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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 10-24

Effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City


Department of Community Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt

Date of Submission27-Aug-2018
Date of Acceptance16-Oct-2018
Date of Web Publication10-May-2019

Correspondence Address:
Samia F Mahmoud
Department of Community Health Nursing, Faculty of Nursing, Zagazig University, Zagazig,
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_19_18

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  Abstract 


Background Workers in bakeries face many hazards in their work environment. Hazards have the potential for causing injury or illness.
Aim The aim was to evaluate the effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City.
Materials and methods A quasiexperimental design was used, and the period of study lasted from February to April 2018. The study was conducted at bakeries in Zagazig City. All workers in 20 bakeries, randomly chosen from 119 bakeries, were included as the study sample. Three tools were used: tool I was the interviewing questionnaire form that was designed to collect data related to demographic characteristics of the bakery workers, the hazards of job exposures inside bakeries as reported by bakers, and the health problems reported by bakers during the last six months of the study. Tool II was the interview questionnaire form that consists of two parts: knowledge of bakery workers about first aid and ergonomics before/after the intervention. Tool III was an observational checklist used to assess the bakery workers’ practices regarding first aid and practices regarding the ergonomic maneuvers and an observational checklist to evaluate work environment safety of the bakeries.
Results The greatest hazard related to job exposure inside the bakery as reported by the study sample was poor position (92.1%), and the lowest hazard is syncope (16.1%). Furthermore, the major health problems reported by bakers during the last six months were musculoskeletal problems (55.1%), and the least was gastrointestinal (4.5%). The total adequate score of their knowledge about first aids increased from 9.0% before sessions to 100.0% after sessions; moreover, none of bakery workers had satisfactory first aids practices at pre-educational sessions compared with 76.4% after the intervention. Additionally, none of the bakery workers before intervention performed practices of ergonomic maneuver, whereas after intervention implementation, the percentage increased to 84.3%.
Conclusion The post-test score was higher than the pretest score in both knowledge and practices about first aid and ergonomic maneuver.
Recommendations Continuous educational intervention should be initiated for all workers of bakeries in Sharkia Governorate to raise their knowledge and practices about first aid and ergonomics related to occupational hazards.

Keywords: bakery workers, educational intervention, ergonomics, first aid, occupational hazards, performance


How to cite this article:
El-Ghany GM, Mahmoud SF. Effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City. Egypt Nurs J 2019;16:10-24

How to cite this URL:
El-Ghany GM, Mahmoud SF. Effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City. Egypt Nurs J [serial online] 2019 [cited 2019 Aug 25];16:10-24. Available from: http://www.enj.eg.net/text.asp?2019/16/1/10/257965




  Introduction Top


The nature of the work in bakeries exposes the workers to a dangerous environment. They should be directed on how to avoid possible health problems and should be properly trained to follow the recommended work safety instructions (Emmanuel and Sussan, 2014). Occupational hazards include physical, chemical, biological, and psychological hazards. Physical hazards include heat, cold, light, noise, and radiation, and chemical hazards include inhalation of dust, gases, etc., and localized effects such as dermatitis. Biological hazards include viruses, bacteria and parasites that cause diseases. Psychological hazards come from harassment law enforcement such as stress and anxiety (Yossif and Abd Elaal, 2012).

In baking, dust from baking flour is a factor in the environment that may cause occupational asthma in some workers. Occupational asthma increases when an individual becomes very susceptible to flour dust, which he/she frequently breathes in at the workplace (Fahim and El-Prince 2013). Chronic obstructive pulmonary diseases like emphysema and bronchial asthma as workplace health hazards are high among bakery workers (Rushton, 2007).

Musculoskeletal disorders (MSDs) among bakers like muscle pain and arthritis arise from manual handling and moving of heavy loads, and other causes of MSDs include work requiring repetitive movements and poor work posture. Most of these are due to poor consideration of ergonomic factors in the workplace (Ghamari et al., 2009).

First aid is the immediate care given to an individual who is injured or who suddenly becomes unwell. First aid is a main part of company’s emergency response system and overall health and safety program. Think about what could happen if someone at work suddenly stopped breathing and no one knew how to help that person. Providing and maintaining first aid equipment, facilities, and trained first aiders in the workplace are very important (Workplace Safety & Prevention Services (WSPS), 2012). The first aid management of burns injury is paramount for the survival of burned victims. It takes time, ranging from hours to days, to transfer patients to the definitive care facilities. Therefore, proper first aid and initial treatment can significantly reduce the severity and improve the survival of a person with burns injury (Mlcak et al., 2012).

