Evaluation of work-related health and safety risks associated with hairdressers in Nairobi County, Kenya City

Hairdressers are exposed to awkward posture, prolonged standing, long working hours and chemical hazards capable of causing adverse health effects. The present study aimed to evaluate hairdressers' safety and health risks. The study adopted a descriptive cross-sectional and analytical design. Systematic random sampling was used to select salons and hairdressers. Closed and open-ended questionnaires were distributed to 286 hairdressers who consented to participate in the study. An observation checklist, WISHA caution checklist, thermometer, light meter and noise level meter were used to collect data in the sampled salon. Data were analyzed descriptively and with regression analysis. It was found that the average space for salons was 8.79 m 2 , and 68.5% of hairdressers work for long hours (11-12 hours). It was established that 5.48% of salons have an adequate amount of light and that 8.22% of salons have high temperatures. Aprons were the most used personal protective equipment by hairdressers. Manual handling of salon equipment and awkward posture cause musculoskeletal disorders among hairdressers. Their odd ratios impacting the health and safety of hairdressers were 2.706 and 2.728, respectively. The study reveals that hairdressing salon designs, space, lighting, and temperatures affect the health and safety of hairdressers. The hours off work and minimal or no breaks also have negative impacts on the health and safety of hairdressers


INTRODUCTION
Hairdressing is an occupation in the hair and beauty industry that deals with cutting, dyeing, bleaching, perming, blow-drying or styling hair in order to change or maintain a person's image.It is a predominantly feminine occupation, with over 80% female workers (Senthong and Wittayasilp, 2021).Women and girls spend a lot of time experimenting with their hair; therefore, perceived to be naturally inclined to the profession.The sector is characterized by a young workforce with an average age of 26 (Mishra, 2021;Khalaf, 2021).Small establishments dominate the hairdressing trade; therefore, salons have an average of two workers, run by self-employed hairdressers who often work independently without dependent employees.
Hairdressers are exposed to various hazards in the workplace, such as awkward posture, prolonged standing, heat stress, noise, muscle load, long working hours, and physical and chemical agents.These are capable of causing adverse health effects, particularly musculoskeletal disorders, respiratory problems and other stress-related psychological disorders (Tolera, 2019;Kozak, 2019).
Work-related injuries and diseases have been a worldwide issue with substantial economic burden in terms of direct medical costs, loss of work productivity, work disability, increased time off work, early retirement and absenteeism.The International Labour Organization (ILO) estimates that, globally, about 2.3 million people die every year from occupational injury and illness (Bureau of Labor Statistics, 2022) with their cost estimated at 2-14% of the Gross National Product (GNP) and 4% of the Gross Domestic Product (GDP) of the various countries (EU-OSHA, 2022, US.It has been reported that 75% of hairstylists suffer from musculoskeletal disorders (MSD) affecting hands, fingers, wrists, shoulders, necks, backs and legs (Martolia, 2020).MSDs have been found to cause 21% of all years lived with disability (Tolera, 2019).Occupational heat exposure threatens hairdressers' health when heat illness occurs and their performance and work capacity are impaired (Fasiha et al., 2022).
Workplace organizational and physical designs affect the well-being and comfort of a hairdresser.A study to identify the determinant factors for MSDs in female hairdressers in Ethiopia shows that the MSD prevalence is 76.5 % (Tolera, 2019 andDaka, 2019).An investigation into the causes of work-related health problems among hairdressers shows that 86% result from poor working conditions (Tsegay, 2021).In developing countries, the hairdressing industry has been given minimal consideration and neglected by key players in the labour ministry; to most people, it seems unprofessional and is just a supplementary source of income (Tolera, 2019;Khalaf, 2021).
This study evaluated the work-related health and safety risks associated with the hairdressers in Roysambu Sub-County, Nairobi County, Kenya.

