RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PERFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

MS. SUMAN DAHYIA

1 Name of the Candidate
and Address 1ST Year M.Sc. (Nursing)

Karnataka College of Nursing,

33/2, Thirumenahalli,
Bangalore – 64

Karnataka College of Nursing

2 Name of the Institution

M.Sc. (Nursing)
3 Course of Study and
Subject Community Health Nursing

4 Date and Admission to 1.09.2010

Course

5 “A study to evaluate the effectiveness of

Title of the Topic
structured teaching programme on
knowledge regarding effects of noise
pollution on health among workers in
selected iron and steel industries at
Bangalore.’’

0
6. BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION

“The past two decades have witnessed revolutionary changes in the nature of work

and workplaces and the global economy in India. Industrialization and globalization are

changing Indian occupational morbidity drastically with an ever increasingly demand for

a comfortable living. In recent days the number of industries is on the increase. In India

there are approximately 60 million workers over the age of 16, are involved in various

kinds of industrial work, such as iron and steel industry, textile industry etc. Which leads

to different type of pollutions.1

Pollution is the introduction of contaminants into a natural environment that cause

instability and disorder, harm or discomfort to ecosystem .One among them is noise. The

word ‘noise’ comes from the latin word nausea meaning ‘seasickness’, referring

originally to nuisance noise. Noise is defined as wrong sound, in wrong place, at wrong

time. The 20th century has been described as the ‘century of noise’.2

Noise pollution is displeasing human- or machine-created sound that disrupts the

activity or balance of human or animal life. A common form of noise pollution is from

transportation, principally motor vehicles, industries etc.Noise pollution can negatively

impact the body in significant ways, including elevated blood pressure, impaired

cognitive functioning, and other effects of chronic stress.The following are effective

strategies we can use to limit the negative impact of noise pollution and safeguard our

health.2

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 Industrial noise refers to noise that is created in the factory which is jarring and

unbearable. Sound becomes noise only it becomes unwanted and when it becomes more

than it is referred to as "noise pollution". Heavy industries like shipbuilding, iron and

steel industries have long been associated with Noise Induced Hearing Loss (NIHL).This

is posing to be a big challenge with very passing day and is a threat to safety and health

of the people who are working in the industry and common people as well. It has been

scientifically proved that noise more than 85 decibels can cause hearing impairment and

does not meet the standards set for healthy working environment.3

Operations in the iron and steel industry may expose workers to wide range of

hazards or workplace activities that could cause incidents, injuries, death, ill health or

diseases. Noise-induced hearing loss is a major health risk worldwide, while tinnitus is

frequent in patients with permanent hearing impairment. Tinnitus patients have often

been exposed to noise, but not always and noise exposed workers often have tinnitus but

this may not be the case if hearing is normal. The frequently recorded health disorders

between iron and steel industry workers includes: respiratory, skin problems and noise-

related hearing impairment.3

Thus public awakening is very essential for the control and prevention of the

noise pollution. In India, most of the persons lack any idea about the ways in which noise

pollution could be controlled. Very few people are aware of the problem and its control.

In this regard television, radio, internet, and newspapers should give a campaign for wide

publicity. 3

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6.1. NEED FOR THE STUDY

The work place is that in which person not only earn his daily bread but also

spent one third of average adult life. As the number of industries are on the increase.

Several industries like cement industries, steel industries, textile industries etc. Thus the

workplace has significant influence on individual’s heatlh and is a primary site for the

delivery of preventive health care. The protections of health of working population in

these are primary concern. 4

Health of workers working in iron and steel industries are more affected by noise

pollution. Noise above 80 decibel (db) can produce adverse auditory and non auditory

health effects. Repeated exposure to hazardous level of noise damages structures

contained within the inner ear. An explosion or any large and abrupt pressure change can

also cause damage to middle ear which could cause auditory damages. In addition to

hearing loss exposure of workers to noise level of 90-119decible (db) was also found to

result in disorders like mental fatigue, annoyance and reduce alertness, hypertension and

irritability leads to accidents.5

A cross sectional study was done on noise induces hearing loss among 150

workers from area A and 52 employees from area B .The sample were collected by

random method. The results show that in both study areas the noise level was above the

safe limit of 85decible (db). In area A 28 worker and in area B 8 employees had noise

induced hearing loss. In area A 81.1% of the workers and in area B 85 % of the

employees knew that noise cause hearing loss. All workers from both study area knew

that noise induced hearing loss could be prevented by some form of ear protection .The