The work environment is an important determinant of health. It can affect health positively or negatively. Bakery work can be fun and rewarding, but some bakery processes can be dangerous (State Compensation Insurance Fund, 2010). Besides environmental exposures, occupational factors also play an important role in affecting the health of the employees (Das et al., 2017). The repetitiveness of work movements during the handling of the dough is frequently observed in the baking job. According to Salvador (2009), the workers involved in the production of bread and cakes as well as the salesperson are susceptible to the occurrence of work-related MSDs. It is common to observe how the transport, lifting, and handling of loads causes physical overload and may contribute to the appearance of mechanical tension in the muscles, ligaments, and articulations and therefore, pains in the neck, back, shoulders, wrists, and other parts of the muscular-skeletal system (Minette, 2006). A better understanding of workplace situations, the identification of the real ergonomic demand, and recommendations for a better execution of the activity and worker’s safety and well-being are important for bakery job (Salvador, 2009).

Ergonomics is the relationship between the worker and the job and focuses on the design of work areas or work tasks to improve job performance (Health and Safety Authority Ergonomics, 2015). A systematic ergonomic improvement process removes risk factors that lead to musculoskeletal injuries and allows for improved human performance and productivity (Workplace Ergonomics, 2018).

Occupational health nursing is a specialized practice that focuses on promoting health, as well as preventing and restoring health in a safe and healthy environment. It provides occupational and environmental health and safety services for workers, and community groups (Yossif and Abd Elaal, 2012).


  Significance of the study Top


Providing first aid in the workplace during or after work accidents can lead to unpleasant consequences for the worker’s health and life (Hatzakis et al., 2005), and practicing good ergonomics can help workers stay healthy (Practice Good Ergonomics, 2015). Consequently, the aim of the study was to evaluate the effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City.

Hypotheses

  1. Bakery workers’ knowledge and practice score regarding first aid will be improved after educational sessions.
  2. Bakery workers’ knowledge and practices score regarding ergonomic maneuvers will be improved after educational sessions.



  Materials and methods Top


Design

A quasiexperimental design was used to conduct this study.

Setting

This study was conducted at bakeries in Zagazig City; each bakery composed of a storage room, a mixing room, an oven place, a bread selling place, a changing room, and a toilet.

Sample

All the bakery workers in 20 bakeries were chosen randomly from 119 bakeries in Zagazig City; from each bakery, 4–8 workers were recruited for the study, averaging 6 workers. The total number of bakery workers in this study was 89 workers.

Tools of data collection

The researchers used three different data collection tools, namely, an interview questionnaire form regarding bakery worker’s knowledge about first aid and ergonomic maneuvers, an observational checklist used to assess the bakery worker’s practices to first aid and ergonomic maneuvers, and an observational checklist used to assess the work environment safety among the bakeries.

Tool I: interview questionnaire form: this tool was developed by the researchers and guided by Emmanuel and Sussan (2014). It consisted of the following 4 parts:
  1. Part 1: this involved questions concerning the demographic data of the bakery worker such as age, residence, educational level, and marital status.
  2. Part 2: this part included questions covering the job characteristics of the baker in the study sample, such as previous job (same or different) and current job, with experience years and job type (cutting dough, dough, sahlagui, tanseem, baker, or vendor). Moreover, this part asked about the working hours/day and job training. It also asked about the details of the medical services of bakery workers as preplacement examination, chest radiography, laboratory tests, health certification, and updated and regular checkup.
  3. Part 3: this part included questions covering the hazards of job exposures as reported by the bakery worker such as physical (heat, cold, light, and noise), chemical (dust inhalation and ingested toxics), biological (bacteria, parasites, and viruses), psychological (stress and anxiety), and musculoskeletal (ergonomics) hazards (heavy lifting, falls, and bone aches), involving awkward position, wound, burn, asthma, and syncope.
  4. Part 4: this part dealt with questions covering the health problems reported by the bakers during last 6 months in the study sample, such as skin (burns, dermatitis, and hair loss), eye (inflammation, cataract, conjunctivitis, and decreased visual acuity), gastrointestinal (anorexia, nausea, vomiting, and diarrhea), respiratory (asthma, wheezing, running nose, chronic cough, dyspnea, dry and reproductive cough, chest pain), cardiovascular (arrhythmia, hypertension, and angina), neurological (dizziness and headache), and musculoskeletal problems (fatigue and bone aches), and varicose veins. The reliability of the questionnaire was checked by Cronbach’s α test at 0.89.


Scoring system

For hazards related to exposure

Items were scored 0, 1, and 2 for the responses never, once, and more than once, respectively. For each group of hazards, the scores of the elements were summed up and the total divided by the number of the elements, giving a mean score for the group. These scores were converted into percent scores. The group hazard exposure was considered high if the percent score was 60% or more and low if less than 60%.

