Abstract
Migrant workers constitute nearly one-third of Saudi Arabia’s population, with a significant portion engaged in low-skilled manual labour. Limited data exists on work-related injuries and the use of personal protective equipment (PPE) among workers. The current cross-sectional survey focused on seven occupational groups, (i.e., auto-repair workers, city cleaners, construction workers, hairdressers, hospital cleaners, poultry factory workers, and restaurant workers) in the Al-Qassim region of Saudi Arabia. The sample of 2,123 workers were predominantly men (85.3%) and from the Indian subcontinent (64.9%). Among the workers, 21.5% reported having one or more work-related injuries, with cuts (27%), slipping/falling (17%), and thermal injuries (9%) being the most common. Compliance with PPE varied across professions, with city cleaners (86.1%) and restaurant workers (85%) being the most compliant. The study highlights a concerning prevalence of injuries and insufficient PPE usage among migrant workers, emphasizing the need to enhance workplace safety.
Keywords: Migrant workers, Work-related injury, Workplace safety, Personal protective equipment, Saudi Arabia
Introduction
Migrant workers make up a considerable portion of the population in the Kingdom of Saudi Arabia (KSA). Accounting for nearly one-third of the total population (36.6 million, 2022), they play a vital role in nearly every sector of the economy (e.g., agriculture, construction, health, petroleum industry, and various service industries)1). KSA and other Gulf Cooperation Council (GCC) countries have been heavily reliant on migrant workers for economic development for the past several decades1,2,3,4). While elsewhere in the world, migrant workers make up, on average, only 4.9% of the workforce, in GCC countries, this percentage is as high as 41.4%5). In 2019, KSA was ranked the third most common destination in the world for international migrant workers1).
Migrant workers are exposed to a wide variety of hazards, such as physical (cuts, slipping/falling, trauma), chemical, electrical, and vascular hazards3, 6) because of the nature of their jobs. They often operate dangerous equipment, are exposed to extreme heat and/or fire, and may handle high-risk chemicals. These workers may or may not be aware of safety concerns and health consequences. Many factors influence accidents and injuries in workplaces, but the primary factors are unsafe environments (poor work organization or poor maintenance of tools or equipment) and unsafe behaviour (lack of experience or training and poor knowledge about safety guidelines)6,7,8,9,10,11,12).
Personal protective equipment (PPE) is considered essential to combat workplace hazards and prevent injury10, 12, 13). Not utilizing recommended PPE can result in serious injury and medical complications. One systematic review and meta-analysis of 36 studies and over 12,000 international migrant workers from 25 different countries found that migrant workers mainly work in low-wage manual labour positions, are commonly exposed to workplace hazards, and have a high risk of physical and mental health comorbidities11). One study by the Saudi Organization for Social Insurance found that non-Saudi insured workers had a significantly higher prevalence of workplace injuries than Saudi insured workers14).
Studies conducted in GCC countries on PPE usage and work-related injuries among various professions of migrant workers have been limited by small sample sizes and focused on men and often one particular profession (i.e., farming or small-scale industries). They predominantly reported only PPE usage or only injury responses. To date, only a few publications in Saudi Arabia have been devoted to researching migrant workers’ health, well-being, workplace injuries, and outcomes of injuries. Some migrant workers, like auto-repair workers, city cleaners, etc., may be at higher risk of injury, yet they have not previously been studied.
Therefore, a cross-sectional study was conducted by collecting and analysing data from migrant workers in different professions in the Al-Qassim region of KSA to better understand migrant workers’ compliance with PPE recommendations, the incidence of work-related injuries, and the resulting actions and compensation.
Materials and Methods
Sample
This cross-sectional survey of migrant workers was conducted in 2022 in Al-Qassim province, Saudi Arabia. A convenient sampling strategy, stratified by occupation, was adopted for recruitment of participants from the following seven occupations: auto-repair workers, city cleaners, construction workers, hairdressers, hospital cleaners, poultry factory workers, and restaurant workers. Workers who were non-Saudi and currently employed in KSA were eligible to participate in the survey.
