Identification of Work-related Diseases in Small-scale Fishermen in Batam Island, Indonesia

2.1. Small-scale Fisheries

The small-scale fisheries sector is concerned with the role of communities, local traditions, and values. Small-scale fishermen are self-employed and usually provide caught fish for direct consumption by their families or communities. Thus, small-scale fisheries support coastal communities economic and social livelihoods by ensuring food and nutrition safety. Without fishermen as human components, fishery resources will not have value and benefits regarding social, cultural, economic, and biodiversity [16]. The definition of small-scale fisheries and their scope in several research results show the relationship between various aspects, namely, social, cultural, economic, ecological, health, and governance, as well as regulation, law, and policy [2, 17-21].

Characteristics of small-scale fisheries include fisheries management at the household level, fishing without or with fish vessels measuring less than five (gross tonnages (GT), and fishing gear operated only by human labor. This definition combines the attributes of boat size, mechanization of fishing gear, decision-making business units (households), and directed government assistance to poor fishermen prone to social and economic shocks [18]. The term small-scale fisheries have been used to characterize a subsector of fisheries to distinguish it from medium-scale and large-scale fisheries. The Food and Agriculture Organization (FAO) defines small-scale fisheries as traditional fisheries involving fishing households (as opposed to commercial enterprises), using capital and relatively little power, relatively small vessels, short fishing trips, near the coast, and mainly for local consumption [22].

2.2. Fisherman's Work Environment

Risks to occupational safety and health are influenced by work environment factors, including the physical environment, work processes, human factors, and economic factors [23, 24]. Occupational environment factors include potential workplace hazards, including aspects of the physical, chemical, ergonomic, biological, and psychosocial environment [13]. Influential factors in the work process are hazardous materials, working procedures, work skills, and the use of machinery [12].

Physical factors are associated with using machinery, equipment, materials, and environmental conditions around the workplace, such as work, climate, noise, vibration, radiation, air pressure, and lighting that cause disturbances and diseases in the workforce. Biological factors are caused by living things, including animals, plants, and their products, as well as microorganisms that can cause occupational diseases. Chemical factors are caused by using chemicals and their derivatives in the workplace, including chemical contaminants in the air, in the form of gases, vapors, and particulates. The ergonomic factor is caused by a mismatch between work facilities, including the working position, work tools, and the lifting load on the workforce. Psychological factors are caused by interpersonal relationships in the workplace, roles, and responsibilities at work. The psychosocial work environment is how the interrelation of the structure of society, the environment of exposure, and the psychological that have a potential impact in terms of well-being and discomfort, for example, job satisfaction, stress, and fatigue [25].

2.3. Occupational Diseases

A work-related or occupational disease is caused by work and/or work environment. Fishing fishermen are at risk of occupational diseases related to the work environment. The condition of the marine environment has an impact on health [26]. The fisherman's work environment, such as exposure to seawater, working posture, and noise from ship engines, can produce health problems such as dermatitis, indigestion, skeletal muscle disorders, hearing loss, dehydration, and acute respiratory distress infections (ARI) [27-31]. In the work process, fishermen work outside the building and are directly exposed to sunlight, so fishermen are one of the jobs at risk of cataracts. Outdoor workers are at high risk of prolonged and high exposure to solar ultraviolet radiation, known to cause skin cancer [32, 33]. Research by Laraqui et al. [29] found that skin disease prevalence among fishermen was 43%, 27.2%, 9.5%, and 2.5% for respondents who experienced one type, two types, three types, and four types of skin disease, respectively. Skin diseases include skin infections, scabies, and stings of marine life. Percin et al. [34] mentioned that humidity, cold weather, and harsh sea conditions could stimulate rheumatism in fishermen.

3.1. Study Area

The research was conducted on Batam Island, Riau Archipelago Province, Indonesia. Riau Archipelago Province is one of the provinces in Indonesia, with most of its area being an archipelago area, and 95% of the site is the ocean. Its area reaches 8,201.72 km^2, or about 0.43% of the area of Indonesia. Stretching from the Strait of Malacca to the Natuna Sea, Riau Archipelago Province is a strategic area because it borders Singapore, Vietnam, Malaysia, and Cambodia. The population of Riau Archipelago Province was 2,189,653 in 2019, and it is highly concentrated on Batam Island, with about 56.47% or around 1.1 million people.