For health problems

Items were scored 0, 1, and 2 for the responses never, once, and more than once, respectively. For each type of problems, the scores of the elements were summed up and the total divided by the number of the elements, giving a mean score for the type. These scores were converted into percent scores. The respondent was considered abnormal in the type of problems if the percent score was 60% or more and normal if less than 60%.

Tool II. Interview questionnaire form: this tool was developed by the researchers, and guided by Fahmy et al. (2011). It consisted of the following two parts:
  1. Part 1: this involved questions regarding bakery workers’ knowledge about first aid such as first aid definition, goal, first aid phone, civil defense phone, essential pharmacy, wound definition, wound first aid, burn definition, degree of burn, burn first aid, asthma first aid, syncope, and syncope first aid.
  2. Part 2: this involved questions regarding bakery worker knowledge about ergonomics, which composed of open questions, such as what is the proper position in the body mechanics of the bakery worker. The Cronbach’s α coefficient of the instrument measured was 0.93.
  3. Scoring system: for the knowledge items, a correct response was scored 1 and the incorrect zero. For each area of knowledge, the scores of the elements were summed up and the total divided by the number of the elements, giving a mean score, which was converted into a percent score. Knowledge was considered adequate if the percent score was 50% or more and inadequate if less than 50%, and the total of knowledge score was 20 points.


Tool III was an observational checklist that was developed by the researchers and guided by Fahmy et al. (2011) and Yossif and Abd Elaal (2012). It consisted of the following three parts:
  1. Part 1: an observational checklist used to assess the bakery workers’ practices of first aid. It consisted of minor and major wounds (10 steps), burn (nine steps), bronchial asthma emergency (eight steps), and syncope (nine steps).
  2. Part 2: this was intended to assess practices regarding the ergonomic maneuvers, composed of three categories: first, Lifting, as the use of the stronger leg muscles for lifting, bend at the knees and hips, keep the back straight, and lift straight upward in one smooth motion; second, reaching, as standing directly in front of and close to the object, avoid twisting or stretching, use ladder for high objects, maintain a good balance and affirm base of support, and before moving the object, be sure that it is not too large or too heavy; third, pivoting, place one foot slightly ahead of the other and turn both feet at the same time pivoting on the heel and the toe to maintain a good center of gravity while holding or carrying the objects; and fourth, avoid stopping as squat (bending at the hips and knees, avoid stopping) bending at the waist, and use the leg muscles to return to an upright position.
  3. Part 3: this was an observational checklist designed by the researchers and guided by Canadian Centre for Occupational Health and Safety (2017) to evaluate work environment safety of the bakeries. It consisted of the following parts: the safety items observed as training, environment, work process, fire emergency procedures, mean of exit, lighting, housekeeping, sound level/noise, employee facilities, medical and first aid, personal protective equipment (PPE), and material handling and storage.


Scoring system: for practices, the items observed to be done were scored ‘1’ and the items not done were scored ‘0’. For each skill, the scores of the items were summed up and the total divided by the number of the items, giving a mean score, which was converted into a percent score, and means and standard deviations were computed. The practice was considered satisfactory if the percent score was 60% or more and unsatisfactory if less than 60%.

Scoring system for work environment safety: the safety items observed to be fulfilled were scored ‘1’ and the items not fulfilled were scored ‘0’. The scores of the items were summed up, and the total divided by the number of the items, giving a mean score. A higher score indicated better safety of the work environment.

Content validity

The validity of data collection tools and booklets’ content was tested by three experts, one professor from the Community Health Nursing, Faculty of Nursing, Zagazig University, one professor from the Community Health Nursing, Faculty of Nursing, Ain Shams University, and one professor from the Faculty of Medicine, Zagazig University, to assess clarity, relevance, application, comprehension, and understanding of the tools. All recommended modifications on the tools were done.

Field work

After a formal permission was obtained, the researchers visited the bakeries. Each manager was informed of the time and date of data collection. The data collection took a period of 3 months (from February to April 2018). The researchers started the data collection three times/week (Saturdays, Thursdays, and Fridays) from 10.00 a.m. to 2.00 and at noon during working times (5.00 a.m. to 3.00 p.m.). The execution of the study was done through four phases: assessment, planning, implementation, and evaluation.

Assessment phase

This phase involved data collection before intervention to assess the baseline. The researchers first introduced themselves and explained the purpose of the research to the bakery managers. All the bakery workers working in the chosen bakeries were met. The pretest questionnaires were distributed and then the same questionnaires were used after the sessions’ implementation (1 month later) as post-test for comparison. The time consumed for answering questionnaires ranged from 30 to 45 min for each. The data were a preliminary test to provide the basis for the design of intervention sessions.

