Welding is regarded as a hazardous profession where the welders are exposed to heat, burns, radiation, noise, fumes, gases, electrocution, and even the uncomfortable postures involved in the work; the high variability in chemical composition of welding fumes, which differs according to the work place, method employed, and surrounding environment; and the routes of entry through which these harmful agents enter the body [1]. Common health effects in the eyes, lungs, skin and fertility are reported among the welders [1, 2]. The employment of safety measures to minimize the hazards and the use of personal protective equipment has been seen to decrease morbidity and mortality among the welders. There is low awareness of hazards and use of protective equipment among welders around the world [3, 4] and Nepal [5].

In Nepal, the Department of Labor and Employment Promotion established under the Ministry of Labor and Transport Management, in 1971, is responsible for occupational safety, health and working conditions. There is no separate section or branch for safety and health in the ministry of health. The safety and health provisions under the Labor Act, 2048 (1992), are enforced by the Factory Inspectors of Labor Office [6].

Limited studies can be found in occupational health [7–12] and among welders [5] in Nepal. The concept of occupational health and safety is relatively new and very few industries maintain optimum occupational standards even to the oldest industry of Nepal with only a few studies related to working conditions in industries, have been conducted so far [11]. While welders are exposed to hazardous working environment and the employment of safety measures along with the use of PPE is low, it is imperative to find out the existing health problems among these welders [5].

In Eastern region of Nepal, workplaces of welders are usually located around mechanic workshops, motor spare-parts markets and along major highways of cities, where they establish privately owned small-scale workshops. While health effects and conditions are reported from welders around the world, little is known about the health of the welders in Nepal. Thus we conducted this study to find out the morbidity patterns among the welders in eastern Nepal in order to generate evidence for further studies and policy advocacy.

Total of 300 welders from Jhapa, Morang and Sunsari districts participated in this study. The study showed that 100 % of the welder started the job as an apprentice to an experienced welder. They learned welding skills through hands-on apprenticeship. All welders (300) had not been oriented on basic first aid at work through orientations or trainings. The socio-demographic characteristics of the welders can be found in Table 1.

All the welders were male. Males tend to engage in hazardous work, which is seen in this study. This finding has also been reflected by a study in Nigeria [13] and India [17] where welders are predominantly males. The younger age group involvement suggests the early age apprenticeship through hands on training from experienced welders at the start of the job. It was found that about 85.3 % respondents were married, a finding similar in India [18].

This study showed 93 % of welders’ population in this area have had education, similar to a study conducted in Northern Ethiopia [19, 20]. The Census 2001 [21] shows the literacy rate of 54.1 % with Literacy rate among men being 65.5 %. The Nepal Demographic Health Survey 2011 [22] shows 89.2 % of the men in the eastern terai have had some levels of education. This could be a part of the reason for 93 % of the welders having education in the same region. The level of education among the welders showed the 48.3 % of them have completed Secondary school. The reason for not continuing the education over primary education by the 37.7 % could be related to need for financial support of own self and family and a very few who did not find it important to continue further.

Eighty one percent of the welders from this study were living below the poverty line. The national data [23] shows 22 % of the population living below the national poverty line. This gap may need to be explored, despite being employed the welders found below the poverty line.

Less than a fifth of the welders were working for more than 10 years. The mean duration of experience of welders in this study is 6.94 years. The working population in this profession has high turnover in this area with very little people with experience still working here. The welders may have learnt welding and, moved to bigger cities for better wages. However studies in Nigeria [13], shows 74.8 % welders with experience of more than 10 years including 24.7 % of welders with experience of more than 21 years and mean experience of 15.6 years in Nigeria and 81.8 % welders working for 10 years and more including 25, 9 % in 20–29 years and 22.8 % in 30 and above category with mean experience of 20.33 years in Canada [24].

The mean welding hours per day in this study was 4.18 (±0.95) hours with a minimum duration of 2 h per day and a maximum of 6 h per day. In studies from Nigeria [3] and India, [17], the welders had working hours up to 12 h a day with more than 90 % of welders having working hours of more than 6 h up to 12 h. One reason for less duration of hours of welding in our study may be the long hours of power outage in our country [25]. Welders sometimes also performed tasks like cutting, hammering but not a regular basis.

