UNIVERSITY OF GONDAR COLLEGE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF PSYCHIATRY AND AMANUEL MENTAL SPECIALISED HOSPITAL JOINT MSC DEGREE PROGRAM IN INTEGRATED CLINICAL AND COMMUNITY MENTAL HEALTH (ICCMH)A THESIS PROPOSAL TO BE SUBMITTED TO UNIVERSITY OF GONDAR COLLEGE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF PSYCHIATRY AND AMANUEL MENTAL SPECIALIZED HOSPITAL FOR THE PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR MASTERS DEGREE IN INTEGRATED CLINICAL AND COMMUNITY MENTAL HEALTH, 2018.Name of Investigator Hagos MehariName of advisors Mr. Bizuneh Tesfaye(MSc in Clinical Psychology )Mr. Yetinayet (MSc in ICCMH)Mrs.

Wubit Demeke (MSc in ICCMH)Full title of the researchproject Prevalence of occupational stress and associated factors among Addis pharmaceutical factory workers in Adigrat, Northern Ethiopia, 2018Duration of project From January to August 2018Study area AdigratTotal cost of the project 31,380Address of investigator E-MAIL: [email protected]:+251914403300 AcknowledgementFirst, I would like to thank Almighty God without whom; it would not have been possible to complete this proposal. Secondly, I would like to express my thanks to UNIVERSITY of GONDAR College of medicine and health science department of psychiatry and Amanuel mental specialised hospital for giving me the chance to develop this thesis proposal.My deepest gratitude also goes to my advisors Mr. Bizuneh Tesfaye, Mr. Yetinayet and Mrs. Wubit Demeke for their valuable, consistent and timely advices, suggestion, comments and guidance.I would also like extend my deepest thankfulness to my sponsor organization Adigrat University, ministry of education and all Ethiopian people.

Finally, I would like to express my special recognition to all my instructors, friends & my family members for being their greatest patience, for sharing my frustration &who have supporting me emotionally by expressing their love and understanding. LISTS OF ACRONMYSAMSH = Amanuel mental specialized hospitalAPF= Addis Pharmaceutical FactoryEFFORT = Endowment Fund for the Rehabilitation of TigrayERI-Q = Effort Reward Imbalance QuestionnaireGJSQ = Generic Job Stress Questionnaire INRS = Institute National research scientificJCQ = Job Content QuestionnaireOC = Over commitmentSPSS= Statistical Package for Social ScienceUK = United KingdomUOG = University of GONDAR capitalize the first word onlyUSA = United states AMERICA capitalize the first word onlyWHO = World Health OrganizationWWQ = Work and Well-Being Questionnaire LISTS OF TABLES AND FIGURESFigure 1: conceptual framework ……………………………………………8Table 1: Work plan…………………………………………………………17Table 2: Budget plan…………………………………………………………18LISTS OF ANNEXESEnglish version consent form………………………………………………23English Version Questionnaire…………….

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.24Amharic Version Questionnaire ……………………………………………Tigrigna Version Questionnaire ……………………………………………Table of ContentsAcknowledgement iLISTS OF ACRONMYS iiLISTS OF TABLES AND FIGURES iiiLISTS OF ANNEXES ivSUMMERY v1. INTRODUCTION 11.1 Statement of the problem 11.2 LITERATURE REVIEW 31.2.1.

Prevalence of occupational stress 31.2.3 Determinants of occupational stress among factory workers 52.4 Conceptual frame work 81.3 significance of the study 92.

OBJECTIVES 102.1 General objective 102.2 Specific objectives 103.

METHODS AND MATERIAL 103.1. Study area 113.2. Study design and period 113.3. Source population 113.

4 Study population 113.5 Inclusion and exclusion criteria 113.5.1 Inclusion criteria 113.5.2 Exclusion criteria 113.

6 Sample size determination 113.7 Sampling method and technique 123.8 Study Variables 123.8.1 Dependent variable 123.

8.2 Independent variables 123.9 Operational definition 133.10 Data collection tools 143.

11 Data collection procedures 143.12 Data quality control 153.13 Data processing, analysis, interpretation and presentation 153.14 Ethical consideration 153. 15 Dissemination of Results 164. WORK PLAN 175. BUDGET BREAK DOWN 18Reference 19ANNEXES 231.

English version consent form 232. English version questionnaire 24 SUMMERY Introduction: occupational stress is a worldwide epidemic disease. The costs of occupational stress estimated about $5.4 billion each year throughout the globe .

However there is nonexistence of clear and strong data about magnitude of occupational stress in factory workers in Ethiopia,Pharmaceutical factory considered as a high risk and intensive work area for work related stress .Objective:This research will be conducted to assess the prevalence of occupational stressand associated factors among Addis pharmaceutical factory in Adigrat, Tigray, Ethiopia, 2018.Methods: Institution based cross-sectional study design using quantitative method will be conducted from May 1 to 30, 2018 in Addis pharmaceutical factory workers. The 423 study participants will be selected by simple random sampling technique from the total 947 study populations. Data will be collected through self-administration of standardized questionnaire, which was developed by Siegrist’s scale which have three subscales with Cronbach’s ? coefficients are equal to or higher than 0.80 (effort =0.80, reward = 0.84, overcommitment=0.

