Occupational Health Problems Among Women Beedi Workers in an Urban- Field Practice Area - A Cross-Sectional Study

Introduction

Beedi rolling is a prominent unorganized sector activity in India. Beedi production is a labour-intensive cottage industry.¹ Beedi rolling is mainly performed at home and typically involves many women. It is an arduous, labor-intensive task because each beedi is rolled individually. A Beedi is a thin South Asian cigarette made of 0.2-0.3 g of tobacco flake wrapped in a tendu (Diospyroxmelanoxylon) leaf and tied at both ends with coloured thread.¹ It is particularly popular among the non-affluent since it is a cheap method of tobacco consumption, yet it poses more significant health concerns as it delivers more nicotine, carbon monoxide, and tar than ordinary cigarettes.² A single woman, on average, rolls 500-1000 Beedi per day, using an average of 500 grams of tobacco flake.³ A Beedi worker in the rolling process may inhale tobacco dust and other harmful components. Women spend hours sitting, rolling Beedi’s, surrounded by this hazardous tobacco dust.⁴ About the high content of nicotine and other harmful chemicals in Beedi tobacco (compared with cigarette tobacco), these workers are at extreme risk of developing systemic illnesses like musculoskeletal problems, respiratory problems, neurological diseases, eye problems, skin and gynaecological concerns.² Hence, the present study was undertaken to address the need for understanding the occupational health problems faced by women Beedi workers and to evaluate their knowledge and practice of safety measures, as it is essential for planning interventions to enhance the overall health of both the workers and their families.

Materials and Methods

A community-based cross-sectional study was conducted in the urban slum of Bandimetta, Kurnool town, the field practice area of Kurnool Medical College, from May 2024 to July 2024 among women Beedi workers. The current study was conducted after obtaining the Ethical Committee clearance of the Medical College. All participants were asked to provide written and informed consent.

From the previous study, P=62.5, is the prevalence of musculoskeletal problems among women beedi rollers; by using the formula n=(Z₁-α)/2)2p(100-p)/d2, we obtained a sample size of 160 with a 95% confidence interval and 8% absolute error.⁵ The study comprised Women Beedi workers who had been working for at least 6 months. Those who quit their jobs or were absent for two consecutive visits at the time of data collection were excluded from the study.

In the defined study area, a house-to-house survey was conducted by a simple random technique, and the data was collected through face-to-face interviews among women beedi workers who had come under inclusion criteria. An assurance was given regarding the confidentiality of the subject’s data. A pre-designed and pre-tested semi-structured questionnaire was used to collect the sociodemographic data, occupational health concerns, and knowledge and practice regarding safety measures among women beedi workers.

Statistical analysis: Data was analyzed using SPSS version 25, analyzed in the form of frequencies and expressed in tables. Pearson's Chi-square test was used to estimate the association between variables. A P value < 0.05 is taken as statistically significant.

Among 160 women Beedi workers, women aged 31-40 years were primarily involved in Beedi rolling. 90.6% of the subjects were from the Muslim religion. Most were married (91.3%), and 59.4% were illiterate. Most of the women started Beedi rolling because of their poor socioeconomic status and family involvement in this occupation. Approximately 43.1% of the study subjects had been engaged in Beedi rolling for 11-20 years. The work involves prolonged sitting, with 50% of women working more than 9 hours daily. Around 70% work an average of 11-20 days per month, mostly on a weekly basis. Beedi rolling is done at home, along with cooking, feeding, and other daily activities. Because there was no specific site for Beedi rolling, it was done in places where daily activities were conducted. 50.6% of the subjects make >1000 Beedis per day, and they get paid on a weekly basis.

The study showed that among 160 subjects, the majority had musculoskeletal problems (77.5%), followed by eye problems (55.6%) and respiratory problems (48.1%) (Figure 1). Among musculoskeletal symptoms, most of the subjects had back pain (72.8%), and 55.7% had shoulder pain, followed by neck pain (34.2%). Among eye problems, most of the subjects had an eye watering and burning sensation (52.9%), followed by poor vision (25.5%). The most common respiratory problems are cough (50%) and sneezing (25.6%). Among neurological problems, the most common was headache (41.1%).

