Abstract
Globally, ILO estimates 374 million non-fatal and 380,500 fatal occupational accidents annually. Slips, trips, falls and contact with objects are the leading modes of injury, with extremities being the most common body part involved. Occupational accidents are of major concern for high risk occupational groups such as migrant workers, or work areas e.g. construction, manu-facturing, wholesale, and retail industries. This study was aimed to determine the prevalence of non-fatal occupational injuries and its trends among industry workers in Brunei Darussalam. A retrospective cross-sectional review of occupational accidents notified to the Occupational Health Division, Ministry of Health, over a five-year period from January 2014 until December 2018 was conducted. A total of 424 non-fatal occupational accidents were notified, with increasing trend from 44 in 2014 to 132 in 2018. Accidents were more common in males (98%), migrant workers (86%), in the 30–39 age group (42.5%), and in the construction industry (56.4%). Struck by object (37.7%) was the commonest cause and upper limb (43.9%) was the commonest body part involved. There is a need for workplaces to develop capabilities and support mechanisms for risk assessments, as well as auditing and reviewing performances to minimize occurrence of preventable occupational injuries.
Keywords: Non-fatal occupational accidents, Occupational injury, Industry workers, Migrant workers, Construction industry
Introduction
Occupational accident is defined as any occurrence arising out of or in the course of work that results in a non-fatal or fatal injury1). Occupational accidents remain an important public health issue with global estimates of 374 million workers with non-fatal injuries and 380,500 fatal injuries, annually2). The International Labour Organisation (ILO) estimates that 1 worker dies from a work-related accident or disease every 15 seconds, and 153 workers encounter a work-related accident every 15 seconds3). It is, however, acknowledged that this is likely to be an un-derestimate due to under-reporting4). Global economic loss from occupational accidents and illnesses is estimat-ed to be almost 4% of GDP, primarily as a consequence of employee absenteeism, and temporary and permanent disablements2).
Heinrich first described in 1930 that unsafe acts were responsible for 88% of occupational accidents, followed by unsafe working conditions5). Various studies have since identified other contributing factors for occupational ac-cidents such as human factors (e.g. stress, fatigue), ma-chinery and tools, workplace design, and environmental factors6, 7). Gender and age also appear to have an associa-tion, as seen in several studies wherein work sectors have reported a higher number of work-related accidents among younger age group workers and among males8–12). Studies from Qatar and Saudi Arabia reported higher number of occupational accidents among their migrant population. Migrant workers’ employment in high risk work sectors, coupled with communication barrier and lack of training were probable factors contributing to a higher number of fatal and non-fatal work-related acci-dent rates9, 13, 14).
Reports and studies from different countries suggest that occupational accidents are a major concern for high risk work sectors such as construction, manufacturing, agriculture, mining, forestry and fishing15–18). In Brunei Darussalam, construction (60%), mining (14%) and man-ufacturing (12%) were the leading sectors contributing to fatal workplace accidents from 2012–201619). Contact with equipment and falling objects, and slips, trips and falls were the leading causes of occupational injuries in the United States in 201820). This was similarly seen in the United Kingdom with slips, trips and falls contributing to 29% of incidents; followed by handling, lifting and car-rying (20%), and struck by an object (10%)17). Singapore reported slips, trips and falls as the commonest mode of injury among non-fatal injuries, whereas fall from height was the most common mode for occupational fatalities16). A previous study in Brunei Darussalam on workplace fatalities reported that fall from height as the leading mode of fatal occupational injuries (38%)19).
Brunei Darussalam currently has a total employed workforce of 201,742, comprising 58.3% male workers and 25.7% migrant workers. Employment is heavily con-centrated in the services sector, particularly in public ad-ministration (22.9%), and wholesale and retail trade (12.7%). Construction industry is the third largest em-ployment sector in the country comprising 10.2% of the total workforce. Migrant workers are mainly employed in elementary occupations (38%) such as manual labor, mainly in the construction (28%), manufacturing (8.7%), service (5%), and household (22.5%) sectors21). The Workplace Safety and Health Order (WSHO) 2009 and its subsidiary regulations, Employment Order 2009, and Workmen Compensation Act (Revised 1984) are national OSH-related legislations that govern the health, safety and welfare of employees at the workplace in Brunei Da-russalam. These judicial measures have provisions that underscore the duties of the employer and employee with regards to risk assessment and control of hazards, codes of practice, offences and penalties, ac-cident prevention measures, and timely notification of workplace incidents22).