The study was approved by the Qassim Research Ethics Review Committee at the Ministry of Health, Saudi Arabia (H-04-Q001, 4 January 2022). Informed consent was taken from every participant. Confidentiality and anonymity were ensured according to standard ethical guidelines. Trained research assistants interviewed the participants (approximately 15 min) and recorded the data on the SurveyMonkey platform. The survey was available in Arabic, Bengali, English, and Urdu and administrated by native speakers of those languages. Each participant chose his/her preferred language for the interview.
Sample size
According to Saudi Census data15), the Al-Qassim region of KSA has over 250,000 non-Saudi residents over the age of 18. Given that the obtained sample size was 2,123, and with a prevalence estimate of 20% and a 95% confidence interval, the study had a 1.7% margin of error.
Questionnaire and measures
Researchers at Sulaiman Al Rajhi University constructed an online survey from validated questionnaires and relevant literature to investigate several occupational factors and the health of migrant workers in KSA. The survey included demographic questions as well as occupational and medical information such as types of injuries sustained at work.
Workplace injuries
The participants were asked whether they had ever sustained an injury at their work. Those who responded in the affirmative were asked about the type of injury (e.g., In your current employment, which of the following injuries have you experienced? Amputation, ankle sprain, blunt trauma, chemical injury, cut, electrical injury, eye damage, fracture or dislocation, hearing damage, inhalational injury, penetrating injury, slipping or falling, thermal injury, vehicular accident, or other [please specify]”). Participants responded with either ‘yes’ or ‘no’ to each type of injury. The participants with a former or current injury were further asked about the possible reasons for the injury, responses (i.e., what happened after the accident), and compensation (medical or monetary). Respondents were also able to report whether they had had more than one injury. Participants who reported no injuries were asked to confirm if he/she recognized the listed injuries. The questionnaire used was taken from studies conducted on similar populations16, 17).
Personal protective equipment use
Participants were asked about their use of personal protective equipment at work by responding ‘yes’ or ‘no’ to the following questions, which have been validated previously3):
Do you use safety glasses and/or goggles as needed?
Do you utilize earplugs/muffs when required?
Do you wear gloves when necessary?
Do you wear safety boots/shoes as required?
Do you wear a face mask as needed?
Do you use a welding shield, apron, or curtain as needed?
Do you use knee and joint protection mats as needed?
Do you use a head cover (hairnet or helmet)?
Do you wash your hands regularly?
Demographic characteristics
Participants were interviewed about demographic characteristics (e.g., age, gender, education, marital status, occupation, nationality, and residential accommodation), followed by migrant-specific characteristics (e.g., type of job, employment duration in KSA, work hours per day, and workdays per week). Weekly work hours were determined and classified as recommended (≤48 h/week), overtime (49–60 h/week), and illegal (>60 h/week) according to Saudi Arabia’s Ministry of Labor protocols18).
Analysis
The dataset from the online survey was extracted, cleaned, and prepared for analysis. Less than 5% of the data was imputed. Statistical Package for Social Sciences version 26 (SPSS-v26) was used to analyse the data. Descriptive statistics for the study were presented and tabulated in a categorical format (frequency and percentage). Each injury was categorized by type of injury and reported along with the reason for the injury, the response, and compensation. The rate of each type of injury was compared across professions using a χ2 test and considered significantly different if p was <0.05. Furthermore, the quantity of injuries was computed, irrespective of type, and each participant was categorized as either having none, one, or two or more injuries.
We could not find any literature or organization that had PPE guidelines specific to each occupation. Based on the job requirements, we determined which PPE items and how many PPE items were likely recommended for each occupation (Supplementary Table 1). For each occupational group, the proportion of the participants who complied with the use of the PPE according to the number of items recommended for their profession was estimated.
A sub-analysis was performed in order to determine whether there were gender differences in the number of injuries. Women were only recruited from two professions: hairdressers and hospital cleaners. These professions were selected, and a chi-square test was used to determine whether there were significant differences between men and women in the same profession.
