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Transcript of Wah Medical College Research
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WAH MEDICAL COLLEGE, WAH CANTT
DEPARTMENT OFCOMMUNITY MEDICINE
WAH MEDICAL COLLEGE, WAH CANTT
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FREQUENCY AND
PATTERN OF DISEASESAMONG FACTORY
WORKERS OF PAKISTAN
ORDNANCE FACTORIES
(POF) WAH CANTT.
[HOSPITAL BASED
STUDY]
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RESEARCH DONE BY: BATCH C, 4TH YEAR
MBBS,
Farkhanda Jabeen Roll no. 05016Henna Azmat Roll no. 05019
Muhammad Anwar ul haq Roll no. 05076
Muhammad Majid Mehmood Roll no. 05077
Muhammad Nasir Nawaz Roll no. 05079
Muhammad Obaid-ur-Rehman Roll no. 05107
Salahuddin Khan
RESEARCH SUPERVISOR:
Dr. Ambreen Ansar
Post Graduate Trainee (PGT)
Community Medicine Department.
RESEARCH MONITOR:
Dr. Babar Mumtaz Malik
Assistant Professor
Community Medicine Department.
RESEARCH INCHARGE:
Prof. Dr. Musarrat Ramzan
Head of Community Medicine Department,
Vice Principal WMC
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TABLE OF CONTENTS
CONTENTS PAGE NO.
LIST OF FIGURES 6
LIST OF ABBREVIATIONS 6
ABSTRACT 7
INTRODUCTION 8
LITERATURE REVIEW 9
OBJECTIVE 10
METHODS AND MATERIAL 10
RESULTS 11
DISCUSSION 15
CONCLUSION 16
REFERENCES 16
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LIST OF FIGURES
FIGURES PAGE
NUMBER Fig-
1
Bar graph showing percentage and number of patients
of different disease groups in Explosives Factory
12
Fig-
2
Bar graph showing percentage and number of patients
of different disease groups in Filling Factory
13
Fig-
3
Bar graph showing percentage and number of patients
of different disease groups in Brass Mill
14
LIST OF ABBREVIATIONS
ATSDR Agency For Toxic Substances and Disease Registry
CCF Congestive Cardiac Failure
CHE Collaborative on Health and Environment
CNS Central Nervous System
COPD Chronic Obstructive Pulmonary Diseases
CVS Cardiovascular system
DNS Deviated Nasal Septum
ENT Ear, Nose and Throat
GIT Gastrointestinal System
IHD Ischemic Heart Disease
MSDS Material Safety Data Sheet
NEQ’s National Environmental Quality Standards
PETN Pentaerythritoltetranitrate
POF Pakistan Ordnance Factories
QHSE Quality Health Safety and Environment
RDX Cyclotrimethylene-trinitramine
T.B. Tuberculosis
TNT Trinitrotoluene
U.S. United States
UV Ultra Violet
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CONCLUSION: A major correlativity exists between occupational
hazards and disease cases reported.
INTRODUCTION:
Since the very inception of mankind, he has indulged himself
into scores of different occupations to earn his living. These chores
come with a specific price of occupational diseases. According to
ILO/WHO Committee “occupational health should aim at the
promotion and maintenance of the highest degree of physical, mentaland social well being of workers in all occupations; the prevention
among workers of departures from health caused by their working
condition; the protection of workers in their employment from risks
resulting from factors adverse to health; the placing and maintenance
of the worker in an occupational environment adapted to his
physiological and psychological equipment, and, to summarize, the
adaptation of work to man and of each man to his job”.1
Hippocrates
admonished his followers to observe the environment to understandthe origins of illnesses in their patients. From Agricola, 15th century,
who observed that miners in Joachimsthal frequently became short of
breath and died prematurely (due to silico-tuberculosis) to Alice
Hamilton, 20th century, who was the first U.S. physician to devote
her life to the practice of industrial medicine, physicians have always
been intrigued by the phenomenon of occupational health.2
In today’s
industrial revolution occupational health has come up again with a far
more significance than ever before. Physical, chemical, biological,mechanical and psychosocial hazards from industry have been the
part and parcel of modern day research. Phenomena like
pneumoconiosis, lead poisoning, cancer, radiation hazards and
accidents in industry have now become prevalent in the working class
exposed to these hazards.2
In Pakistan, occupational hazards have also been explored with
cases being reported of byssinosis from cotton spinning factories,
anthracosis from coal mines, bagassosis from sugar-cane industry andasbestosis from asbestos industry.
