Objective: To explore the occupational safety and health of fishermen in coastal areas, and the causes and health problems experienced by them.
Method: The systematic review was conducted in February 2021, and comprised search on Google Cendekia, ScienceDirect, ProQuest, PubMed and BioMed Central databases for relevant studies published in English or Indonesian from 2016 to February 2021. The key words used were fisheries, fishermen, occupational, safety and health. The studies identified were assessed using population-intervention-control-outcomes-study framework.
Results: Of the 24,271 studies initially identified, 23(0.09%) were reviewed in detail. Findings showed that fishing accidents occurred every year, causing traumatic injuries. The cause of such accidents had both internal and external factors. Health problems experienced by the fishermen included physical and mental health disorders.
Conclusion: The occupational safety and health of fishermen need to be paid attention to.
Keywords: Global warming, Temperature, Occupational health, Accidental falls, Hunting, Mental health. (JPMA 73: S-182 [Suppl. 2]; 2023)
Occupational safety and health (OSH) is about creating a safe and comfortable work environment by improving and maintaining employees’ physical and spiritual health as well as social condition. It specifically aims at preventing or decreasing incidents and their causes.1 OSH is a right of the employees who work in both formal and informal sectors.2
The International Labour Organization (ILO) in 2013 stated that every 15 seconds, an employee died due to an occupational accident or suffered from occupation-related diseases.3 In 2012, the ILO recorded that the mortality rate due to occupation-related incidents and diseases was around 2 million cases annually, and musculoskeletal disorders (MSDs) increased in many countries.3
A fisherman’s occupation carries significant health risks due to their behaviours, occupational hazards, and unhealthy and unsafe work environment.4 Health problems among fishermen include hypertension, hypothermia and heat stress. Working as a fisherman can cause occupational accidents because the profession has 3D characteristics; Dangerous, Dirty and Difficult.5
According to a study conducted on fishermen in Hative Besar village, the complaints reported by fishermen were back pain and headache due to long stay offshore and insufficient time for taking rest. They could not focus on the job, which triggered from minor accidents, such as slipping to being infected with poisonous fish that can cause death, and to the possibility of a sunken fishing vessel.6
A report by the Census of Fatal Occupational Injuries (CFOI) conducted by the Bureau of Labour Statistics (BLS) mentioned that the risk of occupational accidents in fishermen was 20-30 times higher than other occupations. The main factor is work environment, like most fishing boats being without personal protective equipment (PPE), and low education level which increases the risk because of poor knowledge and questionable attitudes.7
The current systematic review was planned to illustrate OSH level among fishermen, the factors causing occupational incidents, and the health problems suffered by the fishermen.
Materials and Methods
The literature review was conducted in February 2021 and comprised search on Google Cendekia, ScienceDirect, ProQuest, PubMed and BioMed Central (BMC) databases for relevant studies published in English or Indonesian from 2016 to February 2021. The key words used in the search included fisheries, fishermen, occupational, safety, and health. The search was conducted in line with the Preferred reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guideline8, and studies were included or excluded according to the Population-intervention-control-outcomes-study (PICOS) approach8 (Table 1).
Studies were included only if complete text was available in either English or Bahasa Indonesia. Systematic reviews were excluded. The variables of interest were occupational accidents, health problems, factors of occupational accidents, and factors of health problems in fishermen.
The search was conducted by two researchers independently, and data was extracted using the PICOS format.8
Of the 24,271 studies initially identified, 23 (0.09%) were reviewed in Figure.
The review showed that the occupational accidents experienced by the fishermen were slipping/falling, getting cut/punctured, being hit by falling objects, and other incidents, such as having burn injuries/being injured due to explosion or being injured by the boat engines, and the accidents led to fatal and non-fatal injuries.9 Most fishermen suffered from a single injury.10 while others had multiple injuries in such accidents.11 The types of injuries frequently suffered by the fishermen were fractures, minor injuries, upper extremity injuries, sprains, burn injuries, amputations and even intracranial injuries (Table 2).
