A systematic review of the risk management frameworks for potentially toxic chemical elements

In the last 50 years, various frameworks have been used to control and manage potentially toxic chemical risks; however, these chemicals continue to negatively impact environmental and human health. This work was intended to provide a systematic review of the literature on essential aspects of current risk management frameworks for potentially toxic chemicals. The frameworks were reviewed using Organisation for Economic Co-operation and Development (OECD) principles that focus on elements, successes, shortcomings, similarities, and dissimilarities premised on the experiences of many countries. Keywords such as heavy metals, health risk, industrial chemicals, potentially toxic elements, chemical pollutants, and risk management framework were utilised to search the literature from databases and other sources. Ten risk framework documents selected from an initial yield of 1349 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow processes met the inclusion criteria. The key elements of risk frameworks that were identified included the risk assessment paradigm, iteration, tiered approach, weight of evidence, uncertainty analysis, and multi-criteria decision analysis among others. Notable gaps in risk frameworks that required improvements to effectively manage health risks posed by potentially toxic chemicals were identified. While existing risk frameworks have made significant contributions to human health and environmental protection, new and comprehensive frameworks are needed to address the novel and dynamic risks posed by toxic industrial chemicals. Also, there is a need to promote the use of risk management frameworks in developing countries through technology transfer and the provision of financial assistance to improve environmental and public health protection from toxic chemicals.

Health risk management framework for heavy metals and cyanide in Kwekwe city of Zimbabwe: a mixed-method study protocol

BACKGROUND

According to WHO, in 2015, over 35% of ischaemic heart disease, the leading cause of death and disability worldwide, and about 42% of strokes, the second largest contributor to global mortality, could have been prevented by reducing or removing exposure to chemical pollutants. Heavy metal and cyanide pollution are prevalent in developing countries, especially in sub-Saharan Africa where the effects of industrial pollutants are more severe, partly due to poor regulation. In Zimbabwe, the mining industry alone contributed to 25% of occupational conditions and injuries in 2020. Therefore, to mitigate these problems, this study seeks to develop a health risk management framework for heavy metals and cyanide pollution in the industrial city of Kwekwe.

METHODS

The convergent parallel mixed-method study design will be utilised. Qualitative and quantitative data will be collected, analysed, and merged in order to inform the development of the risk framework. An analytical cross-sectional survey would be used to determine levels of heavy metals in surface water, soil, and vegetables. Free cyanide will be determined in surface water samples only. The phenomenological qualitative inquiry will be used to investigate health events and risks associated with potentially toxic pollutants (heavy metals and cyanide) to describe or interpret participants' lived experiences. The qualitative and quantitative results will be used to develop and validate the framework to manage identified health risks. For data analysis, statistical analysis will be used in the quantitative study, while thematic analysis will be used in the qualitative study. The study was approved by the University of Venda Ethics Committee (Registration Number FHS/22/PH/05/2306) and the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2944). All ethical principles will be adhered to throughout the study in accordance with the Helsinki Declaration.

DISCUSSION

While existing risk management frameworks have significantly contributed to human and environmental health protection, novel and comprehensive frameworks need to be developed to counter the ever-dynamic and evolving risks associated with chemical pollutants. If the management framework is successfully developed, it could offer an opportunity for the prevention and control of potentially toxic elements.

Development of a growth monitoring and promotion index to improve child health in Zimbabwe

In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.

Occupational health and safety hazards among solid waste handlers at a selected municipality South Africa

Background

Solid waste management is one of the most dangerous occupations in the world because of its potential harm from the waste to the environment and the public. Therefore, the protection of human health and the environment is a challenge that all countries are facing.

Aim

The study explored occupational health and safety hazards among waste handlers at a selected municipality in Limpopo Province.

Setting

The study was conducted in one municipality in the Vhembe District.

