A CROSS‐SECTIONAL STUDY ON THE HEALTH STATUS 

OF RUBBER TAPPERS OF SULLIA IN SOUTH INDIA 

by

Dr. SURULIRAMAN SURULIYANDIGOWDER MAKUDAPATHY 

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

in partial fulfillment of the requirements for the degree of

M. D. (COMMUNITY MEDICINE) 

Under the guidance of

Dr. A G KULKARNI, MD 

Department of Community Medicine Kurunji Venkataramana Gowda Medical College, Sullia 

2010 

Rajiv Gandhi University of Health Sciences 

i

DECLARATION BY THE CANDIDATE

I  hereby  declare  that  this  dissertation  entitled  “A  CROSS‐SECTIONAL 

STUDY  ON  THE  HEALTH  STATUS  OF  RUBBER  TAPPERS  OF  SULLIA  IN 

SOUTH  INDIA”  is a bonafide and genuine research work carried out by 

me under the guidance of Dr. A G KULKARNI, MD., Professor and Head, 

Department of Community Medicine, K V G Medical College, Sullia. 

 

 

 

Date:                 Signature of the Candidate 

Place: Sullia                 Dr. SURULIRAMAN S M 

ii

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A CROSS‐SECTIONAL STUDY ON THE 

HEALTH  STATUS OF RUBBER  TAPPERS OF  SULLIA  IN  SOUTH  INDIA”  is  a bonafide 

research  work  done  by  Dr.  SURULIRAMAN  S  M,  in  partial  fulfillment  of  the 

requirement for the degree of M. D. in Community Medicine. 

 

 

 

 

Date:            Signature of the Guide 

Place: Sullia          Dr. A G KULKARNI, MD 

Professor and Head of Department 

Department of Community Medicine 

K V G Medical College 

Sullia. 

 

 

iii

ENDORSEMENT BY THE HOD, PRINCIPAL/ HEAD OF THE INSTITUTION 

 

This  is  to  certify  that  the  dissertation  entitled  “A  CROSS‐SECTIONAL 

STUDY  ON  THE  HEALTH  STATUS  OF  RUBBER  TAPPERS  OF  SULLIA  IN 

SOUTH INDIA” is a bonafide research work done by Dr. SURULIRAMAN S 

M, under guidance of Dr. A G KULKARNI, MD., Professor, Department of 

Community Medicine, Kurunji Venkataramana Gowda Medical College, 

Sullia. 

 

 

 

Seal and signature of the HOD           Seal and signature of the Dean & Principal 

 Dr. A G KULKARNI, MD               Dr. SHEELA G NAYAK, MS 

Professor and Head,                                                        K V G Medical College, Sullia 

Department of Community Medicine                   

 Date:               Date: Place: Sullia            Place: Sullia 

 

iv

COPYRIGHT 

 

DECLARATION BY THE CANDIDATE 

I  hereby  declare  that  the  Rajiv  Gandhi  University  of  Health  Sciences, 

Karnataka  shall  have  the  rights  to  preserve,  use  and  disseminate  this 

dissertation/ thesis  in print or electronic format for academic/ research 

purpose. 

 

 

 

 

Date:              Signature of the Candidate 

Place: Sullia               Dr. SURULIRAMAN S M 

 

 

 

 

© Rajiv Gandhi University of Health Sciences, Karnataka 

  

v

ACKNOWLEDGEMENT 

 

First  and  foremost,  I  would  like  to  express  my  deep  sense  of  gratitude  and 

appreciation  towards  Dr.  A  G  Kulkarni,  Professor  and  Head  of  Department  of 

Community Medicine  for his  invaluable guidance, constant encouragement, expert 

suggestions,  constructive  criticism  and  supervision  which  was  most  crucial  in 

completing this thesis work. 

 

I  am  extremely  grateful  to,  Dr.  Anand  D  Meundi,  Professor,  Department  of 

Community  Medicine  for  his  keen  interest,  guidance,  supervision,  and  valuable 

advice for thesis improvement.  

 

I am extremely grateful to Dr. Arvind Athavale, Professor in community medicine for 

his valuable guidance and help. 

 

My heartfelt thanks to Dr.Rahul C Bedre, Assistant Professor in Community Medicine 

for his unrelenting support, help and advice. 

 

I  am  indebted  to  Dr.  Sai  Geetha, MS  and  Dr.  Rangayya, Medical  Officers,  KFDC 

Garden Hospital  for  their  continuous  support  and  kind help  throughout  the  study 

period. 

 

My  special  thanks  to all  the other Senior Officers and  staff of KFDC  for permitting 

and helping me in every possible way during the entire study period. 

vi

 

I would also like to thank our statistician Mrs.Rekha for helping me analyze the data. 

 

My thanks are due to the staff of the Department of Community Medicine. 

I am grateful  to all my  friends and colleagues  for  their untiring support.  I  thank all 

others who have assisted me  in some  form or  the other  in  the preparation of  this 

work. 

 

Last but not  least  I would  like  to  thank all my subjects without whose cooperation 

this dissertation would never have seen the light of the day. 

    Date:              Signature of the Candidate 

Place:  Sullia            Dr. Suruliraman S M 

 

 

 

 

 

 

 

 

 

 

 

 

 

December 2010 

vii

LIST OF ABBREVIATIONS

CRC Cenex Rubber Colony

DK Dakshina Kannada

KFDC Karnataka Forest Development Corporation

DRC Dry Rubber Content

NFHS National Family Health Survey

LPG Liquefied petroleum gas

ILO International Labor Organization

NRC National Research Centre

IOM Institute of Medicine

NRCIM National Research Centre and Institute of Medicine

WHO World Health Organization

MSD Musculoskeletal Disorders

NIOSH National Institute for Occupational Safety and Health

BLS Bureau of Labor Statistics

RSI Repetitive strain injury

ARI Acute Respiratory Infections

WHOQOL World Health Organization Quality of Life

WHOQOL-BREF World Health Organization Quality of Life-Best reference

viii

ABSTRACT

Background and Objectives

Agricultural workers have a multitude of health problems, a fact often forgotten

because of the widespread misconception that occupational health is mainly

concerned with industry and industrialized countries. There is no study available on

the health profile of rubber tappers in India to our knowledge. Hence the present study

was undertaken with the objectives to describe socio-demographic profile, living and

working environment of rubber tappers and also to assess their health profile and

quality of life.

Material and methods

The study area included four randomly selected colonies which had a total of 135

households. All 171 permanent employees of KFDC working as rubber tappers

residing in these four colonies constituted the study population. House-to-house visits

and visits to the place of work were made and required information was obtained by

interview using a semi-structured pre-tested questionnaire and conducting a thorough

clinical examination. The QOL was assessed using QOL-BREF questionnaire.

Results

Among the 171 tappers 70.2% were females and 29.8% were males. Body mass index

in 43.86% of the subjects was not ideal where 26.9% were underweight and 16.96%

were overweight. 45.1% of males consumed alcohol. There was no access to

sanitation facilities at the workplace among 87.1% of the population. Musculoskeletal

disorders were the most commonly observed health problem among 30.4% of the

rubber tappers. Accidents at work were reported by 22.8% of the subjects and there

were no use Personal Protective Equipments by any rubber tapper. The mean QOL

score was highest for social relationships domain. Males had higher mean QOL scores

ix

for physical and environment domains and QOL scores decreased as age advanced

which was found to be statistically significant only for the social relationships

domain.

Conclusion

Musculoskeletal disorders were more common among those with > 2 visits made to

shed with manual load and among those with a work experience of > 20 years in the

rubber tapping occupation.

Key words

Rubber, tappers, musculoskeletal, rural, occupational health, quality of life.

x

CONTENTS

SERIAL NUMBER PARTICULARS PAGE

NUMBER

1 INTRODUCTION 1

2 OBJECTIVES 11

3 REVIEW OF LITERATURE 12

4 MATERIALS & METHODS 21

5 RESULTS 25

6 DISCUSSION 40

7 CONCLUSION 46

8 SUMMARY 47

9 RECOMMENDATIONS 49

10 BIBLIOGRAPHY 50

11 ANNEXURES 55

xi

LIST OF TABLES

Table number Title Page

number

1 Demographic characteristic of Rubber tappers. 27

2 Socio economic characteristic of Rubber tappers based on modified BG Prasad’s classification (2009) 28

3 Distribution of households based on family size and dependant individuals. 28

4 Distribution of substance abuse among the study population 28

5 Housing conditions 30

6 Housing characteristics. 30

7 Work posture and distance of workspace from eyes 31

8 Other characteristics pertaining to occupation of rubber tappers 31

9 Work Experience among rubber tappers 32

10 Self-reported health status of rubber tappers 32

11 Comparison of Body Mass Index between male and female rubber tappers 33

12 General examination findings among rubber tappers 33

13 Health problems assessed from history and clinical examination of rubber tappers 34

14 Age wise distribution of musculoskeletal disorders 34

15 Sex wise distribution of musculoskeletal disorders 35

16 Difference between distances of work area from eyes and its relation to myopia. 35

17 Obstetric history among women rubber tappers 36

18 Logistic regression predicting the likelihood of rubber tappers reporting musculoskeletal disorders. 37

19 Mean Quality of Life scores of the rubber tappers 39

20 Comparison of Mean Quality of Life scores among the genders. 39

21 Comparison of Mean Quality of Life scores among different age groups. 40

xii

LIST OF FIGURES

Figure number Title Page

number

1 Leaning posture 4

2 Standing posture 4

3 Rubber tapping knife 5

4 Latex extraction 8

5 Tapping technique 9

6 Location of a Cenex rubber colony 20

xiii

1. INTRODUCTION

BACKGROUND

Plantations are enterprises which are found primarily in the tropical regions of Asia,

Africa and Central & South America, but they are also found in certain subtropical

areas where the climate and soil are suitable for the growth of tropical fruits and

vegetation. Plantation agriculture includes short-rotation crops, such as pineapple and

sugar cane, as well as tree crops, such as bananas and rubber. Plantation crops have

several characteristics: (1)

· They are either tropical or subtropical products for which an export market exists.

