The study adds to the existing literature, as the findings are discussed using the constraint-response accident model. The constructs used to organize the discussion are 1) prevalence and type of occupational injuries, 2) proximal factors predicting occupational injuries and 3) distal factors influencing occupational injuries.
The prevalence and type of injuries sustained
The study showed that more than half, (57.9%) of construction workers had experienced occupational injuries. The prevalence appears to be higher when compared to previous estimates elsewhere [31]. Even though there are no nationally representative data on the extent of injuries sustained by construction workers, the current prevalence is about 9.3 times higher than previous reports by the labour commission, which estimated that 6.2% of occupational accidents lead to deaths in construction [20]. Of relevance, the present finding demonstrates an increasing burden of injuries among workers. This confirms previous literature in Ghana and Europe which reported the industry to be injury-prone [17, 24, 25]. Specifically, injuries sustained by the workers were open wounds, superficial (on surface) and concussion and internal injury. These injuries are similar to the categories of injuries reported to be sustained by construction workers globally [32–37]. The study recommends that policymakers and occupational health experts should develop preventive and management strategies that incorporate specific injury part sustained.
Proximal factors predicting of occupational injuries
The proximal factors influencing occupational injuries highlight the immediate individual lifestyle characteristics (eg. alcohol consumption, smoking, adherence to safety regulation, type of work and exposure to hazards) and socio-demographic profile. These factors had a relationship with occupational injuries. In this study, the socio-demographic profile such as age, sex, and income significantly predicted occupational injuries among construction workers. In particular, males were at high risk of being injured compared with females. In Ghana, the socio-cultural characteristics restrict the construction activities to males. This is due to the rigorous and hazardous nature of the construction industry [38]. Therefore, female workers are recommended to be placed in roles with limited risk in the industry. In addition, the income level of construction workers is a significant risk factor for occupation injury. Tasks with high risk of injury usually require an expert to execute. However, in performing such duties, the worker’s exposure to such risk becomes higher which may eventually translate to injuries compared to other workers assigned to simple tasks. In Ghana, construction workers with this technical expertise are usually short in supply and also demand relatively higher wages than those doing menial and causal works. This possibly explains why workers in this category were at higher risk of occupational injury.
In addition, the risk of occupational injury increased with older workers compared to the youthful age group (economic active population). Older workers are susceptible to severe injury than younger ones [31, 39–41]. Aging process involves a series of physiological changes to the body that can make construction tasks very difficult for old people. The strength and ability required of a person to carry out physically demanding tasks effectively reduce as one age. Decrease cardiac output may affect a worker’s performance on physical demanding activity and increase his susceptibility to injury [42]. The study recommends stakeholders to consider the age profile, gender identity and socioeconomic status of construction workers when designing preventive and management strategies for injuries. Further, researchers interested in occupational health-related issues should explore the reasons for the increased occupational injuries among different age, gender, and socio-economic wealth quintiles.
Distal factors influencing occupational injuries
The distal factors predicting occupational injuries describe the organizational and work-related characteristics associated with the injuries. Specifically, the study showed that daily production targets, job location, work structure, trade specialization and off working days influence the risk of occupational injuries among frontline building construction workers. Working continuously without breaks, off-days and vacations predict the risk of injury among construction workers. Our study showed that a worker who enjoys off-days in a month is 96% protected from injury occurrence compared to those working every day throughout the month. Once a worker engages in continuous work without vacations, holidays and off-days, there is the possibility of fatigue setting in, and when this happens it affects performance and productivity [19]. Therefore, job schedules that offer workers limited opportunities for breaks, off-days, and vacations should be discouraged by managers of the industry.
Working on a permanent basis or as a temporal worker makes a worker more susceptibility to injuries more compared to working daily paid workers. Daily paid workers in the Ghanaian construction industry are normally engaged for relatively short periods, they visit job sites as and when they think they need to work. Such workers are mostly hired to carry out simple task which does not require any special expertise. Permanent workers are likely to experience the cumulative effects of the exposures on their health, unlike the daily paid workers. Finding from our study revealed that, workers operating from all locations and lower grounds were 71% and 39% protected from the possible risk of experiencing injury compared to working from rooftop and elevated ground. This suggests that the chance of slipping from high and its impact on the individual is greater. This corroborates with previous findings from US, UK, and South Africa which indicated that working from a height and elevation above the ground is the most cited cause of fall-related injuries [41, 43–45]. The study recommends that policymakers and occupational health experts should incorporate the identified distal factors in the planning and designing of construction projects as part of their injury prevention intervention as well as management strategies.