Browsing by Subject "Occupational Medicine"
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- ItemOpen AccessAllergic sensitization and work related asthma among poultry workers in South Africa(2016) Ngajilo, Dorothy; Jeebhay, Mohamed; Baatjies, RoslynnObjective: The aim of the study was to determine the risk factors associated with allergic sensitisation and various asthma phenotypes in poultry workers. Methods: A cross-sectional study of 230 currently employed poultry workers used a modified ECRHS questionnaire, spirometry, fractional exhaled nitric oxide, Phadiatop and ImmunoCAP for specific IgE to poultry farming associated allergens (chicken meat, feathers, serum protein, droppings, sunflower seeds, storage mite) and mould mix to investigate workrelated asthma. Results: The mean dust particulate concentration (geometric mean (GM) =11.04mg/m³) was highest in the rearing department while mean (1-3)-ß-D-glucan (GM=148 ng/ m³) and endotoxin levels (GM=2298 EU/m³) were highest in the catching department. Worker's mean age was 37±9 years, 68% were male, 43% current smokers, 34% atopic and 5% casual workers. The prevalence of non-atopic asthma (NAA=10%) was higher than atopic asthma (AA=6%) or probable occupational asthma (OA=5%). Sensitisation to at least one poultry work related allergen was 24%, with sunflower seed and storage mite sensitisation being the most prevalent (13%). In multivariate adjusted models, workers sensitised to chicken specific allergens were more likely to be atopic (OR=20.9, 95% CI: 4.7-93.2) or have casual job status (OR=6.0, 95% CI: 1.1-35.9). Workers with work-related chest symptoms were more likely to work in the rearing department (OR=3.2, 95% CI: 1.2-8.3) and to report episodes of high gas/dust/fume exposures causing asthma symptoms (OR=4.8, 95%CI: 2.4-9.6). Reversible obstructive airway obstruction was more strongly associated with employment in small broiler farms (OR=11.6, 95% CI: 1.0-129.0) as well as casual work (OR=6.4, 95% CI: 1.4-28.0). Furthermore, NAA was strongly associated with casual work (OR=5.0, 95% CI: 1.3-19.0) as well as working in the automated egg laying system (OR=8.0, 95% CI: 1.0-68.6). Further analysis revealed that the proportion of workers sensitised to at least one poultry work related allergen declined with increasing years of service (chi-square trend p=0.023), with workers having <2 years employment demonstrating a higher risk compared to those with >6 years employment (OR=4.0, 95% CI: 1.2-13.8). Conclusion: Non-atopic asthma is the most common asthma phenotype among poultry workers with work in the rearing department demonstrating an increased respiratory risk. The increased risk of reversible airway obstruction among workers in small broiler farms and the declining prevalence of sensitisation with increasing employment duration suggests a healthy worker effect. Preventive measures, including appropriate training, are recommended to reduce respiratory health risks, particularly in novice workers.
- ItemOpen AccessAssessing the health impact of intervention in supermarket bakeries using fractional exhaled nitric oxide (FeNO) and other clinical endpoints for baker’s allergy and asthma(2018) Al-Badri, Faisal; Jeebhay, Mohamed; Baatjies, RoslynnAim: To assess the health impact of an intervention in supermarket bakeries using fractional exhaled nitric oxide and other clinical endpoints for baker’s allergy and asthma after a one-year follow-up period. Methods: A field randomised controlled trial of 31 bakeries initially assigned to one of two intervention groups (bakery mixer lid and training) (n=244) and a control group (n=93). Health data prior to and after the intervention included a modified ECRHS questionnaire; Phadiatop ® and serum specific IgE to cereal flours (wheat, rye, alpha-amylase); and FeNO performed during the work shift using NIOX MINO®. The data of the two intervention groups was combined into one intervention group for the analysis. Data was analysed using STATA (version 12). Results: The two groups were comparable with regard to age (32-33 years), proportion of females (55%-57%) and smoking status (38%-40%). The intervention group had a significantly higher prevalence of workers with atopy (42%, p=0.025), work-related chest symptoms (25%, p=0.044) and sensitisation to cereal flour allergens (35%, p=0.042) at baseline than the control group (25%, 15%, 23% respectively). At one year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO >25ppb) was similar in the two groups. The mean difference in FeNO was similar across the two groups (2.2ppb vs 1.7ppb, p=0.860). However, when stratifying according to baseline FeNO >25ppb, the FeNO decline was greater in the intervention group (16.9 ppb) than in the control group (7.7ppb), although not statistically significant (p=0.237). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO >25ppb) did not demonstrate an appreciable decline in FeNO (>10%) in the intervention compared to the control group. However, stratification according to the presence of work related ocular-nasal symptoms at baseline demonstrated a significant decline (>10%) in FeNO in the intervention group compared to the control group (OR=3.73, CI: 1.22-11.42). Conclusion: This study demonstrates some evidence of an intervention effect on exhaled nitric oxide (FeNO) one year after the intervention, particularly among bakers reporting work-related ocular-nasal symptoms at baseline. The lack of a demonstrably stronger effect on other clinical endpoints can be attributable to the short follow-up period.
