 years and oldest age is 50 years. According to their experience with chemical industries we divided them into two groups 1st group is

0 to 4.99999 years and 2nd group is 5 to 12 years. We had maximum work experience is 12 years. We also divided two groups for daily working hours in chemical company 1st group is 0 to 5 hours and

2nd group is 6 to 10 hours. Another group is for daily working hours with chemicals we divided into two groups 1st group is 0 to 4 hours and 5 to 8 hours.

For the first objective we used frequencies to calculate amount of time they work with chemical, and which one is the most frequent chemical they work with. How many workers work with particular chemical and how many hours they work with that particular chemical? calculated by this method.

For the second objective we used chi-square test, odds ratio and spearman correlation (Spearman correlations (0.00-0.19- very weak, 0.20-0.39-weak, 0.40-0.59- moderate, 0.06-0.79- strong and 0.80-1.0 – very strong) (45) were calculated. P-value of 0.05 was used to find significance).

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24 to see, which chemical leads to which health problems. In this we calculated percentage of affected workers with particular health problems lead by particular chemical. Highest and lowest health problem occurred to workers calculated in this part of analysis this method also calculate the same criteria for chemicals also.

Last objective calculated by this method that effect of working hours with chemical on effect of health problems (increase or decrease).

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25

8. Results

:

8.1 Characteristic of the respondents

The below figure 1. shows participation of male and females in this study. There are total 191 respondents took a part in this study from chemical industry which are working with chemicals. Among this population there are 152 male (n=152) and 39 female (n=39) respondents in this study. Out of total population 79.6% of male respondents and 20.4% female respondents took part in this research.

Figure 1. Distribution of respondents according to Gender.

Table. 2 shows that age group distribution in study. We divided two groups 1st group is 20 to 30 years and 2nd group is 31 to 50 years. According to calculation 98(51.3%) respondents are in age between 20 to 30 years and 93(48.7%) are in age between 31 to 50 years respectively.

Table 2. Distribution of respondents according to age

Age group Number of respondents Percentage distribution of respondents

20 to 30 years 98 51.3

31 to 50 years 93 48.7

Total 191 100.0

According to table 3 we divide work experience of respondents in two groups. 1st group is 0

to 4.9999999 years, 87(45.5%) respondents with 0 to 4.9999999 years of experience in chemical

152 39 191 79.6 20.4 100 0 50 100 150 200 250

Male Female Total

n u m b er o f resp o n d en ts Gender

Number of participants according to Gender

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26 industry. On other hand, in 2nd group 104(54.5%) respondents with 5 to 12 years of experience in chemical industry.

Table 3. Distribution of respondents according to work experience

Work Experience (years) Number of respondents Percentage distribution of respondents 0 to 4.9999999 87 45.5 5 to 12 104 54.5 Total 191 100.0

8.2 Analysis of working hours among respondents:

First objective of this study is to find out average amount of time working with chemicals. For this objective we divide time in two groups respectively 1st group is 0 to 4 hours and 2nd group is 5 to 8 hours working with chemicals.

Among 191 respondents 138(72.3%) respondents are working with chemicals daily between 0 to 4 hours and 53(27.7%) respondents are working with chemicals daily between 5 to 8 hours.

Table 4. Distribution of respondents according to working hours with chemicals

Working hours with Chemicals (hours) Number of respondents Percentage distribution of respondents 0 to 4 138 72.3 5 to 8 53 27.7 Total 191 100.0

Below figure is showing that how many number of respondents working with each chemical. here total 191 respondents participated in study among them highest number of respondents 104 (50.5%) respondents are working with HCL. 78 (40.8%) respondents are working with H2SO4.

Respondents whom are working with HNO3 are 53 (27.7%). 58 (30.4%) respondents are working

with H3PO4. Respondents whom are working with benzene are 76 (39.8%). Respondents whom are

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27 Figure 2. Distribution of respondents according to working with chemicals

The below figure 3. describes number of respondents according to health problems. Among them eye problems, skin irritation and skin burning are very frequent then other health problems. skin infection, skin rashes, asthmatic symptoms, coughing and chest pain is less frequent among respondents.