Results
There were 2,123 participants in the study; most were from the subcontinent (i.e., Bangladesh, India, and Pakistan) (64.9%) and younger than 40 yr of age (73.6%). Most of the workers were men (85.3%), whereas women were only 14.7% of the total sample and were employed only as hospital cleaners or hairdressers. The majority of the participants were overweight and obese (43.1% and 17%, respectively). More than 70% were married; however, 90% were living with their co-workers. The majority had been working for 2 yr or more in KSA (88.5%). Almost half (48%) of the respondents reported working more than 60 h per week. The education level was relatively low, as there were many with no education (15.8%) or just primary education (32.5%), and only a minority had higher education (7.6%). The average sample size per profession was 303, with hairdressers being the largest (n=450, 21%) and poultry factory workers being the smallest (n=78, 3.5%) (Table 1).
Table 1. Demographic characteristics of a sample of migrant workers from Al-Qassim, Saudi Arabia (n=2,123).
| Characteristics | n | % | |
|---|---|---|---|
| Participant age (yr), mean ± SD: 35 ± 9 | |||
| 18–30 | 70 | 36.3% | |
| 31–40 | 792 | 39.3% | |
| 41–50 | 443 | 20.9% | |
| ≥51 | 118 | 5.6% | |
| Country of origin | |||
| Subcontinental regions | 1,377 | 64.9% | |
| Middle East and North Africa | 493 | 23.2% | |
| Othera | 253 | 11.9% | |
| Gender | |||
| Men | 1,810 | 85.3% | |
| Women | 313 | 14.7% | |
| BMI (kg/m2), mean ± SD: 26 ± 4.8 | |||
| Normal | 848 | 39.9% | |
| Overweight | 915 | 43.1% | |
| Obese | 360 | 17.0% | |
| Marital status | |||
| Not currently married | 578 | 27.2% | |
| Currently married | 1,545 | 72.8% | |
| Accommodation | |||
| Lives with family | 174 | 8.2% | |
| Lives alone or with co-workers | 1,949 | 91.8% | |
| Duration of stay (yr) in Saudi Arabia | |||
| < 2 | 244 | 11.5% | |
| 2–6 | 886 | 41.7% | |
| 7–15 | 624 | 29.4% | |
| >15 | 369 | 17.4% | |
| Weekly work hoursb | |||
| Recommended | 610 | 28.7% | |
| Overtime | 494 | 23.3% | |
| Illegal | 1,019 | 48.0% | |
| Education level | |||
| No education | 335 | 15.8% | |
| Primary education | 690 | 32.5% | |
| Secondary education | 936 | 44.1% | |
| University and above | 162 | 7.6% | |
| Occupation | |||
| Auto-repair workers | 217 | 10.2% | |
| City cleaners | 403 | 19.0% | |
| Construction workers | 170 | 8.0% | |
| Hairdressers | 450 | 21.2% | |
| Hospital cleaners | 422 | 19.9% | |
| Poultry factory workers | 78 | 3.7% | |
| Restaurant workers | 383 | 18.0% | |
aOther countries included Indonesia, the Philippines, Turkey, and Uganda.
bWorking hours per week according to Saudi Arabia’s Labour laws: Recommended (≤48 h), Overtime (49–60 h), Illegal (>60 h).
Among the participants, 21.5% reported having one or more work-related injuries during their stay in KSA. Since some workers had had more than one injury, the total number of injuries was 642 reported from 461 out of 2,123 workers. The most common injuries were cuts and slipping/falling, followed by thermal and ankle injuries (8.2%, 5%, 2.8%, and 2.3%, respectively). The main reported reason for an injury was unsafe actions (44%), resulting in slips/falls, cuts, and traumas (Table 2). Most of the life-threatening injuries, including amputations (100%), fractures (74%), vehicle accidents (56%), etc., received first aid and hospitalization. Cuts (56%) and slips/falls (54%) were treated mostly with either first aid or at-home care. However, 37% of participants did not cite any kind of response following their injury (Table 2).
