HEALTH STATUS OF TEA PLANTATION WORKERS WITH SPECIAL REFERENCE TO THEIR OCCUPATION
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"HEALTH STATUS OF TEA PLANTATION WORKERS
WITH SPECIAL REFERENCE TO THEIR
OCCUPATION"
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PART I
Joint Study
By
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ROSS INSTITUTE UNIT OF OCCUPATIONAL HEALTH
(St. John's Medical College, Bangalore)
&
REGIONAL OCCUPATIONAL HEALTH CENTRE
I
(Indian
Council of Medical Research) Bangalore 560 002
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1979 - 1982
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PREFACE
This is the first part of the report of the study »Health
Status of Tea Plantation 'Workers with special reference to
their Occupation1. The study conducted in 1979 was jointly
undertaken by the Ross Institute Unit of Occupational Health
of St. John's Medical College, Bangalore and the Regional
Occupational Health Centre of I.C.M.R. Bangalore.
The study was carried out in some plantations and tea factories
in South India. It involved investigation of medical histories,
physical examination, anthropometry, basic laboratory estima
tions and some special investigations such as cholinesizerase
levels of the workers and their families in these estates.
Measurements of environmental parameters in the tea factories
were also undertaken. A preliminary analysis of sickness
x,absenteeism and medical records has been included.
This is a pilot study and it has been attempted to buiu-d up
a health profile of the tea plantation workers, determine
possibl? areas of occupational risk and identify areas
requiring further detailed investigation.
I
The preliminary analysis of the data has been limited to the
working population in the 18-60 age group. This is being
presented in this report.
Analysis of the total study population data including the under
18's and over 60’s will be presented in Part II of the Report.
Owing to reasons beyond our control, the reporting of this
study has been much delayed. We very much regret this.
We take full responsibility for the data presented and the
views expressed in this report.
It is hoped that this report on an area of growing significance
will stimulate further research in health in the plantations.
Bangalore
20th October 1982
I
RAVI NARAYAN
C R RAMACHANDRAN
Chief Investigators
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ACKNOWLEDGEMENTS
i.
We the Chief Investigators and the investigation team of the
study "Health Status of Tea Plantation Workers with special
reference to their Occupation" are deeply grateful
I
(1) To:
Indian Council of Medical Research, New Delhi;
Ross Institute of Tropical Hygiene, London;
Dean, St. John’s Medical College, Bangalore;
Director, National Institute of Occupational
Health, Ahmedabad;
for their constant encouragement and continuous
support in undertaking this project.
(2) To:
Professor M N Rao, ICMR Consultant;
Late Major General B Mahadevan, Ex-Director of
Rural Health Services and Training Programmes;
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St. John's Medical College;
Professor S V Rama Rao, Head of the Department of
Community Medicine, St. John’s Medical College;
the members of the Advisory Committee for their
constructive criticisms and timely suggestions.
(3) To:
The Managers, Link Workers, staff and workers of
the participating estates and the staff of UPASI
for their whole hearted co-operation.
(4) To:
The staff of the Regional Occupational Health Centre,
Bengalnrp and Department of Community Medicine,
St. John’s Medical College;
for their wholehearted support and cooperation.
(5) To:
The Director and staff of National Institute of
Nutrition, Hyderabad for their help for copying
facilities.
(6) To:
Several individuals and organisations who have helped
us in this study.
THIl TEAM
DR RAVI NARAYAN,'ND, DTPH (London) DIH (U.K.)
DR C R RAMACHANDRAN, MD, DPH, DIH.
DR H R RAJMOHAN, M.B.B.S.
DR K NAGAxRAJ, B.Sc. MBBS
MR P C GHOSH, M.Sc.
MR D MURALIDHARAN, M.Sc.
MR V MOHAN, B.Sc. DOLT
MR G T THOMAS, B.Sc. DOLT &
MR J MOHAN, B.Sc. DOLT
STATISTICAL CONSULTANT
Dr. S. Radhakrishna
Director
Institute for Research in Medical Statistics
1, Sathyamurthi Road, Chetput, MADRAS-600 031.
LOCAL COORDINATOR
Dr. (Mrs) V. Rahmathullah, MBBS, DTPH (London)
Medical Adviser
United Planters’ Association of Southern India
Glenview, Coonoor-643 101, Nilgiris, TAMILNADU.
DESIGN AND FORMAT OF THE DOCUMENT
Dr. C.R. Ramachandran
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CONTENTS
Title
Introductory Note
Research Team
Acknowledgements
List of Contents: List of figures/Tables/Illustrations
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SECTION - A
Page
No.
I
Introduction
1
(6) Laboratory investigations
ii
Review of Occupational Health Research in
Agriculture with special reference to India,
Plantations and Tea '
'
2
(7) Environmental monitoring
(factory)
(8) Miscellaneous
Page
No.
(A) Definitions
(B) Health of agricultural workers - an overview
(C) Health of agricultural workers in India
(D) Health of Plantation Workers - an overview
(E) Hazards from exposure to Tea and Coffee
dust
(
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Tea Cultivation and Tea Industry in India
IX
(0) Organisational aspects of field
Study '
Plan of Analysis
38
X
Observations and Results
AO
(A) Demographic profile of an estate
(B) Status of Home environment
including sanitation
(C) Health Status
(D) Laboratory Investigations
15
(A) Historical Aspects
(B) Characteristic Features
(C) Health and Welfare
(D) U.P.A.S.I. and C.L.W.S.
(
IV
Chemistry of Tea
(E) Anthropometric measurements
(F) Cholinesterase estimations
(G) Environmental Hygiene parameters
in factories
(H) Miscellaneous data
17
(A) Chemistry of green/black tea
(B) Nutritional aspects
(C) Pharmacological aspects
(
V
Occupations in a Tea Plantations
(descriptions)
“
20
XI
(A) Field Work
The Tea Plantation Environment
24
(£) Psycho-social environment
Scope and Objectives of study
VIII Materials and Methods
(A) Sample estates
(B) Sample populations
(C) Methods
(1) Preliminary survey
(2) Family data
(3) Individual data
(4) Clinical examination
(5) Anthropometric measurements
(D) Methodological problems
(E) Further analysis
Reccommendations for follow-up
Bibliography/References
67
69
APPENDICES
75
a. Preliminary survey form
b. Individual data card
SECTION - B
VII
64
(3) Comparisons
(C) Limitations of data
(A) Physical environment
(B) Chemical environment
(C) Biological Environment
(D) Mechanical environment
•
Discussion
(A) Summary of findings
(B) Factory Work
(C) Supportive Services
(D) Administrative and Supervisory
VI
(a) Seasonal variations of work
and sickness absenteeism
(b) Hospital birth & death
register
32
33
c. Additional information for under-12
d. Environment survey form
e. Family Card.
LIST OF TABLES
Table
No.
Title
Page
No.
Table
No.
1
Agricultural industry in India - a
suggested classification'
5
18d
Neurological system
^8
Eye/Ear/Skin conditions
48
Energy expenditure in some agricul
tural activities
18e
2a &
2b
7
18f
Miscellaneous conditions
48
Occupational hazards reported in
cultivation of specific crops
(Bamboo to Jute)
12
18g
18h
Obstetrical/gynaecological conditions
Suggestive differences in field workers
and control
49
49
4
Occupational hazards reported in
cultivation of specific crops
(Palm oil to Tea)
12
18i
Suggestive differences in factory
workers and control -
50
5
Approximate composition of green
tea shoots
17
18J
Some additional comparisons between
field workers and control
50
6
Estimated composition of black tea
18
18k
Some additional comparisons between
factory workers and control
51
7
Nutritional aspects of tea
18
19
Laboratory investigations
8
Pharmacology of tea
19
9a
Characteristics of tea estates in
sample
34
9b
Characteristics of tea factories in
sample
34
10
Fertilizers used in tea plantation
26
11
Pesticides used in,tea plantation
26
12
Working population of estates - ArB & C
39
13
Working population by Age/Sex used in
final analysis
40
3
)
)
)
14
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42
41
41
Status of home environment
Past History of medical conditions
Past History of Bites/Stings and
accidents
43
46
18a
General signs and symptoms
47
18b
Cardio-respiratory system
47
18c
Gastro-intestinal system
47
17
c. white blood cell count
d. urine and stool examination
46
22
Page
No.
52
53
53
53
Anthropometric measurements
a. by age in males
b. by age in females
c . by religion in males/females
d. by socio-economic class in males/
females
e. by occupation in males/females
21
41
41
c. by occupational status
d. by religion and caste
e. by income group
15
16
a. haemoglobin estimation
b. erythrocyte sedimentation rate
20
Population of Estate A
a. by age and sex
b. by educational status
Title
Cholinesterase estimations
a. Mean values by age/sex/occupatlon
Environmental physical parameters
a. Mean values from total samples by
section
b. in factory A
c. in factory B
d. in factory C
e. in factory D
54
54
54
55
55
56
58
58
59
60
61
)
I.
J
LIST OF FIGURES AND PHOTOGRAPHS
No.
No.
1
A tea plucker with basket
2
A lopper shinning up a tree -»
3
A field supervisor with pluckers
4
A group of pluckers with level stick
and protective 'sacking*
5
Levelling of road (field work)
6
A sprayer
7
A withering loft
8
A roller
23
A schematic diagram of a standard
housing unit
24
A storage water tank
25
Indiscriminate garbage dumping near
latrines
26
A small creche with creche attendant
and under-5s
27
A labour club in the background
A group of school children in the foreground
28
Graph of Mean Anthropometric measurements
by age and sex
29
Graph of production vs. mandays worked and
lost due to sickness
30
Seasonal variations in Estate Jobs vs.
Sickness absenteeism
9
A drier with dried leaf
10
A sifter collecting tea dust
11
A sifting machine in operation
< 12
A tea 'chest maker*
31
A view of Estate A and neighbouring village
32
The garden hospital where medical examina
tions were conducted
33
A family waiting for examination with samp
les
34
Link workers assisting with registration
35
Doctors collecting blood sample
36
Laboratory work in progress
37
Sling psychrometer being used in Roller
Section
38
Dust in sifting section
13
A filled tea basket (close up)
14
A bak-pak sprayer (close up)
15
Spraying of rodenticide
16
Agricultural implements used in
field work
17
The furnace in drying section
18
A tractor & trolley used for
transport of tea bags and chests
19
Population pyramid of Estate 'A'
20 a
Bardiagram of Educational status
20 b
Bar diagram of occupational status
21
Rear of a labour line showing a row
of sanitary latrines as well
. 22
A spring - partially protected
1
CHAPTER I
INTRODUCTION
THE REPORT of the 1971 census shows that 72 percent of the working population of India are involved in
agriculture, livestock, forestry and plantations. Less than 10 percent are in the manufacturing, repair
and processing industries.
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REVIEWS OF Occupational Health Research in India (Rao and Lundgren, 1955 and Rao and Chatterjee, 1964)
show that most of the research undertaken have been for industry and on industrial workers. Very few stu
dies have been done in the agricultural sector or on agricultural workers. Only in the last decade there
is a growing interest in the study of occupational health of agricultural workers of both the organised
and unorganised sectors.
THE ROSS Institute Unit of Occupational Health (RIUOH) at St John's Medical College, Bangalore, was esta
blished in collaboration with the Ross Institute of Tropical Hygiene (London School of Hygiene and Tropi
cal Medicine) to study plantations and non-industrial occupations as one of its primary objectives (Narayan
1977). Because of the historical connections of the Ross Institute with tea plantations and the Interest
shown by the Medical Division of the United Planters Association of Southern India (UPASI), it was decided
that the first organised study would be undertaken on the health status of tea plantation workers with spe
cific reference to their occupation. The study was conducted from March 1979 in collaboration with the
Indian Council of Medical Research (ICMR) through its Regional Occupational Health Centre (ROHC) at
Bangalore.
STUDIES ON tea plantation workers have been undertaken earlier. Ramalingaswami and Patwardhan (1949) stu
died the ditet and health status of South Indian plantation labour; Gilroy (1951) surveyed child nutrition
on tea estates in Assam; Interns of St John's Medical College have studied various aspects of health, mor
bidity and occupational hazards during short term elective postings in plantations 1975-79 (Narayan, 1980
& 1982) ; the morbidity and uortallty among plantation workers and 0-6 year olds has oeen discussed by
Rahmathullah (1979) and Unnikrlshnan (1979) respectively; Chakravartl (1969) has made an appraisal of health
hazards during spraying operations of pesticides in tea plantations.
THE PRESENT study, however, is the first attempt to study the total population of plantation, ie., workers
and their families. The study has also attempted to identify those aspects of ill-health and morbidity in
which ther^ may be an occupational risk factor. The study involved investigation of history, physical exa
mination, anthropometry, basic laboratory investigations and special investigations such as cholinesterase
levels on workers of two plantations and three factories in South India. Measurement of environmental para
meters in various sections of four tea factories were included. Preliminary analysis of hospital records
and sickness absenteeism records were also done.
THE REPORT is presented in two sections. Section ’A’ reviews literature on the health status of agricultu
ral and plantation workers with specific emphasis on India. Apart from general scientific literature the
other sources of information were the World Health Organisation, the International Labour Organization, the
Government of India, the United Planters’ Association of Southern India and the Ross Institute Units in
Cinnemara (before 1971) and in Bangalore (after 1974). A review of the reports on hazards of exposure to
tea and coffee dust, is also given.
THIS IS followed by an overview of the tea industry in India and some background on the chemistry, nutrition
and pharmacological aspects of tea.
A DETAILED description of the occupations on a tea plantation and an outline of the important aspects of
the physical, chemical, biological, mechanical and psycho-social environment on the tea plantation are
presented.
SECTION ’B* -deals with the main study, its scope and objectives, the materials and methods including the
organizational aspects of the field work, the plan of analysis, the observations and results, the discussion
and conclusions and the suggestions for follow up and research work in the future.
AN EXTENSIVE bibliography of the literature reviewed is also included. Wherever possible, references to
these have been given in the main text of the report.
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TABLES BASED on important facts from literature and the data collected during the study as well as a series
of figures and illustrations have also been Included in the hope that this report would stimulate further
research in this increasingly important but much neglected field of agricultural and plantation medicine.
It is expected that the report may act as a reference material for those embarking on such research.
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CHAPTER II
REVIEW OF OCCUPATIONAL HEALTH RESEARCH IN AGRICULTURE
WITH SPECIAL REFERENCE TO INDIA, PLANTATIONS AND TEA
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(a) Definitions
’Agriculture* has been defined as ’’all
** forms
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of activities connected with growing, harvesting and primary
processing of all types of crops, with the breeding, raising, caring for animals and with tending gardens
and nurseries1 (WHO, 1962).
An ’agricultural worker* has been defined as •any person engaged either permanently or temporarily irrespective of his legal status in activities related to agriculture* (WHO, 1962).
The World Health Organisation (WHO) and the International Labour Organisation (ILO) have evinced interest
in the health problems of agricultural workers, since their inception. Expert Committees of both these or
ganisations either Jointly or separately have reported from time to time, about all aspects of agricultural
work and the health and occupational hazards of agricultural workers.
(b) Health of agricultural workers (overview)
The second Joint report (WHO, 1953) identified four important occupational health problems assoc...ted with
agricultural enterprises -these being: (i) infectious diseases transmitted by animals; (11) poisoning by
pesticides; (ill) diseases of the locomotor system; and (iv) conditions more prevalent in rural areas such
as malaria and parasitic infections. Some measures for general health protection of workers in places of
agricultural employment were also described.
The fourth Joint report (WHO, 1962) highlighted the factors responsible for the morbidity patterns seen
among agricultural workers. These Included:
( 1) geographical and ecological characteristics of
the area;
(ii) the type of housing and status of envirormental
sanitation;
(Hi) general low income levels;
(lv) inadequate medical and health services;
(v)
occupational patterns in farming
(vi) association with plants and animals
(vil) psycho-social features of the environment
like isolation, interaction of groups differ
ing in ethnic and other background, paucity
of amusement and absence of leisure;
(vili) working conditions including economic and
physical factors;
(lx) accidents associated with work;
(x) occupational diseases Including poisoning and
infectious diseases and those caused by
physical environmental factors.
The fifth report (WHO, 196?) reviewed the existing resources available for the protection of workers health
in developing countries. It noted the general neglect of agricultural workers even though *it still remains
as the means of subsistence for the majority of the people*. It observed certain features specific to work
in developing countries like ’women performing heavy work when they are pregnant and very young children
also work*. The increase in health hazards to the agricultural communities because of. the Introduction of
mechanization and the extensive use of synthetic fertilisers and pesticides was also stressed.
Occupational Health problems in agriculture have also been reviewed by I.L.O. (196J b). Many aspects of
safety and health including codes of practice have been discussed in I L 0 (1963, 1963a, 1965, 1969, 1972).
Some aspects of ergonomics in the fields of agriculture and forestry have been described in I.L.O. (1977).
3
The state of the art in respect of agriculture with special reference to occupational health and safety
has been reviewed by different authors In 1971. These include agricultural work by Kundler and Mamsikov
agricultural workers by Baztarrlca (1971), agricultural Implements by Jain (1971), agricultural
machinery by Knapp (1971), agricultural chemicals by Matheson (1971) and occupational health in agriculture
by Coppiestone (1971). Emara (1971) is also a very comprehensive review.
Agricultural Chemicals
Agricultural chemicals and their extensive use in the field is the most important factors that has revolu
tionised the occupation of agriculture from its traditional nature to a modern industrial enterprise. Re
views of the chemicals used and their hazards have been attempted by many authors. Pesticides by WHO (1962a)
and Coppiestone (1971a), organophosphorous pesticides by Medred and Kagan (1971), Halogenated pesticides by
Dinman (1971), Fungicides by Hunter (1971) and Rodenticides by Vallet (1971).
Organophosphorous Insecticides have been studied in much greater detail than most of the’ other chemicals
because of its effects on blood cholinesterase enzyme levels. These can be studied in the laboratory as well
as in the field. Hall et al (1957), Huorga et al (1952) and Bigg et al (1958) and Holmstead (1959) have des
cribed cholinesterase activity in normal and pathological sera, the pharmacology of cholinesterase inhibi
tion and described colorimetric methods for measurement of cellular and plasma levels.
Callaway et al (1951) was the first to measure blood cholinesterase levels in healthy adult populations and
delineate the range of personal variation. Studies and reviews of studies have been done on factory workers
field workers, manufacturing or using organophosphorous pesticides and both acute and chronic toxicity has
been well described. These include Barnes et al (1951), Davlgnon et al (1965), Marjorie Bick (1967), Nambe
T (1971 and 1971a), Wayland (1971), Kahn (1976) and Conerski et al (1978).
Occupational diseases
1. Respiratory
Respiratory iiseasea and their associations with agricultural dusts have been reported in literature for
decades. The picture is usually of a condition described as 'extrinsic allergic alveolitis* by Riddle and
Grant (1967) and Pepys (1969).
Reviews of these conditions including Farmers Lung (Pepys 1971) vegetable dusts (El Batawi, 1971), Mycoses
(Ganor and Sagher, 1971) and agricultural dusts and diffuse pulmonary fibrosis (Rankin et al, 1965) are
avallable.
A very large number of specific case studies and conditions have also been described In agriculture and re
lated occupations (Van Toorn, 1970) including Farmers lung, Pigeon breeders or bird fanciers lung, Bagasso-
sis^ wheat weevil disease, Malt workers lung, Maple bark strippers disease, New Guinea Lung disease Paprika
splitters lung, Vineyard sprayers lung, and Furriers lung.
2. Animal bites and stings
Problems related to the contact with wild and domestic animals in agricultural work has been reviewed by
Rao (1971) and the bites and stings of venomous animals, also an important occupation hazard has been reviewed by Riou and Juminer (1971).
3. Zoonoses
The dangers of diseases transmitted from animal to man in agriculture and related occupations has been re
viewed by a Joint FAO/WHO expert committee on zoonoses (WHO, 1967), Abdussalam (1971) and Steele (1975).
Dermatological diseases
The first large study of dermatological conditions in agricultural cooperatives has been reported by
Karchlik and Nikolasova (1976).
Occupational Hygiene
Identification of occupational hygiene problems in agriculture and hazards during work in farmers has gained
interest in the last decade. Zaforski (1972) has reviewed the work environment in modem agricultural plants
and Berry (1975) has described Industrial hygiene aspects of farm hazards.
Legislation
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The diseases related to agricultural work iwhich
* ' *have now been placed on the prescribed occupational disea^
see under the National Insurance (Industrial injuries), ...
Act 1965
in U.K.
are the
following: (Ministry of
Social Security, U.K. 196? & 1972). The method/mode of contact is also described.
(i) Anthrax - Handling of wool, hair, bristles,
hides or skins or other animal products and
contact with infected animals.
(11) Glanders - Contact with equine animals and
carcases.
(Hi) Leptospira icterohaemorrhagica - places in
fested with rats.
(iv) Leptospira canicola - contact with dog kennels
and care of dogs.
(v)
Beat knee, hand, elbow - due to manual labour.
(vl) Farmers Lung - exposure to the dust of mouldy
hay or other mouldy vegetable produce by reason
of employment in
a. agriculture/hortlculture or forestry;
b. loading or unloading or handling in sto
rage such hay or other vegetable produce;
c. handling bagasse.
(vii) Brucellosis - contact with bovine animals
or carcases as in farm workers, veterinary
worker and slaughter house worker.
(viii) Following chemicals used also in agriculture
as indicated:
a. Methyl bromide - pesticide
b. Dinitro ortho cresol - Insecticide,
ovicide, and fungicide
c. Compounds of Mercury - fungicide in seed
dressing
d. Compounds of Arsenic - weed killers. Insec-'
tlcide and fungicide
e. Compounds of Phosphorous - rodenticides
and insecticides.
(c) Health of Agricultural Workers in India
(excluding plantation labour)
Magnitude of problem
An enquiry into the working and living conditions of agricultural labour in India (Labour Ministry, 1957)
revealed that in the year 1956-57 there were 16.3 million agricultural labour households in the country of
which 57.3 percent were landless labourers. The size of the average family was 4.4 and the annual income
per household was Rs.437.00. The average adult male worker had wage employment for 194 days, was self-employed
for 40 days and unemployed for 128 days.
The 1961 census showed that 131 million ie., 69 percent of the total working population of India were enga
ged in agriculture. 16.7 percent of the total work force were landless labourers. The average daily wage of
casual labour was 96 paise for adult male, 59 paise for adult female and 53 palse for child respectively.
According to the 1971 census 43.3 percent of the working population are cultivators, 26.3 percent are agri
cultural labour and 2.4 percent are in plantations, livestock and forestry bringing the total employed in
agriculture and related occupations to 72 percent (Narayan 1977).
Classi flcation
The agricultural sector in India is very diverse and though the agricultural workers are often visualised
as only working in the field producing food and other crops, they are in reality a group of workers engaged
in a diversity of jobs which include primary processing of food and other crops. In the broader sense, it
also Includes other jobs associated with agrarian culture including rural cottage Industry and rural arti
sans who produce goods mainly recycling agricultural wastes, to be used by agricultural workers and their
families. Narayan (1979) suggests a classification shown in Table I.
Overview
Reviews of occupational health research in India, Rao & Lundgren (1955) and Rao & Chatterjee (1964) show
that most of the research work has been done even in India, on industrial workers and factories jobs apart
from basic research aspects. In occupational research the agricultural worker has not received the emphasis
which is his due. In the last decade this trend has shown a change.
Rao & Saha (1962) reviewed the occupation 01 the agricultural worker in a developing country. Narayan (1979)
Natu and Shaikh (1979) and Gupta (1979) have presented broad overviews of the agricultural sector in India,
the known problems and the special features.
5
TABLE I
AGRICULTURAL INDUSTRY IN INDIA
(a suggested classification)
A: PRODUCTION
1. Unorganised sector
Cereals, pulses, oilseeds, cotton,
Jute, sugarcane, vegetable, fruit,
fodder.
2. Organised sector:
Tea, Coffee, rubber, apice, cinchona
(plantations)
3. Sericulture
4. Forestry
5. Livestock and animal husbandry
6. Fisheries
B: PROCESSING
I. Food processing
II. Cottage industry (from agricultural
produce & wastes)
1. Sorting, dehusking, storage
2. Milling, pounding, grinding
3. Oil manufacture
4. Gur manufacture
5. Drying/pickling/preservation
1. Weaving, cotton, wool, Jute, silk
2. Rope making - Jute, hemp, sisal, coir
3. Household items - bamboo, cane, coir
4. Hiding and tanning
6. Distilling
C: RURAL ARTISANS AND OTHER OCCUPATIONS OF
VILLAGE
(not strictly agriculture but supportive
of it)
1. Smithys - iron, tin, silver
gold etc.
2. Carpenters
3. Cobbler
4. Potter
5. Brick/tile maker
Nutrition and Energy Expenditure and Occupational Physiology
Rao & Saha (1962) studied energy expenditure in agricultural operations. Three typical agricultural occu
pations during harvesting were compared with twelve operations in cotton textile industry. The agricultu
ral operations were generally much heavier, mowing required 167 K Cal/M^/Hr, threshing 205 Kcal/M /Hr and
carrying 299 K Cal/M /Hr (refer Table 2a). Studies on energy expenditure and requirement of agricultural
workers were undertaken by Ramamurthy and Belavady (1966) and Belavady (1966). The energy expenditure in
eight agricultural workers were measured by them and this is shown in table 2b. Diet surveys showed a deficit of 250 calories/day between intake and expenditure.
Occupational hazards/diseases of specific groups
Mathur (1957) studied 1948 horticultural workers in Delhi and listed out various occupational hazards of
gardening. Tuberculosis of lung was radio logic ally positive in 2.6$ of workers. Eye injuries were common,
Sen & Khanna (1978) have presented data on Brucellosis and Q fever being occupational health hazards in
dairy and livestock workers.
Ghosh et al (1980) studied agricultural workers engaged in tobacco cultivation and found that 88 percent
of workers suffered from symptoms like nausea, vomiting, giddiness, head-ache, fatigue, loss of appetite
and dyspnoea. These workers showed 5-4 times higher concentration of nicotine and cotinine in their urine
as compared to workers not engaged in tobacco cultivation. Nicotine seemed to be responsible for these
symptoms.
Jejurikar and Jape (1981) did a preliminary study of 255 fisherfolk to find out their morbidity patterns.
The study revealed that though they showed many clinical features common to the general population, the
following conditions were significantly commoner;
)
6
(i) callosities on the palm;
(11) scabies and taenia infection;
(Hi) lacrymation and redness in eyes;
(lv) cramps in the muscle and muscular fatigue
and hypertrophy;
(v) poor personal hygiene;
,
(vi) change in colour and texture of skin; and
(vli) injuries to skin.
;
Occupational Accidents
Gordon, Gulati and Wyon (1967) did .an epidemiological study of Traumatic accidents in rural Punjab in the
year 1959-60. Accidental injuries in 4 villages of Ludhiana district were investigated and followed up.
The study gave epidemiological Insight into the accidents related with agricultural work. The rate per 1000
population was 115.6 (Disabling 110^6 and crippling-5 and fatal- nil). In sen the percentage at work was
much higher. 17 percent were due to agricultural implements, 11.5 due to striking against blunt objects,
9.6 percent due to domestic animals, 9.1 percent each due to falls, and hot liquid*, 3.4 percent due to bi
tes and stings and 3.6 percent due to agricultural machinery. Machinery accidents were mainly due to hand
powered choppers used to prepare feed for animals.
Sekhon (1968) has discussed certain accidents like : i) head injury peculiar to country cane crusher (Kohlu
injury); 11) chaff cutter and wheat thresher injury; iii)) 1hazards of fruit plucking and rural electrifica-
tion and iv) hazards of insecticides and pesticides. Suggestions for ------prevention
--------- 1 are also given.
Datta and Verma (1969)' studied 427* accidents which reported
ueu to a
a rural
luiui health
neaitn centre
centre from
irom 10
io villages
villages near
Pondicherry. The morbidity and mortality rates were 51.9 and 0.5 per 1000 population. 79 percent of these
accidents in both male and female occured at work in the fields. The causes of accidents were - falls and
injuries 64 percent, bites and stings 20 percent; foreign bodies 6.8 percent; bums 6.1 percent; acciden-
tai poisoning 1.9 percent and electric shock 0.9 percent.
Agricultural Chemicals
Research into the hazards of pesticide spraying have been stimulated in recent years nainly due to the extensive spraying operations in malaria control programmes.
Kashyap (1971) has reviewed the effect of occupational exposure to organo phosphrous pesticides,
Waresh Bhu
et al (1976) have studied chronic poisoning in pesticide workers using organophorous pesticides,
Gupta (1978)
has reviewed occupational exposure to pesticides, Gupta (1980) has described health risks in ultra lowr volume aer.al spray of malathion for mosquito control and Kashyap (1980) has reviewed the scope and need of to
xicological evaluation of pesticides under field conditions, especially medical surveillance of malaria spraymen exposed to HCH in India.
M1seeligneous
Datta and Ramanathan (1971) have compared seven modes of carrying loads on the horizontal plane, These were
double pack, head load, rucksack, sherpa type, rice bag, yoke and with hands.
Das et al (1976) have reported case studies of five patients with primary mesothelioma, all belonging to a
rural agricultural community working in sugar cane farming on an allied trade. None of them had any exposure
to asbestos previously. Whether this observation is coincidental or has any aetiological bearing is being
further investigated.
Nag, Sebastian and Malvankar (1980) studied the effective heat load on agricultural workers during summer
season and found that the environmental heat load on workers performing light and moderate activities was
40 and 27 percent of total heat load, respectively suggesting that with increased metabolic heat production
the relative load due to environmental routes was progressively less.
(d) Health of Plantation Workers (overview)
Plantations have been defied ’as any agricultural undertaking regularly employing hired workers, which is
situated in the tropical or sub-tropical regions and which is mainly concerned with the cultivation or pro-
duction for commercial purposes of coffee, tea, sugarcane, rubber, bananas, cocoa, coconuts, groundnuts.
cotton, tobacco, fibres (sisal. Jute and hemp), citrus, palm oil, cinchona or pineapple; it does not Include
family or small scale holdings producing for local consumption and not regularly employing hired workers’
(ILO, 1966).
7
TABLE 2a
ENERGY EXPENDITURE LEVELS IN OPERATIONS IN RICE CULTIVATION
During work
Pulmonary ventilation
L/min/M2
Oxygen consumption
L/ain/M2
Energy expendi
ture K Cal/Hr/
M2
No. of
subjects
Pulse/
Min.
Resp/
Min.
Mowing
12
137
27
15.9
0.566
167
Carrying
14
154
31
25.5
1.017
299
Threshing
10
129
33
18.B
0.730
205
Activity
NB: Average age 26-30. Body surface area - mean 1.49 M2
Source: Rao and Saha, 1962
TABLE 2b
No.
