The World Health Organization defines occupational injury as an epidemic problem in the field of public health in developing countries.[1,2] Construction work is one of the most hazardous works across the globe. The workers involved in the construction industry are being underpaid and extremely vulnerable to the occupational health hazard and absence of social security mechanism. In India, construction industry is the second largest employer when compared to agriculture.[3] The Indian construction labor force is 7.5% of the total world labor force and it contributes to 16.4% of fatal global occupational accidents.[4] Most of the occupational injuries occurs due to non-usage of the safety equipment that was provided, and ignorance towards safety.[5] The construction workers' probabilities of exposure to risks of a workplace accident are high. The workers are exposed to a host of hazardous substances, which has the potential to cause serious health and occupational diseases.

Safety is a major concern in construction industry. According to Bureau of Labor Statistics, even though appropriate measures are enforced in many industries, the fatal accidents are still on rise.[5] They are being exploited in the terms of low wage, non-availability of social security, work with low payment and harassment at workplace. Unsafe behavior is a vital component leading to occupational accidents and it has been a direct cause for on-site accidents.[6–8]

There is a paucity of data on unsafe behaviors among building construction workers in Maharashtra. Hence, the objective of study was to study the socio-demographic and morbidity profile of construction workers, and to assess occupational hazards and use of personal protective equipments (PPE) among construction workers in urban area of Kolhapur.

A cross sectional study was conducted among construction workers (n=152), in Kadamwadi, between July to August 2023. The study samples were selected from three construction sites as per subject availability. Institutional ethical Committee approval and permission from developers had been taken to undertake study. Workers, who were directly involved in the process of construction, and willing to give informed consent, were included. Workers not available during the time of data collection, were excluded from the study.[9]

The predesigned proforma was used to collect information. The proforma contained demographic information, duration of work, involved of injury, health seeking behavior, provision and use of personal protective devise, etc. The workers were interviewed, and the response was noted.

Data were analyzed using R software version 3.6.1. Demographic, health related and seeking healthcare and working condition variables, were represented using frequency distribution. Chi square test was used to find association among the variables, (P<0.05).

Table 1 shows out of the total participants (n=152), male predominance was observed (n=95). Most of them were in the age group of 15- 45 years (n=127), married (n=95), and were Hindus by religion (n=138). A high percentage of the participants were illiterate (n=43). Most were migrants (n=100) and were unskilled workers (n=93).

Table 1: Frequency Distribution of Demographic Variables

Among addictions the most common one seen was to tobacco (n=70). Most construction workers suffered from fatigue/ generalized weakness (n=113), did not seek healthcare due to time constraint (n=132). The most frequent source of injury was either mechanical & thermal burns (n=20), lower limb was commonly involved accidents (n=28) followed by upper limb (n=23).

Table 2 shows majority of the participants worked for more than 8 hours (n=111). Most of the participants were responsible for their own injuries (n=92). Many participants did not use PPE (n=135). Company helped workers with money in illness (n=50), followed by medication (n=42).

Table 2: Frequency distribution of health related & health seeking behavior

Table 3 shows company had provided with houses and meal to workers, (n=144 & 149), respectively. If workers got injured company shifted them to the other work (n=123). Most of them were working as construction workers since less than 14 years (n=121).

Table 3: Working conditions of construction workers

Age (P=0.035), sex (P=0.023), occupation (P=0.045) and education (P=0.007), had a significant association to being prone to injuries. No significant association was observed between being prone to injuries and religion (P=0.380), marital status (P=0.150), experience (P=0.329), migration (P=0.543), and duration of work (P=0.064), respectively. Significant association was seen between experience and workers associated to accidents; in which they themselves responsible (P=0.009). Addiction was not seen to be associated with gender or being prone to accidents (P> 0.05). Significant proportions of males were prone to accident compared to females (P < 0.05).