Table 2. Frequency of different workplace injuries and their underlying reasons and responses in a sample of migrant workers from Al-Qassim, Saudi Arabia (n=2,123).
| Type of injury | Overall injury frequencyn=2,123 (%) | Injury reason | Injury response | |||||
|---|---|---|---|---|---|---|---|---|
| Unsafe actionn (%) | Unsafe conditionn (%) | No specific reason was citedn (%) | First aidn (%) | Hospitalizationn (%) | Homecaren (%) | No specific care was citedn (%) | ||
| Amputation | 11 (0.5%) | 7 (64%) | 4 (36%) | 0 (0%) | 6 (54.5%) | 5 (45.5%) | 0 (0%) | 0 (0%) |
| Ankle sprain | 49 (2.3%) | 18 (36.7%) | 13 (26.6%) | 18 (36.7%) | 12 (24.5%) | 4 (8%) | 12 (24.5%) | 21 (43%) |
| Blunt trauma | 28 (1.3%) | 11 (39%) | 9 (32%) | 8 (29%) | 6 (21.5%) | 4 (14.5%) | 9 (32%) | 9 (32%) |
| Chemical injury | 18 (0.8%) | 9 (50%) | 4 (22%) | 5 (28%) | 6 (33%) | 0 (0%) | 2 (11%) | 10 (56%) |
| Cut | 174 (8.2%) | 92 (53%) | 23 (13%) | 59 (34%) | 64 (37%) | 21 (12%) | 34 (19.5%) | 55 (31.5%) |
| Electrical injury | 19 (1%) | 11 (58%) | 8 (42%) | 0 (0%) | 5 (26%) | 0 (0%) | 4 (21%) | 10 (53%) |
| Eye injury | 48 (2.2%) | 15 (31%) | 8 (17%) | 25 (52%) | 5 (10.5%) | 13 (27%) | 11 (23%) | 19 (39.5%) |
| Fracture or dislocation | 27 (1.3%) | 11 (41%) | 5 (18%) | 11 (41%) | 0 (0%) | 20 (74%) | 1 (4%) | 6 (22%) |
| Hearing damage | 14 (0.6%) | 2 (14%) | 7 (50%) | 5 (36%) | 3 (21.5%) | 3 (21.5%) | 1 (7%) | 7 (50%) |
| Inhalation injury | 36 (1.7%) | 13 (36%) | 10 (28%) | 13 (36%) | 2 (5.5%) | 1 (3%) | 7 (19.5%) | 26 (72%) |
| Penetrating injury | 12 (0.5%) | 7 (58%) | 3 (25%) | 2 (17%) | 4 (33%) | 2 (17%) | 3 (25%) | 3 (25%) |
| Slip/fall | 107 (5%) | 47 (44%) | 36 (34%) | 24 (22%) | 18 (17%) | 27 (25%) | 39 (36.5%) | 23 (21.5%) |
| Thermal injury | 59 (2.8%) | 34 (57.5%) | 7 (12%) | 18 (30.5%) | 10 (17%) | 6 (10%) | 13 (22%) | 30 (51%) |
| Vehicular accident | 27 (1.3%) | 4 (15%) | 13 (48%) | 10 (37%) | 1 (4%) | 14 (52%) | 3 (11%) | 9 (33%) |
| Othera | 13 (0.6%) | 0 (0%) | 2 (15%) | 11 (85%) | 0 (0%) | 2 (15%) | 1 (8%) | 10 (77%) |
| TOTAL | 642 (30%) | 280 (43.6%) | 152 (23.7%) | 210 (32.7%) | 142 (22.1%) | 122 (19%) | 140 (21.8%) | 238 (37.1%) |
aOther injuries include allergic reaction, joint pain, lower back pain, etc.