In this study, all welders had one or more complaints on health, which was similar to findings from Nigeria [13], where 96.4 % welders had one or more health complaints. The most common complaints were injuries (90.7 %) due to physical hazards including cuts by sharp metals, blunt force injury and fall injury. Complaints of injuries among Nigerian welders [13] was 37.7 %. This difference could be due difference in the use of PPE and the duration of employment among the welders in the two settings [13].

After injuries, other common self-reported symptoms were skin problems (74.3 %), and arc eye related problems (61.3 %), asthma problems (46.7 %) while the least common problem was hearing problems (35.7 %). Skin, eye, and respiratory related morbidity are some of the common health hazard related in several studies [13, 17, 26, 27]. Arc eye related symptoms in this study were found among 61.3 % of welders. Arc eye related problems was seen in 75.7 % among the welders of Benin [13]. In a study done among Canadian welders, ocular symptoms were reported by 53.3 % of welders by El-Zein [24].

Metal fume fever related symptoms in this study (43.3 %) is similar with Isah [13] finding of 43.8 %. Likewise, the prevalence of arc eye symptoms was reported to be 36 % in another study in Ethiopia [4]. While our study showed that asthma related symptoms were seen among 46.7 %, a finding that mirrors that of a study by Jani [28] where respiratory morbidity was found to be 44.4 % among welders in India and El-Zein [24] reported 40.5 % among welders in Canada.

Hearing problems (12.4 %) in our study was similar a study conducted by Tadesse [4]. The morbidities among welders in this study seems high, which may not be surprising, considering that only 47.7 % of these welders in the study used at least one type of PPE. The awareness of hazards and use of PPE among these welders has been published in 2014 [5].

Hearing complaints have been reported least in our study population. There could be several reasons for this. Welders with severe hearing complaints may have left this job. The other reason could be the fact that these workers were usually working in outdoor open space resulting in mixture of noise from vehicles. Also, we had not used any objective criteria for auditory assessment such as audiometry, which would have enabled us to diagnose at least mild to moderate hearing loss.

These differences in the prevalence rate of self -rated occupational morbidities could presumably be due to the differences in socio-economic levels, lack of safety training and awareness; and limited occupational safety and health services and practices [5].

Arc eye (P < 0.001), Metal Fume Fever (P < 0.001), Asthma (P < 0.001), Skin problems (P < 0.001), Hearing problems (P < 0.001) and Musculoskeletal problems (P < 0.01) were all seen significantly associated with age of the welders, duration of employment and welding hours per day. This showed that symptoms of the welding related problems are seen more in the more aged welders, welders working for more number of years and welders working for more number of hours per day. These findings coincide with the findings by Isah [13]. Studies done by Sharifian [29], Stoleski [30], Jani [28] and by Erhabor [31] also showed that with increase duration of exposure (years), symptoms were likely to increase showing an association. In another study in India both morbidities were found to be significantly associated with years of employment among welders than non -welders [32].

Injuries were not found to be associated with age of the welders, duration of employment and welding hours per day. Although studies have been conducted with regard to morbid conditions among welders, limited literatures were found to assess association of welding hours with morbid conditions. A study in South India [33] also found no association between injuries with duration of employment and welding hours per day. The reason for no association with age of the welders, employment duration and working hour per day, could not be explained in this study. However a possible reason could be under reporting of the injuries especially of the minor cuts and abrasions which may be ignored. All welders are daily wage workers and any absence from work may lead to no income for that day. So welders may tend to not report minor symptoms. With majority (81 %) of respondents living below poverty line, affordability to healthcare centre for injuries of any kind seems expensive. As for musculoskeletal problems, most of the participants were observed to be spending their working time sitting. This finding has an important implication because welders are involved in sedentary occupation for years and prolonged sitting (usually in squatting position) or standing have been found to be related to high incidence of low back pain [34].

Welders in this study have symptoms of multiple morbidities in huge proportion that could be related to welding. Evidence from around the world have already identified welding as a hazardous profession and the welders have suffered serious conditions due to welding. This is probably among the first evidence on morbidities associated with welding in Nepal. Based on the findings from this studies further researches will be needed to identify ways to decrease the morbidities by reducing hazards at work and increasing PPE use at work by welders in Nepal.