3
study conclude that workers exposed to noise above 85decible (db) will eventually

develop hearing loss, the workers are aware of this hazard. Therefore a need to educate

those exposed on how dust protect their ear from the hazard and provide them with

protective gear. 6

A cross sectional study was carried on noise induced hearing loss in steel factory

among 50 workers. The sample was divided into two groups, a group of 25 workers of

the steel production machine division as case group, and another 25 workers of the

administrative division as control group. The study result show that the noise intensity in

the steel production machine room was 102decible (db) and in the administration room

was 60.4 decibel (db) and a number of 21 workers (84 %) of the case group got, Noise

induce hearing loss (NIHL) compared to 1 worker (4 %) of the control group. The study

concluded that there was a significant difference in the incidence of noise induced

hearing loss (NIHL) between the two groups and there was also a significant difference in

correlation between noise induced hearing loss (NIHL) and working period (p < 0.05). 7

A cross sectional study was carried on the prevalence of noise-induced hearing

loss among 182 workers. The acoustic classifications from the operating units of the

client companies were used to characterize the noise exposure status within the work

environment. The results show that the prevalence of cases suggestive of noise induced

hearing loss (NIHL) was 15.9% and significant associations (p<0.05) were identified

from multivariate analysis between these cases and the variables of age and degree of use

of individual protection equipment. Thus the study concluded that contribute towards

4
better understanding of the behavior of some of the main characteristics of noise induced

hearing loss (NIHL), in a particular situation of the organizing of work. 8

A study was carried out on noise induced hearing loss and blood pressure among 85

workers with long-term exposure to noise levels exceeding 85 decibel (db) .The control

group consisted of 85 workers who had never been exposed to noise levels greater than

recommended 85 decibel (db). The Mann-Whitney test was used for statistical

assessment in their working environment. The result showed that the workers in the

exposed group had hearing loss which was confirmed by audiometer and the systolic as

well as the diastolic blood pressure in the exposed group was increased (P < 0 001),

respectively (P < 0.01).9

Training and education to these workers is an essential component of occupational

health. It is important to make workers aware and concerned about health. Thus in this

study, researcher is going to evaluate the effectiveness of structured teaching programme

on effect of noise pollution among Iron and Steel industry workers. 10

6.2 REVIEW OF LITERATURE

An important aspect of research, literature review is to make sure that is already

done in relation to the problem of interest. Several studies which have been conducted in

correlation between levels of sound and noise induced health problems which needs more

focus for the development of future studies. The investigator with the available resources

was able to review the literature so as to proceed with the study.11

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 A study was conducted on noise induced hearing and hypertension associated with

long term occupational exposure to noise among 140 healthy male employees from a

local petrochemical industry with a history of past and present exposure to noise and 140

matched healthy unexposed individuals from the same industry . A questionnaire with 40

items concerning age, sex, weight, height, length of employment, workplace noise level,

and history of hypertension was administered. The subjects were physically examined,

their blood pressure was taken under normal resting position and all underwent

audiometry testing. Similarly, sound pressure level and octave band analyzing in different

stations of the workplace were carried out for every employee, and then combined noise

level was calculated. The results showed that prevalence of hearing impairment was

38.5% among the exposed and 7.8% among the unexposed group and the difference was

statistically significant. Prevalence of hypertension in the exposed group was

significantly higher than that in the unexposed group.12

An environmental study was conducted on Auditory and Respiratory Health

Disorders among 106 occupationally exposed male workers. Sample were subjected to

Spiro- metric and audiometric measurement .Environmental study for noise ,dust and

fumes measurement was done .The study result show that the higher mean value of noise

and lower mean value of dust ,fumes than the standard level .The study concluded that

workers working in iron and steel industry may be associated with higher prevalence of

chest manifestations, hearing impairment, changes in the mean values of different

spirometric measurements and noise induced hearing loss.13

6
 A study was conducted on hypertension and hearing impairment in workers of iron

and steel industry among 770 workers from five sections. Steel melting section (SMS),

rolling mill section (RMS), quality control department (QCD), maintenance department

(MD) and administration department (AD). Workers working in SMS, RMS, & QCD

formed a continuously exposed group (CEG); workers of MD and AD formed

intermittently exposed group (IEG). Workers were interviewed, examined and

information was collected in a pre-tested pro-forma. Blood pressure was measured, and

tuning fork tests were done to assess hearing ability. Prevalence of hypertension among

CEG (25.51%) was significantly higher than IEG (14.05%). The results showed that there

was positive association between duration of exposure and prevalence of hypertension.

