A risk-factor-based analytical approach for integrating occupational health and safety into workplace risk assessment

 

Ahmed Abou Elmaati, Gehan Raafat, Gihan Hosny

Division of Environmental Health, Department of Environmental Studies, Institute of Graduate Studies and Research, University of Alexandria, P.O.Box 832, Alexandria, Egypt.

2Department of Occupational Health, High Institute of Public Health, University of Alexandria, Alexandria Egypt.

Key words; Occupational health & safety; qualitative and quantitative risk analysis; Physical hazards; risk assessment.

Abstract

The chief goal of an occupational health and safety program, OHS, in a facility is to prevent occupational injury and illness by anticipating, recognizing, evaluating, and controlling occupational health and safety hazards. The underlying study presented a systematic approach for the evaluation of OHS risks and proposed a new procedure based on the number of risk factors identified and their relative significance in an Electrical Power Station, Alexandria, Egypt. Qualitative and quantitative risk assessment was utilized as a systematic approach. A risk factor concentration along with weighting of risk factor categories as contributors to undesirable events of different hazards were used in the analytical hierarchy process multi-criteria comparison model. A case study is used to illustrate the various steps of the risk evaluation approach and the quick and simple integration of OHS at an early stage of a project. The approach allows continual reassessment of criteria over the course of the project or when new data are acquired. It was thus possible to differentiate the OHS risks from the risk of drop in quality over the different project activities.

1. Introduction

Excluding occupational health and safety (OHS) from project management is no longer acceptable. Numerous industrial accidents have exposed the ineffectiveness of conventional risk evaluation methods as well as negligence of risk factors having major impact on the health and safety of workers and nearby residents. Lack of reliable and complete evaluations from the beginning of a project generates bad decisions that could end up threatening the very existence of an organization. Industrial accidents continue to cause human suffering, capital losses, environmental destruction and social problems [1]. In recent years, accidents in construction and industry have occurred in spite of rigorous management of projects and robust occupational health and safety (OHS) management systems in all phases of project lifecycle [2]. The explosion of a power plant in the start-up phase while testing a gas line in a populated region (43,000 inhabitants) of Connecticut (USA) on February 7, 2010 was reminiscent of a series of similar industrial accidents over the decades in terms of gravity and consequences [3]. In most cases, investigation into causes of accidents revealed failure in identification and evaluation of impending risks. In general, risk is evaluated in terms of its consequences with respect to project performance and rarely in terms of human suffering. Smallwood, 2004, confirmed that quality, planning and costs are the parameters given the greatest consideration [4].

Industrial work is risky in many economic sectors, in particular the construction industry [4,5], chemical plants [6],nuclear power plants [7] and the mining industry [8]. Safety and health problems can result from any of several groups of causes, which disparity from one industry to another. The high level of risk in the construction industry is explained by the nature and characteristics of building work, low educational level of workers, lack of safety culture and communication problems [4,5]. In the mining sector, increasing numbers of subcontractors working in mines, the emergence of new mining ventures and recognition of small-scale mining pose new confrontation to the practice of risk control [8]. The most effective way to improve OHS performance is to identify and eliminate hazards at the source [9]. Risk identification and assessment thus become primary tasks that are part of hazard prevention. Risk analysis is the foundation of the risk management process and presents several challenges [10,11]. OHS has not always been a preoccupation of process engineers. Incentives for integrating OHS risk management into engineering have been discussed recently. These include enactment, awareness of the importance of protecting workers and in some cases tangible potential to increase profitability and remain competitive [12-14].

Health, Safety and Environment (HSE) is a management responsibility which follows the company’s line organization in divisions and projects. It will be run in such a way that health and safety are promoted for all employees, a safe and helpful working environment is provided, and the environment and property are protected.(16)

Because of the importance of applying rules targeting better achievement of health and safety, the present study will focus on evaluating HSE, as will be described in Sidi Krir Power Station that is located on the Mediterranean cost at distance about 29 km west of Alexandria. The company started its activity in 1999 by steam plant. It consists of two units; the capacity of each is 320 MW. It represents the most important company in producing electrical power in Alexandria. The company is operated by 1200 workers. The aim of the underlying study is to present a new systematic approach for the evaluation of OHS risks and proposes a new procedure based on the number of risk factors identified and their relative significance in Sidi Krir Power Station.

2. MATERIALS AND METHODS

The underlying study has been performed in Sidi Krir Power Station to examine the application of a systematic approach for evaluation of OHS risks and propose a procedure for calculation of risk factors to identify their relative significance, through the following general tools:

2.1. Study design and local ethical approval;

2.2. Risk identification and qualitative risk assessment;

2.3. Quantitative risk assessment;

2.3.1. Accident analysis

2.3.2. Measurement of time weighted average of physical hazards

2.4. Characterization of the assessed risks and evaluation of their probability and severity to calculate the probable risk factors for the measured physical hazards in order to evaluate the level of practicability of each risk.

2.2. Risk identification and qualitative risk assessment

2.2.1. Employees’ perception for hazard identification

Employees’ perception for physical hazard identification was collected utilizing a self-structured predesigned questionnaire. The questions were designed to cover the following sections; general information to include personal data; Workers awareness for different topics of pollution; the impacts of pollutants such as noise, heat stress, dust, gas vapors, etc….on workers’ health; the diagnosed workers’ health problem that impair their productivity; participation in previous occupational safety training programs; workers’ perception on the impact of training courses on increasing their environmental awareness; and the impact of occupational diseases on workers. The study involved 100 workers from the company whom were selected randomly for two purposes.

