1 BỘ GIÁO DỤC VÀ ĐÀO TẠO ĐẠI HỌC THÁI NGUYÊN HOÀNG THỊ THÚY HÀ THỰC TRẠNG MÔI TRƯỜNG, SỨC KHỎE, BỆNH TẬT Ở CÔNG NHÂN MAY THÁI NGUYÊN VÀ HIỆU QUẢ MỘT SỐ GIẢI PHÁP CAN THIỆP Chuyên ngành: Vệ sinh Xã hội học và Tổ chức Y tế Mã số: 62.72.01.64 TÓM TẮT LUẬN ÁN TIẾN SĨ Y HỌC Thái Nguyên, năm 2015 2 CÔNG TRÌNH ĐƯỢC HOÀN THÀNH TẠI TRƯỜNG ĐẠI HỌC Y DƯỢC - ĐẠI HỌC THÁI NGUYÊN NGƯỜI HƯỚNG DẪN KHOA HỌC: 1. PGS.TS. Nguyễn Văn Sơn 2. GS.TS. Đỗ Văn Hàm Phản biện 1: Phản biện 2: Phản biện 3: Luận án được bảo vệ trước Hội đồng chấm luận án cấp Đại học tại Trường Đại học Y dược – Đại học Thái Nguyên Vào hồi giờ, ngày tháng………. năm 2015 Có thể tìm hiểu luận án tại: - Thư viện Quốc gia - Trung tâm học liệu Đại học Thái Nguyên - Thư viện Trường Đại học Y - dược Thái Nguyên 3 INTRODUCTION Weave and Garment are formed and developed from earlier. How ever, up to now, working condition have been existed risk factors to workr’s health. Researchs of specialists from all over the world show that: working environment and worker’s health in weave and garment industry have characteristic in compare to others. The researchs of Bianna D, Ganer A, Boha S; Denis Hadjiliadis (2013-2014) on weave and garment workers in Bangladesh and Pennsylvania, Philadelphia (USA) are acknowledged that: disadvantageous environmental microclimate, dust polluted and the rate of many diseases are increasing, especially respiratory disease. Researchs in Vietnam are acknowledged many related diseases to weave and garment workers, especially respiratory disease (60 to 80%). Have no perfect and systematical researchs in Thainguyen are conducted on working place, occupational safety and health on garment workers. Intervention researchs for health care, prevention to related diseases on garment worker had been no ever. So that we have been conducted the theme: “The real situation of environment, health, diseases in Thainguyen garment workers and effect of intervention ” aiming at: 1. Describe the status of environment, health, diseases in Thainguyen garment workers in year 2012. 2. Analyses relative factors to health and diseases on Thainguyen garment workers 3. Evaluate the effectiveness of intervention for occupational safety and health in Thainguyen garment workers. 4 NEW CONTRIBUTIONS OF THE DISSERTATION 1. The dissertation has identified the real disadvantageous situation of Thainguyen garment workers’s working environment: some environmental factors exceeded permissible exposure limits (PEL) such as 30-50% of temperature samples; 20-30 of dust samples. The rate of good knowledge, attitude and practice on occupational heath and safety of workers are low (61-75%). Thainguyen garment workers’s health not good: The rate of weak health is high (4.6%); The high rate of nose- throath (TN) diseases was found (67.69% to 76.20%); The rate of bronchitis is: 4.23% to 9.6%; The rate of bysinosis is: 2.31% to 2.92%). Some relative factors to Thainguyen garment workers’s health and diseases were found: occupational ages, practice on occupational heath and safety, dust polluted and using mask. 2. Solutions for intervention have been proposed for worker’s health care, making high effect: diseases on repiratory tract in Thainguyen garment workers are decreasing: - The rate of good knowledge, attitude and practice on occupational heath and safety of workers about prevention for diseases on repiratory tract is increasing; Effect of Interventions to knowledge is 52.7%, to attitude is 61.94%, to practice is 76.96% . - Interventions made decreasing brochitis; The incident rate of acute repiratory tract infection is decreasing. - The model of intervention have been received supporting and cooperating from communities (Employers and employees), maintained and enhanced in garment industry. 5 STRUCTURE OF DISSERTATION The key part of the dissertation is 110 pages, including the following parts: Introduction: 2 pages Chapter 1. Literature review: 27 pages Chapter 2. Subjects and method: 19 pages Chapter 3. Results: 29 pages Chapter 4. Discussion: 20 pages Conclusions and recommendations: 3 pages The dissertation has 106 references, including 76 Vietnamese and 30 documents in English. The dissertation includes 38 tables, 7 diagrams on quantitive results and 7 boxes for qualitative results.The appendix includes 8 subappendices with 14 pages. Chapter 1. LITERATURE REVIEW 1.1. Environment, health and diseases of workers About the environment, health and diseases of worker were conducted by many researchs. However the problem of unshakcable development and occupational safety and health of enterprises become very importance. USA industry is in the first ranges of the world, but have being disadvantageous working environment, for example dust polluted, many factors exceeded permissible exposure limits. Working environment of weave and Garment workers in Asia were polluted by mix compound (organic and nonorganic) dust, disadvantageous microclimate. It’s risk factors for worker’s health. Results of some resarchs showed: 60% of weave and Garment workers exposed to risk factors (with forced position) suffering disease in muscle, bone and rheumatic. 