RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE ...rguhs.ac.in/cdc/onlinecdc/uploads/05_N134_22083.doc ·...
Transcript of RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE ...rguhs.ac.in/cdc/onlinecdc/uploads/05_N134_22083.doc ·...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PERFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1
Name of the Candidate
and Address
MS. SUMAN DAHYIA
1ST Year M.Sc. (Nursing)
Karnataka College of Nursing, 33/2, Thirumenahalli, Bangalore – 64
2
Name of the Institution
Karnataka College of Nursing
3
Course of Study and
Subject
M.Sc. (Nursing)
Community Health Nursing
4
Date and Admission to Course
1.09.2010
5
Title of the Topic
“A study to evaluate the effectiveness of structured teaching programme on knowledge regarding effects of noise pollution on health among workers in selected iron and steel industries at Bangalore.’’
6. BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION
“The past two decades have witnessed revolutionary changes in the nature of work
and workplaces and the global economy in India. Industrialization and globalization are
changing Indian occupational morbidity drastically with an ever increasingly demand for
a comfortable living. In recent days the number of industries is on the increase. In India
there are approximately 60 million workers over the age of 16, are involved in various
kinds of industrial work, such as iron and steel industry, textile industry etc. Which leads
to different type of pollutions.1
Pollution is the introduction of contaminants into a natural environment that cause
instability and disorder, harm or discomfort to ecosystem .One among them is noise. The
word ‘noise’ comes from the latin word nausea meaning ‘seasickness’, referring
originally to nuisance noise. Noise is defined as wrong sound, in wrong place, at wrong
time. The 20th century has been described as the ‘century of noise’.2
Noise pollution is displeasing human- or machine-created sound that disrupts the
activity or balance of human or animal life. A common form of noise pollution is from
transportation, principally motor vehicles, industries etc.Noise pollution can negatively
impact the body in significant ways, including elevated blood pressure, impaired
cognitive functioning, and other effects of chronic stress.The following are effective
strategies we can use to limit the negative impact of noise pollution and safeguard our
health.2
1
Industrial noise refers to noise that is created in the factory which is jarring and
unbearable. Sound becomes noise only it becomes unwanted and when it becomes more
than it is referred to as "noise pollution". Heavy industries like shipbuilding, iron and
steel industries have long been associated with Noise Induced Hearing Loss (NIHL).This
is posing to be a big challenge with very passing day and is a threat to safety and health
of the people who are working in the industry and common people as well. It has been
scientifically proved that noise more than 85 decibels can cause hearing impairment and
does not meet the standards set for healthy working environment.3
Operations in the iron and steel industry may expose workers to wide range of
hazards or workplace activities that could cause incidents, injuries, death, ill health or
diseases. Noise-induced hearing loss is a major health risk worldwide, while tinnitus is
frequent in patients with permanent hearing impairment. Tinnitus patients have often
been exposed to noise, but not always and noise exposed workers often have tinnitus but
this may not be the case if hearing is normal. The frequently recorded health disorders
between iron and steel industry workers includes: respiratory, skin problems and noise-
related hearing impairment.3
Thus public awakening is very essential for the control and prevention of the
noise pollution. In India, most of the persons lack any idea about the ways in which noise
pollution could be controlled. Very few people are aware of the problem and its control.
In this regard television, radio, internet, and newspapers should give a campaign for wide
publicity. 3
2
6.1. NEED FOR THE STUDY
The work place is that in which person not only earn his daily bread but also
spent one third of average adult life. As the number of industries are on the increase.