Methods

The study used a qualitative, explorative and contextual design to explore occupational health and safety hazards among participants. Participants were sampled using purposive sampling. Data were collected through in-depth individual interviews that lasted between 40 min and 45 min. The sampled size comprised 18 participants and was determined by data saturation. Tesch's open coding was used to analyse data, where the main theme, categories and sub-categories emerged.

Results

The findings revealed the main theme, namely municipal waste handlers experience occupational health and safety hazards. Four categories emerged from the main theme, namely physical, psychosocial, biological and chemical hazards. The categories were further divided into sub-categories such as exposure to extreme weather conditions and musculoskeletal injuries.

Conclusion

Solid waste handlers experienced preventable physical and chemical occupational health and safety hazards that are inherent to their job. It is recommended that workers be provided with adequate suitable protective equipment to reduce the level of occupational health hazards.

Contribution

The findings in this study will help in closing the gaps by the municipality for failing to prioritise working conditions for municipality waste handlers.

Alcohol consumption and cigarette smoking: a health-risk behaviour among secondary school learners in South Africa

Background

Health-risk behaviours such as tobacco smoking and alcohol are now identified among adolescents in most of the secondary schools of South Africa.

Objective

The study investigated the prevalence of smoking and alcohol use as health risk behaviours among secondary school learners in Thembisile Hani municipality of Mpumalanga province in South Africa.

Methods

A quantitative descriptive research design was used for the study. A simple random sampling was employed in the selection of schools and proportional stratified sampling was used to select learners from each school according to grades. Closed-ended questionnaires were used to collect data from learners in their schools. Data were analysed using SPSS version 26.0.

Results

Out of 385 learners, 64.4% have drank alcohol whilst 64.7% have smoked cigarette in the school premises. The socio-economic status of many learners such as the employment and income of the family was found to be one of the factors exposing them to alcohol and tobacco use.

Conclusions

There was high prevalence of alcohol use and smoking among learners in secondary schools. Excessive use of alcohol and smoking could affect the health of learners in their late life and therefore community collaboration to curb the problem is crucial.

Prevalence and risk factors of myopia amongst Grade 8 learners in the Vhembe district, South Africa

Background: Myopia is the most common cause of refractive errors in both adults and children in many countries. However, it is not a simple refractive error but sometimes and eyesight-threatening disorder. The disorder has a great impact on public health and the socio-economic well-being of people, particularly children.Aim: The study aimed to assess the prevalence of myopia amongst secondary school learners.Setting: The study was conducted in the Vhembe District, South Africa.Methods: A cross-sectional study was carried out amongst 297 Grade 8 students of 13 to 14 years of age. The students were selected using a multi-stage-stratified cluster sampling technique from three secondary schools. Two public secondary schools and one private secondary school. The learners’ socioeconomic background, type of school and parental myopia were assessed by a questionnaire before visual acuity assessment. Learners with visual acuity of less than or equal to 6/12 in the worse eye, who showed vision improvement with pinhole, underwent non-cycloplegic retinoscopy and subjective refraction were selected. Myopia was defined as a spherical equivalent of less than or equal to −0.50 dioptre (D). Data were analysed using descriptive statistics.Results: A total of 289 learners completed the study (156 aged 14 years and 133 aged 13 years). A total of 30 learners were identified to have myopic refractive error making the prevalence of 10.4%. Of the 154 females, 14 (47.0%) had myopia, whilst 16 (53.0%) of the 135 males had myopia making males slightly more myopic than females. From the total learners diagnosed to have refractive error (n = 40), myopia constituted 30/40 (75.0%) of the learners indicating that it is the commonest type of refractive error amongst secondary learners. Myopia was more common amongst older age children (14 years; 57.0%). About 18 (60.0%) participants were from the urban area. A total of 17 (57%) of the myopic learners attended private school and about 63% of the participants’ parents were myopic.Conclusion: Spending more time indoor and continuous reading without resting are risk factors of myopia whilst increased outdoor activities were observed as protective environmental factors against myopia in secondary school learners. Doing more outdoors activities may be beneficial to protect against myopia onset.

Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa

BACKGROUND

Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs.

OBJECTIVES

The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa.

METHOD

A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study.

RESULTS

Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes.

CONCLUSION

The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.

Self-reported impact of caregiving on voluntary home-based caregivers in Mutale Municipality, South Africa

Background

The establishment of home-based care (HBC) programmes in developing countries has resulted in a shift of burden from hospitals to communities where palliative care is provided by voluntary home-based caregivers.

Aim

The study investigated the impact of caregiving on voluntary home-based caregivers.

Setting

The study was conducted at HBC organisations located in Mutale Municipality of Limpopo Province, South Africa.

Methods

A quantitative cross-sectional descriptive survey design was applied to investigate the impact of caregiving on voluntary home-based caregivers. The sample was comprised of (N = 190) home-based caregivers. Home-based caregivers provide care to people in need of care in their homes, such as orphans, the elderly and those suffering from chronic illnesses such as tuberculosis, HIV and/or AIDS, cancer and stroke. Self-administered questionnaires were used to collect data which were analysed descriptively using the Statistical Package for the Social Sciences software, Version 20.

Results

The results showed that 101 (53.2%) participants were worried about their financial security because they were not registered as workers, whilst 74 (39.0%) participants were always worried about getting infection from their clients because they often do not have protective equipment.

Conclusion

Voluntary home-based caregivers have an important role in the provision of palliative care to people in their own homes, and therefore, the negative caregiving impact on the lives of caregivers may compromise the provision of quality palliative care.

Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

Background

Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model.

Purpose

The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC.

Methods

The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data.

Results

Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%).

Conclusion

Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.

Home-based carers' perceptions of health promotion on sexual health communication in Vhembe District

Background

The introduction of home-based care in rural communities in the 1980s contributed immensely toward the upliftment of the personal and environmental health of communities. Women’s groups provided health promotion skills and health education to communities and made a difference in health-related behaviour change.

Objective

The purpose of the study was to explore and describe the home-based carers’ perception regarding health promotion concerning sexual health communication in Vhembe district, in the context of HIV, amongst communities still rooted in their culture.

Method

A qualitative, explorative and descriptive design was used in order to understand home-based carers’ perceptions regarding health promotion on sexual health communication amongst rural communities which may adversely impact on health promotion practices. The population were home-based organisations in Vhembe. The sample was purposive and randomly selected and data were gathered through semi-structured face-to-face interviews and focus groups which determined data saturation. Open coding was used for analysis of data.

Results

The results indicated that sexual communication was absent in most relationships and was not seen as necessary amongst married couples. Socioeconomic conditions, power inequity and emotional dependence had a negative impact on decision making and sexual communication.

Conclusion

This study, therefore, recommends that educational and outreach efforts should focus on motivating change by improving the knowledge base of home-based carers. Since they are health promoters, they should be able to change the perceptions of the communities toward sexually-transmitted infections and HIV by promoting sexual health communication.

Patient-perceived factors contributing to low tuberculosis cure rate at Greater Giyani healthcare facilities

