Occupational Ocular Injuries and Utilization of Eye Protective Devices among Sawmill Workers in the Ojo Local Government Area of Lagos State, Nigeria

Round 1

Reviewer 1 Report

Dear Authors,

your paper entitled “Occupational ocular injuries and utilization of eye protective device among sawmill workers in Ojo Local Government Area of Lagos State” is interesting, but I believe that it can be re-considered after some major revisions, that are needed, as for my comments listed here below for the different sections of the manuscript.

Best regards,

the Reviewer.

Abstract

1. “Awareness of occupational ocular injuries was high (78.6%) but the utilization of ocular safety device was low (17.7%)”

“High” and “low” sound as not good scientific language, please reformulate.

2. “The major barrier to use of eye protective device was unavailability (43%) of the eye protective devices”

“Protective device” repeated twice.

3. “Age, monthly salary, work experience, awareness of ocular hazard, and use of protective eye device were significantly associated with occupational ocular injuries (P <0.05)”

Not clear from the abs. Whether these factors are positevely or negatively associated with the outcome investigated.

Introduction

4. “8% unintentional injuries”

8% of the/all (?) unintentional injuries?

5. In the introduction it should also be considered that work is a recognized and frequent cause of eye injuries, representing the 30-70% of the accesses to Ophthalmological Emergency Departments according to this reference: doi: 10.3390/ijerph14060604

6. Please consider also that there are some reports on sawmill workers suffering from various other ocular diseases, involving cornea, conjunctiva and the lens, and not necessarily related to eye injuries (please see e.g. the one from Nigeria you cite https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216228/ ; but also this one from India: doi:10.1001/archopht.1967.00980030487014 ). One of the main risk factors for both pterygium and cataract in sawmill workers is related to the characteristic of this outdoor work with exposure to solar UV radiation, wind and dust, and not only to ocular traumas: doi: 10.3390/ijerph15010037 ; and: DOI: 10.1111/aos.13734 .

Material and Methods

7. More objective data on when and how the researchers performed the study are needed: the description of the methodology is too generic.
8. Paragraph 2.1 and sub-paragraph 2.11, 2.1.2, 2.1.3, 2.1.4, 2.1.5 ; these sections need to be expanded: the reader needs to know how the specific variable was investigated, i.e. what type of question, and how the answers have been collected, evaluated and categorized.

9. Why the statistical subparagraph has not its specifci subsection?

Results

10. The age range needs to be indicated. 80 years old seems definetely too much for a sawmill workers: how many workers above 70 years age are included in the study? Not possible to exclude them from the analysis? It would be better because they may have a lot of comorbidities, involving the eyes and not related to work, but to aging. On the other hand, also <20 years is not acceptable. How man y workers between 15 and 20 years at work (i.e. a working age recognized by the I.L.O.)? How many workers can be considered childs with 14 ys or less? Also in this case, if possible, I would exclude child workers, if any, from the study.

11. Section 3.3. Why “pinguecular”? Should be pinguecula.

12. Section 3.4. A proportion of 36% of injured workers going to the emergency department can really be defined as a good proportion? I don’t think so.

13. Section 3.5: please consider the same comment on this data made in the abstract section.

14. Table 5: p value can’t be 0.00

15. Table 5: Nil , JSS , SSS : these words need to be explained with a note added to the Table.

Discussion

16. General comment: perhaps the Discussioni is too long: please try to shorten it

17. “This is the first study”

Maybe add “to the best of our knowledge”. Moreover does it make sense to speak about “first study” for Ojo? It seems to me not a very big and populated area (around 600.000 inhabitants according to Wikipedia): am I true? According to this, it would be better to compare your study at least with a regional or national level (i.e. Lagos? Nigeria?) when not possible to consider also other nations in the same world area.

18. “a high response rate was recorded” and first lines of the section 4.1

Is it really necessary to use so many lines to speak about the high response rate of your study? I am not sure: the study includes not so many participants, and the details on the selection of the sample are too few to spend so much words. Moreover, are there estimates of how many sawmill wokers are employed in Ojo? Is this job all part of the formal economy or is there a relevant amount of worlkers of the informal economy?  

19. Sixth line of the Discussion & section 4.2 (two times): “pinguecular” should be “pinguecula”

20. Section 4.2. it is not clear to me how your study has confirmed the role of UV radiation, dust and wind in the occurrence of pterygium and pinguecula.

21. Section 4.2 “Moreover, even though cataract is predominantly an age related condition, prolonged exposure of sawmill workers to ultraviolet rays due to their outdoor work”: a reference is needed here. The same indicated before for the introduction can be used.

22. Despite the Discussion is long, probably the Limitations section is too short, as your study has several limitations that need to be mentioned. E.g. observational nature, only descriptive analysis with no investigations of the relations between parameters, low consideration of possible confounders, etc.

