Asian Pacific Newsletter3 2005

Asian-Pacific Newsletter
ON OCCUPATIONAL HEALTH AND SAFETY

Volume 12, number 3, November 2005
Occupational health and safety in Asia:

Practical solutions
Asian-Pacific
Newsletter on
Occupational
Health and Safety
Contents
Volume 12, number 3, November 2005

Occupational health and safety in Asia:
Practical solutions
Editorial
Kazutaka Kogi
55
Published by the
Finnish Institute of Occupational Health
Topeliuksenkatu 41 a A
FI-00250 Helsinki, Finland
Challenges in the application of Control Banding

Tools case studies from South India
R Steinberg, J Hannak, K Balakrishnan
56
Guest Editor-in-Chief
Suvi Lehtinen
The practical application in developing countries

Gerry Eijkemans, Berenice Goelzer
60
Capacity Building of Occupational Safety and

Health in Agriculture in Vietnam
Initial results of the project
Vu Nhu Van
63
Ergonomic problems among foundry workers

in China A field survey and simulation study
in the laboratory
Ling Lei, Youxin Liang
65
Participatory work improvement in Thailand

Sudthida Krungkraiwong
68
Prevention and control of silicosis

Experience in agate industry
Lakho J Bhagia, Harasiddh G Sadhu, Habibullah N Saiyed
71
Results of five years implementation of the

National Programme for Elimination of Silicosis
in Vietnam
Nguyen Thi Hong Tu, Tran Thi Ngoc Lan, Tran Anh Thanh
75
Meeting in response to the World Day for Safety

and Health at Work and the 10th International
Noise Awareness Day in Vietnam
Pham Ngoc Hai
79
Guest Editor
Inkeri Haataja
Linguistic Editor
Sheryl Hinkkanen
Layout of the cover pages
Tuula Solasaari-Pekki
The Editorial Board is listed (as of
28 February 2005) on the back page.
This publication enjoys copyright under
Protocol 2 of the Universal Copyright
Convention. Nevertheless, short excerpts of
the articles may be reproduced without
authorization, on condition that the source
is indicated. For rights of reproduction or
translation, application should be made to
the Finnish Institute of Occupational
Health, Office of Information and International Affairs, Topeliuksenkatu 41 a A, FI00250 Helsinki, Finland.
The electronic version of the AsianPacific Newsletter on Occupational Health
and Safety on the Internet can be accessed
at the following address:
http://www.occuphealth.fi/
Asian-PacificNewsletter
The issue 1/2006 of the Asian-Pacific Newsletter deals with health and safety culture.
Photograph on the cover page:
International Labour Organisation/
Cassidy K.
Printed publication:
ISSN 1237-0843
On-line publication:
ISSN 1458-5944
Finnish Institute of Occupational
Health, 2005
The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement
by the International Labour Office, the World Health Organization or the Finnish
Institute of Occupational Health of the opinios expressed in them.
54
Occupational health in Asia:

practical solutions
ractical workplace improvements are the focus of attention in occupational health
throughout Asia. We are increasingly
aware that solving work-related health
problems requires the prompt implementation of locally adjusted improvements. This is especially true in
solving health problems related to the
increasingly complex work environment, work methods and daily stress.
We now know that we can learn
much from many practical types of
improvements achieved by actionoriented programmes that are spreading in many Asian countries.
Examples of practical solutions are
numerous. The use of hand-trucks
and lifters combined with heat barriers, screening of hazardous sources
and machine guards are essential in
reducing health risks of various forms
of materials handling work. Elbow-height workstations with
conveniently located containers and controls allowing natural work postures and smooth teamwork are helpful for preventing musculoskeletal disorders. Similarly, flexible teamwork systems and supportive communication aids are contributing to the reduction of stress-related risks.
Case study results reported from our Asian network partners confirm the usefulness of these practical solutions in
various work settings. For example, experiences in our work
improvement network (www.win-asia.org) cover small enterprises, farms, construction sites, working homes and
processing plants. These experiences show that multiple improvements of practical nature are usually implemented at a
workplace. When these improvements are done by using local materials and skills, they tend to be sustainable. As practical improvements are in most cases readily applicable and
lead to visible benefits, they can encourage local people to
further improve their workplaces in multiple, practical ways.
This is demonstrated in South and Southeast Asia, China,
Korea and Japan.
Three types of support measures that can facilitate the
voluntary use of practical solutions may be mentioned. Such
measures are commonly used by our network partners. They
help people examine practical options and benefits as well as
how to proceed. The three types are (a) presenting many
positive and simple examples of improvements achieved locally; (b) utilizing solution-oriented group work tools, such
as action checklists and low-cost improvement manuals; and
(c) training local trainers who act as facilitators of practical
solutions. It is encouraging that various short-term training courses and

workshops, held in a number of
countries in Asia, apply these measures fully. These efforts were initially
supported by the effective application
of the WISE (Work Improvement in
Small Enterprises) methodology developed by the ILO, and are now
developed into similar action training programmes for manufacturing,
agriculture, construction, and the
informal sector.
It is striking that the group work
steps used in implementing practical
solutions to work-related health risks
correspond with the Plan-Do-CheckAct cycle of occupational safety and
health management systems. Learning positive local examples helps to
plan practical solutions. The use of
action checklists and manuals supports the implementation of risk-reducing practical improvements. Trainers trained in facilitating group work for these
improvements assist local people in continual improvement
while acting on their own positive achievements.
Evidence of the effectiveness of the practical improvements achieved by participatory workplace steps is accumulating. It is clear that accident rates fall, musculoskeletal loads
decrease, environmental risks decline and mental strains diminish as a result of implementing voluntarily chosen practical solutions. Training in practical, low-cost improvements
has real effects.
The exchange of experiences involving the above-mentioned types of support measures will be important for our
future international cooperation. This can surely be linked with
the activities of the ILO and WHO and other international
organizations as well as NGO networks such as the win-asia
net. Communication through websites will be a great help.
Kazutaka Kogi
Advisory Researcher
Institute for Science of Labour
Kawasaki,Japan
E-mail: k.kogi@isl.or.jp
55
Asian-Pacific Newslett on Occup Health and Safety 2005;12:55
Challenges in the application of
Control Banding Tools

case studies from South India
R Steinberg, J Hannak, K Balakrishnan, India
Introduction
Control banding is widely regarded as
a useful tool for the management of
chemical hazards in workplaces, especially in small and medium-sized enterprises (SMEs). During the international planning meeting on control banding in developing countries, held in
Utrecht, the Netherlands, June 1416,
2004 under the aegis of the World
Health Organization (WHO), it was
agreed to further explore the possibilities and limitations of practically applying the control banding approach in
countries such as India. In line with this,
the National Institute of Occupational
Health (NIOH), Ahmedabad, and the
Department for Environmental Health
Engineering at the Sri Ramachandra
Medical College, Chennai, initiated
steps to look specifically into the following three issues:
1. the reliability of control banding in
predicting likely exposure to chemicals, with reference to established
(national) occupational exposure
limits
2. the usability of control banding in
the context of Indian small and medium-sized enterprises, particularly
in terms of identifying and assessing chemical hazards, deciding on
appropriate control measures and
evaluating the impact of measures
and reduction of exposure
3. identification of measures and steps
to facilitate the use of control banding tools by wide strata of industry
in India.
WHOs Task Force 10 seeks to evaluate the usability of some of these tools,
such as the ILO Safework Chemical
Control Toolkit (1), the UK Health and
Safety Executive (HSE) Control of Substances Hazardous to Health Regulations (COSHH) Essentials and the German Gesellschaft fr Technische
Zusammenarbeit (GTZ) Chemical
Management Guide. In emerging econ-
omies like India, although chemical use

is high, the infrastructure for occupational hygiene is grossly underdeveloped. Demonstration of the validity of
alternative risk management tools is
therefore considered to be of tremendous importance for the improvement
of workplace environments.
With regard to the first issue, it was
decided to compare, with the help of
an exploratory study, the results obtained with traditional occupational
hygiene methods against those obtained
with the application of control banding tools in a cross-section of large industries in South India. While the control-banding concept may be equally
applicable to large, medium and small
enterprises, given the paucity of baseline information in SMEs, it was decided to pilot the validation on the situation in large enterprises where a large
dataset dealing with workplace evaluations was readily available to the investigating team.
For the assessment of the usability
of control banding in the context of
Indian small and medium-sized enterprises, selected SMEs were invited to
apply the ILO tool and share their experience and insights. To date, only limited information is available on the applicability and acceptability of such risk
assessment tools in SMEs in India.
In continuation of these efforts, a
technical working group meeting, the
first of its kind to be held in India, was
organized in April 2005 to present and
discuss the results. This meeting involved different stakeholders, such as
chemical manufacturers, formulators,
end-user of chemicals (tanneries, textile
units, etc.) participating in the consultation mechanisms at the national level. The purpose was to arrive at a suitable common course of action to address
the above-mentioned aspects, as well as
to establish a mechanism for continuation of efforts in India.
56
Methods
Validation of tools against
established exposure evaluation
methods
For a period of three years the investigators have been conducting numerous
occupational hygiene studies in the local industry. For the purpose of the validation study, the results from a crosssection of 35 different enterprises representing various industrial sectors (i.e.
the petrochemical, automotive, manufacturing and engineering sectors, tanneries, textile units, pesticide formulators, chemicals, glass and polymer manufacturers) were used as the reference
database.
The underlying exposure evaluations were based on occupational hygiene measurements according to protocols outlined by NIOSH, USA. The
specific contaminants addressed include
common solvents, organic compounds,
asbestos, silica, acids and bases, metal
fumes, and dusts.
The findings and recommendations
of the corresponding evaluation reports
were transferred to a standardized datasheet format. The datasheets listed
such information as a description of the
specific operations (job tasks), the
chemical name (CAS No.), the available risk information (e.g. MSDS, Rphrases), the scale of use and controls
(if any) for the individual tasks.
The data thus compiled were subsequently run through the ILO Toolkit
and the COSHH Essentials. On a selective basis, data were also crosschecked with the GTZ Chemical Management Guide. The respective outcomes from the control band and evaluation studies were compared in terms
of (i) recommended control measures
and (ii) concentration ranges.
Assessment of the usability of

control banding tools in SMEs and
identification of specific challenges
Based on the investigators previous collaboration on occupational safety &
health related issues with different tanneries in the Indian state of Tamil Nadu,
India, eight voluntary tanneries were
selected for field-testing of the control
banding tools (i.e. ILO Toolkit/
COSHH Essentials and the GTZ
Chemical Management Guide). Introductory training on the application of
the tools was given to employers and
technical personnel in these tanneries.
Then the tanneries were requested to
use control banding on their own, to
identify potential hazards in handling
chemicals and to determine adequate
controls.
The conversion of rawhides to finished leather requires a great amount
and a large variety of chemicals. On
average around 500 kg of chemicals are
used for the processing of one ton of
raw material, which in the end will yield
around 250 kg of finished leather. In
India, leather tanning is predominantly carried out in small and medium-sized
companies. The size categorization is
usually done in accordance with the installed production capacities. Accordingly, a small-scale tannery has a daily
production capacity of up to 1 ton of
raw material and employs around 35
workers, with the owners usually taking active part in the day-to-day operations.
During regular meetings between
the investigators and tannery representatives, issues and difficulties arisen during the exercise were listed and discussed
with users of the toolkits. These findings were compared against the findings
obtained in other countries and discussed further in the technical working
group meeting.
Results
Validation of the tools against
established exposure evaluation
methods
With regard to the categorisation of chemical substances in the hazard bands, some
inconsistencies were noted. For example,
a comparison of the hazard band tables
used by the ILO Chemical Toolkit and
the GTZ Chemical Management Guide
revealed that some R-phrases were allocated to different hazard bands.
The ILO Chemical Toolkit was

