Prevalence of occupational injury and its contributing factors among rubber tappers in Galle, Sri Lanka Kayla Stankevitz1  , Catherine Staton2,3, Ashley Schoenfisch1,4  , Vijitha de Silva5, Hemajith Tharindra5, Marissa Stroo1  , Truls Ostbye1,2  Department of Community and Family Medicine, Duke University, Durham, NC, USA, 2Duke Global Health Institute, Duke University, Durham, NC, USA, 3Division of Emergency Medicine, Duke University, Durham, NC, USA, 4Duke School of Nursing, Duke University, Durham, NC, USA, 5Faculty of Medicine, Department of Community Medicine, University of Ruhuna, Galle, Sri Lanka 1

Background: Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury among this vulnerable working population. Objective: To assesses the prevalence, severity, and contributing factors associated with occupational injury among Sri Lankan rubber tappers and to identify possible interventions to improve occupational safety. Methods: A questionnaire was administered to 300 Sri Lankan rubber tappers. The associations between tapper characteristics and injury within the last year were examined using log-binomial regression models. Short response answers were analyzed using qualitative content analysis. Results: 300 tappers reported 594 injuries in the previous 12 months, and missed 1,080 days of work. The prevalence of one or more injuries was 49%. Factors associated with injury were being female, working an additional job, tapping with a two-handed approach, and depressive symptomology. Qualitative findings suggest three interventions to address injuries: (1) landscaping, (2) personal protective equipment, and (3) provision of eyeglasses. Conclusions: Work-related injuries are common among Sri Lankan rubber tappers. These results highlight the importance of working with and including informal workers in the creation of Sri Lankan occupational health and safety regulations. We believe that the three interventions identified by respondents could help to reduce the risk of occupational injury among rubber tappers. Keywords:  Occupational injuries, Rubber tappers, Sri Lanka

Background

Injuries are a major cause of disability and death, accounting for 10% of global deaths and 16% of disabilities each year.1,2 Many injuries are the result of occupational hazards. On a global scale, researchers estimate that 700,000 people are injured at work every day.3 Agriculture is the most hazardous industry for both morbidity and mortality.4−9 In Sri Lanka, 28% of the active labor force is employed in agriculture.10 Rubber, the country’s third largest agricultural export, employs more than 200,000 workers.11 In recent years, the extent of land under rubber cultivation in the country has grown steadily, resulting in an increased demand for rubber tappers throughout the country.12−14 However, the tapping process is strenuous, and could put workers at risk for injury.

Rubber tapping

The rubber tapping process involves three main tasks: tapping, collecting, and transportation; shown in Figure 1. In the morning, tappers go to the fields and begin tapping. This process includes removing the collecting cup, making an incision in the tree with a sharp knife, placing the collecting cup, and repeating with subsequent trees. After tapping 300–600 trees, tappers wait for the latex to fill the cups. After the latex drip is finished, tappers collect the latex in a large metal bucket. Full buckets can weigh up to 5 kg. After they have collected latex from all of the trees, workers transport the latex on their head to a collecting station, up to 2 km away. The rubber tapping process involves sharp tools, steep terrain, and heavy loads, putting tappers at risk for occupational injuries.

Rubber estates in Sri Lanka Correspondence to: Kayla Stankevitz, Department of Community and Family Medicine, Duke University, DUMC 104006, Durham, NC 27710, USA. Email: [email protected]

© 2016 Informa UK Limited, trading as Taylor & Francis Group DOI 10.1080/10773525.2016.1247026

In Sri Lanka, many rubber tappers live and work on estates. Geographical regions in Sri Lanka are characterized in

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Figure 1  The three main tasks in rubber tapping (from left to right): tapping the tree, collecting latex, and transporting latex

three sectors: rural, urban, and estate. The estate sector is defined as plantation areas more than 20 acres with 10 or more residential laborers. The estate sector houses 5% of Sri Lanka’s overall population, and is associated with higher rates of illiteracy, poverty, and lack of access to health care.15,16 In 1995, estates in Sri Lanka were privatized, leaving health care provision responsibilities to management. In practice, responsibility for health services vary: on some estates, health care provision is provided by the Department of Health, while on others, estate hospitals are operated by management.17 In recent years, many government and foreign assistance programs have been implemented to improve housing, childcare, and sanitation in the sector.16 Despite these efforts, health outcomes and nutritional status are still lower for people living on estates, compared to the other sectors.18