This study aimed to determine the prevalence of re-ported cases of non-fatal occupational accidents among industry workers over a five-year period from January 2014 until December 2018. The objectives were to calcu-late the rate and analyze trend of non-fatal occupational accidents; to determine occurrence by demographic pro-files (age, gender, nationality, mode and type of injuries, commonly affected body part); and to determine the ac-cident by type of industry.
Materials and Methods
This retrospective, cross-sectional study reviewed oc-cupational accident records that were notified to Occupa-tional Health Division (OHD), Ministry of Health from January 2014 to December 2018. All notified cases of accidents occurring at the workplace in the government and private sectors were included. Fatal workplace acci-dents and sharps injuries occurring in the healthcare sec-tor were excluded from the study. The study variables were age, gender, nationality, type of injury sustained, mode of injury, affected body part, and type of industry. Age was stratified into age groups, whereas nationality was categorized into ‘local’ or ‘non-local’. Industry was classified as per ILO International Standard Industrial Classification of all Economic Activities (ISIC) 200423). Type and mode of injury and affected body part were classified according to ILO Statistics of Occupational Injuries1). Data collected were analyzed using SPSS ver-sion 25. Frequency and percentage were used to describe categorical variables, and Monte Carlo Exact Test was used as a test of significance to determine for association between demographic variables, industry type, mode and type of injury, and affected body part. A p value of less than 0.05 was considered to be statistically significant.
The study obtained approval from the Institute of Health Sciences Research Ethics Committee (UBD/PAPRSBIHSREC/2017/028).
Results
A total of 424 non-fatal occupational accidents were notified to OHD over the five-year period. The prevalence rate for non-fatal occupational injuries ranged from 2.32 per 10,000 in 2014 to 6.54 per 10,000 in 2018 (Table 1). There was an increasing trend in number of cases notified year on year from 44 (2014) to 132 (2018) (Fig. 1.). The mean age of injured workers was 37.2 years, with injuries mostly occurring in the 30–39 age group (42.5%) and predominantly in males (98%). Migrant workers ac-counted for majority of the injured workers (86%) (Table 2).
Table 1. Prevalence rate of occupational accidents by year per 10,000 workers.
| Year | No of accidents | No of workers | Prevalence Rate (per 10,000)* |
|---|---|---|---|
| 2014 | 44 | 189,573 | 2.32 |
| 2015 | 55 | 188,678** | 2.91 |
| 2016 | 108 | 187,783** | 5.75 |
| 2017 | 85 | 186,886 | 4.54 |
| 2018 | 132 | 201,742 | 6.54 |
*Accident Prevalence Rate = Number of accidents in workers aged 15 years and above / Workforce x 10,000 workers.
**Estimates are based on employed workforce data for 2014 and 2017 (Labour Force Survey by Department of Economic Planning and Development).
Fig. 1. Trends of Non-fatal Occupational Accidents from 2010 until 2018.
Table 2. Demographics of workers.
