Work-time Behavioral Risk Factors among Slaughterhouse Workers in Mina during Hajj, 1427 Hijra

Annually more than two million Muslims congregate in Makkah to perform Hajj. In Mina each Hajjee sacrifices at least one animal, usually a sheep, as one of the essential rituals of Hajj. A huge number of animals are sacrificed within three days (between the 10th to 12th Dhul Hajja) in accordance with Islamic teaching. Performing this kind of work within a few days requires a large number of slaughter house workers.

This descriptive cross-sectional study was conducted in Almuaeisem slaughterhouses in Mina, during Hajj 1427 H. It aimed to identify high risk behaviors of slaughterhouse workers that exposed them to occupational hazards in relation to their demographic characteristics, in addition to estimating the prevalence of skin lesions on their hands. Data was collected by a pre-prepared questionnaire consisting of two parts. The first part was completed through interview with butchers and other workers, inquiring on personal data including age, nationality educational status, work experience, type of function, compensation, hours of daily work, product per hour, type of handled animal and information about cutting or other type of injury during work. The second part was completed by observation of the workers during implementation of their work. Data was collected during the period from 10th to 12th Dhul Hajja, 1427 H.

The study included 300 workers as a representative sample which was selected randomly from five slaughter houses. Their mean age was 35 years (SD ±7 years).

According to type of function, the participating workers were divided into three groups: Group A included 196 (65.3%) butchers who dealt with meat using sharp instruments, Group B included 60 (20%) butchers who dealt with meat without using sharp instruments, and Group C included 44 (14.7%) workers who did not deal with meat and did not use sharp instruments, but were responsible for cleaning the work areas and fed transported animals.

Among the participants 205 (68.3%) were of Syrian nationality, 58 (19.3%) Egyptian, 11 (3.7%) Yemeni, 11 (3.7%) Bangladeshi, 8 (2.7%) Ethiopian and 7 (2.3%) Chadians. Workers who dealt with butchering were Syrians and Egyptians. Syrian butchers dealt exclusively with goats and sheep, while Egyptian butchers dealt with cows and camels.

Regarding education, 6.0% were illiterate, 31.3% Primary School, 43.7% Middle School and 19.0% High School or above. The majority (84.3%) claimed that they had a valid health certificate, but were not available for examination at the time of interview, while 15.3% did not have a valid health certificate. Only 29.3% had been instructed about safety measures before working at these slaughterhouses.

Ninety percent of the workers had been hired internationally and 10% locally; 44.3% were compensated by a lump sum for the whole season, 27.7% on a daily basis and 25.7% were compensated per unit (animal).

Specific dress cover was used by 63%, gloves by 8.3%, masks by 2.3%, head covers by 10.0%, and protective shoes (boots) by 41%.

During the current working season in Mina, 13.0% of the 300 had suffered from a cutting injury. The majority of injured cases (76.3%) had not sought medical care, 19.4% received dressing only, while 5.3% had been stitched with dressing. A higher prevalence of cutting injuries was recorded among butchers from Egypt than those from Syria; 27.6% and 8.8% respectively. The prevalence of cutting injuries among knife users (Group A) was higher than among non-knife users (group B) and non-butcher workers (Group C); 15%, 8.7% and 11.4% respectively. There was no significant association between the prevalence of cutting injuries and type of functional group.

The prevalence of cutting injuries was four times higher among those who were compensated per unit (22.1%) than those compensated by lump sum (5.3%) and one and a half times that among those compensated daily (16.2%). There was a statistically significant association between the prevalence of cutting injuries and type of compensation of butchers (P < 0.001).

The prevalence of cutting injuries was higher among cow handlers (32%) than that among camel (28.1%) and goat handlers (8.1%). There was a significant association between the prevalence of cutting injuries and type of handled animal (P< 0.0001).

When comparing the prevalence of injuries among workers by type of shoe worn, injuries were two times higher among sandal/slipper wearers (21.1%) than among boot wearers (9.8%) and three times more than among normal shoe wearers (6.1%). This difference was statistically significant (P < 0.006). The prevalence of injuries among glove and non-glove wearers was 12% and 13.1% respectively, and the difference was not statistically significant.

On inspection of the hands and forearms of slaughterhouse workers, 19% had old scars, 3.7% open sores, 6.3% dermatitis, 4% warts, 0.3% fungal nail infection and 0.3% blisters. The highest prevalence of skin lesions was observed among butchers of group A; 28.9% old scars, 4.8% open sores, 8.0% dermatitis, 5.9% warts and 0.5% fungal nail infection; In Group B, the prevalence was 4.3% old scars, 1.4% open sores, 2.9% dermatitis and 1.4% blisters; and in Group C, the prevalence was 2.3% open sores, 4.5% dermatitis and 2.3% warts.

Butchers and other meat handlers are prone to high disease transmission from infected animals, mainly as a result of poor safety practices and unhygienic behavior.1'2'3 Even minor cutting injuries can serve as a portal of entry for microbiologic agents, culminating in serious infection to the injured individual.[1,2,3,4]

Despite the heavy workload at Almuaiesem slaughterhouses, compounded by poor safety practices among temporary slaughterhouse workers, the majority of observed injuries were minor. The relative limitation of serious injuries among the butchers is probably due to newly applied safety measures, semi-automated work and other facilities in these slaughterhouses.

Our study attempted to identify the main work-time behavioral risk factors among the current batch of slaughterhouse workers and association of these factors with the occurrence of injuries. Low awareness and poor hygienic practices can explain the occurrence of cutting injuries among non-knife users, and the high prevalence of injuries among cow and camel handlers compared with sheep/goat handlers.

Functional groups of workers were significantly different in acquiring cutting injuries as a result of the type of handled animal, type of shoes used and method of compensation, while there was no difference regarding use or none use of knife and gloves. Other risky behaviors that may cause direct injury or facilitate transmission of infection included placing the knife in the mouth during work, none use of protective shoes, masks, and gloves, in addition to not changing or cleaning of dress cover during the work session. Findings of this study regarding the existence of some types of skin lesions on the hands and forearms of butchers such as skin sepsis, warts and dermatitis are consistent with those of several other studies.[4-6]

Strict demand of pre-employment examination for all slaughter house workers within Saudi Arabia, and arrangement of training sessions on hygienic and safety measures before the beginning of the work season in Mina slaughter houses are recommended. The role of health inspectors for covering all related aspects of supervision should be enhanced, and more coordination between the administrations of slaughter houses in Mina and the Ministry of Health is also required.