Previous work

Previous research indicates agricultural workers suffer from a range of occupational injuries. Common farming injuries include lacerations, hand injuries, eye injuries, animal bites, and falls, however, no data is available on agricultural injuries in Sri Lanka.19−23 A ­community-based study in rural Sri Lanka found common injuries in community members to be animal bites, falls, contact with objects, cuts, and road trauma.24 Yet there is no published literature on the nature or incidence of injuries on rubber plantations, in Sri Lanka or otherwise. The purpose of this study was to document the injury experiences of Sri Lankan rubber tappers. Specifically, our aims were to determine the 12-month prevalence, severity, and factors associated with work-related injuries including: demographic characteristics, characteristics of the work environment, behavioral characteristics, and depression.

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Methods Study setting

This study took place on two privately owned plantation companies in the estate sector, herein called Plantation A and Plantation B. Both plantations were located in the Galle district. The Galle district has a total population of 1,082,000.25 The economically active population is 63.9% male and 36.1% female, with 32.6% of the working population employed in agriculture. The overall literacy rate in the district in 94.4% and is similar for males and females.10

Sample size and sampling

This study was part of a larger study of musculoskeletal disorders on Sri Lankan rubber plantations.26 The target sample size was 300 tappers. The sample population comprised rubber tappers from the two plantation companies. Members of the study population were informed about the study by plantation management and participants were selected using a convenience sample of those willing to participate. Inclusion criteria included: (1) employment as a rubber tapper on a study plantation and (2) more than one year of experience working as a rubber tapper. Participants were recruited until the target sample size was reached.

Data collection

In this cross-sectional study, data were collected from September 2014 to November 2014 via questionnaire and direct worker observation. The questionnaire contained detailed information on demographic characteristics, work environment, work-related injuries, musculoskeletal disorders, medical history, depression, and behavioral characteristics. Prior to the study, researchers consulted with local medical practitioners to determine common injuries on plantations. The injury section of the questionnaire included five main injury categories identified from these

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consultations: skin irritation, eye irritation, snake bites, knife cuts, and falls. An “other” option was also included. For each injury category, workers were asked if they had sustained the injury in the last 12 months, if they saw a doctor, and if they missed work due to their injury. An open-ended question was included to allow additional feedback: “What else would you like to tell us about injuries you experienced while at work?” Depression was measured using the Peradeniya Depression Scale, a tool developed in Sri Lanka to measure depression using culturally appropriate questions.27 Twenty-five questions were asked from five categories, including: biological symptoms, somatic symptoms, effect of depression, depressive thoughts, and depressive behaviors. A score of 10 is indicative of depression. This depression scale has been shown to have high sensitivity and specificity with clinical diagnosis of depression, and has been used in previous studies of depression in Sri Lanka.27,28 Questionnaires were developed in English, then translated into Sinhala and back-translated for accuracy. The translated questionnaire was pretested by study staff and wording was updated to improve the translations and minimize confusion. Data were collected via trained Sinhalaspeaking interviewers to allow participation by those who could not read or write. In addition to the questionnaire, researchers performed approximately 15  h of direct observation of 90 tappers during their work activities. During the observation, interviewers asked open-ended questions to address barriers to safety.

Data analysis Quantitative analysis

The data were collected on paper and de-identified data were entered into REDCap version 5.5.21 software for storage.29 All analyses were conducted using SAS software version 9.4. Continuous variables were clustered based on naturally occurring gaps in the data, or categorized based on logical categories (e.g. BMI) to examine non-linear relationships. Summary statistics were used to describe four aspects of the sample population; personal characteristics, working environment, behavioral characteristics, and depression. The frequency and prevalence of workrelated injuries and number of days of work missed in the past 12 months were tabulated. Previous literature, as well as the potential for different job tasks for male and female tappers led us to believe that the injury pattern may differ by gender.30−32 Sex-specific statistics were calculated to examine possible differences. Univariate models were constructed to estimate the prevalence ratio (PR) and 95% confidence interval (CI) between covariates and injuries. Models were constructed for each injury category (skin irritation, eye irritation, snake bites, knife cuts, and falls) and for the outcome variable of reporting one or more injury in any category. 