· Most require prompt initial processing.

· The crop passes through few local marketing or processing centres before reaching

the consumer.

· They typically require a significant investment of fixed capital, such as processing

facilities.

· They generate some activity for most of the year, and thus offer continuous

employment.

Plantations require a large resource of manpower. Employment in plantations is year-

round wherein workers can think of plantation work as secure income job. Relatively

little is known about the health status of hired farm workers either today or at any

time in the past. Thus, epidemiology in this population is severely restricted by the

lack of reliable denominator data. There have been no national, cross-sectional

assessments of the health status of this population that included a reasonably

1

comprehensive physical examination but few studies have been done on some aspects

of agricultural workers. (2) Many of the aspects of agricultural work are applicable to

rubber tapping.

There have been many studies on industrial sector workers. However, studies on

health of other industrial sectors may not reflect the status of farm workers because of

differences in age, ethnicity, economic status, work conditions, family structure, and

health-related behaviors. (2)

Until recently the concept of occupational diseases denoted a specific clinical and

pathological syndrome caused by a hazard specific to a particular type of work or the

work environment. Today this concept has changed. We know that occurrence of

occupational diseases may be affected by non-occupational factors such as nutritional

state and on the other hand the prevalence and incidence of several common diseases

may also be influenced by occupation. (3) The contribution of poor housing conditions

to adverse health outcomes among farm workers is unknown, but is likely to be

significant. (2) Occupational health in the agricultural sector is a new concept. From

the standpoint of capital investment and number of persons employed, agriculture

may be termed as a ‘big industry’. Agricultural workers have a multitude of health

problems – a fact which is often forgotten because of the widespread misconception

that occupational health is mainly concerned with industry and industrialized

countries (4).

With modern technology, many hazardous exposures at work have been reduced .The

workload and the intensity of activity is the ergonomic factor that largely determines

the effects on health. Harmful effects at work may not necessarily occur

simultaneously but may be consecutive or intermittent. Evaluation of the adverse

health effects of long term exposure to low level of harmful factors at work is

2

currently the most pressing problem in occupational health. (4) The adverse effects

defined by a WHO study group, as harmful effects are:

- those that indicate early changes of clinical diseases.

- those that are not readily reversible and indicate a decrement in the body’s ability to

maintain homeostasis.

- those that enhance the susceptibility of the individual to the deleterious effects of

their environmental influences.

- those that cause relevant measurement to be outside the ‘normal’ range if they are

considered as an early indication of decreased functional capacity.

- those that indicate important metabolic and biochemical changes.

The health hazards prevalent in agricultural occupation have failed to draw the

attention of the experts. The health hazards involved in it are totally of different

pattern in comparison to the hazards involved in other industries where heavy loads

are moved or dangerous chemicals are handled.

The health hazards produced in such agricultural occupation are therefore of different

nature since they appear to be originating from various interacting factors working

over a large span of time. Such hazards are likely to go unnoticed. This in itself

underlines the need to approach such occupation with conscious efforts to see that

these hazards are brought into focus. The chief hazards to field workers are exposure

to the elements, animal and insect bites and hazards related to the sharp tools. Injuries

that result should be treated promptly to reduce the risk of infection. Preventive and

therapeutic measures can reduce the hazards related to climate and pests. The

incidences of malaria and gastro-enteric diseases have been reduced on modern

plantations through prophylaxis, mosquito control and sanitary measures. (5)

3

Electricity is used on plantations for processing crops and lighting buildings.

Improper use of electric installations or equipment can expose workers to severe

shocks, burns or electrocutions. The danger is more acute in damp places or when

working with wet hands or clothing. Electricity as well as open flames or smoldering

cigarettes can provide the ignition source for fuel or organic dust. Kerosene, gasoline

or diesel fuel can cause fires or explosions if mishandled or improperly stored. Greasy

and combustible waste poses a risk of fire.

The use of toxic agrochemicals is a major concern, particularly during the intensive

use of pesticides, including herbicides, fungicides and insecticides. Exposures can

take place during agricultural production, packaging, storage, transport, retailing,

application (often by hand or aerial spraying), recycling or disposal. Risk of exposure

to pesticides can be aggravated by illiteracy, poor or faulty labeling, leaking

containers, poor or no protective gear, dangerous reformulations, ignorance of the

hazard, disregard of rules and a lack of supervision or technical training.

Poisonous snakes may be present on the ground or some species may fall from trees

onto workers. Infectious diseases can be transmitted to plantation workers by insects,

pests or by drinking water or food. Unsanitary water leads to dysentery, a common

problem among plantation workers. Confined spaces can pose problems of toxic gases

or oxygen deficiency.

Rubber tappers like agricultural workers are exposed to the elements as they have to

mostly work outdoors. The climate in Sullia taluk is highly humid. The rubber tappers

assume a leaning forward (Fig. 1) or standing upright (Fig. 2) posture while tapping

and most of the times they are subject to near work to make precise incisions on the

tree barks. Working in a bent or stooping position and lifting heavy loads imposes

4

strain on the back. Working with arms above the shoulder can cause upper-extremity

musculoskeletal disorders.

Figure 1. Leaning forward posture. Figure 2. Standing posture.

Average duration of work for a day lasts from anywhere between six to eight hours a

day. The long hours and demanding work make fatigue a major concern. Fatigued

workers may be unable to make safe judgments; this may lead to incidents that can

result in injuries or other inadvertent exposures. Physical stress is increased by heat

and relative humidity.

Figure 3. Rubber tapping knife

5

Rubber tappers use knives specially designed for rubber tapping (Fig 3). Poorly

designed tools will often result in poor work posture, and poorly sharpened tools will

require greater physical effort to complete tasks. Injuries can result from improper

uses of hand tools, in the present study’s context referring to specially designed

knives used for tapping rubber. Machinery and equipment are also sources of

excessive noise.

Rubber (6)

The para rubber tree initially grew in South America. Charles Marie de La Condamine

is credited with introducing samples of rubber to the Académie Royale des Sciences

of France in 1736. In 1751, he presented a paper by François Fresneau to the

Académie (eventually published in 1755) which described many of the properties of

rubber. This has been referred to as the first scientific paper on rubber. There are over

600 latex producing species in the world, rubber being one among them. Rubber is

described in chemistry as ‘isoprene polymers’. Rubber (Hevea brasiliensis) is a native

of the tropical South America. In India, commercial cultivation of natural rubber was

introduced by the British planters. The experimental efforts to grow rubber on a

commercial scale in India were initiated as early as 1873 at the Botanical Gardens,

Calcutta. The first commercial Hevea plantations in India were established at

Thattekadu in Kerala in 1902. In the 19th and early 20th century, it was often called

"India rubber." With the invention of motor vehicles, the demand for tyre and

consequently rubber shot up, bringing about its extensive cultivation.

6

Rubber in Karnataka & Birth of KFDC

According to the bilateral agreement in October 1964 between the Governments of

India and Sri Lanka, popularly known as the Sirimavo-Shastri Pact, (6) India agreed to

confer citizenship on 5.25 lakh persons from Sri Lanka, with their natural increase,

over a period of fifteen years. This was followed by another agreement in 1974

(Sirimavo-Indra Gandhi Pact, 1974) as a result of which India was to receive another

75,000 persons of Indian origin, within a period of two years, after those under the

first agreement had been repatriated. The entire process was expected to be completed

by October 1981. Of these 22,000 were trained only in rubber plantation work.

Rubber was introduced in Karnataka by the Forest Department in 1961 as an

experiment, which proved to be successful. This eventually became a rehabilitation

project for the Sri Lankan repatriates (Annexure V), many of whom had previous

knowledge of rubber tapping while in Sri Lanka. (7) Rubber plantations were started as

a joint venture by the Central and State governments in 1972 who opted Kerala and

Karnataka for rehabilitation. In the spirit of the pact between Sri Lanka and India, the

Union Government had directed the respective State Governments to bring forest land

under rubber cultivation. This was followed by the Karnataka State Government's

initiative in bringing 2,000 hectares under rubber cultivation in 1971. Plantation had

expanded to 4,443 hectares of land consisting of 11, 07,882 rubber trees by 2003. On

their part, the Sri Lankan Tamil repatriates took it as a challenge and converted what

were once dense deciduous forests in Dakshina Kannada (DK) district into a thriving

rubber growing area.

According to the corporation records, there are 1,960 employed permanently in the

rubber plantations and 95 per cent of them are of Sri Lankan Tamil origins. Two

7

persons per family were given employment in the rubber plantations. The job could be

transferred to anyone that the job holder wishes to transfer it to. Retirement age for

rubber tappers is 58 completed years. Jobs could be transferred at any time during

their employment to any individual they wish to nominate.

The Forest Department transferred to the Karnataka Forest Development Corporation

(KFDC) by lease 4,443 hectares of standing rubber plantations located in several

Reserve Forests in Sullia and Puttur talukas of DK, vide Government Order dated 27-

9-1980. (7) The intention of transfer was to manage the plantations more efficiently

and in a business like manner, by availing institutional finance. The main product of

KFDC is centrifuged latex (Cenex). In order to make centrifuged latex, the Dry

Rubber Content (DRC) of the field latex which contains about 30% of DRC is

concentrated to the extent of 60% DRC, by removing water through high speed

centrifugal action. The centrifuged latex is called as Cenex rubber.