METHODOLOGY
This study used a descriptive and analytical cross-sectional design.The studied population consisted of hairdressers working in various salons in Roysambu Sub-County in Nairobi County, Kenya.
The number of hairdressers in the study area is estimated at 900.Mugenda and Mugenda's (2008) formula was applied to establish the sample size.The number of participants was established as 270.A 10% interval was added to cover for non-response, and the number was rounded off to 300.
The study involved all the male and female hairdressers who were working in a hair salon and had at least one year of experience working as full-time or part-time workers engaged in hairdressing activity.About 300 questionnaires were administered after obtaining participants' consent.Two Focus Group Discussions were held in Zimmerman and Githurai wards to gather information regarding ergonomic risks among hairdressers.WISHA (Washington State Deartment of Labour and Industries, 2002) Caution checklist, an ergonomic screening tool,which establishes if a job task has ergonomic stressor present for sufficient duration, was used to establish the possible ergonomic risks among the hairdressers.A tape measure was used to determine the space of a salon.Noise level measurements were performed in each sampled salon using a Digital Sound Level Meter (model Auto-ranging NM102) measuring 30dBA to 130dBA.A Digital Lux meter (model MrC Lx-103) measuring range of 0 to 100000Lux was used to take the illumination measurements for the sampled salons.A thermometer (model ThermoPro TP49 Digital Indoor Hygrometer Thermometer) measuring range of -20˚C to 50˚C was used to measure temperatures in the sampled salons.
The soft copy questionnaires, observational checklists, and WISHA checklists were securely stored on electronic devices.Both raw and analysed data were stored in hard disks and electronic files.
All the quantitative data collected were checked, cleaned, coded and tabulated in Excel sheets.Data were transferred to SPSS version 18.0 for analysis.Descriptive statistics, Chisquares and logistic regression analysis were carried out.Results were presented in tables, charts and graphs.Qualitative data were gathered, reviewed and explored.The data was coded and put into themes and thematically analysed.
Ethical approval was sought from the Kenyatta University Ethics and Review Committee.Approval for the proposal was obtained from the Kenyatta University Graduate School.A research permit was obtained from NACOSTI.The participants were informed of the confidentiality of the information they were giving.Consent was sought from them.
In this study, 141 (49.3%) participants had attended secondary school, 125 (43.7%) had participated in tertiary institutions, and 20 (7.0%) hairdressers had a primary level of education.No hairdresser was found to have not gone to school.
In this study, participants used particular personal protective equipment (PPE) depending on their task.All the participants (100%) reported that they used PPE at their workplaces.Among them, 140 (49.0%)used aprons, 108(37.8%)used gloves, 104(36.4%)used face masks, and 45 (15.7%) used flat-closed shoes (Figure 4).From the results of Table 4, it can be seen that 68 (23.8%) hairdressers reported that they had had severe back pains in the last six months, 180 (62.9%) said that they had moderate back pains, while 38(13.3%)had mild back pains over the previous six months.Twentyeight (9.8%) have had severe neck pains, 168(58.7%)had moderate neck pains, and 48 (16.8%) had mild neck pains in the last six months.Among the respondents, 150(52.4%)reported that they had had moderate pains in their hands, 57 (19.9%) had mild hand pains, and 79 (27.6%) did not have pain in the last six months.One hundred and fortythree hairdressers (50.0%) had felt pain in the ankles of their legs during the previous six months, 75(26.2%)had mild pain in their legs, while (24.8%) did not have pain in their legs in the last six months of their work.The results showed that awkward postures and manual handling were significant to the model, awkward postures (OR=2.728,95% CI: 1.276 to 5.834) and manual handling (OR=2.706,95% CI: 1.145 to 6.395), Table 5.In the present study, 174 (60.8%) hairdressers did shampooing, 69(24.1%)hairdressing did cutting, 109 (38.1%) did styling, 145(50.7%)did blow drying, 210 (73.7%) treatment and hair coloring, Figure 5.

