A Qualitative Study on Noncommunicable Diseases in Waste Pickers in Brazil

BACKGROUND

Noncommunicable chronic diseases are associated with multiple risks factors and negative outcomes that are long-lasting and difficult to treat. Some populations may be at greater risk because of their socioeconomic status, lack of healthcare, environment, and poor work and living conditions. Informal waste pickers may experience higher levels of chronic diseases and often do not have access to care to manage symptoms.

OBJECTIVES

The aim of the present study was to understand the prevalence of chronic diseases in waste pickers, along with perceived associated risks and available treatments.

METHODS

A qualitative study was conducted, using interviews with 24 waste pickers who worked at Estrutural dumpsite in Brasilia, Brazil which was historically the second largest open-air dumpsite in the world.

RESULTS

Participants believed their commonly experienced chronic diseases were a result of working in the open-air dumpsite. Chronic diseases commonly noted in the interviews included hypertension, chronic pain, respiratory disease, diabetes, and kidney problems. Participants discussed self-medication or prescribed medication used to treat their conditions. Most participants had varying beliefs regarding prevention strategies to reduce disease; some ideas for prevention focused on religion, fate, and God when discussing outcomes related to illnesses. When answering questions regarding ideal working conditions to help prevent diseases, participants responded by expressing a desire for protective gear (e.g. PPE) which could help mitigate hazards associated with the dump.

CONCLUSIONS

Recyclable collectors were aware of occupational hazards to which they were exposed and associated noncommunicable chronic diseases but lacked education on the importance of preventive measures and access to healthcare services. The findings of the present study confirm the need to strengthen intersectoral actions to protect and uphold the health rights of this vulnerable population.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016.

COMPETING INTERESTS

The authors declare no competing financial interests.

A systematic review on informal waste picking: Occupational hazards and health outcomes

Informal waste picking is a common way for people to earn an income, especially in low-income countries; unfortunately, there are various occupational hazards and health outcomes associated with waste picking. This study focused on comprehensively identifying and exploring occupational hazards and health outcomes associated with informal waste picking. A systematic review of available relevant and peer-reviewed literature was completed to exhaustively analyze the full scope of these hazards and outcomes associated with informal waste picking; 58 papers were included. The results from this study provided insight and information related to the most common occupational hazards and negative health outcomes associated with informal waste pickers outlined in available literature. The most common reported occupational hazards were physical (77.6%), social (70.7%), biological (65.5%), chemical and safety (53.4%), ergonomic (34.5%) and mechanic (25.9%). Health outcomes appeared to include epidermal (50.0%), communicable disease (46.6%), musculoskeletal (44.8%), respiratory disease (41.4%), non-communicable diseases (39.7%), physiological (34.5%), gastrointestinal (31.0%) and waterborne diseases (17.2%). Physical hazards were often associated with slips, trips, and falls, which makes sense because of the unstable environment where waste pickers work. Health outcomes related to these hazards included bruises, cuts, and lacerations. This information also aligns with health outcomes, as epidermal outcomes were most reported in waste pickers (50.0% of data). It is clear that moving forward, additional research related to these occupational hazards and health outcomes associated with informal waste picking is needed to help create change in this affected population, as well as finding effective solutions to mitigate these hazards and outcomes. These hazards can be mitigated by simple, common control measures, like providing safety equipment, reducing hazards from the outside environment (e.g., less time in sun, breaks, etc.), and placing barriers between waste pickers and the hazards (e.g., covered stations, flat ground, etc.) or more complex engineering, administrative or work controls. Because of the breadth of health problems faced by workers, more research is needed to correctly assess health outcomes (e.g. use of health practitioners) in waste pickers across time to ensure accurate data and a focused answer to the far-reaching problem.

Sugar-free chewing gum and dental caries: a systematic review

Objective:

To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients.

Method:

9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles.

Results:

Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids.

Conclusion:

The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.