Apart from the government-owned rubber plantations, the district has 3,900 hectares

of private plantations in smallholdings spread over Sullia, Puttur and Kundapur taluks

(now in Udupi district). They too employ Tamil repatriates, who are experts in the

profession.

Latex extraction method from the rubber tree

Latex is the milky sap of the rubber tree, Hevea

brasiliensis. Rubber trees are tapped for latex by

cutting a spiral groove in the bark and placing a

spout and collection cup at the base. (Fig. 4) Figure 4. Latex extraction.

8

Latex tree extraction

Starts when the tree is 4-5 years (when the trunk is 45cm / 17" in circumference).

Tapping panel is a half spiral (Fig. 5), starting about 150cm / 60" from the ground

(about the height of the tapper). Each incision is 1-2mm.

Tapping the rubber tree for its sap Figure 5. Tapping technique

Tapping is done early in the morning

even if it is raining or the trees are wet.

A tapper taps 350 trees in about 3-3 ½

hours, has a break and then collects the

latex after 4-5 hours after tapping.

After 4-5 hours the latex vessels become blocked and the latex coagulates leaving a

white strip of latex on the tree. This is known as "Tree lace".

Latex vessels run down from right to left and tapping is done downwards from left to

right to maximize production which is usually about ½ cup of latex which is 30-35%

rubber and the rest is water. Trees produce their best yields in the first 5 years. Rubber

trees are tapped on alternate days, although the frequency and method of tapping vary.

The latex is collected in cups hung on the tree below the cuts. The contents of the

cups are transferred to large containers and moved to processing stations. Ammonia is

usually added as a preservative. Ammonia disrupts the particles of rubber and

produces a two-phase product consisting of 30 to 40% solids. The ammonia is used as

a preservative to avoid coagulation and contamination of the latex.

9

Need and rationale

Occupational health should aim at the promotion and maintenance of the highest

degree of physical, mental and social well being of workers in all occupations; the

prevention among workers of departures from health caused by their working

conditions; the protection of workers in their employment from risks resulting from

factors adverse to health; the placing and maintenance of the worker in an

occupational environment adapted to his physiological and psychological equipment,

and, to summarize, the adaptation of work to man and of each man to his job. (8)

By “occupational environment” is meant the sum of external conditions and

influences which prevail at the place of work and which have a bearing on the health

of working population. The industrial worker is placed in a highly complicated

environment which is getting more complicated as man is becoming more ingenious.

There are three types of interactions in a working environment

1. Man and physical, chemical, and biological agents.

2. Man and machine

3. Man and man.

Little has been published about the health status of workers employed in rubber

tapping occupation, despite the fact that this occupation is a way of livelihood for

many people. It is disappointing that the rubber tapping occupation has not been given

the appropriate attention by the research workers with particulars to study the living

conditions, working conditions and the health hazards. One such attempt has been

made here to assess the health profile of rubber tappers.

10

2. OBJECTIVES

1. To describe the demographic and socioeconomic characteristics of rubber tappers.

2. To assess the living conditions of rubber tappers.

3. To describe the occupational environment of rubber tappers and related hazards.

4. To assess the health profile of rubber tappers.

5. To assess the Quality of life of the study population.

6. To suggest recommendations based on the study.

11

3. REVIEW OF LITERATURE

Read not to contradict and confute, not to believe and take for granted, not to find talk

and discourse, but to weigh and consider. (9)

It is the foundation stone based on which are built strong research methods. This in

turn forms the crux of effective programs and policy structures.

‘When you come to a patient’s house, you should ask him what sort of pain he has,

what caused them, how many days he has been ill, whether the bowels are working

and what sort of food he eats’, said Hippocrates in his work Affections. “I may

venture to add one more question, what occupation does he follow?” wrote

Bernardini Ramazzini (1700), (10) implying the role of occupation on health of an

individual.

From the review of various literatures it was understood that little research has been

conducted on the health status of rubber tappers. Therefore with the available

literature on rubber tappers and other literature on similar populations (agricultural

workers, rural populations) a study to assess the health status of rubber tappers was

attempted. These studies are to some extent applicable to rubber tappers as well.

Review on Socio-demographic characteristics

In a study done by T.V.Ushadevi and V.N.Jayachandran among rubber tappers in

Kerala in 2001 with a sample of 200, 4.5% were illiterates and 33% dropped out of

their studies at the primary level itself. Percentage of tappers having educational

qualifications of SSLC and above was 8.5%. Percentage of tappers with debts were

86.5. (11)

12

C Nancy et al described the socio demographic profile of a sample of 180 rubber

tappers in Sumatra, Indonesia where 59.66% had secondary jobs ranging from

farming, mechanic, carpentry, brick making and livestock raising. Age of the tappers

ranged from 33 – 40 years. Education levels were 60.5%, 9.75% and 29.75% for

primary, secondary high and high school respectively among the sample tappers. (12)

Review on housing conditions

National Family Health Survey 3 (NFHS-3) (2005-06) reported that

• 7% lived in kachha, 55% lived in semi-pucca (Annexure V) and 37.6% lived

in pucca houses in rural Karnataka. 85% of rural households had improved

source of drinking water. 16% of rural households had piped water into their

dwelling, yard, or plot. In urban and rural Karnataka, 43% of households treat

their drinking water to make it potable.

• Nationwide about 25% of households had drinking water piped into their

homes or yards. Other households rely on public taps, tube wells, or borewells.

About 33% of households treated their drinking water by boiling or other

methods to make it safer to drink.

• Sanitation facility in rural Karnataka was observed to be 78% as open space

defecation and 14.4% as flush/pour flush leading to piped sewer system, septic

tank, or pit latrine. Nationwide, only 29% of households have improved toilet

facilities.

• Cooking fuel used was wood in 87.8% of rural households; LPG/natural gas in

7.9%; 1.5% used kerosene in rural Karnataka.

• In rural Karnataka, cigarettes or bidis smokers were 0.1% of females and

28.7% of males. Paan masala, gutkha, or tobacco chewers were 6.0% of

13

females and 25.8% of males. Alcohol drinking was observed in 1.5% of

females and 27.5% of males.

• Adults in rural Karnataka suffer from a dual burden of malnutrition; over one-

third of adults were too thin, and 15 percent of women and 11 percent of men

were overweight or obese. Only 49 percent of women and 55 percent of men

were at a healthy weight for their height.

• The contraceptive prevalence rate among currently married women was 64%

(both urban and rural). Among the ever-married women, 37.3% had a birth

order of 1, 33.9% had 2 children 16.0% had 3 children and 12.8% had more

than 4 children. (13)

According to a study conducted by C U Thersia (2004) in Kerala among women

workers in agriculture, it was revealed that more than one-fifth (20.6%) of the ever-

married women in a sample of 165 had undergone abortion. Stillbirths were reported

in 2.4% of them. (14)

Review on Occupation related observations

The General Conference of the International Labor Organization (ILO), convened at

Geneva in 1967 and decided upon the adoption of certain proposals with regard to

maximum permissible weight to be carried by one worker which may be cited as the

Maximum Weight Recommendation, 1967. The recommendations mentioned that one

adult male worker may transport manually not more than 55 kilograms and where,

adult women workers are concerned, the maximum weight of such loads should be

substantially less than that permitted for adult male workers or should not be assigned

to regular manual transport of loads. Measures should be taken as speedily as possible

14

to reduce it to that level. This Recommendation applies to all branches of economic

activity. (15)

Agriculture has been rated as one of the most dangerous occupations (Mazza

1997).(16) The National Research Council and Institute of Medicine (NRCIM), (2001)

defines work related illness as being caused by, aggravated, accelerated or

exacerbated by workplace exposures, which result in impaired work capacity.

WHO report in 1985 stated that work environment, performance of work,

(17)

personal

characteristics, environmental and socio-cultural factors contribute to the cause or

aggravation of the disorder. (18) Also it was found that the incidence of farm

workplace injury during the twelve-month study period was reported to be 6% in male

workers and 2% in female workers. (18)

Generally, an estate with a predominantly hilly terrain will be more difficult to

work.(19) Gordon J E studied about the traumatic accidents in rural tropical regions

and reported that there were 116 injuries per thousand farm workers per year in rural

India in Punjab. (20)

A study was carried out in Madhya Pradesh (Central India) by Tiwari P S et al to

collect data on injury-causing agricultural incidents during the period 1995-1999. The

overall incidence rate was 1.25/1000 workers/year. (21)

H.Y. Umar et al (2008) showed that 53.85% of the respondents were victims of bites

and stings among rubber tappers in Edo and Abia States in Nigeria. (22)

Review on health problems

Based on the description of musculoskeletal disorders (MSD) by National Institute of

Occupational Safety and Health (NIOSH, 1997a) back pain and pain in the shoulders,

arms and hands are the most common symptoms reported by farmers (NIOSH,

15

2001).(23) Unfortunately, the majority of studies investigating MSD are completed in

settings other than agriculture. (24) Bobick and Myers, 1994 investigated agriculture–

related strains and sprains and found that injuries to the back and extremities were

quite common. (25)

More than 1 million workers annually sustain injuries severe enough to result in lost

time from work due to overexertion or repetitive motion (BLS, 1999). (26) The main

groups are back pain and injuries, and Work Related Upper Limb Disorders,

commonly known as “repetitive strain injuries” (RSI). (27) Musculoskeletal disorders

have been reported from all sectors of society. They are common to both the workers

in the organized industries, in the unorganized industries and have been reported even

among sedentary workers. A majority of these are either due to ergonomic stress or to

work load. The etiology may differ in different situations but the predominant cause

of these disorders is invariably a wrong ergonomic posture during work. In

unorganized industries, incorrect working posture often results in musculoskeletal

disorders in more than 1/4th of the employees. This may be well defined organic

lesions or may manifest as subjective symptoms. In both the cases industrial workers

are prone to suffer from painful conditions. This often results in decreased efficiency

and hampered production.

