Occupational Dermatoses Disease in Tobacco Farmers in Jember

2017

Tri Martiana, Anita D. P. Sujoso, Firman Suryadi Rahman

Faculty of Public Health, Universitas Airlangga Surabaya, Kampus C Mulyorejo Surabaya, Indonesia

Keyword: Tobacco ; Occupational dermatoses ; farmers

Abstract: Tobacco farmers in Indonesia are the largest number in ASEAN amounted to 527,688 people. From this

number, most of the farmers are in East Java that is amounted to 301,867 people. The purpose of this study

is to analyze the incidence of dermatoses cases due to work on tobacco farmers and the affecting factors.

This research employed the observational technique and it was conducting at the time when the tobacco

farmers were harvesting their plantation product. The population and sample of this research were taken

from one village. 46 people were recruited to be the sample of this research. The variables studied include

independent variables (respondent characteristics and behavioral use of PPE (Personal Protective

Equipment) and personal hygiene) while dependent variables (Occupational dermatoses skin disorder). The

prevalence of OD in a hamlet which is one of the areas for tobacco farming amounted to 13.04%. female

experienced more Occupational dermatoses (16.7%) when compared with men. Tobacco farmers with more

smoking behavior experienced more OD (13.3%). Tobacco farmers who encountered OD and positive

cotinine content were 18.5%. When compared to tobacco farmers who experience OD, the positive cotinine

is 83.3%. The conclusion is that Tobacco Farmers may be exposed to occupational dermatoses. The cause is

because in the process of working they not only plant and pick tobacco leaves but also process the drying

and packing up to the storage. The incidence of OD is related to smoking history, duration of work,

occupational status of cotinine content and use of APD.

1 INTRODUCTION

Tobacco farmers in Indonesia are the largest number

in ASEAN amounted to 527,688 people. From this

number, most of the farmers are in East Java that is

amounted to 301,867 people

. In East Java which

becomes the region for tobacco farmers are Jember,

Probolinggo, Lumajang, Pamekasan. Research on the

health problems of tobacco farmers was often done

by researchers related to the risk of green tobacco

sickness . There has been a lot of research related to

the high levels of urinary cotinine associated with the

use of personal protective equipment, personal

hygiene and long exposure.

The Green Tobacco sickness suffered many

tobacco farmers suffer has been previously proven,

furthermore, it is very important to study other

diseases that can increase the risk of GTS. The

incidence of GTS is caused by the entry of nicotine

from tobacco leaves through peasant skin. Nicotine

from tobacco leaf can enter into the body through the

healthy skin. If the skin is protected by a non-

translucent work suit, the cotinine level can be

prevented. However, if the farmer’s skin has many

lesions or been exposed to dermatoses. This will

increase the level of cotinine in the body. Tobacco

farmers are potentially affected by occupational

dermatoses, this condition will aggravate the GTS

case

The risk of dermatoses due to work is caused in

the work process undertaken by these farmers

ranging from the phase of planting - harvesting -

drying - packing. At each phase, there are risks that

can lead to occupational dermatoses disease. In the

planting phase, the farmers are exposed to fertilizers

and pesticides. Both of these chemicals can cause

acute irritation. In the harvesting phase, there are

mechanical scratches with equipment for harvesting.

Scratches on the skin can cause acute lesions. The

drying and packing phase can also cause acute and

chronic wounds. This condition can be prevented if

these tobacco farmers use personal protective

equipment in the form of rubber gloves. The purpose

of this study is to analyze the incidence of

302

Martiana, T., Sujoso, A. and Rahman, F.

Occupational Der matoses Disease in Tobacco Farmers in Jember 2017.

DOI: 10.5220/0008156203020306

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 302-306

ISBN: 978-989-758-494-7

dermatoses cases due to work on tobacco farmers and

the affecting factors.

