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Abstract
Purpose Good eye protection is the most important factor in preventing eye injuries. Most eye injuries are due to the improper use or lack of use of eye protection equipment. Therefore, this study aims to assess eye protection practice and associated factors among welders in small-scale industries in Hosanna town of Southern Ethiopia.
Methods A cross-sectional study was conducted on 420 welders between 14 August and 14 September 2023. A structured questionnaire was used to collect the data entered into Epi-data V.4.6 and analysed using a statistical package for social science V.25.0. Descriptive statistics was used to describe the characteristics of study participants. Binary logistic regression analysis was carried out to identify factors associated with eye protection practice. Finally, the OR with a corresponding 95% CI was computed to show the strength of the association. A p value <0.05 was considered to declare statistical significance.
Results A total of 420 study participants were included. Good eye protection practice was 43.6% (95% CI 43.41 to 43.79). Monthly income between 4000 and 8000 and above 8000 Ethiopian birr, knowledge (adjusted OR (AOR)=3.90, 95% CI 1.96 to 7.78), permanent work pattern (AOR=2.86, 95% CI 1.59 to 5.17), previous ocular trauma (AOR=3.09, 95% CI 1.53 to 6.22) were positively associated with good eye protection practice.
Conclusion The results of this study revealed poor eye protection practice among welders. Factors such as monthly income, previous ocular injury, work pattern and knowledge of eye Personal Protective Equipment were significantly associated with eye protection practice.
- Equipment
- Public Health
- Cross Sectional Study
- Epidemiology
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Occupational ocular trauma and injury are among the frequently reported cases in the eye clinics so far. However, welding is among the high-risk jobs for ocular injury, little is known regarding the ocular protection practice and eye personal protective equipment use. To improve the quality of life, productivity of this active working group and to prevent further complications, we intended to conduct such a study that can identify the gap associated with.
WHAT THIS STUDY ADDS
This study unveils the ocular protection practice status and associated factors among welders in the current study area.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The findings from this study disclose poor overall practice of eye protection at work with informative and modifiable factors associated with. The current study was conducted by incorporating vital variables not assessed domestically so far. Findings from this study could be used as a baseline data for the future studies conducted to ensure consistent understanding and give valuable information for stakeholders in charge of securing and controlling occupational safety.
Introduction
Welding is a valuable manufacturing technique for joining metals and alloys effectively. However, it necessitates the use of Eye Personal Protective Equipment (EPPE) to minimise ocular injuries. Welding generates various hazardous by-products, including ultraviolet and infrared radiation, heat, noise, vibration and metals like nickel, magnesium, lead, iron and zinc.1
Studies have shown that people who work in the welding area are at risk of various diseases, including lung disease, cardiovascular disease and cancer.2 3 From a total of 2.78 million occupational injuries, 2.4 million people died due to occupational diseases.4 Occupational injury and diseases are declining more slowly in most industrialised countries than in developing countries.5 In sub-Saharan Africa, 16 000 out of 100 000 workers were injured at work.6 The costs associated with occupational injury are estimated to account for around 4% of global gross domestic product.7
Ocular injuries are common causes of visual morbidity and blindness worldwide.8 9 A common problem among welders is prolonged exposure to visible light, infrared and ultraviolet radiation. Long-term exposure to ultraviolet radiation has been associated with eye diseases such as photokeratoconjunctivitis, chronic actinic keratopathy, photophthalmia, pterygium, pinguecula and maculopathy. Additionally, welders face high susceptibility to eye injuries such as traumatic mydriasis, traumatic iritis, and incidents involving foreign bodies like airborne metal shavings and thermal burns.10 11
About 60% of work-related eye injuries are due to either the lack of use or incorrect choice of Personal Protective Equipment (PPE) at the time of injury.12 A study on the assessment of occupational injuries among welders in northwest Iran found that 92% of welders suffered from eye problems.13