| Variable | 2014 n (%) |
2015 n (%) |
2016 n (%) |
2017 n (%) |
2018 n (%) |
Total |
|---|---|---|---|---|---|---|
| Age (years) | ||||||
| 20-29 | 5 (11.4) | 11 (20) | 18 (16.7) | 24 (28.2) | 29 (22) | 87 (20.5) |
| 30-39 | 18 (40.9) | 23 (41.8) | 41 (38) | 34 (40.0) | 64 (48.5) | 180 (42.5) |
| 40-49 | 17 (38.6) | 18 (32.7) | 39 (36.1) | 18 (21.2) | 33 (25) | 125 (29.5) |
| 50-59 | 4 (9.1) | 3 (5.5) | 10 (9.3) | 6 (7.1) | 6 (4.5) | 29 (6.8) |
| >60 | 0 | 0 | 0 | 3 (3.5) | 0 | 3 (0.7) |
| Mean age | 38 | 37 | 38 | 37 | 36 | 37.2 |
| (Range) | (24-51) | (21-52) | (22-58) | (20-69) | (20-57) | (20-69) |
| Gender | ||||||
| Male | 44 (100) | 55 (100) | 107 (99.1) | 82 (96.5) | 128 (97) | 416 (98) |
| Female | 0 | 0 | 1 (0.9) | 3 (3.5) | 4 (3) | 8 (2) |
| Nationality | ||||||
| Local | 0 | 5 (9.1) | 18 (16.7) | 8 (9.4) | 20 (15.2) | 51 (12) |
| Non-Local | 40 (90.9) | 46 (83.6) | 90 (83.3) | 77 (90.6) | 112 (84.8) | 365 (86) |
| Unknown | 4 (9.1) | 4 (7.3) | 0 | 0 | 0 | 8 (2) |
Our study findings showed that common causes of non-fatal occupational injuries were struck by objects/ falling objects (37.7%), falls from height (25%), and con-tact with sharp items (20%), all of which were statistically significant (Table 3). 51.1% of injuries were superficial injuries and open wounds, followed by internal injuries (20.2%) and fractures (15.5%); these were significantly higher than other types of injuries sustained (Table 3). Most affected body parts were upper extremities (43.1%), followed by lower extremities (19.3%) and head (18.2%) (p=0.03 respectively) (Table 3).
Table 3. Mode and Type of Injuries, and Affected body part.
| Variable | 2014 n (%) |
2015 n (%) |
2016 n (%) |
2017 n (%) |
2018 n (%) |
Total |
p-value** (95% CI) |
|
|---|---|---|---|---|---|---|---|---|
| Mode of Injury* | 0.00 (0.00-0.01) |
|||||||
| A. | Contact with electrical voltage, hazardous substances, or temp. |
1 (2.3) | 3 (5.5) | 4 (3.7) | 6 (7.1) | 6 (4.5) | 20 (4.7) | |
| C. | Falls | 16 (36.4) | 15 (27.3) | 35 (32.4) | 13 (15.3) | 27 (20.5) | 106 (25) | |
| D. | Struck by falling objects |
16 (36.4) | 18 (32.7) | 39 (36.1) | 25 (29.4) | 62 (47) | 160 (37.7) | |
| E. | Contact with sharps | 4 (9.1) | 10 (18.2) | 15 (13.9) | 31 (36.5) | 25 (18.9) | 85 (20) | |
| F. | Crushed between objects |
4 (9.1) | 4 (7.3) | 9 (8.3) | 8 (9.4) | 7 (5.3) | 32 (7.5) | |
| G. | Acute overloading of body |
0 | 0 | 0 | 1 (1.2) | 5 (3.8) | 6 (1.4) | |
| H. | Animal bites | 0 | 1 (1.8) | 1 (0.9) | 1 (1.2) | 0 | 3 (0.7) | |
| Z. | Unidentified | 3 (6.8) | 4 (7.3) | 5 (4.6) | 0 | 0 | 12 (2.8) | |
| Type of Injury* | 0.00 (0.00-0.01) |
|||||||
| A. | Superficial Injuries and open wounds |
14 (31.8) | 38 (69.1) | 62 (57.4) | 37 (43.5) | 66 (50) | 217 (51.2) | |
| B. | Fractures | 15 (34.1) | 9 (16.4) | 22 (20.4) | 3 (3.5) | 17 (12.9) | 66 (15.5) | |
| C. | Dislocations, sprain and strain |
1 (2.3) | 0 | 5 (4.6) | 0 | 5 (3.8) | 11 (2.6) | |
| D. | Traumatic amputations |
2 (4.5) | 1 (1.8) | 3 (2.8) | 4 (4.7) | 4 (3) | 14 (3.3) | |
| E. | Internal injuries | 4 (9.1) | 2 (3.6) | 9 (8.3) | 36 (42.4) | 35 (26.5) | 86 (20.3) | |
