Occupational Disease and Injury in Malaysia: A Thematic Review of Literature from 2016 to 2021

Awaluddin, S. Maria; Mahjom, Maznieda; Lim, Kuang Kuay; Shawaluddin, Noor Syaqilah; Tuan Lah, Tuan Mohd Amin

doi:https://doi.org/10.1155/2023/1798434

Journal of Environmental and Public Health

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Abstract Introduction Materials and Methods Results Discussion Conclusion Data Availability Ethical Approval Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Review Article | Open Access

Volume 2023 | Article ID 1798434 | https://doi.org/10.1155/2023/1798434

Occupational Disease and Injury in Malaysia: A Thematic Review of Literature from 2016 to 2021

S. Maria Awaluddin,¹Maznieda Mahjom,¹Kuang Kuay Lim,¹Noor Syaqilah Shawaluddin,¹and Tuan Mohd Amin Tuan Lah¹

Academic Editor: Issam A. Al-Khatib

Received15 Jul 2022

Revised25 Oct 2022

Accepted12 Nov 2022

Published31 Jan 2023

Abstract

Introduction. Working people are exposed to occupational hazards and are at risk of having occupational disease or injury in a rapidly industrializing country like Malaysia. This study aims to review and summarize the occupational disease and injury in Malaysia from 2016 to 2021. Methods. This study used PubMed and Scopus databases to conduct a systematic literature search using a set of keywords. The selected records dated from 1 January 2016 to 8 September 2021 were extracted into the Mendeley Desktop and ATLAS.ti 8 software. Systematic screening was conducted by two independent researchers and finalized by the third researcher. Data were coded and grouped according to the themes. The results were presented as the table for descriptive analysis and cross-tabulation between the themes. Results. A total of 120 records were included in this study. Under the theme of main health problems, the findings showed that mental health, infectious disease, and work-related musculoskeletal disorders are the top three problems being discussed in the literature for the working people in Malaysia. The findings also showed an increasing trend of mental health problems during pandemic COVID-19 years. In addition, hospital was the highest workplace where the occupational health problems were reported.Discussion/Conclusion. There was substantial work on the mental health problem, infectious diseases, and work-related musculoskeletal disorders as the main health problem among workers in Malaysia in the past five years. The employers must report any occupational health and injury case to the authority and prompt intervention can be initiated.

1. Introduction

People are exposed to occupational hazards or risks at the workplace which predisposes them to work-related injury or disease [1, 2]. In 2016, almost two million deaths were attributable to occupational risks and accounted for an estimated 2.1% of all deaths and 2.7% of the disease burden worldwide [3]. There are nineteen identified occupational risk factors with the most common factor being exposure to chemical hazards. The newly added occupational risk factor is exposure to long working hours (defined as working ≥55 hours per week) which pairs with the specific health outcomes of ischemic heart disease and stroke [4]. The occupational risks contribute to the total burden of chronic diseases such as 37% of all cases of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease, 11% of asthma, 8% of injuries, 9% of lung cancer, 2% of leukaemia, and 8% of depression [5].

Occupational disease or injury which occurs directly due to the nature of work and workplace environment may reduce workers’ productivity, increase sick leave, and reduce the quality of life [6]. Substantial studies reported the prevalence of occupational disease and work-related disease in their country according to certain types of diseases such as asthma and work-related musculoskeletal disorders (WRMSDs) [7, 8]. Healthcare workers (HCWs) are the group who may exposed with biological hazards at the workplace as mention in previous studies [9, 10]. The International Labour Organisation (ILO) is responsible to compile the list of occupational diseases and classifying them into the disease caused by an agent (chemical, physical, biological) and the diseases according to the target organ (respiratory, skin, musculoskeletal, mental, and behavioural, occupational cancer and other diseases) [11, 12]. A similar classification is being used by the Department of Occupational Safety and Health Malaysia (DOSH) for surveillance data in Malaysia as well as in other countries [13]. Unfortunately, underreporting of occupational disease and injury is a known challenge for the stakeholders in estimating the true burden, worldwide. Taking China as the country with the largest working population of 776 million in 2018, more than 200 million of its workers are exposed to multiple risks including dust, chemicals, and poison, and this number is still underreported [14].