Only 15.6% of the subjects have knowledge regarding safety measures and the need for them, but none wear gloves or masks. Regarding safety measures, only 45% of beedi workers wash their hands after rolling (Table 2). Additionally, 10.6% of their children participate in the beedi rolling process, contributing to production alongside their families (Figure 2).

It was observed that as the number of beedis rolled per day increased, the occupational health problems also increased. Among the study subjects who roll more than 800 beedis per day, 81.6% had musculoskeletal problems, as compared to 54.2% who roll less than 800 beedis per day. There is a statistical significance between the number of beedis rolled per day and musculoskeletal problems. Among the study subjects, musculoskeletal problems are more common among illiterates than literates, and it is statistically significant; this is because of the taking of protective measures by literates.

Discussion

Beedi rolling is a labour-intensive traditional activity in India that relies on an unorganized workforce. After agriculture, handloom and construction, the beedi business employs the most workers in India. According to published literature, women comprise roughly 76% of overall beedi employment.⁶ Women beedi workers face poor pay, piece-related payments, limited social security, and lack of organization in their workplace. Women are drawn to beedi rolling for two reasons: it can be done from home, allowing them to balance work and family responsibilities, and their deft fingers are better suited to the task.⁶ Numerous studies have revealed that beedi workers face numerous health risks that could eventually result in their loss of life. Although the government's efforts for the unorganized sectors benefit the workers, they cannot cover their present necessities for health care and transportation. Beedi workers stated in numerous study interviews that they are compelled to perform multiple jobs in order to support themselves because of their poverty and the low pay they receive from contractors.¹

The majority of the participants in the current study were between the ages of 31-40. In a study done by Surya Prabha et al. most of the women were between the ages of 21-40.⁵ The majority of the subjects (43.1%) have been working for 11-20 years indicating that they began Beedi rolling at a younger age. Illiteracy was identified as a major contributing factor to musculoskeletal problems among women beedi rollers, and it is statistically significant with a P value of <0.005. In this study, the majority of the subjects were illiterate, similar to the study conducted by Surya Prabha et al., where 75.86% of the subjects were found to be illiterate.⁵ The study found that women beedi workers may experience health issues owing to exposure to tobacco flakes and dust as well as sitting in one position for long hours at a time. In the current study, most of the subjects reported musculoskeletal symptoms, which is consistent with the findings of the Nanjesh Kumar S et al., study, where 31.66% showed similar findings.⁷ Among musculoskeletal symptoms, most of the subjects had back pain, and half had shoulder pain followed by neck pain. Among the eye problems, most of the subjects had eye watering and burning sensations, followed by poor vision. Mittal et al., reported that 62.9% of the study subjects had poor vision.⁸ Beedi dust in the air can cause respiratory issues for rollers and their families. The most common respiratory problems are cough and sneezing. Among neurological problems, the most common was headache. The Beedi workers also reported other problems like acidity, callosities of fingers, white discharge, and dermatitis. It was found that knowledge and practice regarding safety measures is poor among study subjects, which was similar to the study conducted by Joshi et al., where 87% of the subjects had poor knowledge and practice.³

Conclusion

The present study concluded that the majority of the female beedi workers were illiterate and in the age group of 31-40 years. Nearly half of the study subjects had been in this occupation for 11-20 years and worked for more than nine hours per day. Half of the study subjects roll more than 1000 beedis per day, and it is observed that as the number of beedis rolled per day increases, the occupational health problems also increase, the most common being musculoskeletal Problems followed by eye problems, respiratory, neurological issues, and skin problems. Most women beedi workers have poor knowledge and practice regarding the safety measures they need to follow during their work.

Recommendation

Awareness sessions regarding the implementation of safety measures, hand hygiene practice, and posture correction should be done to reduce the risk of occupational health problems among women beedi workers by the stakeholders at the time of enrolment. Providing alternative livelihood opportunities for women is crucial for their economic viability and skill development.

Conflicts of Interest

The authors had no conflict of interest throughout this research.

Funding

This is self-funded research.

Acknowledgement

I would like to express my gratitude to the ADME/ Principal, Dr. K. Chitti Narasamma, for permitting me to conduct this study and to The Professor and HOD, Dr. P. Sudha Kumari, and Staff of the Department of Community Medicine, for their timely help and guidance during the study and to the Study Participants for their active participation in the study.