ENERGY EXPENDITURE IN SOME AGRICULTURAL ACTIVITIES
Activity
No. of
subjects
studied
Average
we i ght
(kg)
R.Q.
Cal/kg/Hr
Cal/Min
1
Ploughing
11
44.7
0.89
7.02
5.48
2
Puddling
11
45.5
0.89
8.65
6.45
3
Working
push hoe
12
45.7
0.88
5.87
4.66
4
Trimming bunds
10
43.4
0.91
9.30
6.28
5
Making channels
for irrigation
6
42.3
0.86
4.56
3.25
6
Harvesting
10
43.2
0.87
5.22
3.8
7
Making of bundles
9
44.7
0.85
4.66
3.48
8
Threshing
9
44.8
0.87
6.97
5.27
NB: Figures given are averages
Ranges were indicated in original article
Source: Ramanamurthy and Belavady, 1966
8
The definition nay be extended to include rice, chicory, cardamom, geranium, pyrethrm or any other croc
(ILO, 1966).
In India, the legal definition for plantations adds a clause on size (10.117 hectares or Bore) and on raw-
ber of employees (thirty or more persons in addition to limiting it to tea, coffee, rubber and cinchona
(PLA, 1951).
-----------------“
(
Government of India and I.L.O. Sources
Surveys and reports on the health of plantation workers have been undertaken by the Governnent
of India and
others like the International Labour Organization, since the 19AO*a.
(1) A labour investigative committee in 1943 observed that »the health and physique of plantation workers
were not too good though it was better than that prevalent in the villages....Common complaints were bowel
complaints, worm Infestation, respiratory disease and malaria....* (Rege, 1946). ’
(2) A survey of standards of medical care for tea plantations in India was made by Lloyd Jones (1947). He
observed that "vast bulk of morbidity and mortality were due to conditions arising from poor diet, poor
sanitation, untreated or inadequately treated water supply and ignorance of workers". The main diseases
were malaria, bowel diseases like cholera, typhoid and the dys-enteries, anaemias, hookworm infection.
Kala-azar, tuberculosis and leprosy. Comparing the three areas he visited, Assam,
North Bengal and South
India, he noted that Assam labour were the worst off; in Bengal the state of nutrition was better but tuberculosis, bronchitis and fibrosis were <common; in South India the standards of health were better and
maternal mortality was relatively low. Kala-azar was unknown but hookworm and other intestinal
— - --- ———~
very common.
(3) The Government of India initiated a study in 1948 into the cost and standard of living of plantation
workers in South India. This included a diet survey and medical evaluation of
a sample of plantation- workers and their families in tea, ccoffee and rubber estates in South India (Labour Ministry, India, 1948).
This study which probably is the only• comparable
*--------- ■
’ one
one io our
our study
study m
in The
the plantations
plantations included
included recording
record!ng of
medical history, measurements of heights and weight and physical examinations and hemoglobin estimation and
stool examination (Ramalingaswami and Patwardhan, 1949).
The salient findings/features of this study were:
(1) 1592 Individuals were included;
(ID diets were low in calories and proteins and
grossly deficient in calcium, Vitamin A and
its precursors and thiamine;
(ill) 79 percent of the adults were under-weight by
10 percent or more as compared with the ave
rage for South Indian adults;
(iv) 81.2 percent above 12 and 61.3 percent below
12 showed morphological changes of early
Vitamin A deficiency.
(v) 30.8 percent above 12 had evidence of neuro
logical involvement due to thiamine defici
ency;
(vi) 12.1 percent showed one or more signs of ri-
boflavin deficiency;
(vli) 291 persons had haemoglobin levels below 13.2
gms and 148 had less than 9.0 gms percent;
(viii) a stool examination in one locality (Coorg)
(ix) Malaria as assessed by palpable spleen was not
detected in most of the estates. Splenic indexin Coorg was 50 percent and in Malabar 11.1
percent;
(x) Scabies and coccal dermatitia were frequently
encountered;
(xl) Upper respiratory tract infections were common
but chronic lung disease was rarely seen;
(xii) Histories suggestive of chronic gastro
duodenal ulcer were obtained occasionally;
(xili) No cases of cirrhosis of liver and infective
hepatitis;
(xiv) Diarrhoea was frequently complained of more
especially among children and over half of
them had blood and mucus;
(xv) Lack of appetite, distension and easy fatiga
bility were frequently complained of.
revealed an infestation rate of 40 percent by
hook worm;
(4) The Ross Institute Unit in Assam surveyed the nutritional status of 4564 children of tea estate labour
ers and villages of Assam Valley (Gilroy, 1951). 44 tea estates were included and two subsidiary groups of
medically backward estates and villages.
The salient features were that:-
9
(1) physical development were reasonably satis
factory when compared to weight tables for
tea estate children of Wilson arxi Mitra (1938)
and Mitra (1939);
(11) xerophthalmia was very common, dry skin mode
rately common and pyoderma absent;
(ill) beriberi, scurvy and rickets were completely
absent;
(iv) Vitamin A deficiency was seen in 75 percent,
Vitamin B2 in 0.6 percent, caries in 0.4 per
cent and discolouration of hair in 19.8 percent;
(v) Assamese village children had poorer physique
but less vitamin deficiency signs showing there
by that the diet was qualitatively balanced but
quantitatively deficient in comparison to plan
tation children.
(5) MacDonald (1954) reporting on the health problems
of the tea industry noted the changing clinical pro
file of estate hospital practice wl th the disappearance of malaria and the reduction in the proportion of
dyssenteries and pneumonia. Tropical ulcers
had become relatively rare and this was attributed to the reduction in the prevalence of leeches due to increased use of chemical fertilizers,
The most important causes of invalidism was anemia, either acting uncomplicated
or complicated by pregnancy or infectious disease
and tuberculosis.
(6) Foy and Kondi (1956) 1and Misra (1959)
- . have reported on the incidence of anemia based on studies done in
Assam at the Labac Central Laboratory. Of the 7155 anemic aubjects Investigated,
,21.43 percent were anemic
pregnant females. Macrocytic
anemia
. —-----—j was seen in 47.88 percent of the total and 54.95 percent of the pregnant females. Macrocytic anemia of
pregnancy was 11.78 percent of the total. All these showed marked imp
rovement with folic acid administration.
(7) In 1962 a team of experts from I.L.O surveyed the standard of living and conditions of employment In
anampocoa, palmoil, rubber, sisal, sugarcane and tea plantations In twelve countries of the Aslan. Afri
can and Latin American region (IU>, 1966)-. In India, the enquiry dealt with a dozen tea plantations, the
largest of which had 2025 workers,
The survey concluded that -despite substantial progress the health posltion on plantations was jnot
' universally satisfactory. Malaria had been eliminated but bad hygiene, malnutritlon and under-nourishment
-c..t are often responsible for Intestinal or pulmonary diseases as well as anemia.
(8) ILO in 1970, reporting on the social consequences of technological development in plantation, observed
that technological changes have led to two main spheres of concern in connection with the health and safety
of plantation workers, These are the hazards surrounding the use of agricultural chemicals and secondly to
the operation of tractore and their equipment.
( )
( 970a) iniers from general and epidemiological data that "socio-economic, cultural and environmen-
tai conditions and the wllleu In which the plantations live and work, which are close to -nature In the rawhave a specific Influence on the morbidity and mortality rates of plantation workers". With regard to occupational health hazards it identifies three major areas:
(i) harmful effects to workers health of new che
(ill) hazards due to insects and poisnous reptiles
mical products used for weeding, controlling
such as scorpion and snakes.
plant diseases and eradicating insect pests;
(ii) different type of lung
j affections and bronchial troubles from the inhalation of dust in
the work place particularly the factories in
the plantations;
(10) ILO (1976) reporting on the Housing, Medical and welfare facilities
and occupational safety and health
on plantations notes that
- plantation communities tend to be <--------- -• ■
exposed to a wide spectrum of communicable diseases, Infections acquired
through the handling of animals, insect borne infections
----- --- and diseases associated with low standards of personal and environmental hygiene.
- In Sri Lanka 50 percent of total sickness on plantations is
caused by respiratory diseases, and 25 percent
by intestinal diseases. Intestinal parasites are
common. Hookworm infestation is the main cause of anaemia
which is very common among women and children. Malnutrition,
Tetanus and epidemics of influenza are also
common.
- With regard to work related hazards
data available from Sri L—ka showed that falls are the main cause of
major field accidents closely followed by cutting and digging implements and falling objects. Number of accidents are due to encounter with reptiles, /
, insects and wild animals. In factories the commonest types of
major accidents are due to improper handling of machinery, falls,
» falling objects and improper handling of
co’/rthjity health cell
I
V Main, I Llock
^oram©ngala
)
BangaJore-560034 *
------ . Iririia
9
(i) physical development were reasonably satis
factory when compared to weight tables for
tea estate children of Wilson and Mitra (1938)
and Mitra (1939);
(ii) xerophthalmia was very common, dry skin mode
rately common and pyoderma absent;
(iii) beriberi, scurvy and rickets were completely
absent;
(iv) Vitamin A deficiency was seen in 75 percent.
Vitamin B2 in 0*6 percent, caries in 0.4 per
cent and discolouration of hair in 19.8 percent;
(v) Assamese village children had poorer physique
but less vitamin deficiency signs showing there
by that the diet was qualitatively balanced but
quantitatively deficient in comparison to plan
tation children.
(5) MacDonald (1954) reporting on the health problems
of the tea industry noted the changing clinical profile of estate hospital practice with
i the disappearance of malaria and the reduction In the proportion of
dyssenteries and pneumonia. Tropical i
ulcers had become relatively rare and thia was attributed to the reduction in the prevalence of leeches t
due to Increased use of chemical fertilizers. The most Important causee of invalidism was anemia, either acting uncomplicated
or complicated by pregnancy or infectious disease
and tuberculosis.
(6) Foy and Kondl (1956) and
and M16ra
MlBra ’(l
959) have
have reported
the Incidence
incidence of
based on studies done In
( 1959)
reported on
on the
of anemia
anemia based
LLL
..Central.LabOratOry- 01 the 7155 aneml° 6^cts investigated, 21.45 percent were anemic
pregnant females. Macrocytic anemia was rseen in 47.88 percent of the total and 54.95 percent of the pregnant females. Macrocytic anemia of pregnancy
was 11.78 percent of the total. All these showed marked inprovement with folic acid administration.
(7) In 1962 a team of experts from I.L.O surveyed the standard of living and conditions of employment In
ana^ocoa, palmoil, rubber, sisal, sugarcane and tea plantations in twelve countries of the Asian, AfriiLest L b.TL08" reSi0" (IW’ 1966)‘
Indla> the entlUlry dealt
a
taa Plantations, the
argest of which had 2025 workers. The survey concluded that -despite substantial progress the health posi
tion on plantations was not universally satisfactory. Malaria had been eliminated but bad hygiene, malnut
rition and under-nourishment are often responsible for Intestinal or pulmonary diseases as well as anemia.
L t t
’ rePOrtlng °n the Eoclal consequences of technological development In plantation, observed
that technological changes have led to two main spheres of concern In connection with the health and safety
of plantation workers. These are the hazards surrounding the use of agricultural chemicals and secondly to
the operation of tractors and their equipment.
(9) ILO (1970a) infers from general and epidemiological data that
"socio-economic, cultural and environnentai conditions and the milieu in which the plantations live and work, which are close to ’nature in the raw’
have a specific influence on C
the morbidity and mortality rates of plantation workers". With regard to occupational health hazards it identifies
-----------three major areas:
(i) harmful effects to workers health of new che(iii) hazards due to insects and poisnous reptiles
mical products used for weeding, controlling
controlling
such as scorpion and snakes.
plant diseases and eradicating insect pests;
(ii) different type of lungJ affections and bron-
chial troubles from the inhalation of dust in
the work place particularly the factories in
the plantations;
(10) ILO (1976) reporting on the Housing, Medical and welfare facilities
and occupational safety and health
on plantations notes that
- plantation communities tend to be exposed to
a wide spectrum of communicable diseases, infections acquired
through the handling of animals, Insect borne infections
-------------- - and diseases associated with low standards of personal and environmental hygiene.
- In Sri Lanka 50 percent of total sickness
on plantations is caused by respiratory diseases, and 25 percent
by intestinal diseases. Intestinal parasites
are common. Hookworm infestation is the main cause of anaemia
which is very common among women and children. Malnutrition, Tetanus
and epidemics of influenza are also
common.
- With regard to work related hazards i
data available from Sri L.—ka showed that falls are the main cause of
major field accidents closely followed by cutting and digging implements and falling objects. Number of accidents are due to encounter with reptiles '
, insects and wild animals. In factories the commonest types of
major accidents are due to improper handling of machinery,
,, falls, falling objects and improper handling of
co'zr. urjiTy rHEALTH cell
I
)
V Main, II Slock
Korambngal?
bangalore-560034 ’
India
10
loads. The next category of frequent accidents are caused by the use of improperly guarded machines and
moving belts.
Deaths at work were mainly due to falls, snake and insects bites, and exposure to natural hazards including landslides and lightening and due to drowning. ‘
No reliable data was available on hazards due to pesticides and agricultural chemicals.
11. U.P.A.S.I, Sources
The United Planters Association of Southern India has been collecting data as part of its Comprehensive la
bour welfare scheme. Some important epidemiological information on the health status of plantation workers
and other sections of the plantations have been reported.
(i) A study of the health of 526 women workers registered on a No-birth bonus scheme (UPASI 1971a) found
that 85 percent suffered from anemia (hemoglobin less than 60%), 90 percent had non-specific leucorrhoea
and 72.2 percent complained of epigastric pain and 5 had pulmonary tuberculosis (1 percent).
(ii) An analysis of major causes of death in Munnar Plantations (UPASI, 1979) revealed that old age and de
bility were the causes for 21.82 percent, prematurity 18.A8 percent bronchopneumonia 14.55 percent, malnut
rition 4.5 percent congestive cardiac failure 3.6 percent and suicide
percent. An analysis of major cau
ses of infant deaths in Munnar (UPASI, 1979) revealed prematurity to be the major cause (52.59 percent) fo
llowed by bronchopneumonia (24.14 percent), umbilical sepsis (6.03 percent), malnutrition (5.18 percent)
and gastroenteritis (5.1S percent).
(ill) A study on the morbidity and mortality patterns among under six year olds in four tea estates in
Munnar (Unnikrishnan, 1979) found that 0-6 year olds formed 13.05 percent of the cases attending estate
hospital out patients. Respiratory tract infections, water borne illnesses and fevers accounted for 88.84
percent of the morbidity. Respiratory tract infections were maximum in infants, water borne illnesses in
1-2 year olds and fever increased with age. Among in-patient admission respiratory infections (31.58 per
cent); fevers (13.68 percent) and diarrhoea (8.52 percent) remained the three major categories. Mortality
was mainly due to prematurity and bronchopneumonia.
‘(iv) A study of water borne Illness on 26 estates in Munnar (UPASI, 1979) showed incidence per 100G popula
tion for three years - 1976, 1977 and 1978 to be 400, 376 and 382 respectively (only diarrhoea, dysentery
and gastroenteritis was included). Of the 21,097 cases recorded in 1978 gastro^enteritis was diagnosed in
12.7 percent, bacillary dysentery 6.8ft}amoebic dysentery (13 percent), diarrhoea in 65.7 percent, infective
hepatitis (1 percent) and enteric fever in 0.37 percent.
(v) A retrospective study of diarrhoeas in children admitted to the plantation hospital (Basu, 1977) in
Munnar showed that it was commonest in the 0-1 and 1—2 age groups (46.9 and 30.4 percent respectively).
Stool examination revealed roundworm ova in 23.5 percent, active amoeba in 15.7 percent, giardia in 2.6 per
cent. Hookworm ova, E.coli and tapeworm ova was also reported. In 54.8 percent of cases no organism was
found.
(vl) Hahmathullah (1979) has reported that in the estates under the Comprehensive Labour Welfare Scheme, re
markable Improvement in malnutrition in children had been shown. In 1974, the figures for Normal, 1°, 2°, 3°
based on the under-five weight chart (Morley card modifed for India) was 27, 46, 16 and 10 percent respect
ively. In 1978 the figures were 31, 39, 25 and 3 percent respectively. Hahmathullah (1982) also showed a
change in crude birth rate, death rate and infant mortality rate from 41.7, 9.5 and 111.80 in 1970 to 24.9,
5.3 and 52.5 in 1980.
12. Hoss Institute Unit Sources
The Ross Institute Unit of Occupational Health, Bangalore, undertook over forty short term field projects
on various aspects of health of plantation workers including aspects of occupational hazards and safety
from 1975-79 as part of an internship training programme in the plantations. These projects include statis
tical analysis of hospital or health centre records, community survey of a specific health problem and eva
luations of a component of the health service. Community surveys were either total family units or specific
target populations such as pre-school children, primary school children, factory workers and so on. A re
view of these projects (Narayan, 1982) highlight the following epidemiological information on health status
of tea plantation populations.
(1) A systematic study of 20 percent of the population of 12 estates in Munnar showed that
goitre. Some associated epidemiological features were also studied.
had endemic
11
(il) Over ten nutritional assessment surveys were undertaken - five in samples of creche children, two in
primary school children, two in children of estate population (house to house survey) and one in the total
estate population. Malnutrition based on weight alone ranged from 42 to 93 percent of the sample (Mt deg
ree and above). Vitamin A deficiency signs from 0.65 to 75 percent. Vitamin B deficiency signs from 3.2 to
25 percent, carles from 22 to 45.5 percent among the children 0-6 and primary school age groups. All asse
ssments were based on clinical signs.
(lii) Hemoglobin estimation was done on 490 subjects representing twenty percent of the total population of
an estate. 3.47 percent had less than 8 gms percent, 31.43 percent had between 8.1 to 10 gms percent, 45.92
percent had between 10.1-12.4 gms percent and 19.18 percent had above 12.5 gms percent.
In another house to house survey of three divisions of an estate, anemia was found to be clinically present
in 48 percent of the population. In females, it was 60 percent and in females in the 15-45 age group it was
81 percent.
(iv) A study analysing morbidity and mortality patterns among under fives found that the top ten diseases
affecting under-fives were bronchopneumonia, gastroenteritis, PCM, primary complex (Tb), amoebic dysentery,
acute nephritis, lobar pneumonia, bronchial asthma, infective hepatitis and ascariasis.
(v) In a nutrition survey of the labour population 476 stool examinations were done. 57 percent were posi
tive for amoebic cysts, round worm ova were found in 73 percent, hookworm ova in 9 percent, whipwonn ova in
8 percent, threadworm ova in 3 percent and tapeworm ova in 0.42 percent of cases.
(vi) The percentage of cases. admitted to the garden hospital attributable to water borne diseases on an es
tate were 12, 20 and 28 percent in 1975, 1976 and 1977. The diseases included were typhoid, amoebic and ba
cillary dysentery, diarrhoea, gastro-enteritls and infective hepatitis. More than forty percent of the ad
missions were below 5 years of age.
(vii) In a study of 101 female subjects above 18 years in an estate in Nllglris, 19.6 percent complained of
one of the following complaints - dysmenorrhoea, menorrhagia, prurltis vulvae, irregular menstruation, and
white discharge.
(vili) A house to house survey on one tea estate in the Nilgiris showed 4.02 percent of the population hav
ing presence of sugar in the urine (Benedicts test) and 6.32 percent having blood pressure recordings above
140/95 in a single recording in the field.
(ix) A review of accidents in two tea factories in Munnar in the past twenty years showed that (a) 90 per
cent occured while working at the tea leaf roller; (b) 75% were cases of hand injuries and two thirds of
these involved the right hand; (c) 20 percent were cases of fractures and the rest were contusions, lace
rations and sprains; (d) males were most often affected.
(x) In a retrospective analysis of cases of accidents at work admitted to a plantation hospital it was found
that hand injuries constituted 23.5 percent of the cases. Among factory workers, 70 percent were working in
the rolling section and among field workers 80 percent were pruning during the accident.
(xi) A survey of 238 permanent workers of five tea factories in Munnar region showed that 74,4 percent of
the workers had signs and symptoms of respiratory disease. In males (205 subjects) it was 75.1 percent and
in females (33 subjects) it was 69.7 percent. Prevalence was higher in older age groups and those with lon
ger years of experience. 79.4 percent of the smokers and 68.8 percent of non-smokers in the sample had po
sitive signs. 66.8 percent had clinical signs of emphysema but in the absence of chest'x-ray and respira
tory function tests further classification was not attempted. The two other surveys carried out later in
159 workers in five factories and 78 workers of two factories in Munnar showed a much lower prevalence.
(xii) A pilot study undertaken to identify health related difference in women pluckers belonging to two
groups of low and high productivity (based on mean plucking performance) showed that low pluckers and grea
ter experience of disease especially anemia with corresponding effect on their absenteeism rates.
Many other studies done on retrospective analysis of burns, acute nephritis, bronchtis, bronchopneumonia
and others admitted to estate hospitals as well as health practice research on family planning programme,
creche services and others had no direct relevance to the current study.
Other Sources
(1) Fernando (1971) has reviewed "the processes involved in tea cultivation and the tea industry highlight
ing some of the known hazards.
)
12
(2) Reviews of the state of the art and related hazards associated with the cultivation of various planta
tion crops have been compiled by,the International Labour Organisation and shown in Table 5 & 4. A compre
hensive overview of plantations themselves has been given by Cabrera (1971).
(3) Mackay (1977) attempts to ascertain the health patterns in a Bangladesh tea garden population using
three parameters derived from crude data ie., causes of loss of working time, causes of death and ages at
death. He found that intestinal and respiratory disease account for half of the total loss of working time.
Traditional tropical diseases such as malaria, tuberculosis and venereal diseases contribute hardly at all,
Intestinal infections are a major cause of death; respiratory infections are not. The other principal
of death is cardiovascular disease.
cause
(4) Mackay (1979a) in a clinically descriptive and taxonomic paper based on twenty years of personal 1
experience in rural industries in the tropics highlights the effects of stress on indigenous and expatriate
executives in plantations and describes the psychosomatic illness and social maladjustment resulting from un~
successful adaptation to stress. He describes behaviour patterns classified into manifestations such as the
alcoholic, the agressive, the hermit and the transgressor of cultural barriers.
TABLE ?
Types of crop
occupational hazards reported in cultivation of specific crops
raj
Hazards reported
Source/authority
Bamboo
Venomous snakes, falls, cuts, tetanus, skin punctures, hyper keratosis
Bananas
Pesticide poisoning, snakes, venomous insects, harvesting injuries with
machetes
Coconut
.?--Js2_injuries_from_cutting and digging implements, snake bites
Coffee workers lung, skin & respiratory allergy, snake bites, falls
from trees, burns, minor cuts and abrasions, electrical hazard and
ation_injuries_from unguarded drying machinery
Coffee
Cocoa
Cuts from saws/machetes, snake bites, elephants and other dangerous
,af^malj,_pesticide poisoning, diseases of low socio-economic standards
Animal and plant. diseases, snake bites, cjrc
eye/skin
infections
/ omu j.xu.eu
uxuud, insect
borne diseases, pesticides,
f "' ' ’
accidents due to agricultural machinery
and implements.
Cannabosis, toxicomania, obstrutive arteritis, machine accidents?
fire hazard
'
'
Accidents, fire hazard, pesticides, non-specific lung disease, mill
fever
Cotton
Hemp
Jute
Ko Yuanchi ng
(1971)
Ko Yuanching
(1971)
Fernando (1971)
Bedrikow (1971)
SoFuluwe (1971)
Gupta (1971)
B a r be ro-C arni ce ro
_____ (19712___
Khin Maung Nyint
(1971)
Source: Encyclopedia of Occupational Health and Safety, I.L.O (1971)
TABLE 4
==
Type of crop
Oil palms
Pineappies
Rubber
Rice
Sisal
Sugarcane
Tobacco
Tea
OCCUPATIONAL HAZARDS REPORTED IN CULTIVATION OF SPECIFIC CROPS
BW ■•BXBn = wa»aoBBBXBBMmBZ»WBBm = aBBBBBBBBBBBBBaBBBBWWSB«XWBBBI
Hazards reported
Source/authority
Snake bites, dangerous animals, falls, cuts from implements, skin
punctures, pesticides and herbicides
Pesticides, heat stress, accidents due to machines and tools, skin
pricks from thorns
Falls, cuts from implements, snake/insect bites, pesticides and
herbicides, acids and chemicals, unguarded machinery, fire and heat
hazard
Uncomfortable posture, heat stress, fertilizers and pesticides,
stigmata, raynauds phenomena, cyanosis of extremities, dermatitis,
bites/stings, psycho-social stress
Cutting implements, airborne dusts, injury from processing plants
Cutting implements, accidents from tractors and machines, cuts and
abrasions from plant, bites/stings, veils disease from rats,
pesticides
Pesticides and weedicides, skin disease, conjunctivitis,’ laryngitis,"
knife injuries, tetanus, lifting/handling accidents, trensport
accidents
Falls, cutting implements, bites/stings pesticides and herbicides,’
caterpillar allergy
: = = = “ = ««5 «“ = = «= = = = = »- = « = « «* = = = = = BB3:c = BBB XB = 3I«
• ■ ■ at b * a k ai ■ ■ a a ■ b s ■■ ■
=
=
Source: Encyclopedia of Occupational Health and Safety - I.L.O (1971)
Sofoluwe (1971)
Ko Yuanching (1971)
Dunlop Co Ltd
(1971)
Wongpanich (1971)
Arreguin Velez
(1971)
Munoz & Sucbman
(1971)
Sengroy Torres
(1971)
Fernando (1971)
13
(5) Kroeger and Fernando (1974) have presented data on the incidence of diseases among plantation labourers
in Ceylon.
(6) Tarigan et al (1977) have studied health status of pre-school children in some settlements of tobacco
plantation labourers in North Sumatra.
(7) Fenwick and Figenschou (1972) and Collins et al (1976) studied productivity in cane cutters in
Tanzania and physiological performance and work capacity in cane cutters in Sudan respectively. Both these
studies were done primarily to determine the effects of schistosoma mansoni infection on work performance
but are very well planned studies particularly the latter on occupational physiological measurements of
plantation workers.
(8) Roy Chowdhury (1959) presents statistical data in a review of sickness absenteeism in a tea factory at
Calcutta. Each worker was losing 12.6 man days on medical grounds and in addition 1.5 man days on account
of accidents. The average daily absenteeism was 1.1 percent. Introduction of mechanisation increased the
man days lost by 51 percent but number of injuries were reduced by 49 percent.
(9) Chakravarti (1969) has presented an appraisal of health hazards during spraying of pesticides in tea
plantations for the first time in Indian literature.
(e) Review of Literature of hazards from exposure to tea and coffee dust
Tea dust
Hazards associated with the inhalation of tea dust has been reported in literature since the 1770*s and
well documented by Pinnagoda (1971).
Lettsom (1$79) describes that some tea blenders are "seized with sudden bleeding from nostrils, and others
attacked with violent coughs ending in consumption". He, however, was doubtful whether they were caused by
tea dust.
Thackrah (1852) reports that "Tea men, in removing tea from chests, are much affected by the dust especia
lly by that from the green. But as this annoyance is occasional only, we can scarcely suppose it capable
of producing permanent injury either to the nervous system or the lungs".
Johnstone (1855) mentions "the headache and giddiness to which tea tasters are subject, the attacks of pa
ralysis to which, after a few years, those who are employed in packing and unpacking chests of tea are
found to be liable".
Morton (1879) described what he called ’Tea Drinkers disorder*, an ’occupational disease* occuring among
"tea brokers qr tea tasters on the lines of painters colic or glass grinders disease". He described acute
and chronic effects of nervous and systemic poisoning. These were due to tasting of Infusions of tea and
not smelling the leaves and hence were thought to be due to Ingestion of tea and not inhalation of dust.
Castellan! (1920) mentions ’tea tasters cough’ and ’tea factory cough’ which, after a guinea pig experiment
he concludes, are types of fungal infections of the upper respiratory tract caused by inhalation of dust
during a tea tasters occupation.
Doig (19^9) reports pulmonary fibrosis and dyspnoea in a worker engaged in tea blending in a grocers ware
house for five years. No other dust exposure was discovered.
Wegeman (1968) has reported conditions similar to asthmatic bronchitis among tea packers in Hungary. His
study on this occupational lung disease showed that sputum and blood were highly eosinophilic. X-rays sho
wed condensed hili and prominent bronchial markings. Candida was collected from the patients sputum and the
effected workers responded to intracutaneous administration of thrush antigen. He, therefore, concluded that
this condition was also a fungal disease (form of bronchomoniliasis).
Uragoda (1970) reported a case of asthma in a tea maker as a result of inhalation of tea fluff in the at
mosphere of the factory. Provocative inhalation of the fluff produced an attack within a few minutes. A
positive reaction was obtained on skin testing with tea fluff antigen. He called it ’tea maker’s asthma*.
Pinnagoda (1971) in a very comprehensive study of the health hazards from exposure to tea fluff in the blending and packing industries in U.K., found that workers were not exposed to a major risk of developing res
piratory disease at the dust levels prevailing in the two factories surveyed. The main findings were:
f
<r
14
(i) in the dusty
areas the average total dust
concentration was in the region of 2/Jt/V?;
(li) after correcting for the differences in sex
and smoking habits and comparing tea workers
with controls a significantly higher propor
tion of tea workers were shown to suffer from
persistent cough and breathlessness (Grade II),
Tea workers and controls did not show signi- •
ficant differences in prevalence of other ch
ronic symptoms;
(ill) Respiratory function tests showed that FEV,
decreased among groups exposed to dusty en
vironments but the change was not satlstlcally significant;
(iv) Male workers with heavy dust exposures comp
lained more of symptoms of irritation in eyes
skin and nose. Females complained less of sy
mptoms of irritation;
{y} Radiological axaniination did not a box any groaa
abnonnalitiea attributable to fluff;
(vi) None of the workers examined showed any positive
reaction to tea fluff antigen or chlorogenio
acid.
(vii) Chemical analysis by liquid chromatography has
shown that tea fluff chemical composition in
similar to that in black leaf tea. Microscopical
examination of air borne tea fluff revealed the
presence of the four identifying components found
in the tea dust.
To summarise:
There is evidence in literature that workers in tea factories with high dust concentrations are at a greater
risk of respiratory infections than others. The symptomatology may be due to the direct effects of inhala
tion of tea dust by the irritation of the upper respiratory passages. Hypersensitivity mechanisms probably
also occur. Fungal contamination of tea leaf has been observed and hence the possibility of bronchomycosis
should also be kept in mind.
