Comparative statistical records on fatalities in fisheries around the globe put fishing as one of the most dangerous jobs ahead of driving, fire fighting, policing and others who ply their work on land and remains history’s most dangerous occupation.1 Globally, it is estimated that 24,000 fatalities occur in the fisheries industry annually. In coastal countries of West Africa, artisanal canoe fatality rates range from 300 to 1000 per 100,000 fishermen. In Nordic countries where there is evidence of best practices regarding accident prevention, survival training, search and rescue services, fatality rates still persist between 90 and 150 per 100,000 people. This underscores the likelihood of under estimation of fisheries fatalities in countries where there are no data.2,3
Reports of non fatal injuries are rather too common in spite of evidence of under reporting attributable to paucity of and unsatisfactory documentation from several countries of the world.4,5 Apart from the vast evidence of fatalities and injuries among workers in the fisheries industry, ocular injuries, most of which are sight threatening, have been specifically cited.6-8 These injuries are commonly associated with the hazardous working environment in most fisheries which include the use of fishing hooks, lures, weights, biofuels and excessive reflection of extraneous sun rays.6,7 The specificity and diversity of hazards, depending considerably on geographical-climate and cultural factors, make the differentiation of problems and solutions important in different zones of fishing.
Ghana has a marine coastline of 550 km, which extends from Aflao in the East to Half Assini in the West; the fishing industry serves as a source of livelihood for some 10% of Ghanaians.9 The sector has seen a decline in its contribution to the Nation’s gross domestic product (GDP) over the past decade. It is estimated to contribute some 1.5% of the Agriculture GDP (GSS, 2013 Budget).10 Most fish consumed in Ghana comes from the marine fishing industry and it remains the favorite and cheapest source of animal protein with about 75 per cent of total annual production being consumed domestically.11,12 An average of 500,000 fishermen, fish processors, traders and boat builders are employed in the fishing industry.13 A canoe census conducted for the marine fisheries estimated the number of artisanal fishermen at 124,000.14 Artisanal fishing involves the use of dugout canoes propelled by outboard motors. Ghana’s coastline stretches along the Atlantic Ocean providing rich grounds for artisanal marine fishing.3 The Central Region has long been noted as a fishing hub.15 Historical records trace the subsistence of the fishing industry in the Central Region as early as 1471,15 operating in household-based entities and utilizing small vessels. Notwithstanding the importance of the fishing industry to the overall economy and nutritional needs of the country, players within the industry are exposed to several workplace hazards with long term consequence for their health especially their eye health. Recent data from the International Labor Organization (ILO) and the World Health Organization (WHO) indicate that overall occupational accident and disease rates are slowly declining in most industrialized countries,16 but are on level or increasing in developing countries.
Generally, there are several hazards associated with the fishing industry but those that directly pose threats to the eye as outlined in the literature include dust/sand, plants, chemicals, decomposing leaves, micro-organisms in the fishing environment, smoke, radiations and heat, equipments and machines with sharp and pointed edges.17 It has been noted that there is a dearth of information on the potential effect of such exposures on the eyes of workers of the fishing industry mainly fishermen and fishmongers. We therefore sought to evaluate the correlations between these hazards and ocular disorder in the fishing industry of Ghana.
Materials and Methods
The Central Region of Ghana has the widest continental shelf and the longest coastline of 150km spanning eight (8) coastal districts18 (Figure 1). There are 43 coastal towns and villages from Gomoa Nyanyano in the East to Kafodzidzi in the West with a total of 103 landing sites. The two main types of marine fishing are; artisanal or Canoe Fisheries and inshore Fisheries. There are 46,513 artisanal fishermen working with 4675 canoes as against 1500 inshore fishermen operating over 100 inshore motor fishing vessels. The fishermen in the region dock about 36% of the Nation’s fish production.19 These include some exportable species of marketable value such as: lobsters, squids and octopuses, shrimps, soles, sea breams, mackerels, groupers, skipjack tunas, yellow fin tunas, round and flat sardinellas and sailfish.19
Multi-stage random sampling was employed. Four out of the eight coastal districts were randomly selected of which a fishing town or villages each was also randomly selected (Figure 1). In each of the four fishing towns or villages, two landing sites were randomly selected. A register of fishers /fishermen and fishmongers for each chosen landing site was then obtained from the chief fishermen and the queen fishmongers as per their records. A total of 683 (involving 358 fishmongers and 325 fishers) people within these four major communities were sampled. The minimum sample size for the survey was determined as quoted by Glenn using the formula developed by Cochran (1963).20 The minimum sample size computed was 374. However, the sample size was adjusted to 683 to include 358 fishmongers and 325 fishers to reduce the incidence of reporting false positive responses.