Figure 3. Distribution of respondents according to health problems

104 78 53 58 76 48 54.5 40.8 27.7 30.4 39.8 25.1 0 20 40 60 80 100 120 HCL H2SO4 HNO3 H3PO4 BENZENE TOLUENE Number of repondents Ch em ica l n am e

Number of respondents working with chemical

Yes % Yes n 0 20 40 60 80 100 120 140 160 Headache Eye Problems Skin Burning Stomach pain Suffocation Nose irritation Nausea, Vomiting, Vertigo Breathing problems Coughing Chest pain Asthmatic symptoms Skin Irritation Skin Rashes Skin Redness Skin Infection Number of respondents H ea lt h pro blem s

Distribution of respondents according to health problems

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28

8.3 Effect of chemicals on different health problems:

According to second objective which chemicals are cause which health problems. We have total 16 health problems in given questionnaire 7 general health problems, 4 respiratory related health problems and 5 skin related health problems. We calculate p value and risk estimate by comparing chemical with health problem. We observing that, which chemical causes what kind of health problems to selected population.

8.3.1 Effect of chemicals on general Health problems:

Table 5. Headache complaints in relation with chemicals in the work environment

Chemical Name

Headache complaints

No headache P value Odds ratio (95% CI) N (%) n (%) HCL 12 21.1 45 78.9 0.928 0.966 0.45-2.06 H2SO4 9 15 51 85 0.141 0.546 0.24-1.23 HNO3 7 21.9 25 78.1 0.951 1.029 0.41-2.58 H3PO4 7 14.3 42 85.7 0.156 0.529 0.21-1.28 BENZENE 25 43.9 32 56.1 <0.001 5.762 2.75-12.06 TOLUENE 21 52.5 19 47.5 <0.001 7.239 3.32-15.77

Table 5 shows relation between chemicals which are responsible for headache. In case of benzene and toluene, 57 respondents are working with this chemical. Among them 25(43.9%) respondents complain frequent headache with associates to benzene (p value= <0.05) and (52.5%) respondents complain frequent headache with associates to toluene (p value= <0.05). In case of HCL, H2SO4, HNO3 and H3PO4 respondents do not having major complaints regarding headache. There is

no statistical significance (p = >0.05).

Table also shows the risk estimate of different chemicals here HCl, H2SO4, and H3PO4 is lower

than one so there is very low risk of these chemicals in case of headache. On other hand, HNO3 (1.02),

benzene (5.76), toluene (7.23) is higher than one so there is high risk of headache in association with these chemicals specially benzene and toluene.

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29 Table no. 6. Eye problems complaints in relation with chemicals in the work environment

Chemical Name

Eye problems complaints

No eye problems P value Odds ratio (95% CI)

N (%) n (%) HCL 54 94.7 3 5.3 <0.001 8.800 2.60-29.72 H2SO4 57 95 3 5 <0.001 9.609 2.84-32.42 HNO3 27 84.4 5 16.6 0.196 1.938 0.70-5.36 H3PO4 36 73.5 13 26.5 0.717 0.872 0.45-1.83 BENZENE 48 84.2 9 15.8 0.065 2.111 0.94-4.72 TOLUENE 33 82.5 7 17.5 0.241 1.699 0.69-4.14

Table 6 shows relation between chemicals which are responsible for eye problems. 57 respondents are working with HCL among those 54(94.7%) respondent’s complaint frequent eye problems with associates to HCL (p value= <0.001). In case of H2SO4, 60 respondents are working

with this chemical. Among them 57(95%) respondents complain frequent eye problems associates to H2SO4 (p value= <0.001). On the other hand, HNO3, H3PO4, benzene and toluene is showing no

statistical significant (p= >0.05).

Table also shows the risk estimate of different chemicals here HCl (8.80), H2SO4 (9.60),

HNO3 (1.93), benzene (2.11), toluene (1.69) is higher than one so there is very high risk of these

chemicals in association with eye problems. On other hand H3PO4, odds ratio is lower than one so

there is no risk of eye problems in association with H3PO4.