Coffee dust
i) Figley and Rawllng in 1950, Bruun in 1957 and Gronmeyer and Fuchs in 1950 have reported that workers in
coffee industry frequently develop asthma, rhinitis and dermatitis (Freedman et al 1962).
ii) Figley in 1950 showed that patients 'who are allergic to coffee dust showed positive intra-dermal reac
tions to castor bean in the absence of any known exposure to castor bean (Figley and Rawllng, 1950).
Coulson in 1950 suggested that this cross reactivity may be explained by the facts that bags of coffee and
bags of castor bean come in contact with each other in the holds of ships coming from South America since
both are imported from there. He also reported sufficient contamination of the burlap coffee sacks with ca
stor bean to sensitise the coffee workers to castor bean (Freedman et al 1962).
iii) Kaye and Freedman (1961) showed that a small percentage of coffee workers were allergic to coffee dusts which fill the air of the factory during coffee manufacturing process. Large positive intradermal tests
obtained in allergic workers with extracts of green coffee, whereas rotated coffee produced only small
were
reactions. Heating or roasting the coffee bean appeared to destroy its allergenicity. Thus the workers who
were allergic to inhaled green coffee dust were able to drink ordinary coffee which is prepared from the
roasted bean without adverse reactions. Previous family history or past history of allergy Increased the
response clinically. Allergic reactions were generally in the form of coryza, dermatitis, lacrimation and
bronchial obstruction.
iv) Freedman et al (1961 and 1962) found that among the substances present in green coffee, phenolic com
pounds particularly chlorogenic acid has been reported to be responsible for allergic reactions. Chlorogenic acid has been found to be capable of inducing the formation of circulating antibodies in animal species.
Layton et al (1964) from studies done by them suggested that the antigenic effect may not be chlorogenic
acid but by trace amounts of protein impurities in it. Bariana et al, (1965) after further investigations
have found evidence for the antigenic and allergenic activity of chlorogenic acid.
v) Turula (1966) studied the incidence of coffee allergy in a Helisinki roastery. Of 102 subjects who were
studied,55 workers were identified with history of allergic symptoms to raw coffee including rhinitis, der
matitis’, conjunctivitis, headache, dyspnoea and asthma. The investigation included skin scratch tests, nose
provocation tests, and x-rays of chest and maxillary cavities. Raw coffee allergy showed all the signs of
occupational disease; ie.,
15
(a) intensity decreases with continuous exposure;
(b) symptoms disappearing with change of job or
vocation;
(c) symptoms intense on returning;
(d) symptoms intense during working hour's;
(e) symptoms failing to occur when a gas mask is used;
(f) akin scratch tests and nose provocation testa were
positive in subjects and not controls. X-rays of
maxi Hary sinuses showed thickening of mucous
membranes in some subjects.
who worked for more than twenty years in a coffee roastery favi) Ven Toorn (1970) reported a case of a man
------ ? of circulating antibodies
ctory and developed lung lesions. By immunological investigations the presence
j vas demonstrated. Immunofluorescence of the lung biopsy deagainst coffee bean dust in the patients serum i— ---------------------monstrated deposits of IgG and complement among alveolar capillaries. He therefore felt Justified to call
the condition coffee workers lung - an extrinsic allergic alveolitis analogous to farmer's lung.
vll) BedrlKow (1971) in review articles on coffee cultivation and coffee industry mentions the allergic re
actions of skin, mucous membranes and respiratory symptoms encountered in some persons handling green cof
fee. Symptoms observed Include nasal discharge with mucous congestion, akin eruptions, dyspnoea, asthma and
lacrimation often with headaches. Severe reactions follow first time exposure or return to work after abs
ence and mild symptoms are encountered in persons who have a long history of exposure. Allergy testing with
fungal and other impurities found in coffee proved negative. Chlorogenic acid has been identified as a pos
sible allergen. This acid derives from caffeic and qulnic acid and is found not only in coffee but also in
castor bean, oranges and various other plants. Further studies are required to establish the exact nature
of this coffee allergy.
chapter III
TEA CULTIVATION AND TEA INDUSTRY IN INDIA
It is one of the most important plantaTea is grown in India as an organised agro-industrial undertaking.
tion crops in India. The others are coffee, rubber, spices and cinchona.
Tea plantations are located in the States of Assam, West Bengal (North) Tamil Nadu, Kerala and Karnataka
(South). In 1978, it was estimated that the total acreage under tea was 363,303 hectares. South Indian tea
plantations account for 20.; percent of tea acreage and 23.4 percent of tea production in India. In South
India, the tea is grown on the slopes of the Western Ghats, principally on the Kenan Devan Hills of Kera a
and the Nilgiris and Anamallai hills of Tamllnadu (UPASI, 1978).
History
Tea is the name given to both the Shrub Camellia Sinensis, and the •beverage, brewed from the leaves of this
•te* pronounced tay (Ukers, 1935 quoted in
shrub. The word tea comes from the Chinese Fukien dialect word
Pinnagoda, 1971).
•• • •beverage
-—>1b attributed to
The orgin of tea has its roots in Chinese mythology and the first use of- this
(Ukers, 1935 quoted in Pinnagoda, 1971). Another myth which tries to explain
Emperor Shen Nung in 2737 B.C. (
, —
to China in the 5th century A.D. It is said
the effects of tea relates to a Buddhist monk, Dharuma, who came
that during a period
of
meditation
he
became
drowsy
ana
seizing
oib
period of meditation he became drowsy and seizing his oiieudxug
offending eyelids he cut them off and
cast them from him. A plant grew where they fell the tea plant, from whose leaves can be prepared a drink
that drives away sleep (Harler, 1973). Between 5th century A.D and 19th century, tea spread all over the
world and began to be cultivated in many countries.
- 3 tea shrub had been known for centuries. The locals used it as a vegetable in the
In India, the indigenous
discovered by Robert Bruce in Upper Assam in 1823. Chinese tea plants were first impoform of mang. It was <—
3 decided that Assam was the
rted from Onton and planteo in Calcutta in 1780. After some experiments, it was <
East
best area .or growing it commercially using the wild Assam type of tea. The L---- -- India Company which had
lost its monopoly on Canton tea trade turned to India to establish a rival source of supply under its control. By 1838, it began producing tea in Assam by employing villagers and processing-r it with the help of im-
first auctioned in London in 1840. In the following years, the Assam
ported Chinese labour. Assam tea was 1^.-- ------------- — — 284,470 acres
Tea Company was formed with 2636 acres of tea. By I860, the total north-east Indian tea was
yielding 86 million pounds (Pinnagoda, 1971).
--------- —•> that the
Tea was first introduced in Nilgiris in 1834. Plants were brought Kew garden, London, unaware
well-established by 1880.
plant was indigenous in Assam. Commercial tea planting started in 1853 and was
the last planting district to be opened at the end of the century (Rahmathullah, 1977).
Anamallais was
J
(
16
By 1970, 881,000 acres was under tea in India and the annual production was 926 million pounds. In the same
3,258,000 acres and the production was 2790 million pounds (Harler,
year, the tea acreage in the world was
1973).
Characteristic features
The tea industry occupies an important position in the national economy. It provides employment to over 8
lakh workers. Of these, 56 percent are women. The family ratner than the individual is unit of recruitment.
Most of the labour force in the South Indian plantations were recruited from the plains of Tamilnadu under
the traditional KangApi or ’labour contract* system.
Tea is the largest earner of foreign exchange in the country. 75 percent of tea plantations are under cor
porate ownership and a large proportion of the remaining 25 percent is in the small grower sector. The other
important economic features are participation of large equity capital, system of iixiustrial management, con
siderable amountof. foreign capital, crop specialization and very low average labour/land ratio (Cabrera,
1971).
The labourers in a tea plantation are widely dispersed because only by having them so can they be within
economic reach of their working area. This is in very marked contrast to a factory oriented industry or mi
ning where workers are concentrated around the factory or mine-shaft (Mackay, 1974).
Health and Welfare
The Plantation Labour Act, 1951 Is one of the most comprehensive labour welfare legislation in the statute
books and makes detailed provisions for health, welfare and social security benefits (PLA, 1951). The Act
covers all plantations measuring 10.117 hectares or more and employing 30 or more persons. It provides for:
recreational facilities; vi. edu1. drinking water; ii. sanitation; iii. medical aid; iv. creche;
ix. hours of work; x. leave with wages and
viii.
protective
clothing;
cational facilities; vii. housing;
xi. sick leave.
i. full employment; ii. maternity beOther statutory benefits applicable through various enactments are:
iii.
Employment
injury
benefit;
iv.
Provident
fund
and
family
pension; v. Gratuity; vi. Festival
nefit;
holidays (UPASI, 1978).
Other non-statutory benefits for the labour include:
(i) annual leave and travelling expenses to home and
back;
(ii) cattle keeping and grazing facility;
1H) facilities of free collection of fire wood;
(iv )ex-gratia payment in cases of non-occupa-
tional chronic disease;
(v) issue of free liquid tea/coffee at work spots;
(vii) ex-gratia payment for promotion of family
planning;
(viii) uniforms for certain categories of employees;
(ix) arrangement for issue of food grains in some
areas on a no-profit no-loss basis (UPASI,
1978).
.
(vi) kitchen gardens;
Wages and Bonus
The tea industry is covered by the Minimum Wages Act and in addition also pays an annual bonus to the
workers.
Unions
best organised sections of workers in the country. All the central trade
Plantation labour are among the
union organisations are represented in the plantations . For white collar workers there is a separate union.
UPASI and Comprehensive Labour Welfare Scheme
The United Planters Association of Southern India represents employers and has organised a number of impor
tant services for its members lncludinE Information and advise on tea research, planting techniques, modem
management techniques, labour legislation, labour welfare and health. It also acts as a liaison agency for
the industry with government and international organisations. In the seventies it initiated a Comprehensive
Labour Welfare Scheme to Improve the health and living standards of plantation workers and their families.
The components of the scheme are:
I
l
17
(1) Maternal and child Health;
(ii) Child development;
(v) Nutrition;
(vi) Planning of Leisure; and
(vii) Family Planning (Rahmathullah, 19B2).
(ill) Education on personal Hygiene;
(iv) Environmental sanitation;
The scheme was initially funded by USAID, later extended and supported by the Government of India and is
now being gradually taken over by the managements.
From the point of view of working conditions and welfare measures the workers in the plantations are in a
much better position than the farmers in the rural areas and are relatively on par with urban industrial
workers. However, the presence of organised health services do not necessarily mean a better health status
and the present study proposes to look into this matter in greater depth.
chapter IV
CHEMISTRY OF TEA
The chemistry of the tea leaf and the composition of black tea has been studied and the constituents esti
mated by Millln & Rustlge, 1967 and Millin, Crispin and Swalne, 1969.
The green tea shoots contain - i) Caffeine;
il) Catechins - the colourless compounds contained in the
vacuoles of the leaf cells; ill) Flavanols like kaempferol; iv) Leucoanthocyan!ns mainly as leucocyanins;
v) Phenolic acids like theogallin, chlorogenic acid and gallic acid; vi) Free Amino acids eighteen of them
of which theanine is the most abundant; vii) Minor amounts of B group of vitamins and Vitamin C (Das, Ghosh
end Guha, 1964) and Inositol and biotin^Fhe approximate chemical composition of green tea shoot is shown
in Table V,,
Soluble carbohydrates Including mono and polysaccharides;
During the processing of tea leaves the leaf cells are ruptured bringing catechins in contact with polyph
enol oxidase enzyme in the cell chloroplasts. Aerial oxidation catalysed by the enzyme and subsequent di
merization produces theaflevins and derivatives. Furthur oxidation produces dull brown pigment called
thearubiglns. Flavanols undergo little or no change during processing. Leucocyanins are completely oxidised
during enzymic action and therefore are not found in black tea.
The composition of the soluble components of black tea is shown in Table VI. It reflects the above mentioned
changes. Theaflavln imparts the bright golden colour and gives astringency to the beverage. Thearubiglns
also add to the colour. Caffeine is responsible for the stimulant action.
TABLE
Approximate composition of green tea shoots
Substances soluble in water
Flavanols
(-■
epigallocatechin gallate
epicatechin gallate
epigallocatechin
epicatechin
other flavanols
Flavonols and Flavonol glycosides
Leucoanthocyanins
Acid depsides
Total polyphenols
Caffeine
Amino acids
Simple carbohydrates
Organic acids
pry weight(%)
9-13
3-6
3-6
1- 2
3-4
2- 3
5
30
3- 4
4
Approximate composition of green tea shoots
Substances partially soluble in hot water
PolysacchaTXides - starch
pectin substances etc
Proteins
Ash
1-2
12
15
5
Substances insoluble in water
Cellulose
Lignin
Lipids
Pigments
Volatile substances
4
0.5
(Millin and Rustidge, 1967 included in Pinnagoda, 1971)
7
6
3
0.5
0.01-0.02
18
Estimated coapoeition of black tea components aoluble in water
TABLE 6
% Dry weight
of leaf
% Dry weight
of leaf
1-3
Flavanols (mainly epigallocatechin
gallate)
Flavonols and flavonol glycosidest
Phenolic acids and depsides
2-3
4
Theaflavln
1-2
Non-dialyzable phenolic substances .
1- 5
2- 4
Other phenolic substances
(bisflavanols, dialyzable thearubigins
Partially soluble substances
Ca.
Proteins
Polysaccharides
Nucleic acids
Mineral salts (ash)
Ca.
15
14
0.09
5
and other fermentation products)
3-4
5
4
0.5
Caffeine
Amino acids and peptides
Simple carbohydrates
Organic acids
(Millin Grispin and Swaine, 1969 included in Pinnagqda, 1971)
NUTRITIONAL ASPECTS OF TEA
CHAPTER IV (B)
Das et al, 1964 has presented a detailed
review of: the nutritional values of tea based on studies undertaTable
7
presents
the main findings or ranges of findings on the protein, sugar,
ken in India and abroad.------- . .
and
fluorine
content of green and black teas in India. Since tea is a
caffeine, vitamin B, C, A, copper
extensively
especially in the North, the nutritional value of
very popular beverage in India and is drunk
the brew gains some significance.
Processing of tea, use of certain fertilizers, season and other environmental factors change the levels of
these constituents in the sample of teas used for brewing.
It is an established fact that tea has no calorific value exclusive of any accessories like milk and sugar
that may be added to it. It is also established that there is no sodium in tea. Hence it is a beverage that
or ’salt free’ diets.
can be freely prescribed in all obesity diets and ’salt poor’
It has been estimated that many Indians take upto 5-6 cups of tea in a day. Based on thia pattern of consu
mption it has been further estimated that 5-6 cups of tea can supply an adult 9-14% of daily requirement of
thiamine, 5% of dally requirement of niacin, 6% of folic acid requirement, W of pantothenic acid require
ment, entire requirement of Vitamin E and K and 155 ug of copper and 1 mg of fluorine. These are small but
not insignificant amounts.
Cohen & Mclendon (1954) have recommended more tea drinking - beginning on a email scale at the age of one
BS a possible preventive measure against tooth decay since tea is an auxiliary source of fluorine. The
high copper value of tea may help in hemoglobin formation though thia has not yet been adequately studied.
NUTRITIONAL ASPECTS OF TEA (INDIAN)
TABLE 7
Nutrients
Green
Black
1. Protein (g/)
25.55
22.60
4.67
3.06
31-34 ppm
180
ppm
6300-13800
300-500
4.90
2. Sugar
3.
(g/)
Caffeine(g/)
4. Copper *
5. Fluorine
6. B Carotene (ug/)
7. Vitamin K»*
(biological
units)
Nutrients
8.
4200-11100
9.
Green
Black
164-207
940-2048
7400-8400
4500-5900
966-2510
148-311
1652-2048
6400-7500
7800-9300
B.Vitamins (ug/)
a) Thiamine—B^*
b) Riboflavin *
c) Niacin
d) Folic acid
e) Pantothertlc acid
3.51
(per 100 gm)
Vitamin C (mg/g)
(ascorbic acid)
1323-1967
0.02-0.03
0.07
Extracted from Tables presented in Das et al, 1964
* - Dry weight base. Samples from various parts of India
♦♦ - Russian processed tea
19
CHAPTER IV (C)
pharmacological aspects of tea
z Das et al '1965» have presented a detailed review of the distribution of caffeine, theobromine, theophylline
and of tea tannin’s which are flavonoid compounds in different varieties of tea. They have also outlined
their pharmacological and physiological effects.
It has been reported that a cup of tea contains 40-100 mg of caffeine depending on whether it is weak, me
dium or a strong brew. It also contains 1J0 mgm of tannins and 30 mgm of flavanols. The pharmacological and
physiological effects of these compounds have been studied in the laboratory as chemical solutions on both
animals and man. Studies have also been reported on the effects of a brew of tea on human subjects-these
effects being attributed to the above constituents.
Table 8 summarises the main effects and the clinical significance of some of these effects. The range of
effects reported in literature are very wide in their scope. It is important to remember, however, that
green leaf Infusions show the above effects and some of these are reduced or lost by the tea during proces
sing.
TABLE 8
PHARMACOLOGY OF TEA
.....................
Constituent
1. Xanthines mainly Caffeine
i.
Stimulation of central nervous system
Alleviation of fatigue
11.
Increased ease of muscular activity
? Contra-indication in labile
autonomous nervous
system
iii. Diuresis
iv. Stimulation of cardiac muscle
? Contra-indication in
hypertension
v.
Vi.
Augmentation of gastric secretion,
tone and motility
Effects on thyroid gland
Contra-indicated in peptic
ulcer
? Contra-indicated in
hyperthyroi di sm
vii. Hypocholestrolemia
Use in hyperxholestrolemia
vili. Decreases blood sugar
ix. Role in brain metabolism
2. Tannins including
flavonols
i. Demonstrable Vitamin P activity le.,
reduces capillary fragility and
permeability.
Treatment of haemorrhagic
ii. Increases storage of Vitamin C and
reduces excretion
Use for bleeding gums, Wound
disorders
healing
iii. Effects on haemopoiesis
Treatment of anemia
iv. Antibacterial effect on salmonella,
shigella, eltor vibrio and staph,
aureus
Treatment of plague, typhoid
bacillary dyf-entry and in-
v. Reduces fluid loss in Intestine
te-tinal infection
Useful in treatment of
cholera.
vi. Normalises thyroid hyperfunction
vii. Inhibits growth of virus in embryonated egg.
Extracted from Das et al, 1965.
Therapy of toxic goitre
I
20
Das et al 1965 sum it up very well by stating that "our age-old idea about the food value of tea which was
so long in a rather conflicting state is prone to change in view of the rapidly accumulating scientific
data about tea and its products. The knowledge gained about the vitamin contents of tea, nutritional, physiological and pharmacological importance of tannins and caffeine, the Important constituents and lastly
though not the least, its most important role in maintaining intestinal hygiene either by-killing or preventing growth of harmful microflora present there, reveal tremendous possibilities for popularising the ade
quate use of tea in human dietaries. In view of the shortage of vitamins and minerals in the principal diets
of India and other under-developed countries, the regular and adequate consumption of tea as a supplement
to the diet, may contribute significantly to our dietary requirements”.
CHAPTER V
OCCUPATIONS IN A TEA PLANTATION
The occupations in a tea plantation may be classified broadly into:
A. Field work
B. Factory work
C. Supportive services
D. Administrative including supervisory and managerial.
Most of the working population, if not all, reside in the plantations in labour lines and accommodation
provided by the management. The work and home environment especially for the field workers are not as cle
arly distinguishable as In industrial workers. The work is varied as in most agricultural operations and
the load varies with season, production demands and other factors. Workers are shifted from Job to Job and
distinct Job appointments are not always given. Workers may move from field to factory and vice versa. Du
ring a life-time-worker may have been involved with different types of work for carying periods of time. An
occupational history therefore requires patience and insight. Clear cut division for epidemiological analy
sis are not always possible.
A. Field Work
As in the rest of agriculture field Jobs are very varied and could be described under the following headings
(a) Plucking
(b) Clearing
(I) Pruning
(c)
(g) Lopping
(h) Pesticide spraying
(e) Weeding
(i) Other miscellaneous manual Jobs
including transportation
Planting
Manuring
(d)
(a) Plucking
This Job has been described in great detail by Rahmathullah and Pothi (1981) in their preliminary report
on Productivity of women pluckers. The manual removal of the tender green tea shoots - ’the two leaves and
a bud’ using the thumb and fingers of both hands is done mainly by women workers
though additional male workers may be allotted the Job during the ’flush’ season.
The skilled hand movements consist of:i) Automatic finger movements using a differential group of movements with the ten fingers;
11) The thumb and forefinger of both the hands are used to pluck two different units of the ’two leaves and
a bud and then transferred to her two palms held by the other six fingers. When one of the two palms is full
the right one in the right handed women and the left one in the left-handed woman—the collection is thrown
on to the basket on the back strapped to her forehead. (Figure-1)
iii) These movements are further complicated by the responsibility for selective plucking, ie., avoiding
over-mature or immature leavels and maintaining the surface configuration of the bush of either the horizo
ntal normalcy or convex shape as in ’dome plucking’. This requires good finger-eye-brain coordination.
iv) This work is done for eight hours in the open with constant mobility along the gradients of the field.
v) The most skilled workers pluck upto 100 kilograms in a working day, which is about 4.9 lakhs
half a
million units of two leaves and a bud in a single workingday.
Though plucking is classified as manual labour in actual fact it is a highly skilled, incredibly taxing
Job requiring the further interest of the applied physiologist, psychologist and ergonomist.
21
(b) Clearing
This includes felling of trees, uprooting stumps, burning undergrowth and removing old tea plants. It also
Includes other land preparatory work such as ditch and irrigation channel digging, bunding, levelling and
sloping.
(c) Planting
This includes soil preparation, care of the nursery, planting of vegetatively propaged cuttings, intercul
tivation with shade trees and early care including watering.
(d) Manuring
This includes application of both organic and sophisticated chemical fertilisers in powder or spray form.
The types of .compounds used are nitrogenous, phosphatic, compound or mixed and trace element fertilizers.
(e) Weeding
This is done manually using a hoe or by the hand pulling method which is traditional. A wide range of che
micals weedicides and herbicides are being used currently. They are applied or sprayed around the tea
bushes.
(f) Pruning
This is an operation done once in 5-5 years of a cycle of plucking. Using pruning shears the whole bush is
pruned fairly drastically. The older leaves and matured wood are removed by this method and the tea bush is
thus maintained as a constant leaf producer.
(g) Lopping
This involves the lopping of branches of the shade trees usually silver oak, that are cultivated in between
the tea bushes. The worker 'spins’ up the tree or climbs up sometimes using a ladder and 'lops’ of the ex
tra branches using an axe, lopping sickle or other sharp cutting implements.
(h) Pesticide spraying
This Includes formulation, mixing, transportation, dusting and spraying of a large number of chemicals used
to destroy insects and other biological pests that attack tea bushes. The chemical may be an insecticide,
rodenticide, fungicide, bactericide, miticide or nematocide. The details of the chemical nature of these
products ere described elsewhere in the report.
The transportation is mainly done using a Bak-pak sprayer, ie., a motor operated sprayer strapped to the
back of the sprayer. The load may be upto 25 kilograms since the machine weighs 12.5 kilograms and about
10 litres of ins’ecticide and about 2 litres of fuel are usually carried. The operation is carried out for
5-7 minutes at a time followed by a gap for some time. A session may last for about 5 hours depending on
the demands of the cycle of spraying. (Figure 6)
(i) Other manual .jobs
The plucked tea is usually kept in baskets or sacking carried on the backs of the pluckers or workers and
supported by shoulder straps or head hands. These have to be carried, when full to centrally located weigh
ing sheds for weighment. From here they are transported to the factories for processing.
Being an agricultural operation, there are many other miscellaneous manual jobs in the field apart from
those described above. Tnese include building of roads and rail tracks, digging wells, maintaining irriga
tion trenches and spring outlets, construction repair and maintenance of buildings and sheds, keeping of
cattle, grazing raising of other live stock including poultry , maintenance of gardens and landscaping and
other such related agricultural work. (Figure 5)
Epidemiological features
1. Sex distribution:
Field jobs on a tea plantation have a distinct sex distribution. While plucking in most plantations is al
most exclusively done by female workers all other manual agricultural work is done by male workers.
2. Work distribution
Most of the agricultural work described are done by the male workers in rotation or according to the
cycle/seasonal demands. ’Sprayers’ tend once again to be specially trained, skilled agricultural workers.
22
They are trained on the job and during the spraying season they carry out the required spraying. In the fie
ld they are assisted by other workers who help them with transportation and formulation. In check rolls of
ten these helpers arenot indicated’as 'sprayer assistants' since this is a changing responsibility. Occupa
tionally speaking they are as much at risk as the sprayers. Epidemiologically field workers in tea planta
tions can be divided into three groups:-
i. Pluckers (mostly female)
lii. Sprayers (always male)
ii. Field workers (mostly male)
B. Factory Work
After weighment of the freshly plucked, tender, green tea leaves, they are transported to tea factories situated on the estate or in one of the neighbouring estates. They are then dried through a special process
to obtain the dried ’black tea’ that is packed and commercially sold. Black tea may be divided into various
grades consisting of the leaf and tne ’broken tea*. The latter is further sub-divided into pekoes, broken
orange pekoes, fannings and dusts (Fernando, 1971). Tea processing consists of five stages:
1. Withering (Figure 7)
The green leaves are spread manually on large withering lofts (60 ft x 6 ft) located on the upper floors of
the factories. They consist of wooden frames with a nylon or wire mesh netting. The workers spread upto 1000
kilograms of leaf per day. The leaf density may be 1-4 kilograms per square foot.
Air at ia controlled
‘
temperature
of 80 deg. F and humidity 60-70% (wet and dry bulb difference must be atleast 6 deg for this process) is blown over
and
under the
leaves, Once in eight hours the air blowing is stop-------—-----ped and the leaves in the loft are manually turned.
The withered leaf is then scraped from the mesh and collected in sacks. These are then weighed and dumped
into the chute leading to the roller. A full sack may weight from 25 to 30 kilograms.
Withering takes out upto 50% of the moisture in the leaf. By this process the cell membranes in the tea leaf
are made more permeable and the enzymes in the nucleus mix with the cell contents starting the fermentation
process.
2. Rolling (Figure 8)
Withered leaves are passed through rolling machines which twist the leaf causing cells to rupture further,
Rollers are used in the •orthodox’ method of manufacture but in some of the newer factories-the use of re-
torvanes or CTC machines (cutting, tearing and curling) are common.
Leaves are pushed into rollers manually and the opening and closing of the roller table door and its lock
ing is also done manually. The temperature maintained is 70-80 Deg. F and the machine usually has a speed
of 36-45 r.p.m. From rollers the tea is collected in trolleys manually by workers. A full trolley weighs
150 kilograms.
After crushing the leaves are passed over roll breakers which are sieves which separate the broken sections
of the leaf from those that need furthur reduction in the rollers. Leaves are fed into roll breakers by hand
though sometimes a wooden board is used like a tray. Roll breakers vibrate at 310-320 r.p.m.
3. Fermentation
This is an oxidation process. From the rolling section the crushed leaves are carried in trays, 1£ feet sq
uare to the fermentation trough. Each tray when full weighs 10 kilograms. A fan blower and a humidifier ma
intain the temperature at 70 deg. F and the humidity at 90-100 percent (the wet and dry bulb difference be
ing less then 1<>-20F.
4. Drying/Firing (Figure 9)
Following fermentation the leaf is then manually fed onto a dryer on a contlnous belt over which a forced
draft of hot air drawn from a furnace is blown. The temperature is about 200 deg. F and the process takes
about 20-21 minutes per batch. The dry tea produced by this process has-only 2-3 percent moisture, Apart
from removing the moisture the process also stops further fermentation.
23
5. Sifting/stalk extraction
(Figure 10)
The dried leaves from the drier are collected in boxes and taken to the sifter. Coarse stalk is extracted
by hand or by the use of electrostatic extractors working at 210 r.p.m. and separating brown and black tea.
Sifting into various grades and categories is done on mechanically agitated bays filled with wire mesh of
various gradations. (Figure 11)
6. Pecking
(Figure 12)
The sifted tea is then packed in wooden tea chests lined with paper and foil. Often a ’tea-chest maker* is
appointed specially for this purpose. The chests are filled, nailed, sealed and labelled. Each box weighs
40 kilograms. Sometimes sacks reinforced with foil are used. These weigh about 25-30 kilograms, when full.
Tea chests are loaded onto trucks manually and transported to the auctions.
Furnace operation
In addition to the above operations a furnace is kept continously operative at 250 deg. F. Coal is fed once
in 10-15 minutes using a shovel and the slag is removed periodically.
Epidemiological features
1. Sex distribution
The factory workers are mostly if not exclusively male. In some factories women are employed in the sifting
! ■ section.
2. Work distribution
Workers are not strictly allotted or confined to specific sections in the factory. They may work in different sections of the factory during the year or even during a specific quarter. They may be shifted from
one section to another according to work load and experience.
3. Type of work
In most sections the work is manual labour—mainly consisting of feeding various machines and collecting
the finished products. Work in the withering loft is the most strenous of all. The environmental parameters
of temperature, humidity, Illumination, noise and dust levels vary greatly between the sections.
4. For epidemiological studies
Factory workers may be classified into five groups taking environmental parameters, type of work and usual
number of work into account. These are
a) Withering lo'ft workers or ’witherers’
d) Sifting section or ’sifters’
b) Rolling/roll breaking section or ’rollers'
e) Packing section or 'packers'
c) Fermentation/firlng/drying section or ’fermenters'
C. Supportive services
Sections A and B have outlined the occupations which are characteristic of a tea plantation and a tea fac
tory. Being an agro-industrial undertaking, there are a wide range of supportive services/jobs done by ski
lled worKers which need to be listed here for the sake of completeness. The nature of these jobs are simi
lar to those done by individuals with the same job description in any organised agricultural or industrial
enterprise. Most, if not all of them, live on the estate and though they share the same home environment
and quite a bit of the work environment, they are not in direct contact with the tea bush or products of
tea in the factory for long hours. Epidemiologically speaking they form a good internal control group on a
plantation. Sometimes many of these jobs may be allotted to field or factory workers when their active, productive life is over.
1. Sweepers
2. Gardeners
3. Helpers or attenders in office, creche, water
supply, hospital and bungalows
4. Watchmen
5. Drivers of trucks, jeeps and other vehicles
6. Storekeepers
7. Electrician/s
8. Mechanic/s
9. Plumber/s
10. Medical staff - including doctors, compounders,
nurses and midwives
11. Welfare staff - personnel officers, social work
ers, school teachers etc ■
12. Office staff - including accountants and clerks
24
D. Administrative staff
As in all industrial enterprises tea plantations have an important component of supervisory and managerial
staff. These are usually people with many years of experience. They not only share the general and occupa
tional environment of the labour population, but also have the added factor of stress which is now accepted
as an important and unavoidable factor of jobs requiring supervision or responsibility over large numbers
of people and processes. They may be classified as 1. Manager/Deputy Manager/Asst. Managers
3. Factory supervisors or tea makers
2. Field supervisors or conductors (Figure J)
Though these could also be included as internal controls in an epidemiological study, they represent a hi
gher income group which is reflected in a better home environment and nutritional status and these must be
taken into account during interpretation.