2 METHODS

This research was conducted in an observational

manner and implemented at the time these farmers

were harvesting tobacco. Population and sample are

tobacco farmers in the location of 1 village in East

Java. The variables studied include independent

variables (respondent characteristics and behavioral

use of PPE (Personal Protective Equipment) and

personal hygiene) while dependent variables

(Occupational dermatoses skin disorder).

Occupational dermatoses (OD) skin disorder is a

disorder in the form of acute and chronic symptoms.

Symptoms of acute skin disease are characterized by

reddish laions, for symptoms of chronic skin diseases

accompanied by skin eruptions, thickening, and

hyperkeratosis. Data analyzed descriptively using

computer software. The content of cotinine is

measured through laboratory testing.

3 RESULTS

Tobacco farmers are particularly susceptible to

Occupational dermatoses which can be seen directly,

either by GTS or by cotinine levels. The prevalence

of OD in a hamlet which is one of the areas for

tobacco farming amounted to 13.04%. The causal

factor can be physical, mechanical, chemical, and

biological. Physical factor is derived from the heat

of the sun. Furthermore, the cause of mechanical

factor is when the farmers pick and tie these tobacco

leaves to show. The respondents who suffer from

OD will be analyzed in relation to the work, the use

of personal protective equipment and the duration of

exposure and work processes undertaken.

The results of the description of individual

characteristics variable of tobacco farmers can be

seen in the table below.

Table 1: Individual characteristics of tobacco farmers and their relation to Occupational Dermatoses.

No.

Variable

Experiencing Occupational

Dermatoses

Yes No

n (%) n(%)

1. Gender

Male 3 (12) 22 (88)

Female 3 (16.7) 18 (83.3)

2. Smoking History

Yes 4 (13.8) 25 (86.2)

No 2 (11.8) 15 (82.2)

3. Status

Farmer 0 4(100)

Landowner 10 (47.6) 11 (52.4)

Both of them 8 (61.5) 5 (38.5)

4. Working Period

<1 year 0 1 (100)

≥1 year 6 (13.3) 39 (86.7)

Working period

in tobacco

plantation in one

<3 months 1 (14.3) 6 (85.7)

≥3months 5 (12.8) 34 (81.2)

The results of the individual characteristics of

tobacco farmers showed that based on the gender

variable, female experienced more Occupational

dermatoses (16.7%) when compared with men.

Tobacco farmers with more smoking behavior

experienced more OD (13.3%) when compared with

non-smokers. Landowner status also indicates a

difference in the number of farmers who experience

occupational dermatoses. From the data,

61.5%farmers who also own land experience OD.

Occupational Dermatoses Disease in Tobacco Farmers in Jember 2017

303

Among farmers who suffer from OD, farmers who

have worked for more than 3 months in a year have

more proportion than farmers who work only for 3

months. GTS is one of the syndromes that should be

considered in tobacco farmers. Tobacco farmers who

encountered OD and positive cotinine content were

18.5%. When compared to tobacco farmers who

experience OD, the positive cotinine is 83.3%.

One of the preventive efforts for the occurrence

of OD is using PPE. In practice, not all farmers use

PPE. Description of APD usage on tobacco farmers

will be presented in the table below.

The use of long-sleeved shirt against OD can

indicate that farmers who have never used long-

sleeved shirt have the greatest proportion among

other behaviors amounted to 25%. Not using

trousers has the greatest contribution amounted to

22.2% experiencing OD. There are 16.2% of farmers

who do not use an apron and have OD. The use of

raincoats is necessary in case of rain when farming

tobacco. Among people who are affected by OD,

farmers who never used raincoats have a greater

proportion of 83.3%. Gloves are one of the most

important PPDs to prevent OD in the hands which

are the most heavily interacted body part with

tobacco. All farmers who experience OD never use

gloves. There were 18.3 % farmers who do not use

gloves and having OD. The use of the mask is an

attempt to avoid the ingestion of particles from

tobacco to enter the body. Among people who have

OD, 50% never use a mask, whereas farmers who

never use mask will likely suffer OD amounted to

12%.

