Occupational health and safety challenges in China--focusing on township-village enterprises

Prevalence and gender disparity of those who screen positive for depression in China by the classification of the employer and industry: a cross-sectional, population-based study

BACKGROUND

The important role of mental health in sustainable economic development is gradually being recognized. This study aimed to evaluate the prevalence and gender disparity of those who screen positive for depression in China by the employer and industrial classification.

METHODS

We used data from a nationally representative survey, the China Family Panel Studies. Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Employer classifications were categorized according to the local characteristics of Mainland China. Industrial classifications were defined using level-1 of the China version of the International Standard Industrial Classification of All Economic Activities. Weighted logistic regressions were fitted to estimate the gender disparities, controlling for confounders.

RESULTS

Forty eight thousand six hundred twenty eight adults were included. 18.7% (95%CI 18.1-19.4) of sampled adults were screened positive for depression symptoms, with 16.6% (95%CI 15.8-17.5) in males vs 21.0% (95%CI 20.1-22.0) in females. By classification of the employer, the prevalence was lowest among those employed by Government/party organisations (11.8%, 95%CI 8.9-15.4), and highest in those self-employed (21.8%, 95%CI 20.8-22.9); the gender disparity was mainly found in those employed by Sole proprietorship (Adjusted odds ratio [AOR] = 1.95, 95%CI 1.19-3.19) and Private enterprise (AOR = 1.34, 95%CI 1.13-1.59), as well as those self-employed (AOR = 1.49, 95%CI 1.3-1.17). By industrial classification, the prevalence was lowest among those who worked in the industry of Real estate (7.2%, 95%CI 4.8-10.6), and highest among those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (22.9%, 95%CI 15.5-32.4); the gender disparity was mainly found in those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (AOR = 3.29, 95%CI 1.18-9.15), Manufacturing (AOR = 1.41, 95% CI 1.09-1.82), Wholesale and retail trade (AOR = 1.48, 95% CI 1.07-2.06), and Accommodation and food service (AOR = 1.91, 95% CI 1.15-3.18).

CONCLUSION

The prevalence of depression in China had a wide variation by classifications of the employer and industry. Gender disparities were identified among workers from Sole proprietorship, Private enterprise, and self-employed, or workers from the industry of Agriculture, forestry, animal husbandry and fishing, Manufacturing, Wholesale and retail trade, and Accommodation and food service.

Association between occupational health and safety knowledge and behaviours among migrant workers: results from a cross-sectional study in China

OBJECTIVES

To assess the relationship between occupational health and safety (OH&S)-related behaviours of migrating workers in China and their knowledge regarding OH&S laws and regulations (L&Rs).

MATERIALS AND METHODS

We sampled 1282 migrant workers from 12 labour-intensive manufacturers in Guangdong, China, with a response rate of 98.6%. Self-reported questionnaires were completed by the participants. Logistic regression models were used to examine the association between OH&S-related behaviours and knowledge among migrant workers adjusting for their demographic features and the survey sites.

RESULTS

Migrant workers' behaviour of seeking occupational disease (OD) diagnosis and treatment was found to be statistically significantly correlated with their knowledge of all three OH&S L&Rs. A higher score of knowledge regarding these OH&S L&Rs is associated with a better chance to seek OD diagnosis and treatment. The ORs of the high-score group (subjects correctly answered more than one question) versus the low-score group (subjects correctly answered less than or equal to one question) are 2.02 (95% CI: 1.33 to 3.07) for Law of Occupational Disease Prevention and Treatment, 2.89 (95% CI: 1.65 to 5.09) for Regulations on Safe Management of Dangerous Chemicals and Regulations on Labor Protection for Using Toxic Substances in Workplace and 2.25 (95% CI: 1.34 to 3.77) for Work-Related Injury Insurance Regulations. However, knowledge about these L&Rs is not statistically significantly associated with OH&S-related protective behaviours such as wearing a mask or gloves at work.

CONCLUSIONS

Knowledge of OH&S L&Rs helps migrant workers in China to seek OD diagnosis and treatment.

Child nutrition during conflict and displacement: evidence from areas affected by the Boko Haram insurgency in Nigeria

OBJECTIVES

The objective of this study is to examine the association between forced displacement and child nutritional status among households affected by the Boko Haram insurgency in Nigeria.

STUDY DESIGN

The study design is a cross-sectional analysis.