Background: Compliance with tuberculosis (TB) treatment is unpredictable. Most patients do not comply because they do not see the importance of doing so, which is usually influenced by lack of knowledge.Objectives: The purpose of the study was to explore and describe the factors contributing to low TB cure rates in Greater Giyani Municipality, as viewed by patients.Method: The study was conducted in the Greater Giyani Municipality in Limpopo Province which had a TB cure rate ranging from 14% to 94%. The research design in this study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of all TB patients diagnosed and referred for treatment and care in Primary Health Care (PHC) facilities. Non-probability purposive sampling was used to select TB patients and health facilities which had a cure rate lower than the national target of 85%. One patient was sampled from each PHC facility. An in-depth face-to-face interview was used to collect data using an interview guide.Results: The findings showed that most of the TB patients come from poor families, which makes it difficult for them to obtain financial and food security. The health facilities often run out of food supplements and TB medicine. Cultural beliefs about TB also lead to TB patients seeking assistance from traditional health practitioners and faith-based healers.Conclusion: There is a need to have a policy regarding how discharged tuberculosis patients on treatment are supervised when at home. Healthcare facilities should also ensure that there is enough medication for these patients as lack of medication can lead them to default. Agtergrond: Dit is onmoontlik om te bepaal of pasiënte by hulle tuberkulosebehandeling gaan hou. Die meeste pasiënte hou nie daarby nie omdat hulle nie die belangrikheid daarvan insien nie.Doelwitte: Die doel van die studie was om die faktore wat in die Groter Giyani Munisipaliteit tot lae genesingskoerse onder TB-pasiënte lei, te ondersoek en te beskryf, soos deur pasiënte gesien.Metode: Die studie is in die Groter Giyani Munisipaliteit in die Limpopo Provinsie gehou, waar die genesingskoers vir TB tussen 14% en 94% is. Die navorsing in hierdie studie was kwalitatief, verkennend, beskrywend en kontekstueel van aard. Die populasie het bestaan uit alle gediagnoseerde TB-pasiënte wat vir behandeling en sorg na primêre gesondheidsorgfasiliteite verwys is. Nie-waarskynlikheid, doelgerigte steekproefneming is gebruik om TB-pasiënte en gesondheidsfasiliteite te kies wat ’n laer genesingskoers as die nasionale doelwit van 85% het. Een pasiënt uit elke primêre gesondheidsorgfasiliteit is by die steekproef ingesluit. ‘n Diepgaande persoonlike onderhoud is gebruik om data met behulp van ‘n onderhoudgids in te samel.Resultate: Die bevindinge toon dat die meeste van die TB-pasiënte uit arm gesinne kom, wat dit vir hulle moeilik maak om finansiële en voedselsekerheid te hê. Die gesondheidsfasiliteite se voedselaanvullings en TB-medisyne raak dikwels op. Kulturele oortuigings oor TB lei ook daartoe dat TB-pasiënte by tradisionele gesondheidsorgpraktisyns en geloofsgebaseerde genesers hulp soek.Gevolgtrekking: Dit is nodig dat ‘n beleid oor toesig oor die behandeling van ontslaande TB-pasiënte wat tuis aansterk, opgestel word. Gesondheidsorgfasiliteite behoort ook seker te maak dat daar genoeg medisyne vir hierdie pasiënte is, aangesien ‘n gebrek aan medisyne daartoe kan lei dat die pasiënte ophou om hulle medikasie te gebruik.

Views of professional nurses regarding low tuberculosis cure rate in Greater Giyani Municipality, Limpopo Province

BACKGROUND

Management of patients suffering from tuberculosis (TB) after discharge from hospital plays a critical role in the cure rate of TB. Despite interventions developed by the World Health Organization (WHO) to improve the cure rate, TB remains a worldwide health problem.

OBJECTIVE

The purpose of the study was to explore and describe the views of professional nurses regarding the low TB cure rate in primary healthcare facilities of Greater Giyani Municipality in Limpopo Province, South Africa, with the aim of determining strategies that can be used to improve this low rate.

METHOD

This study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of professional nurses working in primary healthcare facilities within Greater Giyani Municipality, which has a TB cure rate below the national target of 85%. Data gathering was through individual face-to-face interviews using an interview guide. Open-coding was used to analyse the data in this study.

RESULTS

The theme that emerged from data was ‘factors contributing to low TB cure rate’. This theme was supported by the following sub-themes: poor referral system, lack of knowledge about TB and its treatment, stigma attached to TB, and cultural and religious beliefs. The professional nurses suggested counselling of TB patients upon diagnosis, advice about patients’ responsibilities and the involvement of family members.

CONCLUSION

The involvement of community stakeholders in TB prevention, health promotion and education activities devoted to disease spread and cure is vital so that the stigma attached to TB can be eliminated. TB education and awareness programmes should be included in the curriculum of primary schools.