| F. | Burns, corrosion and scalds |
1 (2.3) | 3 (5.5) | 4 (3.7) | 4 (4.7) | 4 (3) | 16 (3.8) | |
| H. | Others specified types of injuries |
0 | 0 | 0 | 1 (1.2) | 1 (0.8) | 2 (0.5) | |
| Z. | Unspecified | 7 (15.9) | 2 (3.6) | 3 (2.8) | 0 | 0 | 12 (2.8) | |
| Affected body part* | 0.00 (0.00-0.01) |
|||||||
| A. | Head | 10 (22.7) | 10 (18.2) | 11 (10.2) | 12 (14.1) | 34 (25.8) | 77 (18.2) | |
| C. | Back, Trunk and Internal Organs |
1 (2.3) | 1 (1.8) | 8 (7.4) | 5 (5.9) | 10 (7.6) | 25 (5.9) | |
| D. | Upper Extremities | 15 (34.1) | 25 (45.5) | 48 (44.4) | 39 (45.9) | 59 (44.7) | 186 (43.9) | |
| E. | Lower Extremities | 10 (22.7) | 10 (18.2) | 24 (22.2) | 19 (22.4) | 19 (14.4) | 82 (19.3) | |
| F. | Multiple Body Parts | 7 (15.9) | 5 (9.1) | 11 (10.2) | 10 (11.8) | 10 (7.6) | 43 (10.1) | |
| X. | Unspecified | 1 (2.3) | 4 (7.3) | 6 (5.6) | 0 | 0 | 11 (2.6) | |
*Classification as per International Labour Organization, Statistics of Occupational Injuries, 1998.
**Monte-Carlo Exact Test was used for statistical association as >20% of cell for expected values were less than 5.
Construction industry recorded the highest number of non-fatal injuries, with a mean of 56.4% over the five years. The second most common industry was wholesale and retail trade, repair of motor vehicles and motorcycles (13%), followed by manufacturing (8.0%) which was sig-nificantly higher than the number of non-fatal accidents recorded from other work sectors (Table 4).
Table 4. Incidence of occupational accidents categorised by industry and year.
| Type of Industry* | 2014 n (%) |
2015 n (%) |
2016 n (%) |
2017 n (%) |
2018 n (%) |
Total n (%) |
p-value** (95% CI) |
|
|---|---|---|---|---|---|---|---|---|
| A. | Agriculture, forestry and fishing | 1 (2.3) | 0 | 0 | 6 (7.1) | 2 (1.5) | 09 (2.1) | 0.00 (0.00-0.01) |
| B. | Mining and quarrying | 0 | 0 | 2 (1.9) | 0 | 0 | 2 (0.5) | |
| C. | Manufacturing | 7 (15.9) | 10 (18.2) | 8 (7.4) | 4 (4.7) | 5 (3.8) | 34 (8) | |
| D. | Electricity gas, steam and air- conditioning supply |
2 (4.5) | 1 (1.8) | 3 (2.8) | 0 | 4 (3) | 10 (2.4) | |
| F. | Construction | 22 (50) | 22 (40) | 49 (45.4) | 55 (64.7) | 91 (68.9) | 239 (56.4) | |
| G. | Wholesale and retail trade, repair of motor vehicles and motorcycles |
2 (4.5) | 3 (5.5) | 16 (14.8) | 15 (17.6) | 19 (14.4) | 55 (13) | |
| H. | Transportation and storage | 0 | 3 (5.5) | 3 (2.8) | 0 | 2 (1.5) | 8 (1.9) | |
| I. | Accommodation and food service activities |
3 (6.8) | 1 (1.8) | 4 (3.7) | 4 (4.7) | 9 (6.8) | 21 (5) | |
| J. | Information and communication | 0 | 2 (3.6) | 0 | 0 | 0 | 2 (0.5) | |
| L. | Real estate activities | 0 | 1 (1.8) | 0 | 0 | 0 | 1 (0.2) | |
| S. | Other service activities | 4 (9.1) | 3 (5.5) | 14 (13) | 0 | 0 | 21 (5) | |
| T. | Activities of households as employers; undifferentiated goods and services-predicting activities of households |
0 | 2(3.6) | 0 | 0 | 0 | 2(0.5) | |
| X. | Unknown | 3 (6.8) | 7 (12.7) | 9 (8.3) | 1 (1.2) | 0 | 20 (4.7) | |
*Classification as per International Standard Industrial Classification of all Economic Activities (ISIC), 2004.