Several industries like cement industries, steel industries, textile industries etc. Thus the
workplace has significant influence on individual’s heatlh and is a primary site for the
delivery of preventive health care. The protections of health of working population in
these are primary concern. 4
Health of workers working in iron and steel industries are more affected by noise
pollution. Noise above 80 decibel (db) can produce adverse auditory and non auditory
health effects. Repeated exposure to hazardous level of noise damages structures
contained within the inner ear. An explosion or any large and abrupt pressure change can
also cause damage to middle ear which could cause auditory damages. In addition to
hearing loss exposure of workers to noise level of 90-119decible (db) was also found to
result in disorders like mental fatigue, annoyance and reduce alertness, hypertension and
irritability leads to accidents.5
A cross sectional study was done on noise induces hearing loss among 150
workers from area A and 52 employees from area B .The sample were collected by
random method. The results show that in both study areas the noise level was above the
safe limit of 85decible (db). In area A 28 worker and in area B 8 employees had noise
induced hearing loss. In area A 81.1% of the workers and in area B 85 % of the
employees knew that noise cause hearing loss. All workers from both study area knew
that noise induced hearing loss could be prevented by some form of ear protection .The
3
study conclude that workers exposed to noise above 85decible (db) will eventually
develop hearing loss, the workers are aware of this hazard. Therefore a need to educate
those exposed on how dust protect their ear from the hazard and provide them with
protective gear. 6
A cross sectional study was carried on noise induced hearing loss in steel factory
among 50 workers. The sample was divided into two groups, a group of 25 workers of
the steel production machine division as case group, and another 25 workers of the
administrative division as control group. The study result show that the noise intensity in
the steel production machine room was 102decible (db) and in the administration room
was 60.4 decibel (db) and a number of 21 workers (84 %) of the case group got, Noise
induce hearing loss (NIHL) compared to 1 worker (4 %) of the control group. The study
concluded that there was a significant difference in the incidence of noise induced
hearing loss (NIHL) between the two groups and there was also a significant difference in
correlation between noise induced hearing loss (NIHL) and working period (p < 0.05). 7
A cross sectional study was carried on the prevalence of noise-induced hearing
loss among 182 workers. The acoustic classifications from the operating units of the
client companies were used to characterize the noise exposure status within the work
environment. The results show that the prevalence of cases suggestive of noise induced
hearing loss (NIHL) was 15.9% and significant associations (p<0.05) were identified
from multivariate analysis between these cases and the variables of age and degree of use
of individual protection equipment. Thus the study concluded that contribute towards
4
better understanding of the behavior of some of the main characteristics of noise induced
hearing loss (NIHL), in a particular situation of the organizing of work. 8
A study was carried out on noise induced hearing loss and blood pressure among
85 workers with long-term exposure to noise levels exceeding 85 decibel (db) .The
control group consisted of 85 workers who had never been exposed to noise levels greater
than recommended 85 decibel (db). The Mann-Whitney test was used for statistical
assessment in their working environment. The result showed that the workers in the
exposed group had hearing loss which was confirmed by audiometer and the systolic as
well as the diastolic blood pressure in the exposed group was increased (P < 0 001),
respectively (P < 0.01).9
Training and education to these workers is an essential component of
occupational health. It is important to make workers aware and concerned about health.