2.2.2. Walk through observational survey

Hazard identification was performed through walk through exhaustive safety checklist in order to accomplish the fore mentioned objectives. The checklist was predesigned, pre-tested and finalized before data collection. The safety checklist were divided into the following sections; general information to include review plan and safety of workers in the company; health and safety plan in the company; emergency communication procedures; periodic inspection of tools and equipment on the workers’ health; inspection of personal protective equipment; occupational safety training programs; and inspection of the safety measures in the work environment.

Almost, all sections were close-response ones pertaining to assess the opinion and perception towards environmental protection measures and regulations, to identify the impacts of regular monitoring of work environment, drinking and waste waters, in addition to traffic control measures, and periodic waste treatment on occupational health and safety.

2.3. Quantitative risk assessment

Quantitative risk assessment was performed through reviewing reported accident and measuring time-weighted averages of physical hazards; noise, heat stress and illumination in different work places with different activities to determine the levels of exposure and quantify the risk factors for each depending on severity and probability of hazards [16,17].

2.3.1. Noise:

Noise was measured, using Sound Level Meter (Bruel & Kjaer sound level meter, type 2250 and calibrator, type 4231). It was dependent on transfer of sound energy to electrical energy and this energy measured by decibel (dbA). The noise type may be continuous noise (machinery and equipment), intermittent (hammers) or white noise (at the start of the steam boilers). The levels were analyzed and compared to documented permissible levels either locally or internationally.

2.3.2. Heat Stress:

Heat stress was measured, using wet bulb globe thermometer /Heat Stress Monitor. It was calculated by temperature radiation, the degree of wet thermometer and the degree of dry thermometer. Heat stress in workplace can be recognized by the human sense of heat and humidity, which increase the sense of heat together (Humidex). It was transferred by plug, convection currents and radiation. Results were compared to documented permissible levels.

2.3.3. Light:

Light was measured, using Lux Meter. It depends on theory called photoelectric cell that can be transformed by the light falling on the cell to electric currents which differs in severity depending on the intensity of the light falling on them. It is natural energy spread in all direction in straight lines in the form of waves. It may be direct, semi direct or indirect light. Levels of light were compared to documented permissible levels.

3. RESULTS AND DISCUSSION

This study was conducted in Electric Power Station to evaluate risk factors using qualitative and quantitative risk assessment to improve the acceptability of each risk and support the decision-making process within the company [16,17].

The qualitative risk assessment utilized employees’ perception toward the recognized risks and walk through checklist for hazard identification (data not shown). The-quantitative risk assessment comprised measurement of time weighted averages of frequent physical hazards.

3.1. Levels of occupational noise

A-weighted equivalent noise levels during one month of normal work activities were measured with a total of 24 measurements daily. The measurements were conducted so that they covered all workplaces (turbine, boiler, pump house, metal, and electrical workshops). Data entry and analysis was performed using Microsoft Excel 2010software. Table (1) shows the measured noise levels. The levels of noise varied from 75 to 92 dbA in different compartments of the company. Comparing the results of the current study with permissible levels documented by National Radiological Protection Board (NRPB) [18] and by Egyptian Environmental Law, 9/2009 [19], it is clear that the power station has some risky levels for noise. One-Sample Kolmogorove-Smirov Z Test revealed highly significant noise levels’ variable (p <0.05, C.I. =95%), as shown in Figure (1). Therefore, this variable did not follow normal distribution (non-parametric). Hence; the data was expressed as [median (Inter Quartile Range IQR)]. The time-weighted noise levels at turbine and boiler were equal [89.9(0.7)]. They were higher than pump house [88.1(0.9)], metal [86.5(0.8)], and electric [76.8(0.9)] workshops (Figure 3.2). They were lower than the threshold limit values (TLV=90 dB) stated in the Egyptian Environmental Law No 9-2009 and its Executive regulation of the Prime Minister Decision No 1095-2011. Kruskal-Wallis Test revealed significant differences of time-weighted equivalent noise levels in different work areas (p<0.05; C.I. =95%). Mann-Whitney test disclosed significant differences in noise levels among the five work areas (p<0.05; C.I. =95%).

Table (1) illustrates the noise risk factors at each work area. It is clear from the table that the noise has fifteen low acceptable risk factors (<60, 60-70, and 70-80 dB), three medium unacceptable high (>90 dB), six unacceptable high (70-80, 80-90, >90 dB), and one unacceptable very high-risk factors (80-90 dB). The risk factor of one and two (low acceptable) was observed at turbine, boiler, pump house, metal and electrical workshop at (<60 dB) and (60-70 dB). These locations required remedial actions as advising engineers and techniques of the code of practice for the safe use of turbine in the power plant, in addition to the application of the site inspection program to ensure compliance. The risk factor of three and four (acceptable low) was recorded at 70-80 dB in turbine, boiler, pump house, and metal workshop. It needs corrective actions like doing a pre-event assessment of what could generate noise and the development of a Noise Management Plan that is compliant with the Environmental Protection Act, and the plan must be provided to the site manager. Risk factors of five to nine (unacceptable medium) were reported in pump house, metal and electrical workshops. It requires a reduction of workers’ exposures by using personal protective equipment PPE. Risk factors of 10-19 (unacceptable high) were noted at 70-80dB in electrical workshop, 80-90dB, and >90dB in turbine and boiler. These risks can be managed by reduction of noise emissions at the source checking that the equipment within the structure’s safety management plan (periodic maintenance). The very high unacceptable risk factor (>19) occurred only in the pump house at 80-90 dB. It needs the substitution of noisy equipment by engaging a licensed electrician to make changes to the existing power supply.

