View of Factorial Analysis of the Risk Related to Byssinosis among Textil Workers in Cimahi

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International Seminar on Global Health (ISGH) 2017 Stikes Jenderal Achmad Yani Cimahi

Factorial Analysis of the Risk Related to Byssinosis among Textil Workers in Cimahi

1

**Lela Juariah*,**

²

Juju Juhaeriah,

³

Novie E. Mauliku

1,2,3

Stikes Jenderal Achmad Yani Cimahi

*Email: [email protected],

Abstract

Byssinosis been recognized as other form of occupational pneumoconiosis caused by exposure of cotton dust. NIOSH (2012) estimated that the mortality rate caused by occupational pneumoconiosis are 705 from the total of occupational mortality. This study aimed to identify the risk factors related to byssinosis among textile workers. Using cross sectional approach, this study employed 64 employees in convenience sampling. Data were obtained through questionnaires, observations and measurements. Factorial analysis utilized to identify the factors related to byssinosis. The results showed the proportion of the incidence of byssinosis were 79.7%. Bivariate analysis showed that the length of exposure, smoking habit, history of diseases, occupational history, habit of using PPE, age, working period, nutritional status were significantly correlated with the incidence of byssinosis (p value ≤ 0,05). The factorial analysis identified two factors related to the incidence of Byssinosis. First factor consist of nutritional status, dust levels, smoking habit, history of disease, history of work and habits using PPE which contributed 37,2%. While the second factor consists of age, working period and the length of exposure contributed 31.7% to the incidence of byssinosis. According to this reserach finding, it is recommended to the textile factory to perform an appropriate effort in controlling the risk factors in order to protect the workers from the incidence of byssinosis.

Key words: Analysis Factorial, Byssinosis, Textile worker Introduction

According to the NIOSH, (2012), estimated that the mortality rate caused by occupational pneumoconiosis are 705 from the total of occupational mortality. The prevalence data of pneumoconiosis variety in each country in the world. Based Surveillance of Work-related and Occupational Disease (SWORD) data on UK from 1990-1998 showing cases of pneumoconiosis by 10% in Canada, cases of pneumoconiosis in 1992-1993 were 10%, while data in South Africa 1996-1999 was 61 %. The cumulative cases of pneumoconiosis in China from 1949-2001 reached 569,129 cases and until 2008 reached 10/963 cases. Data in the United States, the deaths caused pneumoconiosis in 2004 found as many as 2,531 cases of death (Susanto, A.D., 2011).

The form of pneumoconiosis is byssinosis that caused by inhalation of cotton dust as a textile base material. Complaints that often arise are shortness of breath and chest pain like stricken burden that appears after workers rest. This complaint is thought to be due to acute obstructive airway obstruction, and if the worker was not removed from the dusty environment, then the first acute reversible obstruction will be persistent (Wahab, 2001).

The risk factors for the incidence of byssinosis are multifactorial that can be affected by various risk factors such as age, sex, lenght of exposure, working period, smoking habit, occupation type, average or cumulative dust levels, occupational history at previous workplace, history of disease associated with respiratory tract, gram-negative bacterial contamination, nutritional status, and habit of using personal protective equipment (Ikhsan M, 2009;

Moeljosoedarmo, 2008, Saoji, et.al, 2010).

Age has a risk of incidence of byssinosis. The older age of a person has the consequence the higher the dust that enters and is buried in the lungs (Suma'mur, 2014).

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Prolonged contact with the environment containing dust particles will cause severe stress on the respiratory tract so that will cause respiratory function disorders. Generally, symptoms of pneumoconiosis occur after exposure to dust after working for at least 10-20 years. The severity of symptoms that arise depends on the intensity and lenght of exposure (Harrianto, 2009).

Smoking habits can cause lung disease or accelerate the occurrence of lung disease due to work (Harrianto, 2009). Smoking effects are known to disturb the effectiveness of some respiratory defense mechanisms.

The habit of using PPE (mask) is mostly related to the occurrence of respiratory disorders (Moeljosoedarmo, 2008).

Byssinosis is an unreported disease, it is because lung disease is still dominated by specific and non-specific infectious diseases, so detection of pneumoconiosis is often considered a common lung disease. In addition, the lack of knowledge of health workers about the disease is due to symptoms and patophisiology diseases almost the same to lung diseases that are not related to work. Textile workers are particularly at risk for the occurrence byssinosis.

PT. Garuda Mas Semesta is the one of the textile factory in Cimahi which used cotton as base material. Workers at PT. Garuda Mas Semesta has a worker risk against the incidence of byssinosis, therefore the formulation of the problem in this study include :

1. How many is the prevalence of byssinosis that occurs in textile workers at PT. Garuda Mas Semesta Cimahi.

2. Is there a correlation of individual factors with the incidence of byssinosis in worker at PT.

Garuda Mas Semesta Cimahi.