METHODS

Cross-sectional survey data from 1278 host community households and 531 internally displaced households in north eastern Nigeria were used. Acute child malnutrition was measured using the mid-upper arm circumference. The main independent variable was self-reported internal displacement. Household, child, and community characteristics were included as covariates. Probit and ordinary least squares regressions were used to model the association between forced displacement and child malnutrition.

RESULTS

Displacement was associated with a 57% increase in the likelihood of acute malnutrition and the effects were notable among infants and in areas with a greater incidence of conflict. Displacement also significantly reduced dietary diversity and increased hunger.

CONCLUSIONS

Conflict-induced displacement is associated with poor child nutritional status, and this is potentially achieved through the reduction of household dietary diversity and food security. The use of data from areas affected by an ongoing conflict provides insights that can shape nutrition policies and humanitarian assistance planning.

Diagnostic and clinical application value of magnetic resonance imaging (MRI) for progressive massive fibrosis of coal worker pneumoconiosis: Case reports

RATIONALE

Using magnetic resonance imaging (MRI), we diagnosed pneumoconiosis by identifying the content and distribution of hydrogen protons in the water molecules in different tissues and lesions.

PATIENT CONCERNS

25 cases of CWP patients with progressive massive fibrosis (PMF) lesions.

DIAGNOSES

Patients were correctly diagnosed, with one case each of Phase I and II pneumoconiosis and 23 cases of Phase III pneumoconiosis.

INTERVENTIONS

None.

OUTCOMES

Through MRI, 39 PMF pneumoconiosis lesions exhibited equal, low or equally low, and uneven signals on T2WI and fat suppression (SPIR) (38/39, 37/39).

LESSONS

MRI has good specificity to identify the characteristics of PMF lesions of CWP, as well as has high application value for the differential diagnosis of lung cancer and other lung tumor-like lesions.

What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status

Background

Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy.

Methods

Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC).

Results

Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test’s P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725).

Conclusions

This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China’s healthcare system reform.

Study protocol: a cluster randomized controlled trial to assess the effectiveness of a multi-pronged behavioural intervention to improve use of personal protective equipment among migrant workers exposed to organic solvents in small and medium-sized enterprises

Background

In China, most of migrant workers work in the small and medium-sized enterprises (SMEs) and are a vulnerable group for occupational health. Migrant workers are at increased risk of occupational health risks due to poor occupational health behaviours such as the low use of personal protective equipment (PPE). However, there is a lack of solid evidence regarding how to improve the use of PPE among migrant workers in SMEs. The current study will assess the effectiveness of a multi-pronged behavioural intervention designed to promote PPE utilization among migrant workers exposed to organic solvents in SMEs.

Methods/Design

This is a single blind, three-arm cluster randomized trial with 60 SMEs equally randomized to receive a top-down intervention (i.e. general health education and mHealth intervention provided by researchers) or a comprehensive intervention (which includes both top-down intervention and peer education) or a control condition (participants will not receive the intervention, but study measures will be obtained). Interventions will be conducted at the SMEs level for 6 months and all eligible migrant workers in these SMEs will be enrolled into the trial. The primary outcome is effective use of PPE during the last week. The secondary outcomes are occupational health knowledge and attitude and participation in occupational health check-up. Data will be collected and assessed at baseline; 3 months post baseline and the end of the intervention.

Discussion

This theory- and evidence based intervention will contribute to the limited evidence of behaviour change intervention in improving PPE utilization of migrant workers in SMEs, and provide timely evidence for the development of basic occupational health services in China and elsewhere with similar industrialization contexts.

Trial registration

ChiCTR-IOR-15006929. Registered on 16 August 2015.

Self-reported illnesses and service utilisation among migrants working in small-to medium sized enterprises in Guangdong, China

OBJECTIVES

As one of the most vulnerable populations in China, many migrants work in the small-to-medium-sized enterprises (SMEs). This study aims to describe the self-reported illnesses and service utilization of the migrants working in the SMEs in Pearl River Delta Areas (PRDA) of Guangdong province, China.

STUDY DESIGN

Cross-sectional survey.

METHODS

We interviewed 856 migrants working in the SMEs of different manufacturing industries in 2012. Descriptive analysis was employed to report self-reported illnesses and service utilisation among migrants in the last two weeks and in the last year. Statistical tests such as χ2 test were used to explore factors influencing their service utilisation.

RESULTS

In the last two weeks, 91(11%) of the respondents reported having any illness. The most reported illness was respiratory problem (69%), while 9.9%, 7.7% and 13% reported having digestive, skin and other problems respectively. The most important symptom was cough (39%). Thirty-seven percent of the respondents who reported any illness had visited health facilities. The lower income group were more likely to visit health facilities than the higher income group (P = 0.006). The most reported reason for not visiting health facilities was 'feeling not serious' (65%). In the last year, 13% reported having respiratory problems and 7.8% reported accidental injuries. Less than 3% received hospitalization care. The proportion of those without hospitalization to those who should have been hospitalized was 31%.