We chose a log-binomial model, to provide a direct estimate of the PR as recommended over the logistical model to reduce overestimation.33 This was accomplished using PROC GENMOD in SAS.34

Qualitative analysis

Responses to two open-ended questions, “What are the largest barriers you face to doing your job?” and “What else would you like to tell us about injuries you experienced while at work?” were analyzed using Excel 2013 to perform inductive content analysis.35 Transcription and translation were performed by a bilingual researcher who was present at the interviews (HT), and were performed as soon after the interview to maintain recollection of subtle connotations. Data were coded according to themes that arose from the short answer responses. Themes were reviewed and revised by two researchers (KS, HT) one of whom was a native speaking Sinhalese researcher, and both were present during the interviews.

Ethical approval

This study was approved by the Institutional Review Boards at Duke University in Durham, NC, U.S.A and the University of Ruhuna in Galle, Sri Lanka. Written informed consent was obtained from all questionnaire and observation participants.

Results

A total of 300 rubber tappers completed the questionnaire. Participants ranged between 21 and 89 years old, with a mean age of 46. Tappers had worked an average of 21 years in the industry, with a range of 1–52 years. The distribution of participants by participant characteristics is shown in Table 1. No workers reported wearing any personal protective equipment (PPE), including: closed toed shoes, eye protection, gloves, or face masks.

Prevalence and causes of injuries

Table 2 shows the prevalence of injuries among participants in the last 12 months by injury type. Half of participants (49%; n = 147) reported one or more injuries, including 47.0% of men and 49.7% of women. Knife cuts (n = 182) and skin irritation (n = 176) were the most common injuries. Five injuries were reported in the “other” section, including: a monkey bite, a wasp sting, a rubber branch falling on a tapper, severe headaches, and numbness. Injuries reported more than 12 months ago were not included in the analysis.

Factors associated with occupational injuries

The crude PR of sustaining one or more injuries (coded as a binary variable) were calculated across participant characteristics, as shown in Table 1. Working an additional job (PR = 1.6) and presence of depression (PR = 1.5) were both significantly associated with increased prevalence of injuries. Working on plantation B versus plantation A

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(%) 117 (39.0) 183 (61.0) 53 (17.7) 188 (62.7) 59 (19.7) 150 (50.0) 150 (50.0) 82 (27.3) 143 (47.7) 75 (25.0) 122 (40.7) 178 (59.3) 232 (77.3) 66 (22.0) 19 (6.3) 281 (93.7) 83 (27.7) 146 (48.7) 71 (23.7) 216 (72.0) 82 (27.3) 267 (89.0) 33 (11.0)

Gender

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1 1.1 (0.8, 1.4) 1 1.1 (0.8, 1.5) 1.0 (0.7, 1.4) 1 0.8 (0.6, 1.0)* 1 0.9 (0.7, 1.2) 0.8 (0.6, 1.1) 1 1.6 (1.3, 2.0)* 1 1.0 (0.8, 1.4) 1 1.4 (0.7, 2.5) 0.8 (0.6, 1.0) 1 1.0 (0.8, 1.3) 1 1.0 (0.8, 1.3) 1 1.5 (1.2, 2.0)*

PR (95% CI)

Any injury 1 1.2 (0.6, 2.5) 1 1.3 (0.5, 3.8) 1.4 (0.4. 4.5) 1 1.2 (0.6, 2.5) 1 1.7 (0.6, 4.6) 2.0 (0.7, 5.6) 1 1.02 (0.5, 2.1) 1 3.0 (1.5, 6.1)* 1 1.0 (0.3, 13.2) 0.5 (0.2, 1.5) 1 1.6 (0.8, 3.4) 1 0.7 (0.3, 1.7) 1 2.6 (1.2, 5.6)*

PR (95% CI)

Skin irritation 1 1.4 (0.7–3.2) 1 0.9 (0.4, 2.4) 0.9 (0.3, 2,9) 1 0.6 (0.3, 1.3) 1 1.2 (0.4, 3.1) 1.3 (0.5, 3.6) 1 2.0 (0.9, 4.2) 1 1.1 (0.5, 2.7) ** – 0.9 (0.4, 2.1) 1 0.7 (0.3, 2.0) 1 0.6 (0.2, 1.6) 1 3.0 (1.4, 6.6)*

PR (95% CI)

Eye irritation 1 0.4 (0.2, 0.9)* 1 1.4 (0.4, 4.7) 1.5 (0.4, 6.0) 1 0.4 (0.1, 0.9)* 1 2.9 (0.9, 9.6) 1.8 (0.5, 7.4) 1 1.9 (0.9, 4.2) 1 0.7 (0.3, 2.1) ** – 1.6 (0.6, 3.9) 1 1.4 (0.5, 3.7) 1 2.0 (0.9, 4.4) 1 0.4 (0.1, 2.6)