The simulation illustrates the use of the proposed approach, which ranks risks as a function of their impact in terms of undesirable events as noise. In the example studied, the calculation allowed us to differentiate the OHS risks from the risk of drop in quality. For the paired comparisons of the identified risk factors, levels of noise can be controlled by: substitution of high noise equipments; good maintenance to equipments; application of sound reduction materials; regulation of exposure time among workers according to laws; and ensure use of personal protective equipments [17].

3.2. Levels of occupational heat Stress

Table (2) illustates the heat stress risk factors in each work area. The highest heat stress risk factor (nine) was encountered at 28-30°C in heater turbines I & II, and in boiler. These locations required remedial actions as advising engineers and techniques of the code practice for the safe use of heater turbine in the power plant. In addition, site inspection program must be applied to ensure compliance. The lowest acceptable risk factor (one) was observed at the four work areas. The risk factor of three and four (acceptable low) was recorded at (28-30, 30-32.2 °C) in the four work area.

One-Sample Kolmogorove-Smirov Z Test revealed highly significant differences in levels of heat stress (p <0.05, C.I. =95%). Data was expressed as median; Inter Quartile Range, IQR. The heat stress at heater turbine I and heater turbine II were equal [28.1(0.9)]. They were higher than that at turbine and boiler [27(1)], (Figure 2). They were lower than the threshold limit values of heat stress of easy 25% work and 75% rest (TLV=32.2 °C) stated in the Egyptian Environmental Law No 9-2009 and its Executive regulation of the Prime Minister Decision No 1095-2011, annex-9 [19]. Kruskal-Wallis Test revealed highly significant variation of heat stress in different work areas (p<0.05; C.I. =95%). Mann-Whitney test disclosed significant differences in heat stress among the heater turbines I & II, and turbine; as well as among turbine and boiler (p<0.05; C.I. =95%).

The risk factor of one to four (low acceptable) requires corrective actions of developing an “Extreme Weather Policy” and “Contingency plan” in Heater turbine I. In addition, monitoring the weather as related to the work plan should be conducted in the early or late hours of the day. The risk factor of five to six needs corrective actions of ensuring the presence of a responsible person for heat stress services on site. The risk factor of seven to nine (medium unacceptable) necessitates the use of “pre event assessment” for the amount of water available on or close to the site. Moreover, ordering a drinking water fountain or arranging to give bottled water away to the workers for free is necessary [20].

The range of heat stress from 26 to 30 °C is the most common range in the four compartments of the company. Comparing the results of the current study with permissible levels [20] and by Egyptian Environmental Law, 9/2009 [19], it is clear that the power station has some rise levels for heat stress in light work and exposure time (4-6 hours), (as illustrated in Table 2) like heater turbine unit II(29.4 Co) and boiler unit (30 Co). Nature of risk factor to most of these locations considers low risk factor and few it considers medium risk factor. Comparing the results of the current study with permissible levels documented by classes of probability of heat stress, (as shown in Table 2.3), and Classes of severity of heat stress, (as shown in Table 2.4). So cautions should be taken to control levels of heat stress and its health impacts; levels of heat stress can be controlled by: a worker may not be made to work precautionary supervision when exposed to high temperature levels; if any worker is exposed for a period of one continuous or intermittent hour during two working hours to working conditions of extreme temperature in excess of 26.18 centigrade for men and 24.58 centigrade, one or more of cooling methods shall be used to ensure that the worker’s internal temperature does not rise above 38 centigrade [21]; acclimatizing the worker to the temperature over a period of six days by exposing him/her to 5% of the daily exposure period on the first working day then increasing the period of exposure by 10% a day until it reaches 100% on the sixth day [22]; a worker who is absent himself for a period of nine days or more after the acclimatization process or who falls ill for a period of four consecutive days must be re-acclimatized over a period of four days by being exposed to 50% of the daily exposure period on the first day and an additional 20% a day thereafter so as to reach 100% exposure on the fourth day [23]; scheduling work so that jobs exposed to high temperatures are slotted into coolest periods of the day and scheduling short rest breaks at least once every hour to enable workers to drink a saline solution. Each worker shall be given a minimum of 2 liters of potable water in which 0.1% salt is dissolved (without giving salt pills), and the water supply must not be further than 60 meters from the workers [21].

3.3. Levels of occupational illumination

Table (3) presents the light intensity risk factors in work areas with tasks require medium accuracy in details (TLV=323 luxes) [24]. There were five high unacceptable risk factors, two of which were within the metal workshop, two in the electrical workshop, and one in the water-treatment unit. So, the proposed corrective actions must be doing a pre-event assessment of what could generate light intensity and the development of a Light intensity management plan that is compliant with the Environmental Protection Act, and the plan must be provided to the site manager. It is required to take appropriate precautions to avoid diffusion of glare and reflected light. There were five medium unacceptable risk factors, of which two in the instrumental workshop, two in the pump house, and one in the water-treatment unit. In addition, there were fifteen low acceptable risk factors distributed all over the work areas.

Table (3) illustrates the light intensity risk factors in work areas with tasks require accuracy in details (TLV=753 luxes) [25]. The table declares that the light intensity had one high unacceptable risk factor in control room that needs corrective actions of wear personal protective equipment such as special glasses for welding and cutting and avoid the great disparity in the distribution of light in places converged. Eliminate this risk by checking that the different lightings in the site with the structures safety management plan; administer this control by doing a pre event assessment of the lighting available on or close to the site. It had seven medium unacceptable risk factors, three at each of financial and management affaires, which requires remedial actions of proper lighting for the type of work that is being practiced, whether natural or artificial lighting and allow to homogenous distribution of light in the workplace. It had also seven low acceptable risk factors distributed among the three work areas.