Hazardous Behavior demonstrated by the workers were, not using PPE (n=141), working when tired (n= 63), and not using PPE & working when tired (n= 35). The construction workers who did not use personal protective equipment’s (OR= 4.77), were unskilled (OR= 2.73) and worked for a duration of more than eight hours (OR= 3.12) were more likely to be injured. When PPE was used, injury among workers were less (n=1). On contrary when PPE was not used, a greater number of workers got injured (n=31).

The construction industry is characterized by a high level of hazard to the health and life of workers.[10,11] Building design, materials, dimensions and site conditions are often unique, which requires adaptation and a learning curve from region to region.[12] Hence, usage of PPE and avoidance of hazardous behavior becomes even more important. Therefore, the aim of the study was to assess the occupational hazards and use of PPE among construction workers in urban areas.

Age, sex, occupation, and education were significantly associated with being prone to injuries. Most of the construction workers who participated were male, in age group of 15-45 years, followed Hinduism. Literacy rate was low, and maximum were migrants. This demography is comparable to previous study.[13,14] Male gender dominance might be attributed to nature of work. Hence, a higher proportion of males were observed to be prone to accident compared to females. Employing workers less than 15 years is against the prohibition of child labor act of 1986.[15] Eight percent of the construction workers belonged to this category. This age group should be in schools. Hence, parents need to be counseled regarding importance of education. Financial incentives along with social welfare measures may serve as a solution.[14] The construction companies should also be counseled against employing individuals of this age group.

According to the census 2011, national literacy level is 74.04%.[16] However, literacy was seen to be low. The inability to understand or read instructions regarding PPE would hamper its use. Migrants were maximum among the participants. It can be attributed to purpose of employment.

The recommended hours of work by the Maharashtra government is nine hours per day.[17] However, workers are seen working more than the stipulated time. Longer working hours has a dominoes effect prolonging exposure to hazards with limited time recovery. This results in the worker being physiologically depleted and this continues into the new day. This can lead to an increase in addictions and cause of fatigue among workers.[13,18] Respondents suffered mainly from mechanical and thermal burns. It can be attributed to non-usage of PPE.[18] Most of the participants cited lack of time for not seeking hospital care. Long working hours would leave them devoid of time for personal healthcare. Limbs were commonly affected in injuries. This is the most prevalent injury site in construction industries.[19]

The construction company had no provision of regular health check-up or first aid. Only provisions were made for medication. This suggests a lack of care for workers and onsite safety management.[18] The workers had provisional housing and working meals. This would be beneficial to migrants specifically as well as the others as it would reduce their personal expenditure.

PPEs are designed to prevent or reduce the severity of injury during an accident.[12] Maximum participants demonstrated unsafe behaviors. One of the factors which is significantly associated with injuries were non usage of PPE. This was consistent with previous studies.[6,18] Non usage of PPE can be attributed to lack of awareness about it among workers.[20] Unskilled workers were more likely to be injured as previously seen.[18] It indicates more intense physical labor, unsafe behaviors, and risky working conditions.[6,14]

Construction work is one of the most hazardous works across the globe. The workers involved in the construction industry are being underpaid and extremely vulnerable to the occupational health hazard and absence of social security mechanism. They are being exploited in the terms of low wage, non-availability of social security, work with low payment and sexual harassment at workplace.[21]

Workers were mostly themselves responsible for the accidents as seen in previous study.[6] A significant association was observed between experience and worker accidents. Those with greater than fourteen years’ experience were more aware of what to avoid.

Limitations include the small sample size and since the workers were interviewed and response was noted, there could be investigator’s bias. How many extra hours workers were working beyond the stipulated hours was not considered and should be studied further.

It can be concluded that; safety of construction workers was compromised by hazardous and risk-taking behavior which was demonstrated in non-usage of PPE. The illiteracy, poverty, lack of infrastructure and security, inadequate provision of PPE and inadequate health service utilization made the construction workers more vulnerable population.

