wah medical college research

8/14/2019 Wah Medical College Research

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WAH MEDICAL COLLEGE, WAH CANTT

DEPARTMENT OFCOMMUNITY MEDICINE

WAH MEDICAL COLLEGE, WAH CANTT



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FREQUENCY AND

PATTERN OF DISEASESAMONG FACTORY

WORKERS OF PAKISTAN

ORDNANCE FACTORIES

(POF) WAH CANTT.

[HOSPITAL BASED

STUDY]



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RESEARCH DONE BY: BATCH C, 4TH YEAR

MBBS,

Farkhanda Jabeen Roll no. 05016Henna Azmat Roll no. 05019

Muhammad Anwar ul haq Roll no. 05076

Muhammad Majid Mehmood Roll no. 05077

Muhammad Nasir Nawaz Roll no. 05079

Muhammad Obaid-ur-Rehman Roll no. 05107

Salahuddin Khan

RESEARCH SUPERVISOR:

Dr. Ambreen Ansar

Post Graduate Trainee (PGT)

Community Medicine Department.

RESEARCH MONITOR:

Dr. Babar Mumtaz Malik

Assistant Professor

Community Medicine Department.

RESEARCH INCHARGE:

Prof. Dr. Musarrat Ramzan

Head of Community Medicine Department,

Vice Principal WMC



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TABLE OF CONTENTS

CONTENTS PAGE NO.

LIST OF FIGURES 6

LIST OF ABBREVIATIONS 6

ABSTRACT 7

INTRODUCTION 8

LITERATURE REVIEW 9

OBJECTIVE 10

METHODS AND MATERIAL 10

RESULTS 11

DISCUSSION 15

CONCLUSION 16

REFERENCES 16



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LIST OF FIGURES

FIGURES PAGE

NUMBER Fig-

1

Bar graph showing percentage and number of patients

of different disease groups in Explosives Factory

12

Fig-

2


of different disease groups in Filling Factory

13

Fig-

3


of different disease groups in Brass Mill

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LIST OF ABBREVIATIONS

ATSDR Agency For Toxic Substances and Disease Registry

CCF Congestive Cardiac Failure

CHE Collaborative on Health and Environment

CNS Central Nervous System

COPD Chronic Obstructive Pulmonary Diseases

CVS Cardiovascular system

DNS Deviated Nasal Septum

ENT Ear, Nose and Throat

GIT Gastrointestinal System

IHD Ischemic Heart Disease

MSDS Material Safety Data Sheet

NEQ’s National Environmental Quality Standards

PETN Pentaerythritoltetranitrate

POF Pakistan Ordnance Factories

QHSE Quality Health Safety and Environment

RDX Cyclotrimethylene-trinitramine

T.B. Tuberculosis

TNT Trinitrotoluene

U.S. United States

UV Ultra Violet



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CONCLUSION: A major correlativity exists between occupational

hazards and disease cases reported.

INTRODUCTION:

Since the very inception of mankind, he has indulged himself

into scores of different occupations to earn his living. These chores

come with a specific price of occupational diseases. According to

ILO/WHO Committee “occupational health should aim at the

promotion and maintenance of the highest degree of physical, mentaland social well being of workers in all occupations; the prevention

among workers of departures from health caused by their working

condition; 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”.1

Hippocrates

admonished his followers to observe the environment to understandthe origins of illnesses in their patients. From Agricola, 15th century,

who observed that miners in Joachimsthal frequently became short of

breath and died prematurely (due to silico-tuberculosis) to Alice

Hamilton, 20th century, who was the first U.S. physician to devote

her life to the practice of industrial medicine, physicians have always

been intrigued by the phenomenon of occupational health.2

In today’s

industrial revolution occupational health has come up again with a far

more significance than ever before. Physical, chemical, biological,mechanical and psychosocial hazards from industry have been the

part and parcel of modern day research. Phenomena like

pneumoconiosis, lead poisoning, cancer, radiation hazards and

accidents in industry have now become prevalent in the working class

exposed to these hazards.2

In Pakistan, occupational hazards have also been explored with

cases being reported of byssinosis from cotton spinning factories,

anthracosis from coal mines, bagassosis from sugar-cane industry andasbestosis from asbestos industry.



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A major share of today’s industrial revolution is defence

productions. Considerable numbers of chemicals like TNT, RDX,

PETN, Nitric acid, White phosphorus and zinc oxide etc have been

identified as a major risk factor for workers related to this industry. In

addition to these chemicals workplace hazards like accidents, burns

and radiations are also rampant among this industry’s workers.

Therefore the significance of occupational health and safety in today’s

era cannot be understated.

Pakistan also joined the elite club of nations by establishing

Pakistan Ordnance Factories (POF) Wah Cantt in 1951. Our research,

based on the patient data from POF workers admitted in POF

Hospital, Wah Cantt, primarily analyses diseases prevalent in these

workers and their association with risk factors.