Thus in this study, researcher is going to evaluate the effectiveness of structured teaching
programme on effect of noise pollution among Iron and Steel industry workers. 10
6.2 REVIEW OF LITERATURE
An important aspect of research, literature review is to make sure that is already
done in relation to the problem of interest. Several studies which have been conducted in
correlation between levels of sound and noise induced health problems which needs more
focus for the development of future studies. The investigator with the available resources
was able to review the literature so as to proceed with the study.11
5
A study was conducted on noise induced hearing and hypertension associated
with long term occupational exposure to noise among 140 healthy male employees from
a local petrochemical industry with a history of past and present exposure to noise and
140 matched healthy unexposed individuals from the same industry . A questionnaire
with 40 items concerning age, sex, weight, height, length of employment, workplace
noise level, and history of hypertension was administered. The subjects were physically
examined, their blood pressure was taken under normal resting position and all
underwent audiometry testing. Similarly, sound pressure level and octave band analyzing
in different stations of the workplace were carried out for every employee, and then
combined noise level was calculated. The results showed that prevalence of hearing
impairment was 38.5% among the exposed and 7.8% among the unexposed group and the
difference was statistically significant. Prevalence of hypertension in the exposed group
was significantly higher than that in the unexposed group.12
An environmental study was conducted on Auditory and Respiratory Health
Disorders among 106 occupationally exposed male workers. Sample were subjected to
Spiro- metric and audiometric measurement .Environmental study for noise ,dust and
fumes measurement was done .The study result show that the higher mean value of noise
and lower mean value of dust ,fumes than the standard level .The study concluded that
workers working in iron and steel industry may be associated with higher prevalence of
chest manifestations, hearing impairment, changes in the mean values of different
spirometric measurements and noise induced hearing loss.13
6
A study was conducted on hypertension and hearing impairment in workers of iron
and steel industry among 770 workers from five sections. Steel melting section (SMS),
rolling mill section (RMS), quality control department (QCD), maintenance department
(MD) and administration department (AD). Workers working in SMS, RMS, & QCD
formed a continuously exposed group (CEG); workers of MD and AD formed
intermittently exposed group (IEG). Workers were interviewed, examined and
information was collected in a pre-tested pro-forma. Blood pressure was measured, and
tuning fork tests were done to assess hearing ability. Prevalence of hypertension among
CEG (25.51%) was significantly higher than IEG (14.05%). The results showed that there
was positive association between duration of exposure and prevalence of hypertension.
The prevalence of hearing impairment was significantly more in CEG (20.5%) as
compared to IEG (8.91%). Occurrence of hearing impairment was also directly
proportional to the duration of exposure. The study concluded that hypertension and
hearing impairment are common in workers continuously exposed to high levels of
occupational noise. 14
A study was conducted on combined effect of smoking and occupational exposure
to noise on hearing loss in steel factory among 4,624 steel company workers.
Occupational exposure to noise was determined based on company records. Logistic
regression was used to examine the dose-response association between smoking and
hearing loss. The results showed that smoking was associated with increased odds of
having high frequency hearing loss in a dose-response manner. The prevalence rate
ratio(PRR) for high frequency hearing loss among smokers exposed to occupational noise
was 2.56 (95% CI 2.12 to 3.07), while the prevalence rate ratio(PRR) for smokers not
7
exposed to noise was 1.57 (95% CI 1.31 to 1.89) and the prevalence rate ratio( PRR) for
non-smokers exposed to noise was 1.77 (95% CI 1.36 to 2.30). The synergistic index was
1.16. Smoking was not associated with low frequency hearing loss. Thus the study
concluded that Smoking may be a risk factor for high frequency hearing loss, and its
combined effect on hearing with exposure to occupational noise is additive.15
A cross-sectional study was conducted on do ambient noise exposure levels
predict hearing loss in a modern industry among 6,217 employees of an aluminum
manufacturing company. Industrial hygiene and human resources records allowed for
reconstruction of individual noise exposures. The results showed that workers in higher
ambient noise jobs tend to experience less high frequency hearing loss than coworkers
exposed at lower noise level. The hearing conservation efforts appear to be reducing
hearing loss rates, especially at higher ambient noise levels. The greatest burden of
preventable occupational hearing loss was found in workers whose noise exposure
average 85 decibel(db) or less. The study concluded that reduce rates of occupational