**Monte-Carlo Exact Test was used for statistical association as >20% of cell for expected values were less than 5.
Discussion
Our study findings showed that the number of non-fatal occupational accidents in Brunei Darussalam ranged from 44 to 132 per year with a prevalence rate of 2.3 to 6.5 per 10,000 workers during the five-year period. The Ministry of Health had embarked on an electronic patient medical records system in 2013 (Bru-HIMS) in three phases cov-ering government health facilities under the ministry. Prior to 2013, the number of notified occupational inju-ries via submission of completed ‘Accident at Work Re-porting Form’ to OHD were 99 (2010), 167 (2011), 233 (2012), 63 (2013) 24). A drop in 2013 is likely to be at-tributed to the transition period for the implementation of Bru-HIMS coupled with lack of awareness among health professionals in using the online method for notification to OHD. However, the numbers were observed to have improved after 2014 due to regular continuous medical education (CME) sessions that provided a valuable plat-form to highlight, educate and increase awareness to health professionals on occupational health and safety and reporting mechanism, as well as the role of OHD within the ministry.
In South East Asia region, the occupational injury rate in Brunei Darussalam is lower than that of Malaysia (28 per 10,000 workers) and Singapore (35.5 per 10,000 workers for minor occupational injuries and 1.74 per 10,000 workers for major occupational injuries)16, 25).
A high proportion of occupational accidents were seen in male workers as males are more likely to be employed in labour-intensive and high risk industries such as con-struction and manufacturing. A similar result was seen with nationality; this is because migrant workers are mostly employed in labour-intensive and service indus-tries and therefore are susceptible to workplace injuries.
Our study showed that most occupational accidents occurred in the construction sector and the three leading causes of occupational accidents were struck by falling objects, fall from height, and contact with sharp items. A meta-analysis study on seventy-five articles found that fall from height was the leading cause of reported serious and fatal injuries in most countries, with the highest rate observed amongst construction workers when compared to other industries26). Contributing factors for occupa-tional accidents were lack of and/or non-adherence to company safety policies, lack of proper supervision, lack of training and educational programs for workers, incor-rect work procedures, and negligence on personal protective equip-ment usage27).
Superficial injuries and open wounds (51.1%) were the commonest type of injury in our study. Internal injuries (20.3%) and fracture (15.5%) were the next leading types of injuries, which was similarly seen in a study conducted in Malaysia where 10% of occupational injuries resulted in fractures28).
This study showed that 43.9% of injuries occurred in upper extremities followed by 19.3% in lower extremities and 18.2% for head injuries. This was similarly seen in reports from countries such as United States, Ireland, and Malay-sia where common non-fatal occupational injuries oc-curred in upper extremities, lower extremities and head29–31).
Conclusion
Our study showed that occupational accidents mostly occurred in male, migrant workers in the 30–39 age group. The main cause of workplace injury was struck by falling objects which resulted in superficial and open wounds, with upper limbs being affected the most. Major-ity of the accidents occurred in the construction industry. More proactive interventions are needed at the organisa-tional and individual levels. Organisations should de-velop capabilities and support mechanisms for risk as-sessments, auditing and reviewing performances, as well as cultivate an open communication between employer and employees. Employees should instill in themselves a safety culture at the workplace, and pro-actively work with their employer or management to integrate and maintain a high standard of health and safety practices at their workplace.
Acknowledgments
The authors would like to thank Dr Norizni Mosli from Occupational Health Division, Ministry of Health for as-sisting with the work-related injury registry; and Dr Kyaw Thu from Disease Control Division, Ministry of Health for his support with data analysis.
Conflict of Interest
The authors declare that this study did not have any conflict of interest.
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