Conclusions

23. “The finding of this study suggest that there is a high prevalence of occupational ocular injuries among sawmill workers in Ojo Local Government Area of Lagos State, Nigeria due to unavailability of ocular protective devices”.

Unfortunately, your study does not prove this. Your research indicate that there is a high rate of ocular injuries among sawmill workers from Ojo, confirming similar studies in similar groups of workers, and therefore confirming that sawmill work is an impiortant risk factor for ocular injuries. Moreover, your results indicate that sawmill workers from Ojo are concerned for the scarce availability of eye protective devices.

References

24. Please consider to update the list with the suggested citations.

Author Response

Abstract

1. “Awareness of occupational ocular injuries was high (78.6%) but the utilization of ocular safety device was low (17.7%)”

“High” and “low” sound as not good scientific language, please reformulate.

Response

The sentence has been corrected in the manuscript (line 19-21)

1. “The major barrier to use of eye protective device was unavailability (43%) of the eye protective devices”

“Protective device” repeated twice.

Response

The sentence has been corrected in the manuscript (line 15-16)

1. “Age, monthly salary, work experience, awareness of ocular hazard, and use of protective eye device were significantly associated with occupational ocular injuries (P <0.05)”

Not clear from the abs. Whether these factors are positevely or negatively associated with the outcome investigated.

Response

The statement has been corrected in the manuscript (line 16-19 )

Introduction

1. “8% unintentional injuries”

8% of the/all (?) unintentional injuries?

Response

The statement has been corrected as suggested in the manuscript (line 30)

1. In the introduction it should also be considered that work is a recognized and frequent cause of eye injuries, representing the 30-70% of the accesses to Ophthalmological Emergency Departments according to this reference: doi: 10.3390/ijerph14060604

Response

The statement has been added to the introduction in the manuscript (line 34)

1. Please consider also that there are some reports on sawmill workers suffering from various other ocular diseases, involving cornea, conjunctiva and the lens, and not necessarily related to eye injuries (please see e.g. the one from Nigeria you cite https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216228/ ; but also this one from India: doi:10.1001/archopht.1967.00980030487014 ). One of the main risk factors for both pterygium and cataract in sawmill workers is related to the characteristic of this outdoor work with exposure to solar UV radiation, wind and dust, and not only to ocular traumas: doi: 10.3390/ijerph15010037 ; and: DOI: 10.1111/aos.13734 .

 Response

The studies have been added to the manuscript (line 43-44)

Material and Methods

1. More objective data on when and how the researchers performed the study are needed: the description of the methodology is too generic.

Response

The method of data collection has been expanded (line 66-149).

1. Paragraph 2.1 and sub-paragraph 2.11, 2.1.2, 2.1.3, 2.1.4, 2.1.5 ; these sections need to be expanded: the reader needs to know how the specific variable was investigated, i.e. what type of question, and how the answers have been collected, evaluated and categorized.

Response

The method of data collection has been expanded in the manuscript (line 66-49)

1. Why the statistical subparagraph has not its specifci subsection?

Response

Statistical sub graph has been created (line 145-149).

Results

1. The age range needs to be indicated. 80 years old seems definetely too much for a sawmill workers: how many workers above 70 years age are included in the study? Not possible to exclude them from the analysis? It would be better because they may have a lot of comorbidities, involving the eyes and not related to work, but to aging. On the other hand, also <20 years is not acceptable. How man y workers between 15 and 20 years at work (i.e. a working age recognized by the I.L.O.)? How many workers can be considered childs with 14 ys or less? Also in this case, if possible, I would exclude child workers, if any, from the study.

 Response

The study did not include those less than 18 years and that has been corrected in the manuscript. Also, less than 20 years and above 80 years were not excluded from the study due to small sample size. Moreover, those above 80 years reported in the study did not affect the analysis and comorbidity they have were revealed in the result (Table 1).

Section 3.3. Why “pinguecular”? Should be pinguecula.

 Response

Pinguecular has been corrected to pinguecula in the manuscript (line 167)

1. Section 3.4. A proportion of 36% of injured workers going to the emergency department can really be defined as a good proportion? I don’t think so.

 Response

The sentence has been corrected in the manuscript (line 172-173)

1. Section 3.5: please consider the same comment on this data made in the abstract section.

 Response

It has been corrected in the manuscript (line 176-179).

1. Table 5: p value can’t be 0.00

 Response

The p-value was 0.001 (line 176).

1. Table 5: Nil , JSS , SSS : these words need to be explained with a note added to the Table.

Response  

The words have been explained in the manuscript (table 1).