One-Sample Kolmogorove-Smirov Z Test revealed highly significant differences in light intensity (p <0.05, C.I. =95%). The data was expressed as median; Inter Quartile Range, IQR. The light intensity at the instrumental workshop [513(10) lux] was higher than that at metal and electrical workshops [466(12) lux], pump house [432(13) lux], and water treatment [369(15) lux] (Figures 3&4). They were higher than the threshold limit values (TLV=323 lux) stated in the Decision of Minister of Manpower and Immigration No 211-2003. Kruskal-Wallis Test revealed significant variations of light intensity in different work areas (p<0.05; C.I. =95%). Mann-Whitney test disclosed significant differences in light intensity among the instrumental workshop, metal and electrical workshops, pump house, and water treatment (p<0.05; C.I. =95%). Furthermore the light intensity at financial affairs was equal [1726(23)]. They were higher than that in the management affairs [1382(11)], and control room [912(13)] (Figure 3). They were higher than the threshold limit values (TLV=753 lux) stated in the Decision of Minister of Manpower and Immigration No 211-2003. Kruskal-Wallis Test revealed highly significant variation of light intensity in different work areas (p<0.05; C.I. =95%). Mann-Whitney test disclosed significant differences in light intensity among the financial affairs, management affairs, and control room (p<0.05; C.I. =95%).

4. Conclusion

The underlying risk evaluation approach was conducted as quick and simple integration of OHS at an early stage of a project. The approach allows continual reassessment of criteria over the course of the project or when new data are acquired and it is able to overcome the difficulties of current tools in the manufacturing industry. The proposed approach is based on known techniques and tools, such as multi-criteria analysis techniques (e.g. analytic hierarchy process), expert judgment and the analysis of accidents and incidents. The analytic hierarchy process is selected to minimize the inconsistencies in expert judgments and to support approaches that use mixed qualitative–quantitative assessment data.

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17- Larson, Ch. D., Forman, Er. H., 2007. Application of analytic hierarchy process to select scope for video logging and noise pavement condition data collection. Journal of the Transportation Research Board (1990), 40–47.

18- National Radiological Protection Board (NRPB). (1993). Restrictions on human exposure to static and time varying electromagnetic fields and radiation. Documents of NRPB; 4:8-69.

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Table (1): Noise risk factors in the company at different workplaces (Turbine, Boiler, Pump house, Metal workshop, and Electrical workshop).

Location

Noise range

No.a

S(P) b

S(S) c

RF d

P-value

Nature of risk factor

Acceptability

Proposed actions f

Turbine

<60 dB (138)

0

1

1

1

<0.05b

Low

Acceptable

1

60-70 dB (139)

0

1

2

2

Low

Acceptable

1

70-80 dB (140)

0

1

3

3

Low

Acceptable

2

80-90 dB (141)

1956

3

4

12

high

Not acceptable

4

>90 dB (142)

1592

2

5

10

high

Not acceptable

4

Boiler

<60 dB (138)

0

1

1

1

<0.05b

Low

Acceptable

1

60-70 dB (139)

0

1

2

2

Low

Acceptable

1

70-80 dB (140)

0

1

3

3

Low

Acceptable

2

80-90 dB (141)

1897

3

4

12

high

Not Acceptable

4

>90 dB (142)

1672

2

5

10

high

Not acceptable

4

Pump house

<60 dB (138)

0

1

1

1

<0.05b

Low

Acceptable

1

60-70 dB (139)

0

1

2

2

Low

Acceptable

1

70-80 dB (140)

0

1

3

3

Low

Acceptable

2

80-90 dB (141)

3447

5

4

20

Very high

Not acceptable

5

>90 dB (142)

0

1

5

5

medium

Not Acceptable

3

Metal workshop

<60 dB (138)

0

1

1

1

<0.05b

Low

Acceptable

1

60-70 dB (139)

0

1

2

2

Low

Acceptable

1

70-80 dB (140)

8

1

3

3

Low

Acceptable

2

80-90 dB (141)

3459

4

4

16

high

Not acceptable

4

>90 dB (142)

0

1

5

5

Low

Acceptable

2

Electrical workshop

<60 dB (138)

0

1

1

1

<0.05b

Low

Acceptable

1

60-70 dB (139)

0

1

2

2

Low

Acceptable

1

70-80 dB (140)

3476

4

3

12

high

Not acceptable

4

80-90 dB (141)

8

1

4

4

Low

Acceptable

2

>90 dB (142)

0

1

5

5

medium

Not Acceptable

3

aNo. Total numbers of noise readings during a month.

b S(P); the score of the probability

c S(S) ; the score of the severity

d RF; the risk factor

f Proposed actions: 1;Administer this control by advising engineers and techniques of the Code of Practice for the Safe Use of Turbine in Power Plant. Site inspection to ensure compliance. 2; Administrate this control by doing a pre event assessment of what could generate noise and the development of a Noise Management Plan that is compliant with the Environmental Protection Act. Plan has been provided to site manager. 3; Eliminate the risk by using personal protective equipments. 4; Eliminate this risk by checking that the equipment is within the structure’s safety management plan. 5; Eliminate the hazard by engaging a licensed electrician to make changes to the existing power supply.