CHAPTER VI
THE TEA PLANTATION ENVIRONMENT
Environment may be defined as "the aggregate of all external conditions and influences affecting the life
and development of an organism, human behaviour or society?
The tea plantation environment is a complex blend of agricultural work in a rural setting with the organised dynamics of an industrial undertaking. In addition to the environmental factors operating in any rural
area it has its own distinctive features.
The environment of the tea plantation worker may be considered under five broad groups;
A. Physical
B. Chemical
C. Biological
D. Mechanical
E. Psychosocial
Tea plantation workers reside on the plantations with their families. These environmental factors can effe
ct their health and living both in the home and work situation. A rigid demarcation between residential and
occupational environment is not always possible except for the factory workers.
A. Physical Environment
1. Altitude
Tea plantations are usually situated at altitudes between 1000 m to 2000 m above sea level and though they
experience changes of seasons and fluctuations in temperature and humidity, they do not have the extremes
of climate conditions experienced in the plains.
2. Geography
The terrain is also very hilly and all distances involve gradient changes. Most plantations are nestled in
the valleys or slopes of hill ranges and are usually at some distance from traditional conglomeration of
people in villages on the hills.
3. Tem[>e nature
because of the altitude the temperatures on plantations are ambient most of the year. During summer months,
it never gets higher than 30°C (96°F) and during winter months it gets as low as 6°C (43°F).
A. Hunicity
The humidity varies from 54-70% in the summer months to 80-95%
in the colder seasons. Monsoons are hea
vy especially in the months of June to September. The South India tea plantations also experience the winter
monsoon. The maximum rainfall per year has been as high as 10-11 inches.
t?. Air velocity
A cool breeze is present most of the year. Stronger winds occur in some of the months.
6. Water supply
The source of water in most plantations are mountain springs. In many, wells and tube wells have also been
provided. The springs are usually protected at the point of intake. Water is stored, treated and distribu
ted to the labour lines and points near the fields, and the factory. The water has all the charactei -txcs
of spring water (physical and chemical) but may be polluted to various degrees depending on encroachment in
and around the spring by the human population.
25
7. Housing
In the past, housing on plantations was of a very poorstandard-not being very different from the thatched
’kutcha’ dwellings of the rural areas. Due to the recommendations of various inspection committee supported
by legislation a very large proportion of the labour population and all the other categories of staff have
now been provided by a ’pucca’ construction with damp-proof floor and tile, concrete or asbestos roof. Th
ese are distributed in small groups of labour lines situated close to their respective fields.
6. Sanitation
Labour lines now-e-days have sanitary latrines attached to each unit of bousing or of houses. These may be,
dug well, bore-hole or the septic tank latrines.
Drains are provided to carry away sullage from kitchens and wash rooms. These usually lead into gulleys and
streams in the field. Soakage pits are not very common.
Indiscriminate excreta disposal in and around the lines especially by the children and in the fields is
still not uncommon.
Garbage and household wastes are also disposed of rather indiscriminately though in many plantations manure
pits are becoming popular. Animal wastes are used as fuel or manure as in most rural areas. In the absence
of these practices they add greatly to the insanitary conditions and facilitate rodent and fly breeding.
Popularisation of vegetable plots, gardens and small plots for food crops, in recent years, have resulted
in greater recycling of wastes and have helped remarkably in Improving sanitation in areas where they have
been accepted in larger numbers.
9. Factory environment
Though the tea factories are usually situated on the top of hills and are well ventilated, there are sections of the factory which have high temperatures and humidity like the firing/drying section, the fennentation room and the furnace room. Dust levels are high in the sifting rooms. Noise levels as well as vib
ration levels of most of the machinery are high.
13 . Chemical Environment
A few decades ago tea plantations, like most agricultural operations were relatively free of chemicals.
However, reporting on the social consequences of technological development in plantations, I.L.O. (1971)
observes that "the technological changes which have taken place in connection with plantation work have
led to two main spheres of concern in connection with the health and safety of workers. These relate fir
stly to the hazards surrounding the use of agricultural chemicals
. Agricultural chemicals which could
constitute a hazard to the health of the workers are those disseminated as insecticides, fungicides, herbicides, rodenticides and similar products. There is a pressing need to assess more accurately than has been
possible so far the real incidence of ill-effects of occupational exposure to toxic chemicals used on plan
tations
Enough is known however to indicate that what are generally referred to as pesticides ^o cause
occupational illness in calculable measures....”.
Agricultural chemicals used in tea plantations can be divided into three broad groups:
1. Fertilisers;
2. Pesticides;
3. Herbicides or Weedicides
1. Fertilisers
These are substances added to the soil to ensure a high and stable crop yield. They are classified as or
ganic and mineral. Organic fertilisers are manure from farm animals, bone meal, pect and composts. Mineral
fertilisers are proauced by the chemical industry either synthetically or by the treatment of naturally occuring minerals. The essential nutritive elements are nitrogen, phosphorous, pottassium and trace elements
(Ersov, 1971). Table 10 shows some of the common fertilisers used in tea plantations classified into nitro
genous, phosphatic potash, trace and compound fertilisers (UPASI, 1979a).
2. Pesticides
A ’pesticide’ has been defined as "a chemical substance used for the destruction of an organism detrimen
tal to man or his interests”. (Coppiestone, 1971). Pesticides used in tea plantations may be classified in
to the following groups depending on the organism which they are designed to kill.
26
i) Insecticide;
ii) Miticide;
iv) Fungicide;
iii) Rodenticide;
vi) Nematocide
v) Bactericide
Table 11 shows the common pesticides used in South Indian tea plantations and the organism against which
they are used (UPASI, 1979a).
Based on their chemical nature, the pesticides used in tea plantations can be classified into the following
groups (UPASI, 1979a).
(a) Pesticides, halogenated; These are further divided into 3 groups.
iii) Aromatic derivatives, eg., Kelthane, DDT, BBC
1) Olefin derivatives
ii) Diolefin derivatives, eg.’, Heptachlor, Endosulphan
(b) Pesticides, organophosphorous, eg., Malathion, Formothion, Dimethoate, Dimeton.
(c) Rodenticides: These are toxic chemicals used for destruction of harmful rodents such as rats, mice and
other destructive vertebrates (Voilet, 1971). Those used in the plantations includes
i) Toxic and vesicant gases like hydrocyanic acid,
hydrogen sulphide and phosphine.
phosphide.
FERTILISERS USED IN TEA PLANTATIONS
TABLE 10
wen
ii) Inorganic poisons - metallic phosphides like zinc
ca t OHM
c
c«»»
Nutritive element/type
ww a c c n w WWW ww w w ■ tz w n —mw M WWW « ■WBtxMHasaaiB waHKBBSSKHBHWKaaa ww
Common examples
Ammonium sulphate, Urea,
Calcium Ammonium Nitrate
1. Nitrogenous
2. Phosphatic/Potash
Nutritive element/type
Common examples
3. Trace ion
Zinc
4. Compound Formulations
NPK Fertilizers '
Rock phospate Muriate of
potash
PESTICIDES USED IN TEA PLANTATIONS
TAELE 11
(classified by use)
(Refer Text for Chemical Classification)
Type
1. Pesticide
Organisms
Red spider
Aphids etc.
Common products
Fonnothion, Acarthane .
EC, Dinobuton, Phosphamiden Quinalphos, Nialate Heptachlor, Dicofol
Malathion Oxythioquinox
Dimethoate, Monocrotophos Endosulphan, Phasolone
2. Rodentici
des
Rats, Mice
HCN, H^S, PHj
Zinc phosphide
3. Nematicide
Nematodes
Methyl bromide, Oxythioquinox Metham sodium
Type
4. Fungicide
5. Weedicides
and
Herbicides
■ BB —«---«==«-»-WW = = »-«- = -BW = =X = W — BBB.« = = ,W = = = = W=.B — —— — = =
Source: UPASI, 1979a
Organisms
Common products
Copper oxychlo
Blister blight
ride, Methyl Bro
Black rot
mide, Oxythioqu
Cercospora leaf
spot Root disea inox, nickel ch
loride, Methamse Red rust and
sodium, Zineb
others
Annuals and Pere- Dalapon, Diuron
nnials Grasses, •2,4-D salt, MSMA
2,4,5-T salt,
Dicots Ferns,
DNOC Paraquat,
Lichens Mosses,
Triazine
Shrubs
Simazine
W
X «»
27
(d) Fungicides
,
Are chemicals used to destroy fuhgi by killing mycelium and spores or by preventing germination of spores
(Hunter, 1971). Fungicides used commonly in tea plantations can be chemically classified into:
i. Copper salts; eg, copper■oxychloride
v. Sodium-N-methydi thiocarbamate; eg, vapam
ii. Bromomethane; eg, methyl bromide
Viv 6-methyl-2 J-quinoxaline dithlol cyclic carbonate
eg, oxythioquinox
iii. Nickel salts; eg, nickel chloride
iv. Zinc ethylenebis dithiocarbainate, eg, zineb
(e) Miticides
The common chemicals used against mites infesting the tea bushes are:-
i. Nialate: 0.0.0’0 tetraethyl 5.5r* methylene
tisphosphrorodithioate
iii. Monocrotophos—cir (2 nethyicarbamoyl-l-methyl
vinyl) dimethyl phosphate
ii. Dicofol: 1.1. bis (chlorophenyl) 2. 2. 2-tri-
iv. Phasolone
chloroethanol
(f) Nematicides:
The common chemicals used against nematodes infecting tea bushes are:iii. Oxythioquinox (ref d(vi)
1. Methyl bromide
ii. Metham sodium-(Vapam, ref d (v)
J. Herbicides
These are chemicals used for weed control (Hammond, 1971). Herbicides commonly used on tea plantations
include:-
vi. 2,4,5-T: 2,4,5-Trichloro phenoxy acetic acid
vli. Diuron: N,-(3-4-Dichlorophenyl)-N-N-Dimethylures
i. Dalapon: 2,2-Dichloropropionic acid
ii. 2,4-D: 2,4-Dichlorophenoxyace tic acid
iii. DNOC: 2,4-Dinitro-0-Crefl8ol
iv. Paraquat: 1,1'Dimethy1-4,4’-bipyridinium salt
v. Simazine: 2-chloro-4.6-Bls(ethylamino)-S-
viii. MSMA: Monosodium methane arsonate
lx. Glyophosate formulation: N-(Phosphonomethyl)
glycine
triazine
C. Biological Environment
The biological environment of the tea plantation is a very complex one and includes the flora and fauna of
the hills in which they are situated, the wild game of the neighbouring forests, the domestic animals in the
labour lines and the insects and biological pests of the tea bush. From the point of view of hazards these
can be broadly classified into:
(a) Wild animals/Game
These include elephants, bear, wild pigs, wolves, foxes, jackals, porcupines and so on. Normally they do
not seek out human victims or attack them unprovoked. They usually attack when they are surprised, sense
danger or there is accidental invasion of the privacy of their lairs. Scratching, bites, severe mauling and
infections with animal disease particularly rabies can be the result of such encounters (Rao, 1971).
(b) Domestic animals/livestock
These include animals in the service of man like transport animals such as horses, bullocks, donkeys and
elephants; productive animals such as cattle, goats, sheep, pigs, chicken, ducks and geese; pets such as
dogs, cats, rabbits and monkeys. The risk to the worker and his family members are mainly when tending any
of these animals. Aggressive reactions like kicking, biting, goring, butting, trampling and scratching are
not uncommon (Rao, 1971).
(c) Snakes
Highly venemous snakes are not as common at the high altitudes where tea is grown but most of the common
species are present and snake bites are rather common.
(d) Bltinfi/stinging insects
These occur as anywhere else in the residential and work setting. Hives are not uncommon on tea bushes, sha
de trees and dwellings. These include bees, wasps, scorpions, hornets, spiders, butterflies and caterpill
ars. Injury caused by caterpillars have been reported by Mackay (1967)a) in teafgarden workers in East
;■ ■; ■/ i-;?
Paklstan32.. ’
lih cellc
iVisin, I jk ck
Korsmc.nga!
.1
x
Banzai orc-5 60034
India
28
'.
(e) Stinging and allergy producing plants
Thorny shrubs and stinging plants such as nettle occur in the undergrowth of the tea plantations. A detai
led study has not been done.
(f) Pests of tea bush
A very large number of insect pests of tea have been reported. The medical importance of these arthropods
have not been studied especially from the point of view of stings, injury or allergy. These can be classi
fied into ten groups (Cranham —
).
v. Sucking insect pests.
Lygus bug (Lygus viridanus) Tea aphis (toxoptera
i. Shot hole borer - xyleborus fornicatus
ii. Tea tortix - Homona ccffearia
iii. Mites - Tea red spider mite (oligonychus coffeae), Scarlet mite (Brevipalpis californicus)
Yellow mite (Hemitarsonemus latus), Purple mite
(Calacarius carius carinatus)
vi» White grups - cockchafer larvae, Holotrichia
iv. Defoliating caterpillars:
Nettle grubs, gelatine grubs, geometrid cater
pillars, Twig caterpillar (E. bhurmitra)
disparilis.
▼ii* Red ants - Oecophylla smaragdina
ix. Crickets - Brachytrupes partentotus
Loopercaterpiliar (B. strigaria)
Begworms, faggot worms
auranti) Tea mosquito bug (Helopeltis spp)
Mealybugs (Pseducoccidae) Scaly insects (family
coccidae and Diaspidldae) Thrips (Thysanoptara)
x. Miscellaneous - Red borer (Zaurera coffeae)
Red slug (Eterusia sedea cingala)
Lobster caterpillar (stauropus alternas)
Tea leaf miner (Melanagromyza theae)
Leaf eating weevils
Cutworms (Noctoidae), Army worms (Spodoptera
litura) Tea leaf roller (Gracilaria theivora)
Tea leaf skeletoniser (Piermopoda rufi margine)
(g) Diseases of the tea bush
V.Agnihothrudu has described many diseases of the tea bush. These are primarily fu
ngal infections. No information is available whether they can affect human beings who come in constant tou
ch with them. The following are common:
ix. Thorny stem blight (Tunstallia aculeatta)
i. Black root rot (Rosellinia arcuata)
x. Blister blight (Exobasidium vexans)
ii. Brown root disease (Forces noxius)
xi. Red rust (Cephaleuros parasiticus)
iii. Red root disease (Poria hypoteteritia)
xii. Brown blight (Glomerella cingulata)
iv. Branch Canker (Macrophoma theicola)
xiii. Grey blight (Pestalotia theae)
v. Collar canker (Phomopsis theae)
xiv. Leaf spot (Cercospora theae)
Vi. Chaxxoal stump rot (Ustulina zonata)
xv. Thread blight (Pellicularia Koleriga)
vii. Root splitting disease (Azraillaria melleu)
viil. Diplodia root disease (Botryodiplodia theobromae) xvi. Copper blight (Guignardia camelliae)
(h) Soil transmitted helminths
It has been reported that due to insanitary conditions in labour lines and habit of indiscriminate excreta
disposal around the lines and in the fields that hookworm larave (Filariform) abound in the soil of the
plantations.
(i) Other helminths
Round worm, thread worm and pin worm infections are rather common in labour population and because of the
insanitary habits their cycle of transmission is maintained in the environment from man to man.
(J) Insect vectors of disease
Mosquitoes and flies are common insect vectors found in plantations and hence malaria and gastro-intestinal
diseases are rather common. Other insect vectors like fleas, ticks and mites have not been identified com
monly and this may probably be due to the climatic conditions.
Mechanical Environment
Mechanization of work on tea plantations has been proceeding very slowly as newer and newer technological
developments are introduc ... As in all agricultural operations implements have been used from earliest ti
mes. The factory was always mechanised through innovations decreasing manual handling of tea or feeding of
machinery which were being introduced from time to time.
29
be deBcribed as having
The mechanical environment of the worker, taking into account potential hazards nay
the following components.
1. Plucking
gradient in between the tea bushes with a basket on the back, which
This involves walking up and down a
when full, can weight upto 15 kilograms . This can lead.to accidental falls. (Figure 15)
Though plucking io done by hand all over India, mechanical plucking has been attempted in Japan and USSR.
However, this requires a flat terrain and the growing of bushes In a set pattern (Fernando, 1971). Since
this is a very recent innovation the hazard due to this machinery If at all has not yet been reported.
2. Agricultural work
The field work done in the plantations, described earlier require the use of various foms of digging and
cutting implements which Include:
vi. pruning i sheara
i. Axes and pick axes
ii. Shovels
ill. Hogs
iv. Pitch forks and reves
v. Sickles and scythes
vii. Cutlasses and machetes
viii. Digging forks and blade harrows
Knives of various sorts
Ropes, chains and pulley mechanisms
Physical injuries due to cutting edges of the implements when they
The mechanical hazards are two fold: (a)
...
are carelessly used; and (b) Fatigue due to improperly designed tools resulting in excessive physical exer
tion and awkward positions during use (Jain, 1971).
• toppers' have
have a
a double
double risk
risk of
of using
using cutting
cutting equipments
equipments as
as well
well as
as climbing
climbing trees
trees. For the letter, they
•Loppers'
may shin up trees or use ladders, both of which if done carelessly increases the risk of falls.
5. Sprayers
With the increasing amounts of agricultural chemicals being applied or sprayed on the tea bushes, sprayers
have additional mechanical hazards associated with carriage of large bulky containers of chemicals and motor or battery operated spraying equipment . The fire hazard because of the carriage of fuels is another im-
portant factor. (Figure 14)
4. Load Carriage
Lifting, carriage and loading of full tea baskets, sacks or tea chests go on continously in the tea planta
tions. Most of this is done up and down gradients in the fields. In the factory these may be done, up and
down spiral staircases to the tea loft. In the absence of proper lifting and carrying techniques the work
ers are at great risk of accidents, falls and physical and muscular strain.
5. Factory work
The sections of the factory and the processes have been described earlier. The mechanical .hazards include
(Fernando, 1971):
i. Machinery: Unfenced transmission machinery or
unprotected rotating and pressing parts and
sharp edges of cutting knives and rotor vanes
can increase hazard of injuries to hands and
iii. Hazards of open stair ways and unguarded leaf
chutes. Accidental falls are not uncommon.
iv. Load handling especially in the absence of good
housekeeping.
fingers.
ii. Furnace: The main hazard is that of a 'blow
back' explosion when relighting a dryer fur
nace. Mechanical hazards are also present when
the furnace is stoked, charged or slag is
removed.
6. Tractors and agricultural machinery
I.L.O (1971) has identified the operation of tractors, bull dozers and their associated equipment as» one
of two main snhere of concern in connection with the health and safety of workers. "Tractors
'------------- in particular
are responsiole for a high proportion of all serious accidents in mechanised agriculture. Many of these
are caused by overturning....*.
30
7. Transportation
'
In addition to tractors, transport of tea by trucks and wagons are very common. Rope ways and rail roads
and in some plantations animal drawn vehicles are not uncommon. Loading, unloading and transporting of
goods in these vehicles along steep slopes, narrow roads, narrow culverts and bridges have their own ass
ociated hazard.
8. Miscellaneous
As in all agricultural work there are many associated Jobs which have their own mechanical hazards. In the
plantations these include:
1. Construction, repair and maintenance of
buildings;
ii. Storage/stacking of materials;
iii. Vehicle and implement their workshops;
iv. Use of welding equipment, generators, internal,
combustion engines
v. Vater collection, storage and purification opera
tion and so on.
9. Working hours
Most work operations on the tea plantations with or without mechanical Implements entails hard physical
labour. Because of the seasonal nature of crop yields, the hour of work vary. Though legislation and regu
lations have attempted to fix the working hours and over time hours, these are often exceeded during peak
production months or other contingencies of the work. Long hours of physical work often in inclement wea
ther, increases fatigue which in turn increases the risk of accidents associated with factors described in
1 to 8.
Psycho-social Environment
The importance of psycho-social factors in any occupational environment are being recognised only in recent
years. Emphasis in occupational health has all along been on physical, chemical, biological and mechanical
factors.
The tea plantation workers and their families are a relatively closed population separated from the rural
population by geography and terrain. Historically because of the ’kanganl' or labour contract system they
were transplanted from the plains of Tamil Nadu and were settled on the interior and relatively inaccessi
ble hills where the tea plantations were being developed by the pioneer British planters.
In the absence of a detailed study of psycho-social factors operating in the tea plantation environment,
some tentative suggestions are offered based on personal observations of the local population. The factors
described may possibly affect life styles, relationships and attitudes both at work and at home among this
population.
1. Isolation
Geographical isolation from village or town life because of sating of estates in the hills is an Important
reality. This is associated with factors like long distance travel, lack of market and other amenities and
severance of ties with the socio-cultural aspects of village life. This engenders loneliness, boredom and
stress. Alcoholism which is rather common may be related.
2. Status of women
Women working is a traditional pattern of agricultural work in rural areas of India. In the plantation however they have a better status since plucking which is an important aspect of plantation work is mainly
cone by them. They are seen as wage-earners and employment is both continous and has the added associated
security of bonus and welfare benefits. This factor must have its own effects on the dynamics of the home,
family life, child rearing practices and field and factory work environment.
3. Dependence
The historical development of plantations has necessitated the plantation management having to provide all
types of amenities to the working population. Because of the geographical isolation this has not only meant
facilities in the working environment but also basic amenities of living such as housing, food rations, wa
ter supply, sanitation, clothing, medical care, schooling, creche for under fives, recreational facilities,
transportation and so on. Being cut off from village life there has been little contact with the ideas of
local self-government or community organisation to provide for community needs. This situation has resulted
31
in a great sense of dependence. Plantation legislation has put the complete onus of such aenrices on the
management. Government responsibility Is minimal and predominantly supervisory. This has further Isolated
the population from the general socio-political changes in the country.
Managements have thus traditionally been authoritarian or paternalistic. Trade unionlam is, therefore, weak
and has not been seen by managements as progressive involvement of workers and their representatives in so
lving common problems.
4. Social Stratification
A distinctive feature of plantation life is the clear cut social stratification of the plantation population
into:
iii. Management
i. Labour population
11. Staff
There are distinct entitles well separated through differing standards of housing, life style, social rela
tionships, work patterns and amenities. There was not much social interaction between these entitles tra
ditionally and the relationships were rather feudal. In recent years, this situation is changing. Social
mobility has also been practically impossible in this artificial society because of the stratification.
5. Diversity of population
- ■
■*">» who were predominantly
Historically plantations had only labour from the Tamllnadu plains
and- managements
,
In
the
last
decade
or
two,
there
has
been
a
very
significant
change
in this matter.
expatriate. — —----- ---------Labour have migrated from the plains of Kerala and Karnataka into the plantations of their own respective
States. Tribal populations common in the hills, who had kept aloof for years, have now been increasingly
seeking employment in the plantations. A very massive rehabilitation programme is also afoot, wholly spon
sored by Government, involving the Tamil, repatriates from Sri Lanka.
Staff have been increasingly drawn from the State of Kerala.
Management cadre has been drawn from the educated upper classes all over India. Of late many of them are
professionally trained agricultural graduates. Such a diversity, not uncommon in the urban conglomerations
of India have their own disadvantages and advantages which can affect work relationships.
All
All health
health problems
problems of
of tea
tea plantations,
plantations including those that may be work-related must, therefore, be studi
ed against the background of this psycho-social ethos—characterised by an isolated migrant labour popula
tion in a markedly stratified social setting, lacking traditional cultural supports and working in an occupation in which the entire adult members of the family may be wage earning and fully dependent on the emp
loyer for all their needs.
Health in the Plantation Environment
Having considered some of the important aspects of the physical, chemical, biological, mechanical and psy
cho social factors in the tea plantation environment one has to conclude that the plantation workers will
suffer from health problems common to other agricultural labour and also experience some of the hazards
and stresses that are becoming increasingly common among industrial workers.
The ecology of health in such a situation is very complex and studies on health status will have to include
among other things health problems related to inclement weather, poor environmental sanitation, chronic ef
fects of handling of agricultural chemicals, hazards of close proximity to animal, insect and plant life,
accident hazards related to increasing mechanisation, dust problems especially in the factory as well as
stress related problems caused by isolation and stratification of plantation society.
A
J J
■*/
oocO
/
32
CHAPTER VII
SCOPE AND objectives of the study
Introduction
Occupational Health Research in Agriculture and related occupations has not been very extensive- in the past
because agriculture by and large is predominantly an unorganised sector. Y.H.O (1962) outlined ten areas of
research which would be of direct benefit to the agricultural worker. These were:
vi. Problems of nental health and psychology;
i. Definition of safe working conditions on a
vii. Survey of home environment;
scientific basis;
viii. Problems of working women and child labour;
ii. Safety in farm equipments;
ix. Veterinary problems in relation to man;
ill. Physiological studies on agricultural operati
x. Hygiene and public health with special refeMnce
ons and -work studies;
to occupational diseases from animals, plants
iv. Toxicology of agricultural chemicals;
and micro-organisms.
v. Epidemiology of farm accidents;
W.H.O (1975) has stressed the need for environment and health monitoring of occupations as an important
public health measure and an epidemiological research tool..The aims of such monitoring should be:—
i. to strengthen preventive action against occupa
tional health hazards;
ii. to Identify unrecognised health risks at the
work place;
iii. to identify variations in individual suscepti
bility and tolerance;
iv. to identify the interactions between work and
the general health of the gainfully employed.
Some suggestions for preliminary survey, observational survey, hygiene survey and medical survey are also
given.
W.H.O. (1975) in a study group report on the Early detection of health impairment In occupational exposure
to health hazards has clearly defined four categories of criteria of health impairment. These are:
i. Changes in biochemical and morphological para
meters to be measured by laboratory analysis;
ii. Changes in physical state and functions of
physiological systems to be evaluated by phy
sical examinations and loading tests;
iii. Changes in well being to be evaluated by medi
cal history taking and questionnaires;
iv.
Integrative changes that may result from effects
on several physiological systems: These are not
specific and could be affected by factors unre
lated to work such as nutrition and communicable
diseases. These include studies of subjective
states, behaviour patterns, anthropometry, emp
loyee records and medical service statistics.
The report goes on to stress that the epidemiological methods must always be used in interpretation of oc
cupational health evaluation efforts. These include:
i. Comparison of parameters established in exposed workers with those in workers not exposed to the work
factors under study;
ii. Keeping in mind endogenous factors such as age, sex, genotype and exogenous factors such as nutrition,
past or present disease status, previous or concomitent exposure and social conditions, which could
influence variability.
Keeping these guidelines in view and the findings of the review of literature a preliminary study of the
total estate population of a tea plantation was planned by the Ross Institute of Occupational Health and
Regional Occupational Health Centre with the following general and specific objectives.
General Objectives
1. To study the health status of the workers on a tea plantation with specific reference to the physical,
chemical and biological factors in the occupational environment.
2. To study the parameter of the occupational environment of tea plantation workers in:
(a) the field; and (b) the factory
Specific Objectives
1. To observe and describe the occupations on a tea plantation as a preliminary s cep to further occupatio
nal health, physiological and ergonomic assesment (Refer Chapter V).
33
2. To outline the physical, chemical, biological, mechanical and other factors in the field enviroment
(Refer Chapter VI).
.
%
3. To outline the physical, chemical, biological and mechanical factors in the factory environment and to
monitor -
iv. noise; and
v. dust levels in different sections of tea
i. temperature;
11. humidity;
factories.
iii. light;
4. To study the health status of tea plantation population particularly workers by assessing -
(b) occupational history and symptojn review;
(d) basic laboratory investigation of blood, urine,
stool in all and special investigation like chest
(c) physical examination and anthropometry;
x-ray» ECG and sputum for AFB» and vaginal smear
(a) historical experience and morbidity;
whenever indicated.
5. To assess the factors in the home environment of plantation workers that contribute to their ill health.
6. To monitor the exposure of the plantation population to organophosphorous insecticides by measurement of •
cholinesterase levels in their blood samples.
7. To analyse some of the medical and sickness absenteeism records to get additional evidence of occupatio
nal factors that determine these patterns.
8. Finally to study and analyse all of the above data with a view to separating out the effects of the home
environment and the influences of the work environment. By so doing, the study will attempt to:
(b) identify aspects of health status which need fur
(a) identify the areas of health Impairment which are
ther assessment with reference to occupation.
related to occupational hazards;
CHAPTER VIII
materials and methods
a. Sample estates/Factories
Three medium sized tea estates and four tea factories in the Nilgiris around Coonoor were selected for the
study because of the following factors:
1. willingness of the management to participate
iii. presence of dependents and family members in the
in the study;
11. proximity to the UPASI headquarters where a
working age group on these estates who lived on
the estates but worked in Jobs outside the es
central diagnostic laboratory was set up by
tates so that this group could form a control
the Ross Institute of Occupational Health/
group;
iv. comparability in size and operation and medical
Regional Occupational Health Centre team;
services.
b. Sample population
The family was the unit of investigation. The total population of estate •A’ was investigated in the study.
Since the field workers outnumber factory workers by 20 to 1 factory workers of estates ’ B' and ’C were
included to increase the number of factory workers in the sample. These were neighbouring estates and sho
wed very similar features as seen in Tables 9a and 9b.
c. Methods
The following were undertaken during the study:
(1) Preliminary survey of Estate
This baseline information to dermine compattibility of the estates was done on a proforma (Appendix -a) wh-
ich included:
(a) Identification data;
(b) Size of estate;
(c) Number of workers: Total, and classified by sex,
residential status, service conditions (temporary/permanent), occupational status;
I
(d)
Welfare facilities and medical services provided
(e)
to labour;
Fertilisers, pesticides and weedicides used.
34
CHARACTERISTICS OF THE TEA ESTATES IN THE SAMPLE
TABLE 9a
Chracteristics
A
B
C
1.
Planted area
(in hectares)
157.38
65
356.87
2.
Total number
of workers
458
183
1067
271
187
30
66
117
435
632
403
35
143
52
‘'918'
13
5
M
F
3.
4.
5.
Factory workers
Field workers
Skilled workers
6.
characteristics
.A
B
C
Administrative
staff
13
9
29
Medical team
1 MO
1 MO
1 MO .
(visiting (visiting) 1 com
pounder
1 compound- 1
compounder
1 staff
er
t.
nurse
1 staff
nurse
1 midwife
5 kn
12 km
7 km
Distance from
Coonoor
8.
