Knowledge, attitudes and practices regarding occupational hazards among grain mill workers in Soroti City, North Eastern Uganda: A cross-sectional study.

Abstract

Grain milling is a hazardous occupation associated with respiratory diseases, musculoskeletal disorders, and noise-induced hearing loss. However, evidence on knowledge, attitudes, and practices (KAP) regarding occupational hazards among grain mill workers in sub-Saharan Africa is limited. This study assessed KAP regarding occupational hazards and factors associated with safety practices among grain mill workers in Soroti City, Uganda. A cross-sectional study was conducted among 384 grain mill workers from August to October 2025. Consecutive sampling was used to recruit eligible workers present during the study period, with data collected across different shifts and days to minimize selection bias. Data were collected using a structured interviewer-administered questionnaire and an observation checklist. Knowledge, attitude, and practice levels were categorized using composite scores. Modified Poisson regression with robust error variance was used to identify factors associated with good safety practices, with adjusted prevalence ratios (aPR), 95% confidence intervals (CI), and p-values reported. Most respondents had good knowledge (59.9%, n=230), while 7.3% (n=28) had poor knowledge. Attitudes were evenly distributed between positive (50.0%, n=192) and negative. Despite relatively good knowledge, 68.3% (n=262) demonstrated poor safety practices. Availability of occupational safety and health (OSH) policies was the only factor significantly associated with good safety practices; workers reporting policy availability were less likely to have good practices (aPR=0.39, 95% CI: 0.25–0.60, p<0.001). This paradoxical finding may reflect the absence of written and displayed policies, with reported availability referring mainly to verbal instructions. Grain mill workers had relatively good knowledge and mixed attitudes, but safety practices remained poor, indicating a critical implementation gap. Written and displayed OSH policies, regular inspections, enforcement of safety measures, and continuous worker training are needed to improve workplace safety.