Planning phase

Based on a review of the literature and results obtained from the assessment phase, the researchers designed the content of the intervention sessions. An illustrated booklet was prepared by the researchers, and after verification of its content, it was distributed to bakery workers for use as a guide for self-learning.

General objective: the general objective of the bakery workers’ sessions was to increase their knowledge, and practices about first aid and ergonomic related to occupational hazards.

Specific objectives: by the end of the sessions, the bakery workers should be able to do the following:
  1. Identify the definition and goal of first aid.
  2. List the first aid and civil defense phone.
  3. Describe the essential pharmacy of first aid in the bakeries.
  4. Discuss the definition and knowledge about first aid of wound.
  5. Identify the definition and degree of burns and first aid of burn.
  6. Recognize the knowledge about emergency aid of asthma.
  7. Discuss the definition and first aid of syncope.
  8. Explain the proper position in ergonomic maneuvers among bakery workers.
  9. Apply effectively the practice of wound, burn, syncope, and asthma.
  10. Demonstrate the ability to work according to ergonomic maneuvers.


Implementation phase

The intervention was implemented in the form of sessions; the program was implemented at their place of work (bakery). To ensure that all bakery workers have the same educational experience, they all received the same content using the same training methods. The training methods included demonstration, individual discussion, role play, and reinforcement. The sessions were aided by using video, pictures, and posters through laptop. The intervention was implemented in four theoretical sessions and two practical sessions.

Evaluating phase

The evaluation of educational intervention was done one month later after implementation of the sessions through applying the same tools of the pretest for comparison of results.

Pilot study

A pilot study has been carried out before starting data collection on 10% of the total studied sample (nine bakery workers) to test the feasibility of the study and the clarity and applicability of the tools. The necessary modifications were done accordingly. Those who participated in the pilot study were excluded from the main study sample.

Administrative and ethical considerations

Permission to conduct the study was obtained through submission of an official letter from the Faculty of Nursing, Zagazig University, forwarded to the Zagazig Health Administration for permission to visit the bakeries. Moreover, consent to participate in the study was obtained from each bakery manager. Moreover, an informed consent for participation was taken verbally from each bakery worker after full explanation of the aim of the study. They were informed that their participation in this study is voluntarily. The bakery workers were given the opportunity to refuse participation, and they were notified that they could withdraw at any stage of the data collection without giving any reason. They were assured that any information taken from them would be treated confidentially and used for the research purpose only.

Statistical analysis

Data entry and statistical analysis were done using the statistical package for the social services (SPSS Inc., Chicago, Illinois, USA) version 20.0, which is a statistical software package. Quality control was done at the stages of coding and data entry. Data were offered using descriptive statistics in the form of frequencies and percentages for qualitative variables, and means and standard deviations and medians for quantitative variables. Cronbach α coefficient was calculated to assess the reliability of the scales through their internal consistency. Quantitative continuous data were compared using the nonparametric Mann–Whitney or Kruskal–Wallis tests. Qualitative categorical variables were compared using χ2-test. Paired t-test was used for comparing dependent groups. Whenever predicted values in one or more of the cells in a 2×2 tables were less than 5, Fisher exact test was used instead. Spearman rank correlation was used for assessment of the inter-relationships between quantitative variables and ranked ones. Ecologic correlation analysis was used to relate workplace safety and hazardous exposures. To identify the independent predictors of the knowledge and practice scores, multiple linear regression analysis was used and analysis of variance for the full regression models done. Statistical significance was considered at P value less than 0.05.


  Results Top


Results

The age of the bakery workers in the study sample ranged between 15.0 and 62.0 years, with a median of 29.0 years, as [Table 1] indicates. Additionally, 55.1% were unmarried and 67.4% resided in rural areas. Furthermore, 55.1% in the study sample had secondary education. Moreover, 59.6% of bakery workers were smokers, having a mean pack-years of smoking of 14.8±16.1 years, with a median of 10.0 years.
Table 1 Demographic characteristics of bakers in the study sample (n=89)

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[Table 2] shows that 75.3% of the study sample had a previous job, and of them, 64.2% of them had the same job. Moreover, the mean years of experience for the study sample was 7.9±9.3 years, with a median of 4.00 years. Additionally, regarding the job type, 23.6% and 20.2% of the study sample were tanseem and dough workers, respectively, followed by baker and sahlagui with equal percentage, with median 10.0 work hours/day. Furthermore, 94.4% of the study sample had job training and 34.8% had preplacement examination. An equal percentage of 31.5% had chest radiography and laboratory tests, whereas 42.7% of bakery workers had health certification and only 10.1% of them had regular checkup.
Table 2 Job characteristics of bakers in the study sample (n=89)

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[Figure 1] reveals that the greatest hazards related to job exposure inside bakeries as reported by the study sample was poor position (92.1%), followed by physical (60.7%), musculoskeletal (55.1%) and psychological hazardous (36.0%) and the lowest hazard was syncope (16.1%).
Figure 1 Frequency distribution of hazards related to job exposures inside the bakeries as reported by bakers (n=89).

