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P=
ERSONAL
PROTECTION EQUIPMENT AND OCCUPATIONAL SUN EXPOSURE IN VIEW OF THE CASHEW
CULTIVIVATION WORKER'S HEALTH=
EQUIPAMENTOS DE PROTEÇÃO INDIVIDUAL E EXPOS=
IÇÃO
OCUPACIONAL SOLAR DIANTE DA SAÚDE DO TRABALHADOR DA CAJUCULTURA<=
/span>
Objective:
To ev=
aluate
the use of personal protective equipment and sun exposure among workers in =
the
processing of cashew nuts and their derivatives. Method: This is a cross-sectional, quantitative, epidemiological
research, carried out in the city of Barreira -=
CE,
between December 2019 and May 2020. Data collection took place through anam=
nesis
and the application of a semi-structured instrument which addressed the wor=
king
conditions and sociodemographic aspects of these workers. Statistical data
processing was performed using the PPE Info v. 7.2.1.0. This research was
approved by the Ethics and Research Committee under the technical report nu=
mber
3.466.070. Results: One hundred
people participated in the study, predominantly male participants (66%). It=
was
observed that sun exposure caused erythema in 23% of respondents. Regarding=
the
use of personal protective equipment (PPE) during labor activity, 63% of
respondents worn only one PPE, with a higher prevalence of wearing a
long-sleeved shirt in 26% of the participants. Thus, it was possible to obs=
erve
that the non-use of PPE and sun exposure due to work activities are
considerable risk factors that can lead to serious consequences for workers'
health, the occurrence of skin cancer being one of them. Conclusion: It is essential to rethink strategies in favor of t=
he
health of this group so that both the employee and the employer are aware of
the Regulatory Norms that aim to support the work activity with cashew and =
its
derivatives. Keywords: Personal Protective Equipment. Occupational Exposure.
Occupational Dermatitis. Occupational Health. Occupational
Health Nursing.
RESUMO<=
/span>
Objetivo:
Avaliar a utilização de equipamentos de proteção individual e a exposição s=
olar
entre trabalhadores que atuam no beneficiamento da castanha de caju e seus
derivados. Método: Trata-se de=
uma
pesquisa transversal, quantitativa, epidemiológica, realizada no município =
de
Barreira – CE, no período entre dezembro de 2019 e maio de 2020. A coleta de
dados deu-se por meio da anamnese e da aplicação de instrumento semiestrutu=
rado
que abordou as condições laborais e aspectos sociodemográficos desses
trabalhadores. O processamento estatístico dos dados foi realizado através =
do programa
EPI Info v. 7.2.1.0. Essa
pesquisa foi aprovada pelo Comitê de Ética e Pesquisa com parecer de número
3.466.070. Resultados: Partici=
param
do estudo 100 pessoas, predominando participantes do sexo masculino (66%).
Observou-se que a exposição solar acarretou, em 23% dos entrevistados, erit=
ema.
Sobre a utilização de equipamentos de proteção individual (EPI) durante a
atividade laboral, 63% dos entrevistados utilizavam apenas um EPI, havendo =
uma
maior prevalência da utilização de camisa de manga comprida em 26% dos
participantes. Assim, foi possível observar que a não utilização de EPIs e a
exposição solar devido à atividade laboral são fatores de risco consideráve=
is
que podem levar a sérias consequências à saúde do trabalhador, como por exe=
mplo
a ocorrência de câncer de pele. Co=
nclusões:
É imprescindível repensar estratégias em prol da saúde desse grupo para que
tanto o empregado como o empregador tenham conhecimento das Normas
Regulamentadoras que visam amparar a atividade laboral com o caju e seus
derivados. Palavras-chave: Equipamento de Proteção Individual. Exposição
Ocupacional. Dermatite Ocupacional. Saúde do Trabalhador. Enfermagem do
Trabalho.
INTRODUCTION
=
Family farming represents a strong
presence in the context of agriculture in northeastern Brazil (82.6%)(=
1). This
reality is due to the need for rural producers to efficiently use the land =
and
labor factors of their own family in economic activities that allocate them=
in
the most rational way possible, aiming at family support and job generation=
for
the population(2).
About 75% of t=
hese
producers are made up of family farmers who owns areas smaller than 20
hectares, generating 250 thousand direct and indirect jobs annually. Cashew
generates an even greater economic importance in the Northeast region becau=
se
the harvest allows for an intercalation between other subsistence crops, su=
ch
as rice, beans, cassava and corn(3).
Thus, the
cultivation and marketing of cashew, also known as cashew farming, has been
widespread in the Brazilian Northeast, both because it is an agricultural
activity more conducive to regions with hot and dry climates, and because i=
t is
a fruit supplier of raw material for the manufacture of various by-products
such as wood, nuts, cajuína – a soft drink made=
out
of cashew meat – and cashew nut liquid (CNL)(4).
