Epidemiological Profile of Dermatosis among Automobile Repair and Maintenance Garages in the City of Parakou in 2020 ()
1. Introduction
One of the most important distinctions made by the International Labor Organization (ILO) are diseases resulting from work-related exposure, such as cancers, and diseases affecting functions and organs, such as dermatosis [1]. Occupational dermatosis, in this case, is very common in workplaces. They are still relevant in spite of prevention actions [2]. Their incidence has increased in recent years due to industrial development, incorporating new materials in the work, synthesis of chemical substances for production, inappropriate use of cleaning products, and insufficient training of workers in preventive measures, with particular emphasis on general and individual hygiene. These pathologies are encountered in worksites around the world. Clinical aspects are diverse [3]. In France, occupational dermatosis accounts for more than 50% of occupational diseases and made up about 10% of skin diseases by 2005 [2]. In Tunisia, the annual incidence of occupational allergic contact dermatitis was estimated at 32 cases per 100,000 workers between 2002 and 2012 [3]. In Morocco (2000), the prevalence of occupational dermatosis was 84.70% among mechanics in garages [4]. There are many different sectors of activity that can cause occupational dermatosis. Automotive repair and maintenance is one of them. It mobilizes various skills (mechanics, bodyworkers, painters, electricians, welders, vulcanizers, and refrigeration technicians) gathered in a functional entity that is the car garage. Like any other sector of activity, it is full of risk factors for dermatosis. And these factors are constantly changing [4]. They can be physical, chemical and/or infectious. In Benin, the repair and maintenance of automobiles has grown spectacularly in the last two decades due to the increasing number of imported second-hand vehicles (cars, buses, trucks). Several thousand of these vehicles are imported and released on road each year [5] [6]. Given the involvement of different categories of workers and especially the handling of various products, it seemed necessary to conduct a study to investigate and to determine the epidemiological profile of dermatosis among automobile repair and maintenance garages in Parakou.
2. Study Design
This was a cross-sectional and descriptive study done from April 20 to May 17, 2020. It focused on car repair and maintenance garages in the city of Parakou. The study included all garage owners present in their garage during the collection period who gave their free and informed consent to participate. It was a non-probability sampling by exhaustive census of garage owners. Data collection was done by means of a questionnaire which includes 42 items (see Annex) developed by ourselves during a face-to-face interview with the respondent, a dermatological examination of those found to have any skin lesions, and observation of the worksites. The dermatological examination was performed by a skin specialist without paraclinical examination. The variables studied were dermatological lesions, sociodemographic features (age, sex, nationality, ethnicity, level of education), occupational features (category, work position, seniority), dermatological history, and dermatosis risk factors (substances handled, microtrauma). The data collected were processed and analyzed using Epi Info software version 7.2.2.1.
3. Results
A total of 358 people were surveyed out of 365 contacted, for a participation rate of 98.08%. There were two females and 356 males, giving a sex ratio (male/female) of 178. The mean age of the respondents was 25.80 ± 10.22 years. Youngests were 10 years old and the oldest were 61 years old. There were 56.43% in the 14 - 25 age group, 2.51% less than 14 years old and 61.22% less than 5 years in the business. Mechanics constituted 65.64% of the sample. In this sample, 95.81% had frequent skin contact with fuels, 84.08% had contact with motor oils and 15.92% had contact with dilute battery electrolyte solutions. With bare hands, 100%) handled rubber, 95.53% handled glues and/or sealants and 22.91% paint. All of them had suffered at least one micro trauma to their skin. The remaining socio-professional features are shown in Table 1. Overall, 263 subjects had dermatosis, i.e., 73.46%. Mechanics were affected by all types of dermatosis diagnosed (see Table 2). About 121 (33.80%) of the respondents had dermatological lesions at the beginning of their activity of repair and maintenance of automobiles. In 237 (66.20%), the dermatosis had occurred during exercise. Of all the dermatosis found on the subjects, keratoderma came first with 80.01%. Figure 1 and Figure 2 illustrate the type of keratoderma that affected the respondents, particularly the mechanics. In the mechanics’ corporation, 84.89% suffered from keratoderma, 73.33% from contact eczema and 53.33% from inflammatory dermatosis (see Table 3). The hands and wrists were the body sites of 47.35% of the dermatological lesions. Keratoderma was located more frequently (85.6%) on the hands and wrist, while inflammatory dermatoses were found in 60% of cases on the arm and forearm (Table 4).