The injury types and frequency were significantly different across professions. Hairdressers showed a higher frequency of injuries than workers from other professions; they had a higher proportion of cuts (15%), inhalation injuries (6%), thermal injuries (5%), eye injuries (5%), and ankle injuries (4%). Auto-repair workers also reported a higher proportion of injuries than other groups, such as slips/falls (7%), blunt trauma (5%), fractures (3%), electrical injuries (3%), and penetrating injuries (2%). Restaurant workers experienced cuts (10%), thermal damage (5%), and ankle injuries (3%). Construction workers also had a significantly high proportion of ankle injuries (3.5%). Certain types of injuries such as hearing damage and chemical and electrical injuries were reported by less than 2% of migrant workers and did not differ by profession (Table 3). Most (78.5%) respondents did not report any injury, 16% reported only one injury, and only 5.5% reported having had two or more injuries (Table 4). The proportion and type of injury varied by gender in the two occupations that included both genders in this study. Female hairdressers were 3 times more likely than male hairdressers/barbers to report injuries (65% vs. 21%, p<0.001). Similarly, female hospital cleaners sustained twice as many injuries as their male counterparts (22% vs. 9%, p<0.001) (Supplementary Table 1).
Table 3. Frequency of different workplace injuries among specific occupations in a sample of migrant workers from Al-Qassim, Saudi Arabia (n=2,123).
| Type of injury (total reported cases of each injury) | Auto-repair workers (n=217) | City cleaners (n=403) | Construction workers (n=170) | Hairdressers (n=450) | Hospital cleaners (n=422) | Poultry factory workers (n=78) | Restaurant workers (n=383) | p |
|---|---|---|---|---|---|---|---|---|
| Amputation (n=11) | 1 (0.5%) | 3 (0.7%) | 0 (0%) | 0 (0%) | 0 (0%) | 4 (5.1%) | 3 (0.8%) | 0.350 |
| Ankle injury (n=49) | 3 (1.4%) | 7 (1.7%) | 6 (3.5%) | 16 (3.6%) | 4 (0.9%) | 0 (0%) | 13 (3.4%) | 0.044 |
| Blunt trauma (n=28) | 11 (5.1%) | 0 (0%) | 3 (1.8%) | 7 (1.6%) | 4 (0.9%) | 1 (1.3%) | 2 (0.5%) | 0.001 |
| Chemical injury (n=18) | 2 (0.9%) | 0 (0%) | 0 (0%) | 7 (1.6%) | 2 (0.5%) | 0 (0%) | 7 (1.8%) | 0.380 |
| Cut (n=174) | 21 (9.7%) | 6 (1.5%) | 9 (5.3%) | 68 (15.1%) | 13 (3.1%) | 18 (21.3%) | 39 (10.2%) | 0.001 |
| Electrical injury (n=19) | 6 (2.8%) | 4 (1%) | 3 (1.8%) | 3 (0.7%) | 2 (0.5%) | 0 (0%) | 1 (0.3%) | 0.640 |
| Eye injury (n=48) | 8 (3.7%) | 6 (1.5%) | 1 (0.6%) | 23 (5.1%) | 7 (1.7%) | 1 (1.3%) | 2 (0.5%) | 0.001 |
| Fracture or dislocation (n=27) | 6 (2.8%) | 2 (0.5%) | 2 (1.2%) | 2 (0.4%) | 6 (1.4%) | 3 (3.8%) | 6 (1.6%) | 0.480 |
| Hearing damage (n=14) | 2 (0.9%) | 6 (1.5%) | 0 (0%) | 4 (0.9%) | 0 (0%) | 1 (1.3%) | 1 (0.3%) | 0.119 |
| Inhalation injury (n=36) | 3 (1.4%) | 1 (0.2%) | 2 (1.2%) | 29 (6.4%) | 1 (0.2%) | 0 (0%) | 0 (0%) | 0.001 |