Table (2): Heat Stress risk factors in the company at different work areas (Heater turbine I, Heater turbine II, Turbine, and Boiler).

location

Heat Stress range

No.a

S(P) b

S(S) c

RF d

P-value

Nature of risk factor

Acceptability

Proposed actions f

Heater turbine I

<26 0C (148)

0

1

1

1

<0.05b

Low

Acceptable

1

26 -28 0C (149)

1671

2

2

4

Low

Acceptable

1

28 -30 0C (150)

2431

3

3

9

Medium

Not acceptable

4

30 -32.2 0C (151)

10

1

4

4

Low

Acceptable

2

>32.2 0C (152)

0

1

5

5

Medium

Not acceptable

3

Heater turbine II

<26 0C (148)

0

1

1

1

<0.05b

Low

Acceptable

1

26 -28 0C (149)

1670

2

2

4

Low

Acceptable

1

28 -30 0C (150)

2432

3

3

9

Medium

Not acceptable

4

30 -32.2 0C (151)

7

1

4

4

Low

Acceptable

2

>32.2 0C (152)

0

1

5

5

Medium

Not acceptable

3

Turbine

<26 0C (148)

38

1

1

1

<0.05b

Low

Acceptable

1

26 -28 0C (149)

3502

4

2

8

Medium

Not Acceptable

4

28 -30 0C (150)

212

1

3

3

Low

Acceptable

1

30 -32.2 0C (151)

3

1

4

4

Low

Acceptable

2

>32.2 0C (152)

0

1

5

5

Medium

Not Acceptable

3

Boiler

<26 0C (148)

0

1

1

1

<0.05b

Low

Acceptable

1

26 -28 0C (149)

1696

2

2

4

Low

Acceptable

1

28 -30 0C (150)

2430

3

3

9

Medium

Not acceptable

4

30 -32.2 0C (151)

25

1

4

4

Low

Acceptable

2

>32.2 0C (152)

0

1

5

5

Medium

Not Acceptable

3

a No. Total numbers of heat stress readings during a month.

b S(P); the score of the probability

c S(S) ; the score of the severity

d RF; the risk factor

f Proposed actions: 1; Administrate this control by developing an Extreme Weather Policy and Contingency plan in Heater turbine I. Control the hazard by providing sun screen and making shade available. Monitor the weather and plan for work to be conducted in the early or late hours of the day; 2; Administrate this control by developing an Extreme Weather Policy and Contingency plan in site. Control the hazard by providing sun screen and making shade available. Monitor the weather and plan for work to be conducted in the early or late hours of the day; 3; Administrate this control by ensuring responsible service site of heat stress and security on site; 4; Administer this control by doing a pre event assessment of the amount of water available on site or close to the site. Order a drinking fountain or arrange to give bottled water away for free.

Table (3): Light intensity risk factors in the company at different workplaces.

Location

Light intensity range

No.a

S(P) b

S(S) c

RF d

P-value

Nature of risk factor

Acceptability

Proposed actions f

Metal workshop

<323 lux (158)

1651

2

5

10

<0.05b

High

Not acceptable

4

323-400 lux (159)

2001

3

4

12

High

Not acceptable

5

400-500 lux (160)

0

1

3

3

Low

Acceptable

1

500-753 lux (161)

0

1

2

2

Low

Acceptable

1

>753 lux (162)

0

1

1

1

Low

Acceptable

1

Electrical workshop

<323 lux (158)

1613

2

5

10

<0.05b

High

Not acceptable

4

323-400 lux (159)

1911

3

4

12

High

Not acceptable

5

400-500 lux (160)

0

1

3

3

Low

Acceptable

1

500-753 lux (161)

0

1

2

2

Low

Acceptable

1

>753 lux (162)

0

1

1

1

Low

Acceptable

1

Instrumental workshop

<323 lux (158)

0

1

5

5

<0.05b

Medium

Not Acceptable

3

323-400 lux (159)

0

1

4

4

Low

Acceptable

2

400-500 lux (160)

0

1

3

3

Low

Acceptable

1

500-753 lux (161)

3444

4

2

8

Medium

Not Acceptable

3

>753 lux (162)

0

1

1

1

Low

Acceptable

1

Pump house

<323 lux (158)

0

1

5

5

<0.05b

Medium

Not Acceptable

3

323-400 lux (159)

0

1

4

4

Low

Acceptable

2

400-500 lux (160)

30

1

3

3

Low

Acceptable

1

500-753 lux (161)

3416

4

2

8

Medium

Not Acceptable

3

>753 lux (162)

0

1

1

1

Low

Acceptable

1

Water treatment

<323 lux (158)

0

1

5

5

<0.05b

Medium

Not Acceptable

3

323-400 lux (159)

0

1

4

4

Low

Acceptable

2

400-500 lux (160)

3475

4

3

12

High

Not acceptable

5

500-753 lux (161)

8

1

2

2

Low

Acceptable

1

>753 lux (162)

0

1

1

1

Low

Acceptable

1

Financial affairs

<753 lux (158)

0

1

5

5

<0.05b

Medium

Not Acceptable

7

753-800 lux (159)

1686

2

4

8

Medium

Not Acceptable

7

800-900 lux (160)

2447

3

3

9

Medium

Not Acceptable

7

900-1000 lux (161)

10

1

2

2

Low

Acceptable

6

>1000 lux (162)

0

1

1

1

Low

Acceptable

6

Management affairs

<753 lux (158)

5

1

5

5

<0.05b

Medium

Not Acceptable

7

753-800 lux (159)

1699

2

4

8

Medium

Not Acceptable

7

800-900 lux (160)

2417

3

3

9

Medium

Not Acceptable

7

900-1000 lux (161)

7

1

2

2

Low

Acceptable

6

>1000 lux (162)

0

1

1

1

Low

Acceptable

6

Control room

<753 lux (158)

33

1

5

5

<0.05b

Medium

Not Acceptable

7

753-800 lux (159)

3521

4

4

16

High

Not acceptable

8

800-900 lux (160)

308

1

3

3

Low

Acceptable

6

900-1000 lux (161)

7

1

2

2

Low

Acceptable

6

>1000 lux (162)