found to contain an instance of ambiguous allocation of chemicals hazard
properties from the users point of view.
For example, a layperson, for whom the
tools are meant, may have difficulties
in identifying the correct hazard band
for R40, as the ILO Chemical Toolkit
differentiates between R40 Carc. Cat.
3 and R40 Muta. Cat. 3. (Hazard band
D or E).
The R-phrases of certain chemicals
given in the ILO website chemicals information sheets (www.ilo.org) and the
MSDSs of chemical manufacturers do
not match with the R-phrases listed in
the ILO Toolkit (1). This may cause
confusion when determining the hazard group. This was particularly the case
for the following chemical substances:
As per the ILO website/IPCS, the
R-phrases listed for n-butanol specifically include R10 and R20. The ILO
Toolkit does not consider these R-phrases in the table Hazard group allocation
from classification definitions. R10 is
not relevant, as it describes the physical
hazard flammable which is under the
purview of the tool. This issue is not
explained in the preamble of the ILO
Toolkit. With regard to R20, the ILO
Toolkit only lists combined R-phrases
for the respective hazard group allocation. R20 appears as R20/21/22, R40/
20/21/22 and R48/20/21/22. An inexperienced user is not sure how to identify the correct hazard band. In contrast,
the hazard allocation matrix in the GTZ
Chemical Management Guide explicitly differentiates single and combined Rphrases.
In the ILO Safework Chemical Control Toolkit, the preset grouping of common solvents in hazard groups is not
consistent with the given R-phrases
when reference is made to the ILO
chemical information sheets and other
MSDSs. For example, as per Table 1:
Hazard Group, the preset hazard group
for identification of toluene among
common solvents is B. When the given hazard allocation is used, however,
the R-phrase 48/20 leads to hazard
group C.
With regard to the comparability of
recommended controls, comparison
between the target concentrations of
specified hazard bands (2), recommended control approaches, actual exposure
concentrations, occupational exposure
limits (OELs) and controls in place in-
57
dicated that some OELs are higher than

the underlying target concentration
ranges for the different hazard bands
(see Table 1) (3). In some cases, the recommended controls as per the outcome
from the control bands exceed the level
of controls in place. However, the controls in place, which belong to lowerlevel control strategies as per control
band tools, are sufficient to reduce exposure levels below the respective OELs
(see Table 2). When translated to the
SME level, this implies an unnecessary
financial burden for the respective enterprises.
As has been pointed out by studies
done in other countries, the current
scope of chemical and exposure situations actually covered is limited. This
has also been confirmed by the feedback
received from trial applications in
SMEs. Process generated components,
which represent a considerable part of
the exposure situations in the industry
concerned, fall out of the scope of the
control banding tools; harmful fumes
or gases which evolve as a result of mixing of certain chemicals are not covered.
An example is ammoniacal silver
nitrate, which reacts with a reducing
compound used for preparing silvercoated glass. During the process, harmful ammonia vapours are released. The
control banding approach cannot be
applied. The same has been experienced
with copper and zinc fumes, with toluene and xylene vapours generated during different operations, or with H2S,
which is occasionally generated as a byproduct during leather manufacture.
With regard to the example of ammoniacal silver nitrate, the current limitation of practical use for risk assessment has become obvious. Ammoniacal silver nitrate develops explosive properties, which would need to be considered for the purpose of risk assessment.
As the tools focus mainly on inhalation
exposure (as yet not all tools take skin
exposure into consideration), exclusion
of such hazard properties by the control banding tool creates doubts about
practicability among users.
Table 1. Airborne concentration ranges (2)
Hazard band
Range in ppm
A
> 50 to 500
B
> 5 to 50
C
> 0.5 to 5
D
< 0.5
Table 2. Some of the results obtained through application of Control Banding in various industries
Chemical
substance
Process/Operation /
Task
Hazard band
Automotive supplier, brakes manufacturer

Ammonia
Manual dosing of
C
ammonia and printing
of drawing sheets
TCE
Degreasing in open
C&S
tank
Nitric acid
Dipping of material
into bath in plating
shop
Chromic
Auto zinc plating
acid
(Dipping of material
into bath)
HydroZinc barrel plating
chloric
(dipping of material
acid
into bath)
Sodium
Dipping material into
hydroxide
baths (phosphating
line)
Car manufacturer
FormalManual spray painting
dehyde
with air gun
Toluene
Manual spray painting

with air gun
Xylene
with air gun
n-Butanol
with air gun
Cosmetics, household cleaner
Manual dosing during
Sodium
blending operation
hydroxide
Hydrochloric
acid
Ammonia

blending operation

blending operation
Glass/mirror manufacturer
Ammonia* Mirror plant
Xylene
Manual transferring
and dosing xylene in
the paint mixer
Control
approach
Measurement results
[ppm]
STEL
TWA
14
270
190
42
45
TLV
[ppm]
Controls in place
STEL: 35
Engineering control
(LEV) and PPE
STEL:
100
TWA:
50
Engineering controls:
general ventilation,
cooling coil in the
degreasing tank and
PPE
General ventilation
< 0.052
TWA:
0.05
0.00075
TWA:
0.010
PPE and general

ventilation
C&S
< 0.088
Ceiling:
2
PPE and general

ventilation
C
(CMG => B)
0.039
TWA:
0.61
PPE and general

ventilation
C
(D or E; R40,
carcinogenic or
mutagenic?)
STEL:
0.3
PPE and general

ventilation
C&S
0.18
TWA:
50
B&S
1.5
TWA:
100
7.9
TWA:
20
PPE and general

ventilation
PPE and general
ventilation
PPE and general
ventilation
C
(CMG => B)
< 2.017
22
n.a
B&S
(CMG =>
C & S)
C&S
0.1
34
* Ammoniacal silver nitrate reacts with reducing compound and gives off ammonia vapour
TLV: Threshold Limit Value issued by the ACGIH
STEL: Short Term Exposure Limit
TWA: Time Weighted Average
CMG: GTZs Chemical Management Guide
PPE: Personal Protective Equipment
58
< 0.07
Ceiling:
1.22
PPE
Ceiling:
2
PPE
STEL:
35
PPE
11
TWA:
25
Fully automated, local

exhaust ventilation
160
STEL:
150
TWA:
100
Engineering control
(LEV) and PPE
Usability and specific challenges of

control banding tools in SMEs
The applicability of control banding
tools fundamentally rests on the availability of reliable hazard information. As
far as generic chemical substances are
concerned, the participating companies
did not face any problems in accessing
MSDSs. However, a majority of chemical substances used in this sector are in
the form of preparations for which in
many cases the companies could not
obtain the corresponding MSDS or Rphrases.
As pointed out above, problems were
encountered with regard to correct determination of hazard bands. For example, R-phrases listed for toluene include
R 11-38-48/20-63-65-67 as per the
ILO information sheet. This R-phrase
matches partly with the R-phrase given
in the Toolkit. Furthermore, R48/20
did not exist in the enumeration of the
ILO Toolkit. The definition All dusts
and vapours not allocated to another
band was found to be unspecific and
needed a clearer definition.
The chosen bridging examples for
determination of respective quantities
were found to be helpful and appropriate. However, with regard to the quantity ranges given in kg or litres, the users felt that the quantity ranges were too
wide. For example, the use in kg might
refer to anything between 1 and 999
kg, and 1 kg seemed to be closer to 999
mg than 999 kg. The user had difficulties in deciding on the correct use at
different stages. For example: How are
dilution factors taken into consideration? Or: How should one handle situations when chemicals are mixed prior
to actual use? The amount of use was
usually determined by the quantity used
at the point of processing. The users did
not apply a differentiated determination
of quantities at previous steps or tasks
where the same chemical was handled
(e.g. in chemical store, in preparation
or dilution, transport to the dosing
point).
In certain compositions (e.g. paints),
the boiling point was found to be an
inadequate measure for characterizing
volatility. Even slight changes in concentration, i.e. in the range of a few per
cent, can increase or decrease the volatility. In most cases, information with
regard to the concentration of individual components was not available.
The users were not clear about the

term operating temperature. It was
uncertain whether temperature referred
to the substance or the surroundings.
Besides, most users did not have any
provisions in place to determine the actual ambient temperature and relied on
estimates only.
With regard to the general determination of the exposure prediction band,
it is felt that several additional aspects
need to be taken into consideration to
arrive at a high level of reliability and
precision. Such amendments could possibly encompass aspects that are considered in existing risk assessment and
chemical management tools, such as the
Austrian Risk assessment of chemical
agents tool (4) and the German Column Model (embedded in a statutory
guideline [5]). These additional aspects
might include:
Technical setting: Likelihood of exposure due to the workplace and
plant design, processes and equipment)
Organizational issues: Frequency
and duration of exposure, number
of exposed persons, level of personal protective equipment
Personal issues: Training, education,
workload.
In course of further development of
the chemical control toolkit, other hazardous properties such as flammability, explosives, and reactivity should
be also considered.
Representatives of participating
companies were able to use the tools
following a short on-site introduction
to arrive at the general control strategies, but they did not proceed to the
actual implementation of control measures based on the risk assessment. The
users were unclear about the best way
of translating these into situation-specific control measures suitable for the
local conditions. They expressed the
need for external guidance in finding
and implementing controls for any of
the four standard control strategies.
The current control fact sheets under the COSHH Essentials and ILO
pertain to a very few industrial sectors.
The control sheets of the COSHH Essentials take into account European
framework conditions for SMEs. Accessibility to these was limited. It was felt
that sector-specific guidance sheets,
preferably based on good practices,
were required.
59
It was felt that basic understanding

and awareness of chemical exposure
hazard are prerequisites. Implementation would require initial coaching in
starting the process (in line as propagated in the GTZ Chemical Management Guide) by a facilitating structure.
As per the users, the main immediate advantage of applying the tool was
the increased awareness of the need of
inventorying and categorizing the
chemicals in use. When beginning with
the application, the user recognized that
chemical management was helpful for
understanding the companys use of
chemicals. The entrepreneurs started to
assess their handling of chemicals in the
various areas at the same time. Thereby
they identified critical operations using
chemicals and started by developing
inventories with all relevant information
on hazards and operational parameters.
These steps are well in line with GTZs
Chemical Management Guide, which
uses the control band as an element of
an otherwise more comprehensive approach to chemical management.
Conclusion
Hazard communication, in terms of
access to and basic understanding of
hazard information to determine hazard band, is the critical and, at present,
the most limiting factor in the application of the tools. Existing limitations
pertain to (1) availability and access to
relevant hazard information (MSDS,
container labels and markings) and (2)
interpretation of R-phrases. The quality of MSDS (e.g. in terms of correct
and sufficient information content) and
the labelling of containers are inconsistent. The available information as required by law and provided by mostly
large-scale chemical manufacturers does
not reach the end-users given the current structures and practices in the distribution of chemicals.
Furthermore, European suppliers
and their Indian subsidiaries and counterparts mostly use R-phrases. It is recommended the R-phrases or the Global Harmonised System (GHS) standards be incorporated into the Indian
Standards, for easy access to relevant
hazard information. Initial efforts
should focus on ensuring proper labelling of all chemical containers along
with the safety instructions.
To increase the understandability of
MSDS (e.g. retrieval of relevant infor-
mation), the comprehensive MSDS