| Penetrating injury (n=12) | 5 (2.3%) | 4 (1%) | 1 (0.6%) | 2 (0.4%) | 0 (0%) | 0 (0%) | 0 (0%) | 0.043 |
| Slip/fall (n=107) | 15 (6.9%) | 24 (6%) | 9 (5.3%) | 19 (4.2%) | 23 (5.5%) | 3 (3.8%) | 14 (3.7%) | 0.562 |
| Thermal injury (n=59) | 8 (3.7%) | 3 (0.7%) | 0 (0%) | 21 (4.7%) | 8 (1.9%) | 0 (0%) | 19 (5%) | 0.001 |
| Vehicular accident (n=27) | 3 (1.4%) | 3 (0.7%) | 2 (1.2%) | 4 (0.9%) | 3 (0.7%) | 3 (3.8%) | 9 (2.3%) | 0.118 |
| Othera (n=13) | 1 (0.5%) | 3 (0.7%) | 3 (1.8%) | 2 (0.4%) | 3 (0.7%) | 1 (1.3%) | 0 (0%) | 0.310 |
| TOTAL (n=642) | 95 (44%) | 72 (18%) | 41 (24%) | 207 (46%) | 76 (18%) | 35 (45%) | 116 (30%) | 0.001 |
aOther injuries include allergic reaction, joint pain, lower back pain, etc.
Table 4. Frequency of workplace injuries by the number of workers in specific occupations among a sample of migrant workers from Al-Qassim, Saudi Arabia (n=2,123).
| Occupation (n) | Number of injuries | ||
|---|---|---|---|
| None | One | Two or more | |
| Auto-repair workers (217) | 149 (68.5%) | 51 (23.5%) | 17 (8%) |
| City cleaners (403) | 352 (87.5%) | 38 (9.5%) | 13 (3%) |
| Construction workers (170) | 138 (81%) | 26 (15.5%) | 6 (3.5%) |
| Hairdressers (450) | 314 (70%) | 94 (21%) | 42 (9%) |
| Hospital cleaners (422) | 367 (87%) | 41 (10%) | 14 (3%) |
| Poultry factory workers (78) | 50 (64%) | 22 (28%) | 6 (8%) |
| Restaurant workers (383) | 292 (76%) | 73 (19%) | 18 (5%) |
| TOTAL (2,123) | 1,668 (78.5%) | 342 (16%) | 113 (5.5%) |
Reported PPE use varied significantly by type of PPE and by profession. For example, a high proportion of workers from all professions reported using facemasks and gloves except auto-repair workers, while few workers from all professions reported using earplugs or joint protection mats. The other types of PPE varied according to professional requirements; hairdressers were the most likely to use an apron (34%) and restaurant workers were the most likely to use hair covers (87%). Around 20–25% of workers from auto repair, construction, and poultry factories reported using safety glasses, while other groups had lower proportions (Supplementary Table 3).
The recommended types of PPE per profession were identified in order to determine compliance with PPE (Supplementary Table 1). Compliance to recommended PPE varied across occupations. The most compliant professions were restaurant workers and city cleaners; around 76% and 86%, respectively, reported using the PPE related to their profession. Hairdressers had an intermediate level (44%) of compliance with PPE usage. However, the other workers had low compliance with PPE: poultry factory workers (18%), hospital cleaners (15%), auto-repair workers (<5%), and construction workers (<5%) (Table 5).
Table 5. Proportion of workers compliant with recommended personal protective equipment (PPE) among specific occupations in a sample of migrant workers from Al-Qassim, Saudi Arabia (n=2,123).