Source: Estate offices
TABLE 9b
CHARACTERISTICS OF TEA FACTORIES IN THE SAMPLE
Characteristics
A
B
c
0
1. Workers by Section
7
5
13
1
i. Collection/
Spreaders
ii. Rollers
iii. Driers
3.
12
5
6
10
6
15
6
4
7
3
1
v. Packers
3 ’
8
8
vi. Others
5
2
iv. Sifters
2.
Characteristics
A
B
C
D
Method
(orthodox or CTC)
CTC
CTC
CTC
Orthodox
No. of workers
30
35
52
10
1
Source: Estate Officer
2. Family Data
(a) A Family Card (Appendix-e) was completed for each family unit included in the investigation.
This included data on:
i. Age;
11. Sex;
iii. Marital status
iv. Place of birth
!
v. Education
vi. Occupation
vii. Duration of stay in estate; and
viii. Vital events for previous year.
(b) Home visits: The residential accommodation of the families were visi^ted and the living conditions were
assessed especially:
i. room space
ii. illumination
iii. ventilation
iv. water supply
v. sanitary facilities, latrines and waste disposal
vi. possessions in house
(c) Map of lines: Each labour line was mapped out in detail and numbers of houses clearly indicated.
3. Individual data
f
For each person adult or child included in the investigation a special individual data sheet (Appendix-b)
was filled which included:
i. identification data;
ii. Occupational History - present, additional and previous occupations with durations;
iii. Personal history including(e) Smoking and tobacco habits;
(a) Appetite; (b) Sleep; (c) Micturition; (d) Bowel movements;
(h)
Drug
habits
(g)
Chewing
habits;
(f) Alcohol;
35
iv. Past History - for eight specific conditions:
(d) Peripheral neuritis;
(b) Tuberculosis; (c) Chronic dermatitis;
(f) Hypertension; (g) Allergies; (h) Mental illnesses and any others.
(e) Diabetes;
(a) Asthma;
v. Family History for the same eight conditions outlined above and any others.
other health conditions-subjective assessment by
vl. Assessment of working conditions and relation to any
the worker.
vii. Symptom review of previous or presenting illness including:
(a) Cardio-respiratory system;
(b) Gastro-intestinal;
(c) Neurological;
(d) Skeletal;
(e) Skin;
(f) Miscellaneous
For women workers and controls
vlll. Menstrual, obstetrical and gynaecological history were recorded (Appendix - e) -
For children under 12 (Appendix - c)
/
ix. Additional information was recorded on:
(a) Past history of 16 child-hood illnesses;
(b) Immunization status
For children under 2
x.
Additional information on feeding habits was recorded
A. General Clinical Examination
A standardised proforma was used on the reverse of the individual card
the study was examined for:
(Appendix-b) and every subject on
(g) bone deformi(a) Pulse; (b) B.P.; (c) Lymphadenopathy; (d) Pallor; (e) Cyanosis; (f) Jaundice;
(k) Hydrocele; (1) varico^b
ties; (h) Odema; (i) Hernia; (J) Glossitia/cheilosis/angular stomatitis;
(o) respiratory system; (p) per•abdominal examlveins; (m) Elephantiasis; (n) Cardio-vascular system;
nation; (q) Assessment of nervous system.
For children under 12
(r) Assessment for nutritional deficiency signs was done.
5. Anthropometric measurements
On all the subjects of investigation the following measurements were recorded:
(a) standing height;
(b) weight;
(c) sitting height;
(d) waist height;
(e) total arm span;
(f) chest circumference in inspiration and expiration.
For children under 2
The following were also recorded:
(g) head circumference;
(h) mid arm circumference
6. Laboratory invest!get!ons
all the subjects included in the investigation;
The following investigations were done on
(e) X-ray of the chest - done by the assistance of
(a) Urine examination - for albumin, sugar and micro
the District TB Control Programme at the Distri
scopic deposits
ct Hospital, Coonoor.
(b) Stool examination for ova and cysts
(f)
Sputum
for acid fast bacillus
(c) Blood examination for
(g) Vaginal/cervical smear for monilia, trichomonas
i. leucocyte count-total and differential
or G.C infection
ii. erythrocyte sediment atipn rate
(h) Electro-cardiogram
(d) Plasma cholinesterase levels
The following additional investigations were
done when indicated by symptom review or the
findings of clinical examination:
For children
Examination of blood was done whenever sample was
were collected in infants under 2.
L .
easily available, for children 2-12 age group. No samples
36
7. Environmental Monitoring of factories
The following were undertaken in each of the four factories Included in the study:
i. Mapping: A detailed mapping of factory indicating
sections, ventilation outlets, exits and entran
Determination of indices
iii. The indices of thermal stress namely VBCT, GET
ces and distribution of machinery was done.
il .Environmental parameters measured;
At specific pre-determined points eight hourly
(working shift) samples were monitored for:
were computed for each department.
iv. The total dust in ’million particles per cubic
foot' and. the frequency distribution of the
particle size was done for each department.
a. humidity - wet bulb;
b. air cooling - kata thermometer reading;
c. noise levels;
d. dust levels by collecting dust in midget
impingers (Appendix-d)
8. Miscellaneous
Description of occupations on tea estate
i) The workers undertaking different occupations in the field and various sections of the factory were ob
served in the field. Photographs were taken wherever possible. Descriptions based on these observations
were noted (refer Chapter V).
ii) Information was collected on the following additional aspects from planters, managers and the scientiiic department of UPASI.
a. List of pesticides, fungicides, herbicides and weedicides and fertilisers used in the tea estates
(Chapter VI)
b. Diseases of the tea bush:
i. entomological; il. microbiological
(Chapter VI)
c. Other observations of:
1. general environment, ii. psycho-social factors; iii. life styles; iv. attitudes by informal inter
view with Link Workers, field and factory workers and estate staff and management (Chapter VI).
iii) Records Analysis:
The following records and registers were perused and analysed wherever possible for a year's duration previous to the month of beginning the study.
a . V.ork register of estate: Ma nd ays worked classi
fied by different occupations and available on
a monthly basis.
b. Absenteeism records: Monthly/Quarterly basis
c. Estate Hospital Birth Register
d. Estate Hospital Death Register
e. Estate Hospital Out patient Records and Register
f. Sickness absence Register.
available from estate office.
Organizational Aspects of Field Study
A study such as this even though it may be considered a preliminary or pilot study requires adequate pre
paration because of the nature of data collection. Family based investigations, involving history taking
and examination of all members of the family and including a home visiting give rise to many field problems.
Laboratory investigations involving collection of urine blood and stool samples especially from a rural ag
ricultural population, in our experience in the field, has been not very successful. However, in the plan
tation study we received great support and cooperation and we were able to undertake most of what we had
planned to do. Though we attribute this mainly to the enthusiasm of the Link Workers, we have outlined all
the stages in our planning and field work to place on record our experience.
Planning of the project, preparation and standardisation of forms and procedures, mid-course evaluation and
corrections and concurrent and terminal checks on reliability of data collected and laboratory investiga
tions done were undertaken as in any research programme.
Planning and organization of the field work, however, consisted of the following steps:
-| . Meetirr with Mpr.?rcrs and medical Officers of all the selected estates. During these meetings the obje
ctives and methodology of the study was explained. The limitations of the study were also explained to
37
prevent any undue expectations regarding the immediate value of the findings to the estate
It was decld
that all positive laboratory Investigations and or clinical findings would be listed out and given to
medical officer for follow up within the resources and constraints of the estate health services No tree ment would be given as part of the study though advise on possible management would be given by the
am
required or requested. Administrative problems regarding getting field worters off work on day of examine-
. tlon and so on were discussed.
2. Meeting, with Link Workers
As part of the UPAS I-Comprehensive Labour Welfare Scheme, plantation estate workers have been selected by
the workers themselves and trained by the Hedical Advisor and the team as Link Workers. As the term signi
fies, the Link Worker acts as a link between the estate health service and the labour population in the 11-
n»s. These workers inform the health team about vital events and health problems of the workers and thelr
famllies. The health team in turn take the assistance of these workers to organise preventive and premotive
programmes. This, concept has greatly improved the participation of the labour in health decision making as
•
well as taking responsibility in health matters.
held with
In all the 5 estates in which we worked, the Link Worker scheme was in operation. A meeting was
links
between the
all aspects of the field study was discussed. Since they were expected to act as
them and
fears
and doresearch team end the families, they were requested and encouraged to bring up all the common
held
on
matters
included
in
our
pro
ubts that such a study may generate. Very interesting discussions were
formas such as:
(a) occupational history and its significance;
(b) reasons for enquiry on religion/caste;
(c) confidentiality of findings;
(d) follow up of positive laboratory investigations;
(e) significance of testing of blood, and so on.
Methodology of collection of urine, stool in all
cases and sputum (whenever required) was expla
ined in detail. The detailed role of the link
worker was outlined end they were made wholly
responsible for;
1) meeting the families;
il) distributing urine bottles and stool cups the
day before the examination;
iii) Explaining to them the mode of collection;
iv) labelling the samples;
v) accompanying workers, and families to the health
vii) following up defaulters;
viil) following up those that require further
examination;
lx) accompanying doctors on line visiting, and
assisting with mapping of lines and home
visiting.
centre for examination;
vi) assisting with blood collection, anthropometry
history taking and examination;
All instructions were in local language and list of defaulters and other matters of follow up were also
given or written down in Tamil.
During the actual field study the enthusiasm, sense of responsibility and interest in the project of all
the Link Workers was an unusually effective help in data collection.
final meeting was
Meetings were held with them as and when necessary during the period of field study and a
also held at the end of the study.
J. Lanruare fluency
In a country such as ours, this can often be an important problem in the field. Of the eight medical off!
cers involved in the project four were fluent in the language. All history taking was undertaken by them.
translated into
All the details in the individual data form including points regarding examination were
local language and all medical officers were informed about these terms.
4. Review of Investigation Load
The number of Individuals covered as well as laboratory samples processed/investigated in a day were revi
ewed from time to time to ensure that the work went on efficiently and at the same time the
a
too heavy on the staff.
much pressure of work often means that field staff begin to take ^hort cut p
cedures and methods, that grossly affect the reliability of the readings. Factors such as climatic
ons, transport breakdowns, illnesses of staff made additional demands on the work. All these were, ho
responded to by suitable and realistic adjustments in the work schedule.
*
38
CHAPTER IX
PLAN OF ANALYSIS
1. Data
To summarise, the data collected in this field study included:
A. Personal data
i) Family data on family units in two plantations in the Nilgiris. This included family details and assess
ment of home environment.
ii) Individual health data - both history and findings of clinical examination of
subjects of three pl
antations in the Nilgiris. These subjects represented the total population of estate *A', the factory wor
kers and their families of estate ’B* and the factory workers of estate ’C*.
lii) Laboratory investigations including haemoglobin estimation; total and differential WBC count; erythro
cyte sedimentation rate; urine for albumin, sugar and microscopy; stool test for ova and cysts; plasma cho
linesterase levels on all the adults and a large percentage of the children.
iv) Special investigations like chest x-ray and FVC on some of the factory workers.
v) Anthropometric measurements including weight, height, chest inspiration and expiration, arm length, bi
sacromial, sitting height and leg length.
B. Environmental Parameters
i) Measurement of temperature (wet and dry bulb and globe thermometer), humidity, noise and illumination
and dust concentration in the withering, rolling, sifting, firing and packing sections of 4 tea factories
in the Nilgiris.
C. Records Analysis
1) Preliminary analysis of hospital records, sickness absenteeism and work records on one estate in the
Nilgiris.
2. Coding,
As a preliminary to statistical analysis all the personal data 1A and environmental data IB above was coded
in consultation with the statisticians of Institute of Research in Medical Statistics in Madras. The code
was on a scale of 1 to 9 and wherever numbers were involved these were recorded as such in two or three co
lumns allotted for the purpose. Points of history and groups of symptoms were often clubbed together taking
into account possible combinations and mutually exclusive categories.
(a) The family data information was put on a separate card.
(b) The individual data was divided into three groups to be punched on three different cards and a punch
code was developed for all the three. A method of linkage of cards was also devised.
Card No.1
Identification data, occupational history, personal history, past history and family history for all and
menstrual, gynaecological and obstetrical history
for women workers,.
Card No.2
Symptom review and clinical examination. Also additional information including history and examination for
under 12’s and under 2’s.
Card No.
Anthropometric measurements, Pulse, blood pressure and laboratory investigations.
(c) The environmental survey data was also coded and put on a separate card.
3. Plan of Analysis
The analysis of the data was planned in two stages:
1st stage: Analysis of data of individuals in the age group 18-60 since the study was primarily interested
in occupational history and this age group may be designated as the working age group. Main purpose would
be to identify important associations between health status and work.
39
a complete picutre of general hea2nd stage: Analysis of data on individuals below 18 and above 60 to get
1th status of the whole population.
4. Method of 1st Stare Analysis
The following were the guidelines used for the 1st stage analysis of 16-60 age group.
divided into six groups;
1) the total sample in this age group were
d) female field workers;
e) female factory workers;
f) female controls.
a) male field workers;
b) male factory workers;
c) male controls;
-? compared for all points of occupational history, personal,
ii) The male groups and the female groups were
clinical
examination and laboratory investigations.
past and family history, symptom review and
for which there was a suggestive difference between groups at the 10 periii) All items were selected out
statistical significance of the contrasts was 1 ; worked out and given as
cent levels of significance. The
probability values.
5. WoTKing population of study
Table 12 shows the registered working population of the three estates ie., 18 to 60 age group, classified
by field, factory and other occupations.
Controls were taken as persons who had never worked in field or factory previously, were of the same income
level and shared the same home environment. It was found that some people had worked in one or other capa
city in the past in the field or factory. They were excluded from the study and the final population used
in the analysis is shown in Table 13.
In Table 13, it is seen that female factory workers were only 17 in number. Being a very
small number they
we re excluded from further analysis. The final categories were:
(b) Females - field workers and controls
(a) Males - field and factory workers and controls
WORKING POPULATION OF ESTATES A, B, & C (18-60 AGE GROUP).
TABLE 12
B ■■■■■ w KCSSM B = tX =
aw nWB B
9K = W « = =
Male
»C“=““=
Female
CW
Sprayer
Total
Male
Female
Total
76
12
63
9
12
33
44
85
24
33
107
151
98
249
420
393
813
C. Other nobs
A. Field
Pluckers
Agr. labour
Conductor/Supervisor
Bi ■ ■ ■
Total
277
90
20
14
124
277
90
20
14
277
Others within/
without estate
Students
Housewives
Retired/unemployed
401
Total
B. Factory work
18
Other jobs
115
30
133
30
Total
145
18
163
Processes
Grant Total A+B+C)
I
40
WORKING POPULATION USED IN ANALYSIS BY AGE AND SEX
TABLE
Both sexes
Females
Males
Age
(years)
Field
Factory
Control
Field
Factory
Control
Field
Factory
Control
18-54
51
50
55
112
5
41
143
55
9A
35-44
44
46
5
84
3
5
128
49
10
45-60
48
37
6
69
9
7
117
46
13
Total
•123
155
64
265
17
53
388
150
117
: b « = ats
CHAPTER X
www w = = ssk csbksbk
OBSERVATIONS AND RESULTS
This pilot study has attempted to build up a holistic picture of the health status of the tea plantation
workers by looking at a wide range of measurements of indicators of health status as well as quantitative
and qualitative observations on various environmental parameters. In a preliminary study such as this it
may not always be possible to link all the findings but taken together they do help in building up a more
complete picture of the community health situation.
The observations are presented in eight sub-sections:
1. Demographic profile of an estate
2. Status of Home environment of plantation workers
5. Anthropometry of working population
6. Cholesterase levels in the working population as
including sanitation
3. Health Status - current and historical experience
7. Occupational environmental parameters in the tea
4. Basic Laboratory investigations for anemia, gut
factory
8. Miscellaneous data from hospital and absenteeism
infestations and urine chemistry.
an indicator of pesticide toxicity.
records.
CHAPTER X(A)
DEMOGRAPHIC PROFILE OF AN ESTATE
To develop a demographic profile the data on Estate -A' was analysed since it represented a total popula
tion data. 261 families were registered and Investigated and these Included all the families resident on
the estate (Field and factory worKers and their families, and all other involved in supportive, administra
tive and supervisory services and their families). Estates -B' and -C> were included mainly to increase the
number of factory workers in the sample since field to factory worker ratio was 20 : 1.
1) Geographical Distribution of Residence
Estate ’A' may be said to be representative of a medium sized tea estate in the Nilgiris. 261 families were
spread out over 8 groups of labour lines A to H. Thirteen families were of the management/administrative/
staff category who lived in bungalow scattered over the estate. Forty one families were resident in a vill-
age nestled in the hills adjacent to the estate.
ii) Family characteristic
The total population was 11B9 and the average household size was 4.55. Both joint and nuclear families were
present in the sample. Aged parents who had worked previously on the estates as well as adult unmarried
and daughters and in some cases unmarried brothers and sisters were also present. Most of the families
sons
were second or third generation plantation families.
iii) Age and sex characteristics
distribution of the population in standard five year class intervals.
Table I^A shows the age and sex
similar to other agricultural communities in most age groups, there
Though the percentage distribution is
are some interesting differences to be noted.
a) The 0_4 age group constitute 9.5 percent of the total population which is much lower than similar rural
There were
communities probably indicative of the effects of the family planning programmes in the estate.
only 8 infants in the sample.
41
b) Females ere more than males in O-fc, JO-W, and 50-59 age group, which 1. a little
ing the Ltl numbers, this may be a chance diiierence. Emplo^ent i.
stable and pendent. Hence this Improves their economic status probably
number of pregnancies may be an additional factor. It mus be kept in
1”^
employment among
^y
-t have been
seek employment outside the estate including in the plains. Tney
y
males is higher and many
affecting
the
totals
in
the
working
age
group.
registered in the census thus
46.7 percent under nireteens constituting ft large dependent
c) The population is a young population with
population,
d) The population in the 15-44 age group ere 49 percent.
e) 1.8 percent are above 60 - very aimilar to other areas.
f) The dependency percentage is 58.32.
AGE AND SEX DISTRIBUTION
(ESTATE A)
TABLE 14a
AGE
GROUP
0-4
5-9
10-14
15-19
20-24
25-29
30-34
%
MALE
i
FEMALE
4.37
6.56
5.04
5.04
7.06
6.98
6.05
5.55
A.20
4.79
4.12
2.52
3.b6
3.70
TOTAL
total
9.41
11.60
14.04
QUttULAIT
VE PERCENT
% OF
% OF
males females
MALES
FEMALES
AGE
GROUP
9.41
8.69
13.04
10.15
35-39
40-44
21.01
11.60
8.99
7.98
6.22
35.05
46.65
55.64
14.04
12.04
63.62
69.84
8,19
5.01
10.15
14.04
11.60
8.46
9.53
7.78
7.44
55-59
60 ♦
TOTAL
IN SAMP
LE
CUMULATIVE
PERCENT
female total
3.02
3.70
4.20
6.72
7.82
76.56
84.38
2.77
6.05
4.28
3-44
90.43
94.70
1.76
3.01
3.28
1.93
1.93
1.00
598
2.35
1.51
0.75
591
% OF
% OF
MALES FEMALES
6.02
7.44
8.46
98.15
7.19
6.52
3.84
3.84
99.91
2.00
1.52
5.58
4.73
3.04
1189
DISTRIBUTION BY INCOME •
TABLE 14D
RELIGION AND CASTE
(ESTAIL-AJ
TABLE 14E
45-49
50-54
%
%
%
MALE
SBnBBBMB BDBBBWBB ■■mKKBBail
RELIGION
FAMILIES NO.OF
PEOPLE
5*
SC/ST
FAMILIES •
%
HINDU
202
903
75.94
1^5
71.78
CHRISTIAN
‘59
286
24.05
48
81.35
MUSLIM
261
193
1189
INCOME GROUP
NUMBER OF
FAMILIES
PERCENT
LOW INCOME
62
23.75
LOWER MIDDLE
181
69.34
UPPER MIDDLE
15
UPPER
3
5.74
1.14
73.94
99.97
261
EDUCATIONAL STATUS OF 5-60(4) AGE GROUP
(ESTATE-AJ
TABLE 14B
%
%
IN
male
ILLITERATE
AGE GROUPS (Ln %)
%
IN
female
OF
TOTAL
15-19
20-34
55-44
45-59
36.5
13.1
33.8
74.5
52.0
56.1
21.5
21.8
26.9
8.7
17.4
11.6
31.9
19.3
primary
12.6
17.7
27.0
. 15.9
6.8
22.8
14.0
MIDDLE
12.2
6.8
9.6
31.4
15.5
4.2
HIGH
POST-SCHOOL
(P.U.C./DIPLOMA/
GRADUATION)
9.1
19.7
17.4
6.8
6.8
6.4
11.5
1062
137
269
163
559
523
171
TOTAL IN SAMPLE
LEVEL
41
little unusual though considerb) Females are more than males in 0-4, 30-44 and 50-59 age groups which 1. a
Ing th^ small numbers, this may be a chance dliierence. Employment la much more among---------women1 and is relatively
• ' r reflected in lower Bortality. Leae
atable and permanent. Hence this improves their economic status probably 1----------------. It must be kept in mind however that unemployment among
number of pregnancies may be an additional factor. }
the estate including in the plains. They may not have been
males is higher and many seek employment outside
registered in the census thus iaffecting
-------------- the totals in the working age group.
46.7 percent under nireteens constituting a large dependent
c) The population is a young population with
population.
d) The population in the 15-44 age group ere 49 percent.
e) 1.8 percent ere above 60 - very similar to other areas.
f) The dependency percentage is 58.32.
AGE AND SEX DISTRIBUTION
(ESTATE A)
TABLE UA
%
AGE
GROUP
MALE
0-4
5-9
10-14
15-19
20-24
25-29
30-34
4.37
6.56
7.06
6.05
4.79
4.12
2.52
%
FEMALE
TOTAL
% OF
% OF
CUMULATI
VE PERCENT males females
AGE
GROUP
5.04
9.41
9.41
5.04
6.98
5.55
4.20
3.86
3.70
11.60
21.01
10.15
10.15
14.04
11.60
8.46
7.78
7.44
35-39
40-44
35.05
46.65
8.99 55.64
7.98 65.62
6.22 69.84
14.04
11.60
1%
FAMILIES NO.OF
PEOPLE
SC/ST
FAMILIES ■
’cumulative
%
FEMALE TOTAL
3.02
3.01
45-49 3.28
50-54 1.93
55-59 1.93
1.00
60 ♦
TOTAL 598
6.72
7.82
6.05
4.28
3-44
1.76
1189
3.70
4.20
2.77
2.35
1.51
0.75
591
INCOME GROUP
202
903
75.94
145
71.78
LOW INCOME
62
CHRISTIAN
‘59
286
24.05
48
81.35
LOWER MIDDLE
181
UPPER MIDDLE
15
UPPER
3
261
73.94
7.44
8.46
5.58
4.73
3.04
1.52
6.02
7.19
6.52
3.84
3.84
76.56
84.38
90.43
94.70
98.15
99.91
2.00
NUMBER OF
FAMILIES
HINDU
193
% OF
% OF
MALES
FEMALES
1
DISTRIBUTION BY INCOME ■
%
MUSLIM
PERCENT
IN SAMP
LE
TABLE 14D
RELIGION AND CASTE
(ESIAl*-A)
TABLE 14E
RELIGION
8.69
13.04
14.04
12.04
9.53
8,19
5.01
%
%
MALE
PERCENT
23.75
69.34
5.74
1.14
99.97
261
EDUCATIONAL STATUS OF 5-6o(+) AGE GROUP
(ESIATE-A)
TABLE 14B
B-CZ c rr r .. a m OU - "W “s:r 3 *r
AGE GROUPS (in %)
%
IN
MALE
%
IN
FEMALE
OF
TOTAL
15-19
20-34
55-44
' 45-59
52.0
36.5
13.1
33.8
74.5
21.5
56.1
ILLITERATE
21.8
26.9
8.7
17.4
11.6
31.9
19.3
primary
12.6
17.7
27.0
• 15.9
6.6
22.8
14.0
MIDDLE
12.2
6.8
9.6
31.4
15.5
4.2
HIGH
9.1
19.7
17.4
6.8
6.8
6.4
11.5
523
1062
137
269
171
163
539
LEVEL
POST-SCHOOL
(P.U.C./DIPLOMA/
GRADUATION)
TOTAL IN SAMPLE
%
42
OCCUPATIONAL STATUS OF 18-60 AGE GROUP
--------------------(ESTATE - A)
TABLE 14C
GROUP
MALE
%
FE
MALE
%
To
tal
%
FIELD WORKER
130
39.75
255
71.62
385
56.36
FACTORY WORKER
44
13.^5
5
1.40
49
7.17
83
12.15
517
75.69
MALE
%
FE
MALE
%
To
tal %
ENEMPLOYED REGO
54
16.51
38
10.67
92 13.46
STUDENTS
11
3.36
12
3.37
23
3.36
26
7.30
26
3.80
25
3.66
GROUP
HOUSE WIVES
OTHER JOBS
(inside 4 outside
estates)
76
23.45
7
1.96
TOTAL EMPLOYED
250
76.45
267
75.0
RETIRED
12
3.66
13
3.65
TOTAL NUMBER
(Sample)
327
47.87
356
52.12 683
iv) Educational Status (Table 14B and Figure 20a)
The literacy rate is as high as 63.5 percent. Males show a literacy of 78.5 percent and females 48 percent
of the provision of schools by estate managements
both of which are well above the national average.. Because
.
in
the
later half of the table. Though females show lothe educational status is improving rapidly as seen
*
of
much
better educational level among females than
ver rates in every category, the rates are indicative
23.7 .percent of males and 13.6 percent of females have comp
in comparative rural situations. Interestingly
-----------------leted high school and many have goneon to FUC, Diploma courses and graduation. The higher educational status of the staff families especially among wives has slightly biased the sample . All the same the labour
population is found to be rapidly becoming an educated group with possible affect on their health status.
v) Occupational Status (Table 14C and Figure b)
Our of 660 people in the 18-60 age group in the population only 24.31 percent are unemployed. These Include
students, housewives, retired individuals and those registered as unemployed. Of the 75.69 percent who are
unemployed 56.3 percent worx in field Jobs, 7.1 percent in factory Jobs and 12 percent in other Jobs inside
and outside the estate. These other Jobs include the following:
Among males there were coolies, tailors,, cooks, drivers, office assistants, watchmen, mason, postman, store
keeper, hospital staff, gardeners, peons, sweepers, carpenters, a baker, a wireman, a trade apprentice, a
pharmacist, a scientific assistant, bus conductors and factory workers (other than tea factories). Among
females the other jobs Included sweeper, creche attendants, a nurse and a typist. Most of these were inclu
ded in the control group in the study. (Refer Table 12 and 13). Field workers included agricultural workers
sprayers, pluckers, conductors and supervisors. These occupations have been described in Chapter V.
Included those working in withering, rolling, drying, sifting and packing sections and skiFactory workers
electrician, mechanics, carpenter and fitter (descrilied factory staff including supervisors, tea makers,
bed in Chapter V).
vi) Distribution by religion (Table 14E)
Of the 261 families in the estate 202 were Hindus (75.04 percent) and 59 were Christian families (24.05
percent). There were no Muslim families in Estate 'A' but in some of the neighbouring estates there were
a few Muslim families. The percentage of Christian families was much higher than usual (National average
20,.). The Christian families consisted mainly of Catholics and Protestant denominations. One family each
belonged to the Marthomite and Pentecost denominations.
vii) Distribution by Caste/Region (Table 14E)
Majority of the families were second or third generation plantation labour from the Tamilnadu plains, The
castes mentioned on enquiry included Pallar; •Parayar’, ■Adidravida’, 'Gounder', 'Madarl', -Eshuvan',
■Eluvar', ’Cobbler', 'Nair', 'Boyan', 'Chakkilian', 'Devar', ’Vanan', 'Kamalan', 'Barber', 'Pullalmar',
•Thandan', 'Ezhutachan and Brataln.Of the 201 Hindu families 72.1 percent belonged to scheduled castes and
tribes. Of these 20 were Badagar families - a local tribe. Interestingly even the Christian families iden
tified themselves with certain castes-probably those previous to their conversion. Forty nine out of fifty
nine families mentioned the' following castes as identification - Parayar, Pallar, Adidravida, Nadar,
Badagar and Cobbler.
43
vi11) Social Class (Table 14D)
This is always a difficult parameter to assess in an agricultural community since agricultural economy is
usually a subsistence economy. In the plantations as in industry, the workers ere mostly wage labour the
assessment is made easier. However, because of the varying numbers of family members employed we found a
much greater variation than expected. The opportunity presented by the home visit was made use of to asse
ss the income level based on possessions, type of cooking vessels (alumntmum or stainless steel) and other
such criteria.
23.7 percent were low income; 69.3 percent were lower middle income; 5.7 percent were upper middle income
and 1.3 were upper income group. The latter two groups were constituted by the administrative/supervisory
and technical staff of the estate.
HOME ENVIRONMENT
CHAPTER X (E)
Tea plantations are required by legislation to provide residential accommodation for their workers and
their families.
Figure 23 is a schematic diagram of the type of house including its measurements which was provided for
the workers and their families in Estate ‘A*. This is fairly typical of the accommodation provided in the
estates in the Nilgiris area.
Depending on the number of permanent workers in a family, one or two units may be provided to a family.
Many workers enclose additional portions and thereby extend the accmodation. Some of the families had not
been provided accommodation on the estate and had taken up accommodation in the village adjacent to the
estate. Many resident in the village had temporary accomodation of poor quality.
i) Lighting
Lighting was good only In 45.6 percent of the houses. In 54.4 percent of cases it was average to poor.
the
This was mainly because of the houses being wall to wall and the absence of windows on t.
—side
--- walls. In
some houses the lighting had been improved by the use of skylights or glass tiles.
11) Ventilation
Ventilation was good only in 46.8 percent of the houses. Windows provided in the front and back walls were
available.
often blocked by shelves thus reducing further the little cross ventilation that was
SI
No
Parameter
roor
1.
2.
Lighting
Ventilation
12.4
3.
Water supply:
a. Source
5.
Flooring
6.
Kitchen
7.
Bathroom
8.
Lavatory
Separate enclosure
94.4
Present
90.8
==
.s
t
42.0
45.1
Spring
75.4
Tap
91.596
91.5
Present
48.8
Mud plaster
80.4
Separate
90.8
c. Protected Source
Electricity
Qualitative Indicator
Average
7.9
b. Supply
4.