In a study conducted by Villarejo D et al on agricultural workers, significant numbers

of both male (41%) and female (40%) workers reported persistent pain (every day for

more than one week) in the back, neck, knees, shoulders, hands, feet, or multiple body

parts. (28)

Doyne (1923) stated that myopia was common among the educated and those engaged

in near work. (29)

16

Infection of the respiratory tract is perhaps the most common human ailment. It is

well known that the traditional domestic practice of cooking in primitive stoves with

low-grade fuels and in badly ventilated kitchens can have serious implications for the

health of women and children (Bruce et al., 2000).(30)

Many risk factors for respiratory tract infections have been identified. They include

not only the climatic conditions but also the housing, level of industrialization and

socio-economic development. In developing countries overcrowded dwellings and

intense indoor smoke pollution underline the high rates of respiratory infections.

United Nations Development Programme (UNDP) has recently pointed out that as

many as 2.8 million deaths per year result from breathing elevated levels of indoor

smoke from dirty fuels around the world. (31) The finding translates to about 6% of all

deaths per year. With this kind of effect indoor air pollution would be responsible for

one of the largest single risk factors for health and economy of any country.

Epidemiological studies have indicated that indoor air pollution due to bio-fuels is

linked to at least four major groups of illness which are acute respiratory infection

(ARI) in children, chronic obstructive lung diseases like asthma and bronchitis, lung

cancer, still births and other birth related problems.

There are no well-defined systems of recording agricultural injuries, as a standard

definition of agricultural injury does not exist (Howell and Smith, 1973). (32)

In the study done by T.V.Ushadevi and V.N.Jayachandran in Kerala in 2001 among

rubber tappers, 24.5% of rubber tappers use head light while tapping during

twilight.(11)

17

Review on Quality of Life

Increasingly, health care planners are recognizing that measures of disease alone are

insufficient determinants of health status. Over the past decades, two classes of

complementary health status measures have emerged to fill the information gap –

objective measures of functional health status and subjective measures of health and

well-being. (33–36) These measures are multilevel and multi-dimensional. There are

many published Quality of Life (QOL) measures but there is still a lack of consensus

among researchers about its definition and this is reflected in the choice of items for

their instruments. The WHO defines QOL as ‘an individual’s perception of their

position in life in the context of the culture and value systems in which they live, and

in relation to their goals, expectations, standards and concerns’. (37) In measuring QOL

therefore, the WHOQOL Group takes the view that it is important to know how

satisfied or bothered people are by important aspects of their life, and this

interpretation will be a highly individual matter. The World Health Organisation

Quality of Life assessment – the WHOQOL-100 – is a cross-culturally valid

assessment of well-being. Assessment is operationalized through 100 items

representing 25 facets organized in six domains. (38, 39) The tool was developed

through a collaboration of 15 sites around the world working in their own national

language. The WHOQOL-BREF was developed as a short version of the WHOQOL-

100 for use in situations where time is restricted, where respondent burden must be

minimized and where facet-level detail is unnecessary. Using data from 15 centres

collected for the WHOQOL-100 field trials, items for the WHOQOL-BREF were

selected for their ability to explain a substantial proportion of variance within their

parent facet and domain, for their relationship with the overall WHOQOL model and

for their discriminant validity. Analysis of these extracted items showed that a four-

18

factor structure best fitted the data. (40) Although this contrasted with the original

concept of a 6-domain model for the WHOQOL, it was consistent with empirical

results from the previous WHOQOL-100 field trials. (41) Based on these results, the

WHOQOL-BREF was developed in the context of four domains of QOL: physical,

psychological, social and environment. It was predicted that sick participants would

report poorer QOL than well participants but no predictions were made for other

socio-demographic differences. (40)

WHOQOL-BREF domains and Domain Facets incorporated within domains

1. Physical health

Activities of daily living

Dependence on medicinal substances and medical aids

Energy and fatigue

Mobility

Pain and discomfort

Sleep and rest

Work Capacity

2. Psychological

Bodily image and appearance

Negative feelings and Positive feelings

Self-esteem

Spirituality / Religion / Personal beliefs

Thinking, learning, memory and concentration

3. Social relationships

Personal relationships, Social support and Sexual activity.

19

4. Environment

Financial resources, freedom, physical safety and security

Health and social care: accessibility and quality

Home environment, physical environment (pollution / noise / traffic / climate)

Opportunities for acquiring new information and skills

Participation in and opportunities for recreation / leisure activities, transport

Figure 6. Location of a Cenex rubber colony.

The tranquility of rustic village life is acutely palpable. It is something that an urbanite may never get to experience!

20

4. MATERIAL AND METHODS

Study area

The rubber tappers with their families have been sheltered in settlements called as

Cenex Rubber Colony (CRC) situated in the forest areas converted as rubber

plantations since 1975. The Karnataka Forest Development Corporation (KFDC) has

established a total of 42 colonies for its permanent employees situated in various parts

of the 4,443 hectares of plantations in DK, Karnataka. Four of these 42 colonies were

selected randomly. There were a total of 135 households in these four colonies and all

135 houses were included in the study.

Study Population

The study population consisted of all rubber tappers residing in the selected four

colonies, who were engaged in rubber tapping for more than one year with KFDC

only.

Study Design

A cross-sectional study

Sampling

The KFDC has established 42 colonies for its permanent employees situated in

various parts of the 4,443 hectares of plantations in DK, Karnataka. Four of these 42

colonies were selected randomly. There were a total of 135 households in these four

colonies and all 135 households were included in the study. The total number of

21

rubber tappers employed by KFDC residing in the selected four colonies was 171. All

the 171 rubber tappers were included in the study.

Inclusion and exclusion criteria

Schematic representation of study design

Inclusion and exclusion criteria

Inclusion Criteria  1) Rubber tappers who are permanent residents of the selected four colonies. 2) Tappers must be employed by KFDC. 3) Tappers with experience > 1year. 4) Persons willing to participate in the study.

Exclusion Criteria  1) Tappers not employed by KFDC 2) If employed by KFDC, those with experience < 1year. 3) Persons not willing to participate in the study. 

Study group  1) Interview of rubber tappers.  2) Physical examination of subjects.  3) Observational assessment of work and work site. 

Selected study population

22

IMPLEMENTATION OF STUDY

It consisted of following four phases:

1. Preparatory phase

2. Phase of data collection

3. Phase of data analysis

4. Phase of documentation

Preparatory phase

Seeking administrative approval

The necessary approval was obtained from following authorities to conduct the study:

1) The Professor and Head, Department of Communiy Medicine, K V G Medical

College, Sullia.

2) Ethics Committee, K V G Medical College, Sullia.

3) Managing Director, KFDC, Bangalore (See Annexure I)

4) Executive Director, KFDC, Mangalore

5) Divisional Manager, KFDC (Sullia Division), Sullia

Constructing tools for the data collection

A semi-structured, pretested questionnaire was used for collection of data.

Questionnaire (See Annexure II) included,

1) Socio-demographic details like name, age, sex, religion, education status,

residential address, work-site address, total family members, income.

2) Housing conditions like natural lighting, ventilation, overcrowding, source of

drinking water, sanitation, cooking fuel used

23

3) Work details like total years of experience in rubber tapping, means of transport to

work, distance to work, working hours, work posture, preventive measures, and

distance to delivery point with load.

4) Work site observation of light, noise, drinking water and sanitation facility.

5) Detailed history with general and systemic examination.

6) World Health Organization, Quality of life questionnaire. (WHOQOL-BREF) was

used to assess the quality of life of the study subjects. (See Annexure III)

Arranging tools needed for study

The necessary arrangements were made to ensure the availability of the weighing

scale, measuring tape, torch, B.P. instrument, stethoscope for the study.

Phase of data collection

The study population was surveyed by house-to-house visit. Visits to place of work

were made. The data collection was carried out from April 2009 after obtaining

permission from KFDC to December 2009. (Annexure I)

Phase of data analysis

The data collected was entered, analyzed and tabulated using a Microsoft Excel

package of MS Office and SPSS 11.5 package of statistics. Statistical tests used were

Chi-square test, multiple logistic regression, unpaired t-test, ANOVA and LSD as

post-hoc test. The QOL scores of the WHOQOL- BREF version questionnaire (42)

were calculated as one overall score and four domains scores. These score were later

transformed to 0–100 scale which represents the scores if the respondents would have

been subject to the WHOQOL-100 questionnaire.

24

5. RESULTS

This cross sectional study was conducted to assess the health status of rubber tappers.

A total of 171 rubber tappers were assessed and the following results were observed.

The results obtained are discussed under the following headings.

5.1. Socio-demographic profile

5.2. Housing and living environment

5.3. Occupation related observations

5.4. Health profile

5.5. Quality of life

25

5.1. SOCIODEMOGRAPHIC PROFILE

Table 1. Demographic characteristic of Rubber tappers.

Variables N (%) N (%) N (%)

Gender Female 120 (70.2)

Male 51 (29.8)

Total 171 (100)

<35 years 26 (15.2) 14 (8.2) 40 (23.4) 36 - 45 years 40 (23.4) 12 (7.0) 52 (30.4) Age

> 45 years 54 (31.6) 25 (14.6) 79 (46.2)

Hindu 111 (64.9) 50 (29.2) 161 (94.2) Religion

Christian 9 (5.3) 1 (0.6) 10 (5.8)

Illiterate 13 (7.6) 2 (1.2) 15 (8.8) Primary school 42 (24.6) 15 (8.8) 57 (33.3) Middle school 43 (25.1) 15 (8.8) 58 (33.9) High school 19 (11.1) 13 (7.6) 32 (18.7)

Intermediate or Post High School

Diploma 3 (1.8) 5 (2.9) 8 (4.7)

Education

B.A/ Honors, M.A. 0 (.0) 1 (0.6) 1 (0.6)

Married 107 (62.6) 48 (28.1) 155 (90.6) Unmarried 2 (1.2) 3 (1.8) 5 (2.9) Marital

status Widowed 11 (6.4) 0 (.0) 11 (6.4)

In the present study it was found that the proportion of females (70.2%) was more

than males (29.8%). The age ranged from 23 to 58 years with mean age of the study

population being 42.98 years (S.D = 0.805). Females were more in all age groups.