3. Whether the concentration of dust levels in the work environment can affect the incidence of byssinosis in textile workers at PT. Garuda Mas Semesta Cimahi.

4. How is the risk factors identifying incidence of byssinosis in textile workers at PT. Garuda Mas Semesta Cimahi.

Method

The research design used analytical survey with Cross Sectional approach. The research population is all textile workers part production at PT. Garuda Mas Semesta as many as 195 employees, through sampling technique convenience sampling on workers in the work area with exposure to high dust levels and areas with low dust obtained 64 employees. Data was obtained by measuring the Vital Lung Capacity (VLC) used spirometer; measurement of dust level used dustmeter; and measurement of nutritional status through measurement of Body Mass Index (BMI) using microtoice and body scales. In addition, the data were obtained through a questionnaire for risk factor for the incidence of byssinosis. Data analysis was done gradually starting univariate analysis. Bivariate analysis to know the correlation of risk factors with the incidence of bysinosis and factorial analysis to identify factors related to the incidence of byssinosis in textile workers at PT. Garuda Mas Semesta.

Results

1. Prevalence of Byssinosis in Textile Workers at PT. Garuda Mas Semesta

Tabel 1 Prevalence of Byssinosis in Textile Workers at PT. Garuda Mas Semesta Prevalence of Byssinosis Frequency

e

Percentag

Byssinosis 51 79,7

Not Byssinosis 13 20,3

Total 64 100 %

Table 1 can be concluded that of 64 employees at PT. Garuda Mas Semesta 79.7% of them experienced the incidence of byssinosis.

2. Correlation of Individual Factors with Incidence of Byssinosis in Textile Workers at PT. Garuda Mas Semesta

Individual factors in the study include : lenght of exposure, smoking habits, history of diseases associated with the respiratory tract, Occupational history with exposure of dust, habit of using PPE, age, working period, nutritional status. The result of bivariate analysis can be seen in the following table :

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Table 2 Correlation of Individual Factors with Incidence of Byssinosis in Textile Workers at PT. Garuda Mas Semesta

Variable Byssinosis Not byssinosis Total PR p

Table 2 can be concluded that there are correlation of individual factors (lenght of exposure, smoking habits, history of diseases related to respiratory tract, occupational history with exposure of dust, habit of using PPE, age, working period, nutritional status) with incidence of byssinosis in textile workers at PT. Garuda Mas Semesta with p value ≤ 0,05.

3. Correlation of dust levels with the incidence of byssinosis in textile workers at PT. Garuda Mas Semesta

Table 3 Correlation Dust levels with Incidence of Byssinosis in Textile workers at PT.

Garuda Mas Semesta

Level Byssinosis Not Total PR

Dust byssinosis P

F % F % F % (95% CI) value

Lenght of

exposure 43 86 7 14 50 100 1,505 0,028

Long 8 57,1 6 42,9 14 100 (0,943-

New 2,401)

Smoking

Habits 35 100 0 0 35 100 1,813 0,000

Yes 16 55,2 13 44,8 29 100 (1,306-

No 2,516)

History of

Disease 39 97,5 1 2,5 40 100 1,950 0,000

Yes 12 50,0 12 50,0 24 100 (1,303-

No 2,918)

Occupational

History 37 97,4 1 2,6 38 100 1,808 0,000

Yes 14 53,8 12 46,2 26 100 (1,262–

No 2,591)

Habit of

using PPE 41 100 0 0 41 100 2,300 0,000

No 10 43,5 13 56,5 23 100 (1,443–

Yes 1,665)

Age

Risk 37 92,5 3 7,5 40 100 1,586 0,003

No at Risk 14 58,3 10 41,7 24 100 (1,118–

2,249) Working

period 41 87.2 6 12,8 47 100 1,483 0,030

Long 10 58,8 7 41,2 17 100 (0,982-

New 2,240)

Nutritional

status 37 97,4 1 2,6 38 100 1,808 0,000

Abnormal 14 53,8 12 46,2 26 100 (1,262–2,591)

Normal

TOTAL 51 79,7 13 20,3 64 100

F % F % F % (95%

CI)

value

abnormal 9 100 0 0 9 100 1,310 0,185

Normal 42 76,4 13 23,6 55 100 (1,130-

1,517)

TOTAL 51 79,7 13 20,3 64 100

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Table 3 can be concluded that of 55 employees working in a place with normal dust level of 76.4% of them experience incidence of byssinosis, with p value = 0.185 (> 0.05), it means there is no correlation of dust levels with the incidence of byssinosis.