0

1

1

1

Low

Acceptable

6

a No. Total numbers of light intensity readings during a month.

b S(P); the score of the probability

c S(S); the score of the severity

d RF; the risk factor

f Proposed actions: 1; Eliminate this risk by checking that the different lightings in the site with the structures safety management plan; 2; Eliminate this risk by ensuring that all light weigh equipment is adequately weighted or harnessed. Administer the control by monitoring light prior and during the event; 3; Eliminate this risk by checking that the different lightings in the site with the structures safety management plan; 4; Administer this control by doing a pre event assessment of the lighting available on or close to the site; 5; Administer this control by doing a pre event assessment of the amount of lighting required in Instrumental workshop. 6; Eliminate this risk by checking that the different lightings in the site with the structures safety management plan; 7; Administer this control by doing a pre event assessment of the amount of lighting required in Management affairs; 8; Administer this control by doing a pre event assessment of the lighting available on or close to the site.

clip_image002

Figure (1): A-weighted equivalent noise levels at different work areas within the Power Station.

clip_image004

Figure (2): Heat Stress levels at different workplace areas within the Power Station.

clip_image006

Figure (3): Light intensity levels at different workplace areas (Metal workshop, Electrical workshop, Instrumental workshop, Pump house, and Water treatment) within the Power Station.

clip_image008

<

p align=”justify”>Figure (4): Light intensity levels at different workplace areas (Financial affairs, Management affairs, and Control room) within the Power Station.

A CASE STUDY OF THE BURDEN OF CARE AMONG CAREGIVERS OF HIV/AIDS PATIENTS IN JOS PRISON, NIGERIA

BY

UGWUOKE, KELVIN ABUCHI

PSYCHOLOGICAL SERVICES UNIT

MAXIMUM SECURITY PRISON

JOS, PLATEAU STATE

AND

NIMYEL REMMIKAT

DEPARTMENT OF GENERAL AND APPLIED PSYCHOLOGY

UNIVERSITY OF JOS

PLATEAU STATE, NIGERIA

ABSTRACT

This study investigated the burden of care among caregivers of people living with HIV/AIDS in Jos prison. Emphasis was placed on the challenges that caregivers face in providing care and health services to prisoners who are living with HIV/AIDS. The study employed a case study research method to investigate the subject matter. The purposive sampling technique was used to select 15 caregivers who were used for this study. The Zarit Burden Inventory (Zarit, Reever and Bach-Peterson, 1980) and a structured interview schedule were used to collect data for this study. Results showed that the caregivers burden were severe. Also, the study found out that lack of health facilities, qualified health professionals, logistics among others are some of the challenges that caregivers face. Recommendations were made on how to ameliorate the burden of care among caregivers of prisoners living with HIV/AIDS.

Key words: Burden, care, prisoners, caregivers, HIV/AIDS, patients.

Introduction

In Nigeria and many parts of the world, HIV/AIDS has become a very serious public health concern, and has posed a challenge to the world at large. According to Asuquo, Adejumo, Etowa and Adejumo (2013), AIDS has become one of the greatest public health challenges of our time. It is estimated that globally over 35 million people are living with HIV at the end of 2014 with the vast majority of these people living in sub-Saharan Africa (World Health Organisation-WHO, 2014). In Nigeria, over 3.4 Million people representing 2.7 percent are presently living with the virus, with a greater number of them in the age range of 15 and 49 years (UNAIDS, 2015).

According to UNDOC (2007), about 668,000 people are incarcerated in sub-Saharan Africa with South Africa having the highest prison population of 157,402 people incarcerated. Other African countries have high prison population, though West African countries have the lowest prison population. According to the Nigerian prisons Service 2014 statistics report, there are about 55 Million prisoners in Nigerian prisons, and about 95% of them are in the age range of 18 to 49. Therefore, it can be said that the prison population in Nigeria is vulnerable to HIV/AIDS. A prevalence of 8.7 % had been previously reported among Nigerian prison inmates in (Iwoh, 2004). According to a Survey of some prisons in Nigeria, there is a seemingly high level of homosexual activities among prison inmates in Nigerian prisons (Olayide, 2001). This sexual behaviour may be as a result of the lack of conjugal visits for the inmates. Hence, most prisoners discharge their sexual energies through homosexuality. Again, homosexual activities among inmates occur either voluntarily because of lack of other ways of channeling sexual energies, or through threats and coercion (Joshua and Ogboi 2008).

Prisoners living with HIV/AIDS are often confronted with the problem of lack of liberty, poor health care system in the prison, poor feeding and sanitation, stigmatization, amongst others. The stigma associated with HIV/AIDS makes many prisoners reluctant to admit they are infected or seek care, and can make health workers reluctant to provide care (WHO, 2006). For AIDS patients in prison, caregiving is not always available from their families and friends. Most often the care for AIDS patients in prisons falls on prison staff and fellow inmates (Olenja, 1999). This poses enormous responsibilities, stress and burden primarily on the staff and inmates of the prison. Furthermore, the prisoner who has AIDS has to deal with the burden related to the illness and also with the stigma surrounding it. AIDS patients in prison and their caregivers will have to contend with the stigma surrounding HIV infection and management (Kalondo, 1996). Stigma often leads to social isolation and loneliness not only for AIDS patients in prison, but also for their caregivers who are prison staff and inmates. According to Casaux and Reboredo (1998), this further adds on their burden of care for the prisoner with the chronic and lethal condition such as AIDS. Again, HIV/AIDS dramatically increases the burden on health services, especially since most victims are young adults who otherwise would require little health care. At the same time, stress and AIDS-related deaths among health care personnel reduce the number of health workers available to care for patients (Ainsworth and Over, 1997).