6 By Nguyen Huy Dan, Nguyen Duy Bao ( National Institute of Occupational and Environmental Health) in year 2012, pollution by ocotton dust in working place and surrounded areas of weave and garment enterprises always risky and must be concerned. How to resolve? Need to be intervention by solutions how to decreasing environmental pollution, health care and preventing occupational disease of workers. 1.2. Affective factors to health and disease of worker Earlier from XVIII century, while the light industry had been developed in European, many researchs concerning about time of exposure to occupational risk factors and diseases in Engglish’s weave and garment industry. Especially in the first half of XX cetury, while the weave and garment industry had been developed, many relative risk factors affect to worker’s health and relative, occupational diseases had been determimed. In last ten years at XX cetury, many researchs about impact of working environment, physiology, biochemistry, clinical occupational disease have been conducted. Researchs in other fields were developed but have non matching suitability, therefore it is low effect for solutions to protect harmfulness, health care and preventing the occupational diseases of worker in many countries. 1.3. Intervention research for decreasing the harmfulness, protect and enhancement of worker’s health, preventing the occupational accident and disease From the last of XX cetury scientists in over the world have been researched focus to 2 orientations: environmental impact assessment and intervention for environmental improve and health protection. Asia-Pacific Occupational Safety and Health Organization (APOSHO) have been orienting the health care of worker in the first half of XXI century is preciding Occupational Safety and Health, 7 health care, preventing accident, occupational disease of workers by any ways, how to coincide to eco-social condition of the each country (The 23 Th of APOSHO council’s resolutions, year 2007 in Singapore). Research about labor and health care on garment worker in Bangladesh (2013), Me Huq, MR Rahman, S Shermin, et all showed that: 93% workers being tired, so that leading to exhaust after work. Authors recommended about solutions for improvement of working environment and primary health care to workers, especially solutions how to make up for health’s losses, enegy’s restablish. It was not many of researchs concerning to garment worker’s health care in our country, especially intervention studies. About solutions for worker’s health care in general, in particular of garment worker, Scientists and employers show that: It is very important for combinative suitable solutions from communication, health care, technic for occupational safety and health. Chapter 2. SUBJECTS AND METHODS 2.1. Study subjects 2.1.1. Enterprises: Describe about working environment Active choice 03 garment companies, enterprises have characteristic engineering processing of Thainguyen garment industry. Garment, cut, accomplish worshops of enterprises were chosen. 2.1.2. Employers and employees Garment workers direct - exposing to relative, risk factors were chosen. Group of wokers doing in characteristic environment and occupation, garment relative factors are being chosen. For intervention study to health protection and health care: - Intervention group: Garment workers are doing direct exposure to engineering processing of TDT Company. 8 - Control group: Garment workers are doing direct exposure to engineering processing of Chienthang garment enterprise. 2.2. Study setting and duration 2.2.1. Study setting 03 garment company, enterprises were chosen: Thainguyen garment company; Garment TDT Company and Chienthang garment enterprise. In which, workers of Garment TDT Company for intervention and workers of Chienthang garment enterprise for control. 