- ItemOpen AccessAuditing healthcare facilities against the National Core Standards for occupational health and safety and infection prevention and control: compliance, reliability and impact(2016) Cloete, Brynt Lindsay; Ehrlich, Rodney; Yassi, annaleeAuditing in health care has been recommended by many national organisations to improve patient safety and quality of care, despite inconclusive evidence to support its effectiveness. In South Africa, the National Core Standards for health establishments in South Africa (NCS) was published in 2011. The NCS recognises that staff are vital to ensuring that the health system delivers quality health care and therefore require protection against the risk of injury, infection and other occupational hazards, consistent with the South African Occupational Health and Safety act of 1993. The aim of this study was to determine: (a) the compliance of public sector primary healthcare (PHC) facilities with the NCS for occupational health and safety (OHS) and infection prevention and control (IPC), (b) the impact of the audits three years after baseline audits, at follow up self-assessment audits and (c) the reliability of self-assessment audits when compared to external audit results. This dissertation is divided in three parts. Part A is the study protocol which received ethics approval in March 2015. Part B is a structured literature review covering standards for health care, the impact and effectiveness of accreditation/certification/auditing in health care, interrater reliability and factors associated with OHS/IPC compliance. Previous studies have failed to address whether evaluating occupational health and safety or infection prevention and control standards using accreditation/certification in a primary healthcare, low and middle income setting is effective or reliable. Part C is the journal ready manuscript presenting the results of the study in the form of a manuscript for an article for a named peer reviewed journal. This was a cross-sectional study of NCS OHS/IPC audit data, with a longitudinal component, of a sample of public sector PHC facilities in the Western Cape province of South Africa between 2011 and 2015. Baseline PHC facility compliance with OHS/IPC measures was low. There was no significant improvement in compliance after three years. Poor inter-rater reliability indicates a large degree of measurement error. Practical implications of these results are the need to improve reliability of assessments and a process to convert low compliance scores into implemented improvement actions.
- ItemMetadata onlyExamining evidence for a protective occupational exposure limit for inhalable manganese dust below which there are no adverse subclinical nervous system effects(2009) Williams, Haidee Maxine; Myers, JonathanThe aim of this study was to investigate the exposure-response relationship between the concentration of inhalable manganese dust and subclinical nervous system outcomes amongst workers in a South African manganese smelter with a view to identifying any exposure threshold below which adverse effects do not occur.