The prevalence of hearing impairment was significantly more in CEG (20.5%) as

compared to IEG (8.91%). Occurrence of hearing impairment was also directly

proportional to the duration of exposure. The study concluded that hypertension and

hearing impairment are common in workers continuously exposed to high levels of

occupational noise. 14

A study was conducted on combined effect of smoking and occupational exposure

to noise on hearing loss in steel factory among 4,624 steel company workers.

Occupational exposure to noise was determined based on company records. Logistic

regression was used to examine the dose-response association between smoking and

hearing loss. The results showed that smoking was associated with increased odds of

having high frequency hearing loss in a dose-response manner. The prevalence rate

ratio(PRR) for high frequency hearing loss among smokers exposed to occupational noise

was 2.56 (95% CI 2.12 to 3.07), while the prevalence rate ratio(PRR) for smokers not

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exposed to noise was 1.57 (95% CI 1.31 to 1.89) and the prevalence rate ratio( PRR) for

non-smokers exposed to noise was 1.77 (95% CI 1.36 to 2.30). The synergistic index was

1.16. Smoking was not associated with low frequency hearing loss. Thus the study

concluded that Smoking may be a risk factor for high frequency hearing loss, and its

combined effect on hearing with exposure to occupational noise is additive.15

A cross-sectional study was conducted on do ambient noise exposure levels

predict hearing loss in a modern industry among 6,217 employees of an aluminum

manufacturing company. Industrial hygiene and human resources records allowed for

reconstruction of individual noise exposures. The results showed that workers in higher

ambient noise jobs tend to experience less high frequency hearing loss than coworkers

exposed at lower noise level. The hearing conservation efforts appear to be reducing

hearing loss rates, especially at higher ambient noise levels. The greatest burden of

preventable occupational hearing loss was found in workers whose noise exposure

average 85 decibel(db) or less. The study concluded that reduce rates of occupational

hearing loss, hearing conservation programmers may require innovative approaches

targeting workers with noise exposures close to 85 decibel (db). 16

A study was conducted on effect of chronic and acute exposure to noise in

physiological function among 75 normal healthy individuals exposed to occupational

noise of 88 -107 decibel(db) for 10-15 years and in 36 normal non-exposed subjects .The

result showed that blood pressure, both systolic (P < 0. 01) and diastolic (P< 0. 001), and

heart rate (P< 0 .05) were found to be significantly higher in the exposed subjects,

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irregularity in cardiac rhythm, both in amplitude and duration, was found in 18 % of the

exposed subjects as against 6 % in the non-exposed group. Variation in the heart rate

during acute noise exposure of 90 decibel (db) has been shown to be related with the

preponderance of tonicity of sympathetic and parasympathetic’s .Measurement of hand

blood flow during the same exposure showed a lesser degree of vasoconstriction and a

slower recovery rate in the exposed group.17

A study was conducted on Effects of workplace noise on blood pressure and heart

rate among 114 workers employed in different sections of lock factories exposed to

industrial noise levels exceeding 80 decibel (db). The control group consisted 30 people

who never lived or worked in a noisy environment. The study result show that significant

changes in systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse

pressure and heart rate in the workers of lock factories. The study concluded that

industrial noise could be possible contributing factor in the development of arterial

hypertension. 18

A study was conducted on multiple work-related accidents: tracing the role of

hearing status and noise exposure among 52,982 male workers aged 16-64 years with

long-standing exposures to occupational noise over a 5-year period, using "hearing

status" and "noise exposure. The results showed that exposure to extremely noisy

environments > or =90 decibel (db) is associated with a higher relative risk of accident.

The severity of hearing impairment increases the relative risk of single and multiple

events when threshold levels exceed 15 decibel (db) of hearing loss. The relative risk of

multiple events is approximately three times higher among severely hearing-impaired

9
workers who are exposed to > or =90 decibel (db). The study concluded that Single and

multiple events are associated with high noise exposure and hearing status. 19

A cross-sectional study was conducted to determine the prevalence of hearing loss

associated with occupational noise exposure and other risk factors among 269 exposed

and 99 non-exposed workers. Otoscopic examination and conventional frequency (0.25–8

kHz) audiometry were used to assess the hearing loss in each worker. The results showed

that 75% (202 subjects) from the exposed group were exposed to a daily combined noise

level above the permissible level of 85 decibel (db) and most (61%) of these did not and

had never used any form of hearing protection. Hearing loss was found to be bilateral and

symmetrical in both groups. The study concluded that gross occupational exposure to

noise has been demonstrated to cause hearing loss. Thus strategies of noise assessment

and control are introduced which may help improve the work environment.20

A study was carried on hearing parameter in noise-exposed among 130 industrial

workers who were exposed to high level of noise and 33 subjects in control group with

normal hearing. Hearing and acoustic reflex thresholds were obtained from all subjects

and the results from age-matched subgroups were compared. The sensor neural hearing

losses which were detected in 71 workers were bilateral, symmetrical and affected mainly

frequencies of 4–6 kHz. In essence, the hearing losses were developed within the first 10

years of noise exposure and associated with slight progress in the following years. When

acoustic reflex thresholds derived from the study and control groups were compared,

