Occupational health hazards of the traffic police could get more severe when the duration of exposures to physical strain, exhaust of vehicles, noisy environment due to blowing of horns and blow of dust in the air by a speeding vehicle, increase [16-18]. This was supported by the fact that age, a proxy of duration of work, was significantly associated with severe anxiety among the traffic police in our study.
The relatively low use of protective equipment found in this study can contribute to high burden of occupational health problems among traffic police [18 19]. Studies have shown a significant protective effect of using N95 mask from several respiratory health problems and infections [20 21]. Among Nepalese traffic police, the low use of such protective equipment could be a consequence of poor knowledge or low intention even with adequate knowledge [4 9]. A study (2015) reported that the level of knowledge regarding the prevention of respiratory problems among Nepalese traffic police was significantly higher than the use . Since the preventive practice is poor, and the burden of self-reported health problems is high, the government should strongly mandate the use of protective equipment during the work to improve the level of preventive practice among traffic police.
In this study, a significant proportion of traffic police had never accessed health screening services and reported having various physical and mental health symptoms. For instance, over 65% of the traffic police reported having back pain; this may be because a clear majority of traffic policemen reported working in standing position an average of 11 hours a day. In addition, having symptoms such as eye irritation and ear ringing are clearly linked with the air pollution and congested traffic, and reporting these symptoms was also significantly associated with moderate anxiety among the traffic police in the study. Government of Nepal, however, does not recognize the occupational health of traffic police as a major public health issue and there are no specific health services that are provided to traffic police to protect them from potential occupational health problems and injuries.
It has been reported in online-media (Facebook page of Nepal Health Clinic Association) that sporadic health camps were being organized by non-governmental organizations targeting traffic police; however, most traffic police, especially females and those working long shifts, are less likely to participate in those health camps. Moreover, these camps may not have all the services and resources required to comprehensively screen for all the occupation-related physical and mental health problems among traffic police. It is recommended that a special occupational health taskforce under Ministry of Health and Population of Nepal should be established and mobilized to target traffic police with the tailored occupational health screening services (e.g., monitoring exposure to environmental toxicants, noise, accidents, communicable diseases and mental stress).
Unless the occupational surroundings (air pollution, noise pollution and traffic congestion) are not made healthier, the health and safety of traffic police is less likely to be insured [8 16 18]. It is therefore suggested that pollution control and traffic management policies and strategies are of utmost importance and should be effectively implemented to ameliorate occupational health and wellbeing of traffic police working in Kathmandu and Lalitpur. The traffic management authorities in Kathmandu and Lalitpur have introduced several rules and strategies (e.g., banning and removing vehicles that are 20 years and older, mandatory use of filter for gas exhaustion, introduction of electrically powered vehicles, improvement in traffic management) to tackle the problems of traffic congestion and air pollution; however, the effective implementation of such rules and strategies has become a challenging task. Further research on implementation issues of how and why such polices are not producing desired (health and traffic-related) outcomes could come up with insightful conclusions .
In this study, we approached and invited 260 traffic policemen and we received a high response rate (97%), given that traffic police in Kathmandu and Lalitpur usually have long shifts and tiring nature of work. We also used a standard instrument to measure general anxiety, which increases comparability of our findings with other studies and prevented misclassification of information. Nevertheless, the following limitations ought to be considered when interpreting the results: first, since we relied on self-reported data and no medical tools were used to assess health problems systematically, it appears likely that the higher prevalence of occupational health problems among traffic police might be due to reporting and recall bias. Second, the cross-sectional nature of the study prohibits inference of causality. Third, we did not consider other social and environmental factors that can potentially be associated with health problems of traffic police. Forth, research has demonstrated that the ordinal categorization of continuous constructs, such as anxiety, may lead to less reliable measurement . Last, gender was significantly associated with severe anxiety despite the very low number of female traffic police included in the study. In fact, the representation of women in traffic police department of Nepal is very low and therefore, this finding should be cautiously interpreted.