Table 7. Skin burning complaints in relation with chemicals in the work environment

Chemical Name

Skin burning complaints

No skin burning P value Odds ratio (95% CI) N (%) n (%) HCL 41 71.9 16 28.1 0.039 2.016 1.03-3.94 H2SO4 42 70 18 30 0.076 1.797 0.93-3.44 HNO3 22 68.6 10 31.2 0.309 1.521 0.67-3.42 H3PO4 37 75.5 12 24.5 0.014 2.459 1.18-5.10 BENZENE 38 66.7 19 33.3 0.273 1.436 0.75-2.75 TOLUENE 27 67.5 13 32.5 0.324 1.447 0.69-3.02

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30 Table 7 shows relation between chemicals which are responsible for skin burning. 57 respondents are working with HCL among those 41(71.9%) respondents complain skin burning with associate to HCL (p value =0.039). more than 75% respondents complain of skin burning in association with H3PO4 (P value = 0.014). In case of H2SO4, HNO3, benzene and toluene do not show

statistical significance (p = >0.05).

Table also shows the risk estimate of different chemicals here H2SO4, HNO3, benzene and

toluene is higher than one so there is very high risk of these chemicals in association with skin burning. Here HCL and H3PO4 have higher risk than other chemicals.

Table 8. Stomach pain complaints in relation with chemicals in the work environment Chemical

Name

Stomach pain complaints

No stomach pain P value Odds ratio (95% CI) N (%) n (%) HCL 3 5.3 54 94.7 0.060 0.317 0.09-1.11 H2SO4 9 15 51 85 0.395 1.475 0.60-3.62 HNO3 4 12.5 28 87.5 0.930 1.053 0.33-3.33 H3PO4 13 26.5 36 73.5 <0.001 4.767 1.93-11.76 BENZENE 6 10.5 51 89.5 0.675 0.810 0.30-2.17 TOLUENE 6 15 34 85 0.518 1.391 0.51-3.79

Table 8 shows relation between chemicals which are responsible for stomach pain. 49 respondents reported to work with H3PO4, among those 13(26.5%) respondents complain stomach

pain with associate to H3PO4. (P value=<0.001). HCL, H2SO4, HNO3, benzene and toluene

respondent’s response towards stomach pain is not signify statistical significance (p value= >0.05) In association with stomach pain, the risk estimate of different chemicals as shown in table 8. HCL and benzene is lower than one. So, there is no risk of stomach pain. In case of H2SO4, HNO3

and toluene is higher than one so there is a risk of stomach Pain in association with these chemicals. On other hand, H3PO4 (4.67) is with very high risk of stomach pain among selected respondents.

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31 Table 9. Suffocation complaints in relation with chemicals in the work environment

Chemical Name

Suffocation complaints

No suffocation P value Odds ratio (95% CI) N (%) n (%) HCL 10 17.5 47 82.5 0.333 0.678 0.30-1.49 H2SO4 12 20 48 80 0.653 0.842 0.39-1.78 HNO3 18 56.2 14 43.8 <0.001 7.232 3.17-16.46 H3PO4 15 30.6 34 69.4 0.091 1.879 0.89-3.93 BENZENE 12 21.1 45 78.9 0.838 0.924 0.43-1.96 TOLUENE 7 17.5 33 82.5 0.441 0.703 0.28-1.72

Table 9 shows relation between chemicals which are responsible for suffocation. 32 respondents reported to work with HNO3, among those 18(56.2%) respondents having suffocation. P

value (<0.001) is significant. HCL, H2SO4, H3PO4, benzene and toluene are showing no statistical

significance.

In association with suffocation, the risk estimate of different chemicals as shown in table 9. HCL, H2SO4, benzene and toluene is lower than one so it shows no risk of suffocation. In case of

H3PO4, odds ratio is higher than one so it shows there is a risk of suffocation. On other hand, HNO3

(7.23) is with very high risk of suffocation among selected population.

Table 10. Nose irritation complaints in relation with chemicals in the work environment

Chemical Name

Nose irritation complaints

No nose irritation P value Odds ratio (95% CI) N (%) N (%) HCL 15 26.3 42 73.7 0.063 2.036 0.95-4.34 H2SO4 14 23.3 46 76.7 0.226 1.594 0.74-3.40 HNO3 8 25 24 75 0.285 1.630 0.66-4.01 H3PO4 10 20.4 39 79.6 0.662 1.200 0.53-2.71 BENZENE 11 19.3 46 80.7 0.821 1.096 0.49-2.42 TOLUENE 4 10 36 90 0.126 0.430 0.14-1.30

Table 10 shows relation between chemicals which are responsible for nose irritation. HCL, H2SO4, HNO3, H3PO4, benzene and toluene are not showing statistical significance.

