Knowledge and practices associated with exposure to nail products among informal nail technicians in Braamfontein, South Africa

Abstract

Background The global nail care industry is an annual $13 billion industry and attracts a large workforce market, comprising both formal and informal nail technicians. In Braamfontein, one of the busiest and mixed-use zones in Johannesburg, South Africa, the informal nail sector is thriving, with numerous salons operating from often overcrowded and poorly ventilated rooms. Exposure to nail polish, gel removers, adhesives, acrylics and other nail products increases the risk of acute respiratory and chronic health issues. Assessing the knowledge and practices of informal nail technicians regarding exposure to nail products is critical to help develop interventions to promote occupational health and safety. Objectives i. To describe the knowledge and practices of informal nail technicians regarding the chemicals in the products they use. ii. To identify factors (sex, age and work experience) that are associated with informal nail technicians’ knowledge about these chemicals. iii. To identify factors (sex, age and work experience, knowledge) that are associated with nail technicians’ practice regarding the use of nail products. Methods This was a quantitative, cross-sectional study, for which we recruited 60 participants, comprising 31 informal nail technicians who participated in a previous larger study on exposure to chemicals in nail products and 29 additional nail technicians who were selected using convenience sampling. The data were collected using an English interviewer-administered questionnaire with close-ended questions. The questionnaire was divided into sections related to 1) demographic characteristics, 2) knowledge, 3) symptoms, and 4) practices. Sections 2 to 4 consisted of multiple- choice questions with responses such as “yes” or “no”, and “harmful” or “not harmful”. Knowledge and practice scores were allocated for responses and then summed, after which participants were grouped into high or low (knowledge or practice) categories. Descriptive statistics were used to summarise the demographic and work-related characteristics of the study participants, and their reported symptoms, and their knowledge and practice scores. Multivariable logistic regression analysis was used to assess the relationships between socio-demographic factors, and both practices and knowledge. Results Most of the participants were females (n=40, 66.7%). The mean age was 33 ±6.6; 50% had a tertiary education. Twenty-two (36.7%) reported experiencing symptoms that are associated with exposure to nail products. The average knowledge and practice scores were 33.3% and 78.3%, respectively. Work experience was negatively associated with knowledge: for every increase in years of work experience, the odds of having higher knowledge decreased by 19% (OR = 0.81, 95% CI = 0.67–0.97, p= 0.025). However, the association was not statistically significant in the adjusted model (OR = 0.85, 95% CI = 0.66–1.08, p=0.174). Age was positively associated with knowledge: with every year of increase in age, the odds of having higher knowledge increased by 14% (OR = 1.14, 95% CI = 1.02–1.26, p=0.021). However, this result was also not significant in the adjusted model (OR = 1.08, 95% CI = 0.95–1.24, p=0.237). There were no associations between demographic and work-related factors, and level of practice. Conclusion In this study, we found no significant associations between socio-demographic or work-related characteristics and the knowledge or practices of informal nail technicians regarding the chemical composition of nail products and associated health hazards. This is possibly due to the limited population to participate in the study. Overall, the findings suggest a disconnect between knowledge and practice. Although informal nail technicians demonstrated relatively good safety practices, their limited knowledge of chemical hazards may explain the persistence of exposure-related symptoms. These results highlight the urgent need for targeted educational programs to improve awareness and safety interventions to promote healthier practices in the informal sector.