The DOSH published a yearly report on occupational poisoning and disease in Malaysia which shows increasing trends from 454 cases in 2005 to 9860 cases in 2019 [15]. The documentation of occupational disease is important for workers’ compensation due to occupational disease or injury. Besides that, the information is useful for the stakeholders in planning for a preventive program at the national level in line with the healthy workplace campaign [5]. In Malaysia, the highest number of reported cases was recorded in the manufacturing sector and the highest number of diseases was the occupational noise-related hearing disorders [15].

Various studies were conducted concerning the occupational health issues in Malaysia in terms of occupational diseases and specific jobs [16–22], but the summarized literature was not found. Scarce evidence in the literature can summarize the recent occupational disease and injuries in Malaysia, and thus the study aims to review and summarize the occupational diseases and injuries being discussed in Malaysia from 2016 to 2021. Therefore, the underpinning of this paper is to review the occupational disease and work-related issues that have been discussed from the year 2016 to 2021.

2. Materials and Methods

A thematic review uses the basic concept of any systematic literature search by constructing a set of keywords for the initial record search in the established database. The term thematic review was introduced by Clarke and Braun as a process of identifying the important information, assigning a code to see the pattern, and summarizing the final themes [23]. The review process is facilitated by computer software, namely, ATLAS.ti, which was introduced by Dr. Zairul [24].

2.1. Search Strategy

In thematic review, the minimum number of databases required is at least two of the most common databases such as PubMed and Scopus [25]. The final search was conducted on 8 September 2021. The works of literature were searched for the period 1 January 2016 to 8 September 2021. A set of keywords was identified, and the search strings are shown in Table 1.

2.2. Inclusion and Exclusion Criteria

The summarized inclusion and exclusion criteria are shown in Figure 1. Inclusion criteria:(i)Primary research on worked-related disease or injury(ii)Conducted in Malaysia(iii)Focused on standard working age of 15–64 years(iv)Recent 5 years (1 January 2016–8 September 2021)(v)Cross-sectional, case-control studies or cohort(vi)Mentioned prevalence, proportion of occupational disease, or injury Exclusion criteria:(i)Any review articles(ii)Focused on occupational hazard, intervention, or risk assessment without mentioning occupational disease or injury(iii)Articles are written in languages other than English(iv)Articles on review case based on DOSH report

2.3. Screening and Study Selection

The initial metadata of the two databases were exported to Mendeley Desktop for checking a duplicate record. A total of 164 articles were selected for review. Two researchers were assigned to screen the title, abstract, and full-text article, and any disagreement was resolved by the third researcher. Figure 1 shows the details of the screening process. The quality of study was assessed according to the National Heart Lung and Blood Institute guideline for observational cohort and cross-sectional studies [26].

2.4. Data Analysis

All the full-text articles were read by the researchers thoroughly to familiarize themselves with the data. The next step was to assign codes to the important text data followed by searching for themes, reviewing themes, and finally defining and naming the themes as described by Braun and Clarke [27]. A figure of word cloud was generated using ATLAS.ti 8. The descriptive analysis is conducted using Microsoft Excel and Atlas.ti.8 according to themes such as years of publication, main hazard, main health problems, working sector, workplace, occupation, main job title, and industry classification. The main job title was categorized according to the Malaysia Standard Classification of Occupations (MASCO) 2013 while Malaysia Standard Industrial Classification (MSIC) 2008 was used to classify the industry in Malaysia [28, 29].

3. Results

A descriptive analysis was conducted for a total of 120 articles. The quantitative findings are tabulated in Tables 2–4. The majority (65.5%) of the articles were produced by authors from medicine and health, engineering (13.3%), and biomedical (12.5%) fields as shown in Table 2. Approximately, 90.8% of the literature was based on a cross-sectional study design and 65.8% stated the sample of the respondent of more than 150 respondents. Word cloud was generated as shown in Figure 2 and shows the word musculoskeletal as the largest size equivalent to the number of literature.

There were seven sub-themes identified under the theme of main health problems as shown in Table 3. Table 3 also describes other themes such as type of hazards, main job title classification, industry classification, and the specific occupations’ name according to the frequency and percentage. Table 4 shows the cross-tabulation of the main health problem theme with the explanatory themes according to the number of articles. Each of the main health problem theme is explained further in the following qualitative section of in terms of the prevalence of specific health problem.