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In [Table 3], the major health problems reported by bakers during last six months in the study sample were musculoskeletal problems (55.1%), followed by neurological problem (50.6%) and skin problems (21.3%), and the lowest health problems was gastrointestinal (4.5%). Additionally, the same table shows that 13.5% of study sample had reported exposure to high health problem (more than once).
Table 3 Health problems reported by bakers during last six months in the study sample (n=89)

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[Table 4] displays knowledge about first aid among bakery workers in the study sample before and after the intervention. None of the bakery workers identified the wound and burn definitions at pre-educational sessions compared with 76.4% and 82.0% at post-test sessions. A considerable improvement was noticed between the studied sample before and after intervention implementation related to knowledge of all first aid items and proper position in the body mechanics among the studied sample (P=0.001). Furthermore, the total adequate score of their knowledge increased from 9.0% in presessions to 100.0% at postsessions. All the differences in knowledge items related to first aid were observed as statistically significant (χ2=148.64, P=0.001).
Table 4 Percentage of correct knowledge of first aid among bakers in the study sample before and after the intervention

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Data in [Table 5] show the first aid practices as observed among bakers in the study sample before and after the intervention. None of bakery workers identified had satisfactory practice about wound care, first aid for burns, syncope, asthma, and ergonomic maneuvers at pre-educational sessions compared with 78.7,76.4, 74.2, 79.8, and 84.3%, respectively, after educational sessions. Moreover none of the bakery workers had satisfactory first aid practices at pre-educational sessions compared with 76.4% after the intervention. All the differences in practice items related to first aid were observed as statistically significant (χ2=110.04, P=0.001).
Table 5 Percentage of first aid practices as observed among bakers in the study sample before and after the intervention

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[Table 6] indicates that the mean of the total knowledge score was 28.3±14.8 before the intervention compared with 91.8±12.4 after the intervention. Moreover, regarding score of first aid practices before and after the intervention, the mean first aid practice before intervention was 8.3±5.3 compared with 74.6±18.0 after the intervention. The difference between knowledge score and practice score before and after intervention was statistically significant (P<0.001).
Table 6 Total scores of first aid knowledge and practices among bakers in the study sample before and after the intervention

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As displayed in [Table 7], there were significant negative correlations between bakery workers’ knowledge score and hazards’ score (r=−0.209) and health problems score (r=−0.223). Additionally, there were negative correlations between bakery workers’ practice score and age (r=−0.329) and pack-years (smoking) (r=−0.425). However, there was a positive correlation between bakery workers’ practice score and educational level (r=0.832) and daily hours worked (r=0.210).
Table 7 Correlation between bakers’ knowledge and practices and their characteristics

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In multivariate analysis, [Table 8] shows statistically significant independent positive predictors of bakery workers’ knowledge scores related to first aid were their intervention, urban residence, educational level, and chronic diseases. The model explains 93% of the variation in this score. Regarding practice score, the same table indicates statistically significant independent positive predictors of bakery workers’ practice scores related to first aid were their intervention, age, and chronic diseases. Conversely, their education was a negative predictor. The model explains 94% of the variation in this score. Concerning hazards’ exposure score was a positive predictor of bakery workers was detected with white bread bakery, chronic diseases, and practice score. However, educational level had a negative predictor. The model explains 23% of the variation in this score, whereas none of the other bakery workers’ characteristics had a significant influence on it.
Table 8 Best fitting multiple linear regression model for the knowledge, practices, and hazardous exposure scores

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Concerning work environment of the 20 bakeries, [Table 9] reveals that the owners of bakeries were training all persons newly assigned to a job. Additionally, 70% of bakery work surfaces and grip surfaces were safe when wet. Moreover, only 20% of bakery workers dealt with fire emergency procedures and 50% knew the means of exit. Moreover, 60% recall that the level of light is adequate for safe and comfortable performance of work; for 70%, the work area is clean and orderly; for 35%, hearing protection is available and used properly; and for 90%, facilities are in good shape. Furthermore, none of bakery workers wore PPE. Overall, 65.0% of bakeries had unsafe work environment.
Table 9 Work environment safety of the 20 bakeries in the study sample

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[Figure 2] demonstrates a negative correlation between bakers’ hazard exposure and workplace safety scores. It indicates an increase in these hazards with decreasing workplace safety precautions.
Figure 2 Ecologic correlation between hazards related to exposure and workplace safety scores.