Most of the workers (94.2%) were Hindus. Primary and middle school education

accounted for 67.2%, only 9.3% of the workers were unmarried or widowed.

26

Table 2. Socio economic characteristic of Rubber tappers based on modified BG

Prasad’s classification (43) (2009) (Annexure V)

Total households N = 135 Class N %

Class I 09 6.7 Class II 45 33.3

Class III 54 40.0 Class IV 26 19.25 Class V 01 0.75

Majority of the households (40%) belonged to class III followed by Class II (33.3%).

Table 3. Distribution of households based on family size and dependant individuals.

Total households N=135Parameters N (%) 1 - 4 individuals 66 (48.9) Family size > 4 individuals 69 (51.1) 1 - 4 individuals 129 (95.56) Total dependants > 4 individuals 06 (4.44)

Family size (Annexure V) was more than four in 51.1% of the households. Only

4.44% households had more than four dependants. The maximum number of

dependants in a house was 10, which was observed in one household.

Table 4. Distribution of substance abuse among the study population.*, **

Substance Study population N = 171

Alcohol 25 (14.61)

Chews paan masala, gutkha or other tobacco 24 (14.03)

Smoking 14 (8.18) *Figures in parentheses represent percentages. **some persons were addicted to both Alcohol and Tobacco

Alcohol consumption was a habit in 14.61%, 14.03% chewed paan masala, gutkha or

tobacco and 8.18% of the study subjects were smokers.

27

5.2. HOUSING AND LIVING ENVIRONMENT

Description of the houses in the CRCs: All houses in the colonies built by the forest

department for the permanent workers were semi-pucca houses. The houses were built

in rows. Area of each house measures 20 by 25 sq ft. consisting of 3 rooms. Each

house has a kitchen with no wash area and vent for outlet of smoke. All houses have

electricity supplied by the Karnataka Electricity Board (KEB). Sanitary latrines have

been individually constructed by the residents. Some households could not afford the

construction of sanitary latrines. Each household spends about 5000 rupees for

building a sanitary latrine, which are attached to closed pits, and is usually situated in

the backyard. Pit type latrines with slab were part of the original colony houses built

by the Forest department which were not received well by the population. Presently

these rooms which housed the pit latrines are being used as either puja rooms or

storage rooms after the pits had been filled and closed. The houses do not have piped

water supply but most houses have a water tap in front of the house which receives

water from a common municipal overhead tank. Each colony has a well which is used

for drinking and other domestic purposes. The wells in all the colonies were not

covered, do not have a common pulley and pot for drawing water. Each individual

household use their respective pot and pulley for drawing water from the common

wells. The wells are lined, have parapets, platforms and drains. These wells have been

constructed on the lines of a sanitary well but the maintenance and usage of a sanitary

well are not being followed by the residents using the wells. The residents do not

prefer to use the water supplied by the municipality for drinking even though it is

common knowledge among the residents that the overhead tank is closed, disinfected

after cleaning every month.

28

Table 5. Housing conditions. **

Total households N = 135 Parameters N %

Inadequate Ventilation 56 41.5

Inadequate Natural lighting 63 46.6

Overcrowding 59 43.7 **More than one parameter observed in some houses.

Inadequate ventilation was observed in 41.5%, Overcrowding (Annexure V) in 43.7%

and absence of adequate natural lighting of houses in 46.6% of the households.

Table 6. Housing characteristics.

Total households N = 135 Housing characteristics N % Public well 77 (57.03)

Private Bore well 4 (2.96) Source of Drinking water** Piped water into

dwelling/yard/plot 76 (56.3)

Boiling 31 (22.96) Water treatment prior to drinking No treatment 104 (77.04)

Flush/pour flush to piped sewer system, septic tank, or pit latrine 119 (88.15)

Sanitation facility No facility/open space/field 16 (11.85)

Firewood 135 (100) Gas 34 (25.19) Cooking fuel**

Kerosene 3 (2.22) **Total percentages may add to more than 100.0 because multiple answers were allowed.

The main source of drinking water was public wells which were used by 57.03% of

households. Amongst them 77.04% did not treat water prior to drinking. Sanitary

facility was unavailable and open space defecation was practiced by 11.85%. All

households use firewood as their main source of cooking fuel, of which 25.19% use

gas and 2.22% use kerosene as additional sources of cooking fuel.

29

5.3. OCCUPATION RELATED OBSERVATIONS

Table 7. Work posture and distance of workspace from eyes.*

Leaning forward 78 (45.6) Work posture

Standing 93 (54.4)

< 30 cms 123 (71.9) Distance between work area and eyes > 30 cms 48 (28.1)

*Figures in parentheses represent percentages of the total population. N = 171.

The proportion of rubber tappers adopting standing posture was 54.4% while those

adopting a leaning forward posture were 45.6%. The distance between the eyes and

the work area was < 30 centimeters in 71.9% of them.

Table 8. Other characteristics pertaining to occupation of rubber tappers.*

Walk 142 (83.0) Means of transport to work Motor vehicle 29 (17.0)

< 6 kms 77 (45.0) Distance to workplace from home > 6 kms 94 (55.0)

< 2 visits 148 (86.5) Number of visits to shed manually transporting load > 2 visits 23 (13.5)

*Figures in parentheses represent percentages of the total population. N = 171.

Walking was the main means of transport for 83% of the population. Distance to the

allotted plantation block was more than 6 kilometers (two-way) for 55% of the study

population. There were 13.5% of the tappers making > 2 visits to the shed carrying

load manually.

30

Table 9. Work Experience among rubber tappers.

Number of subjects N=171 Number of years of tapping

N (%) < 10 YEARS 42 (24.56)

11 - 20 YEARS 45 (26.31)

21 - 30 YEARS 63 (36.84)

> 30 21 (12.28)

Majority (36.84%) had work experience of 21-30 years and 12.28% had an experience

of more than 30 years. (Annexure V)

5.4. HEALTH PROFILE

Table 10. Self-reported health status of rubber tappers

Self reported health status N %

Excellent 2 1.16 Good 128 74.85 Fair 34 19.88 Poor 7 4.09 Total 171 100

On asking how the rubber tappers perceived their health status (Annexure V) during

the last one year 74.85% responded as good and 4.09% as poor. Only 1.16% felt their

health status was excellent.

31

Table 11. Comparison of Body Mass Index between male and female rubber tappers.

Sex Body Mass Index Females N=120

N (%) Males N=51 N (%)

Total N = 171 N (%)

Underweight 35 (29.16) 11 (21.56) 46 (26.90)

Normal range 62 (51.66) 34 (66.66) 96 (56.14)

Pre-obese 17 (14.61) 6 (11.76) 23 (13.45)

Obese class I 06 (5.0) 0 (.0) 06 (3.50)

BMI (Annexure V) in 56.14% of the population were in normal range. However more

percentage of females were underweight and pre-obese compared to males. Of the

obese class I all were females.

Table 12. General examination findings among rubber tappers.

Study population N = 171 Category N (%)

Pallor 49 (28.65)

Oral lesions 48 (28.07)

Skin lesions 18 (10.5)

High blood pressure 16 (9.35)

Eye lesions 13 (7.6)

Scalp lesions 11 (6.4)

Nose lesions 07 (4.1)

Ear lesions 05 (2.9)

Clubbing 04 (2.34)

Icterus 03 (1.75)

Pallor was seen in 28.65% and oral lesions predominantly dental caries was seen in

28.07% of the subjects. Skin lesions mainly dermatitis and callosity were observed in

10.5% and High blood pressure(Annexure V) was seen in 9.35% of the study subjects.

32

Table 13. Health problems assessed from history and clinical examination of rubber

tappers.

Study population N = 171 Category N (%) Musculoskeletal disorders 52 (30.40) Accidents at work 39 (22.8) Tuberculosis 1 (0.58) Hypertension 9 (5.26) Asthma 5 (2.9) Chronic gastritis 4 (2.34) Diabetes Mellitus 3 (1.75) Myocardial Infarction 1 (0.58) Congenital anomaly of CVS 1 (0.58) Epilepsy 1 (0.58) Thyrotoxicosis 1 (0.58)

Musculoskeletal disorders (Annexure V) were the most common clinical finding

among 30.40% of the rubber tappers. Among chronic conditions, Hypertension was

seen in 5.26% and Diabetes was seen in 1.75% of the study subjects. 2.9% of the

subjects were asthmatic.

Table 14. Age wise distribution of musculoskeletal disorders.

Musculoskeletal disorders

Age groups

Present

N (%)

Absent

N (%)

Total

N (%) <35 years 5 (12.5) 35 (87.5) 40 (100)

36 - 45 years 16 (30.8) 36 (69.2) 52 (100)

> 45 years 31 (39.24) 48 (60.76) 79 (100)

Total 52 (30.40) 119 (69.60) 171 (100)

X2= 8.97 Df= 2

p value=0.01

There was significant difference between the age groups and presence of

musculoskeletal disorders. Musculoskeletal disorders were more common in older

individuals compared to the younger age groups.

33

Table 15. Sex wise distribution of musculoskeletal disorders.