- ItemOpen AccessMesothelioma in South Africa 3 decades post peak of asbestos production an analysis of a claims database of asbestos ex-miners(2012) Mothemela, Mokgadi; Ehrlich, R; Te Water Naude, JMThe peak in production of the three forms of asbestos that were commercially mined in South Africa occurred in the years between 1970 and 1977. Given the latency period of 20-40 years, we should expect to observe a rise in the incidence of mesothelioma throughout this decade. However, all we may ever observe is just the surface of what may be an immeasurable burden of disease due to amongst other reasons, the lack of representative data and the nature of mesothelioma itself. As a result of the obstacles that impeded earlier research, South African studies that have been conducted since Wagner et al. first established the association between asbestos and mesothelioma in 1960, have reported under estimated measures of occurrence of the disease, especially amongst black examiners. It also due to the exploitation and injustice to former miners throughout the asbestos mining history that we remain with an unknown burden and epidemiology of disease as well as heavy costs towards healthcare and rehabilitation of mine dumps. The author sought to review the medical information of claimants registered on an asbestos compensation database hosting the largest number of black asbestos ex-miners of all case series published in South Africa to date. The aim was to describe the demography and the epidemiology of the disease amongst those who had been diagnosed with mesothelioma between 2003 and 2010. The protocol (PART A) describes a brief background of the two Trusts on which this study was based, and the methodology of the study. The literature review (PART B) illustrates the conditions that prevailed in the asbestos mining industry and how these have distorted the epidemiology of mesothelioma in South Africa. The manuscript of the article (PART C) illustrates the data analysis, the results, as well as the discussion of the results. The objective was to describe the proportions of mesothelioma cases within the database by various characteristics. We also described by race the investigations that the claimants underwent to reach the diagnosis. The results showed that out of the 15 461 claimants registered on the database, 295 (1.91%) had mesothelioma. Of these, 54.24 % were black, 7.80% coloured and 37.97% white. There were more men (76.69%) than women (23.39%).
- ItemOpen AccessPredictors of obstructive lung disease among seafood processing workers along the west coast of the Western Cape of South Africa(2007) Adams, Shahieda; Jeebhay, Mohamed FareedIntroduction: This study examined the patterns and the prevalence of obstructive lung disease (asthma and COPD) and associated risk factors (age, gender, atopy, smoking history, allergic history, previous history of lung disease, occupational exposures, seafood intake) in a working population of seafood processing workers along the West coast of the Western Cape of South Africa. Materials and method: A cross-sectional study was conducted 643 currently employed workers in two fish processing plants working fish canning and fishmeal processing. A modified version of the European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergen. Lung function spirometry and methacholine challenge tests (tidal breathing method) conducted using Vitallograph S-model bellows volume-time spirometers according to ATS guidelines. Serum omega-3 and omega-6 fatty acid levels also analysed to examine the association between dietary fatty acids and asthma outcomes. Multivariate regression models were developed for asthma outcomes after adjusting for age, gender, sex and atopic status whilst the models were adjusted for age, gender and smoking history for COPD outcomes.
- ItemOpen AccessPredictors of occupational skin disease among seafood processing workers in the Western Cape(2012) Burdzik, Amy; Jeebhay, Mohamed; Todd, GailOccupational skin disease is common in seafood processing workers. While previous studies have reported an increased prevalence of symptoms (as high as 50%) and protein contact dermatitis (3-11%), the prevalence and patterns of type IV allergic contact dermatitis have not been well characterised in epidemiological studies. The aim of this study was to identify host and environmental risk factors for symptoms, clinical eczema, positive patch tests, possible and probable allergic contact dermatitis in seafood processing workers. A cross-sectional study of 594 seafood processing workers was conducted in two seafood processing plants in the Western Cape Province of South Africa. The study used an interviewer administered questionnaire to collect information on demographic characteristics, occupational history, work practices and skin symptoms in the preceding 12 months. A subgroup of symptomatic workers (n=120) were investigated further and compared to a group of randomly selected asymptomatic workers (n=134). Both groups underwent clinical examination by experienced dermatologists and patch testing with a battery of standard allergens (adapted British Contact Dermatitis Group Standard Series) supplemented by various seafood products and additives used in the factory. Data of skin prick tests to common aeroallergens and seafood products, and serum omega-3 fatty acid (Eicosopentaenoic acid) collected in a previously reported study were also used.
