All the welders were male. Males tend to engage in hazardous work, which is seen in this study. This finding has also been reflected by a study in Nigeria [13] and India [17] where welders are predominantly males. The younger age group involvement suggests the early age apprenticeship through hands on training from experienced welders at the start of the job. It was found that about 85.3 % respondents were married, a finding similar in India [18].
This study showed 93 % of welders’ population in this area have had education, similar to a study conducted in Northern Ethiopia [19, 20]. The Census 2001 [21] shows the literacy rate of 54.1 % with Literacy rate among men being 65.5 %. The Nepal Demographic Health Survey 2011 [22] shows 89.2 % of the men in the eastern terai have had some levels of education. This could be a part of the reason for 93 % of the welders having education in the same region. The level of education among the welders showed the 48.3 % of them have completed Secondary school. The reason for not continuing the education over primary education by the 37.7 % could be related to need for financial support of own self and family and a very few who did not find it important to continue further.
Eighty one percent of the welders from this study were living below the poverty line. The national data [23] shows 22 % of the population living below the national poverty line. This gap may need to be explored, despite being employed the welders found below the poverty line.
Less than a fifth of the welders were working for more than 10 years. The mean duration of experience of welders in this study is 6.94 years. The working population in this profession has high turnover in this area with very little people with experience still working here. The welders may have learnt welding and, moved to bigger cities for better wages. However studies in Nigeria [13], shows 74.8 % welders with experience of more than 10 years including 24.7 % of welders with experience of more than 21 years and mean experience of 15.6 years in Nigeria and 81.8 % welders working for 10 years and more including 25, 9 % in 20–29 years and 22.8 % in 30 and above category with mean experience of 20.33 years in Canada [24].
The mean welding hours per day in this study was 4.18 (±0.95) hours with a minimum duration of 2 h per day and a maximum of 6 h per day. In studies from Nigeria [3] and India, [17], the welders had working hours up to 12 h a day with more than 90 % of welders having working hours of more than 6 h up to 12 h. One reason for less duration of hours of welding in our study may be the long hours of power outage in our country [25]. Welders sometimes also performed tasks like cutting, hammering but not a regular basis.
In this study, all welders had one or more complaints on health, which was similar to findings from Nigeria [13], where 96.4 % welders had one or more health complaints. The most common complaints were injuries (90.7 %) due to physical hazards including cuts by sharp metals, blunt force injury and fall injury. Complaints of injuries among Nigerian welders [13] was 37.7 %. This difference could be due difference in the use of PPE and the duration of employment among the welders in the two settings [13].
After injuries, other common self-reported symptoms were skin problems (74.3 %), and arc eye related problems (61.3 %), asthma problems (46.7 %) while the least common problem was hearing problems (35.7 %). Skin, eye, and respiratory related morbidity are some of the common health hazard related in several studies [13, 17, 26, 27]. Arc eye related symptoms in this study were found among 61.3 % of welders. Arc eye related problems was seen in 75.7 % among the welders of Benin [13]. In a study done among Canadian welders, ocular symptoms were reported by 53.3 % of welders by El-Zein [24].
Metal fume fever related symptoms in this study (43.3 %) is similar with Isah [13] finding of 43.8 %. Likewise, the prevalence of arc eye symptoms was reported to be 36 % in another study in Ethiopia [4]. While our study showed that asthma related symptoms were seen among 46.7 %, a finding that mirrors that of a study by Jani [28] where respiratory morbidity was found to be 44.4 % among welders in India and El-Zein [24] reported 40.5 % among welders in Canada.
Hearing problems (12.4 %) in our study was similar a study conducted by Tadesse [4]. The morbidities among welders in this study seems high, which may not be surprising, considering that only 47.7 % of these welders in the study used at least one type of PPE. The awareness of hazards and use of PPE among these welders has been published in 2014 [5].
Hearing complaints have been reported least in our study population. There could be several reasons for this. Welders with severe hearing complaints may have left this job. The other reason could be the fact that these workers were usually working in outdoor open space resulting in mixture of noise from vehicles. Also, we had not used any objective criteria for auditory assessment such as audiometry, which would have enabled us to diagnose at least mild to moderate hearing loss.
These differences in the prevalence rate of self -rated occupational morbidities could presumably be due to the differences in socio-economic levels, lack of safety training and awareness; and limited occupational safety and health services and practices [5].
Arc eye (P < 0.001), Metal Fume Fever (P < 0.001), Asthma (P < 0.001), Skin problems (P < 0.001), Hearing problems (P < 0.001) and Musculoskeletal problems (P < 0.01) were all seen significantly associated with age of the welders, duration of employment and welding hours per day. This showed that symptoms of the welding related problems are seen more in the more aged welders, welders working for more number of years and welders working for more number of hours per day. These findings coincide with the findings by Isah [13]. Studies done by Sharifian [29], Stoleski [30], Jani [28] and by Erhabor [31] also showed that with increase duration of exposure (years), symptoms were likely to increase showing an association. In another study in India both morbidities were found to be significantly associated with years of employment among welders than non -welders [32].
Injuries were not found to be associated with age of the welders, duration of employment and welding hours per day. Although studies have been conducted with regard to morbid conditions among welders, limited literatures were found to assess association of welding hours with morbid conditions. A study in South India [33] also found no association between injuries with duration of employment and welding hours per day. The reason for no association with age of the welders, employment duration and working hour per day, could not be explained in this study. However a possible reason could be under reporting of the injuries especially of the minor cuts and abrasions which may be ignored. All welders are daily wage workers and any absence from work may lead to no income for that day. So welders may tend to not report minor symptoms. With majority (81 %) of respondents living below poverty line, affordability to healthcare centre for injuries of any kind seems expensive. As for musculoskeletal problems, most of the participants were observed to be spending their working time sitting. This finding has an important implication because welders are involved in sedentary occupation for years and prolonged sitting (usually in squatting position) or standing have been found to be related to high incidence of low back pain [34].
Limitations of the study
This study did not use any objective instruments (audiometry, spirometry etc.) to measure the welding related health problems. The use of self-reported symptoms may have under/overestimated the welding related health problems in this study. We attempted to address this issue by using operational definitions. The welding hours are short in this study, the electricity supply in the in the study area was 4–6 h/day only. In Nepal we have country frequent power cuts for up to 16 h in a day [25]. We could not quantify the time the welders may have contributed to other physical works of cutting and hammering which could also contribute to symptoms. However, it was noted that welders are not involved in other physical tasks regularly.