LITERATURE REVIEW:

Workers of ordnance factories are exposed to a number of risk

factors. Out of these risk factors, TNT (trinitrotoluene), RDX

(cyclotrimmethylene-trinitramine), PETN (pentaerythritoltetranitrate),Nitric acid, white phosphorus, Zinc oxide, copper, Ultraviolet (UV)

light and accidents are the most significant ones.

TNT (trinitrotoluene), an explosive by nature, has nitric oxide

fumes in it which when exposed to causes respiratory tract irritation,

nausea, headache, reduced blood pressure and possible CVS

effects.3,4,5,6,7

It is also a factor in the development of cataracts.8,9

Similarly RDX (cyclotrimmethylene-trinitramine) is also an explosive

which causes convulsions, lung congestion and psychoses.10,11,12

PETN (pentaerythritoltetranitrate), an explosive and used in

detonating devices, is also a respiratory tract irritant and a known

coronary vasodilator causing lowering of blood pressure, headache or

faintness. Repeated over-exposure with PETN may result in chest

pains later, even in the absence of exposure.13,14

Nitric acid, a well known respiratory irritant and congestant and

a corrosive by nature, is a potential hazard for accidental injuries in

concentrated form and potentially very toxic in case of inhalation.15



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• Sample size216(two hundred and sixteen only)

• Sampling technique

Convenient method• Inclusion criteria

Male patients from Brass Mill, Explosives and Filling factories

admitted in various wards of POF Hospital Wah Cantt.

• Data collection procedure

Data was obtained from the HMIS department of POF

Hospital, Wah Cantt. Permission to get the data was

granted by the competent authority, after applying for it

through proper channel.

RESULTS:

A total of 216 patients were scrutinized for the study from the

three major factories namely Brass Mill, Explosives and Filling

factory. We divided the patients into ten major disease groups.Out of 216 patients, 102 were registered with Explosives

factory. Among them 40 (39.22%) were CVS cases (17 cases of

Ischemic Heart Diseases (IHD), 16 cases of hypertension, & 7 cases

of congestive cardiac failure) 15 (14.71%) had infections (mainly of

respiratory (5) and urinary tract(10), 10 (9.8%) were surgical cases (3

abdominal surgeries, 4 abscess drainage procedures, & 3 cases of

orthopedic surgeries), 10 (9.8%) CNS cases (mainly depression and

acute psychosis), 7 (7.14%) diabetics, 6 (6.12%) had cataracts, 3(3.06%) with GIT problems, 3 (3.06%) had cancer, 5 (5.1%) had

respiratory problems (majority i.e. about 70% presented with COPD)

and 3 (3.06%) presented with ENT related problems.



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Fig-1: Percentage and no. of patients of different disease groups in explosives factory

CVSRespir

ation

Infecti

onsGIT

Surge

ry

Diabe

tics

Cance

rENT

Catar

actsCNS

No. Of patients 40 5 15 3 10 7 3 3 6 10

39.22%

5.1%

14.71%

3.06%

9.8%

7.14%

3.06% 3.06%

6.12%

9.8%

0

5

10

15

20

25

30

35

40

45

N o .

o f P a t i e n t s

Disease Groups

Explosives Factory



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78 patients were from the filling factory. Out of these, 26 (33.33%),

patients were of CVS diseases (19 cases of Ischemic Heart Diseases

(IHD), 7 cases of hypertension), 9 (11.53%) respiratory cases, 14

(17.94%) with infections (mainly of respiratory (7) and urinary

tract(7), 2 (2.56%) with GIT problems, 9 (11.53%) had undergone

surgery (1 case of abscess drainage procedure & 8 cases of

laprotomies), 5 (6.41%) were diabetics, 1 (1.28%) cancer case, 1

(1.28%) ENT case (DNS), 8 (10.25%) with cataract, and 3 (3.84%)

CNS cases (acute psychosis).

Fig-2: Graph showing percentage and no. of patients of different disease groups in

filling factory

CVS

Respi

rator

y

Infect

ionsGIT

Surge

ry

Diabe

tes

Canc

erENT

Catar

actsCNS

No. Of patients 26 9 14 2 9 5 1 1 8 3

33.33%

11.53%

17.94%

2.56%

11.53%

6.41%

1.28%% 1.28%

10.25%

3.84%

0

5

10

15

20

25

30

N o .

O f P a t i e n t s

Disease Groups

Filling Factory



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Out of a total of 36 registered patients from Brass Mill, there were 5

(13.88%) CVS cases (all were cases of IHD), 6 (16.66%) respiratory

cases ( 3 T.B. patients & 3 cases of COPD), 7 (19.44%) infections (all

respiratory), 6 (16.66%) GIT cases, 8 (22.22%) surgical cases (6 cases

of orthopedic surgeries & 2 cases of Laprotomies), 2 (5.55%)

cataracts, 2 (5.55%) CNS cases and 0% diabetic, cancer and ENT

cases.