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  Discussion Top


The work is viewed as important ones of life experience. Most adults spend one- third of their time at work. There is no risk-free work, and all workers must have some basic knowledge about work force populations, and work-related hazards (Stanhope and Lancaster, 2008). Ergonomics is the study of the design of a workplace, equipment, machine, tool, product, environment, and system which takes into consideration human being’s physical, physiological, biomechanical, and psychological capabilities and optimizes the effectiveness and productivity of work systems while ensuring the safety, health, and well-being of the workers. In general, the goal of ergonomics is to fit the task to the individual, not the individual to the task (Practice Good Ergonomics, 2015).

The aim of this study was to evaluate the effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City. The study findings demonstrate deficiencies in the knowledge and practices among these bakery workers about first aid and ergonomics in pretest implementation. Additionally, a significantly brought out were improvements detected in the knowledge and practices of bakery workers regarding first aid and ergonomics after intervention.

The current study result showed that the age range of bakery workers was 15–62 years with a mean of 31.8±12.2 ([Table 1]). These results were in line with those of a study by Mohammadien et al. (2013), in Sohag Governorate, which reported that the age of the flour milling workers ranged between 17 and 66 years with a mean of 38.8±11.2 years. However, this study result was in disagreement with that of Emmanuel and Sussan (2014) in Nigeria, who found that the age range of bakers was 21–25 years. This might be owing to the difference of location and economic causes.

The findings of current study showed that more than half of studied sample had secondary educated, whereas more than one-quarter were either (or just) illiterate or knew how to read and write, and less than one-fifth had basic education ([Table 1]). The results were accordingly to those of Yossif and Abd Elaal (2012), in Benha, which reported that more than half of the bakers were highly educated, whereas more than a quarter were less educated, and less than one-fifth had intermediate education. The high level of education of workers may contribute to improving their knowledge and practices in the post-implementation phase. On the contrary, this study result was in disagreement with that of Das et al. (2017), in Bangladesh, who revealed that majority of the workers are not highly educated which was also observed in scattered studies as those of Shaikh et al. (2012), Shewale et al. (2013), Das (2015), Vikrant et al. (2016), and Patil et al. (2017).

Regarding years of experience, the current study finding revealed that more than half of bakery workers had past experience of less than 5 years and about three-fifths of them worked nine or more hours/day ([Table 2]). These results agreed with those of a study carried out by Emmanuel and Sussan (2014), in Nigeria, which reported that most bakers had worked five years or less, and approximately half of the bakers worked between 7 and 12 h a day. This result was also in agreement with that of Yossif and Abd Elaal (2012), in Benha, which mentioned that most bakers worked 6–12 h/day. However, the previous results were in disagreement with past experience, as 60% of them had past work experience of more than 5 years, which agreed with Clark (2008), who reported that majority of the respondents had worked 5 years or less and about half of the bakers worked an average of between 7 and 12 h a day. This result was not congruent with a study by Das et al. (2017), in Bangladesh, which revealed that most workers worked 7–8 h per day. The contradiction with this study results might be owing to differences in settings.

Concerning the hazards related to job exposures inside bakery, the current study result revealed that the majority of the study sample reported the greatest hazards related to job exposure inside bakeries was poor position, followed by about two-thirds physical, more than half musculoskeletal, and more than one-third psychological hazardous, as shown in [Figure 1]. This might be due to that none of bakery workers wore PPE and about two-thirds of bakeries had unsafe work environment in the current study. These results are consistent with the results of Sheha (2009), which reported that the highest hazards were physical and psychological as a result of the enforcement of the harassment law such as stress and anxiety. Similarly, this result is congruent with that conducted by Alexopoulos et al. (2009) which revealed that the most significant occupational hazards in the bakery industry involves dealing with heavy loads, heat, high working rate, and noise. Moreover, this study was in agreement with Thompson (2008), who mentioned that there were more workers who had accidents at work. In contrast with the previous findings, Beheshti (2014), in Iran, reported that the high prevalence of risk factors for MSDs is of the neck, back, and hands; high postural load index; and 3 and 4 level ergonomic measures in 83% of bakery staff. In this respect, Mukhopadhyay (2008), in India, clarified that having assorted health problems is owing to handling of heavy loads without taking adequate rest breaks. Additionally, this finding is consistent with that of a study conducted by Abou-Elwafa et al. (2017), who found that workplace hazards, which included noise, temperature extremes, and psychosocial stressors, were the most hazards.