CONCLUSION

Underuse of the health service among migrants working in the SMEs could be associated with the 'healthy migrant' effect. However, when assessed among the ill migrants in the SMEs, the utilisation rate was still low mainly due to their poor health awareness. Improving their risk perception and integration of occupational and general health service is crucial to improve the health conditions and utilisation of service among migrants in the SMES.

Is occupation a good predictor of self-rated health in China?

Background

China’s rapidly changing economic landscape has led to widening social inequalities. Occupational status in terms of occupational type and prestige may reflect these socio-structural shifts of social position and be more predictive of self-rated health status than income and education, which may only reflect more gradual acquisitions of social status over time. The goals of this study were to understand the role of occupational status in predicting self-rated health, which is well known to be associated with long-term mortality, as well as compare the occupational status to the other major socioeconomic indicators of income and education.

Methods

Data from the 2010 baseline surveys of the China Family Panel Studies, which utilized multi-stage probability sampling with implicit stratification was used. Logistic regression was used to examine the relationship of various socioeconomic indicators (i.e. occupational status, income, and education) with self-rated health as the primary outcome of interest. A series of models considered the associations of occupational category or occupational prestige with self-rated health.

Results

The final sample consisted of 14,367 employed adults aged 18–60, which was nationally representative of working adults in China. We found that occupation was not a major predictor of self-rated health in China when age, ethnicity, location, marital status, physical and mental health status were controlled for, with the exception of women working in lower grade management and professional jobs (OR = 1.82, 95% CI: 1.03–3.22). In comparison, income followed by education exhibited greater association with self-rated health. The highest income group had the least probability to report poor health (In men: OR = 0.30, 95% CI: 0.21–0.43. In women: OR = 0.44, 95% CI: 0.26–0.73). People educated with junior high school had better self-rated health than those with primary and below education level (In men: OR = 0.62, 95% CI: 0.50–0.75. In women: OR = 0.53, 95% CI: 0.42–0.68). Income, education and occupation were correlated with each other.

Conclusions

Within the context of rapid societal changes in China, income and its implications for greater healthcare access and benefits had the greatest association with self-rated health followed by education. Occupational status was not associated. Occupational categories and prestige should be better adapted to reflect China’s unique sociopolitical and historical context.

Health-related quality of life and its correlates among Chinese migrants in small- and medium-sized enterprises in two cities of Guangdong

Objectives

To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China.

Methods

A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small- and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM).

Results

Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (β = −0.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (β = 0.40), predisposing (age, family separation, education) (β = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (β = −0.20).

Conclusions

Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources.

Occupational injury among migrant workers in China: a systematic review

OBJECTIVES

This review considers the state of occupational injury surveillance and prevention among migrant workers in China and suggests areas of focus for future research on the topic.

METHODS

Bibliographic databases were searched for qualitative and quantitative studies on surveillance of and interventions to prevent occupational injury among migrant workers in mainland China. Additional abstracts were identified from the citations of relevant articles from the database search. Studies fitting the inclusion criteria were evaluated, and findings were extracted and summarised.

RESULTS

The search uncovered 726 studies in the English-language databases searched, and 3109 in the Chinese database. This article analyses a total of 19 research articles that fit the inclusion criteria with qualitative or quantitative data on occupational injury surveillance and prevention of migrant workers in China. Despite evidence of the vulnerability of migrant workers in the workplace, there is little systematic surveillance of occupational injury and few evaluated interventions.

CONCLUSIONS

Migrant workers account for a disproportionate burden of occupational injury morbidity and mortality in China. However, data are inconsistent and inadequate to detail injury incidence or to evaluate interventions. The following are suggestions to decrease injury incidence among migrants: strengthen the national system of occupational injury surveillance; focus surveillance and interventions on high-risk occupations employing migrants such as construction, manufacturing and small mining operations; improve occupational safety training and access to appropriate safety equipment; evaluate recent changes in occupational health and safety and evaluate outcome of multi-party interventions to reduce occupational injury among migrant workers.

Challenges and Opportunities for Occupational Health Nurses in Asia

This article provides a brief overview of the effect of economic globalization on Asia, presents occupational health issues from select countries, and discusses challenges and opportunities for occupational health nurses.