Assessment of Musculoskeletal Disorders among Pourakarmikas in Bengaluru, Karnataka: A Cross-sectional Study

Introduction

Municipal solid waste disposal is a challenging task in a metropolitan city like Bengaluru, where Pourakarmikas play a very important role. ‘Pourakarmikas’ is the terminology used in Karnataka for the people aged between 17-60 years, who are officially employed to collect garbage in baskets, segregate them into wet and dry waste, sweep the streets, and manually load the collection into lorries. The term ‘Poura’ means ‘Citizen’, and ‘Karmika’ refers to ‘Labourer’.¹ It includes activities like collecting garbage, recyclable materials, and commercial & industrial wastes. Bruhat Bengaluru Mahanagara Palike (BBMP) is the administrative body that is responsible for all civic amenities and some infrastructural assets of the Greater Bengaluru metropolitan area. Their responsibilities include zoning and building regulations, health, hygiene, licensing, trade and education. They also look in to quality-of-life issues such as public open spaces, water bodies, parks, and greenery.² BBMP is spread over 713 sq. km area with a 1.3 crore population and more than 29 lakh households which are divided into eight zones, 27 divisions, and 198 wards. There are about 18500 Pourakarmikas employed under BBMP.³ BBMP has submitted the draft of ward delimitation report to the Urban Development Department, which has the report increasing the number of wards in the area from 198 to 243.⁴

Rapid industrialization and population explosion in India has led to the migration of people from rural areas to urban area, which generates thousands of tons of municipal solid waste daily.⁵ The working conditions of Pourakarmikas are risky as they are constantly exposed to hazardous, biological, infectious, and industrial wastes.⁶ They work under unhygienic conditions and are prone to many occupational risks. They have to be physically fit to quickly climb in and out of large trucks and lift heavy trash containers.⁷ The maintenance and promotion of workers’ health and working capacity, improvement in working conditions, and working environment are some of the objectives of occupational health.⁸

In India, municipal solid waste is collected manually requiring repeated heavy physical activity like pulling, pushing, lifting, and carrying. Musculoskeletal disorders are an important public health problem in both developed and developing countries, which can affect the quality of life and result in substantial economic burden due to compensation costs, lost wages, and productivity.⁹ These problems are common among waste collectors due to their nature of work, and long working hours. The present study was undertaken to assess musculoskeletal disorders and sociodemographic & occupational factors causing musculoskeletal disorders among Pourakarmikas.

Materials and Methods

BBMP area is divided into eight zones, 27 divisions, and 198 wards (243 wards),⁴ with around 18500 Pourakarmikas.³ Chickpet ward of South zone BBMP was selected which is near to our urban field practice area. Around 601 Pourakarmikas are working under the Chickpet ward. The sample size was calculated according to the previous study by Reddy EM et al, ¹⁰ and was rounded up to 140. They were selected by systematic random sampling method.

A validated assessment tool called Modified Nordic Musculoskeletal Questionnaire was used to collect information on musculoskeletal pain. The questionnaire used for the study had three parts- first part consisted of socio-demographic information about their age, gender, height, weight, family, comorbidities, and habits. The second part included occupational information like total working days, shift timings, sleep patterns, posture, etc. The third part was about overall discomfort of the body comprising of questions regarding the symptoms which appeared from the past 7 days to 12 months.¹¹

After obtaining study approval from the Institutional Ethical Committee, the data was collected. Written informed consent was obtained from all of the participants who were willing to be involved in the study, before administering the questionnaire. Subjects with chronic musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis were excluded from the study. Subject/s with a history of trauma were not considered for the study. The data was collected by interview method using google forms.

The descriptive analysis in the form of the mean with standard deviation or percentage was conducted for demographic variables and occupational information. Tests of significance such as independent “t-test” and Chi-square tests were used for comparison, considering the level of significance at p <0.05. Data analysis was performed using SPSS v 27.0. 

Discussion

In the present study, 92.9% of the participants were females, and 49% of the participants belonged to the age group of 31-40 years.

Among 140 Pourakarmikas included in the study, 125 (89.28%) had musculoskeletal pain in the last year, which was higher compared to previous study by Reddy E M et al., where 70% of the study subjects reported being troubled with musculoskeletal pain during the last 12 months, while 91.8% reported having pain during the last seven days.

The major affected areas were lower back, knees, shoulders and upper back. A higher prevalence of symptoms was observed in lower back (96%), followed by knees (79%), upper back (70%), and shoulders (70%), whereas in the previous study reported by Reddy E M et al., the higher prevalence of symptoms was noted in knees, shoulders, and lower back (84.5%, 74.5%, and 50.9%, respectively). 

Most of the participants belonged to lower socioeconomic status, and only a few were from the lower middle class.

Conclusion

The magnitude of musculoskeletal pain among Pourakarmikas was observed to be high. This could be due to the nature of their job, which is physically demanding like lifting, pulling, and manually collecting the waste. Higher risk of musculoskeletal disorders were mainly due to their work profile, duration of the occupation, pre-disposing conditions, or chronic undiagnosed illnesses. The most frequently affected body regions were the lower back, followed by the knee joint, upper back and shoulder joints. The symptoms were attributed to their work experience of more than 20 years, followed by 5-10 years.

Recommendations

• Proper training, if required retraining sessions related to the work to be arranged. 
• Regular health screening camps are to be organized for the workers’ health and safety, which can also increase their efficiency in the occupation. 
• Workers are to be advised about the regular and proper way of wearing personal protective equipment. 
• They should cultivate the habit of doing exercises-back exercise.

Limitations of the study 

• The study was conducted only in one ward under the South zone, BBMP, Bengaluru; hence the results cannot be generalized to all the Pourakarmikas working under BBMP. 
• Subjects who had chronic illnesses like diabetes and hypertension were included in the study. In such cases, musculoskeletal pain cannot be attributed to occupation alone.

Conflict of interest

None

Acknowledgments

We would like to thank our Director/Dean, Bangalore Medical College, Research Institute, Bengaluru, and Special Commissioner Solid waste management BBMP for permitting us to conduct the study among Pourakarmikas. This endeavor would not have been possible without the study participants, Pourakarmikas. Also, we would like to express our deepest gratitude to our entire department for supporting us in the smooth conduction of the study.