4. Factorial Analysis

The result of bivariate selection obtained p value > 0,05, then the ninth independent variables corresponding the criteria of factorial analysis, the result of factorial analysis can be seen in the following table :

Table 4 Factorial analysis Results

Factor Variable Contribution

1 1. Smoking habits 37,179 %

2. History of disease 3. History of job 4. Habit of using PPE 5. BMI

6. Levels dust

2 1. Lenght of exposure 31,739 %

2. Age

3. Working period

Cumulatif 68.918 %

Table 4 based on factorial analysis results identified two risk factors associated with the incidence of byssinosis. The first factors consisted of smoking habits, history of disease, occupational history, habit of using PPE, nutritional status and dust levels contributed 37,2% to the incidence of bisinosis. While the second factor consists of lenght exposure, age and working period contributed 31.7% to the incidence of byssinosis. Cumulatively, both factors contribute 68.9% to the incidence of byssinosis.

Discussion

The results showed that of 64 textile workers at PT. Garuda Mas Semesta who experienced the incidence of byssinosis as much as 79.7% and 20.3% did not have byssinosis. Byssinosis is a disease or lung damage that occurs due to exposure to cotton dust, hemp, or residue to workers in the workplace, which causes airway obstruction. (Ikhsan M, et al, 2009). Determination of byssinosis in this study based on measurement of vital capacity of lung (KVP) conducted on 64 employees part production, that is warping unit as many as 9 workers; unit weaving I is 30 employees and unit weaving II of 25 employees. The researh results showed that 51 employees among them had VLC < 75%, it is meaning that workers had already experienced pulmonary obstruction (Permenakertrans RI No. Per.25/MEN/XII/2008). So it can cause complaints in the form of a dry cough that can still be lost initially when workers removed from dusty cotton. Other symptoms are a sense of weight or tightness in the chest (chest tightness), fever (mill fever), cough and shortness of breath on the first day back to work after resting the weekend. According with research conducted Syahputra (2015) obtained results that as many as 36 people (77%) possible byssinosis according to Schilling criteria. While (Karnagi, 2011) research, the prevalence of byssinosis was 27.3%, chronic cough 6.9%, chronic bronchitis 4.5% and acute obstruction 4.5%.

The occurrence of byssinosis is a multifactors, these factors include (Ikhsan M, 2009;

Moeljosoedarmo, 2008): dust (nature of dust chemistry, dust size, the levels of dust particles), and individual factors (age, working period, smoking habits, habit of using PPE). While individual factors in this study include: age, working period, long exposure, smoking habits, habit of using PPE, history of diseases associated with the respiratory tract, occupational history with exposure to dust, and nutritional status. The result of bivariate analysis shows that there is correlation between individual factor and the incidence of byssinosis with p value

<0,05.

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Age will affect the frequency of respiration and lung capacity at normal term. Respiratory frequency in adults between 16-18 times per minute and has a vital capacity of lung is greater than children and infants. Certain conditions the consequences of a disease, breathing can increase faster or decrease (Syaifuddin, 2006). The older age has the consequence the higher the dust that enters and is buried in the lungs as a result of inhaling daily dust (Suma'mur, 2014). Additional with a history of diseases associated with the respiratory tract will exacerbate the disruption experienced lung. For that need to be balanced with adequate nutrient intake according to age and health conditions, so that lung function can work optimally. According to Syahputra, et.al (2015) research obtained result that in the age group of 22-25 years did not encounter the incidence of byssinosis, in the age group 25-48 years 3 people experience byssinosis degree 2 in carding workers and 3 people in the age group> 48 years. However in the (Prasetyo, 2016) research obtained the result that there is no significant difference between nutritional statuses with byssinosis in workers PT. Argo Pantes Tbk Tangerang (p value > 0.05)

Prolonged contact with an environment containing dust particles will cause severe stress on the respiratory tract so that will cause respiratory function disorders. Generally, symptoms of pneumoconiosis occur after exposure to dust for at least 10-20 years. The severity of symptoms that arise depends on the intensity and duration of exposure (Harrianto, 2009). Additional with previous occupational history of exposure dust will further extend contact with dust-proof environments. The longer work period and have previous occupational history of exposure of dust in a factory, so the longer worker experienced exposure of dust. This is consistent with Mulyati. S, et.al (2015) study that the average length of work or duration of employee exposure of unit spinning is 25.4 years, unit weaving 25,04 years and administrative unit 12,7 years and analysis result show there is mean significant difference the average working period of production and non-production workers. While Wahab (2001) research shows that there is a significant difference between the working period > 5 years with the working period < 5 years with prevalence ratio 2, it means that working period is positively correlated to the incidence of byssinosis and the tendency of the incidence of byssinosis 2 times more risk at working period

> 5 years.