85 ). The collected data will be entered using Epi-data version 3.1 and will be analysed using SPSS version 20.0. Descriptive statistics will be used to summarization and presentation of the results.Both binary and Multivariable logistic regression analyses Siegrist’s scale will be done to identify important factors having association with occupational stress.Budget and work plan: The total cost of this research will be31,380Ethiopian Birr which will be accomplished from January to August 2018. 1.

INTRODUCTION1.1 Statement of the problemThe pharmaceutical factory workers can be defined as all those who contribute to the innovation, formation and fund of pharmaceuticals products, medications vaccines and others(1) .Stress is often defined as agroup of psychological, physiological and behavioral response by an individual when they recognize a lack of balance between the demands placed upon them and their capability to encounter those demands or negative emotions and sustained responses due toextraordinary efforts spent and little rewards acknowledged(2,3). Specifically, occupational stress is the harmful physical and emotional response that occurs when the demands of the job do not match or exceed the capabilities, resources, or needs of the worker caused by an imbalance between the perceived demands, the perceived resources and abilities of a person to cope with those demands(4,5).Occupational stress studied interchangeably by giving different names like work-related Stress, job stress, workplace stress, and work stress in many areas, but all represents forcommon sense(6).The Cause of occupational stress includes internal situations such as Mental attitude, thinking way and lifestyle of the person and external situations such as working environment, demands of Work, relationships (with co-workers and manager) and communication(7).

According to the statistics , stress affects about one out of four workers worldwideand it is the second most commonly reported work-related problem, which affected 22% of employees in the European Union(8).The costs of occupational stress estimated about $5.4 billion each year throughout the globe(9) and it is the second highest cause of absenteeism for non-manual workers(10).In USA over all stress considered as Health Epidemic of the 21st Century because $300 billion a year lost due to stress and increased by 10 to 30 percent among all demographic groups with over 50% of individuals perceived that it negatively impacted work productivity(11) .Recently report in Great Britain also shows 526,000 workers suffered , 12.5 million working days lost due to work-related stress, depression and anxiety in 2016/17(12). There is also high level of occupational stress in Africa amongdoctors , bank worker, cocoa farmers, polices, teachers and factory workers(13–18).Many studies reported that occupation stresses were highly affecting the education, agriculture, health institution and industries(19).

Occupational stress and its related comorbid diseases are responsible for a large proportion of disability world-wide since it has impact on individual persons psychological or physical wellbeing like increased medical and insurance costs with reduced incomeand on organizational like financial implication, deteriorate of productivity, increase employee absenteeism and turnover(7,20).As studies in Ethiopia among textile factory workers reported that occupational stress increases occupational injuries(21–23)Occupational stress is related to the low quality of life, job burnout, increasing the risk of accidents and work–related injuries and cause job change and early retirement of employees(24)Over all occupational stress is associated with age, seniority, workload, poor support, perceived non-adaptation to work, worker status, gender, separated and divorced marital status, low income, the poor perception of organisation and alcohol consumption (6,15,18,25–27)There are several studies on occupational stress and have concentrated on almost all sectors of human activity and all socio-professional categories in Europe, but there is a scarcity of studies in Africa even also in factories those are possessed by these European countries(28)In my view,scientific research studies on occupational stress amongdifferent factory workers in developed countries are more enoughand showed as their main problem in that population. There are also some studies on occupation stress in Africa, but in Ethiopia there are no studies about occupational stress among private as well as governmental factories workers despite some studies among teachers and health professional especially among nurses are more shows that occupational stress is more prevalent.

So this this research aims to assess the prevalence of occupational stress and associated factors among Addis pharmaceutical factory in Adigrat in order to get attention by concerned body as well as to serve as base line data for further studies .1.2 LITERATURE REVIEW1.2.1.

Prevalence of occupational stressAccording to World Health Organization about 25% of the entire population experience symptoms of stress at least one time in his/her life(7).A Cross sectional survey done in UK Naval service workers between 1999 and 2004 the occupational stress according to the Work and Well-Being Questionnaire (WWQ) was found to be 32%(29).A cross sectional study was conducted to determine the prevalence of occupational stress as a non-auditory effect of noise among 67 palm oil mill workers in Malaysia shows that 21% of them were occupational stress based on O’Donnell Personal Stress Inventory (30). Moreover another cross-sectional study conducted in MALAYSIA among 91 polymer manufacturing workers in 2012 the result showed that occupational stress were 25% by using job content questionnaire(31). A study done among 133 JAPAN daytime governmental employees in 2017 found that higher occupational stress subdivide stress group “role conflict” (OR = 5.29, 95% CI, 1.

61–17.32) by using the Generic Job Stress Questionnaire (GJSQ)(32).A cross-sectional study done among garment factory workers in TURKEY show that, the mean level of occupational stress was 43.45 with SD 5.05 in males and 43.85 with SD 5.61 in females(33).