Fig-3: Graph showing percentage and no. of patients of different disease groups in

Brass Mill

CVSRespira

tory

Infectio

nsGIT Surgical

Diabete

s

Cancer

sENT

Catarac

tsCNS

No. Of Patients 5 6 7 6 8 0 0 0 2 2

13.88%

16.66%

19.44%

16.66%

22.22%

0.00% 0.00% 0.00%

5.55% 5.55%

0

1

2

3

4

5

6

7

8

9

N o .

O f P a t i e n t s

Disease Groups

Brass Mill



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DISCUSSION:

The analysis of data was difficult as we were not allowed full

access to the inside of factories due to security reasons. However,while analyzing the data, we came to know that majority of patients

from Explosives and Filling factories were CVS cases, i.e. 39.22%

and 33.33% respectively (This can be attributed to the presence of

TNT), whose fumes contain nitric oxide, which reduces blood

pressure, causes headache, vomiting, and cyanosis and therefore

possible CVS manifestations.3,4,5,6,7

Similarly PETN has a role in

decreasing blood pressure and causing headache, and also some CNS

manifestations.13,14

There was also a significantly high prevalence of CNS cases

(9.8%) in Explosives factory owing to the blood pressure lowering

effects of TNT and PETN. Similarly RDX can also be regarded as a

causative factor for CNS disorders, including anxiety psychoses and

abnormal reflexes.10,11,12

A large number of surgical cases were reported from all the

three factories particularly Brass mill (22.22%). This can be imputed

to the occurrence of accidents due to highly explosive materials and in

particular the blast furnaces present in Brass Mill. Another

perpetrator, white phosphorus, which is highly toxic and causes burns,

can also be held responsible for accidents and consequently surgical

cases.16,17

We noticed an alarmingly high incidence of cataracts in

Explosives factory (6.12%), Filling factory (10.25%) and Brass Mill

(5.55%), which is self explanatory due to UV light emitted by

explosions and welding procedures and also partly due to exposure to

TNT. A considerable proportion (11.53%) of respiratory cases in

Filling factory can be related to the presence of nitric acid (irritant and

corrosive) and RDX (causes lung congestion). In Brass Mill, what

seemed particularly important was the presence of 16.66% respiratory

cases specifically including “INHALATION FUME SYNDROME”,

caused by Zinc Oxide fumes.

It is worth mentioning here that POF has enforced strict safety

measures and precautions, including protective wear, minimizing

amount and duration of exposure to risk factors. This is according to



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QHSE (Quality Health Safety and Environment) standards and safety

recommendations of NEQ’s (National Environmental Quality

Standards).26

Still there is considerable prevalence of occupational

diseases among factory workers and this can be ascribed to personal

negligence and lack of health education.

CONCLUSION:

After calculating and analyzing the frequencies and pattern of

diseases, our study supports the fact that there is a positive association

between different chemicals and other material used in PakistanOrdnance Factories, Wah Cantt, and several diseases. The prevalence

of occupational disease is very high for a state of the art facility like

Pakistan Ordnance Factories. It is need of the hour that emphasis

should be given on health education of the workers and stringent

regulations be imposed to reduce these problems.

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edition,

chapter 15, p 606.

2. William N, Rom. Environmental And Occupational Medicine. 4th

edition, unit

1, chapter 1, p.4, 5.

3. Material Safety Data Sheet (MSDS), Clayton Associates, Inc. USA. Issued

19/02/2005;http://www.jclayton.com/ProductPDFs/3-74137-

MSDSTNTPLUS.pdf ; (visited on: May 20, 2009, 7:26pm)

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The Collaborative on Health and the Environment (CHE).http://database.healthandenvironment.org/index.cfm ; (visited on: May 20,

2009, 7:03pm)

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Allergy and Clinical Immunology, August 2007 volume 20, No. 3.

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http://www.hamiltonnw.com/MSDS/MSDS_TNTTapingAndToppingJointCo

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in dynamite workers and controls. British Journal of Industrial Medicine 1980;

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http://database.healthandenvironment.org/index.cfm


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8. Kruse A, Hertel, M, Hindsholm M, Biskum S. TNT-induced Cataract in

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http://www.scentlogix.com/ScentLogix-K9%20Untagged%20RDX%20MSDS%20Sheetv1.1.pdf



http://www.dynonobel.com/NR/rdonlyres/4C3D45B5-90E9-4EA6-8B62-F89F27C7C607/0/1126DetCord012405.pdf



http://www.detotec.com/pdf/petn.pdf


http://en.wikipedia.org/wiki/Nitric_acid


http://www.jtbaker.com/msds/englishhtml/p4017.htm


http://files.aws.org/technical/facts/FACT-25.pdf



http://www.pof.gov.pk/maboutus.htm















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