Smoking habits cause lung disease or accelerate the occurrence of lung disease due to work (Harrianto, 2009). Smoking effects are known to interfere the effectiveness of some respiratory defense mechanisms. Cigarette smoke products are known to stimulate the formation of mucus and decrease cilia movements. According with Syahputra, et.al (2015) research obtained the result that workers have medium and heavy smoking habits have closeness correlation to the incidence of byssinosis. Even in Wahab (2001) study indicating that smoking habits have the most significant association to the incidence of byssinosis with RP-adjusted 3.3 means that worker who smoke have a 3.3 times greater risk incidence of byssinosis than non-smokers.

The habit of using PPE (mask) is closely correlated to the occurrence of respiratory tract disorders. If someone do not use protective equipment (masks) the frequency to entry of dust into the respiratory tract more and can lead to pneumoconiosis. This is because of the lung tissue is a medium that has the ability to capture and absorb the most efficient air pollution in the body (Moeljosoedarmo, 2008). According with the Eko et al (2010) research obtained the result that workers who do not always use mask has risk to experience lung function disorders almost 15 times greater when compared with workers who always use the mask. In (Mulyati. S, et.al, 2015) research, shows that there is a correlation of using personal protective equipment with lung function disorder with p value = 0.001.

The results showed that 9 employees who were worked at the room with abnormal levels of dust, all (100%) experienced byssinosis with p value = 0.185 (p value > 0.05), it means that there is no correlation between levels of dust with incidence of byssinosis. Low levels particles of dust in air inhalation, can be cleaned are completely, but the higher the levels of dust in the environment, more people who will experience pulmonary deposition. Different case with Prasetyo (2016) research showed results that there is a significant difference between the concentration of levels dust with incidence of byssinosis at workers in PT. Argo Pantes Tbk Tangerang (p value < 0.05).

Factorial analysis results showed that there were two factors formed incidence of byssinosis at textile workers of PT. Garuda Mas Semesta. The first factor consists of the habit of smoking, history of diseases related to respiratory tract, a history of previous work are exposed to dust, habitual using PPE, nutritional status and levels of dust contributing

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amounting to 37.2% incidence of byssinosis. This factor is labeled name factor habit, because its includes several habitual at textile workers in PT. Garuda Mas Semesta. This habit of contributing factors of 37.2%, meaning that if the worker in PT. Garuda Mas Semesta has the habit of smoking, history of diseases related to respiratory system, a history of previous work are exposed to dust, habits of using PPE, nutritional status and levels of dust are not good, then the employee has the risk experienced incidence byssinosis amount 37.2%. Then the PT. Garuda Mas Semesta have to make prevention efforts by managing habit factors toward better or healthier, so the textile workers at PT. Garuda Mas Semesta can still work safely and comfortably.

While the second factor consists lenght of exposure, age and working period contributed 31.7% to the incidence of byssinosis. The second factor is labeled as a factor that can not be changed, because of the factors have been experienced by worker at PT. Garuda Mas Semesta.

The irreversible factor contributes 31.7%, its meaning that the factors was experienced the textile workers at PT. Garuda Mas Semesta can be controlled by minimizing risk factors through job rotation.

Cumulatively both factors contribute 68.9% to the incidence of byssinosis, its meaning that if the workers has a risk of unfavorable habits and irreversible factors, then the employees of PT.

Garuda Mas Semesta has a risk of incidence of bisinosis of 68.9%. Efforts should be made to manage worker habits and irreversible factors by PT. Garuda Mas Semesta to prevent the incidence of byssinosis.

In this study added variable history of diseases associated with the respiratory tract, previous occupational of history exposed to dust, nutritional status and long exposure. The Vaiable is considered important for study, since in determining the occurrence of byssinosis can be established by looking at the history of respiratory-related diseases and previous work history with exposure to dust supported by examination of lung physiologic examination support with spirometer. The old variable of exposure is also an important note in this study relating to the work period and occupational disease, while the nutritional status variable with the aim to offset the age factor and history of diseases associated with the respiratory system.

Conclusion

Based on the results of the research, obtained that the prevalence of byssinosis in textile workers at PT. Garuda Mas Semesta were 79.7%. There is a relation of the individual factors (leng of exposure, smoking habit, history of disease, occupational of history, habits using of PPE, age, working period, nutritional status) with incidence of byssinosis. But there were no correlation of levels of dust with incidence of byssinosis. Identified two factors related to the incidence of byssinosis, the first factor consisted of nutritional status, the levels of dust, smoking habit, history of disease, occupational history and habit of using PPE which contributed amounted to 37.2 %. As for the second factor consisted of age, working period and the lenght of exposure contributed 31.7% of incidence of byssinosis.

Acknowledgement

This researh is made possible by support from grant administered by DIKTI, Ministry of Education and Culture of Indonesia; K3 of Laboratory, Stikes Jenderal A. Yani Cimahi and PT.

Garuda Mas Semesta for support of the research.

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