3.2. Data Collection

This study applied both quantitative and qualitative methods. The quantitative research method is carried out by survey using questionnaires. The qualitative method was a case study method, including observation, in-depth interviews, and focus group discussion (FGD). The questionnaire contains questions including the socioeconomic and demographic data of fishermen: age, education level, ethnicity, income level, length of work, place of residence, employment status, smoking history, and marital status. The interview question list contains complaints of occupational diseases based on work environment factors: physics, chemistry, biology, ergonomics, and psychosocial. Data collection is carried out when fishermen are not at work. Questionnaire filling and interview activities are conducted at fishermen's homes or associations. Data collection was carried out from July to September 2022. The data source in this study was 119 fishermen selected by purposive sampling. A reliability test was carried out to strengthen the questionnaire as one of the instruments. From the test, the alpha is obtained as follows:

The rule in determining the alpha value is if the alpha value > 0.90, then the reliability is perfect. The reliability is high if the alpha value is 0.70 < alpha < 0.90. The reliability is moderate if the alpha value is 0.70 < alpha < 0.5. If the alpha value is <0.5, then the reliability is low. The test results in Table 1 showed an alpha of 0.504, meaning the questionnaire has moderate reliability.

3.3. Data Analysis

The data collected from the questionnaire results were processed using descriptive statistics. In contrast, the data from the interview was summarized and coded. Then the results were displayed in the form of a table to provide an easy outlook of the types of occupational disease complaints based on the type of work environment. Concerning complaints of occupational diseases, interview data may show some similarities, even from different subdistrict locations, due to similar work environment characteristics, including socioeconomic and natural conditions.

4.1. Socioeconomy Characteristics

The socioeconomic characteristics of the fisherman's demographic consisted of age, education level, ethnicity, income level, length of employment, working status, smoking history, and marital status (Table 2). Most fishermen, for about 32% of the population, are aged between 56 and 65. Most fishermen's education level is elementary school graduates, with a percentage of 60%. The most numerous fishing tribe is the Malay tribe, with about 92% indigenous tribes. 75% of fishermen have an average monthly income of between 96-160 USD. For about 34% of the population, most fishermen have worked for more than 20 years. 77% of fishermen work full-time, and 23% work part-time. Employment as a fisherman is a hereditary occupation for parents, recognized by 86% of fishermen. Most fishermen, about 83% of the population, had a smoking habit. 90% of fishermen were in married relationships. 87% of fishermen lived near the coastline, and 13% were far from the coast.

4.2. Work-related Diseases based on the Work Environment

Complaints of diseases suffered by fishermen included fever, fatigue, soreness, back and waist pain, colds, flu, stinging, blistering from the spines of fish or marine animals, headaches, eye disorders/myopia, rheumatism, ulcers, skin allergies or hives, sprains and fractures (Table 3). Complaints of diseases suffered by fishermen are the types of diseases that fishermen often experience when doing fisherman work, including being exposed to sea breezes, being exposed to fish spines, holding fish catches for too long or often pulling and lifting nets, exposed to ultraviolet light, and hungry from carrying little food. The most mentioned disease complaints by fishermen are colds, fever, stinging or blisters, skin allergies or hives, eye disorders, or myopia.

The type of work environment could be identified according to complaints of occupational diseases in fishermen (Table 4). The working environment consisted of physical, chemical, biological, ergonomic, and psychological factors. Based on Fig. (1), the fisherman's work environment factors consisted of physical, biological, and ergonomic factors. Complaints of diseases related to chemical and psychological factors were not mentioned directly by fishermen. Factors of physics are a type of fisherman's work environment related to the natural or open environment. Fishermen complained about frequent colds and fevers due to sea breeze and seawater exposure. Biological factors were related to fishermen catching fish influenced by other living things, such as exposure to fish stings and spines. Fishermen also complained about skin allergies and itching. Ergonomic factors were associated with complaints of fatigue, soreness, sprains, and fractures due to pulling and lifting activities that required muscle strength and working posture corresponding to the workload.