During 2016, t=
he
territorial occupation of cashew plantations in Brazil corresponded to 594
thousand hectares, with 99.4% of this total being concentrated in the North=
east
region, with the state of Ceará as the main producer, with 384 thousand
hectares (64.7%)(4-5). Ceará state has the municipalities of Aracati, Aracoiaba, Beberibe, Bela Cruz, Cascavel, Itapipoca, Russas, Barreira and Pacajus as t=
he main
producers of cashew nuts. The latter two stand out as cashew and cashew ker=
nel
producing poles, with agglomeration of micro and small formal and informal
agribusinesses. In Barreira, cashew farming is
characterized as the main source of income, with production based on manual=
and
semi-mechanized handling with exposure to the components of the CNL(4)=
.
CNL is used as=
a
base for coatings, electrical insulators, plasticizers for rubber, photo
developers, inks, varnishes, enamels, abrasives and antioxidants. However, =
the
main product of the Northeastern cashew industry is still the cashew nut (C=
N)(6).
The nuts, on the other hand, contain an enveloping film that is removed dur=
ing
processing, from which alkaloids and tannins are extracted. From the husk, a
flammable caustic liquid is obtained, a by-product of the cashew agribusine=
ss,
the CNL, which constitutes approximately 25% of the total weight of the nut=
(7).
It has caustic and irritating properties that, in direct contact with the s=
kin
of workers, can cause irritation and chemical burns(8).
All the steps that make up this nut processing have several risks to=
the
health of the workers, such as environmental exposure like dust, heat and c=
old,
as well as aspects related to the activity itself such as almond frying,
packaging and storage, in which it can having frequent contact with the CNL=
(8).
Constant exposure to ultraviolet rays without the correct use of preventive
measures leaves workers vulnerable to the development of skin cancer(3=
).
Given the above, the adoption of biosa=
fety
measures in the work environment is a determining factor in the prevention =
of
accidents and occupational diseases, with the use of personal protective
equipment (PPE) being recommended by law, as well as the correct handling a=
nd
supervision in their use, in addition to behavioral and organizational meas=
ures
at work(9) .
Nursing, in turn, has a fundamental role in the context of preventing
health problems for workers. For this to happen, it is important for the
professional to be able to perform an active search, in addition to guiding=
and
instigating the use of PPE(7).
In this sense, it was necessary to investigate the use of PPE and sun
exposure among individuals who work with cashew nuts because, in addition to
being a little explored topic in the literature, this work/production
environment exposes the farmer to agents that can cause risks and harm to
health.
METHODOLOGY
This is a
cross-sectional study, carried out in the city of Barr=
eira,
in the state of Ceará, which was chosen due to the relevance of this city in
the context of cashew cultivation. From December 2019 to May 2020. The study
population was composed of individuals who practiced work activities of
processing cashew nuts, pseudo fruit and derivatives.
The municipali=
ty
has an estimated population of 22,425 inhabitants in 2019, with the majorit=
y in
rural areas (58.48%), equitable gender distribution, with a slight majority=
in
men (9,837 - 50.25%), with the main source of income being the processing of
cashew nut and its derivatives and a considerable proportion of inhabitants=
in
extreme poverty (4,560 - 23.3%)(5). The study population consist=
ed
of individuals who practiced work activities of processing cashew nuts, pse=
udo
fruit and derivatives.
The place of application of the data collection
instrument was the Dermatosis Ambulatory, which operates at the headquarter=
s of
the Rural Producers Union of Barreira, a
first-degree, non-profit union that covers about 20 mini nut factories. The
Clinic has a waiting room and an office, according to the standards of the
Unified Health System.
The study population was selected through the
application of the methodological snowball sampling technique, according to
which the initial study participant indicates three new participants who, in
turn, point out new individuals, and so on, until the proposed objective(10)
is reached.
The following in=
clusion
criteria were used: individuals aged 18 years or over, who had skin lesions
arising from contact with the CNL due to work activity related to the
processing of cashew nuts, pseudo fruit and by-products. Individuals with a=
ny
neurological impairment that made it impossible to understand the research
objectives and presented skin lesions arising from other causes not associa=
ted
with contact with the CNL were excluded, resulting in a sample of 100
individuals.
Initially, the dissemination of this research was =
broadcast
on the local radio station as well as dissemination by health professionals=
and
local chestnut producers, through the Union. Volunteers were invited to att=
end
the clinic, bringing together people who had skin lesions and who performed
activities directly related to contact with cashew, cashew nut and/or by-pr=
oducts.