Musculoskeletal disorders

Sex

Present

N (%)

Absent

N (%)

Total

N (%) Chi square

Female 37 (29.41) 83 (70.6) 120 (100)

Male 15 (30.83) 36 (69.17) 51 (100)

Total 52 (30.40) 119 (69.6) 171 (100)

X2= 0.034 Df= 1

p value=0.85

Musculoskeletal disorders were more common among the males compared to females.

However, this difference was not statistically significant.

Table 16. Difference between distances of work area from eyes and its relation to

myopia.

Myopia Distance between eye and work area

Present

N (%)

Absent

N (%)

Total

N (%)

Chi square

Less than 30 cms 19 (79.2) 104 (70.7) 123 (71.9)

More than 30 cms 5 (20.8) 43 (29.3) 48 (28.1)

Total 24 (100) 147 (100) 171 (100)

X2= 0.724 Df= 1

p value=0.395

Myopia was present among 14.03% of the subjects and in Table 16 among the

myopics it was more common (79.2%) in those who worked at a distance < 30

centimeters between eyes and work area compared to those working at a distance > 30

centimeters. But this difference was not statistically significant.

34

Table 17. Obstetric history among women rubber tappers.

Parameters N %

Women who have attained menopause N = 120 42 (35.0)

Nulliparous 07 (5.93)

1 12 (10.17)

2 43 (36.44)

3 47 (39.83)

Births to ever-married women N = 118

4+ 09 (7.63)

History of Abortion in among the ever-married women N = 118 14 (11.86)

History of Stillbirths among the ever-married women N = 118 04 (3.38)

Contraception not used by currently married women N = 76 44 (57.89)

The total number of women in this study was 120 of which 118 were ever-married

women. Of the 118 ever-married women 5.93% were nulliparous, and most (39.83%)

of them had a birth order of 3. One woman had a birth order of 10 which was the

highest. Abortions in ever-married women were reported in 11.86% and stillbirths in

3.38%. There were a total of 107 currently married women. Excluding the

menopausal and unmarried women there were 76 women who were currently married

and were eligible for contraception use. But 57.69% of them were not adopting any

method of contraception at the time of the study.

35

Table 18. Logistic regression predicting the likelihood of the study population

reporting musculoskeletal disorders.

95% Confidence

Interval Predictors b S.E. Wald df Sig. Odds Ratio Upper Lower

Workplace distance 0.646 0.387 2.788 1 0.095 0.867 0.292 2.572

Means of transport -0.397 0.563 0.498 1 0.481 0.544 0.207 1.428

Number of visits with

manual load 1.413 0.497 8.087 1 0.004 4.502 1.803 11.242

Number of years in tapping 1.083 0.371 8.538 1 0.003 2.941 1.482 5.833

Work posture -0.271 0.374 0.524 1 0.469 0.555 0.288 1.072

Constant -4.286 1.361 9.914 1 0.002

b is the coefficient of the predictor variables S.E is Standard error Wald test is used to test the statistical significance of each coefficient (b) in the model. df is the degree of freedom Sig denotes Significance

The above table shows the relationship between different work-related factors

(predictor variables) and musculoskeletal disorders. In comparison to the workers

working for > 20 years with those working for < 20 years it was found that occurrence

of musculoskeletal disorders were significantly more in those working for > 20 years.

Comparing those workers making > 2 visits to the shed carrying manual load and

those making lesser visits, the occurrence of musculoskeletal disorders were

significantly more among those making >2 visits. Occurrence of musculoskeletal

36

disorders between those subjects adopting standing work posture while tapping to

those adopting leaning posture was not found to be significant. Similarly there was

no significant difference between those walking to work and travelling by any motor

vehicle, and also between those subjects who walked a distance of >6 kilometers and

<6 kilometers to their respective workplace from their homes.

Health care services

The rubber tappers have health insurance provided by KFDC. A hospital that caters

only to KFDC employees, with both male and female Medical Officers are available

providing inpatient and outpatient services. Weekly visits by one of the Medical

Officers’ are made to the colonies providing consultation and treatment. Medications

are distributed free of charge to all employees of the Corporation. Medical

reimbursement from employer can be availed after treatment from designated referral

hospitals. KVG Medical College Hospital is the designated referral hospital.

37

5.5. QUALITY OF LIFE

Table 19. Mean Quality of Life scores of the rubber tappers

WHOQOL domains N Minimum Maximum Mean Std. Deviation

Physical health 171 31 81 56.95 9.08

Psychological 171 31 81 55.15 10.45 Social relationships 171 25 94 59.41 14.54

Environment 171 25 88 57.73 12.46 Overall score 171 16 36 28.50 4.40

Table 20. Comparison of Mean Quality of Life scores among the genders.

WHOQOL domains Sex N Mean Std.

Deviation t df p value

Female 120 55.508 8.567 Physical health

Male 51 60.333 9.462 -3.264 169 0.001

Female 120 55.333 10.588 Psychological

Male 51 54.725 10.225 0.346 169 0.729

Female 120 59.641 14.915 Social relationships Male 51 58.882 13.776

0.311 169 0.755

Female 120 56.5 12.217 Environment

Male 51 60.627 12.696 -1.997 169 0.047

Female 120 28.533 4.305 Overall score

Male 51 28.392 4.682 0.191 169 0.848

QOL scores were calculated as one overall score and four domain scores. The mean

score was highest for social relationships domain followed by environment domain,

physical health and psychological domain (Table 19). QOL scores when compared

between males and females showed that the overall QOL score was almost same for

both. But males had higher scores for physical and environment domains which was

statistically significant using unpaired t-test (Table 20).

38

Table 21. Comparison of Mean Quality of Life scores among different age groups.

WHOQOL domains Age groups N Mean Std.

Deviation F df Sig.

<35 years 40 57.25 10.79 36 - 45 years 52 57.92 8.25

> 45 years 79 56.15 8.70 Physical health

Total 171 56.94 9.08

0.621 2, 168 0.538

<35 years 40 55.45 8.94 36 - 45 years 52 55.25 11.10

> 45 years 79 54.93 10.84 Psychological

Total 171 55.15 10.45

0.034 2, 168 0.965

<35 years 40 63.47 13.98 36 - 45 years 52 60.94 14.29

> 45 years 79 56.35 14.50 Social

relationships Total 171 59.41 14.54

3.706 2, 168 0.026

<35 years 40 60 13.43 36 - 45 years 52 58.36 13.27

> 45 years 79 56.16 11.31 Environment

Total 171 57.73 12.46

1.358 2, 168 0.256

<35 years 40 29.2 3.96 36 - 45 years 52 28.76 4.34

> 45 years 79 27.94 4.64 Overall score

Total 171 28.49 4.40

1.220 2, 168 0.297

ANOVA was used to determine whether age, education and socioeconomic status had

any influence on the quality of life. It was found that Educational and socioeconomic

status did not have any influence on the quality of life among the study population.

However, it was observed that the QOL scores decreased as age advanced in all

domains but this difference in mean scores was found to be statistically significant

only for the social relationships domain (Table 21). However the post–hoc test (LSD)

revealed that the difference in scores was statistically significant between the age

groups of < 35yrs and > 45 years.

The QOL scores among subjects with no musculoskeletal disorders compared to those

with musculoskeletal disorders was higher for all domains except for psychological

domain. However this difference in scores was not statistically significant (t-test).

39

6. DISCUSSION

This study was conducted on 171 rubber tappers to assess their health status and

quality of life.

Socio-demographic characteristics

The average age of the study population was 42.98 years and the ages ranged from 23

– 58 years. KFDC employed individuals over the age of 18 and age of retirement is 58

years. This is because of the strict implementation of the Child Labor (Prohibition and

Regulation) Act [Act No. 61, 1986]. (44) But in a study done by C Nancy et al (12)

among rubber tappers in Indonesia the age ranged from 33 – 40 years.

The proportion of females (70.2%) was greater than males (29.8%) in this study

which was in contrast to the study done by T V Ushadevi et al (11) among rubber

tappers in Kerala where only 4% of the tappers were women. This is because the work

type, salary and timings in the KFDC plantations are fixed and the hired farm workers

employed by the KFDC finish work by 2 pm in the afternoon. This allows the women

to return home early and take care of the children and household chores. The men do

work but on rubber farms owned by private owners.

In the present study 8.8% were illiterates and 5.3% had qualifications of SSLC and

above which was lower compared to the study done by T.V.Ushadevi et al (11) where

4.5% were illiterates and 8.5% of tappers had educational qualifications of SSLC and

above. This may be because of the known fact that literacy rates in Kerala are high.

The level of education was also higher among rubber tappers in Indonesia where none

were illiterates and 29.5% had qualifications above high school level.

Majority (40.93%) of the rubber tappers belonged to the upper middle class based on

the BG Prasad’s classification (43) for socioeconomic status in rural India. Rubber

40

tapping was the major source of income in the present study but 7.7% of the tappers

had other sources of income ranging from working as daily wage hired farm workers

in other private farms and masonry. This was lower compared to other studies. (11, 12)

Indonesian rubber tappers in the study by C Nancy et al (12) described 59.66% had

secondary jobs ranging from farming, mechanic, carpenter, brick maker and livestock

raiser. Ushadevi et al (11) reported that 45.8% tappers had other sources of income

which were agriculture, animal husbandry and casual labor. Loans were availed by

74.85% in the present study whereas in a study done by T.V.Ushadevi et al (11) 86.5%

were indebted.

Substance abuse was seen in 29.82% of the study population. Tobacco in either

smoke or chewable form was the most common substance abused by 22.21%

followed by alcohol (14.61%). NFHS 3 (13) reported 0.1% of females and 28.7%

males were smoking, 6.0% females and 25.8% males were chewing tobacco, paan, or

gutkha and 1.5% females and 27.5% males were consuming alcohol in rural

Karnataka. Comparing this with the present study all findings was similar except for

higher consumption of alcohol by males (45.1%).