The occupational accidents were caused by both internal and external factors. High workload, poor concentration and lack of experience were some of the internal factors.10 Fatigue, decreased alertness, lack of skills and knowledge, low awareness of dangers also caused occupational accidents.12 Fishermen were more focussed on financial matters even if they had to take a higher risk of accidents.13 The external factors included broken or insufficient equipment and facilities, improper PPEs, and natural factors.12,13
Fishermen were found to have both physical and mental health problems in addition to occupational hazards. Physical problems included MSDs, skin disorders, allergy, respiratory disorders, hearing loss, fatigue, fever, diarrhoea, hepatitis and cardiovascular diseases.14-17 Mental health problems included work stress, depression, post-traumatic stress disorder (PTSD), anxiety disorder, mental health disorder (MHD), self-harm, suicide attempts, and having abstract thoughts about ending their lives.17,18
The factors causing MSDs were employment period, age, type of occupation, abnormal body mass index (BMI), monotonous jobs and workload.19-22 The skin disorders were due to fungal, bacterial and viral infections as well as because of contact with mud, animals and marine plants.14,23 Some fishermen also experienced fatigue because of lengthy employment period, having pulse rate above the normal range, and sunlight exposure.24 Hearing loss was associated with employment period25. Cardiovascular diseases were significantly caused by sex, employment period, diet and depression.16 Mental health problems were also caused by conflict, poor relationship with co-workers, non-supportive work environment, and having multiple assigned roles on the job.18
Based on the findings, it is clear that occupational accidents still happen on a regular basis, and they need to be controlled so that the fishermen’s productivity level may increase by way of avoiding lost worktime26.
The kinds of occupational accidents experienced by fishermen were falling, slipping, stumbling/tripping, being hit, and being squeezed/pinched27.
Such accidents frequently happen because the fishermen work in slippery and damp surfaces, especially in the area for storing the catch28. A fishing vessel not equipped for the job and fishermen not wearing the correct shoes increase the risk of falling/slipping29.
The types of occupational accidents experienced by fishermen were sprain, minor injuries, bruise, fractures, puncture wounds, lacerated wounds, amputation and even intracranial injury. Upper extremity injuries and fractures were also common. A study mentioned that the fishermen had a higher risk of experiencing occupational accidents compared to office-based employees because 60% of fishermen’s time was used for hard physical labour, leaving them with little time to take rest.30
The factors causing occupational accidents identified in the current review show that fishermen still are not fully aware of the risk of accidents they face while working. Fishermen with poor OSH knowledge have a higher risk than those with good OSH knowledge.2
A study in Tambala village stated that unsafe actions were correlated with occupational accidents.31
Besides occupational accidents, the fishermen also suffered from physical and mental health problems. The physical problems, among other issues, included MSDs, like pain in the head, neck, shoulders, elbows, wrists, back and feet.20 MSDs are often associated with physical labour and uncomfortable postures.32
Another common ailment was skin disorder, and some fishermen had multiple skin disorders at the same time.23 The types of skin disorders included psoriasis, vitiligo, eczema, seborrhoeic dermatitis, lichen amyloidosis, folliculitis, bacterial infection, cutaneous larva migrans, mucocutaneous leishmaniasis, superficial mycoses (tinea), superficial mycoses (candidiasis), actinic keratosis, seborrheic keratosis, and solar melanosis, and fibrous papule (a spot on the nose).33 These skin disorders were frequently suffered by the fishermen because their work environment is wet and exposed to sunlight. The condition of a wet work environment makes the skin dry and potentially damages the dermal membrane, which increases the risk of skin disorders.34
Another common physical health problem was hearing loss, with fishermen having mild (26-40dB), moderate (41-55dB), moderate-severe (56-70dB), severe (71-90dB), and extremely severe (>90dB) hearing loss25. Other than the routine exposure to the noise of the boat engine, some fishermen dived into the sea for a traditional swim who were more likely to have hearing loss because of Inner Ear Decompression Sickness (IEDCS) in which the blood flow that supplies oxygen to the inner ear gets blocked and leads to hearing loss.35
Physical health problems have various causative factors. However, the length of employment period was a critical factor. An employment period is associated with the workers’ exposure duration to the sources of the disease. The longer a worker is exposed to the sources of disease, the risk of suffering from health problems becomes higher.36
Several mental health problems were also identified.17,18 The factors behind such problems were conflicts with co-workers as well as conflicts within. Poor mental health is a possibility if someone does not have good self-adaptation skills or cannot solve a conflict inside or outside of one’s own self.37
The current systematic review has some limitations, like it did not calculate the risk of bias in the studies reviewed. The studies were included only on the basis of PICOS framework, which means there is a possibility that some recent and important findings published in languages other than English and Bahasa Indonesia and published outside the 2016-21 time zone may have been left out.
The OSH levels among fishermen need to be paid attention to because they continue to suffer from occupational accidents owing to both internal and external factors, leading physical and mental health problems.
Limitation: The systematic review was not registered with the international prospective register of systematic reviews (PROSPERO).
Acknowledgement: We are grateful to all authors whose work we have cited in the review. We are also grateful to the Faculty of Public Health, Universitas Indonesia, and the Directorate of Research, Technology and Community Service, Directorate-General of Higher Education, Research and Technology, Ministry of Education, Culture, Research and Technology of the Republic of Indonesia for complete support in conducting the review.
Conflict of Interest: None.
Source of Funding: The Directorate of Research, Technology and Community Service, Directorate-General of Higher Education, Research and Technology, Ministry of Education, Culture, Research and Technology, the Republic of Indonesia.
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