3.1. Qualitative Section

This section describes the seven main health problems in terms of the findings extracted from this review. All of the findings are summarized in Table 5.

3.1.1. Mental Health Problems

A total of 29 articles discussed mental health problems among workers in Malaysia. Depression, anxiety and stress, emotional exhaustion, burnout, and workplace bullying were involved mainly among HCWs (15/29), while another half of the literature was spared for other occupations such as teachers (3/29) and office and general workers. A study conducted among railway workers found that the mean perceived stress was 18.8 which was above the 14/15 of the normal stress level [30]. Among teachers, the prevalence of depressive, anxiety, and stress symptoms was 43.0%, 68.0%, and 32.3%, respectively [31]. Studies conducted among shift workers in the manufacturing industry reported the problem of sleepiness [32, 33]. In terms of workplace bullying, 39.1% of participants reported ever being bullied in a study conducted by an insurance company among 5000 employees in Malaysia [34]. Workplace bullying was also investigated among HCW and the prevalence was 11.2% in one university hospital [35]. A study focusing on the mental health among intern doctors reported that depression, anxiety, and stress were 26.2%, 39.9%, and 29.7%, respectively, in a multi-hospital but a higher prevalence was noted in a study conducted in a single hospital [36, 37]. A study conducted by Abd Ghaffar et al. found that female gender and having depression were associated with lower quality of life among intern doctors [38]. The prevalence of burnout among all HCWs regardless of their specific occupation varies from 15.9% to 17.5% [39, 40] before the pandemic era, while a study conducted during the pandemic era showed that more than half of surveyed respondents reported burnout [41]. The contributing factors were higher works demands and fear of frequent exposure to COVID-19 patients [41, 42].

3.1.2. Infectious Diseases

Infectious diseases among workers are best described according to the workplace environment or those who had contact with the biological hazard. Most of the literature provided the laboratory confirmation test of each biological hazard in their studies. The commonest occupational infectious disease in Malaysia is leptospirosis which can occur in animal farms, forests, palm oil plantations, wet markets, and municipal areas [43–49]. Many other infectious diseases are related to migrant workers who were detected having hydatid disease, blastocysts, entamoeba infections, Giardia duodenalis, worm infestations, and Toxoplasma infection. The prevalence of hydatid disease was 13.6% and 55.3% for leishmaniasis among the migrant worker respondents [50, 51]. A case of malaria was reported in Sabah from an immigrant rubber taper which caused the falciparum malaria outbreak in 2012 [52]. Besides that, migrant food handlers were reported as carriers of non-typhoidal Salmonella and practice poor hygiene practices that may cause food contamination by the pathogens [53, 54].

The recent literature discussing the COVID-19 pandemic put the HCWs at risk of COVID-19 infection. At the beginning of the pandemic, the rate of infections among HCWs was relatively low, except in a study conducted in Hospital Teluk Intan which caused the temporary closure of a few departments [55].

3.1.3. Work-Related Musculoskeletal Disorders (WRMSDs)

WRMSDs may cause problems among the workers who need to use physical strength during working or in the sedentary group. It can be the hand-arm vibration syndrome and pain in a specific body part such as the neck, back, shoulder, and knee or any other body part which can be grouped as a musculoskeletal disorder. Studies conducted among hand-held grass-cutting workers and tyre shop workers highlighted the hand-arm vibration syndrome [21, 56, 57]. In terms of pain to the specific body part, low back pain was among the common problems and various studies reported the prevalence among HCWs: nurses (73.1%–76.5%), ambulance drivers (65.0%), and intern doctors (19.8%) [58–61]. Studies among dentists and dental auxiliaries reported upper back pain which involved the neck region [62, 63].

Various studies were conducted among teachers and noted the similar problems of WRMSD involving the lower back, neck, and shoulder [17, 64–66]. Besides HCWs and teachers, a study among commercial vehicle drivers also reported the prevalence of low back pain at 66.4% [67]. Those who worked in a factory were exposed to MSD due to ergonomic factors such as repetitive activities [68–70].

