Date of Award

12-2024

Degree Type

Thesis

Degree Name

MS in Public Health

First Advisor

Dr Asaad Nafees

Second Advisor

Dr Muhammad Asim

Third Advisor

Dr Hira Tariq

Department

Community Health Sciences

Abstract

Background: Stone workers are particularly vulnerable to silicosis due to persistent exposure to crystalline silica dust. There is a high burden of silicosis in low- and middle-income countries however, limited data is available from Pakistan. The stone-cutting industry in Karachi is thought to employ tens of thousands workers, however no studies could be found on their occupational health issues and the experience of healthcare providers in dealing with such conditions. This study aims to document the landscape of stone cutting work and map the high-risk populations in Karachi. Additionally, this study will help us understand the perceptions of stone cutting workers and stakeholders regarding the health effects that are associated with silica dust exposure; as well as the experiences and familiarity of healthcare providers in dealing with silicosis.
Methods: This qualitative exploratory study was conducted in Karachi, Pakistan, between June 2024 to September 2024. This study included geographic mapping to recognize areas with high-risk population of workers exposed to silica. The study included 20 in-depth interviews with stone workers using semi-structured interview guide to gather insights about their health concerns while working. Moreover, 10 in-depth interviews were conducted with healthcare providers (general health care providers, pulmonologists and radiologists) to understand their familiarity with silicosis and the challenges faced in diagnosis, management of this disease; and four key informant interviews were conducted with the representative from the labor department, chairperson of the stone cutting union, and an employer to explore the policy perspective.
Results: This study mapped the high-risk areas throughout Karachi, and it was noted that the workshops are spread in Karachi West, Korangi, and Karachi South, with the highest density of operations taking place in Karachi West. This study also applied the constructs of health belief model. Within the construct of perceived susceptibility, it was thought that workers with less experience were vulnerable to respiratory symptoms. Some also identified different stones to have different health risks, with artificial stone being more hazardous. However, the health care providers lacked adequate experience in diagnosing and managing the disease. Perceived Severity showed that workers often prioritized physical injury over respiratory symptoms and iv relied more on symptomatic treatment rather than preventive care. The workers also correctly identified high risk tasks. Within the construct of perceived benefits reveled mixed opinions on the benefit of PPE. Perceived barriers included difficulties with the use of PPE use due to discomfort and financial constraints. Financial constraints also came out to be the reason for limited heath seeking behavior. Cues to action highlighted the role of employer support in the use of PPE. Within the theme of self-efficacy it was noted that the workers were confident in self managing their symptoms through self-medication or home remedies. Some of the health The study found that stone cutting workers in Karachi were scattered across different areas and they were generally aware of the hazards of silica dust exposure, although there were several misconceptions. Financial limitation and physical discomfort were identified as potential barriers to the use of PPE while employer support was thought to be crucial in ensuring its adoption. Physicians expressed the need to enhance their capacity for the diagnosis and management of silicosis. The study identifies the need for robust scientific studies in the future to address the burden of silicosis and its risk factors in Karachi. The study also offers key recommendations: policy makers and stakeholders can strengthen advisory services, establish a surveillance system for early detection and conduct awareness sessions to promote safe practices and proactive health seeking behavior. Educational programs can be paired with enforcement mechanisms such as safety audits and penalties for non-compliance. It is also important to equip health care providers near the locality with necessary information and skills as they are the primary point of contact for many workers.
Conclusion: Stone workers in Karachi were aware of silica hazards but had misconceptions and financial barriers to PPE use. Employer support was crucial for safety practices. Physicians faced challenges in diagnosing silicosis, highlighting the need for better training. Based on the Health Belief Model, perceived susceptibility was high, but perceived severity and benefits of prevention were not well understood. The study calls for robust research, surveillance systems, awareness programs, enforcement of safety measures, and improved healthcare provider training to enhance early detection and worker protection.

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Last Page

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