could be translated into simpler and
user-friendlier safety information for
ready use at the SME level.
Uncertainties regarding quantities
and physicochemical parameters (due to
inadequate hazard identification information) contributed the most to difficulties in establishing exposure bands.
Furthermore, exposures through
conscious skin contact and secondary
exposures to chemical by-products cannot be addressed using the available
tools, although this would be desired by
local users. The approach towards arriving at and selecting the appropriate
control bands is widely understood.
However, it was suggested that the existing control bands be translated as sector specific good practices in order to
make these more widely acceptable.
Most of the control measures and equipment recommended in the ILO/
COSHH fact sheets are not appropriate under prevailing local conditions.
In view of the inconsistencies between tools in defining hazard categories, further investigation needs to examine whether these differences result
in corresponding inconsistencies in the
recommended control strategies/approaches. Considerable external guidance and support is still needed to initiate the application of control banding
in SMEs. The GTZ Chemical Guide
tool offers an interesting perspective in
this direction, by emphasizing the economic benefits during the initial phase
of implementation (6).
There is a need for adaptation and
modifications to make it suitable for
micro-enterprises, small enterprises and
the informal sector. For example, the
limited literacy levels of owners and staff
in these units pose a challenge. The
source of information and communication of these tools needs to be made
simpler for a layman (e.g. use of colour
codes to identify hazard). For this purpose a Training-of-Trainer approach
is preferable.
As per the feedback received from
users, there is a preference for an integrated chemical management approach,
which integrates a simple and practical
control banding instrument, rather than
having a tool exclusively meant for
chemical risk assessment only.
References
1. International Labour Office (Programme on
safety and health at work and the environment
Safework): ILO Chemical Control Toolkit,
Draft Guidelines (http://www.ilo.org/public/
english/protection/safework/ctrl_banding/
toolkit/main_guide.pdf, date of access: 17/04/
05), 15 p.
2. Evans P, Garrod A. COSHH essentials easy
steps to control chemicals. In: The Global Occupational Health Network, GOHNET Newsletter, 2004;(7):56.
3. Tischer M, Brekendiek-Kamper S, Poppek U.
Evaluation of the HSE COSHH Essentials Exposure Predictive Model on the Basis of BAuA
Field Studies and Existing Substance Exposure
Data; Ann Occup Hyg 2003;47(7):55769.
4. AUVA Allgemeinen Unfallversicherungs-anstalt (Austrian Employers Liability Insurance):
Sicherheitsinformation Evaluierung Chemische Arbeitsstoffe (Safety information Risk
assessment of chemical agents); Issued by AUVA
(http://www.auva.at/mediaDB/48851.PDF,
date of access: 17/04/05) 26 p.
5. Technische Regeln fr Gefahrstoffe 440 Ermitteln und Beurteilen der Gefhrdungen durch Gefahrstoffe am Arbeitplatz: Ermitteln von
Gefahrstoffen und Methoden der Ersatzstoffprfung (Technical guidelines for hazardous
chemicals 440 Determining and assessing of
hazards of chemicals in the workplace: Determining of hazardous agents and methods for
evaluation of substitutes); Issued by the German advisory board for hazardous chemicals
(AGS), 28 p., 2002.
6. Chemical Management Guide GTZ, November 2003, Eschborn/Germany.
7. Tischer M, Scholaen S. Chemical Management
and Control Strategies: Experiences from the
GTZ Pilot Project on Chemical Safety in Indonesian Small and Medium-sized Enterprises; Ann Occup Hyg 2003;47(7):5715.
R Steinberg
J Hannak
Kalpana Balakrishnan
Department of Environmental
Health Engineering
Sri Ramachandra Medical College
and Research Institute
(Deemed University)
Porur
Chennai-600116
India
E-mail: kalpanasrmc@vsnl.com
60
Gerry Eijkemans
Berenice Goelzer, WHO
here is scientific and technical

knowledge available today that,
if applied could prevent and control most occupational risk factors. However, on a worldwide basis, healthy
work environments are still the privilege
of a few, as too many workers continue
to be exposed to often very serious
occupational hazards. The general environment continues to be polluted including through large scale disasters.
Even in industrially developed countries, there is a knowledge-application
gap. Prevention fails more often due
to an inability to apply existing knowledge, adapted to specific conditions,
than to an absence of knowledge. The
application of the available knowledge
on hazard prevention and control into
appropriate and effective solutions at the
workplace level must be further promoted. The wide dissemination of such solutions is also essential.
Observations in many countries,
particularly developing countries, reveal
that common constraints to the effective implementation of adequate control strategies include insufficient awareness, education and political will, shortage of adequate human and financial
resources, deficiencies in information/
access to information, and in communication among professionals and institutions, inadequate preventive approaches (including too much reliance
on quantitative evaluations, not enough
source control and too complicated control solutions), as well as failure to involve workers and their representatives
directly in problem-solving processes.
For many years the World Health
Organization has promoted the prevention and control of occupational risk
factors. The Global Strategy on Occupational Health for All recommends a
number of key principles for international and national occupational health
policies, which include the following:
avoidance of hazards (primary prevention)
safe technology
optimization of working conditions
integration of production with health
and safety activities.
The practical application in developing countries

When the Health and Safety Executive (HSE, United Kingdom) developed COSHH Essentials, both the ILO
and WHO decided to promote this tool
internationally. The underlying concept
for the COSHH Essentials has been
called control banding (now renamed
occupational risk management
toolkit). In the past, WHO has developed PACE (prevention and control
exchange), and ILO has developed
WISE (Work Improvement for Small
Enterprises). The experiences learned
from those initiatives were important for
the implementation of the control
banding.
The key objective of the promotion
of the International Chemical Toolkit
is to support countries to focus their
efforts on the control of hazards, instead
of only focusing on the assessment of
the hazards. An International Technical Group (ITG) was established with
representatives from WHO, IPCS, ILO,
IOHA, HSE, NIOSH and GTZ in
2004, and prepared a structure for the
project, aiming at individual work plans
and including twinning of organizations
for mutual support, exchange of information and experiences thus strengthening the activities and avoiding duplication. One important aspect is capacity building and training.
Under the Strategy, a meeting was
organized in Utrecht in June 2004, by
the Occupational Health Team of
WHO, together with the International
Programme for Chemical Safety (IPCS).
The objective of the meeting was to
launch effective action in selected countries, including the elaboration of models and strategies for implementation at
the country level. Representatives of
(upcoming) WHO Collaborating Centres in four countries participated; from
their experience, it was expected that the
project will be expanded to include
many more countries. International collaboration can appreciably strengthen
national capabilities for the prevention
and control of health hazards in the
work environment, thus contributing to
the protection of workers health and
of the environment, worldwide. Shar-
ing of knowledge and experiences will

also contribute to avoid duplication of
efforts and waste of valuable resources.
The specific objectives of this meeting were:
To plan pilot projects for the implementation of the chemical safety
toolkit and occupational hygiene in
four countries (Benin, Brazil, India,
South Africa)
To develop effective twinning strategies with the implementing agencies
in the four pilot countries
To plan the training activities on the
chemical safety toolkit in the four selected countries
To develop a network of experts that
will support the implementation of
the project in the selected countries.
Participants were from Benin (Universit dAbomey Calavi, Unit
dEnseignement et de Recherche en
Sant au Travail et Environnement),
Brazil (Fundacentro), India (National
Institute of Occupational Health,
Ahmedabad and Department of Environmental Health Engineering, Sri
Ramachandra Medical College and Research institute, Chennai), South Africa (National Centre for Occupational
Health, Industrial Health Research
Group and Occupational & Environmental Health, Faculty of Health Sciences, University of Cape Town), Belgium (Universit Catholique de Louvain), the Netherlands (TNO), Switzerland (Institut Universitaire Romand de
Sant au Travail (IST, Lausanne), Service Cantonal de Toxicologie Industrielle
et de Protection contre les Pollutions
Interieures, Geneva), the United Kingdom (HSE), and the United States of
America (NIOSH). Participants worked
together for three days to work towards
the development of strategies for effective intervention. Representatives of
WHO, IOHA and UNITAR were also
present.
During the first day of the meeting
the concepts of Control Banding, the
International Chemical Toolkit, the
GTZ Chemical Management Toolkit
and other similar tools were presented
and discussed. The next days were spent
61
on the development of pilot projects in

the four countries, taking into account
their specific needs, capacities, legislation, culture and other relevant aspects.
The pilot projects that were developed included the following phases:
plan, implement, evaluate and improve.
The pilot project also included awareness raising, training, and development
or adaptation of practical and effective
preventive solutions for specific jobs. It
was discussed that this could be enhanced by a Database of Control Solutions and Mechanisms for continued exchange of experiences and information.
In each country, an intermediary was
identified. This would be the organization or institution that receives the
training (train-the-trainers) and will
support the selected workplaces in the
implementation of the project. These
could be national institutes, local/national governments, universities, nongovernmental organizations (NGOs) or
other relevant stakeholders.
Main outcomes and

conclusions of the meeting
There was a general consensus (coming
from earlier discussions internationally) that the title of the methodology had
to be changed for a number of reasons.
The title Control Banding is adequate
for the method initially designed by the
HSE and transformed into the International Chemical Toolkit, for chemicals that are used, either in the liquid or
powder form. However, the principle of
acting (whenever appropriate) without,
or before, carrying out quantitative evaluations opens wider possibilities that
should not be overlooked and which do
not exactly fit into the banding terminology. This is the case when specific guidance is given for specific risk factors, e.g.., silica. For example, the HSE
has developed much control guidance
to avoid exposure to airborne dust containing silica; this is called Silica Essentials. It is possible and desirable to
expand the concept to other hazards and
also to specific operations. Moreover,
the translation of the term Control
Banding into other languages has
posed some problems. For these reasons,

a broader title to indicate the use of this
concept has been sought and the decision was to name it Occupational Risk
Management Toolbox. To avoid initial
misunderstandings, the term Occupational Risk Management Toolbox will
be accompanied by Control Banding,
in brackets. The Toolbox will contain a
set of Toolkits (for example: ergonomics, noise, working conditions) that will
be developed over time.
Country projects
The participants divided into four subgroups, one for each represented country. The objective was to develop an action plan for each country, after brainstorming on the following basic questions:
What is needed for control banding
to be useful in developing countries?
Which tool to use?
What is needed to implement it?
How to reach the established targets?
How to achieve sustainability?
Four pilot projects were developed.
Each country made effective use of the
available resources, twinning institutions and experts. For the detailed pilot
projects please refer to the WHO Website, where the full report of the meeting will be posted (www.who.int/oeh).
Benin focused the pilot effort on the
agricultural sector (cotton). The GTZ
Chemical toolkit was selected as the first
choice instrument for this intervention,
since there is guidance available on pesticides.
Brazil decided to focus the effort on
small and medium enterprises (SMEs)
that use chemicals, for example, furniture and shoe manufacturing and paint
recycling.
India proposed the development of
three pilot projects for medium to large
enterprises in Western India, medium
to large enterprises in Southern India,
and a small enterprise test project (exploring the relations with ILOs International Programme on the Elimination
of Child Labour).
South Africa decided to link the pilot project with the newly adopted (June
04) National Programme for the elimination of silicosis, focusing on quarries
and foundries.
Some of the initial draft proposals,
which were prepared during the meeting, would form the basis for more detailed projects.
Supporting activities
It was considered by all participants that
education and training are of fundamental importance, as well as other aspects of capacity building such as facilities, equipment and access to information. It was also concluded that the impossibility of carrying out quantitative
exposure assessment should never be a
blockage to the implementation of obviously required control measures. Although exposure assessment is necessary
in many cases, there are situations when
much can be achieved without it. This
does not mean that exposure assessment
is not important.
A database containing control solutions for specific operations would be
desirable. HSE, NIOSH and other institutions already have a sizeable collection of tested controls. An inventory of
existing solutions should be elaborated,
as well as guidance for its application,
which may require adaptation (as some
measures may not be feasible in all situations). It is necessary to develop solutions which are adequate for SMEs.
Solutions designed or adapted for use
in developing countries should also be
part of this database. It should be kept
in mind how important it is to search
for source control solutions, including
substitution, modification, and work
practices. It should also be pointed out
that, particularly concerning inhalation
hazards, personal protective equipment
should be regarded as a last resort.
It was considered important to create an interactive, annually updated
CD-ROM of the International Chemical Toolkit. This has now been produced
by HSE and ILO.
Progress made so far

In Brazil, Fundacentro has translated an
important part of the toolkit, and is
implementing it in small enterprises
with several partners. In South Africa,
the National Programme on the Elimination of Silicosis has been established
under the leadership of the Ministry of
Labour, and the feasibility of the use of
the silica essentials is being evaluated.
A first report has been presented by the
NIOH for this purpose. In Benin, the
feasibility of applying in agriculture is
being studied. In this issue the results
of the pilot testing in India are presented. Additionally, the international
toolkit is being evaluated in Singapore
by the Ministry of Manpower.
62
Conclusions and the way

forward
The usefulness of the toolkit for industrially developed countries has been effectively demonstrated in Europe, particularly in the UK. The use in developing countries will, however, be very
different, with particular issues that have
to be addressed, such as political will,
scarce resources, language, just to mention a few.
The development of the pilot
projects is a first step on the long way
towards effective implementation of
control strategies at a large scale in the
South. They will permit to identify issues related to sustainability, bottlenecks, critical factors for success and the
need for additional research and resources (materials, databases, translation, etc.). The (political) commitment
of all participants, and the quality of the
pilot projects developed, indicate that
there is a good possibility for success.
Support for those, and similar initiatives
in other countries will be needed.
For further information please contact