(in percentages)
STATUS OF HOME ENVIRONMENT
TABLE-15
=
=
=
=
Good
Total No.
of Units
(IA)
45.6
46.8
250
226
Well
24.6
Absent
51.2
Cement & tiles
250
19.6
Part of living room
250
9.2
Nil
5.6
Absent
250
250
9.2
Attached to house
24.5
M.. cXE
= « = « = za zc EX r = - = x n = x = z - - z KCtBKKeStaKSBSSBaSWKKKVWBOBSn**11
261
44
lit) Electricity:
Only ^8.8 percent of the houses had an electrical connection.
iv) Kitchen:
90.8 percent had a separate kitchen at the back of the living room (see figure 23). 9.2 percent used a part
of the living room separated by a low wall.-Chimney arrangements were inadequate and the kitchen was thereby
rather smoky.
v) Bathroom:
■■
94.4 percent had a small separate enclosure for bathing purposes. This was often open to the sky.
vi) Latrines;
90.8 percent had been provided separate latrines and of these 24,5 percent had them attached to the main
housing unit. Otherwise they were provided singly or in groups at a short distance and usually lower level
than the housing units. 9.2 percent had no latrines and used the fields. Latrine units at a distance from
the main housing units were often not maintained well and became unfit for use (refer plate 25). Children
especially under five, often defecated along the open drains provided causing some fly nuisance.
vii) Refuse disposal:
Both garbage and sullage were disposed off indiscriminately. Open drains provided usually led sullage into
the nullahs without any treatment. Garbage was thrown at some distance from the houses, in heaps and not al
ways in a manure pit or trench dug for the purposes. Fly and mosquito nuisance was evident.
viii) Domestic Animals:
Chickens, cattle and pet dogs were kept by families though not always in separate enclosures.
ix) Water supply:
The main source of supply was tapping springs. 24.6 percent also had water from a well The spring water
was pumped to large tanks for storage and then supplied through pipes to common tap points in the labour
lines. Shunt feed Chlorinaters were being tested out in some of these tanks. (Figure 22 & 24)
x) Vegetable gardens
Of more recent origin is the popularisation of small vegetable gardens and little plots used for cultiva
tion which were evident during house visits.
Though the overall home environmental status was found to be better than the average rural situation, it
was found that facilities provided were often modified or improperly used or inadequately maintained, thus
increasing the potential for water borne illnesses, infestation by soil transmitted helminths and respira
tory illnesses.
CHAPTER X (C)
HEALTH STATUS
The data available on various aspects of health status of the sample are presented in the following tables:
Tables 18 shows the main morbidity conditions and their prevalence in the total population.
Table 16 shows past history of eight medical conditions in the population.
Table 17 shows past history of bites and stings and accidents which are both specific groups of occupational
and environmental hazards.
Table 18(a) to 18(J) show the percentage prevalence of general signs and symptoms, and those of cardio-respiratory system, gastro-intestinal system, neurological system, eye/ear/and skin conditions and certain
other miscellaneous conditions.
Table 18(g) shows the percentage prevalence of obstetrical and gynaecological conditions in females.
In all these Tables - 18(a) to 18(£) - the data has been grouped into five groups, which are male field wor
kers, male factory workers and controls anc female field workers and controls. This was done to determi
those conditions in which there is a statistically significant difference between workers and control groups
suggesting a possible occupational risk factor.
45
difference, between worker, end controls, field end factory respectively (P - 0.1). The find g
sented for ell subjects, as well es by age and aex. The statistical significance of contrasts
P
also gl
ven in the tables in the form of probability values.
Table 1S(J) and 18(k) are additional tables for some conditions that we had expected to find difference but
in actual study did not find statistically significant differences. Taken together they show a significant
trend.
,
From all the above tables, the following important observations can be made:
GENERAL MORBIDITY
commonest in all the population and its sub-groups (we have taken 20
1. The signs and symptoms which an
arbitrary cut off point indicating common experience).
•
percent prevalence as an i----.
v) Control males: Reduced appetite, chest pain with
i) Leech bite in all groups;
cough with or without sputum, abdominal pain,
if) Factory workers male: Joint pains and back aches
headache and vertigo;
chest pain and cough with or Without sputum,
vi) Control females: Pallor, pedal oedema, Joint pains
usual disturbances and accidents;
. and backache, palpitation, breathlessness, head
Hl) Field worker male: Joint pains and back-ache,
ache, vertigo, dysmenorrhoea and leucorrhoea.
head-ache, vertigo and convulsion, insect sti
ngs, visual disturbances, chest pain with cou
gh with or without sputum, worms in stool, ab
dominal. pain, disturbed sleep, accidents.
iv) Field worker female: Joint pains and ^backache,
headache and vertigo, pallor, pedal odema,
chest pain with cough with or without sputum,
palpitation, breathlessness, dysmenorrhoea,
and leucorrhoea;
From the above profiles we can conclude that the conunonest morbidity experience of
the plantation popula-
tion are (top ten diseases):
i) Leech bite;
ii) Back ache and Joint pains;
111) Respiratory infections;
iv) Signs and symptoms of anemia;
v) Headaches;
vi) Insect stings;
vii) Reduced appetite;
viii) Accidents in men;
lx) Dysmenorrhoea and leucorrhoea in women,
X) Worms infestations.
Field Workers and Controls Comparison
2. The conditions in which there are suggestive difference between field workers
i) History of worms in stool;
ii) Pallor;
iii) Joint pains and backache;
iv) History of peripheral neuritis symptoms;
v) Insect stings;
and controls are:
Vi) Snake and scorpion bite;
vii) Leech bite;
lx) Disturbed sleep;
x) Reduced appetite;
Xi) Varicose veins.
If we take P value of .01 as an arbitrary cut off point for statistically significant
difference then the
following conditions become significant.
i) Joint pains and back ache: In all field worker
iv)
and especially in males and in younger age
group.
ii) Pallor: In all field workers and especially in
females and in younger age groups.
iii) Worms in stool: In all and particularly in
males.
v)
Leech bite in all field workers, both male and
female in all age groups.
Insect stings in all field workers, both male
and females no age difference.
History of peripheral neuritis in all field
Vi)
workers (total), no age difference but more in
females.
46
Factory Workers and Control Comparisons
3. The conditions in which there are suggestive differences between factory workers and control groups
were:
iv) Signs of Vitamin B deficiency;
v) Cervical lymph nodes; and
vi) Varicose veins.
i) History of worms in stool;
ii) Joint pains and back ache;
iii) Infective lesions of skin;
However, only infective lesions of skin in young factory workers showed probability or p value of O.Ci.
Uncommon Conditions
4. The following conditions were very rare or totally absent in the population sample. These were;
Absent:
v) Ascites;
vi) Abnormalities of cranial nerves, gait or
i) Hydrocele;
ii) Elephantiasis;
lii) Jaundice;
coordination;
vii) Mental retardation.
iv) Palpable spleen;
Rare:
iv) Sensory loss (1 case)
v) Cyanosis (1 case)
i) Hernia; (1 case);
ii) Lumps in the abdomen (2 cases);
iii) Abnormality of muscle tone (1 case);
PAST HISTORY
ft
(Medical Conditions)
(Percentage)
TABLE-16
- st m s a K ■ w n ■ ■ » ■ at s n » s k ■ m ■ a M m ■ w n * ■ ■ a ■ ■ ■ “ a s at ■ ■ k w n at B ■ k ■ ■ ■
Criteria/
condition
Field
Factory
Control
Field
Control
Criteria/
condition
ts
Fieldh
Males
Factory
Control
Asthma
1.7
1.5
1.6
0.^
1.9
Allergies
1.6
1.5
0.0
1.1
1.9
Diabetes
0.8
0.0
0.0
0.0
1.9
Peripheral
Neuritis
0.8
3.0
0.0
12.1
1.9
Tuberculosis
0.0
1.5
3.1
0.4
1.9
Mental illness
0.0
0.0
0.0
0.4
0.0
Hypertension
2.4
0.0
0.0
0.8
0.0
Chronic
Dermatitis
4.1
6.8
3.1
2.3
3.8
Females
Males
Males
Females
Field
Factory Control
Field
Control
Scorpion
bite
15.1
13.8
4.9
7.1
0.0
Accidents
20.2
20.0
10.0
4.7
3.9
119-123
130-133
60-64
Criteria/
condition
Females
Males
Field
Factory
Control
Field
Control
Snake bite
7.6
5.4
1.6
3.1
0.0
Dog bite
5.9
10.0
13.1
0.0
0.0
Stings/
insect
30.3
19.2
11.7
20.5
3.9
Leech bite
79.0
51.5
45»0
76.8
254-264 51-53
60-64
(Percentage)
HISTORY OF BITES/STI NGS/ACCIDENTS
TABLE-17
Criteria/
condition
119-123 130-133
Total range
Total range
254-264 51-53
19.6
s:
QC
i
Females
Field Control
*
•_r '■ -
San'’'.
”
ii-.’
'
lai
~
'TH CSLL
47
general signs and symptoms
TAELE 18(3;
Criteria/
condition
Field
Criteria/
condition
Female
Male
Field
Field Control
Factory Control
Female
Male
Factory Control
Field
Control
8.1
2.3
0.0
13.9
6.9
Lymph node
upper
18.5
17.5
15.1
9.8
9.8
0.0
6.5
0.0
0.0
Pallor
11.5
6.3
54.7
28.3
Lymph nodelower
4.1
6.0
6.6
2.3
4.8
26.4
26.4
Reduced
appetite
19.5
15.9
23.4
26.6
11.5
Pedal odema
Joint pains/
back ache
38.2
33.3
17.2
51.3
41.5
Disturbed
sleep
22.1
15.4
9.5
12.2
7.7
Bone deformi
ties
0.0
0.8
0.0
3.4
1.9
Total range
121-123 130-133 62-64 256-265
52-53
Varicose veins
5.0
8.3
0.0
1.5
1.9
1.7
8.3
1.6
4.9
9.4
Weakness/
loss of
we i ght
Glossitis/
Cheilosis
angular
stomatitis
;«wwwwwwwww w w ww wwwwww w:WWW
K K S KKBBSS
.
TABLE 18(b;
Criteria/
condition
Field
Cyanosis
Palpitation
Breathlessness
Sweeling of
feet
Chest paih
Cough with or
without
sputum
0.0
18.7
35.8
Criteria/
condition
Female
Male
12.0
33.1
0.0
9.4
32.8
0.0
0.0
22.6
29.3
26.4
25.9
Factory Control
Field
Control
Haemoptysis
2.4
2.3
1.6
0.4
1.9
Intermittent
claudication
4.1
2.3
1.6
0.4
1.9
Cardiac
disease
2.5
0.0
0.9
1.9
0.0
121-123 130-133 62-64
256-265
52-53
Total range
(Percentage)
CASTRO INTESTINAL SYSTEM
TAELE 18(c)
Female
Male
Field
Factory Control Field Control
(1)
(Percentage)
CARPI0-HESPIKATQRY SYSTEM
E = = = = = = *=» = = = '
Criteria/
condition
Field
Factory
Control
Field Control
Control
2.4
0.0
0.0
0.0
1.9
13.2
Abdominal
tenderness
5.7
3.0
4.7
8.3
3.8
23.1
18.9
Liver palpable
2.5
2.3
0.0
0.0
0.0
10.2
13.2
Spleen palpable 0.0
0.0
• 0.0
0.0
0.0
12.5
7.8
13.3
1.9
Fluid
O.p
0.0
0.0
0.0
0.0
18.9
6.8
6.2
4.5
5.7
Total range
121-123 130-133 62-64 256-265
12.1
7.8
7.2
7.5
15.4
13.6
15.6
16.3
Abdominal pain
22.8
16.7
21.9
Diarrhoea
8.9
3.8
Worms in stool
27.6
Constipation
4.9
1
Field Factory Control Field
Tarry stools
Nausea/
vomiting
feeling of
fullness
Bleeding per
rectum
Female
Male
Female'
Male
52-53
48
(Percentage)
NEUROLOGICAL SYSTEM
TABLE 18(d)
! ts:
Criteria/
condition
30.1
Field Factory
control
Field Factory Cgjtr- Field
Female
Male
Criteria/
condition
Female
Male
Control Field Control
45.3
Babinski’s
0.0
(1)
0.0
(i)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Higher fun
ctions
abnormal
Cranial nerves
0.0
0.0
0.0
0.0
0.0
3.1
14.4
7.5
Gait
0.0
0.0
0.0
0.0
0.0
0.0
Romberg’s sign
0.0
0.0
0.0
0.0
3.8
0.0
1.6
Total range
121-123 130-133 62-64 256-265 52-53
28.1
41.1
Head ache
convulsion
Vertigo
39.8
Incoordination
0.8
1.5
0.0
Neuritis/
Paraesthesis
Loss of power
2.4
3.0
Reflexes
abnormal
2.5
4.5
Muscle tone/
power
abnormalities
(D
0.0
0.0
0.0
0.0
Sensations
0.0
(1)
0.0
(1)
0.0
( Percentage)
EYE/EAR/SKIN CONDITIONS
TABLE 18(e)
■r e:
Criteria/
condition
Male
Female
Field Factory Cont ol
Field Cont_____ rol
Visual
disturbances
29.3
24.1
20.3
9.8
13.2
Eye infections
1.6
1.5
1.6
0.0
0.0
Pterygium
3.3
9.8
4.7
3.0
3.8
Hearing disturbances/Tinnitus
4.9
14.4
12.5
11.0
11.3
Criteria
condition
Male
Female
Field Factory Control
Field Control
Jrlteria/
••or-itio:.
J :.ur r ice
0.0
0.0
0.0
0.0
0.0
Lie pl.antiasis
0.0
0.0
0.0
0.0
0.0
B'yd rccole
0.0
0.0
0.0
0.0
0.0
Hernia
(D
0.0
0.0
0.0
0.0
•'iicturi tion:
frequency
abnormality
2.4
2.3
3.1
0.8
0.0
Field Control
Field
Factory
Control
Ear infection
•8.1
9.1
7.8
11.7
5.7
Skin changes
colour/
sensation
10.7
16.7
10.9
12.6
9.4
Infective
lesions
7.4
14.4
3.1
7.3
7.5
(percentage)
MISCELLANEOUS CONDITIONS
TABLE 18(f?
Female
Male
Female
Male
Criteria/
condition
Field Factory
Control
Field Control
Micturition:
Volume
abnormality
0.8
3.0
1.6
0.4
0.0
Micturition:
Pain/burn/
blood
8.9
14.4
9.4
5.7
3.8
49
taele ie(f,)
OBSTETRICS AND GYNAECOLOGICAL CONDITIONS IN FIELD WORKERS ANT) A CONTROL GROUP
Obstetrics and
Gynaecological
condition
Prevalence (S) in females
Prevalence (%) in females
.'Obstetrics and
Gynaecological
condition
Field workers
3-5 Abortions
2.0 (239)
3.6
(28)
One premature baby
1.7 (233)
0.0
(28)
Control group
Field workers
Control group
Menstrual cycle
irregular
13.9 (194)
12.5 (A8)
Menstrual duration
irregular
4.6 (194)
2.1 (^8)
2 to 7 premature
babies
1.2 (233)
0.0
(28)
Less quantity of
flow
3.2 (194)
4.2 (48)
One still birth
5.0 (240)
3.7
(27)
Excessive quantity
of flow
2 to 7 still births
3.7
(27)
2.1 (48)
1.2 (240)
5.2 (194)
Leucorrhoea
23.7 (262)
22.6
(53)
Menstrual pain
37.9 (190)
40.4 (47)
Pruritis
4.6 (262)
3.8
(53)
Amenorrhoeagestational
6.6 (259)
7.8 (51)
Prolapse
0.0 (262)
0.0
(53)
Amenorrhoealactation
3.9 (259)
3.9 (51)
Amonorrhoeamonopause
27.0 (239)
7.8 (31)
1-2 Abortions
5.9 (239)
7.2 (28)
TABLE 18(h)
SELECTED CONDITIONS IN WHICH THERE ARE SUGGESTIVE DIFFERENCES
BETWEEN FIELD WORKERS AND THE CONTROL GROUP
■BKCCWWM—.......ncn
Prevalence (%) of morl jity condition
Morbidity
condition
F*
C*
According to Age
According to sex
All subjects
35-r60 yrs.
18-34 yrs.
Females
Males
P*
F*
C*
P»
F*
C*
P*
F*
C*
P»
F*
C*
P*
18
5
0.001
28
8
0.01
13
2
0.03
14
5
20
4
0.09
Worms i‘n stool
0.06
1
2
Joint pains and
back-ache
28
0.001
38
17
0.01
51
42
0.2
56
22
0.04
54
52
0.2
47
41
16
0.001
11
6
0.2
55
28
0.001
47
16
17
0.09
Pallor
0.001 38
3
3
1
0.2
5
0
0.1
2
2
0.2
2
1
0.2
3
0.2
Varicose veins
0
4
388
117
123
64
265
53
143
94
Total
245 23
24
18
0.20
20
23
0.20
27
12
0.03
21
15
26
30
0.20
Reduced appetite
0.20
1
Disturbed sleep
15
9
0.10
22
10
0.05
12
8
0.20
6
7
0.2
21
17
0.2
2
3
Peripheral
Neuritis
1
0.01
1
0
0.2
12
2
0.05
3
0
0.20
11
4
0.2
9
4
Bee/Wasp/
insect sting
8
0.01
30
12
0.01
20
4
0.01
15
7
0.09
29
14
0.2
24
0.09
8
2
0.2
3
0
0.2
2
0
6
0.2
5
1
4
Snake Bite
0.02
5
10
3
0.03
15
5
0.08
7
0
0.05
5
0
12
13
0.2
Scorpion bite
0.04
6
Leech bite
77
33
0.01
79
45
0.01
77
20
0.01
72
35
0.01
81
27
0.01
7
Total
386
117
123
64
264
53
143
94
244
23
Note: F* « Field
C* « Control
, . ,
due to change
P* B Probability that the observed difference or a larger one, could have arisen
I
J
J
(
50
SELECTED CONDITIONS IN WHICH THERE ARE SUGGESTIVE DIFFERENCES
BETWEEN FACTORY WORKERS AND THE CONTROL GROUP
TABLE 18(1)
(Males only)
Prevalance (%) of morbidity condition
According to age
35-60 years
All subjects
Morbidity condition
.
18-34 years
Factory
Control
P*
Factory
Control
P*
Factory
Control
P*
1.
Worms in stool
19
8
0.07
18
8
0.2
20
9
0.2
2.
Joint pains and
back ache
33
17
0.03
20
13
0.22
41
36
0.2
3.
Infective leasion (Skin)
14 .
3
0.03
18
2
0.01
12
9
0.2
4.
Lymphnode: Cervical,
tonsilar and axillary
18
8
0.1
25
10
0.08
15
0
0.2
5.
Glossitis, cheilosic
and angular stomatitis
8
2
0.1
8
0
0.05
8
9
0.2
6.
Varicose veins
8
0
0.02
6
0
0.1
y10
0
0.2
133
64
50
53
63
11
Total
Note: P* - Probability that the observed difference, or a larger one, could have arisen due to chance.
COMPARISONS BETWEEN FIELD WORKEHS AND THE CONTROL GROUP ACCORDING TO SEX AND AGE
TABLE 18(J)
a:
OMHMmsBwaKSHVvsmwwvBraDararBssEsrwscsssssocn
Prevalance (%) of morbidity condition
Morbidity condition
According to age
According to sex
All subjects
18-34 yrs.
Females
Males
35-60 yrs.
F*
C»
P*
"F*
C*
P*
F*
C*
P*
F*
C*
P*
F*
C*
P*
1.
Palpitation, breath
lessness and
swelling of feet
26
15
0.03
19
9
0.14
29
23
0.42
20
1
0.04
29
39
0.45
2.
Intermittent
claudication
2
2
0.99
4
2
0.67
0
2
0.31
1
1
0.99
2
4
0.99
3.
Head-ache, convulsion
and vertigo
41
36
0.41
40 28
0.15
41
45
0.68
38 31
0.29
42
57
0.26
4.
Visual disturbances
16
17
0.89
29 20
0.25
10
13
0.62
5 10
0.25
22
48
0.01
5.
Pterygium
3
4
0.99
3
5
0.99
3
4
0.99
2
3
0.68
4
9
0.99
6.
Neutritis, parasthesias and loss of
power
11
5
0.11
2
3
0.99
14
8
0.26
4
4
0.99
14
9
0.75
Reflexes: deep,
Superficial
and visceral
3
1
0.21
2
2
0.99
4
0
0.38
4
0
0.08
3
4
0.99
388
117
123
64
265
53
143
94
245
23
7.
Total
Note:
F*: Field
C#: Control
P*: Probability that the observed difference, or a larger one, could have arisen due to chance.
UBRA^
l /
>
and
documentation
i
)
51
COMPARISONS BETWEEN FACTORY WORKERS AND THE CONTROL GROUP ACCORDING TO AGE
TABLE 18(k)
(Males only)
Prevalanece (%) of morbidity condition
Morbidity condition
According to age
All subjects
35-60 years
18-3^ years
Factory
Control
P»
Factory
Control
P*
Factory
Control
P*
1.
Palpitation, breath
lessness and swell
ing of feet
12
9
0.75
10
6
0.48
15
27
0.99
2.
Intennittent claudi
cation
2
2
0.99
2
2
0.99
2
0
0.99
5.
Head-ache, convul
sion and vertigo
50
28
0.91
58
25
0.21
25
45
0.99
Visual disturbances
24
20
0.69
14
15
0.86
50
55
0.17
4.
10
5
0.34
6
2
0.35
18
0.99
Pterygjmri
12
5.
6.
Neuritis, paresthe
sias and loss of
power
5
0.99
'0
4
0.50
5
0
0.59
5
6
6-
0.99
2
8
0.56
0
0.59
Pallor
8
7.
8.
Reflexes: deep,
superficial and
visceral
2
0.43
2
0
0.49
6
9
0.99
5
155
64
50
55
Total
P* -
85
‘
=
—--------------Probability that the observed difference, or a larger one, could have arisen due to chance.
LABORATORY INVESTIGATIONS
CHAPTER X(D)
Results of the laboratory investigations
carried out by the field laboratory unit are presented in Tables
19A to 19E.
i) Hemoglobin estimation
Table 19A shows the hemoglobin values classified according to sex in field workers, factory
control group. Mean values and standard deviations are also shown.
workers and a
*’ i expectations based
On perusal of the table there appears to be a tendency for overall higher readings than
dehydration of samples during the
on clinical assessment. In a field situation, this could be due to some t
time of transportation.
However, since we are mainly interested in group trends, it is interesting to note that the values for fe
males are lesser than male values as expected and also there is a suggestive difference between
eld worxers (all pluckers) and controls (mostly housewives, students and other unemploye ).
with a hemoglobin value of 12 gms or less are 52% and 38% respectively. However, this difference
gnificant (P 0.1).
il) Erythrocyte Sedimentation Rate
Table 19B shows the ESR according to sex in field workers, factory workers and a control group. There are
no significant differences between the groups either in males or in females. However, the propox °n
an ESR of 21 mm or more is substantially higher in females than in males, both in field workers an
controls (P
0.01) suggesting possibly greater experience of infections.
iii) Total white cell count
Table 19C shows the total white blood counts accoruing to sex in field workers, factory
trol group. There are no significant differences between the groups among the males.
workers and a con-
7
52
Among the females, however, there is evidence that field workers had lower counts than the controls; for
instance, the proportion with a count of less than 9000 were 66 percent and 33 percent respectively (P
0.01). The clinical significance if at all of this finding is not very clear.
iv) Urine examination
Table 19D shows the results of the urine examination according to sex in field workers, factory workers
and a control group.
Urine albumin
There is a suggestive difference between field workers and controls among females.
Urine sugar
Urine positivity for sugar is significant in field workers both male and female being 3.5 to 3.6 percent,
More s ignificantly it is completely absent among factory workers and both control .groups. Since urine sampies were not collected at the laboratory but brought by the subjects no hasty conclusions can be drawn
from these suggestive differences.
TABLE 19A
haemoglobin according-to sex, in field workers, factory workers and a
CONTROL GROUP
Females
Haemoglobin
(gm/100 ml)
Field
workers
No.
%
Factory
workers
No.
%
Control
group
No.
%
Control
group
No.
%
Field
workers
No.
%
7
10
4
3.9
5
4.1
1
1.9
37
17.7
4
10.8
11
12
15
14.7
12
9.8
6
11.5
72
34.4
10
27.0
13 - 1^
28
27.5
41
33.3
19
36.5
82
39.2
19
51.4
15 - 16
46
45.1
53
43.1
20
38.5
16
7.7
3
8.1 .
17 - 19
9
8.8
12
9.8
6
11.5
2
1.0
1
2.7
Total
102
100.0
123
100.1
52
99.9
209
100.0
37
100.0
Mean
14.3
14.4
14.5
12.2
12.8
Standard
deviation
1.96
1.87
1.69
1.91
1.93
The seme argument holds good for the percentage positives for acetone in urine and microscope deposits
which appear to be much commoner than expected.
V) Stool Examination
Table 19D shows the results of stool examination for ova and cysts according to sex in field workers, fac
tory workers and a control group.
Though there are no significant difference between groups, worm infestations are relatively common in all
the groups. Ascariasis ranges from 19.8 to 36 percent, trichuriasis from 2.4 to 7.4 percent and anky ova
are upto 4.1 percent.
Though entamoeba histolytica and giardia lamblia cysts were identified in most of the groups, they were
not as high as one would expect considering the common histories of diarrhoeas and dysenteries and the potential for transmission of water borne infections.
Control population of females mostly housewives and students have a commoner experience of amoebiasis and
trichuriasis .
53
TABLE 19 B
ESR ACCORDING TO SEX, IN FIELD WORKERS, FACTORY WORKERS AND A CONTROL GROUP
Females
Males
ESR/hr (mm)
Factory
workers
No.
%
Field
workers
No.
%
Control
a group
No.
%
Control
group
No.
%
Field
workers
No.
%
16.6
27.6
31.5
24.3
6
18.8
12
5
9
37.5
15.6
4.9
30
50
57
44
100.1
181
100.0
32
100.0
63.4
9
4
2
22.0
8
68.2
25.5
3.6
2.7
26
8.8
75
28
4
3
Total
91
100.0
110
100.0
41
Mean
Standard
deviation
11.3
8.7
9.4
21.2
19.3
9.78
6.77
7.32
11.93
12.37
0-9
10 - 19
20 - 29
30
54
17
12
59.3
18.7
13.2
TABLE 1Q-C
9.8
TOTAL WHITE BLOOD COUNTS ACCORDING TO SEX, IN FIELD WORKERS, FACTORY
~~
*
WORKERS AND A CONTROL GROUP
Females
Males
Total white
blood counts
Field
workers
No.
%
Control
group
%
No.
Field
workers
No.
%
Factory
workers
No.
%
Control
group
No.
%
21.3
8
22
16.7
45.8
10.7
13
5
100.1
48
27.1
10.4
52
83
56
15
25.2
40.3
27.2
7.3
7
17
5
17.1
20.0
48.6
14.3
100.0
206
100.0
35
100.0
6
30
22.5
37.3
29.4
11
10.8
26
55
28
13
Total
102
100.0
122
Mean
Standard
deviation
8635
8448
8628
8369
9139
1944
1932
1698
1782
2146
7000
7000900011000
23
38
TABLE 19-P
28.1
RESULTS OF
45.1
23.0
URINE AND STOOLS EXAMINATION ACCORDING TO SEX, IN FIELD WORKERS,
FACTORY WORKERS AND A CONTROL GROUP
Examination
Field
workers
Urine
Uri ne
I rine
Urine
Stools
Stools
Stools
Stools
Stools
Stools
Albumin
Sugar
Acetone
Deposits
Ascaris
Trichurls
Anky
E. Histolytica
Giardia
E. Coli
Tot?1 (range)
Percentage positive
in females________
Percentage positive in
Male_s____________
0.9
3.5
0.9
3.5
36.1
7.4
2.8
0.9
1.9
0.0
107-114
Control
Factory
group
workers____
0.0
1.6
0.0
0.0
1.8
2.4
5.3
3.2
19.8
30.9
3.6
3.6
29.0
2.4
Control
group
4.2
0.0
2.1
4.2
23.8
7.1
0.0
4.8
0.0
0.0
42-48
Field
wo rk e rs
0.8
3.6
2.4
4.0
3.7
0.0
3.7
0.0
1.8
3.6
0.0
4.1
1.6
2.0
0.0
109-126
55-57
245-251
1.8
54
TABLE 20b
DISTRIBUTION OF MEAN ANTHROPOMETRIC MEASUREMENTS BY AGE ON
Age group
Total
No.
Weight
In Kg.
Height
in Cm.
Sitting
height
in Cm.
Waist
height
in Cm.
Annspan
in Cm.
Full inspi
ration
* in Cm.
6
8
6
48.6 4 10.0
47.5 4 3.3
43.0 4 5.7
44.1 4 5.9
46.4 +_ 7.2
48.8 4 5.8
161.7 4 10.5
164.0 4 4.0
159.0 4 6.8
82.3 4 5.6
79.8 4 4.6
98.9 ♦ 7.4
98.4 4 3.7
96.3 ♦ 6.3
180.0 4 10.8
181.9 ♦ 8.0
177.7 7 9.8
74.3 4 9.5
75.4 4 2.8
75.8 4 6.6
159.0 4
80.2 4 3.0
96.4 4 5.5
179.6 4
95.3 4 4.9
98.5 4 6.6
176.3 ±
9.8
9.4
73.6 4 4.8
82.7 4 4.2
82.1 4 3.0
183.3 ♦
8.0
78.5 4 4.9
82.6 4 3.9
97.3 4 7.4
98.1 4 4.1
9.6
182.5 ♦ 8.0
184.5 4 5.99
183.3 ± 8.98
183.6 4 10.00
78.1 4 5.3
79.6 4 5.6
184.0 4
80.2 4 5.5
18
19
20
21
22
23-27
28-32
33-37
38-42
43-47
48-52
10
7
32
6.2
7.4
5.9
47
41
49.8 4
7.1
162.4 4
51.9 ±
162.7 4
7.0
7.0
52
44
49.6 4
9.1
7.3
9.5'
9.0
163.1 ±
161.9 +
159.9 ±
162.2.4
6.9
6.9
6.0
6.4
49.5 ±
50.2 4
51.2 4
48
53
158.6 4
162.6 4_
35
7.7
83.4 7 4.36
83.5 4 4.0
82.2 4 5.6
81.5 ± 3.8
79.2 4 6.0
81.8 4 3.9
MALES
184.0 4
98.5 4 5.9
97.8 4 4.6
97.0 ± 9.1
97.0 4 6.7
9.99
TABLE 20b
DISTRIBUTION OF MEAN ANTHROPOMETRIC MEASUREMENTS BY AGE ON ^6 FEMALES
Age group
Total
No.