hearing loss, hearing conservation programmers may require innovative approaches
targeting workers with noise exposures close to 85 decibel (db). 16
A study was conducted on effect of chronic and acute exposure to noise in
physiological function among 75 normal healthy individuals exposed to occupational
noise of 88 -107 decibel(db) for 10-15 years and in 36 normal non-exposed subjects .The
result showed that blood pressure, both systolic (P < 0. 01) and diastolic (P< 0. 001), and
heart rate (P< 0 .05) were found to be significantly higher in the exposed subjects,
8
irregularity in cardiac rhythm, both in amplitude and duration, was found in 18 % of the
exposed subjects as against 6 % in the non-exposed group. Variation in the heart rate
during acute noise exposure of 90 decibel (db) has been shown to be related with the
preponderance of tonicity of sympathetic and parasympathetic’s .Measurement of hand
blood flow during the same exposure showed a lesser degree of vasoconstriction and a
slower recovery rate in the exposed group.17
A study was conducted on Effects of workplace noise on blood pressure and heart
rate among 114 workers employed in different sections of lock factories exposed to
industrial noise levels exceeding 80 decibel (db). The control group consisted 30 people
who never lived or worked in a noisy environment. The study result show that significant
changes in systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse
pressure and heart rate in the workers of lock factories. The study concluded that
industrial noise could be possible contributing factor in the development of arterial
hypertension. 18
A study was conducted on multiple work-related accidents: tracing the role of
hearing status and noise exposure among 52,982 male workers aged 16-64 years with
long-standing exposures to occupational noise over a 5-year period, using "hearing
status" and "noise exposure. The results showed that exposure to extremely noisy
environments > or =90 decibel (db) is associated with a higher relative risk of accident.
The severity of hearing impairment increases the relative risk of single and multiple
events when threshold levels exceed 15 decibel (db) of hearing loss. The relative risk of
multiple events is approximately three times higher among severely hearing-impaired
9
workers who are exposed to > or =90 decibel (db). The study concluded that Single and
multiple events are associated with high noise exposure and hearing status. 19
A cross-sectional study was conducted to determine the prevalence of hearing loss
associated with occupational noise exposure and other risk factors among 269 exposed
and 99 non-exposed workers. Otoscopic examination and conventional frequency (0.25–8
kHz) audiometry were used to assess the hearing loss in each worker. The results showed
that 75% (202 subjects) from the exposed group were exposed to a daily combined noise
level above the permissible level of 85 decibel (db) and most (61%) of these did not and
had never used any form of hearing protection. Hearing loss was found to be bilateral and
symmetrical in both groups. The study concluded that gross occupational exposure to
noise has been demonstrated to cause hearing loss. Thus strategies of noise assessment
and control are introduced which may help improve the work environment.20
A study was carried on hearing parameter in noise-exposed among 130 industrial
workers who were exposed to high level of noise and 33 subjects in control group with
normal hearing. Hearing and acoustic reflex thresholds were obtained from all subjects
and the results from age-matched subgroups were compared. The sensor neural hearing
losses which were detected in 71 workers were bilateral, symmetrical and affected mainly
frequencies of 4–6 kHz. In essence, the hearing losses were developed within the first 10
years of noise exposure and associated with slight progress in the following years. When
acoustic reflex thresholds derived from the study and control groups were compared,
10
statistically significant difference was determined only for the thresholds obtained at 4
kHz. 21
6.3 STATEMENT OF PROBLEM
“A study to evaluate the effectiveness of structured teaching programme on knowledge
regarding effects of noise pollution on health among workers in selected iron and steel
industries at Bangalore.’’
6.4 OBJECTIVES OF THE STUDY
The objectives of the study are to:-
Assess the knowledge of workers working in iron and steel industry regarding
effect of noise pollution on health.
Prepare a structured teaching programme on effect of noise pollution on health of
workers.
Evaluate the effectiveness of structured teaching programme on knowledge of
workers regarding effect of noise pollution on health.
Determine an association between the mean pre-test knowledge score of workers
with selected socio- demographic variables.
11
6.5 HYPOTHESIS
H1 The mean post test knowledge score of workers will be higher than
the mean pre test knowledge score.
H2 There will be significant association between pre-test knowledge
score of workers and the selected socio-demographic variables.
6.6 OPERTATIONAL DEFINITIONS
Evaluate :-
It refers to the finding of the value of a structured teaching programme on
knowledge of workers regarding various effect of noise pollution on health.