Subject selection/data collection procedure
The subjects were systematically selected (every nth person) based on the number of participants needed for that area for interview using a pretested interview-based questionnaire and subsequent routine ophthalmic examination (external and internal eye exams) by four experienced optometrists, ODs.
The study participants included fishers/fishermen and fishmongers who had been engaged in the fishing industry not less than 3 years and were aged 18 years and older at the time of the study. All fishers/fishermen or fishmongers who had other part time engagements outside of the fishing industry were excluded.
Data analysis procedure
Data collected was analyzed using SPSS version 19 (Statistical Package for Social Sciences) and reported as frequency tables, percentage tables, bar charts and cross tabulation. Goodness of fit-test was calculated to compare the frequency levels between fishmongers and fishermen. Chi-square model was performed to measure the association between categorical variables. Multivariate logistic regression was also conducted to measure the predictive ability of the independent variable (hazards) to the dependent variables (prevalent ocular diseases and symptoms). The alpha level was set at P=0.05, thus association existed between categorical variables when P≤0.05.
The research was done according to the Helsinki Declaration on Research Regarding Human Subjects. A detailed rationale for the study was given to respondents, after which respondents signed a consent form or verbal consent depending on their educational background. Confidentiality was ensured and a forum was organized to educate participants on basic safety measures regarding their workplace. Those with ocular disorders were treated and some referred to eye clinics for further attention.
A total of 683 participants comprising 325 fishers and 358 fishmongers were interviewed and examined in this study. All the participating fishers/fishermen were males while 354females and 4 males were fishmongers. Majority of the fishmongers (181, 51.0%) and fishermen (158, 48.8%) were in the age range of 36-59 years (adult). Those aged between 18 and 35 (Youth) were 102 (28.7%) for fishmongers and 126 (38.9%) for fishermen and those aged 60 and older were 72 (20.3%) for fishmongers and 40 (12.3%) for fishermen. Goodness of fit test showed no significant difference (P=0.236) between the total participants of fishers/fishermen and fishmongers. The results indicated that the majority of the fishermen and fishmongers had no form of formal education and only one person each among the fishermen and fishmongers had had tertiary education. The most frequent income range for both fishermen and fishmongers was GH 1000-1999 (US$ 350-699) and the least number of the respondents had an income range of GH 4000-4999 (US$ 1400-1749) (Table 1).
There were 623 and 717 responses (due to multiple responses) to ocular hazards identified at the workplace by fishermen and fishmongers respectively. Sun rays was the main ocular hazard reported among the fishermen (299, 36.8%). The fishmongers on the other hand, reported smoke 357 (49.8%) as the main ocular hazard (Table 2).
Ocular symptoms after exposure to hazards
Ocular symptoms after exposure to hazards during smoking of fish by fishmongers indicated 1126 responses (due to multiple responses) with irritation of the eyes being the highest and redness being the least. The most prevalent symptom among fishmongers included photophobia, 222 (62.2%), 217 (60.8%) complaints of burry distance vision, 201 (56.3%) complaints of tearing, 154 (43.1%) complaints of ocular pain, 143 (51.3%) complaints of burning sensation. Ocular symptoms after exposure to hazards during fishing by fishermen indicated 997 responses with blurry distance vision being the highest 273 (72.70%). The others were irritation 138 (61.1%), gritty sensations 232 (71.2%), ocular pains 162 (49.7%), photophobia 211 (64.7%) and tearing 225 (78.2%) (Table 3).
Players within the fishing industry were more prone to suffer ocular irritation (P<0.001) than burning sensation. There was significant association between ocular irritation and some identified workplace hazards such as smoke (P=0.001), heat (P=0.002), dust/sand (P=0.047) and seawater (P=0.016). Complaints of ocular pain were found to be associated with workplace hazards such as sunrays (P=0.001), heat (P<0.001) and smoke (P=0.047), Gritty sensation, tearing and photophobia were associated with sunrays (P≤0.001, 0.015, 0.000). Photophobia was also associated with seawater (P=0.000).
Anterior segment eye examination
Anterior segment eye examination using a handheld slitlamp revealed pterygium was the most prevalent ocular surface disorder and trichiasis the least prevalent. The total number of cases (abnormalities detected) was 396 among the fishermen but 501 among the fishmongers (Figure 2).
There was association between some workplace hazards experienced by fishmongers such as sunrays (P=0.042) and heat (P=0.001) and pterygium but there was no such association between hazards and pterygium among fishermen. Multivariate logistic regression between workplace hazards indicated that exposure to heat was a very significant factor associated pterygium among fishmongers (Table 4).