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32 In association with nose irritation, the risk estimate of different chemicals as shown in table 10. HCL, H2SO4, HNO3, H3PO4 and benzene, are higher than one so it shows there is a risk of nose

irritation in association with these chemicals. On other hand, toluene is with no risk of nose irritation among respondents.

Table 11. Nausea, vomiting, vertigo complaints in relation with chemicals in the work environment

Chemical Name Nausea, vomiting, vertigo complaints No nausea, vomiting, vertigo

P value Odds ratio (95% CI) N (%) N (%) HCL 24 42.1 33 57.9 0.417 0.772 0.41-1.44 H2SO4 32 53.3 28 46.7 0.226 1.594 0.80-2.74 HNO3 17 53.1 15 46.9 0.417 1.369 0.64-2.93 H3PO4 30 61.2 19 38.8 0.017 2.221 1.14-4.31 BENZENE 35 61.4 22 38.6 0.007 2.357 1.24-4.44 TOLUENE 28 70 12 30 0.001 3.443 1.62-7.29

Table 11 shows relation between chemicals which are responsible for nausea, vomiting, vertigo. H3PO4 30(61.2%), benzene 35(61.4%) and toluene 28(70%) respondents are complaining of

nausea, vomiting, vertigo (p value = < 0.05). HCL, H2SO4 and HNO3 is not showing statistical

significance.

In association with nausea, vomiting, vertigo, the risk estimate of different chemicals as shown in table 11. H2SO4, HNO3 and H3PO4 are higher than one so it shows there is a risk of suffocation in

association with these chemicals. benzene (2.35), toluene, (3.44) shows the high risk of nausea, vomiting, vertigo association with different chemicals. On other hand, HCL is with no risk of nausea, vomiting, vertigo among selected population.

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33

8.3.2 Effect of chemicals on respiratory related health problems

Table 12. Breathing problems complaints in relation with chemicals in the work environment

Chemical Name Breathing problems complaints No breathing problems

P value Odds ratio (95% CI) N (%) n (%) HCL 14 87.5 2 12.5 <0.001 14.121 3.10-64.21 H2SO4 25 96.2 1 3.8 <0.001 62.766 8.26-476.55 HNO3 16 100 0 0 <0.001 --- --- H3PO4 24 88.9 3 11.1 <0.001 19.333 5.55-67.24 BENZENE 24 82.8 5 17.8 <0.001 11.400 4.10-31.64 TOLUENE 11 84.6 2 15.4 <0.001 10.549 2.26-49.11

Table 12 shows relation between chemicals which are responsible for breathing problems. HCL, H2SO4, HNO3, H3PO4, benzene and toluene respondents are complaining breathing problems

(p = < 0.05).

In association with breathing problems, the risk estimate of different chemicals as shown in table 12. HCL, H2SO4, H3PO4, benzene and toluene shows the high risk of breathing problems

association with different chemicals. Among these chemicals H2SO4 is with highest risk in association with breathing problems.

Table 13. Coughing complaints in relation with chemicals in the work environment

Chemical Name

Coughing complaints

No Coughing P value Odds ratio (95% CI) n (%) n (%) HCL 2 12.5 14 87.5 0.025 6.107 1.02-36.31 H2SO4 0 0 26 100 0.323 --- --- HNO3 0 0 16 100 0.452 --- --- H3PO4 4 14.8 23 85.2 <0.001 14.087 2.44-81.28 BENZENE 2 6.9 27 93.1 0.208 2.926 0.51-16.51 TOLUENE 0 0 13 100 0.501 --- ---

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34 Table 13 shows relation between chemicals which are responsible for coughing. HCL and H3PO4, with these two chemicals respondents complains of coughing (P= <0.05). In case of H2SO4,

HNO3, benzene and toluene there is no statistical significance.

In association with Breathing problems, the risk estimate of different chemicals as shown in table 12. HCL, H3PO4 and benzene shows the high risk of coughing in association with these

chemicals. Among these chemicals H3PO4 is with highest risk in association with coughing.