2.2.2. Study duration: From february 2012 to october 2014 2.3. Methodology 2.3.1. Study method and Design There are two methods were applied in our research: - Design of cross-sectional descriptive study: The study used for describe the real situation of working environment, health, diseases of workers, KAP about occupational health and health and to determine related factors for health, disease ( For 1 and 2 study subjects, before the intervention). - Intervention study: Before - after intervention design with a control group. - Quantative study combined with qualitative study. Qualitative design with In-depth interviews and focus group discussions. 2.3.2. Sampling chosing method 2.3.2.1. Sampling method for descriptive study * Sample size for a descriptive study: Calculated by the following formula: 2 2 )2/1( . d qp n    Where: p = 0.3 ( Proportion of nose and throat acute infection) taken from the study by Nguyen Dinh Dung (31.7%), d = 0.03, α = 0.05. 9 Substituting these into the formula and giving a value for n of 897 and is rounded up = 1000. Sampling procedures: Active some workshops in choice 03 garment company. Workers were selected from lists of all by single random method, how to fit 1000: Thainguyen garment company: 500 workers Garment TDT Company: 260 workers Chienthang garment enterprise: 240 workers * Sample size for environmental study and lung function testing: Calculated by the following formula: n= Z 2 1-α/2 2 2 s ( X )  Substituting into the formula and giving a value for n of lung function testing is 76. In practice, grand total have 281 workers; n of environmental study is 28 and in practice, grand total have 30 samples. * Sampling method for intervention study - Sample size for a intervention study: Calculated by the following formula: n = (Z 1-/2 + Z 1- ) 2 1 1 2 2 2 12 () p q p q pp   Where Z (1-α/2) = 1.96, α=0.05 , (1 ) Z   = 2.8, sample power is 80%, p 1 = 0.32 (Proportion of nose and throat acute infection) taken from the study by Nguyen Dinh Dung (31.7%). p 2: Proportion of nose and throat acute infection after intervention decreasing additional 15%, so p 2 = 0.15. Substituting these into the formula and n is 94 and is rounded up = 100 for both two groups. This sample size is the same for KAP of occupational health and safety research and diseases. Sampling procedures: - Intervention group: 100 workers of garment TDT Company 10 - Control group: 100 workers of Chienthang garment enterprise. 2.4.2.2. Sampling method for a qualitative study In-depth interviews and focus group discussions were conducted 02 times before and after the intervention as follows: - In-depth interviews: 3 in-depth interviews (02 before and 01 after the intervention). - Group discussion: 04 Group discussions (02 before and 02 after the intervention). 2.4.3. Content of intervention 2.4.3.1. Organizable operation Making the Directive committee of occupational health and safety and prevention for respiratory diseases. Directive committee was managed by Board of Directors and making active contents. Health section chief and occupational safety persons are activist. Director taking the responsibility president of labor protection council is head of committee. Health section chief is sub-head of committee, having responsibility being on duty and assistant board of Directors all problems of occupational health and safety and prevention for respiratory diseases inworkers. 2.4.3.2. Content of intervention - Training and health communication of occupational safety and health, health care, prevention occupational and relative diseases, especially respiratory diseases of workers. - Inspecting and guide workers in practice of using how to rightly, permanently, effectively of personal protection. Guide workers about improving and care of working environment. - Using mask was putting in the first important position and having permanent inspection. - Combination with local committee, branch inspecting of industrial medicine in oder to improve the intervention effect and permanent preservation all intervention results in lasting. [...]... 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GIÁO DỤC VÀ ĐÀO TẠO ĐẠI HỌC THÁI NGUYÊN HOÀNG THỊ THÚY HÀ THỰC TRẠNG MÔI TRƯỜNG, SỨC KHỎE, BỆNH TẬT Ở CÔNG NHÂN MAY THÁI NGUYÊN VÀ HIỆU QUẢ MỘT SỐ GIẢI PHÁP CAN THIỆP . học và Tổ chức Y tế Mã số: 62.72.01.64 TÓM TẮT LUẬN ÁN TIẾN SĨ Y HỌC Thái Nguyên, năm 2015 2 CÔNG TRÌNH ĐƯỢC HOÀN THÀNH TẠI TRƯỜNG ĐẠI HỌC Y DƯỢC - ĐẠI HỌC THÁI NGUYÊN. học Y dược – Đại học Thái Nguyên Vào hồi giờ, ngày tháng………. năm 2015 Có thể tìm hiểu luận án tại: - Thư viện Quốc gia - Trung tâm học liệu Đại học Thái Nguyên - Thư viện Trường