There are different studies on different factories, industries and companies regard to occupational stress in IRAN . Example, a case control study conducted in Iran among 100 cases and 508 controls (those were with injuries in the last year and not injured)car manufacturing workers showed that occupational stress assessed by the Belkic occupational stress index was 21.3% among the control group and 35.

1% among case group workers had occupational stress(34). Another study conducted in IRAN which was cross-sectional study among 400 male employees in IRAN Esfahan steel company 2012 shows that 53% of had occupational stress(35). Assessment of Job Stress and Personal-Related Factors among the Workers of a Military Industry in IRAN in 2013 on all 149 employees found that Mean of occupational stress score was 3.59 ±0.45 and was in no stress range(24). A cross-sectional study among fire-fighters workers of Tehran, IRAN in 2013 among 312 the prevalence of overall stress was 2.

2% with stress level 5.8% in demand area, 41% in control area, 12.5% in communication area 1.5% in role area, 17% in change area 14.1% in manager support area, and 5.4% in peer support area(36).

In the assessment of occupational stress among garment factory employees in Bangalore suburban locality of INDIA in 2016 by cross-sectional study reported that the prevalence was 26% (95% CI; 18.04-26.36). Among of them, Managers had higher prevalence of stress (29.3%) and supervisors (25.

1%), but generally Majority of managers were perceived to have moderate stress level (58.4%) when compared to supervisors (26.10%)(27).Another descriptive cross sectional study conducted in a single thermal power unit located in Tamilnadu state, INDIA by using standard and validated questionnaire by O’Donnell MP to assess the occupational and non- occupational stress reported that the prevalence of occupational stress among 126 participants were 9.

5%(37).A study conducted in 2006 among 413 INDIAN naval workers of sailors and ashore revealed that the occupational stress was 36.7% among junior sailors and 20% among officers and senior sailors(38). As INRS(Institute National research scientific ) occupational health research conference in 2012 revealed workplace stress in SOUTH AFRICA mineworkers had 23 % of miners feel their work is a high strain job among 173 volunteer mine workers by using 18-item Job Content Questionnaire(39).

A cross-sectional survey among textile workers in Democratic Republic of Congo showed that high level of stress which is 28% according to Karasek’s and 22% according Siegrist’s model. Among them 14%-isostrain was calculated when considering all workers(18).There are some studies on occupational stress among health professional in Ethiopia, as institutional based cross sectional study among 592 Mekelle city healthcare workers in 2015 by using self-administration of standardized questionnaire developed by Health and Safety Executive revealed that the magnitude of work related stress was 46.9%, 95% CI (42.

6, 50.8) with (56.7%) of healthcare workers were dissatisfied with their current job(40).

Another institution-based cross-sectional study 343 nurses conducted in public hospitals of Addis Ababa in 2012 reported that occupational stress was 37.8 % (95% CI: 34.3 to 39.1)(41).Institutional based cross-sectional study conducted among 178 nurses in East Gojjam zone public hospitals in 2016 to assess the level of occupational stress shows that 57.

3% of nurses were occupationally stressful(42).Despite the magnitude of occupational stress is high among different factory workers in different countries, there is little data showing such impact in Africa particularly in Ethiopia no data. Therefore this research will aim to identify the prevalence and associated factors of occupational stress among Addis pharmaceutical factory workers at least to give as a gateway for other researchers.1.2.3 Determinants of occupational stress among factory workersA cross-sectional population study on prevalence of work-related stress and its association with self-perceived health and sick-leave in Sweden women comprised 424 employed reported that 10% of the group reported high perceived stress owing to indistinct organisation and conflicts, and 25% high perceived stress owing to individual demands and commitment.

22% percent reported low influence at work and 33% reported work interference with leisure timewith an OR of 3.17 (CI = 1.51–6.62) and 4.53 (CI = 2.71–7.56) respectively.(43)Factors associated with high prevalence of occupational stress in those employees who smoke cigarette (OR=0.74; 95% CI=0.58~0.94), lack of supervisors’ instrumental support (OR=0.34; 95% CI=0.18~0.65), poor emotional support from friends (OR=0.54; 95% CI=0.62~0.96) and physically inactive in their leisure time (OR=1.44; 95% CI=1.16~1.79) as research conducted among CHINA Offshore Oil Worker showed.(44)A cross-sectional study among 400 male employees in IRANEsfahan steel company 2012 showed that A monthly salary of less than $600 (OR = 1.88, 95% confidence interval CI = 1.21-2.94), family-related problems (OR = 2.75, 95% CI = 1.22-6.21), work environment (OR = 3.09, 95% CI = 1.78-5.33) and having a second job (OR = 2.68, 95% CI = 1.78-6.78) were significantly associated with occupational stress.(35)Married status (P = 0.006), lower education (P = 0.011), number of medical visit Prevalence, (P = 0.044), career history (P = 0.047) were significant association with occupational stress as study conducted in IRAN among fighters workers in showed 2013(36).As the result from MALAYSIA come up that there were significant associations between occupational stress and decision latitude (p