The anamnesis was the first step in the
diagnostic approach, with the collection of the history of the current dise=
ase,
occupational history, activities performed in their free time, household
chores, personal products and past history. Subsequently, in order to ident=
ify
what remains ingrained in traditional cashew farming activities, pointing o=
ut
the advances and permanence of traditional habits, two main variables relev=
ant
to the risk of the work activity associated with processing cashew and its
by-products were analyzed using a standardized form applied in the field: t=
he
use of PPE and sun exposure.
In addition, sociodemographic variables correspond=
ing
to age, gender and education were addressed, as well as questions about risk
factors and signs/symptoms resulting from sun exposure, time of exposure, a=
nd
also the use of PPE during labor activity.
The database was built in a Microsoft Excel=
Ò2016 spreadsheet and processed using the Statistical Program Epi Inf=
o,
version 7.2.1.0 for Windows (CDC, Atlanta –USA). Descriptive statistics were
calculated, including measurements of position and variability such as mean=
and
standard deviation (sd) for numerical
characteristics, in addition to absolute and relative frequencies suitable =
for
categorical variables.
Ethical
aspects were respected, complying with Resolution 466/12 of the National He=
alth
Council (NHC)(11); with approval of the Ethics and Research
Committee (ERC) of the Universidade da Integração
Internacional da Lusofonia Afro-Brasileira, with technical report number 3.466.070.
RESULTS
One
hundred people from 21 different locations in the municipality were
interviewed, which showed a predominance of males (66 - 66%), mean age in b=
oth
genders of 33.21 years, (sd ± 12.42), education,
predominated participants who were not currently studying, these being 88% =
(n =3D
88) of respondents.
Regarding
the characteristics due to sun exposure, most of the respondents do not have
symptoms (47 - 47%), but it is worth mentioning that erythema in a place
exposed to the sun (23 - 23%), a burning sensation (21 - 21%) and simultane=
ous symptoms
(9 – 9%) were reported among the group. Workers who are not directly expose=
d to
the sun, that is, working in covered areas, were predominant (41 - 41%).
Table
1 - Daily sun exposure time reported by workers in =
the
cashew and its derivatives production sector, Barreira=
- Ceará, Brazil - 2020.
Daily
sun exposure time
N
%
45
45,0
12
12,0
02
2,0
41
41,0
Source:
Field research data (2020).
As
for the time when the sun is exposed for the longest time, most do it during
the period of the day when there is the highest incidence of sunlight in th=
e area,
between 8 am and 1 pm (52-52%), with most workers not exposed to the sun da=
ily due
to their work activity (41-41%).
Tables
02 and 03 present data on the amount of PPE used among respondents during t=
he
working hours. There was a predominance of workers who do not wear them (63=
%),
which may have consequences. Table 03 was built from a multiple-choice ques=
tion.
For this reason, the percentage exceeds 100%, as a single respondent could =
wear
more than one type of PPE.
Table
02 - Use of personal protective equipment reported by
workers in the productive sector of processing cashew and its derivatives, =
Barreira - Ceará, Brazil - 2020.
Number of used PPEs
Nr=
%
Only one
63
63%<=
o:p>
Up to two
31
31%<=
o:p>
Up to three
05
05%<=
o:p>
Up to five
01
01%<=
o:p>
Source:
Field research data (2020).
Table
03 - Use of personal protective equipment for protec=
tion
during work activity.
Barrier
- Ceará, Brazil - 2020.
Tipo
de EPI=
n=
%
26
26%
09
09%
04
04%
02
02%
01
01
01%
01%
01
01%
01
01%
63
63%
Source:
Field research data (2020).
The
participants unanimously used detergent or soap after work, as well as lemo=
n,
which they reported to be useful to prevent the appearance of dark stains.<=
o:p>
It
is noteworthy that all respondents claimed to use vegetable oil during work
activity to avoid burns due to contact with CNL. In addition, when CNL spil=
ls
onto any part of the skin, workers immediately report using 70% alcohol to
prevent further skin burns.
DISCUSSION
The
male population prevailed, similar to another study that identified the
majority of male workers (66.67%). With regard to the level of education, m=
ost
respondents had a low level of education(12), which can justify =
the
non-adherence to the use of PPE.
In
regards to the characteristics found due to sun exposure, the presence of
erythema prevailed, which is characterized by an inflammatory disorder that=
has
effects on the skin and mucous membranes. It has no predilection for age or
race, but it is more common in young adult males. Cutaneous manifestations,
which are flat, round and dark red, initially appear on the extremities, wi=
th
erythema and sunburn being commonly noted. The most striking cutaneous lesi=
ons
of erythema are the circular and concentric erythematous rings in the shape=
of
a target or a bull's eye(13-14).