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A major share of today’s industrial revolution is defence
productions. Considerable numbers of chemicals like TNT, RDX,
PETN, Nitric acid, White phosphorus and zinc oxide etc have been
identified as a major risk factor for workers related to this industry. In
addition to these chemicals workplace hazards like accidents, burns
and radiations are also rampant among this industry’s workers.
Therefore the significance of occupational health and safety in today’s
era cannot be understated.
Pakistan also joined the elite club of nations by establishing
Pakistan Ordnance Factories (POF) Wah Cantt in 1951. Our research,
based on the patient data from POF workers admitted in POF
Hospital, Wah Cantt, primarily analyses diseases prevalent in these
workers and their association with risk factors.
LITERATURE REVIEW:
Workers of ordnance factories are exposed to a number of risk
factors. Out of these risk factors, TNT (trinitrotoluene), RDX
(cyclotrimmethylene-trinitramine), PETN (pentaerythritoltetranitrate),Nitric acid, white phosphorus, Zinc oxide, copper, Ultraviolet (UV)
light and accidents are the most significant ones.
TNT (trinitrotoluene), an explosive by nature, has nitric oxide
fumes in it which when exposed to causes respiratory tract irritation,
nausea, headache, reduced blood pressure and possible CVS
effects.3,4,5,6,7
It is also a factor in the development of cataracts.8,9
Similarly RDX (cyclotrimmethylene-trinitramine) is also an explosive
which causes convulsions, lung congestion and psychoses.10,11,12
PETN (pentaerythritoltetranitrate), an explosive and used in
detonating devices, is also a respiratory tract irritant and a known
coronary vasodilator causing lowering of blood pressure, headache or
faintness. Repeated over-exposure with PETN may result in chest
pains later, even in the absence of exposure.13,14
Nitric acid, a well known respiratory irritant and congestant and
a corrosive by nature, is a potential hazard for accidental injuries in
concentrated form and potentially very toxic in case of inhalation.15
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• Sample size216(two hundred and sixteen only)
• Sampling technique
Convenient method• Inclusion criteria
Male patients from Brass Mill, Explosives and Filling factories
admitted in various wards of POF Hospital Wah Cantt.
• Data collection procedure
Data was obtained from the HMIS department of POF
Hospital, Wah Cantt. Permission to get the data was
granted by the competent authority, after applying for it
through proper channel.
RESULTS:
A total of 216 patients were scrutinized for the study from the
three major factories namely Brass Mill, Explosives and Filling
factory. We divided the patients into ten major disease groups.Out of 216 patients, 102 were registered with Explosives
factory. Among them 40 (39.22%) were CVS cases (17 cases of
Ischemic Heart Diseases (IHD), 16 cases of hypertension, & 7 cases
of congestive cardiac failure) 15 (14.71%) had infections (mainly of
respiratory (5) and urinary tract(10), 10 (9.8%) were surgical cases (3
abdominal surgeries, 4 abscess drainage procedures, & 3 cases of
orthopedic surgeries), 10 (9.8%) CNS cases (mainly depression and
acute psychosis), 7 (7.14%) diabetics, 6 (6.12%) had cataracts, 3(3.06%) with GIT problems, 3 (3.06%) had cancer, 5 (5.1%) had
respiratory problems (majority i.e. about 70% presented with COPD)
and 3 (3.06%) presented with ENT related problems.
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Fig-1: Percentage and no. of patients of different disease groups in explosives factory
CVSRespir
ation
Infecti
onsGIT
Surge
ry
Diabe
tics
Cance
rENT
Catar
actsCNS
No. Of patients 40 5 15 3 10 7 3 3 6 10
39.22%
5.1%
14.71%
3.06%
9.8%
7.14%
3.06% 3.06%
6.12%
9.8%
0
5
10
15
20
25
30
35
40
45
N o .
o f P a t i e n t s
Disease Groups
Explosives Factory
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78 patients were from the filling factory. Out of these, 26 (33.33%),
patients were of CVS diseases (19 cases of Ischemic Heart Diseases
(IHD), 7 cases of hypertension), 9 (11.53%) respiratory cases, 14
(17.94%) with infections (mainly of respiratory (7) and urinary
tract(7), 2 (2.56%) with GIT problems, 9 (11.53%) had undergone
surgery (1 case of abscess drainage procedure & 8 cases of
laprotomies), 5 (6.41%) were diabetics, 1 (1.28%) cancer case, 1
(1.28%) ENT case (DNS), 8 (10.25%) with cataract, and 3 (3.84%)
CNS cases (acute psychosis).