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Table 1. Distribution of respondents by age, seniority, occupation and risk factors, Parakou,2020(N = 358).
*: Radiator unclogger; automatic transmission specialist.
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Table 2. Distribution of respondents according to the time of occurrence of dermatosis, Parakou, 2020.
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Figure 1. Palmoplantar keratoderma fissure in a garage mechanic, Parakou 2020.
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Figure 2 . Irritation dermatitis of the right hand in an electrician mechanic, Parakou 2020.
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Table 3. Distribution of dermatosis types according to the professional activity in the garage, Parakou, 2020.
*Others: Vulcanizer, refrigeration specialist.
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Table 4. Distribution of respondents depending on the location of the dermatological lesions, Parakou, 2020.
4. Discussion
Almost all the respondents were male, with a sex ratio of 178. In a study carried out in Morocco on garage mechanics in 2000, Bichara and colleagues found that 100% of the respondents were male [4]. The average age of our respondents was 25.80 ± 10.22 years. The age group 14 - 25 years was the majority at 56.43%. A French series (2011) conducted by Géraut and colleagues reported a similar age average (34 years) in mechanics and bodywork-painters [7]. In Ivory Coast (2006), Yoboué and al observed that 10- to 25-year-olds (74.20%) predominated among car mechanics in Abidjan [8]. In Morocco, the under 30 years old were the most represented (67.80%) [4]. There is therefore a high number of young people in the automotive repair and maintenance professions in Africa. This is an expression of the gains that can be made from automotive repair. The near absence of women in automotive maintenance and repair is an expression of the physical stamina required for the job. This fact does not deviate from the perception of some African populations that certain occupations are reserved for the male gender. Subjects under 14 years of age represented 2.81% of the sample. However, the minimum age required to learn a trade in Benin is 14 years [9]. This shows that work legislation is not respected in the country. It is the expression of laws that do not really take into account the socio-cultural environment. In Benin, recourse to apprenticeship often occurs after repeated school failures or the inability of parents to ensure the schooling of their children. The very low rate (1.12%) of respondents with a vocational diploma obtained in a training school is indicative. The rate of Moroccan garage workers with a diploma was twice as high (3%) as that of their counterparts in Parakou [4]. Apprentice training in garages is empirical. As a result, bad habits such as washing hands with fuel and not using protective equipment are also acquired. Thus, the vicious circle of today’s bad boss forming tomorrow’s bad boss is perpetuated in all on-the-job training. As the activities in a car garage are diverse, the risk factors are as varied and numerous. Only 8.63% of the subjects had appropriate work clothes. A study done in France showed that in casual welding workshops, the rate of users of personal protective equipment was much higher (46.67%) in 2011 [10]. About three out of four of our respondents had at least one dermatosis. If the research was restricted to the participants’ statements, the frequency of dermatosis would be 15.92%. But on basis of the dermatological examination 73.46% of the respondents were diagnosed. The most affected were mechanics at 84.89% for keratoderma alone. The Moroccan study by Bichara’s team (2000) found a similar frequency (84.70%) among mechanics [4]. This would lead to the conclusion that the working conditions are also similar in the garages of these two African countries. However, in Ivory Coast (2006), according to the study by Yoboué and al [8], 100% of mechanics in Abidjan were affected by these skin diseases. Keratoderma was also found in Moroccan mechanics with a lower frequency of 73.70% [4]. During the observation phase, most of the mechanics’ activities required the manual use of work tools (wrenches, screwdrivers, hammers) resulting in friction with the palms. This contributes to contact eczema, which affected 6.38% of our mechanics. In France, the Crépy study reached a higher frequency of 15% among car mechanics. The low frequency of these dermatosis in black subjects compared to the French (white race) is consistent with Crépy’s hypothesis that the black race is more resistant to irritants [10].
5. Conclusion
Dermatosis due to car repair and maintenance work in Parakou varies. Mechanics are the most affected of all the guilds working in garages. Working conditions and failure to comply with preventive measures are the main causes behind the occurrence of these diseases. It is therefore necessary to undertake studies to assess the level of knowledge of mechanics with regard to the prevention of skin risks related to their work to ensure that they receive appropriate training on the problem.
Annex: Survey Sheet