Dr. Gerry Eijkemans at the World
Health Organization.
Websites for further information:
www.coshh-essentials.org.uk
www.ilo.org/public/english/protection/
safework/ctrl_banding/ index.htm
www.unece.org/trans/danger/publi/ghs/
ghs.htm
http://www.who.int/occupational_
health/publications/newsletter/
gohnet7e.pdf
Gerry Eijkemans
Berenice Goelzer
Occupational Health
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
Switzerland
E-mail: eijkemansg@who.int
Capacity Building of Occupational Safety

and Health in Agriculture in Vietnam
Initial results of the project
Vu Nhu Van, Vietnam
Risks of occupational
accidents and diseases in
agricultural production
Agriculture plays an important role in
socio-economic development in Vietnam. 57.9% of the labour force was
engaged in agricultural production in
2004. Farmers are exposed every day to
many safety and health hazards related
to agricultural work, such as sunstroke,
awkward posture, exposure to pesticides, unsafe use of electricity and machines, that increase the risk of occupational accidents. Statistics show that on
average, the proportion of accidents
caused by electricity to one thousand
workers in agriculture is 7.9, and the
respective figure for accidents caused by
machines and equipment in agriculture
is 8.6 (MOLISA, internal report on
occupational safety and health in 2004);
on average, more than 30% of poisoning cases are caused by pesticides and
chemicals; 76% of direct sprayers of
pesticides suffer from vertigo, 69.7% of
them have symptoms of headache, and
36.6% have symptoms of rash. These
threaten labourers safety and health,
and probably push them into poverty
and debt. Modernization of agriculture
and increases in productivity and output are necessary to reduce poverty and
raise living standards among farmers. It
is therefore urgent to take feasible measures to safeguard labourers from accidents and diseases.
The project
The project Capacity Building of Occupational Safety and Health in Agriculture in Vietnam (RAS/04/M01/
JPN) funded by the Government of
Japan was launched in May 2004. It is
implemented on the basis of tripartite
cooperation in which the Ministry of
Labour, Invalids and Social Affairs
(MOLISA) functions as the Governments representative agency while the

Ministry of Health, Ministry of Agriculture and Rural Development, Vietnam Cooperative Alliance (representative of employers), the Vietnam Farmers Association (representative of farmers as employees), the Vietnam Women
Association and relevant agencies and
organizations involved in this project act
as collaborative agencies. The International Labour Organisation is the
projects executing agency and provides
general technical support. The project,
which has been implemented in four
selected provinces Ha Nam, Nghe An,
Can Tho and Hau Giang aims to accelerate practical activities that will improve working conditions and ensure
occupational safety and health in agriculture in Vietnam, by means of policy
assistance at the national level and initiative promotion at the grassroots level. It also supports preparations towards
ratifying the ILOs Convention No. 184
on occupational safety and health
(OSH) in agriculture.
The project is driven by three immediate objectives: (1) at the end of the
project, national policy and legislative
frameworks will have been strengthened
to support farmers initiative in improving safety, health and working conditions; (2) sustainable support mechanisms to the self-help initiative of local
farmers in improving safety, health and
working conditions will have been established; and (3) at the end of the
project, local farmers in the project
provinces will have the capacities for
continuous improvement of safety,
health and working conditions in agriculture.
After one year of operation, the initial results gained show that the projects
major objectives have been addressed
seriously and realized effectively.
63
Activities of the project

Development of national policy and legislative frameworks to support farmers
initiative in improving safety, health and
working conditions is one of the three
major objectives of the project. In realizing this objective, the MOLISA has
developed the National Program on
Labour Protection and has made the
draft version available for discussion at
national and international workshops,
such as the workshop Development of
the national OSH programme held in
Ha Long, Quang Ninh in March 2005
and attended by representatives of
ASEAN countries.
A taskforce for developing the national profile of OSH has been set up.
It includes 21 members from 18 functional and relevant agencies and organizations. Fundamental information
from the national profile has been used
to develop the national programme on
labour protection. Members of the National Council for Labour Protection
will be consulted about the draft version before its submission to the Government for approval by the end of
2005.
A set of training materials on OSH
in agriculture has been completed during the implementation of the project.
Among the training material produced
are: (1) training material on OSH in
agriculture (WIND program); (2) a set
of photo books on OSH in agriculture
and manuals for implementing activities as well as for supervising and reporting the improvements made. The set of
materials focuses on action-oriented
training methods, the aim being to
guide farmers as they make improvements in OSH and working conditions.
The training material on OSH in
agriculture (the WIND programme)
consists of an action checklist and five
technical topics on: (1) materials stor-
Photo by Vu Nhu Van
age and handling; (2) safety in the use

of electricity and agro-mechanical machines; (3) appropriate arrangement of
workplaces; (4) the work environment
and safe use of chemicals; and (5) welfare facilities. This manual provides not
only fundamental knowledge of OSH
in agriculture but also introduces pictures of typical improvements and practical measures for improving working
and living conditions with the materials and capacity available to farmers and
at low cost.
The set of photo books on OSH in
agriculture was compiled from hundreds
of pictures of local typical improvements
made after training courses. Thousands
of flyers, leaflets and posters about the
programme on OSH in agriculture and
on improving farmers working conditions have also been disseminated to
farmers. These materials are effective
support tools for agricultural labourers
training.
Beside activities at national level,
activities at grassroots level have also
been actively implemented by the
project support committees in the selected provinces. The provincial project
support committees have organized
eight pilot training courses on the
WIND programme, attended by 244
farmer trainees. After these courses,
farmers have made 275 improvements,
58 of which dealt with agro-product
storage and handling, 16 with safety in
the use of electricity and agro machines,
76 with appropriate arrangement of
workplaces, 50 with the work environment and safe use of chemicals and 75
dealt with welfare facilities.
The improvements were initiated by
simple actions that are easy to do. The
initial actions involve the making of
multi-level shelves for storing agroproducts, materials and tools. Actions
gradually shift to improvements in

working conditions, and subsequently
to the prevention of occupational accidents and diseases by means of guarding moving parts of machines and
equipment and to storage and safe use
of chemicals.
Following the training courses on
OSH in agriculture, workshops reviewing the results of the improvement that
were introduced were held in April 2005
in the selected provinces. Each workshop was attended by 50 representatives
of agencies in the provinces, districts
and communes. Some farmers who had
carried out typical improvements were
invited to the workshops to present their
improvements.
The initial results have been, and
will keep on being, disseminated to other farmers in order to improve working
conditions and ensure occupational
safety and health in agriculture. The
pilot training courses for farmers have
proved the practical impacts of the
project. However, because the need to
provide training for farmers is so great,
it is necessary to organize training courses given by farmer volunteers. For this
reason, a training of trainer course for
Photo by Vu Nhu Van
64
farmer volunteers was held in Nghe An

on 815 June 2005, after which provincial project support committees were
set up to organize other courses for
farmer volunteers in their localities.
Activities to be
implemented
In 2005, each of the selected provinces
will hold four training courses, each
with 20 farmer volunteers. Farmer volunteers will be trained in how to provide training in the mini-WIND method for other farmers living in their area.
They will also be given the necessary
materials (the WIND training material, book of photos on OSH in agriculture, a notebook of improvements, a bag
and hat, etc.).
One important point is to select
appropriate volunteers, who are able to
help the local authorities and the provincial project support committees to
disseminate knowledge of OSH in agriculture directly to other farmers and
who are able to support these farmers
carry out improvements. Around 240
mini-WIND courses are planned to be
held by volunteers in the selected provinces in 2005. In the coming years, the
network of farmer volunteers will be
expanded.
The initial results of the project are
also good examples. They provide valuable experience and useful information
for OSH performance in agriculture in
Vietnam.
Vu Nhu Van
Deputy Director-General
Bureau for Safe Work
Ministry of Labour, Invalids and
Social Affairs, No. 12 Ngo Quyen
Hanoi, Vietnam
E-mail: bsw@molisa.gov.vn
Ergonomic problems among

foundry workers in China
A field survey and simulation study in the laboratory
Ling Lei, Youxin Liang, P.R. China
Introduction
China is undergoing a unique transitional period of economic reform which
is bringing about tremendous changes
in both production technology and the
organization of labour, for which reasons we may face a variety of emerging
challenges with respect to occupational
health and safety. With stringent control of chemical and physical hazards
since the Occupational Diseases Prevention and Control Act, (the ODPC Act),
PR China, was passed, work-related
musculoskeletal disorders have gradually become one of the most predominant problems in occupational health.
There is an urgent need for more efforts devoted: i) to ergonomic issues,
particularly in modern industries with
a better work environment but a lack
of proper work station design and adequate organization of labour; and ii) to
small-scale industries where the physical workload is heavy and work posture
is awkward.
As is the case with efforts to control
other occupational health hazards, the
recognition of ergonomic problems is
the precursory step towards an optimal
approach to control that includes assessment of risk factors and health monitoring, the aim being to provide an evidence base for further ergonomic intervention. This article presents a case
study conducted among foundry workers, field surveys, and a simulation experiment carried out in a laboratory; all
efforts that were made in order to gain
a better understanding of the possible
mechanisms of the problem.
Foundry work process has long been
regarded as a highly hazardous occupa-
tion. It is characterized by heavy exposure to both chemical and physical hazards as well as ergonomic loading. Although profound change has occurred
in foundry technology and in the materials used, the basic process and potential hazards remain much the same
in many foundries. In fact, metal casting is still a labour-intensive and complex process requiring significant
amounts of repetitive manipulation and
stressful physical and postural loads, and
thus is associated with work safety problems, including musculoskeletal disorders caused by manual materials handling and acute injuries caused, among
others, by falling or moving objects.
However, in the past, many more efforts
were focused on the adverse health effects resulting from exposure to chemical risk factors; few studies have been
Sand
preparation
done to assess and seek solutions to ergonomic problems in China.
A general description of the

foundry work processes
As shown in Figure 1, three major tasks
make up the foundry process: moulding; cleaning; and turning. The production of the cast starts from moulding
and includes sand preparation, coremaking, moulding, pouring and shaking out; then cleaners removed the excess metal from the cast and polish; afterwards, the cast is further processed
by turners, yielding the final article. The
study population was recruited from
workers who were working directly for
the foundry. The miscellaneous group,
including electricians, mechanicians,
administrative personnel and cooks,
served as controls for the study.
M olding
Core making
Melting
Alloying
Mold pouring & cooling
Shakeout
Charge
preparation
Cleaning
Polishing
Figure 1.The foundry work process
65
Fini shed
Casting
Lathe
operating
Products
Field survey
Prevalence of musculoskeletal
disorders
Well-trained interviewers used questionnaires to interview 617 foundry
workers, who also received a physical
examination by an orthopedist. It
showed that the highest prevalence of
pain occurred in the lower back
(29.2%), followed by shoulder pain
(10.5%), but there was no significant
difference among four groups. The
positive rate of backache (16.9%)
among moulders was significantly higher than among others; and was followed
by cleaners (9.5%).
However, when work-related musculoskeletal disorders were defined as pain

that had started in the current work and
had lasted for more than one week without a history of injury in that body part
(1), the prevalence of musculoskeletal
disorders differed significantly among
various groups. The prevalence of workrelated low back pain among moulders
and cleaners was 29.9% and 26.2%, respectively; this was significantly higher
than that among turners (15.4%) and
the miscellaneous group (14.4%).
Work system analysis