PR (95% CI)

Snake bite

*P 10–30 years tapper >30 Works an additional job No Yes Tapping hand (missing = 2) One hand Two hands Transport method Not on head On head BMI Underweight (23) Alcohol use (missing = 2) Non-drinker Drinker Depressive symptoms Absent Present

Variable

Frequency

Table 1  Characteristics of study participants and prevalence ratio of reporting an injury by covariates (n = 300)

1 0.7 (0.5, 1.1) 1 0.8 (0.5, 1.3) 0.7 (0.4, 1.4) 1 0.7 (0.4, 1.0)* 1 0.7 (0.5, 1.1) 0.6 (0.4, 1.1) 1 2.2 (1.5, 3.3)* 1 0.8 (0.5, 1.3) 1 0.9 (0.4, 2.0) 0.7 (0.4, 1.2) 1 0.8 (0.5, 1.3) 1 1.4 (0.9, 2.0) 1 0.9 (0.4, 1.7)

PR (95% CI)

Knife cut

1 1.9 (1.1, 3.6)* ** – – 1 0.8 (0.5, 1.4) 1 1.1 (0.6, 2.0) 1.4 (0.7, 2.7) 1 1.4 (0.8, 2.3) 1 0.6 (0.3, 1.2) 1 1.0 (0.4, 3.0) 0.9 (0.5, 1.8) 1 1.7 (0.9, 3.0) 1 0.8 (0.4, 1.5) 1 2.3 (1.3, 4.1)*

PR (95% CI)

Falls

Stankevitz et al.  Prevalence of occupational injury and its contributing factors

Stankevitz et al.  Prevalence of occupational injury and its contributing factors

Table 2  Number* of injuries and days missed due to injuries in the last 12 months, (n = 300) Type of injury

Number of injuries

Skin irritation Eye injury Snake bite Knife cut Fall Overall

176 107 26 182 103 594

Days missed due to injuries 88 73 195 347 377 1080

Average number of days missed per injury 0.5 0.7 7.5 1.9 3.7 1.8

% of injured who saw a doctor 69 58 100 74 63 71

*Participants were allowed to report more than one occurrence of the same injury in the last 12 months.

was associated with a significantly lower prevalence of injury (PR = 0.8). Furthermore, the prevalence of injury decreased as the number of years worked increased, although this association was not statistically significant. We also examined covariates and their relation to individual injury types. Factors associated with occupational injuries varied greatly by injury type.

Qualitative results

In response to the question, “What else would you like to tell us about injuries you experienced while at work?,” two main themes emerged: causes of injury and consequences of injury. Coded responses were characterized in subcategories representing these categories.

Causes of injury

The first category, “causes of the injury,” consisted of environmental factors, job tasks, and personal factors associated with the injury event. Uneven, steep, or slippery ground was a frequently cited cause of injury; “I suffered a blunt force injury after my foot fell into a hole” and “… the rubber lands were slippery and I fell down and hit my neck.” Participants also injured themselves while trying to avoid animals or other hazards: “I became frightened of a snake on the rubber land … and when I was running I fell down and broke my knee.” “When I was collecting latex a branch from one of the trees fell down. I tried to dodge it and dislocated my ankle.” Two job tasks were cited as the primary causes of injury. Falls often occur while transporting latex; “I fell down while carrying the latex bucket and injured my leg. I was hospitalized for three days.” “I fell down with the latex bucket but couldn’t get treatment.” Furthermore, eye irritation was attributed to tapping above the head, which can cause latex to drip into the eyes. “When I do upper tapping (tapping above the head), I get latex in my eyes. This happens about once a week. It makes it difficult to do my job.” Some participants reported personal factors they associated with the cause of the injury. Bad eyesight was a common complaint, although it wasn’t directly linked to specific injury events. Long-term chronic conditions were also associated with injuries by respondents: “I have knee problems. Because of that, I fall a lot.”