According to Asuquo et al., (2013), HIV/AIDS patients are faced with social, physical, psychological and emotional problems which often increase the level of burden of caregivers and portray them as targets of HIV-related prejudice and discrimination. There is a widespread of stigmatization against people living with HIV/AIDS and this causes them social problems. Stigmatization limits the social ability of people living with HIV/AIDS. Case studies indicate that the burden of care increases with the impairment in functional activities and the duration of care and a significant correlation exist between the number of caregiving tasks and caregivers burden (Asuquo, et al., 2013).

Theoretical Background

The present study adopted the coping theory for this study. Fineman (1984), stress is a state of tension felt in the presence of an object or a task that is perceived as presenting a challenge to a person’s safety or self-esteem. Stress emanates from perceived discrepancy between environmental demands and the person’s ability to meet those demands; hence presenting psychological, emotional and even physical distress. Therefore, many people have coping techniques against stress such as denial of stress or avoidance of stress depending on the sources of stress. Coping attempts either to reduce the demands of the stress, to reduce the effects of the stress, or to help the person change the way he or she thinks about the demand of the stress. It could be stimulus-directed coping, where an attempt is made to eliminate or ameliorate the initial sources of the stress reactions; or cognitive coping which involves changing the way the stressor is perceived; or response directed coping which involves the reduction of the magnitude of the stress response. For caregivers of AIDS patients both the internal factors such as knowledge and external factors such as finance and friends are necessary to help them cope with stressful events (Kangethe, 2009).

The increased burden on caregivers of AIDS patients in prison may develop feelings of anger, grief, loneliness, burnt-out and resentment, which may lead to poor quality of care and ill health of the caregivers. This is typical in caring for patients with AIDS who may be in the terminal stage of HIV infection. HIV/AIDS in prison is a growing concern and information emanating from prisons in Nigeria indicates that there are large numbers of HIV-infected prisoners; hence the prison population is at-risk. The present study will investigate the plight of caregivers of HIV/AIDS patient in Jos prison, and the challenges faced by the caregivers. This will provide information which will be used to formulate evidenced based interventions in prisons, so as to reduce the challenges faced by the caregivers.

METHODOLOGY

This study was conducted in the Maximum Security Prison, Jos, Plateau state, Nigeria. The prison is a convict prison that holds all classes of prisoners and has a capacity of 1149 inmates. As at the time this study was conducted, there were 766 inmates locked up in the prison with 19 (2.48%) of them living with HIV/AIDS.

The study participants were medical staff working in the Clinic of the prison. A purposive sampling technique was used to select the caregivers who are health professional from diverse fields: nurses, community health workers, psychologists and social workers. All these health professionals had been involved in care giving of prisoners living with HIV/AIDS. About 15 participants who were working in units that cater for HIV/AIDS participated in the study. Permission was sought from the authority of the Nigerian Prisons Service to conduct the study, of which approval was given. The participants were debriefed, and informed consents were obtained following full description of the purpose of the study.

The study adopted a case study research design and data was obtained through structured interview and the Zarit Burden Interview (Zarit, Reever and Bach-Peterson, 1980). A 7-item structured interview was used to elicit information from the participants. The interview sought for the challenges the caregivers faced in the course of caring for AIDS patients in prison. During the interview schedules with the participants, follow-up questions were asked for clarification and better understanding.

The Zarit Burden Interview (ZBI) was used to measure caregiver burden. It is a 22-item, self-report questionnaire that evaluates the caregiver’s health condition, psychological well-being, finances, and social life in the context of the caregiver-patient relationship. Responses are on a 5-point Likert-type scale ranging from 0 (never) to 4 (nearly always), and item scores are summed to obtain a total score that ranges from 0 to 88. Higher scores indicate greater levels of caregiver burden. The following categories have been developed to identify little to severe caregiver burden: 0-20 indicates little or no burden, 21-40 reflects mild to moderate burden, 41-60 moderate to severe burden, and 60-88 severe levels of burden (Zarit et al., 1980). This instrument has been previously used on Nigerian subjects by Yusuf, Nuhu and Akinbiyi (2009), hence, there is no need for revalidation of the instrument.

RESULTS

Socio-demographic Characteristics of the Participants

The socio-demographic data of the participants is represented in the table below:

Table 1: Demographic Characteristics of Participants

Characteristics

Frequency

Percentage (%)

SEX

Male

Female

RELIGION

Christianity

Muslim

Others

PROFESSIONAL QUALIFICATION

SSCE/Diploma/NCE

RN/BSC

MSC

MARITAL STATUS

Single

Married

Widowed

Divorced

AGE

18-35

36-49

50-above

BURDEN OF CARE

No Burden

Mild

Moderate

Severe

6

9

12

3

3

10

2

2

12

1

0

4

10

1

0

1

2

12

40

60

80

20

20

67

13

13

80

7

0

26

67

7

0

7

13

80

Total

15

100

Source: Field study, 2015

Table 1 shows that the majority 9 (60%) respondents were female, 10 (67%) in the age range of 36 – 49 years. Twelve representing 80% were Christians by religion, and about 80% (12) were married, while 67% (10) had a first degree and/or are qualified nurses. The table also shows that from the scores of the participants in the Zarit Burden Inventory (ZBI), 12 participants representing 80% have severe burden.