- ItemOpen AccessThe relationship between pesticide metabolites and asthma outcomes among women farm workers(2013) Mwanga, Hussein Hassan; Jeebhay, Mohamed; Dalvie, Mohamed AqielVarious studies have demonstrated an association between exposure to pesticides and adverse respiratory health outcomes including non-specific respiratory symptoms, rhinitis and asthma. Few studies have investigated the relationship between pesticide metabolites and asthma outcomes and only a limited number have explored mechanisms for allergic and non-allergic airway inflammation in individuals exposed to pesticides. A previous sub-study of this group reported an association between allergic airway inflammation as determined by fractional exhaled nitric oxide (FeNO) and low levels of whole blood cholinesterase among women farm workers. The main objective of this study was to investigate the relationship between exposure to different pesticides (ascertained through pesticide metabolites concentrations in urine) and asthma phenotypes (based on respiratory symptoms, cytokine patterns and exhaled nitric oxide profiles) among rural women in the Western Cape Province.
- ItemOpen AccessSkin symptoms (allergic and non-allergic) predicting the development of allergic respiratory outcomes and asthma in bakers(20198) Chongo-Faruk, Vânia; Jeebhay, Mohamed; Baatjies, RoslynnBackground: Recent studies have suggested that aside from the inhalational route, skin exposure may also play an important role in the sensitization to allergens, resulting in adverse allergic respiratory outcomes including asthma in workers exposed to these agents. This appears to be reported more commonly for low molecular weight agents such as isocyanates and some cleaning agents. This study investigated whether skin symptoms, in the presence or absence of allergic sensitization, can predict the development of allergic respiratory outcomes and asthma in bakery workers. Methods: A cohort study investigated 263 bakery workers using a modified ECRHS questionnaire; immunological tests including skin prick tests for common local aeroallergens (ALK-Abello´ A/S, Horsholm, Denmark), Phadiatop and serum-specific IgE to bakery allergens (wheat, rye and fungal α-amylase); and pulmonological tests including spirometry, non-specific bronchial hyperresponsiveness, and fractional exhaled nitric oxide (FeNO), after a 4 year period. Results: Workers’ median age was 32 years (IQR: 26-38), 50% were female, 54% were ever smokers and 32% were atopic. At baseline, 26% of workers were sensitized to bakery allergens, skin symptoms were present in 22% and 11% reported work-related skin symptoms (WRSS). 3 While the incidence of general upper (19%) and lower (22%) respiratory symptoms over the follow-up period were very similar, work-related upper (29%) respiratory symptoms were higher than lower (20%) respiratory symptoms. However, the incidence of allergic sensitization to bakery allergens was only 8% and a new asthma diagnosis present in 4% over this period. In multivariate adjusted (gender, atopy and smoking status) regression models, having a history of skin symptoms was associated with an increased risk of developing work-related lower respiratory symptoms - WRLRS (RR=2.2, 95% CI: 1.03-4.83), while having clinically significant symptoms of eczema or urticaria was associated with an increased risk of reporting general upper respiratory symptoms (RR=5.5, 95% CI: 1.30-24.20) as well as WRLRS (RR= 4.8, 95% CI: 1.60-14.40). Furthermore, WRSS was associated with an increased risk of general upper respiratory symptoms (RR=5.1, 95% CI: 1.31-19.81), WRLRS (RR=4.1, 95% CI: 1.43-11.85) and elevated FeNO levels (FeNO>25ppb: RR=2.9, 95% CI: 1.19-7.28). The association between clinically significant skin symptoms or WRSS and new onset upper or lower respiratory symptoms were modified by use of dermal personal protective equipment. Infrequent or absent glove usage was associated with a higher risk (RR=5.3, 95% CI: 1.54-18.43) of having new onset WRLRS. Conclusion: Skin symptoms, more so if work-related, appear to be associated with future development of general and work-related upper and lower respiratory symptoms and inflammatory markers suggestive of asthma in bakery workers.