Consequences of injury

Both short- and long-term consequences of injury were reported. The most commonly cited consequence of injury 

was missed work. This was often accompanied by other consequences including loss of income. One tapper said “I missed 68 days [because of my injury] but only got compensated for 5.” Loss of income was associated with additional consequences including not being able to pay for a child’s education, or not paying for a child’s medicine, although these consequences were not commonly mentioned. “I have back pain and could not work for one week so had no pay … My child has a throat problem but [after my injury] I didn’t have money to get medicine.” Further short-term consequences included stitches and hospitalization. “I fell down while working and injured my backbone. For three months, I was hospitalized and had one additional month of bed rest.” “I cut my hand while tapping and had to get 21 stitches. Because of that, I couldn’t use two of my fingers for 6 months.” Long-term consequences were often more serious. The most frequently mentioned long-term consequence was difficulty working. “I fell down and hit my neck. Now I can’t bend [my neck] forward or sideways. This is a barrier to working.” “I cannot look up to tap the higher trees.” Chronic pain from prior injuries was also associated with difficulty working. “I fell down and now I have back pain. I have to rest in between tapping because of the pain,” and “I fell down and slipped at work causing a blunt force injury to my neck. The pain is so much that I cannot carry the latex on my head and must skip work.” Some tappers reported more serious, but less common, consequences. Two tappers stated that latex dripping into their eyes had caused them to lose eyesight in one eye. One tapper said: “Because I got latex in my eyes, my eyesight is very bad. I can’t see out of one eye … No one will hire me for another job because of the [bad eyesight in] one eye.” One woman fell while walking on uneven rubber lands while pregnant and lost her child. “Ten years ago, I was pregnant and fell down in the rubber lands. I lost my child and was hospitalized for 16 days.”

Barriers to work

Workers were asked: “What are the largest barriers you face to doing your job?” Participants were allowed to give more than one answer. Responses from 42 tappers were coded and categorized into three main categories: physical, work related, and home related, shown in Table 3. Physical barriers were the most common, with 22 participants mentioning pain as one of the main barriers to

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Table 3  Participant responses to the question: “What are the largest barriers you face to doing your job?” (n = 42) Barrier type Physical

Work

Home

Barrier Pain Leeches Poor eyesight Mosquitoes Overgrowth/lack of landscaping Snakes Distance to carry latex is too far Lack of uniform Salary too low/can’t work during rain Too hard Too much work at home

Responses citing barrier (n) 22 14 11 9 8

52.4 33.3 26.2 21.4 19.0

4 6

9.5 14.3

4 3

9.5 7.1

2 2

4.8 4.8

work. Examples include: “When I’m doing low cut, I have back pain.” “I have leg pain, so I cannot carry latex.” Leeches, which are abundant in rubber fields and cause bleeding and annoyance, were also commonly mentioned. Eleven workers suggested poor eyesight was a barrier. Many workers provided insight into the importance of good eyesight for both personal protection and protection of the trees. If the incision in the tree is too deep, it can cause permanent damage and prevent the tree from producing latex. While observing the tapping procedure, researchers estimated approximately 5% of trees did not produce latex because of such damage. Furthermore, workers who cannot see well are more likely to cut their fingers while tapping. Tappers said: “Tappers need good eyesight to not harm the tree and make a clear cut, but also to not cut your fingers.” Work-related barriers were also common. Many workers stated that the distance they were made to carry the collected latex was too far. “I have to walk too much because I am doing two blocks. So I am always very tired.” Tappers also stated that their salary was too low. Lastly, workers stated that there was too much work at home, which made it difficult to come to work. “I am a widow and have a child. I have a lot of work at home so it is hard to come and do my job.”

Discussion

The current study provides a baseline for injury prevalence on rubber plantations in Sri Lanka, an investigation of factors associated with more common injury types, and an analysis of the workers’ perceived causes and consequences of injuries and barriers to work. Rubber tapping requires workers to transport heavy loads, navigate steep terrain and work with sharp tools, putting them at risk for occupational injuries. This study found the 12-month prevalence of injuries on rubber plantations to be 49%. This is more than three times higher than the estimated rates of occupational injury in the country as a whole: in 2006 researchers estimated that 13.9% of Sri Lankan workers suffered an occupational injury.3 A

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Responses citing barrier (%)

Participants citing theme (n)

Participant citing theme (%)

