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Indian Pediatr 2013;50: 411-413 |
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Eyestrain in Working Children of Footwear
Making Units of Agra, India
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Rajnarayan R Tiwari
From National Institute of Occupational Health,
Ahmedabad, Gujarat, India.
Correspondence to: Dr Rajnarayan R Tiwari,
Scientist D, Occupational Medicine Division, National Institute of
Occupational Health, Meghani Nagar, Ahmedabad 380 016, Gujarat, India.
Email:
[email protected]
Received: January 16, 2012;
Initial review: February 10, 2012;
Accepted: August 13, 2012.
PII: S097475591200059
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Children of footwear making units are working in the soling process.
The process includes fixing of upper part with the sole of the
footwear. The adhesives contain a mix of organic solvents, which are
released in the working environment and cause irritation and
lacrimation of eyes. In addition poor illumination and ventilation
further aggravates the eyestrain. The present study was carried out
to find out the prevalence and the associated factors of eyestrain
in working children of footwear making units. The study included 139
exposed and 160 comparison group subjects. Self-reported eyestrain
was recorded through personal interview. The prevalence of eyestrain
in child laborers was 25.9%, which was significantly more than the
12.4% prevalence in comparison group subjects (P=0.01).
Working children of footwear making units were at 2.4 times higher
risk of developing eyestrain as compared to comparison group
subjects, though statistically non significant. Significantly higher
proportion of eyestrain was reported in those aged >12 years, males
and those working daily for >4 hours. The higher prevalence of
eyestrain in the working children of footwear units may be
attributed to exposure to workplace factors.
Key words: Working children, India, Occupational health.
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In India according to 1991 census, out of a total
population of 838.6 million, working children were 11.28 million, which
was 1.34 percent of the total population [1]. The informal economy
harbors most child labor [2].
The footwear industry is a significant segment of the
leather industry in India. The industry is labour intensive and is
concentrated in the small and cottage industry sectors. The major
production centers India are Chennai, Ranipet and Ambur in Tamil Nadu,
Mumbai in Maharashtra, Kanpur and Agra in Uttar Pradesh, Jalandhar in
Punjab, and Delhi. Children are employed in the manufacture of shoes,
particularly in the Agra. Estimates state that as many as 25,000
children may be involved in shoe-making, both for the domestic and
international markets [3].
In the shoe-making industry, children work on soling
(fixing upper portions of shoes to leather or rubber soles) with glue.
Children in cramped poorly lit rooms suffer from continuous skin contact
with industrial adhesives and breathing vapors from glues. Thus, the
children working in the footwear industry are exposed to physical
factors like poor illumination and poor ventilation, and chemicals like
fumes of solvents in glues. These chemicals can result in eyestrain.
Eyestrain (asthenopia) is a symptom complex
that involves sensations of irritation to the eye
itself, changes in vision
(such as blurred or double vision), and associated
symptoms such as headache [4,5]. The main cause of
eyestrain is thought to be
fatigue of the ciliary and extraocular muscles
due to the prolonged accommodation and vergence
required by near-vision work
[4-7]. Another causative factor that
has been implicated in eyestrain is dryness of the eyes
resulting from an increased
exposed surface area of the cornea when focusing
and a decreased blink
rate due to mental concentration [5]. Other causes of
eyestrain include environmental factors (illumination levels, glare,
brightness and viewing angles) and personal factors (uncorrected vision,
stress, visual fatigue, poor posture and alcohol/drug use) [8]. A recent
study among computer operators in India revealed 43.6% prevalence of
eyestrain [9] while in another study among radiologists the prevalence
of eyestrain was 36% [10]. Further exposure to fumes of solvent results
in irritation of eyes and increased lacrimation [11].
This is the first attempt to find out the prevalence
and factors associated with the eyestrain in the working children of
footwear making units.
Methods
The present study aimed to assess the prevalence of
eyestrain among 139 child laborers (not completed 18 years) working in
the footwear making unit at Agra as exposed group and 160 comparison
group children. The comparison group comprised of children from
government-run school from the neighboring areas of the NCLP schools and
from the classes, which matches the age-group of working children.
The Institutional ethical committee cleared the project. The
comparison group included only those children who never worked in any
form of child labor. The informed consent of the parents was not
obtained. However, the informed consent of the class teacher and the
verbal assent of the children were obtained.
Using interview technique as a tool for data
collection the demographic characteristics, occupational and clinical
history were recorded on a pre-designed proforma. The questionnaire was
pretested and the interview conducted by the same investigator. The
socio-economic status of the two groups was group-matched.
Socio-economic status was defined according to the modified Kuppuswamy’s
scale [12]. Eyestrain was assessed through
evaluation of self-reported common symptoms including
itching, burning, lacrimating or irritated
eyes; tired or heavy eyes and difficulty seeing clearly
(including blurred or double
vision). Univariate and multivariate analysis of eyestrain was carried
out according to the risk factors which included age
≥12 years, female
sex, daily working duration ≥4
hours, and experience in the job >2years. The age, daily working hours
and duration of employment were arbitrarily dichotomized.