Table 14. Chest pain complaints in relation with chemicals in the work environment

Chemical name Chest pain complaints No Chest pain complaints

P value Odds ratio (95% CI) N (%) n (%) HCL 0 0 16 100 0.541 --- --- H2SO4 2 7.7 24 92.3 0.032 6.792 0.91-50.49 HNO3 0 0 16 100 0.541 --- --- H3PO4 1 3.7 26 96.3 0.529 2.064 0.20-20.60 BENZENE 3 10.3 26 89.7 0.001 18.577 1.86-185.43 TOLUENE 2 15.4 11 84.6 0.001 16.000 2.05-124.59

Table 14 shows relation between chemicals which are responsible for chest pain. In association with H2SO4, benzene and toluene respondents complains chest pain (p value = >0.05).

HCL, HNO3 and H3PO4 are no statistical significance.

In association with chest pain, the risk estimate of different chemicals as shown in table 14. H2SO4, H3PO4, benzene and toluene shows the high risk of chest pain association with different

chemicals. Among these chemicals, benzene and toluene are with highest risk in association with chest pain.

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35 Table no. 15. Asthmatic symptoms complaints in relation with chemicals in the work environment

Table 15 shows relation between chemicals which are responsible for asthmatic symptoms. HCL and H3PO4 respondents complains asthmatic symptoms (P =<0.05). On other hand, H2SO4,

HNO3, benzene and toluene are showing no statistical significance.

In association with asthmatic symptoms, the risk estimate of different chemicals as shown in table 16. HCL, H3PO4 and benzene shows the high risk of asthmatic symptoms association with

different chemicals. Among these chemicals H3PO4 with highest risk in association with asthmatic symptoms.

8.3.3 Effect of chemicals on respiratory related health problems

Table 16. Skin irritation complaints in relation with chemicals in the work environment

Chemical Name

Skin irritation complaints

No skin irritation P value Odds ratio (95% CI) N (%) n (%) HCL 39 90.7 4 9.3 <0.001 7.226 2.45-21.26 H2SO4 49 89.6 5 10.4 <0.001 6.583 2.46-17.59 HNO3 22 91.7 2 8.3 0.003 7.010 1.59-30.81 H3PO4 29 93.5 2 6.5 <0.001 9.921 2.28-43.02 BENZENE 39 90.7 4 9.3 <0.001 7.112 2.41-20.93 TOLUENE 23 88.5 3 11.5 0.007 4.858 1.40-16.84 Chemical Name Asthmatic symptoms complaints No asthmatic symptoms

P value Odds ratio (95% CI) N (%) n (%) HCL 2 12.5 14 87.5 0.025 6.107 1.02-36.31 H2SO4 0 0 26 100 0.323 --- --- HNO30 0 0 16 100 0.452 --- --- H3PO4 4 14.8 23 85.2 <0.001 14.087 2.44-81.28 BENZENE 2 6.9 27 93.1 0.208 2.926 0.51-16.76 TOLUENE 0 0 13 100 0.501 --- ---

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36 Table 16 shows relation between chemicals which are responsible for skin irritation. HCL, H2SO4, HNO3, H3PO4, benzene and toluene respondents are complaining skin irritation (p = < 0.05).

In association with skin irritation, the risk estimate of different chemicals as shown in table 16. HCL, H2SO4, HNO3, H3PO4, benzene, and toluene shows the high risk of Skin irritation

association with different chemicals. Among these chemicals HCL, H3PO4 and benzene with more

high risk in association with Skin irritation.

Table 17. Skin rashes complaints in relation with chemicals in the work environment

Table 17 shows relation between chemicals which are responsible for skin rashes. HCL, H2SO4, HNO3, H3PO4 and benzene not showing any statistical significance in association with skin

rashes. In case of toluene, respondents complain skin rashes (p = <0.05).

In association with skin rashes, the risk estimate of different chemicals as shown in table 17. H2SO4, HNO3 and benzene are lower than one so it shows no risk on skin rashes. In case of HCL,

toluene is higher than one so it shows there is a risk of skin rashes in association with these chemicals. Chemical

Name

Skin rashes complaints

No skin rashes P value Odds ratio (95% CI) N (%) n (%) HCL 3 7 40 93 0.300 2.145 0.49-9.36 H2SO4 1 2.1 47 97.9 0.400 0.413 0.05-3.44 HNO3 1 4.2 23 95.8 0.995 0.994 0.17-8.45 H3PO4 0 0 31 100 0.203 --- --- BENZENE 1 2.3 42 97.7 0.484 0.476 0.05-3.98 TOLUENE 3 11.5 23 88.5 0.044 4.174 0.93-18.64

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