Studies conducted in Africa indicate a wide range in the adoption of ocular protection practices among welders, spanning from 2.3% to 96.9%.14–17 In Lagos, Nigeria, findings revealed that less than half (43.7%) of surveyed welders used welding goggles, while 45.4% resorted to sunglasses. Alarmingly, a notable portion of respondents abstained from employing any protective aids during welding activities.15 Similarly, investigations in Conakry highlighted a deficiency in the utilisation of protective equipment within welding workshops, contributing to a heightened prevalence of ocular diseases among welders.18 These findings suggest that a significant number of welders are not taking the necessary precautions to protect their eyes from the inherent hazards of welding processes. Conversely, a survey conducted in Thailand demonstrated a contrasting trend, with all participants employing protective devices, although with varying degrees of adherence to correct usage.19
Various previous studies unveiled that factors such as awareness and attitudes regarding EPPE, PPE accessibility, educational attainment, affordability, monthly income, work experience, working hours and absence of training in PPE usage experienced some form of association with suboptimal utilisation of EPPE.20–23 Strategies for reducing ocular injuries include the proper use of PPE, comprehensive training for welders, enhancing accessibility, fostering improved awareness and attitudes regarding PPE, and implementing workplace protocols.20 24–26
Studies conducted among welders in Ethiopia, specifically in Addis Ababa27 and Tigray region,28 primarily focused on assessing awareness of occupational hazards rather than exploring knowledge and attitudes towards personal eye protection and ocular protection practices. Additionally, the study in the Tigray region28 assessed the overall utilisation of PPE, including face masks, boots, hearing protection, gloves, aprons and eye goggles, without specifically addressing ocular protection practices. Furthermore, these studies did not comprehensively investigate certain factors associated with eye protection practices among welders.
Therefore, this study aimed to fill a research gap by incorporating additional variables such as knowledge and attitudes about EPPE among welders in Ethiopia or the specific study area. Additionally, it assessed the prevalence of eye protection practices and identified factors influencing them. Furthermore, the research provides foundational data that policymakers can use in developing occupational eye health safety standards. Finally, the main objective of this study was to determine the proportion of ocular protection practice and associated factors among welders in Hosanna town, Southern Ethiopia.
Objectives
General objective
To assess the practice and associated factors towards eye protection among welders in small-scale industries in Hosanna town, Southern Ethiopia, 2023.
Specific objectives
To determine the proportion of eye protection practice among welders in small-scale industries in Hosanna town, Southern Ethiopia, 2023.
To identify factors associated with eye protection practice among welders in small-scale industries Hosanna town, Southern Ethiopia, 2023.
Methods and materials
Study design
An institution-based cross-sectional census was conducted.
Study area and period
The study was carried out from 14 August to 14 September 2023, among welders in small-scale industries in Hosanna town. Hosanna town is found in Southern Ethiopia, approximately 230 km away from Addis Ababa, the capital city of Ethiopia. The weather in this town is ‘woyinadega’, which is in between the coldest and hottest. The town’s overall population is estimated to be 179 761 based on information from the 2021 census. There are about 430 welders in the town, along with 20 garages and 130 metal workshops.
Source and study population
All welders who live in Hosanna town.
Eligibility criteria
Inclusion criteria
This study included welders of all types who were willing to participate in the study.
Exclusion criteria
The study excludes welders who were not willing to participate in the study.
Sample size determination
The sample size was determined using a single population proportion formula by taking a 95% CI and 56.80% proportion of eye protection practice was used.29
, where
n=sample size
Z=Z statistic for 95% level of confidence=1.96
p=estimated proportion of eye protection practice from previous study=56.80%
d=margin of error=±5%.
Then the calculated sample size result to be:
Considering 10% non-response rate the final sample size confirmed to be 416. Although the calculated final sample size is 416, we took all the welders in the town as the study sample because the number of welders is 420.
Study variables
Dependent variable
Ocular protection practice.
Independent variable
Sociodemographic factors
Age.
Gender.
Marital status.
Socioeconomic variables
Level of education.
Average monthly income.
Work experience.
Knowledge related to EPPE.
Attitude related to EPPE.
Organisation factors
Safety training.
Accessibility of EPPE.
Cost of EPPE.
Duration of the average time in hours spent welding each day.
Work place policy.