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statistically significant difference was determined only for the thresholds obtained at 4

kHz. 21

6.3 STATEMENT OF PROBLEM

“A study to evaluate the effectiveness of structured teaching programme on knowledge

regarding effects of noise pollution on health among workers in selected iron and steel

industries at Bangalore.’’

6.4 OBJECTIVES OF THE STUDY

The objectives of the study are to:-

 Assess the knowledge of workers working in iron and steel industry regarding

effect of noise pollution on health.

 Prepare a structured teaching programme on effect of noise pollution on health of

workers.

 Evaluate the effectiveness of structured teaching programme on knowledge of

workers regarding effect of noise pollution on health.

 Determine an association between the mean pre-test knowledge score of workers

with selected socio- demographic variables.

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6.5 HYPOTHESIS

 H1 The mean post test knowledge score of workers will be higher than

the mean pre test knowledge score.

 H2 There will be significant association between pre-test knowledge

score of workers and the selected socio-demographic variables.

6.6 OPERTATIONAL DEFINITIONS

 Evaluate :-

It refers to the finding of the value of a structured teaching programme on

knowledge of workers regarding various effect of noise pollution on health.

 Effectiveness:-

It refers to the desired change brought by the structured teaching programme and

measured in terms of knowledge score gained in the post test and graded as adequate,

average and inadequate knowledge.

 Structured teaching programme:-

It is a systematically developed information and teaching aid developed by the

investigator for a selected group of workers to provide information about various

aspects of noise pollution on health.

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 Knowledge : -

Refers to correct responses on item of knowledge received from workers on effect

of noise pollution on health.

 Noise Pollution:-

Refers to displeasing machine sound that disturbs the activity of workers.

 Worker: -

Refers to the workers in age group of 20 to50 years who are working in Iron and

steel industries at Bangalore.

 Iron and Steel industry:-

Working unit involve in manufacturing Iron and steel product by melting process.

6.7 ASSUMPTIONS

The study is based on the following assumption

 Workers may not have adequate knowledge regarding effects of noise pollution on

health.

 Structured teaching programme is an accepted teaching strategy that can enhance

the knowledge of workers regarding effects of noise pollution on health.

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6.8 LIMITATIONS

 The study is limited to some selected workers working in Iron and Steel industries at

Bangalore.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

 Workers working in Iron and Steel industry.

7.2 METHOD OF DATA COLLETION;.

 Research method:- Pre experimental method

 Research design: - One group pre-test, post –test design

 Sampling technique:- Convenience sampling

 Sample size:- 50 workers of Iron and Steel industry

 Setting of the study: - Selected steel industry at Bangalore.

7.2.1 CRITERIA FOR SELECTION OF SAMPLE

INCLUSION CRITERIA

The study includes workers who are:-

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  Willing to participate in this study

 Present at the time of data collection

EXCLUSION CRITERIA

The study excludes workers who are:-

 Not willing to participate in the study.

 Not present at the time of data collection.

7.2.2 DATA COLLECTION TOOL

Data collection tool consisting of demographic performa and a structured

knowledge questionnaire, to assess the knowledge of workers regarding effect of noise

pollution on heath .

Content validity of tool will be ascertained with the help guide and experts in field

of community medicine and nursing. Reliability of tool will be established by split half

method.The tentative period for data collection will be for 6 weeks.

7.2.3 DATA ANALYSIS METHOD

The data will be analyses by using descriptive and inferential statistics.Statistical

analysis such as mean, median, standard deviation and percentage distribution will be

done to describe demographic variables .A “t” test will be done to compare the pre and

post test knowledge scores regarding effect of noise pollution on health .A chi –square

test (X2) will be done to determine association between the knowledge score and selected

demographic variable.

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7.3 DOSE THE STUDY REQUIRES ANY INVESTIGATORE OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR

OTHER HUMANS OR OTHER ANIMALS?

Yes,

Only a structured teaching programme will be given for the sample as

intervention.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?

Yes,

- Ethical clearance will be obtained from research committee of Karnataka

College of Nursing Bangalore-64.

- Confidentially and anonymity of the subjects will be maintained.