1. Karvonen M, Mikheev MI. Epidemiology of occupational health. World Health Organization. [Internet]. 1986. Available from: https://apps.who.int/iris/handle/10665/27226.
2. Hämäläinen P. The effect of globalization on occupational accidents. Safety Science. 2009;47: 733–742.
3. Meena SR, Pawar SN, Nemade PM, Baghele AS. Implementation of Safety Management through Review of Construction Activities in M. S. Building Projects. International Journal of Engineering Research & Technology. 2013;2: 1656–1662.
4. Kulkarni GK. Construction industry: More needs to be done. Indian J Occup Environ Med. 2007;11: 1–2.
5. Jayasutha T, Ananthi BG. A Systematic Study of Behavioral Safety in Indian Construction Industry. International Journal of Advance Research in Science and Engineering. 2018;7: 315–324.
6. Guo S, Jiali H, Jichao L, Bing T. Exploring the Impact of Unsafe Behaviors on Building Construction Accidents Using a Bayesian Network. Int J Environ Res Public Health. 2020;17: 2–15.
7. Ye G, Yue H, Yang J, Li H, Xiang Q, Fu Y, et al. Understanding the Sociocognitive Process of Construction Workers’ Unsafe Behaviors: An Agent-Based Modeling Approach. Int J Environ Res Public Health. 2020;17:1588.
8. Wang J, Zou PXW, Li PP. Critical factors and paths influencing construction workers’ safety risk tolerances. Accid Anal Prev. 2016;93: 267–279.
9. Tadesse S, Israel D. Occupational injuries among building construction workers in Addis Ababa, Ethiopia. J Occup Med Toxicol. 2016;11(1): 16-18.
10. Lingard H. Occupational health and safety in the construction industry. Constr Manag Econ. 2013;31(6): 505–514.
11. Mirzaei Aliabadi M, Aghaei H, Kalatpour O, Soltanian AR, SeyedTabib M. Effects of human and organizational deficiencies on workers’ safety behavior at a mining site in Iran. Epidemiol Health. 2018;40:e2018019.
12. Grant A, Hinze J. Construction worker fatalities related to trusses: An analysis of the OSHA fatality and catastrophic incident database. Safety Science. 2014;65: 54–62.
13. Adsul BB, Laad PS, Howal P V, Chaturvedi RM. Health problems among migrant construction workers: A unique public-private partnership project. Indian J Occup Environ Med. 2011;15: 29–32.
14. Patel HC, Moitra M, Momin MIH, Kantharia SL. Working Conditions Of Male Construction Worker And Its Impact On Their Life: A Cross Sectional Study In Surat City. Natl J Community Med. 2012;3: 652–656.
15. Child Labor (Prohibition and Regulation) Act, 1986 [Internet]. Available from: https://labor.gov.in/sites/default/files/act_3.pdf
16. Literacy in India [Internet]. 2011. Available from: https://www.census2011.co.in/literacy.php
17. Industries E and LDM, Mumbai. Maharashtra Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Rules, 2007 [Internet]. 2007. Available from: https://mahakamgar.maharashtra.gov.in/images/pdf/building-and-other-construction-workers-rules-2007.pdf.
18. Kaur D, Lilare RR, Rathod ND, Datta B, Kaswan P. An organization based cross-sectional study of occupational injuries among bridge construction workers in an urban area of Mumbai. Int J Community Med Public Heal. 2019;6: 1211-1214.
19. Kanchana S, Sivaprakash P, Joseph S. Studies on Labor Safety in Construction Sites. Topçu İB, editor. Sci World J. 2015;2015: 5908-5910.
20. Adane MM, Gelaye KA, Beyera GK, Sharma HR, Yalew WW. Occupational Injuries Among Building Construction Workers in Gondar City, Ethiopia. Occup Med Heal Aff. 2013;1: 1000125.
21. Ravikumar Gupta, A study on occupational health hazards among construction workers in India. International Journal of Enterprise Network Management 2021. Vol.12, No. 4