Discussion

1. General comment: perhaps the Discussioni is too long: please try to shorten it

 Response

The discussion has been shortened as suggested

1. “This is the first study”

Maybe add “to the best of our knowledge”. Moreover does it make sense to speak about “first study” for Ojo? It seems to me not a very big and populated area (around 600.000 inhabitants according to Wikipedia): am I true? According to this, it would be better to compare your study at least with a regional or national level (i.e. Lagos? Nigeria?) when not possible to consider also other nations in the same world area.

Response

It has been corrected in the manuscript as suggested (line 183-188).

1. “a high response rate was recorded” and first lines of the section 4.1

Is it really necessary to use so many lines to speak about the high response rate of your study? I am not sure: the study includes not so many participants, and the details on the selection of the sample are too few to spend so much words. Moreover, are there estimates of how many sawmill wokers are employed in Ojo? Is this job all part of the formal economy or is there a relevant amount of worlkers of the informal economy?  

Response

It has been corrected in the manuscript as suggested (line 183-186).

1. Sixth line of the Discussion & section 4.2 (two times): “pinguecular” should be “pinguecula”

Response

It has been corrected (line 209)

1. Section 4.2. it is not clear to me how your study has confirmed the role of UV radiation, dust and wind in the occurrence of pterygium and pinguecula.

 Response

It has been corrected in the manuscript (line 214-216)

1. Section 4.2 “Moreover, even though cataract is predominantly an age related condition, prolonged exposure of sawmill workers to ultraviolet rays due to their outdoor work”: a reference is needed here. The same indicated before for the introduction can be used.

 Response

The references have been added as suggested (line 213).

1. Despite the Discussion is long, probably the Limitations section is too short, as your study has several limitations that need to be mentioned. E.g. observational nature, only descriptive analysis with no investigations of the relations between parameters, low consideration of possible confounders, etc.

Response

Those limitations have been added to the manuscript (line 281 -289)

Conclusions

1. “The finding of this study suggest that there is a high prevalence of occupational ocular injuries among sawmill workers in Ojo Local Government Area of Lagos State, Nigeria due to unavailability of ocular protective devices”.

Unfortunately, your study does not prove this. Your research indicate that there is a high rate of ocular injuries among sawmill workers from Ojo, confirming similar studies in similar groups of workers, and therefore confirming that sawmill work is an impiortant risk factor for ocular injuries. Moreover, your results indicate that sawmill workers from Ojo are concerned for the scarce availability of eye protective devices.

Response

The statement has been corrected in the manuscript (line 291-294)  

References

1. Please consider to update the list with the suggested citations.

Response

The reference list has been updated (line 306-426).

Author Response File: Author Response.docx

Reviewer 2 Report

The authors present an interesting descriptive analysis of ocular injuries and eye protection among Nigerian sawmill workers.  Although a good contribution to the literature, the authors should address several concerns.

1. The paper should be edited to improve English usage.

2. Page 2: the statement that “A Pre-test or pilot was conducted in 5% of the sample outside the study area” is confusing. 5% of what?  How many pretests were conducted?

3. Page 3: Many of the measures used in the analysis are not defined. Of the measure that are presented on page 3, the values for each measure are not noted.

4. Page 6: the actual associations of factors with injuries should be described.

   The authors present an interesting descriptive analysis of ocular injuries and eye protection among Nigerian sawmill workers.  Although a good contribution to the literature, the authors should address several concerns.

    

   1. The paper should be edited to improve English usage.

    

   2. Page 2: the statement that “A Pre-test or pilot was conducted in 5% of the sample outside the study area” is confusing. 5% of what?  How many pretests were conducted?

    

   3. Page 3: Many of the measures used in the analysis are not defined. Of the measure that are presented on page 3, the values for each measure are not noted.

    

   4. Page 6: the actual associations of factors with injuries should be described.

Author Response

1. Reviewers comment

The paper should be edited to improve English usage.

Response

The paper has been edited to improve English usage

1. Page 2: the statement that “A Pre-test or pilot was conducted in 5% of the sample outside the study area” is confusing. 5% of what?  How many pretests were conducted?

Response

A pretest of the questionnaire was conducted on 10 (5% of 215) saw mill workers in Lagos Island outside the study area. After the pre-test, the necessary modifications were made accordingly on the questionnaire. Finally, the data were collected through face-to-face interview (line 99-102).  

1. Page 3: Many of the measures used in the analysis are not defined. Of the measure that are presented on page 3, the values for each measure are not noted.

Responses

The measures used in the analysis have been defined in the manuscript (line 126-149)

1. Page 6: the actual associations of factors with injuries should be described.

Response

The actual associations of factors with injuries have been described in the manuscript (line 175-179).  

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Congratulations to the Authors as they have properly addressed all of my comments.

Reviewer 2 Report

The authors have responded appropriately to reviewer comments.  The paper expands our understanding of occupational vision injuries.