Concerning the distribution of health problems reported by bakers during the last 6 months in the current study, findings revealed that the majority of the studied bakery workers had abnormal musculoskeletal problems followed by neurological problems and nearly one-fifth reported abnormal skin problems, abnormal eye problems, and respiratory problems ([Table 3]). This might be owing to the lack of educational intervention in ergonomics of the bakery workers. Additionally, no such study was previously conducted in Sharkia Governorate. Regarding the skin problems, the results of present study were consistent with those of Brisman et al. (1998) in Swedish, which showed that the highest incidences are during the first year of employment as a baker. This may indicate that hand eczema is induced quickly among bakers. In contrast, a study carried out in Nigeria, by Emmanuel and Sussan (2014), revealed that the most prevalent complaints were respiratory symptoms. MSDs were reported by nearly 16%, whereas rashes and skin irritation occurred in ∼11% of the respondents, and also, the same other mentioned although a high proportion of the respondents were aware that health problems could arise from their occupational exposure in the bakery, most of them lacked knowledge of these hazards and their presenting symptoms. This implies that the bakers may not be applying adequate preventive measures to protect themselves. These results are in agreement with Souza and Filho (2017), in Cataguases City, MG, who found that musculoskeletal pains are most affected. According to the study of Behieshti et al. (2016), conducted in Gonabad, Iran, on 72 construction workers in three groups of jobs including brickwork, joinery, and foundation, the authors found that construction workers are exposed to MSDs.

Regarding knowledge about first aid among bakery workers in the present study before intervention ([Table 4]), the result revealed that only minorities of bakery workers identified wounds and burns first aid at pretest. Moreover, the findings of the present study revealed that minority of the bakery workers had adequate knowledge of first aid. From the researchers’ point of view, these findings could be attributed to lack of education for bakery workers in basic emergency police and to deal with crises in bakery. These results were in line with those of a study in Nigeria conducted by Emmanuel and Sussan (2014), who found that most of bakers lacked knowledge of these hazards and their presenting symptoms. This implies that the bakers may not be applying adequate preventive measures to protect themselves. Similarly, a study carried out by Yossif and Abd Elaal (2012) had also reported poor knowledge of occupational diseases and their methods of prevention. This indicates the need for training needs for these workers to equip them with information on the risks they are exposed to, daily at work, and how to control them. This is because a relationship has been found by Fishwick et al. (2011) to exist among similar workers between reduced occupational symptoms and having good knowledge of the potential health effects of their exposures.

Appropriate first aid and initial treatment can greatly reduce the severity and improve the survival of burn injuries as found by Mlcak et al. (2012). In this regard, Lee and Porter (2007) explained that awareness of first aid for burn injuries in the general population, especially workers in particular as vulnerable groups, plays an important role in ensuring self-rescue and helping each other to reduce the intensity of burns, as well as mortality in case of accident especially in mass casualty incidences. According to global reports, knowledge of community first aid for burns is somewhat limited, particularly in developing and underdeveloped countries as defined by Tay et al. (2013), Kattan et al., (2016). These reports were supported by Wallace et al. (2013), which found that only 35% of respondents had sufficient knowledge. Correct response rate was 15% higher in the first aid groups who had been trained about first aid in the past 5 years (about 50% of participants). Most participants who did not participate in any first aid training for burns had limited knowledge; of these, only 15% had sufficient knowledge and only 10% knew the practice of cooling the surface of the wound with burning.

With regard to answering the first hypothesis regarding bakery workers’ knowledge and practice score related to first aid will be improved after educational sessions, the main objectives of the present study have been achieved to a high degree, where results indicate high levels of knowledge and practices. From the researchers’ point of view, these improvements may be the result of the training courses given to the bakery workers. In addition, they were enthusiastic to participate in the educational sessions and ready to attend future educational programs. Therefore, these interventions have been successful in improving bakeries’ knowledge and first aid practices. The previous result was consistent with Yossif and Abd Elaal (2012), who conducted a study in Benha City and found that generally, high level scores of practices. The total mean score of their practices in particular, the wound, increased from 5.400±5.379 in presessions implementation to 11.380±4.965, and the burn score improved from 4.480±4.432 in presessions implementation to 9.880±4.008. Additionally, the syncope improved from 3.380±3.664 in implementation to 7.060±2.986. First aid training could help to overcome the motivational problem that workers’ direct personal experience of serious negative occupational health and safety consequences. It also seems likely that participants’ have stronger belief that they could personally experience an occupational injury or illness. Consequently, first aid training would be a valuable supplement to such training programs and could enhance their preventive effect.