As
for the time of sun exposure, it was observed that most respondents stay up=
to
two hours exposed to the sun per day, during the week (Monday to Friday), t=
aking
into consideration the journey to the work environment, a result also obser=
ved
in Mato Grosso, Brazil(15).
Cashew
nut production employees are also exposed to numerous occupational hazards =
in
the work environment, including the adoption of forced postures due to manu=
al
and semi-mechanized work during nut cutting, as cashew nut processing requi=
res
intense use of labor. This attribute requires measures to prevent injuries,=
for
this, workers should be provided with an appropriate PPE(16).
For
this reason, the rural or equivalent employer must provide rural workers
exposed to the sun with PPE such as a wide-brimmed hat or head bands, or ot=
her types
of protection against the sun and rain, goggles against non-ionizing radiat=
ion
and protection for the whole body, such as aprons, jackets, capes and overa=
lls(17),
in jobs where there is a danger of injuries caused by agents of thermal,
biological, meteorological and chemical origin.
A
study carried out in another Brazilian setting found that most of its
respondents protect themselves from solar radiation wearing only a hat and/=
or
cap as a form of protection (15 - 42.85%)(18). It can be observed
that the study points out exactly what was found in this research, that is,=
the
vast majority wear only one type of personal protective equipment or do not=
wear
it.
Handling the
liquid from the nut shell becomes extremely harmful due to the fact that the
nut contains a high oil content and the workers do not wear PPE, resulting =
in loss
of their fingerprints. Therefore, the lack of essential instruments is harm=
ful
to physical conditions, in addition to the loss of fingerprints, burns to t=
he
hands caused by the oils contained in the chestnut, smoke inhalation due to=
the
lack of protection in the nostrils, strong radiation from the heat of the f=
ire
and the position of the body in inadequate, low and small chairs, which res=
ult
in future health problems(19).
Other studies show that the working conditions of the villages that
handle the nut end up exposing workers to a situation of socio-environmental
risk, which is often unhealthy and inappropriate for the well-being of work=
ers
and their families, as cashew nut, vegetable oil to protect the hands of
workers who work in the cutting and/or frying stage of the almond(20-2=
1)
are necessary to obtain cashew nut almond.
The respondents
claim that they do not wear gloves because the nut is not firm when they ha=
ndle
it, so it is replaced by the use of an oil(22). This study shows
that the use of vegetable oil stands out in relation to the use of gloves, a
finding that meets the provisions of our research results. However, there a=
re
no studies that can prove the effectiveness of using vegetable oil for burns
arising from the liquid of the chestnut shell. However, it is known that
vegetable oil has an antioxidant capacity that represents part of the
bioactivity of the components of vegetable oils(23).<=
/span>
As mentioned a=
bove,
it is observed that this worker can experience situations of conflict arisi=
ng
from their labor process such as the certainty to guarantee their livelihood
and that of their family on one hand, and the complications affecting their=
health
and risk of death(24), on the other.
FINAL CONSIDERATIONS
From this stud=
y,
it was possible to observe that most professionals do not wear PPE and are
exposed to the sun and considerable risk factors due to their work activity=
that
can lead to serious consequences to the workers’ health, as the occurrence =
of
skin cancer. Therefore, knowing that the agribusiness sector has undeniable
relevance in the Brazilian Northeast, especially with regard to cashew farm=
ing.
One must be aware of the repercussions on the workers' health in the area d=
ue
to the numerous occupational risks.
So, it is
essential to rethink the strategies in favor of the health of this group, w=
ith
targeted actions so that these workers can protect themselves from solar
radiation, as well as guidance provided on the use of personal protective
equipment in work activities in order to avoid that future skin complicatio=
ns
occur, with the objective to prevent diseases and promote health at work.
For this reason, it is
essential that both the employee and the employer are aware of the Regulato=
ry
Standards that aim to support the work activity with cashew nuts, so that t=
he
employer can offer better working conditions and the employee also feel
protected while performing their job. Therefore, the importance of the nurs=
e as
an educating agent, together with his team, is reaffirmed to perform actions
that must go beyond the prevention of diseases. It is also necessary to wor=
k on
changes in the attitude of the ones involved through lectures, training and
workshops so that they can obtain quality of life.
It is notewort=
hy
that the present study presented, as a limitation, the fact that it was not
carried out by a multidisciplinary team. Professional interdisciplinarity, =
in
this context, could provide an even more holistic investigation about the
working conditions of workers related to cashew cultivation, as well as the
dermatological clinical manifestations related to the occupational activity
presented by this population.
Finally,
further studies on the subject are suggested, given the scarcity of
publications, mainly involving people who work with cashew nuts and by-prod=
ucts,
as well as studies aimed at understanding the benefits and harms of prolong=
ed
use of vegetable oil brought to the worker's skin.
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