Pattern of employment (permanent, temporal).
Operational definitions
Eye personal protective equipment:
A type of PPE designed to prevent injury to the eye. Three main types of eye protection exist: safety glasses, goggles and face shields.30
Eye protection practice
Measured by a set of nine close-ended questions. Each correct response was scored one point while the wrong response scored zero. The mean score for the practices of welders related to EPPE was taken at the cut-off point. Those who obtained a score above the mean were considered to have good practice and those who scored below the mean were considered to have poor practice.31
Knowledge towards EPPE
Assessed by four close-ended questions. Each correct response was scored 1 point while wrong/negative responses were scored zero. The mean score for the level of knowledge of welders on EPPE was taken as the cut-off point. Those who obtained a score above the mean were considered to have a good level of knowledge. Respondents who scored below the mean score were categorised as having a poor level of knowledge.31
Attitude towards EPPE
Assessed by eight close-ended questions on a 5-point Likert scale; strongly agree (5-point), agree (4-point), neutral (3-point), disagree (2-point), and strongly disagree (1-point). The mean score for the level of attitude of welders on EPPE was taken as the cut-off point. Then, an overall value greater than the mean score indicated a positive attitude and an overall value less than the mean score indicated a negative attitude towards EPPE.31
Sampling technique and procedure
All welders in small-scale industries were included in the study at the time of data collection, giving the final sample size of 420.
Data collection procedures and personnel
Data were collected from the welders through a self-administered structured questionnaire. The questionnaire consists of demographic data, practice, knowledge and attitude towards eye protection. Data were collected by three optometrists and a pretest was done on 5% of the sample size outside the study area with the same pattern as the study population.
Data processing and analysis
All the collected data were coded, and then data were carried out continuously as the data collection process using Epi-Data V.4.6. SPSS V.25.0 was used for data analysis. Frequency distribution with figures and tables used to summarise the descriptive part of the study. A binary logistic regression model was used to determine factors associated with the practice of eye protection. The variables that were found with p<0.2 at bivariable regression were entered into the multivariable analysis. A variable with a p value of less than 0.05 was considered statistically significant. Hosmer and Lemeshow test was performed to check model fitness by taking a p value of greater than 0.05. Variance inflation factor and Cronbach’s alpha test were used to assess variance and reliability of data. Finally, variables that had significant associations with eye protection practice were identified based on the adjusted OR (AOR) with a 95% CI and p value less than 0.05.
Data quality assurance
All the data collectors were trained for 2 days before the data collection process and the questionnaires were pretested to check for completeness, appropriateness and common understanding then modification was done accordingly. To ensure the quality of data, the principal investigator was closely supervise the data collection process daily. The review was made in the field for checking and the data were codded for the data entry.
Patient and public involvement
This study was conducted exclusively on patient and public involvement. The participants were not requested to comment on the study design and were not consulted to develop public’s relevant findings or to conclude the results. The participants were not asked to write or update this material to make it more readable or accurate. There are also no plans to distribute the outcomes of the study to each study participant.
Results
Sociodemographic characteristics of the study subjects
A total of 420 welders were interviewed. Over half of the respondents 63.3% (266) were between the ages of 15 and 25 years. Off the total study participants, 97.4% (396) were men; 76.2% (310) were single; 33.3% (142) had completed elementary school, and 29.5% (124) had completed secondary education. The majority 66.4% (279) were temporal workers and 42.1% (177) welders work between 4 hours and 8 hours per day. About 20.8% (87) had a history of ocular trauma in the previous year (table 1).
Sociodemographic characteristics of small-scale industry welders in Hosanna town, Southern Ethiopia 2023 (n=420)
Knowledge towards EPPE
Two hundred seventy (48.3%) of the study participants knew that the place where they can buy an EPPE, 149 (35.5%) knew the ultraviolent protection range needed for EPPE, 109 (26%) had a certain training regarding the use of EPPE. Almost all of the study subjects 410 (97.6%) knew EPPE can reduce exposure to hazards. In general, 170 (40.5%) welders had good knowledge regarding EPPE (table 2).