The ergonomic workplace analysis (2)
and the Ovako Working-posture Analyzing System (OWAS) (3) were used to
Figure 3. Lathe operation
Figure 4. Moulding
Figure 5. Pouring
Photos by School of Public Health, Fudan University
Figure 2. Cleaning and polishing
assess the risk factors inducing musculoskeletal disorders. Awkward work postures and movements, and heavy noise
exposure were found to be common in
foundry work (see Figures 25). For
examples, 1) Lathe operators worked in
a standing posture, bending forward
slightly (61.7%) and with repetitive
motions of the arms for the entire work
shift. 2) Cleaners almost always worked
with the back bent (87.2%) and had
hand exposure to vibration. 3) Moulders also frequently carried out manual
materials handling activities, including
shovelling (17.4%), pressing (15.9%),
lifting (8.8%) and carrying (10.2%) in
addition to the posture with the back
bent.
66
The activities of trunk muscles the

erector spinae, rectus abdominis and
external oblique muscles on both sides
were recorded and analysed during five
moulding work cycles. A Noraxon Telemyo 8-Channel System of Surface Electromyography (sEMG) was used for this
purpose (see Figure 6). It was found that
the erector spinae muscles had the highest averaged sEMG values for all the
trunk muscles, with over 20% of the
maximum voluntary contraction
(MVC), and up to 50% of the MVC
for some motions, which reached about
420 times that of the static postures.
By contrast, the averaged sEMG value
for the rectus abdominis muscles was
less than 10% of the MVC. Unsymmetrical sEMG accounted for 60% of the
working time, the average difference in
sEMG values between the two sides of
the body reached 5 times, while the
greatest difference between the two sides
was 100 times. Further analysis also
showed that lifting, carrying and tamping produced high sEMG signals and
shovelling caused asymmetric signals. It
was concluded that imbalanced trunk
muscle activities and overstrain due to
asymmetric motions of the body sides
might be the main reasons for back injuries among moulders.
Simulation study at the

laboratory
In simulation of moulding work, ten
healthy volunteers were asked to perform 100 repeated lifts, at a pace of 8
times/min, within a span of 12.5 minutes. The interval between two lifts was
7500 ms; the object weighed 100N and
was 493922cm3 in size. The sEMGs
of the erect spinae muscles were recorded during repeated lifts and two maximum voluntary contractions (MVC)
before and after lifting in order to analyse amplitude and frequency. Compared against the values measured before repeated lifts, the median frequency intercept was significantly decreased
among 80% of the subjects; it averaged
11.60 Hz (14.58%) on the left side and
9.52 Hz (12.65%) on the right side of
the erector spinae muscle. Spectrum
power analysis showed that the central
frequency shifted to the left. The repetitive lifting imitating the moulding task
was able to induce fatigue of the erec-
Photo by School of Public Health, Fudan University
Surface Electromyography
Measurements
Figure 6. Surface electromyography testing for moulding work
tor spinae muscle, which might be the

mechanical basis for chronic back injury among moulders.
Recommended ergonomic
interventions
The moulding process was one of the
most harmful jobs with regard to low
back injury; the main risk factor was
lifting. Both repetitiveness and ergonomically poor performance of lifting
could pose the risk of inducing low back
injury. Ergonomic intervention was
therefore recommended:
Health surveillance. Employers are required to examine workers for symptoms of musculoskeletal disorders periodically. Those workers suffering from
severe low back pain are then transferred
from their original jobs or referred to
seek medical treatment.
Development of production technology.
Employers are required to improve automation and to minimize the component of manual materials handling, especially lifting.
Improvement of work loading and
posture. A work platform of appropriate height is needed for cleaners to prevent their working in bent postures. For
moulding workers, the tasks involving
lifting should be improved; good handles are needed in order to decrease the
load of lifting and to shorten the distance of carrying.
Organization and schedule optimization of work. Technology training
should be conducted among employees in order to minimize the risks caused
by inadequate work performance. In
67
addition, the work breaks should be

longer, with proper relaxing physical exercises.
Personal protective equipment. The
personal protective equipment is needed to prevent workers exposure to noise
and vibration as well as to prevent injuries at work.
Dissemination of ergonomic knowledge.
Workers should be empowered by providing them with basic knowledge and
skills in ergonomics. This would improve their work style and work postures, thus contributing to self-prevention of musculoskeletal disorders, local
fatigue, and work injury.
References
1. Bernard B, Sauter S, Fine L, Petersen M, Hales
T. Job task and psychosocial risk factors for
work-related musculoskeletal disorders among
newspaper employees. Scand J Work Environ
Health 1994;20:41726.
2. Ahonen M, Launis M, Kuorinka T. Ergonomic
Workplace Analysis. Helsinki: The Finnish Institute of Occupational Health, 1989:130.
3. Louhevaara V, Suurnkki T. OWAS: a method
for the evaluation of postural load during work.
Training Publication II. Helsinki: Finnish Institute of Occupational Health, 1992.
Dr. Ling Lei, Associate Professor

Prof. Youxin Liang
Department of Occupational
Health, Fudan University School of
Public Health
138 Yi Xue Yuan Road
Shanghai 200032, P.R. China
E-mail: llei@shmu.edu.cn
E-mail: yxliang@shmu.edu.cn
Participatory work
improvement in Thailand
Sudthida Krungkraiwong, Thailand
Introduction
During the past decade, occupational
safety and health (OSH) conditions in
Thailand were seen as unsatisfactory
even though the rate of occupational
injuries (occupational accidents and diseases) showed a somewhat decreasing
trend. According to the Workmens
Compensation Fund, in 1992, there
were 131,800 cases of occupational injuries; the rate of occupational injuries
per 1,000 workers was 43.7 for all cases, 17.6 when excluding cases that led
to sick leave lasting 3 days or less. In
2003, a total of 210,673 cases of occupational injuries occurred, and the rate
of occupational injuries per 1,000 workers was 29.9 for all cases, 8.1 when excluding cases that led to sick leave lasting 3 days or less.
Participatory work
improvement: occupational
injuries
The Department of Labour Protection
and Welfare has conducted various activities to improve working conditions
and the environment at workplaces in
order to reduce the rate of occupational injuries. One famous and very powerful activity is the participatory approach by using the Work Improvement
in Small Enterprises, or WISE Technique. The WISE approach was developed by the ILO and is implemented
in many industrializing countries, with
support from the ILO. The WISE
methodology has proved to be effective
in improving working conditions and
productivity at many workplaces. In
many countries it has also been proved
that participatory training courses and
advisory labour systems can play vital
roles in mobilizing managers and workers to take self-help actions in order to
improve working conditions, the work
environment and productivity.
National Institute for the Improvement of Working Conditions and En-
Table 1. Occupational injuries in Thailand 19922003

Year
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Workers under
the Workmens
Compensation
Fund (N)
3,020,415
3,355,805
4,248,414
4,903,736
5,425,422
5,825,821
5,145,830
5,321,872
5,417,041
5,544,436
6,541,105
7,033,907
Occupational Occ. injuries rate/1,000 Workers

injuries
All
Cases involving
Cases
3 days of sick
leave excluded
131,800
43.7
17.6
156,548
46.7
17.7
186,053
43.8
15.7
216,335
44.1
15.1
245,616
45.3
15.6
230,376
39.5
12.8
186,498
36.2
11.7
171,997
32.3
10.2
179,566
33.2
9.7
189,621
34.2
9.4
190,979
29.2
8.1
210,673
29.9
8.1
Table 2. Number of occupational accidents occurring in 19951997 at six metal

pressing factories
Enterprises
Workers
(N)
115
24
54
15
20
28
Factory A
Factory B
Factory C
Factory D
Factory E
Factory F
vironment (NICE) first started to apply the WISE approach in Thailand in

1986, where it was used for the owners,
managers and supervisors in small and
medium-sized enterprises located in
Bangkok and the provinces. In 1996,
NICE launched a WISE methodology
project for enterprises with a high
number of occupational injuries. We
found that enterprises participating in
the project were able to improve their
working conditions and the work environment, and especially were able to
reduce the number of occupational accidents. (See Table 2)
68
Occupational accidents (N)

1995
1996
1997
32
13
10
22
3
1
15
3
2
11
3
0
4
3
2
3
0
0
Participatory work
improvement: hot work
environments
We also applied the WISE approach at
enterprises where the work environment
was problematic; for example, at a lamp
manufacturer where environmental heat
posed the possible problem of heat stress
to workers. On the basis of the WISE
checklist and brain-storming, it was
suggested that the working group place
a shield between the furnace and the
workers. Using a wet bulb globe thermometer we measured the environmen-
Figure 1. A worker in front of the furnace
Figure 2. Environmental measurement with a shield in place
Effect of the shield

N with S
N without S
Mid with S
Mid without S
WBGT
GT
Far with S
DB
WB
Far without S
0
10
15
20
25
30
35
40
45
Figure 3. Environmental measurement indicating the effect of the shield
tal temperature and the temperate at

three distances from the furnace: near
= less than 101 cm, intermediate = 101
250 cm and far = more than 250 cm.
We found that if a shield was in place,
the temperature for the distance in question was lower than that measured for
the same distance without a shield. In
particular, the globe temperatures for
the same distances, were the highest

temperatures among each group.
From the ISO 7243 - 1982: Hot
Environments - Estimation of the Heat
Stress on Working Man, Based on the
WBGT Index, we found that the simple improvement of setting up a shield
can increase the duration of working
time (Table 3).
Table 3. Result of applying a work/rest regimen (each hour) before the improvement
(without a shield) and after the improvement (with a shield)
Distance from the furnace
Near = less than 101 cm
Intermediate = 101250 cm
Far = more than 250 cm
Work / rest regiment (each hour)

Without a shield
With a shield
0
50 / 50
25 / 75
75 / 25
25 / 75
75 / 25
69
Participatory work
improvement:
musculoskeletal disorders
NICE is also conducting the DREAM
(Durable Risk-reduction Emphasised
Activity to prevent Musculoskeletal
problems at work) Project, which is a
participatory approach aiming to improve working conditions and work
environment at enterprises whose workers have problems with musculoskeletal disorders. We use ISO/TS 20646
Ergonomics procedures for the improvement of local muscular workloads
as our guideline. We found that many
workplaces can improve their working
conditions and work environment in
order to reduce workers muscular workloads. In the polishing process, for example, workers have to sit and bend
Figure 4. Before the improvement, polishing process workers sat without a backrest
and footrest could not be adjusted.
their bodies forward to polish materials. Their seats were without backrest
and footrest could not be adjusted.
After a group discussion, it was decided to improve the seats by having
chairs with backrests and by having adjustable footrests. A survey conducted
among the workers before and after the
improvement revealed that the workers
were satisfied with the new chairs, which
had a backrest, and with the adjustable
footrests, especially as these can reduce
muscle workload. (Table 4.)
Another factory made improvements to work organization. There we
found that efficiency was improved after the improvement. As an example,
before the improvement the workers
had to lift the same piece up and down
nine times, whereas after the improvement they had to lift the same piece only
six times. (Table 5.)
Conclusion
Figure 5. After the improvement chair with a backrest and adjustable footrest
Table 4.Workers comments concerning the situation before and after the improvement
Workers comments
Before
After
Appropriate chair size and comfort

while sitting
Suitable height of chairs
Suitable backrest
Appropriate distance between chairs
and footrest
Reducing fatigue while resting
on the backrest
Poor / Fair
Good
Fair
Poor
Poor
Good
Good
Good
Poor
Good
Table 5. Efficiency before and after the improvement

Improvement
Before
After
Safety and ergonomics increase

(lifting up and down)
Reduction in work in process
Reduction of delay time
Reduced moving part distances
Fewer operators needed
Smaller area needed
9 times/piece
6 times/piece
Improvement
in efficiency
33 %
180 sets
0.553 hour
21 meters
4 persons
16.5 meter3
30 sets
0.1196 hour
4 meters
3 persons
10 meter3
83 %
73 %
81 %
25 %
40 %
70
The participatory approach has proved

to be effective in improving working
conditions and the environment at
workplaces, and is thus also effective in
improving productivity. If we focus
improvement efforts on the cause source
of occupational injuries, we can reduce
the numbers of occupational accidents
and occupational diseases.
Literature
National Institute for the Improvement of Working Conditions and Environment. Occupational
Safety and Health Situation Report year 2004.
Department of Labour Protection and Welfare,
2005.
Ms. Sudthida Krungkraiwong

Chief, OSH Development Section
National Institute for the
Improvement of Working
Conditions and Environment
(NICE)
Department of Labour Protection
and Welfare, Ministry of Labour
22/22 Baromrajchachonnanee
Road
Taling Chan
Bangkok 10170
Thailand
E-mail:
sudthida_krung@yahoo.com
Prevention and control of silicosis