3.1.4. Occupational Injury

The literature mainly focuses on non-fatal occupational injury than fatal injury. HCWs were at risk of needle stick injury and exposing them to the blood-borne disease [71–73]. Heat injury was described among outdoor workers such as farmers, forestry workers, and municipal workers [74–76]. Musculoskeletal injuries may happen among athletes, palm oil plantation workers, and construction workers ranging from muscle strains, sprains, and tears to falls from heights [16, 77, 78].

3.1.5. Respiratory Problems

The respiratory problem among workers might include the problem of inhaling chemical hazards such as metal dust, endotoxin, pesticide, and any air pollutants. In terms of occupation, traffic police, firefighters, and farmers are among the at-risk workers for outdoor areas [79–81]. In contrast, indoor workers are also at risk of respiratory problems due to indoor dust. HCWs who worked in an orthopedic clinic might be exposed to dust from the plaster of Paris material [82]. Besides that, those who worked in mechanically ventilated offices in a tropical country were exposed to endotoxin from office dust [83]. Welders and factory workers should practice proper protection to prevent respiratory problems [84, 85].

3.1.6. Cardiovascular Disease Risks

The trend of CVD risk prevalence is increasing in the general population and affecting the most productive population at an early age. The sedentary administrative workers were reported to have a prevalence of smoking, physical inactivity, and unhealthy diet which were at 20%, 50%, and 87%, respectively [86]. HCWs and firefighters were reported to have obesity problems despite their knowledge and nature of work [87–89]. A study conducted among secondary school teachers found that normal-weight participants had metabolic syndrome which put them at risk of progressing to CVD at a later age [90].

3.1.7. Hearing Problems

Hearing loss is not uncommon among factory workers and in all workplaces which are exposed to the level of noise ≥85 dB. Two studies highlighted the hearing loss issue among factory workers while one study examined the noise level in the work area [91–93]. The prevalence of hearing loss was 73% among 146 respondents who worked in small and medium industries in Selangor [92]. Among the factors associated with hearing problems were occupational daily noise, length of service, infrequent use of HPD, age, male gender, and smoking status [91, 92].

4. Discussion and Areas for Further Research

This thematic review summarized the recent five years of literature discussing occupational disease and injury in Malaysia. Technically, DOSH under the Ministry of Human Resources is responsible to ensure the safety, health, and welfare of people at work. The department also produces the yearly statistic on occupational poisoning and diseases according to ten sectors under the 1994 Act. DOSH classified the ten sectors of work activities such as (1) manufacturing, (2) mining and quarrying, (3) construction, (4) hotels and restaurant, (5) agriculture, forestry and fishing, (6) transport, storage, and communication, (7) public services and statutory authorities, (8) utilities—gas, electricity, water, and sanitary services, (9) finance, insurance, real estate, and business services, and finally (10) wholesale and retail trades [15]. The Ministry of Human Resources adapts the International Standard Classification of Occupations (ISCO) to come out with Malaysian version of occupational classification, namely, MASCO, which can be accessed in public domain [29]. This study used the main job title classification to describe the specific occupation name.

Besides Ministry of Human Resources, the Department of Statistics Malaysia (DOSM) conducts the Labour Force Survey to highlight the employment and unemployment rates. The labour force survey used the updated version of MSIC in 2008 consisting of the updated version of industry classification with the current 20 groups of industries from the only nine groups for the year before 2000. The report also stated that the highest number of workers were in Group C (manufacturing) followed by Group G (wholesale and retail trade; repair of motor vehicles and motorcycles), Group I (accommodation and food service activities), Group A (agriculture, forestry, and fishing), and Group F (construction) [94]. DOSM as the main function of recording the general population statistic differs in the industry classification from DOSH because DOSM needs to update the classification according to the recent industrial development. A standard classification should be used by the authority bodies in order to minimize the overlapping job scope and underreporting issues among working people [13].

This thematic review found that a higher number of literature focused on Group Q (human health and social work activities) followed by Group A, Group C, Group O (public administration and defense; compulsory social security), and Group P (education) [15]. The possible reason for these findings is due to the recent pandemic (COVID-19) which affected the HCW group in terms of psychosocial, ergonomic, and biological hazards. Those who work in manufacturing industries might be exposed to the physical hazard while those in agriculture may have zoonosis infection [93, 95]. The increasing number of non-communicable diseases such as diabetes, hypertension, metabolic syndrome, and obesity might affect those who were in sedentary work style [86].