| Occupation (n) | Total number of PPE recommended* | Compliance with number of PPE | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 0 n (%) |
1 n (%) |
2 n (%) |
3 n (%) |
4 n (%) |
5 n (%) |
6 n (%) |
7 n (%) |
8 n (%) |
||
| Auto-repair workers (217) | 8 | 74 (34.1%) | 51 (23.5%) | 45 (20.7%) | 13 (6%) | 18 (8.3%) | 11 (5.1%) | 5 (2.3%) | 0% | 0% |
| City cleaners (403) | 4 | 5 (1.2%) | 18 (4.5%) | 32 (7.9%) | 329 (81.6%) | 19 (4.7%) | ||||
| Construction workers (170) | 8 | 9 (5.3%) | 11 (6.5%) | 21 (12.4%) | 41 (24.1%) | 41 (24.1%) | 29 (17.1%) | 11 (6.5%) | 1 (0.6%) | 6 (3.5%) |
| Hairdressers (450) | 4 | 10 (2.2%) | 28 (6.2%) | 213 (47.3%) | 131 (29.1%) | 68 (15.1%) | ||||
| Hospital cleaners (422) | 5 | 7 (1.7%) | 9 (2.1%) | 16 (3.8%) | 66 (3.1%) | 237 (11.2%) | 87 (4.1%) | |||
| Poultry factory workers (78) | 5 | 13 (16.7%) | 9 (11.5%) | 23 (29.5%) | 19 (24.4%) | 11 (14.1%) | 3 (3.8%) | |||
| Restaurant workers (383) | 4 | 1 (0.3%) | 11 (2.9%) | 79 (20.6%) | 278 (72.6%) | 14 (3.7%) | ||||
*Each worker was evaluated for their use of PPE specific to their profession. Each profession recommends a different combination of the following: apron, earplugs, face mask, gloves, head cover/helmet, joint protection, safety boots/shoes, safety glasses. PPE recommended for each profession is clarified in Supplementary Table 1.
Discussion
Migrant workers around the world and in Saudi Arabia are a vulnerable population that has an elevated risk of injury. This study showed the following results: 1) The proportion of participants with work-related injuries was high (21.5%), 2) The frequency and type of injury varied by profession and also by gender among hairdressers and hospital cleaners, and 3) The proportion of participants who comply with the correct amount and type of PPE was low and varied by profession.
Migrant workers are quite prone to injury due to risks related to their jobs19, 20). According to a U.S. report, 3% of workers on average globally experience an injury in their workplace21). However, the estimates of workplace injuries from the Middle East range from 20% to 35%10,11,12, 14, 20, 22,23,24). The proportion of workers with work-related injuries in this study (22%) is similar to the regional estimates but higher than the global estimate. Most of the previous studies used electronic records of hospital admissions, electronic records of social insurance, or a trauma registry rather than conducting face-to-face interviews. The previous studies that used a similar method to ours, focused only on high-risk groups of migrant workers rather than an inclusive sampling of all migrant workers4, 6, 8, 9, 25, 26). This could explain the variation in the estimates across studies.
The proportion and type of injury varied by profession. The professions that reported a higher proportion of injury included hairdressers (46%), poultry factory workers (45%), and auto-repair workers (44%). These professions require the employees to operate more dangerous equipment, which puts them at an elevated risk for injury. Previous research has shown cuts as the most prevalent type of injury among hairdressers and restaurant employees27,28,29), which the current results replicated. However, our results showed that construction workers had an elevated proportion of ankle injuries but similar or lower proportions of other types of injuries compared to other professions. Overall, the majority of construction workers reported no injuries (81%). This is an unusual finding because previous studies have reported an elevated risk of injury among construction workers16, 30, 31). In the current sample, construction workers had some unique characteristics that may explain the finding. The construction workers were, on average, older and reported working for more years in Saudi Arabia; this may indicate more work experience and a lower likelihood of taking risky/unsafe actions. The majority of construction workers reported the use of gloves and boots (75%), and several reported using a helmet (40%).
The proportion and type of injury also varied by gender among the workers of the two professions that included both genders in this study. We found that women were more likely to have injuries than men. However, previous studies found that most occupational accidents happen to men16). Those studies compared gender differences across various occupations, but we compared men and women doing the same work, which may explain the disparate findings. Furthermore, several psychological studies have revealed a significantly higher tendency among women to recall negative intrusive memories than men, which may have led to more injuries being reported by female participants32, 33). For instance, female hairdressers were much more prone to injuries like thermal damage, ankle injuries, eye injuries, and inhalation injuries. This could also be related to the complexity of the services they provide, as they use more chemicals, hot waxes, and a variety of equipment. Previous research with a majority of women or only women in their sample revealed similar outcomes34,35,36).