Experience in agate industry
Lakho J Bhagia, Harasiddh G Sadhu, Habibullah N Saiyed, India
Introduction
Agate, a variety of chalcedony known
to the world for more than 6,000 years,
is a mineral containing a high percentage of crystalline silica. The Indian agate industry is principally a cottage industry situated in Khambhat (the sea
port of Cambay) and surrounding villages in the state of Gujarat, and in
Jaipur city of Rajasthan, India. Khambhat has been well known for producing agate jewellery and decorative articles for many centuries. This industry
employs a large number of workers
(about 15,000) and earns valuable foreign currency. Being a home-based industry, it is outside the purview of existing regulations such as the Factories
Act, Workmens Compensation Act, etc.
The making of agate jewellery and
decorative pieces consists of the following sequence (Figure 1). The agate
stones are baked in small earthen pots
and then broken down (chipped) to the
required size and rough shape with a
small hammer. The stones are then
abraded against the rotating emery
wheel of a grinding machine, to give the
final shape. After grinding, the articles
are polished in a closed rotating drum
containing water and grinding powder
consisting of silica flour or other abrading material, e.g. dust produced during
the grinding of agate stone. Very little
or no dust is generated during the process of baking, chipping and polishing.
Exposure to airborne dust

Airborne dust generated during the
process of grinding pervades the work
environment and the adjacent areas.
The grinders who are nearest to the
source of dust generation are at maximum risk of exposure. The workers engaged in other processes, such as baking, chipping and polishing, are at a
Figure 1. Process of making agate jewellery and decorative pieces.
variable distance and are thus exposed

to varying concentrations of dust. Factories are located in the midst of residential areas, some of them within
house premises. Thus not only the
workers but also the people living in the
surroundings are exposed to siliceous
dust. Long-term exposure to silica dust
can lead to silicosis, increased susceptibility to tuberculosis (1) and to a higher risk of developing lung cancer (2).
Silicosis is a progressive disease involving fibrosis (scarring) of the lung. There
is no treatment for the disease. It is
therefore important to study the magnitude of the problem and to take appropriate control measures to prevent
the exposure of workers and the surrounding community.
Magnitude of the problem

A study among agate grinders conducted by the National Institute of Occupational Health, Ahmedabad, revealed a
38% prevalence of silicosis. About 60%
71
of the workers showing radiological evidence of silicosis had worked for less than
10 years (3). Another study done among
a group of agate workers (chippers and
grinders) by Rastogi et al. (4, 5) showed
an 18% prevalence of silicosis as well as
a low Vital Capacity (VC) and Forced
Expiratory Volume in one second
(FEV1). A follow-up study carried out
by NIOH six years later, in 1993, showed
that 10.5% of silicosis cases had remained
static and 17.4% had progressed further
when compared against the 1987 study.
In addition, there were 11.6% new cases
of silicosis during the intervening six
years (6). A more recent study among
the people living in the surrounding
households showed an 11% prevalence
of silicosis and a 6% prevalence of tuberculosis (7). Thus there is a high prevalence of silicosis and of tuberculosis
among workers and the surrounding
population; this silicosis is due to inhalation of silica dust emanating mainly
during the process of grinding.
Dust levels in factories and

surrounding areas
An occupational hygienic survey
showed that the total dust concentrations on grinding machines were in the
range of 14.7525.40 mg/m3, whereas
the respirable dust concentrations were
in the range of 2.352.74 mg/m3, with
free silica contents of 60% (8). As per
the Indian Factories Act 1948 (9), the
permissible levels for free silica (quartz)
in respirable air are calculated by following the formula:
Permissible respirable dust =
10
mg/m3 of air .
% respirable quartz + 2
Figure 2A. First local exhaust system developed by the NIOH in

1987.
As per the above formula, the permissible respirable dust levels would be
0.16 mg/m3 of air.
The ambient quartz concentrations
in the vicinity of the agate grinding
machines and control localities were also
measured. The dust concentrations in
the vicinity were in the range of 7.06
mg/m3 to 28.15 mg/m3 with an average of 15.28 mg/m3, whereas the same
in control localities were in the range of
1.83 mg/m3 to 4.30 mg/m3 with an average of 3.03 mg/m3. The average quartz
concentration in the vicinity was found
to be approximately five times higher
than that in the control localities. Although there are no air quality standards for crystalline silica in India or elsewhere, the Environmental Protection
Agency has suggested an Interim Annual Air Quality Standard of 5 mg/m3
(10).
Figure 2B. The Local exhaust system developed by the GRTI (1999).
Steps for prevention and

control of silicosis
Development of appropriate dust control technology; use of a dust control
system. It is evident that high levels of
airborne dust in the work and community environments is responsible for the
high prevalences of various respiratory
morbidities among workers and the surrounding community. The source of
dust is localized at the point of stone
grinding; hence the use of a local exhaust system with a suitable air cleaning device is the method of choice for
preventing dust-related morbidity. Our
efforts in this direction were initiated
in 1987.
Figure 2A shows the first local exhaust ventilation system we developed
in 198788. In this local exhaust system, a pump was used to sprinkle water
Figure 2C. Modified NIOH local exhaust system (20023).

over the dust-laden air sucked from the
source to remove the dust particles. The
water was recirculated. An industrial
hygiene study carried out during the
initial trial reported satisfactory efficacy of this system; however, the industry
did not accept the system due to the
need to change the water frequently and
the rusting caused by the presence of
water.
A local exhaust system consisting of
a three-phase motor (2 horsepower) and
bag filters for dust collection (replacing
72
water sprinkling and bag filters) was

then developed with the help of Gujarat
Rural Technology Institute (GRTI)
(Figure 2B). Two workers could carry
out grinding on one machine. The efficacy of this unit was tested and was
found to exceed 90% in terms of dust
reduction. This system showed satisfactory results during laboratory studies;
however, during the actual field trials,
it was not accepted because of the high
installation cost, increased power consumption and unavailability of three-
phase electric connections in most units.

In consequence of the above feedback, the NIOH together with local
engineers developed a grinding machine
with an inbuilt local exhaust system
(Figure 2C). Three persons could sit at
this machine at one time. The machine
had 0.75 horsepower single-phase motor and an inbuilt blower which sucked
air through a hood placed near the
grinding wheel. The blower and grinding wheel were connected to the same
shaft and rotated by the same motor.
After successful laboratory trials, five
such units were installed at different
places.
After this new device had been in
use for several months, both the workers and the owners were happy because
the dust control device meant that the
environment of the workplace and its
surrounding area was clean, it increased
worker efficiency because the worker
could now sit continuously for a longer
period, and some money could be
earned by selling the dust collected in
the filter bags. The dust sold is used to
polish agate. The workers and owners
also reported the following limitations:
Speed variation: The traditional machine motor operates at 1440 rpm.
When designing the unit, a high speed
(2800 rpm) was selected to get proper
suction. During grinding, the speed has
to be changed slightly, depending on the
size of the article. This is accomplished
in the traditional grinding machines by
adjusting the distance between the
grinding wheel and the motor. With the
traditional machine, the speed can also
be varied by changing the diameter of
the pulley at the bottom. The new unit
posed some difficulties in grinding different sized articles, because of its fixed,
high speed.
Working habits: The new unit required that the workers sit on a chair
while operating it. The workers were reluctant to change their traditional working habits of sitting on the ground while
working.
Fear of electric shock: The traditional machines are normally operated with
loose electric connections, which if unplugged accidentally can lead to electric shock. However, the traditional
machines have an electrically safe wooden frame which minimizes such accidents. Since the new unit has an iron
frame, the workers operating it were
afraid of electric shock.
Reduced efficacy: With the reduced

diameter of the emery wheel caused by
attrition from grinding, the gap between
the hood and emery wheel increased,
reducing the efficiency of the system.
The views of workers and owners
were considered and the local exhaust
system was modified, incorporating following changes:
A hood was designed and installed
over the traditional cutting machine; it
included a wooden work bench to remove the fear of electric shock. The
hood was made flexible so that it could
be moved nearer to the emery wheel
when the diameter of the latter shrinks.
This would prevent a reduction in efficacy owing to the reduced diameter of
the emery wheel. The grinding wheel
and blower were driven with the same
motor. A wooden pulley with two diameters was attached to the shaft of the
motor. The pulley diameters were adjusted so that the grinding wheel rotated at nearly 1440 rpm and the blower
fan at the speed of the motor, i.e. 2800
rpm. The lower portion of the bag filter is metallic and tapering at the end.
Dust laden air was given tangential entry into the bag filter.
The modified dust control device
was installed in ten units (five each with
vertical and horizontal shaft) grinding
machines. Figure 3 shows the efficacy
of each of the five machines evaluated.
Although the new device brought a significant reduction in the dust levels, the
respirable dust levels at machines B and

C were higher than the permissible levels. To increase efficacy, the capacity of
the motor should be increased, but the
owner did not agree to this because it
would increase the electricity bill. These
machines have been in operation for the
past two years.
To secure the commitment of workers and owners, the following additional steps were taken.
1. Legal measures to bring smaller

factories under the purview of law
A Special Notification was issued by the
Chief Inspector of Factories, Gujarat
state which brings agate factories with
four or more workers under the purview of the Factories Act by the State
Government. However, most of the factories are still beyond the reach of the
Factories Act as the workers are selfemployed.
2. Awareness programmes for

stakeholders
To increase awareness among workers
and owners, an exhibition cum workshop (sponsored by WHO) was organized. To ensure commitment at the
highest level, the Minister in Charge of
the Labour and Health Department,
Government of Gujarat, was invited to
inaugurate the awareness workshop
(Figure 4). Scientists from the Institute
gave information on silicosis and how
to prevent it. As a measure of mass
Figure 3. Results of efficacy for the modified NIOH local exhaust system.
73
awareness for workers and the community, the clippings regarding silicosis and
its preventive measures were shown on
local TV channels by cable operators
and in cinema theaters in Khambhat.
Various posters showing the hazards of
silicosis and silicotuberculosis, and how
to prevent these diseases, were prepared
and displayed at public places, including bus stops, the local theater, schools,
panchayat (community) buildings, etc.
A booklet, Agate Workers occupational disease silicosis Prevention and control was compiled in the vernacular language and about 1,000 copies were distributed among various stakeholders
(Figure 5).
Figure 4. Inauguration of the awareness workshop by the Hon. Minister in Charge,

Labour and Health.
3. Capacity building
Manpower development: A oneweek training programme separately for the factory inspectors and
medical officers working in the highrisk areas of Gujarat and Rajasthan
was organized at NIOH.
Building infrastructure at the local
hospital for diagnosis of silicosis
and dust surveillance: With funds
available from the Ministry of
Health and Family Welfare (Government of India) under a special
scheme called Prevention and control of silicosis in small scale indus-
try, the local hospital was supplied

with an X-ray machine and spirometer dedicated for the silicosis patients. From the same scheme, the
industrial hygiene laboratory of
Gujarat State was supplied with
equipment for dust collection and
measurement levels to be used for
surveillance of the agate industry.
Concluding remarks
The above measures have created awareness among workers and owners, yet we
are still far from eliminating silicosis
from the agate industry. Although there
is a solution that would prevent the disease, it is not accepted by large number
of owners although the workers themselves are keen to work in conditions
with a local exhaust system. The reasons for failure to control silicosis include lack of commitment on the part
of the owners, poverty among the workers and scarcity of resources. Many
workers who cannot afford the exhaust
system are using various indigenous
techniques, such as putting wet gunny
bag around the grinder, covering the
face with a cloth, etc. We are continuing our efforts to make the exhaust ventilation system available through the cooperative society, bank loans, subsidy,
etc.
References
1.
Figure 5. Booklet in Hindi entitled Agate

