Background
Occupational injury is any physical injury that affects a labor worker while working [
1]. Occupational accidents, work injury, work-related injury, work accidents, and work-related accidents are synonymous phrases for occupational injury [
2]. Around 20 ILO conventions have been ratified by Ethiopia in particular of the Occupational Safety and Health Convention 1981 (No. 155). According to the Labor Proclamation No.377/2003 form the Ministry of Labor and Social Affairs in Ethiopia, the government itself is responsible for supervising the labor administration, working conditions, occupational safety and health [
3]. Though there is favorable policy and regulatory frameworks in Ethiopia, its monitoring systems and laboratory investigations are inadequate. Even the internal infrastructural capability is also weak and it can’t help to identify and determine workplace injury too. Globally, occupational injury is becoming a public health emergency. It killed more than 300,000 labor force every year and it caused many more cases of disability [
4]. Health at work and healthy work environments are an input to the national economies via improved productivity, product quality, work motivation, job satisfaction and overall quality of the worker’s life and society [
5]. Though occupational injury is preventable, it is becoming amongst the major public health problems that causes an estimated economic loss of 5–10% growth national product beyond its increased risk of fatality and morbidity rates [
6‐
8], in which 14 death reported per 100,000 workers [
9,
10]. This issue is more pronounced in the Sub-Saharan Africa too [
11]. Currently, constructions, human health and social work activities, Sewerage, waste management and remediation activities, and manufacturing industries are increasing in Ethiopia. Consequently, the problem of occupational injury is increasing due to lack of safe working conditions. In Ethiopia, reports indicated that only 5 to 10% of workers have access to occupational health services in their respective workplaces. As mentioned earlier, occupational injury has direct economic costs, have a wide range of social consequences including both psychological and behavioral responses for the worker, family and for the community at all. Beyond its chronic consequences of disability, it has also tremendous impact on economy at individual, household and national level. This is because the disability itself kept people out of work longer than any other disabled condition; which is in-turn its cost is easily calculated via missed working days, related costs of replacing jobs, the cost of disability itself, the cost needed to give medical care, and the substitute labor [
12].
In Ethiopia, different fragmented and few studies have been conducted to assess the prevalence of occupational injury and associated factors. Employment pattern, drinking alcohol, sleep disorder, job satisfaction, use of personal protective equipment, working hours per week, health and safety training, work experience, work schedule, daily supervision, smoking, pollution and occupational safety are expected to be the possible factors for the occurrence of occupational injury [
9]. However, the pocket studies were fragmented and did not representative of the national estimates. Therefore, the main objective of this systematic review and meta-analysis was to estimate the national pooled prevalence and associated factors of occupational injury. These findings will be an input for policymakers and program planners of occupational health and safety in order to inform, plan, implement and evaluate health promotion policies and strategies which are crucial for preventing occupational injury.
Discussion
The aim of this systematic review and meta-analysis was to estimate the pooled prevalence of occupational injury and its associated factors in Ethiopia. This finding reported that the pooled prevalence of occupational injury was 40.39% (95% CI: 30.96, 49.82). This finding was in line with the study done in Ghana 40% [
42]. This can be attributed to many work-related accidents in developing countries. This is due to the fact that poor working conditions, lack of effective injury prevention systems, low health and safety regulations, low wages for workers and low social benefits [
43].
However, our finding was higher than the study done in Norway 31.70% [
44], Brazil 5.6% [
45], Nigeria 13.5% [
46], and Turkey 28.7% [
47]. Likewise, the pooled prevalence was lower than the study done in Japan 44.20% [
48], India 49.70% [
49], Iran 75.4% [
50], Egypt 46.2% [
51], Colombo 43.7% [
52], Zimbabwe 41% [
53] Greek 2.4% [
54]. This can be possibly justified by that work-related injury occur in low- and middle-income countries with the highest proportion of the world’s population and the highest proportion of workers in risky jobs; whereas high-income countries also account for a significant number of work-related deaths [
43]. From the current review, the government has not prioritized occupational safety and health to tackle occupational health problems, and is likely to have a low level of occupational health inspections, recording workplace accidents, and lack of effective surveillance systems.