Eye protection practice and knowledge towards EPPE among small-scale industry welders in Hosanna town, Southern Ethiopia 2023 (n=420)
Attitude towards EPPE
Out of the study participants, 318 (75.7%) agreed that using eye protectors during work protects the eye from work-related ocular hazards/injuries. Respondents (37%–39%) agreed that EPPE does not bother them, it is important for low-risk tasks, and that EPPE must be a compulsory item. A total of 262 (62.4%) respondents agreed to use personal protective eyewear if available. A total of 170 (40.5%) respondents agreed that EPPE is not very expensive compared with benefits. Generally about 187 (44.5%) of the respondents had a positive attitude towards EPPE (table 3).
Attitude towards EPPE on small-scale industry welders in Hosanna town, Southern Ethiopia 2023 (n=420)
Eye protection practice among welders
Four hundred sixteen (99%) have an EPPE at the workplace and 101 (24%) respond they have a workplace policy on EPPE. The majority 300 (71.4%) of respondents had fulfilled the standard criteria for handling and fitting PPE. In general, 183 (43.6%) of the respondents had good eye protection practice (table 2).
Factors associated with eye protection practice among welders
All variables were entered into the bivariable logistic regression model separately. Gender, marital status, safety training, accessibility of EPPE, cost of EPPE and workplace policy had a p value of greater than 0.2 and were not fitted to multivariable logistic regression. Finally, the association was determined using the enter method in multivariable logistic regression. The level of significance was determined using a p value of 0.05 at 95% CI, and the following variables were discovered to have a significant association with ocular protection practice.
Participants who had average family monthly income between 4000 and 8000 Ethiopian birr were 3.45 times more likely to have good eye protection practice compared with those who had family averagely paid less than 4000 Ethiopian birr (AOR=3.45, 95% CI 1.58 to 7.53). Similarly, participants who had average family monthly income higher than 8000 Ethiopian birr were 4.46 times more likely to have good eye protection practice compared with those who paid less than 4000 Ethiopian birr (AOR=4.46, 95% CI 1.62 to 12.20).
This study showed that participants who were permanent workers at their work were 2.86 times more likely to have good practice compared with those temporary workers (AOR=2.86, 95% CI 1.59 to 5.17). Similarly, the odds of good eye protection practice were three times higher in study subjects who had a history of ocular injury as compared with those experienced no ocular injury (AOR: 3.09, 95% CI1.53 to 6.22).
Moreover, in this study, those participants who had good knowledge regarding EPPE were almost four times more likely to have good practice compared with those who had poor knowledge (AOR=3.9, 95% CI 1.96 to 7.78) (table 4).
Multivariate analysis to identify factors associated with eye protection practice among welders in small-scale industry in Hosanna town 2023 (n=420)
Discussion
This institution-based cross-sectional study found that the percentage of welders who adhered to good eye protection practice was 43.6% (95 CI 51.206 to 51.596).
This result was notably lower as compared with similar research conducted in India (45%),32 South Africa (89%),16 Uganda (89.0%),10 Nigeria (96.6%),17 Tigray, Ethiopia (86.5%)20 and Gondar, Ethiopia (56.8%).31 This variance may be attributed to differences in sociodemographic factors, awareness and knowledge regarding EPPE, safety training, healthcare systems and the measurement of outcome variables as well as varying levels of education. For instance, studies in South Africa and Nigeria reported higher levels of knowledge towards EPPE (72% and 46.6%, respectively) compared with our study findings (40.5%), emphasising the importance of a good understanding of EPPE for maintaining good ocular protection practice.24 Additionally, studies in South Africa, Nigeria and Uganda utilised only one question to assess ocular protection practice, whereas our study employed nine questions. Moreover, the study conducted in Tigray, Ethiopia focused on large-scale industries where EPPE provision by companies is more likely, potentially leading to better adherence to industry policies on PPE regulations.
However, the prevalence of good eye protection practice in this study was higher compared with study conducted in Uganda (37.10%),25 Taiwan (41.9%)33 and Benin (2.3%).14 This discrepancy could be attributed to variations in study design, data collection tools, attitude towards EPPE and sample size. For instance, the study in Benin had a small sample size, and a case–control study design was used in Taiwan. Additionally, a significant number of welders in Ethiopia exhibit positive attitude towards EPPE compared with those in Uganda.