Challenges of caregivers

From the interview conducted, the following challenges were highlighted by the respondents:

1. Lack of health facilities: When asked about their challenges, 12 (80%) out of the 15 participants listed the lack of health facilities as their major challenge. Though, there is 10-bed clinic in Jos prison, there are little or no equipments for the management of prisoners living with AIDS. They are not equipped with Anti-retroviral drugs for the management of AIDS patients; hence, they have to make referral to other hospitals outside the prison. The following excerpt from the in-depth interviews with the Officer in Charge of the Prison clinic of Jos prison revealed some challenges which they go through as a consequence of this;

“We are faced with the constraints of health equipments. Normally, we are supposed to screen every admitted inmate, but we are not provided with the testing kits and other materials that aid us in that regard. Infact, we have to seek external support from APIN in Jos University Teaching Hospital, as well as the Plateau State Specialist Hospital, in the area of testing and anti-retroviral drugs.” (The Superintendent of Prison in-charge of the Prison Clinic)

The lack of medical facilities has impeded the effective management of prisoners living with HIV/AIDS in the prison, as it has increased the burden of care of these caregivers. Though, the caregivers are doing well in the areas of counselling/psychotherapy and rendering orientation to the inmates on how to live positively with the illness, the lack of medical equipments and drugs has greatly affected their burdens negatively.

2. Lack of professional Medical personnel: This is another challenge facing the caregivers. Only 15 medical personnel are working in the prison clinic. They are to attend to the 19 HIV/AIDS patient and over 850 others. With a ratio of one medical personnel to attend to about 50 inmates, the caregivers are burnt out in the long run. The prison clinic is bereft of a medical doctor. Only four registered nurse, two (2) Psychologists, one (1) social worker and a handful of community health worker. This is grossly inadequate in a large prison like this.

3. Lack of Logistics: The movement of inmates to attend clinic in referral hospital is usually hampered by the lack of logistics. The prison clinic has no ambulance to convey inmates to and fro clinics outside the prison. The following excerpt from the officer whose schedule is to take the AIDS patients to and fro clinic reveals that funds are not provided for this purpose;

“One of the major challenges I have is logistics problem. Often times, I usually use my hard earned salary to pay for logistics to and fro JUTH where we normally get drugs and screen our patients. The government has not provided us with ambulance or any form of logistics. Hence, I have to compromise by using my salary to pay for transportation fare to and from JUTH.”

4. Poor remuneration: Most of the health workers interviewed complained of poor remunerations. They are not paid their allowances, and other entitlements as at when due. 14 of the participants complained that they have not been promoted in the past 12 years. The Superintendent of Prisons in charge of the prison clinic stated that:

“I have not been promoted since 2002. I have remained on this rank since 2002. My colleagues who are my contemporaries have all been promoted ahead of me. I feel bad for this because I have no record of indiscipline. This predicament is none of my fault!”

5. Lack of funding: Thirteen (13) of the respondents pointed out that the medical unit and the Nigerian prisons Service as a whole suffers from poor funding. They complained of lack of proper funding from government, as they have to depend on Non-governmental organisations and other charity groups for some of their needs.

Discussion of Results

The findings of this study have revealed some information about the burden of care among caregivers of prisoners living with HIV/AIDS in Nigeria prisons. It has been able to expose the loopholes in the Nigerian prisons system that impedes the handling of inmates living with the illness.

From the foregoing, results show that caregivers of HIV/AIDS patients in prison are faced by a myriad of challenges which bug down their operations. From table 1 above, 80 percent of the participants scored very high on the Zarit Burden Inventory, showing a severe burden of care. This may be due to the challenges they face in the course of providing care. From the analysis above, it is clear that the caregivers work under very stressful conditions. Hence, their severe burden of care.

The results also revealed the challenges faced by the caregivers. They include the lack of facilities for the provision of healthcare and services to the prisoners. They are left to compromise on certain needs. They go to extremes to fund some of the needs from their personal earnings. This is a serious challenge. The respondents also complained of the lack of logistics, lack of funding, and poor remunerations. All these may have contributed to the high scores in the Zarit Burden Inventory.

Finally, the result revealed that the prison clinic is bereft of medics. From the results, about 15 medical personnel are to attend to over 750 inmates; a ratio of one personnel to more than 50 inmates. This is grossly inadequate. The results also exposed the fact that the prison clinic has not medical doctor attached to it. These causes a great deal of burden on the available caregivers, making them exposed to more stress. The findings of this study has gone a long way to provide information on the abnormalities happening behind the four walls of Jos prison, and by extension, other prisons in Nigeria.

Conclusion/ Policy implications

The ability to provide quality care for HIV/AIDS prisoners requires caregivers that are endowed with professional skills. HIV infers death to many irrespective of retroviral drugs used and caregivers are well aware of the seriousness of this deathly disease. Therefore, the level of burden of caregivers caring for prisoners living with HIV/AIDS increases due to some challenges which are the lack of medical facilities, lack of funding, lack of medical professionals, poor remuneration, among others.

Consequent upon these, the following recommendations are made for the effective healthcare of prisoners living with HIV/AIDS in Nigeria.

1. The Nigerian Prisons Service should, as a matter of urgency, recruit more medical staff. Increasing the number of healthcare personnel in the prison will reduce their workload and lessen the level of burden.

2. All the prison clinics and sick bays in Nigeria should be made provided with antiretroviral drugs and other kits that will help in the testing and treatment of the prisoners living with HIV/AIDS.

3. Routine and periodic and HIV testing and counselling services should be introduced in prisons nationwide. This will identify HIV positive inmates early and further enroll them into care and support before advanced stages of the disease.

4. The level of knowledge on HIV and AIDS is low in Jos prison, so intensive and correct information on HIV /AIDS should be routinely made available to all inmates by introducing a well-designed HIV / AIDS information, education and communication sessions in prisons at least twice a year so as to increase their knowledge base on HIV and AIDS.

5. Prisons in Nigeria should be properly funded to meet up with their mandates of reformation, rehabilitation and reintegration of the legally interned.

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