19
20
21
22
23-27
28-32
33-37
38-42
43-47
48-52
53
166.6 4_ 5.0
77.9 4 4.9
79.4 4 2.7
78.0 4 7.3
171.1 412.8
77.0 4 4.0
151.4 4. 6.5
75.8 4 2.4
97.0 4 6.7
148.9 + 5.9
148.7 4 4.5
151.2 4 5.0
76.2 4 2.6
90.7 4 5.4
168.2 4 7.7
75.0 411.0
75.8 4 3.3
167.3 ± 5.8
77.2 4 5.5
75.0 4 3.9
149.3 4 5.5
149.2 4 4.8
75.5 ± 2.6
77.5 ± 5.5
75.0 ± 2.9
73.7 4 3.2
89.9 ± 3.9
90.5 ± 5.0
89.8 4 3.9
91.3 4 4.0
168.9 + 6.5
168.1 4 9.0
75.3 ± 5.5
75.7 4 4.0
75.8 4 4.9
164.7 4 8.1
75.7 4 4.5
39.8 4 3.7
40.4 4 6.8
40.7 4 5.4
50
41
41.7 4 5.8
40.9 ♦. 6.4
40.5 + 7.1
40.2 4 5.8
79.2 4 6.0
146.8 ± 5.5
5
7
46
35
37
34
172.8 4 8.0
168.9 4 6.9
171.8 4 6.6
95.0 4 4.8
90.6 4 3.0
151.6 ± 3.7
148.7 4 3.8
152.1 4 5.4
40.3 4 4.8
39.8 4 5.9
Full inspi
ration
in Cm.
76.5 4 3.8
76.3 4 2.6
76.7 4 2.7
75.4 4 4.0
41.5 ± 5.0
41.7 4 4.7
44.0 4 2.0
50
Annspan
in Cm.
Waist
height
in Cm.
Height
in Cm.
9
78.5 4 4.6
79.1 ± 6.1
79.4 4 5.8
Sitting
height
in Cm.
Weight
in Kg.
7
15
18
75.1 ♦ 4.0
148.9 ♦ 6.2
146.1 4 5.9
76.1 4 2.9
93.6 ± 3.9
89.6 4 4.0
168.5 4 7.6
166.8 4 3.9
90.3 4 6.5
88.6 4 4.8
Note: Values are given as Mean ♦. SD
TABLE 20c
DISTRIBUTION OF MEAN ANTHROPOMETRIC MEASUREMENTS BY RELIGION
Rellgion
Sex
Total
No.
Weight in Kg.
Height in Cm.
Sitting Height in Cm.
Waist Height in Cm.
Armspan in Cm.
Full inspiration in Cm.
Note:
MUSLIM
CHRISTIAN
HINDU
Male
(247)
Female
(269)
Male
(67)
Female
(66)
48.8 4 7.0
40.3 + 5.0
149.0 + 5.0
50.8 4 6.7
41.3 ♦, 6,0
149.4 + 5.0
161.7 4 6.9
81.6 4 4.7
97.6 ± 5.0
184.1 4 9.0
78.0 4 5.0
75.7 + 3.0
90.0 4 4.7
166.0 4 7.6
76.0 4 4.7
162.3 4 7.0
81.8 +^4.6
97.4 4 5.0
183.7 ± 8.6
79.6 4 6.0
75.6 ± 3.0
91.3 + 2.0
169.8 ♦ 7.7
76.8 + 5.0
1. Figures in paranthesis indicate total number in each Category.
2. Values are given as Mean 4. SD
Male
(2)
Female
(1)
60.0 4 6.0 40.0
164.0 4 6.0 152.0
85.5 4 7.0 77.0
101.5
2.0 91.0.
188.5 4 7.0 171.0
88.5 + 2.0 74.0
FIG.-28
-Q— MALE
•— FEMALE
MEAN ANTHHOPOMETRIC MEASUREMENTS
BY AGE & SEX
200
4^
40.
180
■9-
s
4>
160
<*•
#*
140
120
100
^-
-a-
9-
80
■e
■Q-
-Q-
60
♦ ARM SPAN
** STANDING HEIGHT
+ WAIST HEIGHT
40
-H- SITTING HEIGHT
20
JO
20
40
AGE GROUP
I
50
+
55
DISTRIBUTION OF MEAN ANTHROPOMETRIC MEASUREMENTS BY SOCIO-ECONOMIC CLASSES
TABLE 20d
Socio
Economic
Classes
Sex
Total No
S.E. Class I
Male
Female
(5)
(6)
50.9 ± 8.0 44.0 4 6.0
Weight
in Kg.
Height 160.4 410.0 148.0 4 8.0
in Cm.
Sitting 78.9 414.0 75.8 4 4.0
height
in Cm.
Waist
93.0 4 9.0 89.6 4 4.0
height
in Cm.
Armspan 181.9 410.0 171.2 4 4.0
in Cm.
80.0 4 5.0
Full
inspi
ration
in Cm.
77.5 ± 5.0
S.E. Class II
S.E. Class III
S.E. Class IV
Male
(62)
Female
(24) -
Male
(204)
Female
(203)
Male
(65)
Female
(103)
52.2 4 7.0
40.5 * 7.0
48.6 ♦ 7.0
40.7 ♦ 5.0
48.9 ±
40.3 ♦ 6.0
163.3 4 7.0 149.2 4 6.0
161.1 4 7.0 148.9 4 5.0
162.8 4 6.7 149.6 4 6.0
83.0 4 4.0
74.8 4 3.0
81.4 4 5.0
81.4 4 5.0
82.1 4 4.0
75.2 4 8.0
98.8 4 6.0
90.9 ± 6.0
96.3 ± 7.0
90.3 4 5.0 • 99.9 ♦ 6.0
90.5 4 5.5
184.9 4 9.0 167.0 410.0
80.4 4 5.0
75.0 4 6.0
182.6 410.0 168.1 4 7.0
78.3 4 6.0
78.6 4 5.0
182.6 411.0 167.8 4 8.0
77.7 ± 6.0
75.9 ± 5.0
NOTE: 1) Figures in brackets indicate total number in each category
2) Socio-economic Classes adapted from B.G. Prasad’s (1970) classification.
DISTRIBUTION OF MEAN ANTHROPOMETRIC MEASUREMENTS BY OCCUPATIONS
TABLE 20e
Profes
sion
Sex
Total No
Pluckers
Male
Female
(6)
(250)
57.2 413.0 40.0 4 6.0
Weight
in Kg.
Height 163.0 4 2.0 149.0 4 5.0
in Cm.
Sitting 81,7 4 3.0 75.6 ± 3.0
height
in Cm.
100.8 4 2.0 90.1 4 5.0
Waist
height
in Cm.
Armspan 188.0 4 7.0 167.0 4 6.0
in Cm.
78.2 4 7.0 76.0 4 5.0
Full
Agriculture
Male
(142)
48.5 4 7.0
Miscellaneous
Factory
Female
(40)
Mele
(105)
Female
(16)
Male
(83)
Female
(50)
39.0 4 7.0
51.0 4 7.0
40.0 4 5.0
50.6 4 9.0
43.6 4 9.0
161.0 4 6.0 149.0 4 6.0
162.3 ± 7.0 148.3 4 5.0
81.2 4 4.0
75.9 ± 3.0
82.3 4 5.0
74.6 4 2.0
82.2 4 5.0
76.0 4 3.0
96.3 4 8.0
88.0 4 9.0
98.7 ± 5.0
90.9 4 6.0
97.3 4 6.0
93.5 4 6.0
182.0 4 9.0 166.0 4 6.0
78.0 4 6.0
74.4 4 4.0
184.0 4 9.0 167.7 411.0
79.1 ± 5.0
70.4 4 5.0
inspi
ration
in Cm.
NOTE:
161.9 * 7.0 150.6 4 7.0
1) Figures in brakets indicate total number in each category
2) Values are expressed as Mean 4 SD
183.7 4 9.0 170.0 4 8.0
78.7 4 7.0
78.6 4 6.0
56
CHAPTER X(E)
/j^thropoketric measurements
The measurements of 336 adult males and an equal wmber of female, in the age group 18-53+ «re subject to
analysis.
These belonged to samples from estate A, B and C.
• -> measurements grouped according to age and sex. The dlstriTable 20a and 20b show the dispersion of various
rellgion, occupation and socio-economic condition are shown in
bution of these measurements according to 1 - „
Tables 20(c), 20(d) and 20(e).
From the anthropometric data, we can conclude:
(1) The data (Tables 20a end 20e) show that:
i) All skeletal growth in the population reaches
optimum by 20, females dimensions being lower
iii) Physical size has little relevance-» to the selection on a particular ^ob on 1the
— plantations.
at all age group.
ii) Religion and socio economic condition do not
modify optimum skeletal growth.
(2) The mean measurements as well as the variability of these measurements
parable to other studies done on South Indian populations.
obaerved in this study are com-
* ~i the mean weiboth male and female subjects in this study are generally lower than
(J) The body weights of
reported in other
i population but they tend to increase with age as i .
ght of each group in the general Indian
different enough to explain this finding.
studies. Their health status was not u.,
i and have ad(4) Though the population is of mixed origin, they have been in Nilgiris for many generations
of
be reflected in the absence c variation in
opted a common cultural pattern including diet habits which may
their anthropometry.
selection of manpower in any Job, it could be concluded that the present physical re(5) Since there is no
a candidate as unparticular Job at the tea estate is not too demanding for rejecting
quirements for any
suitable, purely on his physical dimensions.
(6) As the status of most of the plantation labour in South India are similar, the present dat"
-rve
as the norms for physical standards for pre-placement medical examination. It can also serve
of machines, cards and even ready made dresses for the use of these plantations.
CHAPTER X(F)
CHOLI NESTERASE ESTIMATIONS
Table 21(a) shows the mean enzyme activity of each occupational group within the ssmple of A20 subjects
(236 male and 192 females) divided into two. broad age groups and by sex.
All the individual values were observed to be well within normal acceptable limits but the mean
values in
the group showed the following trends:
1) Agricultural workers and sprayers representing the populations exposed to organo phosphorous pesticides
have mean enzyme values much lower than factory workers and controls.
exposed population but did not show as marked reduction probably because
ii) Pluckers were also considered
prevent pestion the bushes where plucking is due, possibly to
we found that no pesticide spraying is done
potential hazard exists in reality. it is less
cide contamination of tea meant for export. Hence though the
than the earlier group.
iii) Factory workers had the highest levels.
I
tended to show lower values particularly among the young males. Since some of
lv) Miscellaneous groups also
them also do casual Jobs they could also be considered exposed group.
V) Enzyme activity levels decrease with age. This is seen in all the age groups except with the
ous group which is probably because of the fact that some of the younger group go for casual wor
gardens and get exposed to the pesticides whereas the older people have no risk.
57
vi) It is also observed that the females of the age group of 20-45 among agricultural workers have an ave
rage enzyme activity of 82.76 units which is less, when compared to the average enzyme activity of 96.24
units shown by the males in the same group. This is also seen in the total group irrespective of age and
occupation. This may be due to the fact that of the total groups of males (181) and females (150 ) 30* and
84% respectively have definite occupational exposure. This unequal numbers of exposed may be reflected in
lower female means and neutralise the advantage of normal physiological phenomena of higher values in
females.
vii) The data may also suggest that the rate of reduction of enzyme activity when exposed to organophospho
rous pesticides may be related directly to the normal level, le., the higher the initial level, more will be
the drop in level owing to exposure. In other words, the toxicity from the levels of cholinesterase activity
suggests that younger people have higher risk of toxicity compared to older people and also young female
workers have higher risk than the corresponding females. This is well exemplified by the observation on the
agricultural workers where the mean enzyme activity of young females is less than that of young males. This
interesting observation needs further substantiation.
CHAPTER X(G)
ENVIRONMENTAL HYGIENE PARAMETERS IN FACTORIES
Four medium sized tea factories in the Nilgiris were visited and certain parameters were measured shown in
Tables 22A to 22D. The values shown are mean levels of various measurements recorded in the withering, Rol
ling, Sifting, Firing and Packing sections of these factories.
Measurements included temperature by wet bulb, dry bulb and globe thermometers, noise level and illumination.
Humidity, WBGT index and corrected Effective Temperature (GET) were calculated from above.
Dust concentrations and particulate size were also assessed.
Table 22E shows the range of values by sections of factories amalgamating the recordings in all four-
factories.
i) Temperature
The over all range of dry and wet bulb temperature recordings are 14.5* -26°C and 18.5O-43°C respectively.
Withering lofts are the coolest - being also the highest points in the factory and very well ventilated.
The firing/drying sections are the hottest because of the presence of the furnace. The highest temperature
recorded was 43 deg. C. Radiant heat was highest in the drying section because of the furnace. The highest
temperature recorded was 46 deg. C.
11) Humidity
Ranged from 23 percent to 96 percent but the overall value was within normal limits. Higher readings were
obtained in the withering and rolling sections.
iii) Heat stress indices
WBGT index ranged from 16.3 to 30.9 deg and GET from 15.5 deg to 31 deg 0. Except the firing/drying section
these were well within normal limits in all the other sections.
iv) Illumination
This parameter showed a very wide range from 5 to 1650 lux. All the sections showed variation in levels of
illumination but the overall picture was average.
v) Dust levels
We used a midget impinger to collect dust samples and found the concentration of dust to be between 1.1 to
5.5 million particles per cubic feet in all the sections except the sifting sections where the highest recordings were 59.5 mppcf. Sifting sections have, therefore, a definite dust hazard. .
However, since the proportion of particles of less than 5
size in all the samples were between 82-100
percent we presumed that the use of midget impinger was excluding collbction of larger size dust particles
which are expected in situations of dust arising out of vegetable fibres. This phenomena is well known and
though we used the midget impinger, since it was the only apparatus available, dus. concentrations will
have to be redone in the factories in the future using a hexhlet or soxhlet-hexhlet pair described in
Pinnagoda (1971), which gives a better quantitative estimation of dust levels.
58
MEAN SERUM CHOLINESTERASE ACTIVITY BY AGE, SEX & OCCUPATION
table 21
Age
Group
Agricultural
workers
Sprayers
mean
che.
activity
mean
che.
activity
S
E
X
20-45
Years
M
6
122.8
M
All
ages
M
52
F
25
F
1 107.0
100.0
19
420.41
32
111.0
4 -
419.75
104.5
421.03
16 111.3
417.22
56 106.47
418.89
41
1.41
+ 20.06
145 103.18
4 100.8
47 100.65
34
217
98.95
+ 25.2
+ 19,6
418.16
1 120.0
99.7
423.3
114 115.6
417.01
+22.06
192
17 111.81
127.85
142 103.11
+16.67
+14.25
421.63
8
83.75
161 108.39
98.7
426.19
101
4,
95.9
No.
No.
30
143.0
2
418.35
100.76
17
421.06
mean
che.
activity
417.57
70.0
3
mean
che.
activity
416.85.
415.77
46
and
abo
ve
mean
che.
activity
416.9
84.4
22
F
All
Workers
117.4
4 20.4
421.74
Miscellaneous
Group
No.
82
95.2
16
101.2
33
Pluckers
mean
che’,
activity
No.
No.
No.
Factory
Workers
415.67
Values are enzyme activity s)easui*ed at the end of 30 minutes
NOTE:
Group values are expressed as means + SD
Section
(Range of values)
ENVIRONMENTAL PHYSICAL PARAMETERS
TABLE 22(a)
WB
•C
No. of
Samples
Noise
db
Illumination (lux)
16.3-23.5
17.2-21.8
16.5- 24.5 76-92
15.5- 22.00 78-86
5-1650
17.1-26.6
18.00-27.5 78-102
13- 190
CET
•C
WBGT
•C
G.T.
•C
DB
°C
Humidity
%
44-88
20.00-28.00
33-96
36
49
83
14.5-20.00
15.00-20.00
20.00-26.5
18.5- 26.00
15.00-23.5
19.5- 34.00
29-70
18.5- 26.5
19.5- 35.00
Firing/
Drying
18.5-26.00
21.5-43.00
23-60
28.00-46.00
20.4-30.9
22.00-31 <00 70-84
8-700
46
19.5-23.00
27.00-30.00
42-65
27.00-31.00
22.1-24.5
44-65
11
22.5-25.00 96-102
Packing
Withering
Rolling
Sifting
12- 110
ENVIRONMENTAL PHYSICAL PARAMETERS IN FACTORY - A
TABLE 22b
No.of
Sam
ples
WB
•C
DB
WBGT
°C
CET
■C
Illu
Noise mina
db
tion
Humidity
%
GT
•C
73.0
68.0-77.0
20.6
19.0-22.0
18.3
17.6-19.2
19-0
18.0-20.0
80
25
73.0
68.0-77.0
20.6
19.0-22.0
18.3
17.6-19.2
19-0
18.0-20.0
83
60
Depart
ment
Sampling
Point
Rolling:
1
Rolling
Machine
4
17.4
16.5- 18.0
2
Roll
Breaker
4
17.4
16.5- 16.0
20.6
19.5-22.0
20.6
19.5-22.0
Sifter
6
17.2
16.0-18.0
63.0
59.0-70.0
22.0
19.5-24.0
18.6
17.1-19.6
19.5
18.0-20.5
42
1
21.8
19.5-23.5
86
Si X’ting:
Drier
6
28.4
26.0-30.0
45.0
42.0-51.0
30.7
29.5-32.0
23.4
21.8-24.0
24.5
23.5-25.0
700
1
20.2
18.5-21.0
78
F iring:
19.8
16.5-22.5
29.3
21.5-34.5
43.0
35.0-60.0
35.3
29.5-40.0
25.5
24.5
20.4-27.8 . 22.0-28.5
60
Furnace
6
70
2
®C
NOTE: 1) All temperature measurements are means of values recorded by hourly sampling.
2) Second lines indicate range.
3) All measurement were taken for the duration of the shift.
59
ENVIRONMENTAL PHYSICAL PARAMETERS IN FACTORY - B
TABLE 22c
Sampling
point
Depart
ment
Withering
Rolling
Sifting
Firing
Packing
No. of
Samples
%
GT
•C
WBGT
•C
WB
•C
DB
°C
Humidity
GET
• tc
Noise
db
Illu
mina
tion
19.3
19.0-20.0
22.0
22.0-22.0
78.0
76.0-84.0
22.6
22.5-23.0
20.3
20.1-20.9
20.6
20.5-21.0
23
Fan end
4
88
1
19.3
19.0-20.0
22.0
22.0-22.0
78.0
76.0-84.0
22.6
22.5-23.0
20.3
20.1-20.9
20.6
20.5-21.0
35
Mid point
4
81
2
19.5
19.0-20.0
22.5
22.0-23.0
77.0
76.0-80.0
23.3
23.0-23.5
20.7
20.2-21.1
21.5
21.0-22.0
85
Opp. to
fan end
4
76
3
20.5
20.0-21.0
22.1
21.0-23.5
87.0
80.0-96.0
22.4
21.5-23.5
21.0
20.5-21.6
21.0
20.0-22.0
75
Rolling
machine
4
80
1
20.5
20.0-21.0
22.1
21.0-23.5
87.0
80.0-96.0
22.5
21.5-23.5
21.0
20.5-21.6
21.0
20.0-22.0
75
Roll
breaker
4
84
2
Fermen
-tation
4
20.1
19.0-21.0
22.0
20.5-24.0
85.0
80.0-95.0
22.5 •
21.0-23.5
20.8
19.6-21.8
20.0
17.5-21.5
82
55
3
21.8
20.5-23.0
31.2
29.0-34.0
44.0
39.0-47.0
32.1
29.0-34.5
24.9
22.9-26.6
26.0
24.5-27.5
115
Flbrex
machine
7
82
1
22.3
21.5-23.5
31.8
30.0-33.5
45.0
38.0-47.0
32.3
30.5-34.0
25.3
24.2-26.4
26.4
25.0-27.5
47
Sifter
6
84
2
7
20.2
19.3-21.5
29.1
27.0-32.0
43.0
35.0-52.0
30.6
28.0-33.5
23.3
22.4-25.6
25.1
24.0-27.5
65
Milling
Machine
83
3
7
31.3
28.5-34.0
44.0
39.0-51.0
31.8
29.0-35.0
24.9
23.4-26.6
26.1
25.0-27.5
110
Winnower
21.9
21.0-23.0
81
4
26.0
26.0-26.0
38.3
36.0-^40.0
38.0
33.0-45.0
40.4
38.5-42.0
30.3
29.8-30.8
30.6
30.0-31.0
8
Drier
4
80
1
20.5
19.0-22.0
27.0
26.0-29.0
55.0
52.0-58.0
29.5
28.0-31.0
23.2
21.7-24.7
24.8
23.5-26.0
75
Furnace
4
75
2
Packing
6
20.1
19.5-21.0
28.1
27.0-30.0
48.0
42.0-54.0
28.3
27.0-31.0
22.6
22.1-23.7
102
23.7
22.5-25.0
44
1
NOTE:
(D
All temperature measurements are means
of values recorded by hourly sampling
(2)
Second lines indicate range
(5)
All measurements taken for the duration of the shift.
60
F.NVIROhHENTAL PHYSICAL PARAMETERS IN FACTORY - C
TAELE 22d
Withering
Rolling
Sifting
Firing
Packing
No. of
Samp
les
Sampling
point
Depart
ment
•C
DB
•C
Humidity
%
GT
•C
WBGT
•C
CET
°C
■tfB
Illu
Noise mina
db
tion
1
Loft Fan
end
6
20.0
18.5-21.0
23.5
20.0-26.5
74.0
52.0-88.0
23.7
20.0-26.5
21.1
19.0-22.5
21.0
17.0-24.0
92
140
2
Opp. to
fan end
6
19.8
18.0-21.0
23.6
20.0-26.0
71.0
56.0-83.0
24.1
20.0-28.0
21.1 .
18.6-23.5
21.4
16.5-24.5
80
1650
Rolling
machine
5
17.0
16.0-18.0
20.0
19.0-21.0
74.0
63.0-82.0
20.0
19.0-21.0
17.9
17.3-18.6
17.8
15.5-19.5
78
50
2
Roll
Breaker
5
17.0
16.0-18.0
20.0
19.0-21.0
74.0
63.0-82.0
20.0
19.0-21.0
17.9
17.3-18.6
17.8
15.5-19.5
86
90
3
Fermen
tation
5
17.0
16.0-18.5
20.1
18.5-21.5
74.0
59.0-87.0
20.1
18.5-21.5
17.9
17.2-19.1
17.2
15.5-20.0
80
50
1
Fibre
Machine
6
22.1
20.5-23.5
29.3
28.0-30.5
54.0
48.0-60.0
29.8
28.0-31.0
24.4
23.1-25.5
25.4
24.5-26.0
86
190
2
Sifter
6
21.9
20.0-23.5
29.7
28.0-31.0
51.0
45.0-55.0
29.9
29.0-31.0
24.3
22.6-25.8
25.6
24.5-26.0
92
50
3
Killing
6
21.8
19.5-23.0
29.5
26.0-31.5
51.0
46.0-60.0
30.0
27.0-31.5
24.3
21.8-25.2
25.6
23.5-26.5
102
175
4
Winnower
6
25.9
20.0-23.5
29.5
28,0-31.0
51.0
45.0-55.0
29.9
29.0-31.0
24.3
22.6,25.8
25.6
24.5-26.0
86
70
1
Drier
5
21.7
21.0-22.5
28.4
27.0-30.0
55.0
53.0-57.0
31.6
29.0-34.0
24.7
23.7-26.0
26.1
25.0-27.5
76
35
2
Furnace
5
22.3
22.0-23.0
30.2
29.0-31.0
51.0
46.0-56.0
33.2
32.0-34.0
25.6
25.2-26.3
27.0
26.5-27.5
72
55
1
Packing
5
21.6
21.0-23.0
27.1
26.0-29.0
60.0
55.0-65.0
27.0
26.0-29.0
23.3
22.5-24.5
24.2
23.5-24.5
96
65
3
1
NOTE:
(D
All temperature measurements are means of values recorded by hourly
sampling.
(2)
Second lines indicate range
(3)
All measurements were taken for the duration of the shift.
(
61
ENVIRONMENTAL PHYSICAL PARAMETERS IN FACTORY - D
TABLE 22e
Depart
ment
Sampling
point
No. of
Samples
WB
•C
D3
•C
Humidity
%
GT
•C
Withering
1 = Loft .Fan
end
4
17.0
16.0-18.0
24.3
23.0-25.0
48.0
44.0-50.0
24.9
23.5-26.0
19.4
18.3-20.4
2
Loft Mid
Point
4
16.1
15.0-16.5
22.9
21.5r24.0
50.0
47.0-52.0
23.4
22.0-24.5
3
Loft Opp.
to fan end
4
15.9
14.5-17.0
21.5
20.0-22.5
56.0
5UO-59.O
1
Rolling
machine
8
16.0
15.5-16.0
24.8
23.0-25.5
2. Roll
breaker
8
16.0
15.5-17.0
Rolling
Sifting
Firing
WBGT
V. *C
CET
•C
Noiae Illu
mina
db
tion
86
5
18.3
17.1-18.9
74
12
22.5
20.5-24.0
17.9
16.3-19.1
69
260
39.0
35.0-50.0
25.4
23.5-26.5
18.8
17.9-19.5
80
30
24.8
23.0-26.0
41.0
35.0-48.0
25.4
23.5-26.5
18.8
17.9-19.8
86
12
'
3
Fermenta
tion
8
15.5
15.0-16.5
24.6
23.0-26.0
38.0
33.0-48.0
25.3
23.5-26.5
18.4
17.6-19.5
78
.110
1
Fibrex
machine
8
18.2
16.0-20.0
26.7
25.5-29.0
44.0
32.0-49.0
27.4
26.5-29.5
21.0
19.3-22.9
78
16
2
Sifter
8
18.1
15.0-19.0
26.6
26.0-28.0
42.0
29.0-48.0
27.2
25.5-30.0
20.8
18.5-23.0
82
24
3
Milling
machine
8
18.1
15.0-19.5
26.8
26.0-28.5
42.0
29.0-51.0
27.7
26.5-29.0
21.0
18.5-22.4
86
13
1
Drier
8
22.1
20.5-25.0
35.0
29.5-43.0
34.0
23.0-45.0
39.8
33.0-44.5
27.4
24.5-30.9
82
30
2
Furnace
room
8
19.6
18.5-21.0
27.9
25.9-30.0
46.0
39.0-57.0
37.9
32.0-46.0
25.1
23.0-27.9
84
80
i
NOTE:
(D
All temperature measurements are means of values recorded by hourly sampling
(2)
Second lines indicate range
(3)
All measurements were taken for the duration of the shift.
62
Vi) Noise levels
-- four
- •
' -j. All the levels were
Decibel levels were measured In 36 points In various sections of- all
factories
level between 70-90 dB and 5 points had levels above 90 dB.
higher than 70 dB. Thirty one points had a
---- -------------These were the fan end of the withering section in Factory ‘C’, the Sifting and Milling machines in Factory
assessment of the workers was possi•C’ and the Packing sections of Factories ’B* and ’C*. No audiometric
ble because of the non-availability of a mobile audiometric unit.
MISCELLANEOUS DATA
CHAPTER X(H)
During the field study we reviewed the records maintained by the estate offices and medical centres on tea
production, types of Job, productivity, absenteeism (due to sickness and other reasons) and outpatient/inpatient records. Without requiring to collect any date separately and specifically for our study we oo.e
at monthly trends over the reference year, May 1978 to April 1979 to determine any information of epiaem osimplee me
logical significance. The main aim was to try and look at available data on the estates, bo
so that simp
thodiogies can be worked out to derive information and trends on health.
(a) Seasonal variations of work and sickness absenteeism
The following are some of the important trends seen during the 12 month review.
men-
Figure 29 is a graphic recording of monthly tea production, mandays worked by male and female workers.
days lost due to sickness and other leave, for a 15 months period.
Figure 30 is a graphic recording of monthly variations of Jobs on an estate and the relation with sickness
absenteeism. Though there are many Jobs on the estate, for the purpose of comparison five major Jobs ie.,
agricultural work, plucking, spraying,'chemical weeding and factory work are shown. Agricultural work inc
luded clearing, manuring,^pruning flopping and other miscellaneous but related activities.
The important conclusions derived from a perusal of both graphs are:
i) Seasonal variations of jobs
Tea production peaks in March, May-June and November and is low in July, August, October and January.
The five Jobs shown in the graph have their own peaks and lows depending on season, weather conditions and
needs of the tea bush.
Agricultural work
Peaks in July, September, December and March and is low in May, June, November and February. Range is 80-
1400 mandays per month.
Plucking
Peaks in May, June
mandays per month.
, December and March and is low in September, October and February. Range is 3000-8500
Spraying
Peaks in August, December, February and March and is lowest in May to July. Range is 10-500 mandays per
month.
Weeding
Peaks in September , December and March and is lowest in May and February. Range is 100-950 mandays per
month.
Factory work
Peaks in July, September, December and March and is low in May , June, November and February. Range is 130770 mandays per month.
Incidentally February is the month of annual leave and this explains the reason why all work is at its lowest ebb during this month.
•
-*
--- cases
- --3 of illnesses due to the hazards of spe
Epidemiologically these variations are of- significance
since
cific work processes may report to hospital during the peak seasons of that work process. Because of the
he
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63
increased volume of specific work there is a tendency to put more
be more inexperienced hands, hence adding to the health risk.
hands on the job and many of these may
11) Productivity pattern
these being more or less parallel throughMandays worked by male and female workers show similar trends r which is the annual leave period. They
out the year, They peak in March and May and are lowest in February
but interestingly not in November. The range is
coincide with the peaks of tea production in March and May 1— -----2600-4500 mandays per month in males and 3700-6400 womandays in females.
iii) Sickness absenteeism
lowest in February and March. The sickMandays lost due to sickness peak in September and December and are
ia between 80-400 manness is marked between July to December - the monsoon and winter months. The range
days per month.
iv) Absenteeism other than sickness
Mandays lost due to other leave remains constant between March to December and increases in Jan ary
peaks in February which as has been mentioned before coincides with the annual leave period. The range
a
between 900-1200 mandays per month and 2100-2200 in January and February.
v) Suggested co-relationships in these trends
Sicnness absenteeism peaks In September which coincides with peaks in factory work and weeding.
coincides with peaks in factory work - weeding, pluckThe second peak of sickness absenteeism in December
• • • factory
'• -*•
r work and weeding cooperations
ing and spraying. This consistency in the peaks of absenteeism with
is an interesting correlation worth investigating further. Sickness absenteeism itself can be further clas
sified by types of illness or these graphs linked to hospital morbidity statistics and probable cau a
r
lationships discovered.
It is also possible that there are other factors responsible for this trend which need to be further
investigated.
definite inter-relationships or conclusions
The same trencs should be studied for 3-10 year periods before
very
important
study
of great epidemiological signilicance.
can be drawn and this could prove to be a
of timing future fieAnother important use of studying seasonal variations of Jobs will be for the purpose
Id studies to coincide with peaks in productivity and work performance, eg., December may be a better month
than May-June which was selected for this study.