36

85.7

10

23.8

2

4.8

similar 12-month prevalence of injury as found in this study was reported on Indian tea plantations (53%), yet most studies report prevalence of agricultural injury from 9 to 14%.21,22,36−39 These differences may be due to differing methodologies in injury inclusion. The qualitative analysis suggests many factors may contribute to occupational injuries. Rubber tappers navigate rough, overgrown land to do their jobs. In short answer responses, tappers frequently attributed the lack of landscaping to injuries including falls and knife cuts. Uneven land causes tappers to trip on roots, fall into holes, and stumble. As tappers transport their tapping knifes with the blade exposed, this can result in knife cuts to the arms and legs. High grass and hazardous overgrowth can also conceal snakes and other animals. A study on sugarcane plantations in the Democratic Republic of Congo, found that more than half of the snake bites occurred during the rainy season, when undergrowth and grass are the highest.40 Expectedly, the data show that lack of landscaping is a major impediment to work, with 19% of tappers stating that it was one of the largest barriers to doing their job. Despite the fact that no workers reported use of closed toed shoes, gloves, or eye protection, lack of PPE was not mentioned as a barrier to work. This could reflect that rubber tappers are not aware of the uses of PPE. However, studies suggest PPE can improve safety in occupational settings. A study on Thai rubber plantations found that the cost of knife cuts, eye injuries, and stumbles were reduced by 93% after implementing the use the PPE, among other injury interventions.41 Qualitative responses about the causes of injuries suggest that eye protection could help prevent rubber from dripping into the eyes during upper tapping. Furthermore, high, closed toed boots could provide better stability to prevent falls, and provide a layer of protection against snakes and leeches. Another important barrier rubber tappers face in their work is poor vision. Vision is important for tappers to prevent damage to the tree, and avoid cutting themselves while tapping. Over a quarter of short answer responses (26.2%) mentioned poor vision as one of the main barriers to work.

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The average age in the sample was 46, with a maximum age of 89 – suggesting many workers are middle aged or older. As workers age, vision may become worse, exacerbating this issue. Many studies have linked poor vision to increased prevalence of injuries, including falls agricultural injuries and transport injuries.21,40−42 Recently, provision of single-vision eyeglasses has been shown to reduce the risk of falls.43 Such a program could help to make rubber tapping safer, as well as prevent damage to trees, benefiting both the tapper, and the plantation as a whole. These results suggest that three interventions could address many injuries: (1) landscaping of rubber lands, (2) use of safety glasses and closed toed shoes, and (3) provision of eyeglasses for those with impaired vision. With 1,080 days of work missed in our study participants due to injury in the past year, both rubber tappers and management alike should be incentivized to improve these conditions. If implemented in a coordinated fashion by plantation management and workers, these interventions could help improve safety and prevent injuries on rubber plantations.

Strengths and limitations

This study was the first to examine Sri Lankan rubber tappers, and characterize the injuries they experience at work. It employed both qualitative and quantitative methods to provide a descriptive analysis of the injury experience of these workers. Recommendations were provided based both on quantitative findings and workers’ own perceptions and narratives. However, some limitations must be realized when interpreting these results. Study limitations are as follows. First, the cross-sectional design of the study makes it difficult to comment on the direction of causation for many associations. A longitudinal study should be conducted. Secondly, the use of convenience sampling could add sampling bias. Random sampling was not employed, as contact lists were not available for workers, making it unfeasible. Therefore, subjects were limited to those who worked on the days we collected data and were willing to stay after work to participate. Third, the study sample was taken from the southern province of Sri Lanka. While our population was a mix of both Tamil and Sinhalese, many other plantations on the island employ almost solely Tamil workers. This difference in demographics, as well as the differing landscapes throughout the country, suggests that caution must be made when generalizing results to the rest of Sri Lanka.

Conclusion

This study demonstrates the high rate of occupational injury encountered by rubber tappers in the estate sector of Sri Lanka. Qualitative results provided insight into the causes and consequences of injuries on plantations. Injury risk is increased by hazardous terrain in rubber fields, lack of PPE, and poor vision. In the event of an injury, 

rubber tappers face loss of income and sometimes develop chronic pain that can affect their ability to tap trees and transport latex. These consequences highlight the importance of including workers holding jobs in the estate sector in Sri Lankan occupational health and safety regulations. Furthermore, results show that three main interventions could be employed to address the causes of injuries and improve worker health and safety.

Acknowledgments The authors thank the participants for their contribution to this research, and the plantation managers for their support in conducting this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This work was financially supported by the Duke Global Health Institute.

ORCID Kayla Stankevitz   http://orcid.org/0000-0002-9779-7014 Ashley Schoenfisch    http://orcid.org/0000-0003-41144687 Marissa Stroo   http://orcid.org/0000-0003-2796-6457 Truls Ostbye   http://orcid.org/0000-0002-0662-7440

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International Journal of Occupational and Environmental Health   2016  VOL. 22  

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Prevalence of occupational injury and its contributing factors among rubber tappers in Galle, Sri Lanka.

Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury amon...
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