Living conditions

All the households in the present study had electricity and improved source of water

supply whereas only 84% households had electricity and 85% had improved source of

drinking water in rural Karnataka according to NFHS 3. (13) Treatment of drinking

water was lower in the present study (22.96%) compared that of rural Karnataka

(43%). Nationwide about 25% of households had improved sources of drinking water

and 33% treat their drinking water.

41

All houses were semi-pucca (Annexure V). NFHS-3 (13) reported 55% lived in semi-

pucca houses in rural Karnataka. Outdoor defecation was practiced by 11.85%

whereas NFHS-3 (13) reported outdoor defecation to be 78% in rural Karnataka.

NFHS-3 (13) reported 87.8% used wood, 7.9% used LPG and 1.5% used kerosene as

cooking fuel in rural Karnataka. But in the present study all households use firewood

as their main source of cooking fuel, of which 25.19% use gas and 2.22% use

kerosene as additional sources of cooking fuel. There is a risk of smoke accumulating

in the houses. Adding to this 44.44% of study subjects lived in ill ventilated houses,

47.36% in houses with inadequate natural lighting and 43.7% lived in overcrowded

conditions. This exposes the inmates of the households to various respiratory

disorders.

Occupation related observations

In the present study 50.87% had a work experience of >20 years but C Nancy et al (12)

reported that 7.25% of the sample Indonesian rubber tappers had a work experience of

more than 20 years.

Walking was the main means of transport for 83%. Distance to the allotted plantation

block was more than 6 kilometers two-way for 55% of the study population. Among

those who walked to work, nearly half (46.5%) of them walked more than 6

kilometers to work and back home.

In the study done by T.V.Ushadevi et al (11) in Kerala (2001) among rubber tappers,

24.5% of rubber tappers use head light while tapping whereas only 7.6% in the

present study used head light. It is essential to use head light as all tappers are

exposed to working under poor light during early hours. This is the time when

42

pressure of the latex vessels in the rubber trees is highest helping in maximum

productivity.

The present study revealed that 45.6% adopted a leaning forward posture and 54.6%

adopted a standing posture while tapping rubber. But it is important to consider that

posture is decided by the part of the tree which is being tapped rather than the

individuals’ preferred posture.

Myopia was common among those rubber tappers who work at a distance <30

centimeters between eyes and work area. This was not statistically significant. But

Doyne (25) demonstrated that myopia was common among those engaged in near

work. Therefore attention must be drawn to this fact and necessary precautions must

be adopted.

It is important to use Personal Protective Equipments (PPE) in the rubber tapping

occupation like gloves to avoid injuries from knives. It was observed that none of the

tappers were using any kind of protective equipments.

Health profile

The health status was perceived as good by 74.85% of tappers and by 7% as poor.

Only 1.16% felt their health status was excellent.

.NFHS 3 (13) reported that among adults in rural Karnataka over 37% were

underweight, and 15% of women and 11% of men were overweight or obese. Only

49% of women and 55% of men were at a healthy weight for their height. In the

present study 26.90% were underweight and 19.61% of women and 11.76% of men

were overweight or obese. Only 51.66% of women and 66.66% of men were at a

healthy weight for their height. Both underweight and obesity were a problem in

females.

43

Musculoskeletal disorders were the most common disorder observed in 29.4% male

and 30.8% female in the present study. In the study conducted by Villarejo D et al (28)

on agricultural workers, 41% male and 40% female workers reported musculoskeletal

disorders which were higher.

Accidents at work within the last year were reported by 39 tappers at a rate of 228

injuries/1000 workers per year. Gordon J E (20) in Punjab (1962) studied that traumatic

accidents among farm workers and reported 116 injuries/1000 workers per year which

is much lesser than what was observed in our study. A study was carried out in

Madhya Pradesh (Central India) by Tiwari P S et al (21) from 1995-1999 reported an

overall incidence of 1.25 injuries/1000 workers/year agricultural injuries. This was

also lesser than what was observed in our study. A farm workplace injury during the

twelve-month period was reported as 40/1000 workers by WHO (1985) (18) which is

also lesser than our study. The high number of accidents at work in the present study

may be attributed to the non use of PPE. Skin lesions mainly dermatitis and callosity

was observed in 10.5% of the population. This can also be because none of the rubber

tappers use gloves while tapping.

Abortions were reported in 11.7% and stillbirths in 3.3% among the ever-married

women who were part of the present study. According to the study conducted by C U

Thersia (14) in Kerala among agricultural workers in 2004 revealed that 20.6% of the

ever-married women had undergone abortions, higher than our study. Stillbirths were

reported in 2.4% of them which is lesser than our study. Of the 118 ever-married

women 5.93% were nulliparous and 47.46% had >2 children whereas the NFHS 3 (13)

reported that 28.8% had a birth order of >2 among women in rural Karnataka. This

may be attributed to the finding that 57.69% of women who were currently married

44

had not been practicing any method of contraception at the time of our study which

was higher compared to the NFHS 3 (13) report where 36% currently married women

were not using any methods of contraception in rural Karnataka.

Quality of life

A WHO (38) report (1995) predicted that sick participants would report poorer QOL

than well participants but no predictions were made for other socio-demographic

differences. But in the present study, socio-demographic characteristics like gender

and age showed significant differences in QOL. Males had higher scores for physical

and environment domains. Also it was observed that the QOL scores decreased as age

advanced in all domains but this difference in mean scores was found to be

statistically significant only for the social relationships domain.

45

7. CONCLUSION

Some issues of concern to the health of rubber tappers were revealed in the present

study. Musculoskeletal disorders were more common among those making > 2 visits

to the shed carrying load manually and among those with a work experience of > 20

years in the rubber tapping occupation. Other environmental and occupational health

issues are relevant for future interventions or further studies. Analysis has

demonstrated that Body mass Index, oral lesions, skin lesions and work place injuries

as also, working in hot humid weather, long hours of work with odd postures, long

distance of travel with load etc. are some issues of concern.

Some of the results may provide an opportunity to collaborate with local and state

institutions to develop and test health and safety interventions. Studies such as this

may influence community awareness about important issues and prime people to take

action to promote health.

This study is unique in that in addition to describing demographic & socioeconomic

characteristics and health of rubber tappers it brings out certain occupational and

environmental issues, of an occupation about which not many studies are published.

In addition to its strengths, this study had a number of limitations.

• As there were not many published studies on health status of Rubber Tappers,

it was necessary to review other similar studies on similar occupations (Farm

workers, Plantation workers etc).

• Lighting noise level and temperature at workplace were not measured but the

perceptions of the workers were recorded.

46

8. SUMMARY

Very few studies are available regarding the rubber tappers health status. In this

background, an exploratory epidemiological study was carried out with the objectives

to describe socio-demographic profile, living, and working environment of rubber

tappers and also to assess their health profile and quality of life. The total population

of rubber tappers fulfilling the inclusion criteria living in the four colonies randomly

selected was included in the study. There were a total of 171 rubber tappers living in

135 households who were surveyed by house-to-house visit. Necessary information

was obtained by interviewing the rubber tappers using a semi-structured pre-tested

questionnaire and conducting a thorough clinical examination. The rubber tappers

were subjected to QOL-BREF questionnaire for assessment for QOL. The data was

compiled and analyzed using SPSS software.

Among the 171 individuals, 120 (70.2%) were females and 51 (29.8%) were males.

Illiteracy was seen in 8.8% and educational qualification more than high school level

was observed in 5.3% of the population. Majority, 40.9% belonged to BG Prasad’s

socioeconomic class III. Body mass index for 43.86% of the subjects was not ideal

where 26.9% were underweight and 16.96% were overweight. Tobacco abuse in

either smoke or chewable form was the highest substance abused by 22.21% and

alcohol was consumed by 14.61% of the population. All individuals were exposed to

domestic indoor air pollution as firewood was the main source of cooking fuel. There

was no sanitation facility at the workplace for 87.1% of the population and in 11.85%

of households. Only 22.96% households treated water prior to drinking. The

prevalence of musculoskeletal disorders among the study population was 30.4%. This

was found to be associated with the number of years of experience in the rubber

47

tapping occupation and the number of visits made by a rubber tapper with manual

load. Only 7.6% were using headlights at work. Accidents at work were experienced

by 22.8% of the subjects. There was no use of boots and gloves by any of the subjects.

Myopia was present in 14% which was more common among those engaged in near

work but was not statistically significant. High blood pressure was observed in 9.35%

and skin lesions were present in 10.5% of the subjects. Among the ever-married

women abortions were reported in 11.7% and stillbirths in 3.3%. The mean QOL

score was highest for social relationships domain followed by environment domain,

physical health and psychological domains. Males had higher mean QOL scores for

physical and environment domains which was statistically significant. It was observed

that the QOL scores decreased as age advanced but was found to be statistically

significant only for the social relationships domain.

48

9. RECOMMENDATIONS

1. Preventive measures to curb musculoskeletal disorders through IEC and by

organizing group exercise activities.

2. Health education to effectively address alcohol and other substance abuse.

3. At the individual level, clinicians may need to spend more time with workers

to teach them about the unique risks they face at work and approaches they

can take to mitigate those risks.

4. Understanding different levels of concern about environmental and

occupational health risks that exist within a workforce or community may

allow for more effective research studies, educational materials, and

occupational and environmental risk reduction interventions to be developed.

5. Similar studies involving larger samples and geographical areas are needed for

generalization of the results.

49

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54

11. ANNEXURES

ANNEXURE I

KFDC PERMISSION LETTER FOR CONDUCTING RESEARCH

55

ANNEXURE II

QUESTIONNAIRE

56

57

II. HEALTH STATUS

How do you assess your health status during the last one year?