Some more data in this area have been collected and is being analysed. The results will be reported
subsequently.
(b) Hospital Eirth and Death Register
The entries were analysed for the reference year May 1976 to April 1979.
There were 18 births and 8 deaths and 2 deaths under one year of age.
•
“i the estate since
On the assumption that these would represent the actual numbers of births and- deaths
on
the
management
vital indices
registration ensures maternity benefit, funeral benefit and other help from t— —
for the estate were calculated.
1) Crude birth rate « 17.9/1000
iii) Infant mortality rate «= 111
ii) Crude death rate « 7.9/1000
iv) Age of mothers
Further analysis of the IB births recorded showed that 5% of the mothers were
in the 20-24 age group most-
ly first and second para.
v) Site of delivery
There were 10 home deliveries (55 percent) and 8 hospital deliveries (45 percent) and there were equal num-
ber of workers and non-workers among * " mothers (9 each).
vi) Age and causes of death
certified with cau-
The deaths were mostly at home (seven) and only one in the hospital, Four deaths were
The
ses such as cirrhosis liver, pulmonary odema, status epilepticus and hypertension with hemiplegia.
(
64
(
deaths were distributed over all the age groups. Two were 0-1 year, none in the 1-4 age group, one in 5-14,
one in 15-44, 2 in 45-59 age groqp and 2 above sixty.
The numbere were too email to calculate morbidity/mortality rates. Analysis of these registers for longer
periods of time could show useful epidemiological trends.
CHAPTER XI
DISCUSSION
(A) Summary of Findings
The pilot study undertaken by us had a very wide scope of investigation. On review of the literature, it
was obvious that all the studies done on plantations had been on selected sections of the population, ie.,
children, workers and so on and not on the total population. In some^the family had been the Unit of inves
tigation like Ramalingaswami 1949 bit in none had all the families been studied. We proposed such a commu
nity based study in order to get a baseline health profile of all components of the population — different
age groups, different occupational groups and so on so that meaningful comparisons can be made and occupa
tional and home environment influences can be differentiated. This is particularly important in studies on
agricultural communities where the distinct differences between home and work environment as in the indus
trial situation, do not exist. Questions such as whether hazards of snake bites or ankylostomiasis are an
occupational risk or a home risk, and if both then how much is the additional occupational risk etc., can
be answered or atleast attempted to be answered in the presence of total population data. The problem of
total population survey however adds an important quantitative load on the field team making logistics ra
ther challenging. A certain loss of depth perception of problems is bound to take place when one is investi
gating hundreds rather than tens of people since there are limits to the questions, examinations and labora
tory investigations that can be carried out in the field.
Keeping these in mind we will recapitulate the main findings of the study as follows:
I) The pilot study was carried out on approximately 1400 subjects on three estates in the Nilgiris (1169 In
Estate ’A')II) The total population of one estate and the factory workers and families of the second estate and the
factory workers’were'covered-in the study.
ill) The family was the unit of investigation in Estates A & B.
iv) Data on demographic characteristics, medical history, anthropometry, physical examinations and labora
tory Investigations of urine, stool and bj.ood was done on all the subjects, cholinesterase levels especia
lly of the working population was estimated and special investigations such as radiological examination of
the chest were carried out whenever Indicated.
v) The data presented on the analysis of the total population of Estate A (1189 individuals in 26l families)
shows a predominantly younger population showing evidence of stability, higher literacy rate, better accep
tance of family planning and lower unemployment rates than the general population. The population both Hindu
and Christian had a very large percentage of scheduled castes and tribes. Average family size was 4.5, dep
endency ratio 58.32 and predominantly lower and lower middle income groups.
vi) The status of home environment was average- in terms of lighting, ventilation, electrification, kitchens
and bathrooms and very good in terms of water supply (91.5 percent got a protected tap water supply). Sani
tation arrangements were provided but poorly maintained.
vii) Health Status: The data on 655 subjects in the working age group 18-60 was analysed to build up a hea
lth status profile.
The top ten causes for morbidity on the plantations are leech bites, backaches and joint pains, respiratory
infections, anemia, insect stings, accidents in men, menstrual problems and leucorrhoea in women, worm in
festations, headaches and symptom of reduced appetite.
Field workers experience of worm infestations, leech bites, insect stings, anemia, joint pains and back
aches is significantly more than the control group who share the same home environment. Histories of pares
thesia and neuritis are also more common. Varicose veins, snake and scorpion bite, disturbed sleep and re
duced appetite are also common.
Factory workers experience worm infestations, joint pains and back ache, signs of vitamin B deficiency,
varicose veins, infective lesions of skin sore than the control group.
65
Respiratory signs and symptoms are highly prevalent In all groups probably reflective of the weather condl-
tions
in the hills. Though wales in field and factory had a »uch higher prevalence this was not statlatl-
cally significant.
Laboratory investigations showed
showed evidence
evidence of
of anemia
anemia in
in an
all groups
groups of females and worm infestations viii)
ascariasis, ankylostomiasis, trichuriasis in all the groups. Asioebiasis and giardiasis were also c mmon.
comparable to other South Indian populations. Body weights in
lx) Anthropometry showed mean measurements
Inspite of mixed origins the anthropomeboth males and females were lower than general Indian population,
self selection by occupation. Religion and socio-economic class had notry was homogenous and there was no
modifying effect.
x) Cholinesterase levels were within normal limits for all occupational groups but agricultural workers and
sprayers (exposed population) had values lower than factory workers and controls. There was some evidence
that younger age groups and especially females had greater risk of developing toxicity to organophosphorous
pesticides.
xi) Occupational hygiene parameters measured in the factory environment showed a potential noise hazards in
in the drying/firing see
all sections especially the Packing and Sifting sections, evidence of heat stress
tion and a dust hazard in the sifting section.
and sickness absenteeism data collected on a monthly basia
xii) Preliminary analysis of work, productivity
showed that sickness absenteeism was relating to peaks in factory operations and weeding operations with
some consistency.
xiii) To conclude the health profile of the tea plantation workers show evidence that the important occupa
tional hazards are stings and bites and problems of the musculo-skeletal systems. High prevalence of worm
infestations and respiratory problems, may be reflective of sanitation and weather conditions and anemias
may be reflective of the nutritional status and ankylostomiasis. The risk of toxicity to agricultural che
micals particularly organophosphorous pesticides though not conclusively proved is strongly suggested by
the presence of symptoms reported in literature to be associated with chronic toxicity and changes in cho
linesterase levels. Accidents rates are high in men in both the field and factory and skin infections and
varicose veins in males in factory. These need further substantiation. Six symptoms of disturbed sleep, re
duced appetite, weakness, nausea and fullness, abdominal pain and painlul/burnlng micturition thoug
g
y
subjective are rather common and need to be thoroughly Investigated.
(B) Comparisons
Review of literature shows that very few studies were done on total population of the estate and hence com
parisons'of the findings of this pilot study with other reported studies is not possible.
i) Ramalingaswami and Patwardhan (1949) studied 1592 individuals - samples of families from many estates.
Our findings, 50 years later show similar findings on weight, vitamin B deficiency, anemia, skin infections
and upper respiratory infections. Since we took only the occupational age group in the first stage of our
analysis a direct comparison of data cannot be made though this will be attempted in ^tage II when the
tai population data will be present, ie., under 18 and over 6O’s.
Interestingly, they too reported histories of vague symptoms such as1 lack of appetite, abdominal distension, early fatigability and symptoms of gastro-duodenal ulcers as zsigns needing further investigations.
Vitamin A deficiency and malaria are not as important problems now as before.
ii) Our findings on gastro-intestinal infections and worm infestations are slightly higher than those rep
orted by UPASI (1979) and the interns in Narayan (1978) but probably a truer representation since they are
backed by laboratory investigation of stool and not review of hospital data as the earlier study.
iii) Our findings re-emphasise and corroborate the conclusions drawn by interns of—
St John’s Medical
such
as
accidents,
respiratory disCollege in their short term projects reported by Narayan 1982 in areas t-—
—
most
of
these
projects
eases, water borne diseases, anemia and gynaecological complaints. However, since
were not total population data but ’opportunistic’ samples direct comparisons are i rre lev ant.
iv) The study on coir workers reported by the Regional Occupational Health Centre (ICMR) in the Annual report 1978 (R.O.H.C. 1979) is probably the only other total population study which is really comparable with
our study. There asthma, elephantiasis, skin diseases, fever with cough, gastro-intestinal illnesses and
•
-? as non
bleedings were found to be the commonest cause of morbidity. Coir workers had the same experience
coir workers and controls though there was an attributable extra risk for skin diseases, respiratory
•66
diseases and elephantiasis because of the occupation. Elephantiasis conuaon in the coir population were absent in our sample since curs was a non-filarious region.
(C) Limitations of Data
i) A study with such a wide scope as this, because of its pilot nature, cannot indicate more than trends
in morbidity patterns and suggestive differences between occupational groups and controls. Further detailed
investigations need to be done in the morbidity patterns of anemia, musculoskeletal disorders, respiratory
diseases, gastro-intestinal problems, and pesticide toxicity with better links between symptomatology, hi
story and examination and laboratory findings.
ii) Some of the difference between occupational groups and controls especially in the older age groups can
be biased by the fact of smaller numbers in the control groups. This would mean that age related symptoms
and signs cannot be as easily separated between worker and non-worker groups.
ill) Due to problems of logistics and some variations and field modifications in laboratory technique we
would caution any conclusions on our hemoglobin estimations and cholinesterase levels beyond the observa
tion of suggested group trends. These need to be repeated after further standardization of technique to be
able to draw definite conclusion.
iv) In the factory environment measurements the use of midget impinger to collect dust sample created bia
sed readings since all the samples appeared to have mostly dust of less than 5 micrograms in size. When de
aling with vegetable dusts hexlets are better as reported in literature. We used the former in the absence
of the latter equipment mainly to establish some quantltative/qualitatlve difference between dust levels
in various sections.
(D) Methodological Problems
i) Controls
A study such as this has an important problem of comparisons with controls. We got over this by selecting
estates closer to a small town so that we could get a control population of adult males and females who
lived on the estate but worked in non-tea Jobs both inside as well as outside the estate.
Though we succedded to some extent it is obvious from Table 13 that the controls are comparable in numbers
only in the 18_34 age groups, there being very small numbers in the 35-A4 and 45-60 age groups.
ii) Job divisions
Though we attempted this in our study, Jobs both in the field and factory are interchangeable and definite
Job allotments are not given. For instance in the factory it is not easy to divide all workers into one of
the sections since many work between two or three sections. Field workers are put on factory Jobs tempora
rily during times of peak production. Old field workers are often put on lighter factory Jobs. Agricultural
workers and sprayers are not distinctly classifiable. Such situation prevents further clear cut analysis of
data as in factory by section or specific hazardous Jobs. Experience of working in both or many types of
Jobs on the estate are not uncommon and hence epidemiological analysis in neat categories are impossible.
This is a serious but real limitation to’be accepted in planning of research on agricultural populations.
ill) Home end work environment
Categorisation is also neither easy nor realistic since in an agricultural community, these are closely
inter-related and hazard at work only increases an additional risk factor to the same hazard operational
already in the home environment, eg., bites and stings, hookworm, gastrointestinal disease and so on.
iv) Statistical problem
In interpreting the differences seen between groups we kept in mind the fact that when a large number of
tests of significance are undertaken on some data, a few differences might turn up as statistically signi
ficant at tne 5 percent level even though in reality there are no genuine differences (ie., if we did 100
tests of significance it may be expected that 5 of them will turn out to be statistically significant at
the 5 percent level. Hence some of the differences we found may be whims of chance and further data has to
be collected on those aspects in greater detail to actually confirm or corroborate the suggestive differ
ences) .
67
(E) Further Anelysis
Among other things we plan to:
Further analysis of the data is still going on.
13-17 and 60* age groups to get additional evidence to ae•
“
i) Present the morbidity patterns in
0-5, 6-12,
risk from occupational factors.
parate out general environmental
t...-.-.
rather than only the 18-60 age groups will make comparisons with reported studies
The total population data
much easier.
the comparative trends keeping
ii) Separate the sprayers from the rest of male agricultural workers and see
on female factory workers will also be analysed,
in mind the problem mentioned in d(ii). Similarly findings
differences may be discovered keeping the problem of
Though the numbers are less than 20 in both cases some
limitations in numbers in mind.
,
histories are
iii) Respiratory problems and skin diseases have been studied in greater detail and if case
data of clinical significance
more
studied rather than presence/absence of individual signs and symptoms
can be presented in these two problems.
iv) Analysis of the causes of sickness absenteeism is also being done from data collected during the study,
point by point be it sign
v) In a study such as this comparison between occupational groups and controls on
or symptom may not show differences that are statistically significant. But consistency in trends in diff
erences between groups of signs and symptoms may help to Identify areas of potential er chronic risk, espof agricultural chemiecially when there is growing interest and concern, on the use of such a large range
the estate could also be conjectcals. Effects of tea alkaloids and other constituents in certain Jobs in
suggestions and experiences
ured based on observation of group trends. This is being further planned and any
of such analysis by readers and reviewers of this paper will be very much appreciated.
Recommendation, for Follow-Up
of further inveThis was meant to be only a pilot study useful in determining trends and Identifying areas
stigation.
Many findings of this study because of its wide ambit throws up possibilities for future study.
(A) Study of Pesticide toxicity
on the estates.
Three areas need to be studied in much detail with reference to pesticide hazard
large sample of the estate population to corroborate trends
i) Repeating of cholinesterase levels on a
suggested by this study.
ii) A detailed historical and medical assessment of sprayers and their morbidity/symptom experience.
iii) A wider KAP study of pesticide use among all the estates to assess methods of use, application,
mulation and identify potential hazards. The latter is particularly important from the point of view of
field action to be undertaken if the hazard is established and action by managements are necessary. KA
o
managers, supervisors, medical staff and sprayers themselves will be thought provoking.
(B) Studies on anemia and its relation to nutritional factors, hookworm infestation, pregnancy wastage,
work efficiency and productivity.
(C) Studies on Energy Expenditure of field workers particularly agricultural labour and pluckers
-.o be re-
lated to diet and work out puts.
and their relation to work.
(D) Study of vital losses among female workers and also gynaecological problems
1967 and 1979).
(E) A study of mortality rates and causes of death (refer Mackay,
(D Further investigation into the patterns of work and sickness
absenteeism along lines suggested in
Chapter X(H).
(G) Study on patterns of Respiratory Diseases and skin diseases on tea estate.
(H) Repeat of study of Dust hazards in the factories and relation to respiratory
and other morbidity along
the pattern used by Pinnagoda, 1971.
(I) Ergonomic and physiological assessment of pluckers (also suggested by Rahmathullah, 1981).
I
I '
11
rr '■
(
G8
While further studies on tea plantations may be planned, it is very necessary that a similar pilot atudy
be undertaken on a coffee estate and a rubber estate. These studies could well use the experience of the
tea study and make suitable modifications or additions in the protocols, field methodology and laboratory
techniques, to be used.
Many more studies can be suggested, but from our field experience and contact with the plantations one ob
servation in the planning of these future studies may be very important.'
There exists in the plantations a medical set up at the estate level and the central level In which enthu
siastic medical officers are available, many of whom have attended continuing education programmes organised
by us. With a little bit of initial help in appraisal of information and planning of the studies (especially
standardising proformas and methods of analysis), the medical officers are quite capable of undertaking most
of the above suggested follow up studies under the encouragement, technical supervision and support of the
Medical Advisor.
This will not only reduce logistic problems involved with movement of field teams, but more important it
will stimulate a spirit of enquiry among the medical profession already linked to the plantations by virtue
of their occupation. Such a process of involving medical officers can be initiated by making "Research in
Plantation Medicine" - the theme of the next annual conference and after some exposure to discussions on
field oriented research methodologies small working groups can be organised to plan and undertake some of
the above projects.
Those studies requiring laboratory investigation and or physiological and ergonomic assessment can be supp
orted by field units established temporarily by the Regional Occupational Health Centre, Ross Institute
Unit of Occupational Health, Tocklai Experimental Station (Assam), National Institute of Occupational Health
and other interested institutions in the country.
Though the above suggestions are outside the ambit of this report as such they are made with the hope that
existing medical personnel on the plantations will be stimulated to see the wealth of epidemiological res
earch possibilities that exist in closed communities such as plantations. By planning of simple field ori
ented and worker relevant research project, this mine of information can be tapped imaginatively without
requiring too much financial inputs from outside.
This approach will contribute primarily to greater improvements in the health of the worker but secondarily
and equally significantly to the professionalisation and research orientation of the medical workers in the
estates and the growth and future of the tea industry, since man maintenance (ie., workers health) is fast
becoming the key word of future industrial and agricultural development.
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ibid (1979)a, Reactions to stress in executives in rural industries in the tropics (unpublished).
,MARJORIE BICK (1967), Effect on blood cholinesterase activity of chronic exposure to organophosphorous
insecticides, Med. J. Australia, p 1066.
• .
MATHESON, D (1971), Agricultural Chemicals, E.O.H.S., Vol.I, p 48, I.L.O., Geneva.
MATHUR, P.S. (1957), Occupational environment of Gardeners and their diseases - a study among horticultural
workers in Delhi, Ind. Jour. Industrial Med. 1, 45.
McCORMICK, E.J. (1976), Human factors in Engineering and Design, Tata McGraw Publishing Co Ltd., New Delhi.
MEDRED, L.I., & KAGAN, xJu. S., (1971), Pesticides organophosphorous, E.O.H.S., Vol.II, p 1020, I.L.O.,
Geneva*
♦MILLIN, D.J., and RUSTIDGE, D.W. (1967), Tea manufacture, Process Biochem 2, No.6,- 9-13. Paper presented
at International Conference of Occupational Health, Yugoslavia, 1979.
♦MILLIN, D.J., CRISPIN, D.J. AND SWAINE, D (1969), Non volatile components of Black tea and their contri
bution to the character of the beverage. J. Agr. Food Chem, 17(4), 717-722.
MINISTRY OF SOCIAL SECURITY, UK (1967), Pneumoconiosis and allied occupational chest diseases, H.M.S.O.,
England.
ibid (1972). Notes on diagnosis of occupational diseases prescribed under the National Insurance (Industrial injuries) Act, 1965. H.M.S.O., England.
MISRA, (1959), Macrocytic anemia in Cachar tea estate. Report of the Committee of Control, 1959, Ross
Institute, India Branch.
MITRA, D.D. (1939), Ind. Jour of Med. Research, 27:441.
MORGAN, C.T. (1965), Human engineering guide to equipment design, McGraw Hill Book Co., New Tork.
♦MORTON, W.J. (1879), Tea drinkers disorder or toxic effect of tea, J. Nerv and Men. Dis (Chicago), 4,
586-602.
NAG, P.K., SEBASTIAN, N.C. and MALVANKAR, MG (1980), Effective Heat load on agricultural workers during
Ind. J.
summer season, I.._.
J Med. Res, 72:408.
NAMBA, TATSUJI (1971), Cholinesterase inhibition by organophosphorous compounds and its clinical effects,
W.H.O. Bulletin, 44:289.
NAMBA, TATSUJI, NOLTE, C.T., JACKREL, J and GROB, D, (1971)a, Poisoning due to organophosphate insecticides
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. R (1977), Teaching and service responsibilities of a medical college in the field of Occupational
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Bangalore.
on Plantation Health problems, R.I.U.O.H.,
ibid (1982), review of epidemiological projects done by interns
Bangalore.
. ----------------- , s
(1976), Chronic organophosphorous poisoning in pesticide
naresh, bhu, KHABYA, B.L., & MENDIRATTA,
workers, Ind. j/of'Public Health, 20, No.2.
Ind. Jour of
NATU,
NATU, M and SHAIKH, N (1979), Occupational Health problems of farmers and their management,
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PEPYS, J (1971), Farmer’s Lung, E.O.H.S., Vol.I, p 510, I.L.O., Geneva.
PHILIP, John C (1979), Plantations: Delivery of Primary Health Care, Planters Chronicle, 74, No.4, April
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73
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f
’
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/
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Abbreviations used are as follows:
E.O.H.S.
Encyclopedia of Occupational Health and Safety
I.L.O.
International Labour Organization
G.O.I.
Government of India
H.M.S.O
Her Majesty's Stationery Office (U.K.)
R.O.H.C.
Regional Occupational Health Centre, Bangalore
R.I.U.O.H Ross Institute Unit of Occupational Health, Bangalore
U.P.A.S.I United Planters’ Association of Southern India
C.L.W.S.
Comprehensive Labour Welfare Scheme
3
’ri
to
APPENDIX-A
BASELINE INFORMATION FROM ESTATES TO BE
INCLUDED IN ICMR PILOT STUDY: NILGIR1S:
Total Population
Resident
Divisions
if any
PRELIMINARY SURVEY
1.
2.
Name of the estate
Postal address
3.
Name of the Manager
4.
Telegraphic address
(if any)
9. Demographic data:-
5.
6.
7.
Telephone Number
Distance from CoonoorGlenview
10. Facilities:Planted area in hectares
Tea
Others (Specify)
8.
Total population resident on estate.
Number of resident families
Number of resident single workers
Total No. of workers employed in 1978
a) Residential
b) Non-residential
Total
c) Permanent
a)
b)
c)
d)
e)
I)
g)
Total no. of housing units
Number of creches
Number of schools (type specify)
Number of labour clubs
Number of latrines
Number of flushout units
Water supply sources
Wells
Streams
Reservoirs
h) Protection:-
d) Temporary
Chlorinated/other protection/
not protected
Total
Number of water points-
e) Male
a)
Lines
f) Female
b)
Field
g) Adolescent
Total
No. of Workers
Factory
Field
1
77
78
11. Classification of estate work population: (Numbers):-
Drivers
Any others (Specify)
Total:
Administrative
Field Workers:-
Management
Planters
Office Staff
Pruners
Field Staff
Loppers
Factory Staff
Chemical weeding
Medical
Manual weeding
Any other (Specify)
Manuring
Skilled workers
Total:
Road Builders
Total:
Firewood cutting
Watchmen
Driver
X
Pluckers
x
Carpenter
x
Sweepers
X
Mason
x
Sprayers
Tabal man-r-
x
a) Powerx
b) Hand :
Engine driver
Creche attendants
Pump operators
Any others(specify)
Machanic
Cook
12.
Fertilisers used
Hospital Orderlies
13.
Pesticides used
14.
Weedicides used
15.
Health services;
Chest Maker
x
Midwives
Any other (Specify)
Factory workers;
x
x
Medical staff
Date of completion of Form;
Collectors/spreaders
Rollers
Packers
Sifters
(Signature)
79
APPENDIX-B
80
4. Bowels
Nona al
ICMR PILOT PROJECT
Regional Occupational Health Centre & Ross Institute
Unit of Occupational Health (SJMC)
Check Roll No.
Name
(a)
If abnormal, specify:
5.
Family Card No
No
6.
7.
Present Occupation (with duration)
(a) Field
x Plucker
Sprayer
(b) Factory
Smoking Habits (describe amount if elicited)
Never smoked
Recently stopped
Occasional smoker
Regular smoker
Other Tobacco Habits
Snuff
Chewing
Occupational History
1.
Abnormal
Not habituated
Agricultural Worker
8.
Supervisor
Alcohol (Describe Type & amount, if elicited)
Other Chewing Habits
: Withering
Rolling
Present
Absent
Sifting
Firing
Betel Nut
Betel Leaf
Packing etc.
Supervisor
9.
Other Drug
YES
(c) Any other (specify)
If yes, specify
2.
Additional Occupation (specify)
Prescribed/self medicated
3.
Previous Occupations with duration of each
SI. No.
(c)
Years & durations
Occupation
(a)
(b)
(c)
1.
Appetite
Normal
Reduced
2.
Sleep
Normal
Disturbed
Increased
if disturbed, specify in what way:
If increased:
(ii) Volume
NO
For women workers only
1. Menstrual History
Cycle
Regular
Irregular
Duration
Regular
Irregular
Quantity of flow:
Normal Less Excessive
Pain
No
Yes
2. Obstetrical History
Abortion
Premature
Still births
Liveborn
Total No. of living children
Micturition
(i) Frequency
Others
LHP
(b) Personal History
3.
Regular
Occasionally.
3. Gyn History
Normal
Decreased
Increased
Day
Night
Both
Leucorrhoea
Yes/No
Normal
Decreased
I nc re as e d
Prolapse
Yes/No
Pruritis . .
Yes/No
01
82. "
']
(d) Family History
Cough with expectoration
Asthma
Yes/No
Diabetes
Yes/No
Hemoptysis
Tuberculosis
Yes/No
Hypertension
Yes/No
Intermittent claudication
Chr. Dermatitis
Yes/No
Allergies
Yes/No
Raynaud’s phenomenon
Yes/No
Mental
Illness
Yes/No
Peripheral
Neuritis
2.
Any other specify:
(e) Past History
Asthma
.Yes/No
Diabetes
Yes/No
Tuberculosis
Yes/No
Hypertension
Yes/No
Chr. Dermatitis
Peripheral
Neuritis
Yes/No
Allergies
Mental
Illness
Yes/No
Yes/No
3.
Swelling of feet
Gastro-intestinal
Nausea
Vomiting
Feeling of illness
Abdominal pain
Constipating
Diarrhoea
Worms in stool
.Bleeding per rectum
Tarry stools
Piles
Neurological
Visual disturbances
Incoordination
Hearing disturbances
Headaches
Neuritis
Vertigo
Standing
Parasthesias
Tinnitus
Boring
Loss of power
Convulsions
Yes/No
Any other, specify:
■
i
(f) Assessment of work (as stated by worker)
Hot
Damp
Smelly
Cold
Sitting
Dusty
Monotonous
Smoky
Noisy
Fatiguing
4.
Joint Pains
Do you relate any of above factors with any health condition
5.
If yes, specify
Skeletal
(g) Presenting symptoms
Back aches
Miscellaneous
Swellings/Lumps
Weakness
Yes/No
Loss of weight
Yes/No
6.
1. Cardio-respiratory
Palpitation
Yes/No
Breathlessness
Yes/No
Chest Pain
Yes/No
Dry cough
Yes/No
Impotence
Skin changes
Colour
Yes/No
Sensation
Yes/No
Infection/lesion
Yes/No
I
!
If positive then:
(i) Duration of dermatitis/skin change
(ii) Present before joining occupation
Yes/No
(iii) Aggravated by occupation
Yes/No
83
(iv) Itching
Yes/No
(v) Burning
Yes/No
(vi) Are other workers
similarly affected
Yes/No
d‘1
2. Cardio-Vascular
JVP
Normal
Raised
Cardiac dullness
Normal
Increased Decreased
Site
Heart sounds
Normal
Abnormal
Characteristics
Murmurs
Present
Absent
(h) General Examination
3. Abdomen
Weight
Height
Tenderness
Yes/No
Liber palpable
Yes/No
Chest measurement
Inspiration
Spleen Palapable
Yes/No
Other lumps
Yes/No
Expiration
Fluid
Yes/No
Rhythm
Pulse
Rate
B.P.
Systolic/Diastolic
4. Nervous system
Re gul ar/I rre gul ar
Absent
Present
Lymphadenopathy
If present, specify chain/s
Nil
Intelligence
Memory
Cranial Nerves
Normal
Abnormal
Abnormal
If abnormal, specify
Peripheral
Gait
Normal
Pallor
Bone deformities
Muscle tone
Muscle nutrition
Jaundice
Elephantiasis
Muscle power
Glossitis
Varicose veins
Sensations
Cheilssic
Hernia
Reflexes
Ang. stomatitis
Hydrocele
Cyanosis
Normal
Altered
Superficial
Deep
Odema over feet
Visceral
(1) Systemic Examination
Babinskis Sign
1. Respiratory
Coordination
Rombergs Sign
Altered
Normal
Rate
Movements
Equal
Unequal
Percussion
Normal
Dull
Breath sounds
Normal
Increased
Adventitious sounds
Present Absent
Date
Resonant
Decreased
If present, specify rhonchi/rales/crepitations/rub
(J) Investigations
1. Haemoglobin
2. Leucocyte N-count
3. PBS ....
4. ESR
6. Urine sugar
8. Stools
Date
Investigator
gms^oo
E-
MB-
T
5.
7.
9.
Urine Albumin
Urine Deposits
Chest X-Ray
I o
Investigator
86
85
appendix-c
I C M R
PILOT
I
appendix-d
PROJECT
REGIONAL OCCUPATIONAL HEALTH CENTRE
BANGALORE'
12)
(Additional Information for under
ENVIRONMENTAL SURVEY
1. PAST HISTORY:
Measles
Chickenpox
x
Smallpox
Poliomyelitis
Diarrhoea
Rheumeatic Fever :
Dysentery
Tuberculosis
Ear infec
tions
Eye infec
tions
Malaria
Diptheria
Whooping Cough
Asthma
Sample No
Date
Name of the Industry/Institution
Sampling Point
Nature of Sampling operation
x
Sample type; Dust/Gas/Fumes
■
Rate of collection
Scabies/skin
infections
Sampling commenced at
Terminated at
Worms
Duration of Sampling
minutes
2. IMMUNIZATION SCHEDULE;
Litres/cft
Quantity of sample collected
BCC
Trapping medium
Smallpox
Temperature measurements;
I
DPT
1st
2nd
3rd
Boosters
WB
•C...DB.... ....°C
Polio
1st
2nd
3rd
Boosters
GT
®C...KT.... .,. .Seconds
3. NUTRITIONAL ASSESSMENT;
BOTSFORD
Head circumference
cms
Mid Arm circumference
cms
Sampling done by
Name in Block Letters
Nutritional deficiency
signs-(+ve only)
1
(Additional Information for under 2)
SAMPLE ANALYSIS
1. FEEDING HABITS:
■
Sample No
Breast fed alone
I
Date
Estimation/Analysis done on
I
At
Supplements alone
Results;
Breast fed + Supplement
Mention type of supplements:
1.
2.
3.
Internal Standard
Analysis done by
Dilution factor
ame
loc
ter
I
b8
87
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3.
Total floor area
4.
Number of rooms
5.
6.
Natural lighting
Ventilation
7.
Water supply
8.
Electric power supply
9.
Flooring
10.
Separate Kitchen
11.
Smoke outlet
Chimmney
Special tiles
Window
12.
Bath room
13.
Lavatory attached/public
14.
Type of Drainage
<:
15.
Type of waste disposal:
Refuse
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Garbage
Animal waste
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16.
Possessions:
dj
Utensils
Q
Tables
Chairs
Bed
Almirah
Fans
Radio
Animals
- Media
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