From the subgroup analysis, the prevalence of occupational injury showed a sluggish decrement after the period of MDGs (37.37%) in comparison with before the end of the MDGs (45.12%). This is a clue for the concerned bodies to effectively implement legislations to minimize occupational injury and related consequences. The highest prevalence of injury was also reported from construction sites (50.8%) followed by sewerage, waste management and remediation sites (47.31%).
From the current review, being male was statically associated with occupational injury. This finding was comparable with the study done from Brazil [
55], Japan [
48] and Finland [
56]. Since there is no a well-established evidence previously about how sex is related with occupational injury, indeed; it warrants further investigation.
The individuals who were engaged to work more than eight hours per day were also at great risk of being injured as compared to those who were engaged to work for less than or equal to eight hours per day. This finding was comparable with the study done from Bangladesh [
57], USA [
58] Nigeria [
59] and USA [
60]. This could be explained by that work overload my attribute for various emotional, physical and social consequences of employees; this in-turn may expose for occupational injury [
61].
Lack of health and safety supervision at the workplace increases the risk of occupational injury amongst the workers. Compatible findings were also reported from Japan [
48] and Brazil [
55]. For this, professional supervisors may encourage health in the workplace by advising employees if they are within unsafe condition [
62].
Moreover, lack of using Personal Protective Equipment (PPE) is also a risk factor for the occurrence of occupational injury. Consistent findings were also reported among studies done from Norway [
44] and India [
63] and Japan [
48]. As the recommendations are already forwarded from WHO, utilization of PPE will reduce exposure to chemical, radiological, physical, electrical, mechanical and/or other hazards.
Likewise a study reported in Japan [
48], from the current review; there was also higher reports of occupational injury among individuals’ who did not have occupational health and safety trainings. This is the fact that training activities are the basic programs which instruct employees to avoid known hazards by properly using and maintaining equipment and materials. It proactively help workers to identify and resolve potential problems that may cause occupational injury [
64].
In order to minimize this high burden of occupational injury, the concerned body should give special attention to all the identified factors. The consequences of occupational injury can be felt when their work product is not successful and sustainable. The nature of workers ‘exposure to occupational hazards depends on the type of work being carried out. Limited use of PPE, lack of training for staff and poor lighting in places of work were among the causes of such injury. However, the low educational level of the workers, their age, work shift and occupations (for example, weaving or spinning sections) were factors associated with increased risk of injury. Health and health at work to be implemented and ratified for the protection of employees by legislation, regulatory framework and compliance requirements.
Globally, limited workers’ safety coverage and substantial under-reporting of fatal type of occupational injury, disorganized documentation, and incomplete documentation of all data system forms are the main factors leading to underestimation of injury-related occupational deaths [
4,
65‐
67]. In Ethiopia, there is no a comprehensive national surveillance and reporting system for occupational injury. This suggests that the frequency of work-related accidents, illnesses and even deaths are underestimated. Hence, underreporting of occupational injury reduces our capacity to identify and address occupational health issues. This also impacts both workers and the community that require significant research and treatment. Thus, new programs, models and approaches need to be adapted to identify causes of underreporting of occupational injury in Ethiopia.
Strengths and limitations
Primarily, this systematic review and meta-analysis used internationally accepted tools for critical appraisal system for quality assessment of individual studies. It included published and unpublished articles. By including data from unpublished studies and gray literature, this meta-analysis and systematic reviews could account for publishing bias due to under-reporting negative results, which contributes to bias in meta-analysis, thus misinforming researchers and policymakers.
Conclusion
Based on this systematic review and meta-analysis, it is concluded that nearly half of the labor workers in Ethiopia were experienced occupational injury. This issue was more encountered among the labor workers of construction sites and whose working place were at the Addis Ababa city administration respectively. Being male sex, working more than eight hours per day, lack of personal protective equipment, lack of supervision, and lack of training about occupational health and safety had increased odds of occupational injury in Ethiopia. Hence, the concerned body should give special emphasis for all the explored factors in order to minimize occupation related injury, mortality and morbidity in the country.
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