To assess the illumination levels at workplace a walk
through survey was conducted in several houses where the footwear making
was routinely carried out.
Statistical analysis included calculation of
proportions and percentages, application of test of significance i.e.
Chi-square test and calculation of Odds ratio with 95% confidence
intervals. Multivariate analysis was carried out by dichotomizing the
variables. Statistical software SPSS 15.0 was used for statistical
analysis.
Results
The mean age of the child labourers was found to be
10.8 ± 1.5 years while the same for the comparison group was 11.0 ± 1.5
years. The difference was statistically non-significant. The mean
duration of exposure for the child labourers was 20.5 ± 16.2 months
while the mean daily hours of work was 3.9 ± 1.9 hours.
The prevalence of eyestrain in child labourers was
25.9%, which was significantly more than the 12.4% prevalence in
comparison group subjects (P=0.01). Working children of footwear
making units were at 2.4 times higher risk of developing eyestrain as
compared to comparison group subjects (OR=2.44; 95% CI: 0.81-2.69),
though statistically non-significant.
TABLE I Univariate Analysis of Study Risk Factors of Eyestrain in Working Children
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Risk factors |
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Eyestrain |
OR
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(N=139) |
Present(n=36) |
(95% CI) |
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Age (in y ) |
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<12 |
116 |
26(22.4) |
1.0 |
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≥12* |
23 |
10 (43.5) |
2.7(0.6-3.9) |
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Sex |
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Female |
83 |
16 (19.3) |
1.0 |
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Male* |
56 |
20 (35.7) |
0.4(0.3-1.5) |
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Employment duration |
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<2 y
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103 |
26 (25.2) |
1.0 |
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≥2 y
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36 |
10 (27.8) |
1.1(0.5-2.5) |
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Working hours |
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≤4 |
110 |
24 (21.8) |
1.0 |
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>4* |
29 |
12 (41.4) |
2.5(0.6-3.6) |
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*p<0.05 |
Table I shows the univariate analysis of
study risk factors of eyestrain in working children. However, when the
risk of having eyestrain was calculated none of the factors were found
to pose excess risk on univariate analysis. Table II shows
the multivariate analysis of eyestrain according to study risk factors.
The multivariate analysis suggested 3 times higher risk in those aged
³12 years as
compared to those aged <12 years (OR: 3.13; 95% CI: 1.14-8.55). Other
factors were found as statistically non-significant risk factors.
TABLE II: Multivariate Analysis of Study Risk Factors
Risk factor
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Adjusted Odds ratio
(95% CI) |
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Age (<12 years) |
3.13 (1.14-8.55)* |
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Sex (male) |
0.46 (0.2-1.05) |
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Working hours (>4 hours)
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2.06 (0.81-5.24) |
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Duration of exposure (>2 years) |
0.75 (0.28-1.97) |
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*Significant |
Discussion
The prevalence of eyestrain in the working children
of footwear industry was found to be 25.9%. This is the first time the
eyestrain is reported in a working group exposed to organic solvent
fumes at workplace. However, similar high prevalence of eyestrain has
been reported in computer professionals [5,8,9] and radiologists [10].
The suggested causes of eyestrain include fatigue of ciliary and
extraocular muscles [4-7] and dryness of eyes [5]. Irritating effects of
fumes emanating from adhesive solutions could also result in lacrimation.
These adhesives contain a mixture of organic solvents such as
hexane, benzene, propane, dimethyl heptane, cyclohexane, xylene,
cyclopentane. Earlier studies on adult population also reported that the
workers exposed to organic solvents suffer from eye irritation and
lacrimation [11]. When asthenopia was analyzed according to two sexes it
was found that more males had it. This can be attributed to high
proportion of males working in the process of soling where organic
solvents are used. The organic solvent fumes irritate the eyes resulting
in lacrimation and itching [13]. The poor illumination at workplace as
observed during walk through survey further adds to the eyestrain. The
high prevalence in > 12 year old can partly be attributed to the
cumulative exposure to the poor illumination and solvent fumes causing
strain on eyes. The proportion of those complaining eyestrain was more
in those working for more than 4 hours daily. This can be partly
attributed to the development of fatigue. A study among visual display
users working for more than 4 hours a day was found to be a significant
risk factor [14]. A non-significantly higher prevalence of eyestrain in
those working for more than 2 years as compared to those who have worked
for lesser duration was observed.
There are certain limitations to the study. The
asthenopia is self reported and thus is subjected to self-reporting bias
and subjectivity. But the measures were taken to keep this subjectivity
to a minimum by using standard definition and asking for specific
symptoms of eyestrain. Secondly, the illumination levels at the
workplace were not measured and thus the correlation of eyestrain with
different illumination levels cannot be done. However on walk through
survey it was found that the illumination level was poor being provided
by a 40-60W electric bulb or oil-wick in a room of 10ft ×10ft.
We recommend that child labor in any form should be
curbed. Further appropriate personal devices usage such as goggles
should be encouraged to minimize the exposure to harmful chemicals to
the eyes. Workstations with proper illumination and ventilation will
further help in controlling this problem. There should be regular work
rest cycle, which is reported to have positive
effects on eyestrain [15].
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