Workers occupational disease silicosis
Prevention and control.
2.
Parker JE, Wagner GR. Silicosis. In: Stellman JM,

ed. Encyclopaedia of occupational health and safety.
4th ed. Geneva, Switzerland: International Labour
Office, 1998, pp. 10.4310.46.
IARC. IARC monographs on the evaluation of carcinogenic risks to humans: Silica, some silicates, coal
dust and para-aramid fibrils. Lyon, France: World
Health Organization, International Agency for Research on Cancer, Vol 68, 1997.
74
3.
NIOH. Annual Report 198788: Study of respiratory morbidity in agate workers pp. 121. National
Institute of Occupational Health, Meghaninagar,
Ahmedabad 380 016, 1988.
4. Rastogi SK, Gupta BN, Mathur N, Husain T, Mahendra PN. Pulmonary function study in female
grinders exposed to agate dust. Toxicol Ind Health
1990;6:14554.
5. Rastogi SK, Gupta BN, Chandra H, Mathur N,
Mahendra PN, Husain T. A study of the prevalence
of respiratory morbidity among agate workers. Int
Arch Occup Environ Health 1991;63:216.
6. Sadhu HG, Parikh DJ, Sharma YK, Saiyed HN, Rao
PVC, Kulkarni PK, Kashyap, SK. A follow up study
of Health Status of Small-scale Agate Industry Workers. Indian J Ind Med 1995;41:1015.
7. NIOH. Annual Report 200203: Prevention and
control of silicosis and silicotuberculosis in agate industry of Khambhat pp 1821. National Institute
of Occupational Health, Meghaninagar, Ahmedabad
380 016, 2003.
8. Ghodasara NB, Rathod RA, Pandya GL, Saiyed HN,
Parikh DJ, Kashyap SK. Environmental Dust Exposure study in agate grinding units. Indian J Env Protection 1997;17:1247.
9. DG-FASLI (2005) THE FACTORIES ACT,
1948 [Act No. 63 of 1948] As amended by the Factories (Amendment) Act, 1987. Director General,
Factory Advice and Labour Institute, Mumbai
www.dgfasli.nic.in visited last on 25th August 2005.
10. U.S. Environmental Protection Agency (EPA). Ambient levels and non-cancer health effects of inhaled
crystalline and Amorphous silica. EPA/600/R-95/
115, November 1996.
Lakho J Bhagia, Sr. Research

Officer
Harasiddh G Sadhu, Assistant
Director
Habibullah N Saiyed,
(Corresponding author), Director
National Institute of Occupational
Health, (Indian Council of Medical
Research)
WHO Collaborating Centre for
Occupational Health
Meghaninagar
Ahmedabad 380 016
India
E-mail: saiyedhn@yahoo.com
Results of five years implementation of the

National Programme for Elimination of
Silicosis in Vietnam
Nguyen Thi Hong Tu, Tran Thi Ngoc Lan, Tran Anh Thanh, Vietnam
Introduction
Silicosis has been recognized as a compensated occupational disease in Vietnam since 1976. Up till now, among all
the compensated occupational diseases,
silicosis is diagnosed with the highest
percentage. This rate has varied from
one period to another: the highest percentage of silicosis, 95.5%, was found
in the period 19761980, and the lowest, 66.2%, in the period 20012003.
Until 2003, a total of 19,500 cases of
compensated occupational diseases have
been detected in total; of these, cumulative silicosis on average constitutes
75.7%.
According to the surveillance database, there are more than 600 enterprises where workers face the risk of silicosis. These enterprises fall under the
sphere of four main ministries (The
Ministries of Industry, Coal Branch,
Construction and Transportation).
Most of the enterprises are State-owned.
Furthermore, many employees working
in different economic sectors, especially in the private sector, are not included. In these sectors, too, exposure to silica dust and cases of silicosis occur but
these are not yet recorded. It is estimated that there are about one million silica exposed workers in Vietnam. At an
average rate of silicosis of 45%, the
8000
actual cases of silicosis must be some

40,000 to 50,000.
Therefore, in response to the ILO
and WHOs Global Programme for the
Elimination of Silicosis (GPES), which
has as its objective reduction of the incidence of silicosis by 2010 and elimination of silicosis by 2030, in 1999 the
Ministry of Health of Vietnam developed a National Programme for the
Elimination of Silicosis in Vietnam
(NPES).
Objectives of the
programme for the period
19992003
1. To establish a mechanism of silicosis prevention between branches and
organizations representing employers and employees, and to enhance
the capability of maintaining activities and evaluating all aspects of the
project
2. To identify silicosis cases and to determine the prevalence and incidence by industries and occupations,
and then to propose strategies for
each specific time period
3. To provide techniques for the prevention of silicosis
4. To train and re-train personnel responsible for occupational health on
silicosis prevention.
Compensated occupational diseases in total

Compensated cases of silicosis
7424
7000
6000
4914
5000
4026
4000
3000
2553
2165
2000
1000
2060
1831
1657
2683
1501
2152
1188
0
1976-1980
1981-1985
1986-1990
1991-1995
1996-2000
Figure 1. Distribution of compensated silicosis cases by periods
75
2001-2003
Results of the
implementation of the
NPES
Organization and coordination of
the NPES
The Steering Committee and Task Force
Group established play a most important role in creating a necessary backbone for the implementation of the
NPES in Vietnam.
The Steering Committee and Taskforce Group Members include governmental bodies (the Ministry of Health,
the Ministry of Labor, Invalid and Social Affairs, the Ministry of Science
Technology and Environment, etc.);
technical institutions (the National Institute of Occupational and Environmental Health, the National Institute
of Medical Expertise, the Institute of
Labour Protection, the Occupational
Health Centres of branches); representatives of employers (the Vietnam Chamber of Commerce and Industry, the Vietnam Cooperative Federation, etc.) and
representatives of employees (the Vietnam General Federation of Labour).
Annually, the institution in a key
role to the project, the Ministry of
Health, has cooperated closely with different institutions in organizing meetings of the Steering Committee and
Taskforce Group, the aim being to produce guidelines, to monitor the progress
of the project activities, and to discuss
and solve related problems in order to
enhance the implementation of the
project.
Following the NPES, the ministries
and branches concerned have established their own silicosis prevention programmes.
During the period 19992003,
model activities for silicosis prevention
were implemented in ten major provinces at high risk of silicosis in Vietnam.
The principal objectives of this model

were to concentrate on medical screening activities and to run training courses for healthcare workers in order to
improve their knowledge of the risks,
effects and preventive measures for silicosis.
Silicosis risk in Vietnam

A database on silicosis risk in Vietnam
was constructed by conducting investigations at 515 enterprises/factories in
31 provinces. The distribution of silica
exposed workers in various industries is
shown in Table 1.
The results show that number of
workers exposed to silica dust was the
highest (38.7%) in the mining industry. In the construction materials industry, this rate is 30.3%. The lowest percentage of workers exposed to silica dust
(3.7%) was found in the ceramics and
porcelain industry.
Medical surveillance
The programme for medical surveillance
of silicosis includes monitoring of the
work environment and medical examinations with chest radiographs and lung
function tests.
Monitoring of the work environment
Results of environmental monitoring at
workplaces are shown in Table 3.
The environment of 118 workplaces
has been monitored for five years. 51.2%
of the environmental samples exceeded
the permissible exposure levels.
The results for 70% of the dust samples exceeded occupational hygienic
standards. In particular, 7080% of the
respirable dust samples exceeded the
permissible levels.
The free silica concentrations in dust
varied widely: from 1.6% to 80%. The
lowest free silica concentrations were
found at sites where construction materials are manufactured, while the highest concentrations were found in ship-
Table 1. Distribution of silica exposed

workers by industries (Source: Provincial
Centers of Preventive Medicine)
Coal mining, quarrying
Production of contruction
materials
Foundry, metallyrgy, mechanic
Transportation, ship building
Ceramics, porcelain
Others
38.7
30.3
15.8
9.6
3.7
4.3
Table 2. Distribution of workers by duration of exposure

Duration of
Male
Female
Total
exposure (years)
<5
23,822
4,442
28,264
610
9,785
2,711
12,496
1115
7,059
2,575
9,634
1620
6,991
2,597
9,588
2125
4,178
1,728
5,906
2630
1,521
425
1,946
>30
206
31
237
Rate (%)
41.5
18.4
14.1
14.1
8.7
2.9
0.3
Table 3. Results of environmental monitoring at workplaces

1999 2000 2001 2002 2003
Number of workplaces
5
6
44
35
28
Total number of samples
695
484 1,522
762
712
Percentage of samples
42.4
56.8
55.3
49.9
48.7
exceeding occupational
hygienic standards
Number of dust samples
189
196
518
197
209
Percentage of dust samples
72.6
78.6
66.8
55.3
78.9
exceeding occupational
hygienic standards
Number of samples of
95
43
238
65
57
free silica concentration
Range of free
6.0
3
1.8
1.6
3.1
silica concentration
39.2%
84% 58.4% 54.2% 49.1%
3000
Number of cases medically

examined
Number of silicosis cases
2500
Total
118
4,175
51.2
1,309
69.6
498
1.6
84%
2847
2383
2432
1932 2058
2332
2000
1772
1500
970
923
1000
667
394
515
267
500
468
1177
736
656
789
508
717
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Figure 4. Distribution of silicosis cases in 19912003

Table 4. Distribution of silicosis cases by duration of exposure and industry
Duration of
Rate of
Industry
Rate of
exposure (years) silicosis (%)
silicosis (%)
< 10 years
16.4
Shipyard industry
16.8
1115 years
15.1
Foundry, mechanical industry
13.7
1620 years
16.2
Coal mining
8.9
2125 years
25.5
Construction materials
7.0
> 25 years**
13.9
yard industry in Ba Ria-Vung Tau, Ho
Chi Minh City and at rock mining sites
in the central region; for instance,
Khanh Hoa and Da Nang.
Medical monitoring: prevalence and
incidence of silicosis
Activities for the identification of silicosis in the provinces and industrial
branches, according to the guidelines of
76
the Ministry of Health, were worked out

almost completely and became routine
tasks.
In the period 19992003, 76,714
exposed workers were examined for silicosis. In all, 4,389 cases of silicosis were
awarded occupational disease compensation confirmed by the Medical Expertise Committee.
The distribution of silicosis cases by

duration of exposure was 16.4%,
15.1%, 16.2% and 25.5% when the
duration of exposure was under 10
years, 1115 years, 1620 years, and
2125 years, respectively. The silicosis
prevalence among workers exposed over
25 years was 13.9%. The highest rate
of silicosis, 16.8%, was detected among
workers in the shipyard industry. The
prevalence of silicosis among workers in
the foundry and mechanical industry
was 13.7% and 8.9% in the coal mining industry. The corresponding rate in
construction materials production was
7.0%.
Incidence of silicosis
The incidence rate for the foundry
and mechanical industry was 6.6%
The incidence rate among workers
exposed to silica in quarrying and stone
grinding factories under the sphere of
the Ministry of Transportation was
4.9%.
Among those under the sphere of
the Ministry of Construction, 300
workers employed at three factories were
examined in 2003. Ten newly suspected cases, with category 0/1, were found,
making an incidence rate of 0.6%.
Development of techniques for

silicosis prevention
Devising a model for work environment improvement
The National Institute for Labor Protection is devising a model for improvement of the work environment, as follows:
Evaluation of the work environment, including the production process, work sites where dust is present, the
working area, and current dust prevention measures
Analysis of dust concentrations, dust
weight, respirable dust and free silica
dust concentrations
Establishment of criteria for personal protective equipment that can be used

comfortably in tropical countries such
as Vietnam, especially for coal miners
Recommendation of interventions
to improve the work environment.
Activities for improvement of the
work environment
Water spraying systems were adopted at the sand-blasting sites
Advanced production processes releasing less dust into the work environment are used
Ventilation systems were fitted at the
stone-drilling site and water spraying
systems were installed at the stone crushing sites.
Development and distribution of
information, education and communication materials
The project focused on editing and publishing materials, including flyers, posters, pamphlets and a fact-sheet on silicosis prevention.
The fact-sheet was delivered to ministries and industrial branches, provincial offices and institutes participating
in the project as members.
Videotapes on the hazards and effects of silicosis, and on preventive measures, were produced.
Training activities
With the cooperation and assistance of
different institutions involved in the
training programme, the compilation
and distribution of training materials for
training courses on different subjects has
been prepared. The training plan, its
contents and method were developed by
groups of experts appropriate to the
abilities of each group. The training
materials are developed for three target
groups: workers, managers and healthcare personnel.
During five years of implementing
the National Programme for the Elimination of Silicosis in Vietnam, 70 training courses have been conducted for
3,200 participants in order to disseminate basic concepts and knowledge of
silicosis and silicosis prevention.
In 19992000, the project focused
on training core trainers for provinces
and branches. These core trainers were
then responsible for training other people, including healthcare workers, managers and employees at workplaces at
high risk for silicosis, using training
materials provided by the project. However, training courses generally met only
8% of the actual requirements. The distribution of participants at these training courses was: healthcare workers,
77.5%, managers 23.3% and employees 3.5%, respectively.
Studies on the progression of