In this study, income, work patterns, previous ocular injuries and knowledge about EPPE were found to be significantly associated with good eye protection practice.
In the present study, average family monthly income showed a significant association with good ocular protection practice. Participants having family with average monthly earning between 4000 and 8000 Ethiopian birr were 3.45 times more likely to demonstrate good eye protection practice compared with those earning less than 4000 Ethiopian birr. Similarly, participants from family averagely earning over 8000 Ethiopian birr per month were 4.46 times more likely to exhibit good eye protection practice compared with those subjects having family with income below 4000 Ethiopian birr. This finding aligns with results from a study conducted in Ghana.22 Welders with higher incomes can afford better-quality EPPE, ensuring superior eye protection. They may also work in environments that prioritise safety, providing comprehensive training and enforcement of protocols, leading to better adherence to eye protection practice.
This study revealed that participants with permanent employment status were 2.86 times more likely to have good ocular protection practice compared with temporary workers, consistent with findings from a study in Nigeria.34 This could be attributed to the fact that temporary workers are often less experienced, younger, exhibit lower safety consciousness and receive less training compared with permanent workers.21 These factors collectively contribute to poorer eye protection practice among temporary workers.
This study also found that the odds of having a good level of ocular protection practice was 3.09 times higher for participants who had a history of ocular injury compared with those without such a history. This aligns with findings from studies conducted in Canada,35 Nepal,36 Nigeria15 and Gondar, Ethiopia.31 This could be due to welders with previous ocular injuries are more aware of workplace hazards, leading to increased caution and vigilance. Their firsthand experience underscores the importance of eye safety, motivating them to prioritise protection practices.31 Moreover, education or training received after injury reinforces their commitment to safety measures.
In our study, participants with good knowledge of EPPE were 3.9 times more inclined to demonstrate good practice, aligning with findings from Nigeria,24 Uganda25 and Tigray Ethiopia.20 This association is probabily due to the fact that welders who have a good knowledge of EPPE are better able to assess the dangers of welding so that they can prioritise the safety of their eyes and choose suitable protective equipment. This knowledge also empowers welders to recognise EPPE deterioration, prompting timely replacements and reinforces consistent adherence to safety protocols, reducing the risk of ocular injuries.
Strengths and limitations
This study’s strength lies in its thorough examination of factors affecting welders’ eye protection practice, particularly in Ethiopian contexts. By exploring attitude and knowledge among Ethiopian welders, it fills a crucial gap in the literature. The use of rigorous methodologies ensures robust findings, contributing valuable insights to occupational health and safety. This comprehensive approach and methodological rigour enhance the study’s significance in advancing our understanding of eye protection practice among welders.
The limitations of this study are that welders with ocular injuries might cease welding, potentially biasing results as uninjured welders may lack safety awareness and the impact of not using eye protection may be underestimated. Another limitation involves potential biases in respondents’ interpretation of scales assessing eye protection practice, knowledge and attitude as well as in responses to questions about personal protective eye wear conformity to international standards. These variations may impact response consistency and validity. To enhance reliability and ensure consistent understanding, future studies could provide explanations with questions or explore alternative methods.
Conclusion
This study investigated eye protection practice among welders in Hosanna town in 2023, revealing a good practice rate of 43.6%. Factors such as monthly income, previous ocular injury, work pattern and knowledge of EPPE were found to be significantly associated with eye protection practice. Offering training on EPPE to improve protection practice and reduce ocular injuries among welders is essential.
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
Approval was granted by the Ethics Committee of University of Gondar, College of Medicine and Health Science, Comprehensive Specialized Hospital (Date 06 May 2023/No. 622). Participants gave informed consent to participate in the study before taking part.
References
Footnotes
Contributors All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by HEW, GSB, NFA, and BLE. The first draft of the manuscript was written by HEW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. GSB is responsible for the overall content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer-reviewed.