Effectiveness:-
It refers to the desired change brought by the structured teaching programme and
measured in terms of knowledge score gained in the post test and graded as adequate,
average and inadequate knowledge.
Structured teaching programme:-
It is a systematically developed information and teaching aid developed by the
investigator for a selected group of workers to provide information about various
aspects of noise pollution on health.
12
Knowledge : -
Refers to correct responses on item of knowledge received from workers on effect
of noise pollution on health.
Noise Pollution:-
Refers to displeasing machine sound that disturbs the activity of workers.
Worker: -
Refers to the workers in age group of 20 to50 years who are working in Iron and
steel industries at Bangalore.
Iron and Steel industry:-
Working unit involve in manufacturing Iron and steel product by melting process.
6.7 ASSUMPTIONS
The study is based on the following assumption
Workers may not have adequate knowledge regarding effects of noise pollution
on health.
Structured teaching programme is an accepted teaching strategy that can enhance
the knowledge of workers regarding effects of noise pollution on health.
13
6.8 LIMITATIONS
The study is limited to some selected workers working in Iron and Steel industries at
Bangalore.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Workers working in Iron and Steel industry.
7.2 METHOD OF DATA COLLETION ;.
Research method:- Pre experimental method
Research design: - One group pre-test, post –test design
Sampling technique:- Convenience sampling
Sample size:- 50 workers of Iron and Steel industry
Setting of the study: - Selected steel industry at Bangalore.
7.2.1 CRITERIA FOR SELECTION OF SAMPLE
INCLUSION CRITERIA
The study includes workers who are:-
14
Willing to participate in this study
Present at the time of data collection
EXCLUSION CRITERIA
The study excludes workers who are:-
Not willing to participate in the study.
Not present at the time of data collection.
7.2.2 DATA COLLECTION TOOL
Data collection tool consisting of demographic performa and a structured
knowledge questionnaire, to assess the knowledge of workers regarding effect of noise
pollution on heath .
Content validity of tool will be ascertained with the help guide and experts in field
of community medicine and nursing. Reliability of tool will be established by split half
method.The tentative period for data collection will be for 6 weeks.
7.2.3 DATA ANALYSIS METHOD
The data will be analyses by using descriptive and inferential statistics.Statistical
analysis such as mean, median, standard deviation and percentage distribution will be
done to describe demographic variables .A “t” test will be done to compare the pre and
post test knowledge scores regarding effect of noise pollution on health .A chi –square
test (X2) will be done to determine association between the knowledge score and selected
demographic variable.
15
7.3 DOSE THE STUDY REQUIRES ANY INVESTIGATORE OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR
OTHER HUMANS OR OTHER ANIMALS ?
Yes,
Only a structured teaching programme will be given for the sample as
intervention.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM
YOUR INSTITUTION?
Yes,
- Ethical clearance will be obtained from research committee of Karnataka
College of Nursing Bangalore-64.
- Confidentially and anonymity of the subjects will be maintained.
16
8. LIST OF REFERENCES
1. Tiwari Rajnarayan R. C Mrinalini; Zodpey S.P : Low back pain among textile
Workers; Indian journal of occupational and environmental medicine Vol. 7,
No. 1, January-April 2003.
2. Murli Krishana,R.V.and Murthy, K.P.Vithal:Noise pollution due to traffic in
Vishakhapatanam.Indian Journal of Ecology,10(2):188-193(1983).
3. Parrack,H.O.:Evaluatory Effect of Industrial Noise on Man, Arch. Ind.
Hyg.Occup.Med., 5:415, 1952.
4. Greenburg MI. Hamilton RJ. Philips SD. Occupational industrial and
environmental toxicology, 9th ed. Mosby: New York; Laura De Young, 2000;
356-357.