Images of OD symptoms can be seen in the

figure below.

Table 2: APD use in tobacco farmers and their relation to OD.

No.

Variable

Experiencing Occupational

Dermatoses

Yes No

n(%) n(%)

1. Shirt with Long Sleeves

Never 1 (25) 3 (75)

Sometimes 2 (20) 8 (80)

Always 3 (8.9) 29 (90.1)

2. Trousers

Never 2 (22.2) 7 (77.7)

Sometimes 1 (14.3) 7 (87.5)

Always 3 (10.3) 26 (89.6)

3. Apron

Never 6 (16.2) 31 (83.8)

Sometimes 0 7(100)

Always 0 2(100)

4. Raincoat

Never 5 (14.3) 30 (85.7)

Sometimes 0(0) 9 (100)

Always 1 (50) 1(50)

5. Gloves

Never 6 (18.2) 27 (81.8)

Sometimes 0 (0) 11 (100)

Always 0 (0) 2 (100)

Mask

Never 3 (12) 22 (88)

Sometimes 2 (14.3) 12(85.7)

Always 1 (14.3) 6 (85.7)

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Figure 1: OD symptoms on the hand. These symptoms

generally appear during the harvesting season. In general,

they do not wear gloves when doing the sorting process of

tobacco leaf.

4 DISCUSSION

Female are more prone to experience OD when

compared with men. The results of this study are

consistent with the research results conducted by

Diepgen et.al

and Hon et al

which state that the

prevalence of OD disease is greater and more

common in female than in the male. It also deals

with the immune system and the various functional

differences that exist in a woman's body. The link

between smoking and drinking alcohol behaviors

toward OD occurrence is in accordance with

research conducted by Lee

et al stating that

simultaneous smoking behavior and drinking alcohol

will accelerate and aggravate the incidence of

dermatoses. It is strongly recommended to stop the

behavior of smoking and drinking alcohol. Tobacco

farmers with the status of landowners as well as

workers in their farms have the greatest proportion

of others. This is closely related to the length of time

working on land or tobacco farming. Farmers and

landowners will indirectly spend more time on

tobacco farms comparing to regular farmers

Longer exposure will be a greater risk to experience

. The length of time exposed and the duration of

work will affect the amount of exposure and dose-

response that will be accepted by tobacco farmers.

Meding mentions that the longer the dose of cotinine

received by tobacco farmers the greater the risk.

Thus, increasing the incidence of acute dermatoses

up to chronic. Cotinine can be used to estimate the

amount of toxic tobacco exposure on farmers.

Cotinine may be associated with GTS

. Cotinine

can be absorbed through tobacco leaf and can also

come from nicotine that does biotransform into

cotinine in the body.

It is very important for tobacco farmers to use

PPE when working in the tobacco field. PPE is used

to prevent direct contact between the body and

tobacco either through the skin or inhalation. From

the results of the study, it can be seen that all

farmers who do not use PPD rank most in number

experiencing the Occupational Dermatoses when

compared with tobacco farmers who use PPE. PPE

can prevent tobacco from tobacco plants to make

contact with the body directly. It can also be used to

minimize the amount of contact. PPE can prevent

the emergence of various health problems caused by

tobacco. It is suggested to use PPE and wash the

hands with water after doing any activity on tobacco

farming. This method is very effective to prevent

various health problems related to tobacco farming.

5 CONCLUSION

The conclusion is that Tobacco Farmers may be

exposed to occupational dermatoses. The cause is

because in the process of working they not only

plant and pick tobacco leaves but also process the

drying and packing up to the storage. The incidence

of OD is related to smoking history, duration of

work, occupational status of cotinine content and use

of APD.

The most affected areas of lesions are the palms,

fingers, and knees. The incidence of skin diseases

should be prevented if they use the appropriate

protective equipment.

ACKNOWLEDGEMENT

Special thank you to Faculty of Public Health

Universitas Airlangga

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