Traditionally, any occupational diseases were reported to DOSH as the main authority for further investigation. The highest reported health problem to the DOSH was occupational noise-related hearing loss, but this theme was less discussed recently. The literature discussed more biological hazards referring to COVID-19 which affected the healthcare workers. The occupational disease highlighted in the literature may not be reported to the DOSH because it is mainly for educational purposes. The DOSH reported of five, zero, four, and one confirmed cases of workers who had a psychosocial problem in 2017, 2018, 2019, and 2020, respectively, which contradicted the abundant literature on mental health as found in this study. One of the challenges reported by the previous study is the underreporting problem of the occupational disease cases which affects the worldwide surveillance system [13]. The current trend showed that occupational diseases reported to DOSH traditionally are focusing on workers in manufacturing and construction industries while those in other industries such as education and public administration may be left behind. With the current situation of the post-pandemic era, a higher number of mental health problems arise but may not be reported to the authority. Thus, collaborative work among the authorities is needed to increase reporting of any cases suspected of psychosocial problems.

The recent work of WHO and ILO found that the risk of long working hours defined as ≥55 hours/week is paired with the health outcomes of ischemic disease and stroke [96]. The situation during the pandemic which exposed a group of frontliners including the HCWs and public administration and defense staff to the long working hours may contribute to a sudden cardiovascular attack. However, this may need more work since CVD is multi-factorial which includes individual lifestyle, family history, sedentary working type, and mental health problems. Even before the pandemic era, a younger age patient was seen for having a sudden attack of myocardial infarction which led to a new recommendation of CVS screening as early as 30 years [97].

According to the Occupational Safety and Health Master Plan 2021–2025 (OSHMP25), one of the indicators aims to increase the occupational diseases/injuries reported by 30% in 2025 [15]. This may need collaborative work among employers in both public and private industries to be responsible for data reporting. Besides that, the small and medium industries lack in providing the proper channel of healthcare service where the workers’ health assessments are not conducted by the occupational health doctors but are treated as normal patients in the local health facility [98]. The challenges are faced by primary care doctors who may be less trained in occupational health [98].

4.1. Strengths and Limitations of the Study

This study used a thematic review concept to give an overview of the recent issues related to occupational disease and injury in Malaysia. The number of reviewed articles was more than hundreds of articles, and it was managed using the Mendeley reference manager and ATLAS.ti 8 for the qualitative data analysis. The majority of the selected studies are cross-sectional study designs, and nearly three-quarters had adequate sample sizes. Even though the cross-sectional study design lacks a causal relationship, the important content such as the type of main health problems and their prevalence can be extracted from the selected studies. This generated study’s findings via thematic and content analysis managed to answer the research question.

5. Conclusion

This study summarized the literature on the evidence of occupational diseases in Malaysia over the recent five years. The substantial number of literature on mental health problems may not be in line with the reported cases in DOSH. A psychosocial factor may be the main hazard for workers in Malaysia, worsening with the pandemic (COVID-19). This study highlighted that there are discrepancies between issues being discussed in literature among workers with occupational diseases or injuries being reported to the relevant authority. Therefore, working people in Malaysia should be advised to seek help if they are facing any occupational hazards at the workplace. Collaborative work between agencies must be strengthened towards providing a better healthcare service for working people.

Data Availability

The data that support the findings of this study are included within the article.

Ethical Approval

This study was registered under the National Medical Research Registration with NMRR ID-22-00058-A8U.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Authors’ Contributions

SMA, LKK, and MM formulated the research question and decided the study design. SMA, NSS, and TATL were involved in record screening. SMA, NSS, TATL, and MM drafted the manuscript. LKK and MM reviewed and criticized the paper. Finally, all authors approved the final version.

Acknowledgments

The authors would like to thank the Director General of Health, Malaysia, for his permission to publish this paper. The authors would also like to express their sincere thanks to the National Institutes of Health (NIH) for their cooperation and assistance in terms of publication budget. This study is self-sponsored; however, the publication fee was granted from the Ministry of Health Malaysia.

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Copyright © 2023 S. Maria Awaluddin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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