silicosis
Environmental monitoring at stone grinding

worksite in Da Nang
77
A survey on the health situation and silicosis among 600 workers in Hanoi and
Quang Ninh was carried out. The results showed that:
23.4% of silicosis cases found in
Hanoi were at the progressive stage,
while the corresponding figure in
Quang Ninh was 10.8%. It was estimated that the duration of switching to
a higher profusion category was approximately 6.3 years.
The workers average exposure duration was 1635 years. The categories
of 1p and 2p were predominant.
Numbers of workers have been reexamined or undergone a thorough
medical assessment for occupational
diseases since they were diagnosed as
having silicosis in a previous examination.
The rate of misclassification in previous film readings by experts was relatively high (20%), due to a lack of homogeneity in film classification skills
and lack of standard films.
It is difficult for most enterprises to
arrange other workplaces for workers
diagnosed with silicosis.
International collaboration
ILO and WHO have financially
supported the activities undertaken (i)
to establish the working mechanism and
framework and activities of the Steering Committee of the project; (ii) to
conduct medical surveillance at workplaces where silicosis may occur; (iii) to
complete all necessary steps for medical
surveillance; and (iv) to plan strategies
for training and education in order to
enhance peoples awareness with regard
to prevention of silicosis.
Standard radiographs and ILO experts have been provided for organizing a training course on the use of the
1980 ILO Classification of Pneumoconiosis for occupational health staff employed at the preventive medicine centres in provinces where there is a high
risk of silicosis.
The University of Washington has
helped Vietnam in establishing a surveillance system for silicosis.
Conclusion
After the five-years implementation, the
project National Programme for the
Elimination of Silicosis in Vietnam
(NPES) has achieved good results. The
actual organization model and implementation activities constitute the right
way to attain the key objectives of the
NPES: to eliminate silicosis from Vietnam by the year 2030 and to reduce
the incidence of silicosis by the year
2010. This is accomplished by follow-
ing global and national plans, and involves the implementation of preventive
measures, new techniques, administration and occupational medicine.
After five years of implementing the
NPES, the project has achieved results
in line with its specific aims:
The Steering Committee and Taskforce Group were established and played
a most important role in creating the
necessary backbone and coordination
between bodies/agencies in implementing the activities of the NPES.
With the multi-sectional mechanism, the National Action Programme
achieved the active participation of
employers and employees, as well as support from governmental and international agencies.
The medical surveillance guideline
on workplaces involving exposure to silica and workers health was standardized and taken into use. During a 5year period, 118 enterprises involving
silica exposure were monitored; 4,175
samples of total dust were checked (with
51.2% of samples exceeding the occupational hygienic standards) and 441
samples of free silica concentration were
determined (the range detected was
from 39.2% to 84%).
Techniques for silicosis prevention
have been supported and applied at
many enterprises with a high risk of silicosis. Criteria for personal protective
equipment against dust have been developed. The model of work environment improvement was developed and
taken into use in enterprises.
Existing issues to be solved
Dust is still at high levels and workplaces have failed to introduce the
new technology in use to control
dust levels.
Activities focusing on dissemination
and training for enterprises and their
employees are limited.
Shortcomings due to policies and
law enforcement have not been resolved because of the poor co-operation between branches.
The competence of healthcare personnel is still limited. In addition,
there is a lack of equipment for environmental evaluation and diagnosis of diseases.
The budget for the implementation
of the project is limited.
78
Recommendations and
plans for future phases
The following should be undertaken in
future:
1. Enhancement of the framework and
contents of activities in the provinces and in the ministries and industrial branches. Consolidation, development and maintenance of the results
obtained during the previous phases
2. Promotion of the inspection of enterprises potential for silicosis, with
concurrent serious treatment of all
enterprises causing contamination
3. Promotion of dissemination, education, and communications directed
at workers, employers, and healthcare personnel
4. Expansion of medical surveillance to
non State-owned enterprises as well
as to small and medium-sized enterprises
5. Establishment of inter-branches regulations with respect to procedures
for expertise, policies, and allocation
of workers diagnosed with occupational diseases
6. Direct technical assistance will be
needed from the ILO/WHO Global programme in order to provide
occupational physicians with training in the use of the new ILO 2000
Classification of radiographs on
pneumoconiosis
7. Formulation of programmes for the
prevention of occupational diseases
in Vietnam based on the results obtained. A special focus will be placed
on primary prevention in order to
control silica dusts at sources by engineering methods, the goal being
to control and eliminate silicosis in
Vietnam during the coming phases.
Nguyen Thi Hong Tu, PhD, MD
Tran Thi Ngoc Lan, MSc, MD
Tran Anh Thanh, M Med
(Occupational Medicine) MD
The Vietnam Administration of
Preventive Medicine
Ministry of Health, Vietnam
138A Giang Vo Street, Ha Noi,
SR. Vietnam
E-mail:
hongtu@netnam.vn
ttnlan@yahoo.com
thanhytdp@yahoo.com
Meeting in response to the World Day for Safety and Health at Work
and the 10th International Noise Awareness Day in Vietnam
On 27 April 2005 at the National Exhibition Centre in Hanoi, Vietnam, the
Vietnam Occupational Safety and
Health Association (VOSHA) collaborated with the Vietnam AudioPhonology Association (VAPA) and National
Institute of Labour Protection (NILP)
to organize a meeting in response to the
World Day for Safety and Health at
Work (28 April) and the 10th International Noise Awareness Day (27 April).
More than 150 representatives from the
Ministry of Labour Invalid and Social
Affair, the Ministry of Science and Technology, the Ministry of Health, the Vietnam General Confederation of Labour, the Vietnam Union of Science and
Technology Associations, the Vietnam
Red Cross Association, other ministries,
organizations and representatives of the
press took part in the meeting.
At the meeting, Prof. Dr Nguyen An
Luong, president of VOSHA, made a
speech highlighting the meaning of the
World Day for Safety and Health at
Work and the 10th International Noise
Awareness Day, calling upon the organizations at all levels to strengthen activities to improve working conditions,
prevent and reduce occupational accidents, fire, occupational diseases, protect manpower force well, and to take
part in the industrialization and mod-
ernization with a view to developing the

countrys economy and society.
Representatives of VAPA, NILP and
the Hanoi Electricity Measure Equipment Company made speeches in line
with the aim of the meeting.
After the meeting, medical doctors
of NILP and VAPA provided otorhinolaryngological examinations and measured hearing free of charge for 60 workers employed at the Hanoi Electricity
Measure Equipment Company, the Hanoi Sewing Company, and the Minh
Khai Textile Company. This is the most
meaningful response to the World Day
for Safety and Health at Work and the

10th International Noise Awareness Day.
The meeting took place simultaneously with the International Exhibition
on Measuring, Testing and Safety Equipments 2005. This increased the meetings
importance because VOSHA is one of
the three organizers of this exhibition.
Pham Ngoc Hai, Engineer
Chief of the VOSHA Office
Vietnam Occupational Safety and
Health Association (VOSHA)
1 - Yet Kieu Street, Hanoi Vietnam
E-mail: vosha@hn.vnn.vn
Themes of the Asian-Pacific Newsletter in 2006

The themes of the Newsletters to be published in 2006 will be:
1/2006
Creating health and safety culture (manuscripts by 16 January)
2/2006
Noise and vibration (manuscripts by 2 May)
3/2006
Ergonomics (manuscripts by 1 September)
Readers are encouraged to submit manuscripts addressing the above themes. Articles on other topics in the field of occupational health and safety are also welcome. If you are planning to submit a manuscript, kindly contact the Editorial Office in
advance.
For instructions on how to prepare manuscipts, see the Internet:
http://www.occuphealth.fi/Asian-PacificNewsletter. See heading: instructions for contributors.
Please send your manuscript to:
Ms. Suvi Lehtinen, Editor-in-Chief
Asian-Pacific Newsletter
FI-00250 Helsinki, Finland
E-mail: inkeri.haataja@ttl.fi
79
Editorial Board
as of 28 February 2005
Ruhul Quddus
Deputy Chief (Medical)
Department of Inspection for Factories and
Establishments
4, Rajuk Avenue
Dhaka-1000
BANGLADESH
Chimi Dorji
Licencing/Monitoring
Industries Division
Ministry of Trade and Industry
Thimphu
BHUTAN
LIU Qiang
Deputy Division Chief
Bureau of Work Safety
State Economic and Trade Commission
26 Xuanwumen Xi Da Jie
Xuanwu District
Beijing 100053
PEOPLES REPUBLIC OF CHINA
LEUNG Chun-ho
Deputy Chief Occupational Safety Officer
Development Unit
Occupational Safety and Health Branch
Labour Department
25/F, Western Harbour Centre
181 Connaught Road West
HONG KONG
K. Chandramouli
Joint Secretary
Ministry of Labour
Room No. 115
Shram Shakti Bhawan
Rafi Marg
New Delhi-110001
INDIA
Tsoggerel Enkhtaivan
Chief of Inspection Agency
Ministry of Health and Social Welfare
Labour and Social Welfare Inspection Agency
National ILO/CIS Centre
Ulaanbaatar 210648
Baga Toirog 10
MONGOLIA
Ameerali Abdeali
General Manager
Occupational Safety and Health
(Training and Promotion) Centre
Ministry of Manpower Singapore
120 Kim Seng Road
Singapore 239439
SINGAPORE
John Foteliwale
Deputy Commissioner of Labour (Ag)
Labour Division
P.O. Box G26
Honiara
SOLOMON ISLANDS
Nguyen An Luong
Director
National Institute of Labour Protection
1 Yet Kieu Str.
Hanoi
VIETNAM
Jukka Takala
Director
SafeWork, Global Programme on Safety,
Health and the Environment
International Labour Office
CH-1211 Geneva 22
SWITZERLAND
Gerry Eijkemans, Scientist
Occupational and Environmental
Health Programme
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27
SWITZERLAND
Jorma Rantanen
President of ICOH
c/o Finnish Institute of Occupational Health
FI-00250 Helsinki
FINLAND
Harri Vainio
Director General
FI-00250 Helsinki
FINLAND

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Asian-Pacific Newsletter

ON OCCUPATIONAL HEALTH AND SAFETY

Occupational health and safety in Asia:

Volume 12, number 3, November 2005

Challenges in the application of Control Banding

The practical application in developing countries

Capacity Building of Occupational Safety and

Ergonomic problems among foundry workers

Participatory work improvement in Thailand

Prevention and control of silicosis

Results of five years implementation of the

Meeting in response to the World Day for Safety

Occupational health in Asia:

solutions. It is encouraging that various short-term training courses and

Asian-Pacific Newslett on Occup Health and Safety 2005;12:55

Challenges in the application of

Control Banding Tools

omies like India, although chemical use

Asian-Pacific Newslett on Occup Health and Safety 2005;12:5660

Assessment of the usability of

The ILO Chemical Toolkit was

dicated that some OELs are higher than

Asian-Pacific Newslett on Occup Health and Safety 2005;12:5660

Automotive supplier, brakes manufacturer

Manual spray painting

Manual dosing during

Manual dosing during

PPE and general

PPE and general

PPE and general

PPE and general

PPE and general

Asian-Pacific Newslett on Occup Health and Safety 2005;12:5660

Fully automated, local

Usability and specific challenges of

The users were not clear about the

It was felt that basic understanding

Asian-Pacific Newslett on Occup Health and Safety 2005;12:5660

mation), the comprehensive MSDS

Asian-Pacific Newslett on Occup Health and Safety 2005;12:5660

here is scientific and technical

The practical application in developing countries

ing of knowledge and experiences will

on the development of pilot projects in

Main outcomes and

Asian-Pacific Newslett on Occup Health and Safety 2005;12:6062

posed some problems. For these reasons,

Progress made so far

Asian-Pacific Newslett on Occup Health and Safety 2005;12:6062

Conclusions and the way

For further information please contact

Capacity Building of Occupational Safety

(MOLISA) functions as the Governments representative agency while the

Activities of the project

Asian-Pacific Newslett on Occup Health and Safety 2005;12:6364

Photo by Vu Nhu Van

age and handling; (2) safety in the use

gradually shift to improvements in

Photo by Vu Nhu Van

Asian-Pacific Newslett on Occup Health and Safety 2005;12:6364

farmer volunteers was held in Nghe An

Ergonomic problems among

done to assess and seek solutions to ergonomic problems in China.

A general description of the