- ItemOpen AccessVariation in silicosis prevalence in South African gold miners : an industry-wide study(2009) Knight, Dave; Ehrlich, RodneyThis study investigates the prevalence of silicosis in the South African gold mining industry. Gold mining is an important industry in South Africa, yet has been blighted by silicosis and tuberculosis in miners since its inception in 1887. There have been two previous studies conducted in black in-service miners using modern epidemiologic methods that found high prevalences of silicosis .The objectives of our study were three-fold. Firstly, to determine silicosis prevalence stratified by certain variables. Secondly, to compare silicosis prevalences to these two previous studies conducted in order to determine whether any secular trends are present. Thirdly, to report on any variation in silicosis between mining shaft, mining company or mining region, and to generate hypotheses for any variation found.
- ItemOpen AccessWorkers' compensation claims for occupational Tuberculosis in South African health care workers: A survey of process and outcomes(2018) van de Water, Nicholas; Ehrlich, Rodney; Yassi, AnnaleeBackground Occupational TB is the most frequently reported occupational disease in health care workers (HCWs) in South Africa. With the emergence of drug resistant strains and their associated health risks, and the associated increased risk for contracting these strains for HCWs, it becomes increasingly important to ensure that the worker’s compensation system is functioning properly for this disease. Whilst many studies have captured the poor functioning of the compensation system for workers in general in South Africa, the closest proxy examining the compensation of HCWs compensation for occupational TB is a study reviewing practices of occupational health nurses responsible for these cases. Whilst examining occupational injuries, workers, in general, report negative experiences with workers’ compensation processes. This study aimed to investigate the experience of health care workers whose cases of occupational TB were reported via the Western Cape Government Health department (WCG:H) to the Compensation Fund of the Department of Labour for compensation claim purposes. Methods This study was a case series with retrospective description, with a qualitative component. Simple random sampling was done on a subset of the population of cases of occupational TB recorded on a database held by the WCG:H administrative office responsible for submitting claims on behalf of WCG:H employees to the Compensation Fund. The study aimed to interview at least 100 HCWs who had reported their occupational TB as per the above mentioned database. In anticipation of a low expected response rate, 300 cases were sampled. Claim status for this sample were evaluated. Utilising general details obtained, an attempt was made to contact each HCW for a telephonic interview consisting of both open and close-ended (qualitative) questions. Fifty-one interviewers were completed. Interviews comprised of a structured telephonic interview carried out by one of three interviewers. The questionnaire consisted of three main sections examining (a) the experience of benefits available for people getting an occupational disease; (b) the experience of the process of reporting a case of an occupational disease to the Compensation Fund and (c) the process of having developed occupational TB as a HCW. Results Nearly half of the 300 cases from the provincial database had no record found on claim status check on the Compensation Fund website (n = 131, 46%). For claims without resolution with either acceptance or repudiation, the median waiting period from date of submission to 31 Dec 2017 was 5.8 years (IQR 3.2 - 9.2). 51 of the 144 cases for which contact attempt was made, gave consent (35% consent rate). Just under one third (n = 15, 31%) of the interviewees did not access occupational leave for their TB. Three quarters (n = 39; 75%) of employees incurred medical costs either personally or by their personal medical aid in relation to their diagnosis and treatment of TB. 21 (42%) of the participants reported ongoing medical problems and one reported being compensated for this. HCWs’ experience of contracting TB was marked by the experiences of stigma, surprise in contracting TB and financial stress as a result of their diagnosis. In addition, the experience of reporting their cases for compensation purposes was marred by poor administration and communication from all parties involved in the process. Conclusion The workers’ compensation system, i.e. the whole process from reporting through to benefit provision, has again been found to have many deficiencies. In this instance, HCWs are not receiving compensation benefits rightfully due to them for occupational TB. The experiences of HCWs contracting TB have been described as mostly being negative. In these negative experiences remedies to the system can be sought. The administrative components of submitting a claim, both by the claimant and by WCG:H to the Compensation Fund, have been found in this study to have a number of obstacles and gaps. Reform in communication, record keeping and timeously checking of claim status and payment of relevant compensation are required from the provincial level. Dedicated occupational health services were recommended by participants as these were expected to improve the service to potential claimants, as well as provide a source of information about the diagnosis and compensation aspects.