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8. LIST OF REFERENCES

1. Tiwari Rajnarayan R. C Mrinalini; Zodpey S.P : Low back pain among textile

Workers; Indian journal of occupational and environmental medicine Vol. 7,

No. 1, January-April 2003.

2. Murli Krishana,R.V.and Murthy, K.P.Vithal:Noise pollution due to traffic in

Vishakhapatanam.Indian Journal of Ecology,10(2):188-193(1983).

3. Parrack,H.O.:Evaluatory Effect of Industrial Noise on Man, Arch. Ind.

Hyg.Occup.Med., 5:415, 1952.

4. Greenburg MI. Hamilton RJ. Philips SD. Occupational industrial and

environmental toxicology, 9th ed. Mosby: New York; Laura De Young, 2000;

356-357.

5. Glorig, A. and Davis,H.: Age, Noise and Hearing loss, Ann.Otol., 70:556, 1961.

6. B.M Minja,N.H Moshi ,Noise induced hearing loss among industrial workers in

dares salaam East African medical journal vol.80,6 ,2003.

7. Sri Harmadji and Heri Kabullah, noise induced hearing loss in steel factory

workers folia medical Indonesiana vol. 171 40, 2004.

8. Maximiliano Ribeiro Guerrab, Paulo Maurício Campanha Lourençoa, Maria

Teresa Bustamante-Teixeirab and Márcio José Martins Alvesb Prevalence of

noise-induced hearing loss in metallurgical company rev, saudia publica 2005 39.

9. Sanja Milkovi -Kraus Noise-induced hearing loss and blood pressure Int Arch

Occup Environ Health (1990) 62:259-260.

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10. Joshi S. Prevention of occupational health hazards in mechanical

industry.Nightingale Nursing times 2006; 91 (10) 24-27.

11. Howard JK, Tyrer FH. Text book of occupational medicine, Churchill

Livingstone Longman group U K Ltd., 1987; 235-236.

12. M Neghab, M Maddahi2 AR Rajaeefard, Hearing Impairment and Hypertension

Associated with Long Term Occupational Exposure to Noise IRCMJ 2009;

11(2):160-165.

13. Gaafar M. Abdel – Rasoul, Omayma AE. Mahrous, Mahmoud E.Abou Salem,

anal A. Al-Batanony and Heba K. Allam, Auditory and Respiratory Health

Disorders Among Workers in an Iron and Steel Factory ., Zagazig Journal of

Occupational Health and Safety Vol. 2 No. 1 June 2009.

14. Uday W, Bhooshan G, and Sushama S.: “Hypertension and hearing impairment in

workers of iron and steel industry”. Indian J Physiol Pharmacol; (2006) 50(1), Pp:

60-6.

15. T Mizoue, T Miyamoto, T Shimizu , Combined effect of smoking and

occupational exposure to noise on hearing loss in steel factory workers, Occup

Environ Med 2003;60:56–59.

16. P.M Rabinowitz, D Galusha, C Dixon-Ernst, M D Slade, M R Cullen, Do ambient

noise exposure levels predict hearing loss in a modern industrial cohort?, Occup

Environ Med 2007;64:53–59.

17. A P Singh, R M Rai, M R Bhatia, and H S Nayar., Effect of Chronic and Acute

exposure to Noise on Physiological Functions in Man, Int Arch Occup Environ

Health (1 982) 50:169-174.

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18. Sangeeta Singhal, Berendra Yadav, S.F. Hashmi, M d. Muzammil.,Effects of

workplace noise on blood pressure and heart rate Biomedical Research 2009; 20

(2): 122-126.

19. Girard SA ,Picard m, Davis, Simard m, larocque r, Multiple work-related

accidents: tracing the role of hearing status and noise exposure. Occup environ

med. 2009 may; 66(5):319-24. Epub 2009.

20. H. O. Ahmed, j. H. Denni, o. Badran§, m. Ismail,s. G. Ballad, a. Ashoor_ and d.

Jerwood occupational noise exposure and hearing loss of workers in two plants in

eastern Saudi arabia,ann. Occup. Hyg. vol. 45, no. 5, pp. 371–380, 2001.

21. Onur C¸ elik, S¸ inasi Yalc¸ın, Ahmet Ozturk Hearing parameters in noise exposed

industrial workers Auris Nasus Larynx 25 (1998) 369–375.

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9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION:

11.1 GUIDE

11.2 SIGNATURE

11.3 HEAD OF THE DEPARTMENT:

11.4 SIGNATURE

12. REMARKS OF THE PRINCIPAL:

12.1 SIGNATURE

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