Internal eye examination
Direct ophthalmoscopic examination revealed 169 posterior segment disorders among the fishermen, 66 (39.1%) were glaucoma suspects, 53 (31.4%) had cataract, 32 (18.9%) had other posterior segment diseases like retinal degeneration, retinal scars and other retinal disorders, 8 (4.7%) had retinopathies, 5 (3.0%) had toxoplasmosis scar, 3 (1.8%) had optic atrophy and 2 (1.2%) had maculopathies. Fishmongers on the other hand had 213 posterior segment disorders. Ninety-nine (46.5%) had cataract, 49 (23.0%) were glaucoma suspects, 48 (22.5%) had other posterior segment diseases like retinal degeneration, retinal scar and other retinal disorders, 5 (2.3%) had retinopathies, 4 (1.9%) had maculopathies and toxoplasmosis scar, 2 (0.9%) had optic atrophy and posterior uveitis. No association was found between any of the workplace hazards and suspicion of glaucoma among fishermen and fishmongers, nevertheless, exposure to seawater was found to be associated with the development of cataract (P=0.022) among fishermen. Cataract among fishmongers was associated with exposure to heat (P=0.005), sunrays (P=0.035) and dust (P=0.002).
The study employed multi-stage random sampling which was most suitable since the communities studied were diverse (8 coastal districts with 43 coastal towns and villages and a total of 103 landing sites) in a bid to ensure representativeness.21 The male dominance in fishing has long been documented as it is deemed as a risk prone and adventurous task reserved for the males while females are more often than not discouraged and excluded.22 However, fish mongering is an agricultural processing activity known to involve both males and females.23 In Africa, market systems are customarily seen as compatible with the female gender’s role as housekeepers and caregivers hence the few men (1.2%) involved in these post-harvesting activities of the fishing industry.24
A greater proportion of fisher folks were illiterates with nearly half of the fishmongers (47.5%) having no formal education at all. Recent studies have highlighted this high proportion of illiteracy among fishing communities in Africa with Females being the most affected. This phenomenon is attributable to the remote locations, marginalization and mobility of most fishing communities affecting access to education and even health.25-31 Their reported income levels, though only one of the various indices for the determination of socioeconomic status,32,33 were generally low especially among fishmongers who were predominantly females. It is common knowledge that poverty is prevalent among artisanal fisheries of which Ghana is no exception.34 The adult population dominating the fishing industry presupposes that they are in their active age and need to earn to keep their homes. The arduous nature of the work also favors the active working population.
Due to the ubiquity of hazards in the fishing industry, fishing has been tagged as one of the most dangerous occupations in the world.35-37 At the same time, those involved in the processing of the fish are also not spared. The top three most common hazards among the fishermen were sunlight, seawater and dust/sand. These have been reported as major eye health risks among fishermen.38,39 Half of the reports from the fishmongers identified exposure to smoke as the single most important ocular hazard at their workplace due the use of biofuel (i.e. fire wood).40 Excessive heat was also found to be a worrisome hazard among fishmongers. The most prevalent complaint of ocular irritation was found to be associated with exposure to hazards such as smoke, heat, dust/sand and seawater.39-41 Other ocular complaints associated with workplace hazards were ocular pain, gritty sensation, photophobia and tearing which are mostly symptoms of conjunctivitis.42 Conjunctivitis was the second most prevalent ocular surface disease after pterygium. Pterygium was the most prevalent ocular surface disorder and was found to be associated with exposure to smoke and heat which are the two most common hazards encountered by fishmongers relative to fishermen. Fishmongers, most of whom are predominantly women, are frequently exposed to biofuels, mainly firewood and charcoal, which have been implicated in adverse consequences to the human eye.40,43 The continuous use of biofuel in poor communities such as fishing communities has been observed despite its decline in use on the global scene.44,45 Multivariate logistic regression indicated heat as the single most important predictor of developing pterygium (P=0.003). Other studies elsewhere have indicated a high prevalence of pterygium among agricultural workers due to exposure to heat. The linkage between heat and the pathogenesis of pterygium has been predicted previously.40,46
The association between cataract and some workplace hazards in the fisheries sector was implied but has been difficult to establish. Epidemiologists were unable to establish a simple realistic causal model for cataract because each risk factor could be a component cause.47 The multiple risk factors of the workplace environment including heat, sunrays, and dust/sand may wholly or partly be involved in the pathogenesis of age-related cataract commonly found among fishmongers.41,48 The seawater is said to be a good reflector of sunlight and may be indirectly involved in causing cataract among fishermen.38 This study highlights the fact that the continuous engagement in fishing and post harvest activities as an occupation exposes workers to potential risks which have implications for their eye health.49 It is worthy to note that several of these risk factors are manageable through the use of protective eye wears, photoprotective lenses, and re-orientation of fishers and fishmongers on modern fish processing methods. It is therefore recommended that these fishers and fishmongers be educated on safety practices and provision of first aid kits and adequate training be implemented by stakeholders in the fisheries industry.