5. Glorig, A. and Davis,H.: Age, Noise and Hearing loss, Ann.Otol., 70:556, 1961.
6. B.M Minja,N.H Moshi ,Noise induced hearing loss among industrial workers in
dares salaam East African medical journal vol.80,6 ,2003.
7. Sri Harmadji and Heri Kabullah, noise induced hearing loss in steel factory
workers folia medical Indonesiana vol. 171 40, 2004.
8. Maximiliano Ribeiro Guerrab, Paulo Maurício Campanha Lourençoa, Maria
Teresa Bustamante-Teixeirab and Márcio José Martins Alvesb Prevalence of
noise-induced hearing loss in metallurgical company rev, saudia publica 2005 39.
9. Sanja Milkovi -Kraus Noise-induced hearing loss and blood pressure Int Arch
Occup Environ Health (1990) 62:259-260.
17
10. Joshi S. Prevention of occupational health hazards in mechanical
industry.Nightingale Nursing times 2006; 91 (10) 24-27.
11. Howard JK, Tyrer FH. Text book of occupational medicine, Churchill
Livingstone Longman group U K Ltd., 1987; 235-236.
12. M Neghab, M Maddahi2 AR Rajaeefard, Hearing Impairment and Hypertension
Associated with Long Term Occupational Exposure to Noise IRCMJ 2009;
11(2):160-165.
13. Gaafar M. Abdel – Rasoul, Omayma AE. Mahrous, Mahmoud E.Abou Salem,
anal A. Al-Batanony and Heba K. Allam, Auditory and Respiratory Health
Disorders Among Workers in an Iron and Steel Factory ., Zagazig Journal of
Occupational Health and Safety Vol. 2 No. 1 June 2009.
14. Uday W, Bhooshan G, and Sushama S.: “Hypertension and hearing impairment in
workers of iron and steel industry”. Indian J Physiol Pharmacol; (2006) 50(1), Pp:
60-6.
15. T Mizoue, T Miyamoto, T Shimizu , Combined effect of smoking and
occupational exposure to noise on hearing loss in steel factory workers, Occup
Environ Med 2003;60:56–59.
16. P.M Rabinowitz, D Galusha, C Dixon-Ernst, M D Slade, M R Cullen, Do ambient
noise exposure levels predict hearing loss in a modern industrial cohort?, Occup
Environ Med 2007;64:53–59.
17. A P Singh, R M Rai, M R Bhatia, and H S Nayar., Effect of Chronic and Acute
exposure to Noise on Physiological Functions in Man, Int Arch Occup Environ
Health (1 982) 50:169-174.
18
18. Sangeeta Singhal, Berendra Yadav, S.F. Hashmi, M d. Muzammil.,Effects of
workplace noise on blood pressure and heart rate Biomedical Research 2009; 20
(2): 122-126.
19. Girard SA ,Picard m, Davis, Simard m, larocque r, Multiple work-related
accidents: tracing the role of hearing status and noise exposure. Occup environ
med. 2009 may; 66(5):319-24. Epub 2009.
20. H. O. Ahmed, j. H. Denni, o. Badran§, m. Ismail,s. G. Ballad, a. Ashoor_ and d.
Jerwood occupational noise exposure and hearing loss of workers in two plants in
eastern Saudi arabia,ann. Occup. Hyg. vol. 45, no. 5, pp. 371–380, 2001.
21. Onur C¸ elik, S¸ inasi Yalc¸ın, Ahmet Ozturk Hearing parameters in noise
exposed industrial workers Auris Nasus Larynx 25 (1998) 369–375.
19
9. SIGNATURE OF THE CANDIDATE:
10. REMARKS OF THE GUIDE:
11. NAME AND DESIGNATION:
11.1 GUIDE
11.2 SIGNATURE
11.3 HEAD OF THE DEPARTMENT:
11.4 SIGNATURE
12. REMARKS OF THE PRINCIPAL:
12.1 SIGNATURE
20