Excellent/ Good/ Fair/ Poor

PAST HISTORY KNOWN CASE OF

ACCIDENTS AT WORK

HISTORY OF TB/MALARIA/TYPHOID/HOSPITALIZATION

OTHER

FAMILY HISTORY

TB/DM/HTN/ASTHMA/ LEPROSY/ ALLERY TO DRUGS

OTHER

PERSONAL HISTORY

ANY ADDICTIONS (SINCE HOW MANY YEARS)

LEISURE TIME ACTIVITY – RADIO/TV/REST/SOCIALIZE WITH FRIENDS/OTHER

OBSTETRIC HISTORY

H/O WHITE DISCHARGE

PREGNANCY – G P A L

HOSPITAL DELIVERY/HOME DELIVERY/OTHER

DELIVERY PERFORMED BY

WERE THE CHILDREN BREASTFED IMMEDIATELY AFTER BIRTH?

MENSTRUATION

PRESENTING ILLNESS/COMPLAINTS

VACCINATION HISTORY

TT/TT BOOSTER

OTHER

III. PHYSICAL EXAMINATION

1. WEIGHT 2. HEIGHT 3. BMI 4. BLOOD PRESSURE 5.PULSE 6. PALLOR

7. ICTERUS 8. CYANOSIS 9. CLUBBING 10. EDEMA 11. LYMPHADENOPATHY

58

12. SKIN – PYODERMA/SCABIES/HYPOPIGMENTED PATCHED/HYPERPIGMENTED

PATCHES/DRY SKIN/ITCHINESS SCALING/ OTHERS

13. SCALP - PYODERMA/ LOUSE INFESTATION/ OTHER

14. EXTERNAL INJURIES - INJURY TO FINGERS/ ARMS/ FEET/ CALLOSITY OF HANDS/

OTHER

15. EAR - WAX/ FOREIGN BODY/ FUNGAL INFECTION/ DISCHARGE/ OTHER

16. NOSE - POLYPS/ DNS/ RHINITIS/ OTHER

17. EYES - DIFICULTY IN SEEING ― NEAR OBJECTS / FAR OBJECTS/ DURING THE NIGHT

REDNESS/ CONJUNCTIVITIS/ MUDDY CONJUNCTIVA/ YELLOW SCLERA/ OPACITY/ WATERING/

STYE/ OTHER

18. VISUAL ACUITY - RIGHT EYE:

LEFT EYE: __________________________

19. ORAL EXAMINATION - DENTAL CARIES/ GINGIVITIS/ OTHER

20. SPINAL POSTURE - SCOLIOSIS/ KYPHOSIS

21. OTHER PHYSICAL FINDINGS -

IV. SYSTEMIC EXAMINATION

1. RESPIRATIORY SYSTEM

2. MUSCULOSKELETAL SYSTEM

3. GASTROINTESTINAL SYSTEM

4. CARDIOVASCULAR SYSTEM

5. CENTRAL NERVOUS SYSTEM

6. GENITOURINARY SYSTEM

V. OBSERVATION AT WORK

1. POSTURE : STRAIGHT/ LEANS FORWARD (SQUATS)

2. DISTANCE BETWEEN EYE AND WORKAREA

3. HAS SUBJECT RECEIVED ANY KIND OF HEALTH EDUCATION ON USING PROTECTIVE

DEVICES AT WORK? YES/ NO

4. SAFETY PROTECTION GEAR PROVIDED BY EMPLOYERS?

5. SAFETY PROTECTION GEAR USED?

VI. WORK DETAILS

1. REPORTING & RELIEVING TIME AT WORK

59

2. TOTAL NUMBER OF BLOCKS ALLOTED

3. TOTAL NUMBER OF TREES PER BLOCK

4. AVERAGE SAP COLLECTED PER DAY

5. DEVICES USED FOR WORK

6. DEVICE PROVIDED FOR COLLECTION OF SAP

7. WEIGHT OF SINGLE COLLECTION DEVICE FILLED WITH MAXIMUM SAP

8. WHERE IS THE SAP DELIVERED TO?

9. DISTANCE FROM TAPPING BLOCK TO DELIVERY POINT

10. AVERAGE WEIGHT OF EACH LOAD OF SAP COLLECTED AND DELIVERED

11. AVERAGE NUMBER OF VISITS TO SAP DELIVERY POINT PER DAY

12. ARE YOU SUPERVISED DAILY AT WORK?

13. CONTACT WITH CHEMICALS/ IRRITANTS?

14. DO YOU MAINTAIN A RECORD OF SAP COLLECTED BY YOU DAILY? (YES / NO) IF YES,

WHO CHECKS IT EVERYDAY?

VII. ENVIRONMENTAL DETAILS AT WORKPLACE

1. LIGHTING - NATURAL―ADEQUATE/ INADEQUATE

ARTIFICIAL―ADEQUATE/ INADEQUATE

2. TEMPERATURE - COMFORTABLE/ TOLERABLE/ INTOLERABLE

3. NOISE - PEACEFUL/ TOLERABLE/ INTOLERABLE

4. SOURCE OF DRINKING WATER - TAP/ HAND PUMP, BOILED/ UNBOILED

5. TYPE OF FOOD CONSUMED - HOMEMADE/ OTHER

6. GARBAGE DISPOSAL FACILITY - ( YES/ NO)

7. SANITATION FACILITY - (YES/ NO)

8. ANY OBVIOUS ARTHROPODS/ REPTILES SEEN?

60

ANNEXURE III

61

62

63

ANNEXURE IV

VARIABLES

These were the following variables that have been studied.

Age

Sex

Education status

Socio-economic status

Family size

Total number of dependents

Smoking

Alcohol consumption

Paan masala, gutkha, or tobacco chewing

Housing conditions

Sources of drinking water

Sanitation

Cooking fuel used

Ventilation

lighting

Overcrowding

Work posture

Distance to work

Means of transport to work

Number of years (experience) in the

occupation

Number of visits to shed with manual load

Distance between eyes and work area

Pallor

Icterus

Cyanosis

Clubbing

Edema

Lymphadenopathy

Accidents at work

Skin lesions

Oral lesions

Ear lesions

Nose lesions

Eye lesions

Musculoskeletal disorder

Body mass index

Blood pressure

Myopia

Abortions

Stillbirths

Birth order

Contraception use

Quality of life

64

ANNEXURE V

OPERATIONAL DEFINITIONS

HEALTH STATUS: was assessed

1. as perceived and reported by the rubber tappers.

2. based on history and clinical examination.

REPATRIATE: Any individual who by informed choice returns to his or her country

of origin in conditions of safety and dignity. (45)

FAMILY SIZE: It is defined as total number of biologically related family members,

adults and children under one roof and sharing the same kitchen. It reflects the

standard of living and over crowding in the house.

ANTHROPOMETRICS MEASUREMENTS

a) WEIGHT

It is measurement of total body mass using a portable Krups flat spring balance

weighing scale and recorded in kilograms.

b) HEIGHT

It is measure of linear growth and recorded in centimeters. Height was recorded on a

plane vertical wall. Subject’s shoes, footwear were removed and person was made to

stand parallel with heels, buttocks, shoulders and back of head touching the upright

surface. The head was held comfortably erect and the height was marked on the wall

with help of right angled, touching the top of head horizontally with its side flat

against the wall. Height was then measured in centimeters using a tailor’s tape.

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c) BODY MASS INDEX (BMI)

Classification BMI Underweight < 18.50 Normal range 18.50-24.99

overweight > 25.00 Pre-obese 25.00-29.99

Obese class I 30.00-34.99 Obese class II 35.00-39.99

Obese Class III > 40

BMI was computed by the formula

BMI = Weight in kgs/ (Ht in mts) 2

BLOOD PRESSURE: Blood pressure was measured using OMRON digital

sphygmomanometer, and it reflects the stroke volume of heart. B.P. varies from

moment to moment with respiration, emotions, exercise, alcohol, tobacco, pain,

temperature, age, race, obesity. B.P. was recorded in right upper arm in sitting

position, in millimeters of mercury (mm Hg) after resting the study subject for 10

minutes.

DISORDER: It is defined as an alteration in an individual’s usual sense of wellness

or ability to function. A disorder may or may not interfere with usual activities of

daily living or work activities. A disorder may or may not be associated with well-

recognized anatomic, physiologic, or psychiatric pathology.

MUSCULOSKELETAL DISORDERS: The term musculoskeletal disorders

(MSDs) will be used to describe conditions affecting the musculoskeletal system

(including peripheral nerves and vascular system) with the alteration in an

individual’s usual sense of wellness or ability to function. The disorder may or may

not interfere with usual activities of daily living or work activities. The disorder may

or may not be associated with well-recognized anatomic, physiologic, or psychiatric

pathology. (19)

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NUMBER OF YEARS OF EXPERIENCE IN RUBBER TAPPING: It is defined

as the total number of years of experience that an individual had from when he started

rubber tapping for monetary remuneration including his present tenure of employment

in KFDC.

MODIFIED (2009) BG PRASAD CLASSIFICATION FOR SOCIOECONOMIC

STATUS. (43): It consists of per capita income of family (PCI), obtained by dividing

total family income by total family size.

Class I > ` 3584 per month

Class II ` 1792 - ` 3583 per month

Class III ` 1075 - ` 1791 per month

Class IV ` 537 - ` 1074 per month

Class V < ` 537 per month

SEMI -PUCCA HOUSE: A house that has fixed walls made up of pucca material

but roof is made up of the material other than those used for pucca house.

QUALITY OF LIFE: Quality of life is defined as individuals' perceptions of their

position in life in the context of the culture and value systems in which they live, in

relation to their goals, expectations, standards and concerns.

OVERCROWDING: Overcrowding was expressed as persons per room where the

accepted standards were 70 – 90 square feet per person. Any measure lesser than 90

square feet was considered overcrowding. (46)

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