Regarding first aid practices as observed among bakers in the current study before and after the intervention, [Table 5] showed that none of bakery workers identified satisfactory practices about wound care, first aid for burns, syncope, and asthma at pre-educational sessions compared with more than three-quarters after educational sessions. Moreover, none of the bakery workers had satisfactory first aid practices at pre-educational sessions compared with more than three-quarters at post intervention sessions. The results of this study have shown the urgent need to implement intervention in first aid, where knowledge and practices often come from educational programs. In contrast with these findings, Brisman (2002) indicated that baker’s asthma is one of the most common forms of occupational asthma. This finding was consistent with that of a study by Bazargani et al. (2013), which investigated people with burns injuries and found that most of them tried to go to the hospital as soon as possible. Patients believe that using cool water would cause more damage to burns. In addition, patients are also thought of in-home remedies to reduce pain and inflammation that would lead to better wound healing and better scar appearance and few of them knew the methods to extinguish fire and how to escape from a fire.

Concerning answering the second hypothesis regarding bakery workers’ knowledge and practice score regarding ergonomics will be improved after educational sessions, the main objectives of the present study were highly achieved as the results showed high degrees of knowledge and practices. From the researchers’ point of view, these improvements may be because the worker is involved in ergonomic interventions which offer a greater likelihood of reducing musculoskeletal problems. Furthermore, applications of workplace ergonomic principles require removal of two types of barriers: knowledge/practice based and organizational. In the current study, none of bakery workers knew proper ergonomic maneuvers in pretest intervention compared with majority in post-test intervention ([Table 5]). This result agreed with Souza and Filho (2017), who indicated that when working with high surfaces, the neck and back of the workers become overloaded. On the contrary, when these tables are too low, the trunk bends too much. Overcoming these positions can lead to muscle and skeletal dysfunction, as well as musculoskeletal pain as well as muscular pain. In this context, a study was conducted in Brazil by Salvador (2009) aimed at investigating the ergonomic demands of the baker’s position in the bread production company in the city of Natal. For this purpose, the methodology chosen was based on the Ergonomic Work Analysis to provide a better understanding of workplace situations, to identify the real and comfortable demand, and to provide recommendations for better implementation of activity, worker’s safety, and well-being. According to the aforementioned facts, the research was justified because this activity should be better adapted to the workers in the bakery. On the same line, Beheshti (2014) indicated that bakers, because of the nature of their jobs, are at risk of MSDs caused by ergonomic factors. Good manufacturing practices directly affect the health and security of workers and the quality of product.

Concerning work environment of the 20 bakeries in the current study, results revealed that only one-fifth of bakery workers deal with fire emergency procedures, whereas three-fifths reported that the level of light was adequate for safe and comfortable performance of work and none of bakery workers wore PPE. Moreover, approximately two-thirds of bakeries had unsafe work environment. These results are in line with those of Souza (2007), who showed the physical work environment is affected by high temperatures, inadequate lighting, excessive noise, and biological hazards, which interfere with the quality of work and the health of workers. Bakers and confectioners work near the oven and cookers, which generate heat, and this emission can cause a feeling of thermal discomfort for the workers and affect their production outcome, which greatly decrease when they have a temperature of 30°C. Furthermore, this result was in accordance with that of Yossif and Abd Elaal (2012), in Benha, which revealed that with regard to the use of protective devices, all bakers have weak score in all items of protective device before starting work. Protection devices are very important to protect workers from occupational hazards. In each bakery, there must be provision of a first-aid box containing first aid supplies. These results disagreed with those of the study in Nigeria by Emmanuel and Sussan (2014), who indicated that majority of workers used PPE. The contradiction with this study might be owing to differences of economic reasons and culture.


  Conclusion Top


In the light of the findings of the present study, it can be concluded that the study clarified that the educational sessions were effective in increasing the level of bakery workers’ knowledge as well as their practices about first aid and ergonomic maneuvers in bakers.

Recommendations

In the light of the findings of the present study, the following recommendations are suggested:
  1. Continuous educational intervention to all workers at bakeries in Sharkia Governorate to raise their knowledge and practice about first aids and ergonomics related to occupational hazards.
  2. Workers should be adequately informed about the specific hazards associated with bakeries job.
  3. First aid facilities and PPE must be available in all bakeries.
  4. The bakery environment needs more attention to be suitable for the workplace.
  5. It is necessary to conduct further training courses for bakery workers in bakeries at Sharkia Governorate.


Acknowledgements

First and foremost, the authors express thanks and gratitude to ALLAH, the most kind and most merciful. The authors would like to show greatest appreciation to Professor Dr Salwa Abass Ali Hassan, Professor of Community Health Nursing, Faculty of Nursing, Zagazig University, for the continuous support. The authors would like to thank all the participants in the study, the bakery workers who provided with their most valuable asset, and time. Many thanks for all of them as without them the authors would not have been able to conduct this study.[42]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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