The proportion of participants who used the recommended PPE was relatively low and varied by profession. Auto-repair, construction, and poultry factory workers had lower levels of PPE compliance compared with restaurant workers, city cleaners, and hospital cleaners. This may be explained by government regulations since the latter three occupations are regularly monitored by government agencies37, 38). Previous research in Saudi Arabia and adjacent countries have found inadequate compliance with PPE among migrant workers operating in various industries3, 6, 10, 39). However, there are limitations in these comparisons due to the lack of definitive lists of which PPE are required for each occupation. The low compliance might be due to several factors, including low awareness because of possible overall low educational level, lack of availability, etc. However, it is noteworthy that this study did not look at workers’ awareness of PPE, PPE availability, or training regarding PPE, which are important factors of PPE use. Such factors should be considered in future studies aimed at determining the causes of the low utilization of personal protective equipment.
Furthermore, PPE compliance alone does not appear to be the primary contributor to the injury rate. For example, restaurant workers and city cleaners had the highest compliance with PPE, but injury rates differed greatly, with city cleaners having the lowest rate of injuries (12.5%) and restaurant workers reporting twice as many (24%). Other factors should be taken into consideration for future studies, including nature of job, level of experience, etc.
Strengths
This study is one of the most comprehensive projects on migrant health in Saudi Arabia, given that it employed face-to-face surveys of more than 2,000 migrant workers from seven different occupations. The sample size provided adequate power to address the research question, and the sampling strategy provided a representative sample. Furthermore, the assessment of workplace injury and PPE were conducted with validated instruments. Lastly, the interviews were conducted in the preferred language of each participant, which minimized misunderstanding of the questions.
Limitations
The limitation of the injury assessment tool was the lack of severity-related questions. We could not determine whether or not the responses to and compensation for the injuries were adequate. Categories such as cuts may or may not require a hospital visit. Hence, the data on response to injury should be interpreted with caution and should only be considered preliminary. The assessment of PPE usage also had limitations because there are no available occupation-specific recommendations for PPE equipment. We had to construct an original list of recommended equipment for each occupation in order to count the number used as well as the proportion of the sample who used an adequate amount of PPE. Finally, women represented a smaller proportion of the sample because of the occupations that were selected for inclusion in the study.
Conclusion
Migrant workers in Saudi Arabia represent a large portion of the population and may have a higher risk of injury because of the nature of their jobs. This study found a high prevalence of workplace injury and low PPE use among migrant workers. Government agencies and companies should raise awareness among employees of the importance of PPE for injury prevention and enforce PPE use through regular monitoring. We recommend that other researchers continue investigating the topic of workplace injury and injury prevention among migrant workers. The assessment tools should be expanded and improved to attain higher accuracy and overcome the limitations mentioned above. More occupations (e.g., domestic workers) that include a higher proportion of women should be selected and studied more in depth.
Authors’ Contributions
JS and NS contributed to all aspects of the study. IS and AF drafted the manuscript and reviewed the analysis. A. Almazrou critically reviewed both the analysis and manuscript. A. Alshomar critically reviewed the manuscript. AF, TD, AZ, IO, ML, AAI, M. Alfattal, M. Alrabeei, and M. Albabakri contributed to the fieldwork. All authors approved the final version.
Ethical Approval
The study was approved by the Qassim Research Ethics Review Committee at the Ministry of Health, Saudi Arabia (H-04-Q001, 4 January 2022). Informed consent was taken from every participant.
Data Availability Statement
Data from this study is available from the corresponding author upon reasonable request.
Funding
This research was funded by Sulaiman Al Rajhi University through its annual allocated funds for research activities.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Supplementary Material
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Data from this study is available from the corresponding author upon reasonable request.