DISCUSSION
The study established the health and safety risks among hairdressers in Roysambu Sub-County.From the findings, 84.6% of the participants were females.This agrees with the study done in Iran (Tolera, 2019).Most hairdressers were between 24 and 28 years old, with an average of 27 years; most of them have worked for less than five years, and the average is five years.This was favorably comparable to the studies done in Ethiopia (Tolera 2021) on self-reported work-related symptoms in hairdressing.Regarding education level, most hairdressers have attended secondary school, which is consistent with a study done in Ethiopia (Tsegay, 2021).
Regarding the physical design of salons, the study's results showed that the average space in most salons was 7.22 m 2 , far lower than the recommended 120 square meters.This showed that salons in Kenya do not meet the threshold and, therefore, are likely to be straining to carry out their tasks.
The study's results revealed that 2.7% of salons had a higher temperature of 28-29˚C while most of the salons had a temperature range of 24-25˚C.The results were not comparable to other studies on the physical environment's effects on hairdressers' health (Khalaf et al., 2021).The discrepancy might be due to the weather conditions of the study areas.Sixteen (21.9%) salons had noise levels of between 81.0 and 90.9 dB, which is consistent with the studies in Iran (Khafagey et al., 2023).These salons were near busy streets, bars, welding places and shops with loud music.Forty-nine salons had illumination of 300 Lux and below.
These salons were located below tall and congested buildings.Hairdressers would strain to see during evening hours.This is a risk causing strain on the eyes, shoulder and back muscles.This factor significantly predicted the hairdressers' health and safety while at work.Regarding the organizational design of the hairdressing salons, the study showed that most hairdressers (68.5%) worked for 11 to 12 or more hours per day, with an average of 11 hours per day.This is different from other studies in the past (Khalaf et al.,2021), where the average working hours is 8.9.The difference could result from a lack of compliance with labour regulations and the fact that the hairdressing occupation is informal, making the workforce work longer hours.Most hairdressers work six days a week, consistent with studies done in Ethiopia (Tolera, 2019) and Iran (Tsegay,2021).In this study, most of the hairdressers did not have a break, comparable to studies done in Nigeria and Ethiopia (Sahran, 2023;Tolera, 2019).In this study, there was no significant difference in health and safety by the availability of break time, which may be due to hairdressers having minimal breaks within a day that may not create a difference between those who didn't have a break within a day (Kozak, 2019).
All hairdressers agreed they used personal protective gear in their workplace, but the most used PPEs were aprons (49%) and gloves (37.3%).Even with their responses, most hairdressers were observed working without the required PPE.These were comparable with other studies done in Egypt (Titilayo, 2019).
Regarding the work-related musculoskeletal complaints by hairdressers, the results of this study show that participants were likely to develop back pains, neck pains, hand and wrist pains and sore feet or painful legs.This agrees with the studies conducted by different studies (Kozak, 2019).
Regarding the ergonomic risks among hairdressers, the results of the study revealed that awkward postures (85%), repetitive actions (88.1%) and manual handling (89.9%) of salon equipment were the major ergonomic risk factors.These results were comparable to studies done in Cameroon (Martolia, 2020;Kozak, 2019).Although the association is very positive after controlling for the variables, manual handling and awkward postures predicted the odds of hairdressing not being safe and healthy at their workplace.They contributed to the development of musculoskeletal disorders.
From the findings of this study, the respondents' tasks included plaiting, waving, treatments, conditioning, shampooing, drying and cutting.These activities required constant twisting of the back, static postures, prolonged standing periods, high hand force and manual handling of salon equipment.Repetition was also observed in all these clientrelated tasks.They also involve using chemicals whose contents are harmful, especially to the skin and respiratory system.The results were favorably comparable to other studies done in the past (Mishra, 2019, Tolera, 2019, Tsegay, 2021, Kozak, 2019).Due to the awkward positions and prolonged standing on hard floors, the respondents' hairdressing tasks were associated with the perceived musculoskeletal disorders among the participants.

CONCLUSIONS
Due to the alarming rates and prevalence of musculoskeletal disorders and dermatological and respiratory problems among hairdressers, especially in third-world countries, researchers are implementing new strategies to diagnose and contain the cases.In developing countries, such as Kenya, asthma, skin infection, and back pains are soaring.The workspace, physical environments, working hours, personal protection gear, hairdressing tasks, and ergonomic risk factors are all compounding factors that are causing the rise in cases.
All the tasks carried out by hairdressers are done in twisted positions with bent backs and necks, with repetitive movements of fingers and wrists for extended periods.These become the major ergonomic risk factors causing musculoskeletal complaints among the workforce.
Researchers are campaigning for safe and healthy working environments for hairdressers, but the sector is considered unprofessional; therefore, there needs to be more enforcement of occupational health and safety legislation for the hairdressing sector.There needs to be more knowledge of health and safety requirements and even hazards in the workforce.
There is also a need for compliance with the hairdressing laws because the hairdressers need to gain knowledge and training.There is also a gap in adherence to control and prevention measures through the use of personal protective equipment by the workforce and the Ministry of Labor.
Authors' contributions: Koskei Winnie Chebet solely conceived the study, contributed to the design, implementation of the research, analysis of the results and to the writing of the manuscript.Dr. Peterson Warutere and Dr. Bernard Awuonda provided critical feedback and helped shape the research and gave guidance on the analysis Funding: The preparation of this manuscript did not receive any special grants but from funding agents or institutions.
Institutional Review Board Statement: The committee has considered the research protocol in accordance with Kenyatta University Research Policy (section 7.2.1.3)and the Kenyatta University Ethics and Review Guidelines and APPROVED that the research may proceed for a period of One year from 14 th August 2021.
Informed Consent Statement: All participants gave their written informed consent.

Conflicts of Interest:
No conflict of interest is declared.

Figure 1 .
Figure 1.Light in the salons

Figure 3 .
Figure 3. Noise level in salons

Table 3 .
Organizational design of salons

Table 4 .
Severity of perceived musculoskeletal complaints

Table 5 .
Ergonomic risk factors in regression model