The present study reports an important health issue on urinary disorders among workers from traditional leather tanneries as well as compares these disorders with the control group. In terms of toilet access and hygiene measures, about half of tannery workers require 3 or more toilet breaks and the majority of them use tissue/water after toilet. More than two thirds of tanners do not use any type of PPE. However, they reported that the use of PPE was impractical due to the high humidity in Moroccan artisanal tanneries, especially in summer. The high rate of low educational level as one of the factor limited knowledge about the existing health hazards and safety risks at work. Thus, they are at increased risk of contaminants from all possible routes including the oral, inhalation, ocular and dermal.
Regarding voiding problems, the results of our study showed a significant difference urinary tract symptoms (UTS) for voiding problems including dysuria and urinary frequency between the tannery workers and control group. It is true that UTS are not specific and can be increased by factors unrelated to prostatic conditions, fluid intake, including diet and alcohol intake [1, 23, 26]. The finding may sound alarming because many of them report that they suffer from burning urination and uncontrollable urine loss during work. Out of 111 (55%) tannery workers with urinary symptoms, 3.67% had significant bacteriuria as confirmed by bacteriological examination. In comparison with symptomatic controls (1.8%), no bacteriuria were identified (0%). E. coli was the only specie isolated among tannery workers having positive culture. Some infectious diseases such as UTI caused by E. coli are common in the general population, which complicates the attribution to the workplace . According to the Biological Agent Biodefense Category listed in the World Health Organization (WHO) and the National Institute of Health (NIH), E. coli is a pathogen that does not constitute a serious hazard to the community or to the environment . On the other hand, Chinese Laboratory Biosafety Categorization has classified E. coli as a pathogenic agent that can spread easily between people, directly or indirectly, and can cause serious human disease . In the general population, there are several causes of culture-negative urinary tract symptoms including antibiotics in urine, urinary tract malignancy, idiopathic interstitial cystitis, mycobacterial infection, Schistosoma haematobium, fungal infection, viral infection, inflammation or fastidious organisms . A major factors that impact UTI incidence in our study includes poor hygienic conditions, working in a humid area and exposure to biological hazard especially, in the traditional working environment. In agreement with our study, poor sanitation, hygienic measures have a major influence on E. coli species . However, protection strategies, as well as monitoring, are recommended for this community.
Urinalysis is a useful tool to identify not only infection, but also blood counts. In the current study, the hematuria was significantly prevalent in the tannery population compared to the control group (22.9% vs. 1.9%, p < 10–3). The prevalence of hematuria found in our control group (1.9%) was lower than that reported in large previous screening studies among the general population which varied from 9 to 18% [12, 17, 21], particularly in the male population presenting to a health fair (8.6%) . The multivariate analysis of factors associated with hematuria was conducted and showed no increased risk in the tanners' population. Previous risk factors identified of urinary tract malignancy diagnosed following hematuria were age, smoking, the presence of gross hematuria and positive cytology [4, 17]. Moreover, diabetes and proteinuria were also associated with hematuria in another research .
The prevalence of leucocyturia (WBC > 104), in the present study, was significantly higher in the tannery workers compared to that of the control group (10.9% vs. 1.8%, p < 10–3). It was reported that the leukocyturia could suggest sterile pyuria and cannot reflect the possibility of bacteriuria. However, main Clinical Associations including acute or chronic interstitial nephritis, proliferative glomerulonephritis and urological disorders were reported . In such cases, the correct interpretation of the urinary findings requires adequate clinical information and possibly renal biopsy.
Several studies have demonstrated that voiding symptoms among men increase significantly with age and functional disability [16, 21]. Other factors have been implicated in the dysuria progression including metabolic disorders . Data from previous studies highlight an association between high blood pressure, high BMI, diabetes and urinary disorders including dysuria [7, 23, 27]. In the present study, the risk to develop dysuria was associated with different factors such as BMI and high blood pressure but not necessarily age. Thus, multiple working conditions were also found to be correlated with increased risk of dysuria including working area and exposure to biological hazards. These factors are significant in bivariate analysis. The choice of the symptom 'dysuria' for logistic regression was due to the elevated rate of this symptom compared to others reported in the current study. The multivariate logistic regression analysis of factors associated with reported dysuria symptom investigates that exposure to biological hazards increased significantly the odds of dysuria by 6.76 times. However, having low or normal weight (BMI < 25 kg/m2) was an independent protective factor of dysuria. In fact, it is difficult to draw a firm conclusion about causes from observational comparisons of symptoms. Nevertheless, such comparisons are useful in describing the workers-perceived problems in the traditional work environment, to prevent various complications and improve working conditions.
In this context, a significantly higher prevalence of urinary symptoms among male workers demands a serious attention and further investigation. The low number of occupational diseases linked to biological agents should not lead to an underestimation of biological risks, but should be used as a basis for a decision to reduce the number of occupational risks. Since the exposure of traditional tannery workers to biological agents cannot be avoided, it will be reduced by the establishment of occupational health program based on the development of inter-enterprise medical service (pre-employment and periodic), the organization of medical surveillance program and provision of information/training about hazards and risks in the workplace.