Fig-2: Graph showing percentage and no. of patients of different disease groups in
filling factory
CVS
Respi
rator
y
Infect
ionsGIT
Surge
ry
Diabe
tes
Canc
erENT
Catar
actsCNS
No. Of patients 26 9 14 2 9 5 1 1 8 3
33.33%
11.53%
17.94%
2.56%
11.53%
6.41%
1.28%% 1.28%
10.25%
3.84%
0
5
10
15
20
25
30
N o .
O f P a t i e n t s
Disease Groups
Filling Factory
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Out of a total of 36 registered patients from Brass Mill, there were 5
(13.88%) CVS cases (all were cases of IHD), 6 (16.66%) respiratory
cases ( 3 T.B. patients & 3 cases of COPD), 7 (19.44%) infections (all
respiratory), 6 (16.66%) GIT cases, 8 (22.22%) surgical cases (6 cases
of orthopedic surgeries & 2 cases of Laprotomies), 2 (5.55%)
cataracts, 2 (5.55%) CNS cases and 0% diabetic, cancer and ENT
cases.
Fig-3: Graph showing percentage and no. of patients of different disease groups in
Brass Mill
CVSRespira
tory
Infectio
nsGIT Surgical
Diabete
s
Cancer
sENT
Catarac
tsCNS
No. Of Patients 5 6 7 6 8 0 0 0 2 2
13.88%
16.66%
19.44%
16.66%
22.22%
0.00% 0.00% 0.00%
5.55% 5.55%
0
1
2
3
4
5
6
7
8
9
N o .
O f P a t i e n t s
Disease Groups
Brass Mill
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DISCUSSION:
The analysis of data was difficult as we were not allowed full
access to the inside of factories due to security reasons. However,while analyzing the data, we came to know that majority of patients
from Explosives and Filling factories were CVS cases, i.e. 39.22%
and 33.33% respectively (This can be attributed to the presence of
TNT), whose fumes contain nitric oxide, which reduces blood
pressure, causes headache, vomiting, and cyanosis and therefore
possible CVS manifestations.3,4,5,6,7
Similarly PETN has a role in
decreasing blood pressure and causing headache, and also some CNS
manifestations.13,14
There was also a significantly high prevalence of CNS cases
(9.8%) in Explosives factory owing to the blood pressure lowering
effects of TNT and PETN. Similarly RDX can also be regarded as a
causative factor for CNS disorders, including anxiety psychoses and
abnormal reflexes.10,11,12
A large number of surgical cases were reported from all the
three factories particularly Brass mill (22.22%). This can be imputed
to the occurrence of accidents due to highly explosive materials and in
particular the blast furnaces present in Brass Mill. Another
perpetrator, white phosphorus, which is highly toxic and causes burns,
can also be held responsible for accidents and consequently surgical
cases.16,17
We noticed an alarmingly high incidence of cataracts in
Explosives factory (6.12%), Filling factory (10.25%) and Brass Mill
(5.55%), which is self explanatory due to UV light emitted by
explosions and welding procedures and also partly due to exposure to
TNT. A considerable proportion (11.53%) of respiratory cases in
Filling factory can be related to the presence of nitric acid (irritant and
corrosive) and RDX (causes lung congestion). In Brass Mill, what
seemed particularly important was the presence of 16.66% respiratory
cases specifically including “INHALATION FUME SYNDROME”,
caused by Zinc Oxide fumes.
It is worth mentioning here that POF has enforced strict safety
measures and precautions, including protective wear, minimizing
amount and duration of exposure to risk factors. This is according to
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QHSE (Quality Health Safety and Environment) standards and safety
recommendations of NEQ’s (National Environmental Quality
Standards).26
Still there is considerable prevalence of occupational
diseases among factory workers and this can be ascribed to personal
negligence and lack of health education.
CONCLUSION:
After calculating and analyzing the frequencies and pattern of
diseases, our study supports the fact that there is a positive association
between different chemicals and other material used in PakistanOrdnance Factories, Wah Cantt, and several diseases. The prevalence
of occupational disease is very high for a state of the art facility like
Pakistan Ordnance Factories. It is need of the hour that emphasis
should be given on health education of the workers and stringent
regulations be imposed to reduce these problems.
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