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Workplaces are nodes for Severe Acute Respiratory Syndrome Coronavirus 2 transmission and require strategies to protect workers’ health. This article reports on the South African national coronavirus disease 2019 (COVID-19) strategy that sought to ensure workers’ health, protect the economic activity, safeguard livelihoods and support health services. Data from the Occupational Health Surveillance System, Surveillance System of Sentinel Hospital Sites, and government databases (public sector health worker and Compensation Fund data) was supplemented by peer-reviewed articles and grey literature. A multipronged, multi-stakeholder response to occupational health and safety (OHS) policy development, risk management, health surveillance, information, and training was adopted, underpinned by scientific input, through collaboration between government, organized labour, employer bodies, academia, and community partners. This resulted in government-promulgated legislation addressing OHS, sectoral guidelines, and work-related COVID-19 worker's compensation. The OHS Workstream of the National Department of Health provided leadership and technical support for COVID-specific workplace guidelines and practices, surveillance, information, and training, as well as a workplace-based vaccination strategy.

Background In countries such as Eswatini, where there is a high HIV prevalence and low male circumcision the World Health Organization and the Joint United Nations Programme for HIV/AIDS recommend infant and adult circumcision be implemented. The aim of this study was to assess the knowledge, attitudes and acceptability of voluntary medical male circumcision amongst males attending high school in Eswatini. Methods An observational cross-sectional study was conducted during February and March of 2018 amongst 407 young males (15–21 years) attending Form 4, in nine high schools in the Shiselweni region of Eswatini using a self-administered questionnaire of 42 close ended questions. Sociodemographic details, circumcision status, acceptance of voluntary medical male circumcision, knowledge and attitude scores analysed in Stata® 14 statistical software were described using frequencies, medians and ranges respectively. Bivariate and multivariate linear regression was used to assess the impact of independent variables on circumcision status and acceptance of voluntary medical male circumcision. The level of statistical significance was p Results Amongst the 407 high school-going males, 48.98% (n = 201) reported being circumcised. The majority of the adolescents (75.74%; n = 306) were knowledgeable about voluntary medical male circumcision. However, an even larger majority (84.90% (n = 343) had a negative attitude towards it. In the multivariate logistic regression analysis, having parented their own children (aOR: 3.55; 95%CI: 1.2–10.48), and having circumcised friends (aOR: 3.99; 95%CI: 1.81–8.84) were significantly associated with being circumcised. Neither knowledge nor attitude were associated with the acceptability of voluntary medical male circumcision. Conclusion In Eswatini male high school students are knowledgeable about voluntary medical male circumcision but have a negative attitude towards it. Having parented their own children, and having circumcised friends influenced being circumcised.

Female genital schistosomiasis (FGS) is a complication of Schistosoma haematobium infection, and imposes a health burden whose magnitude is not fully explored. It is estimated that up to 56 million women in sub-Saharan Africa have FGS, and almost 20 million more cases will occur in the next decade unless infected girls are treated. Schistosomiasis is reported throughout the year in South Africa in areas known to be endemic, but there is no control programme. We analyze five actions for both a better understanding of the burden of FGS and reducing its prevalence in Africa, namely: (1) schistosomiasis prevention by establishing a formal control programme and increasing access to treatment, (2) introducing FGS screening, (3) providing knowledge to health care workers and communities, (4) vector control, and (5) water, sanitation, and hygiene. Schistosomiasis is focal in South Africa, with most localities moderately affected (prevalence between 10% and 50%), and some pockets that are high risk (more than 50% prevalence). However, in order to progress towards elimination, the five actions are yet to be implemented in addition to the current (and only) control strategy of case-by-case treatment. The main challenge that South Africa faces is a lack of access to WHO-accredited donated medication for mass drug administration. The establishment of a formal and funded programme would address these issues and begin the implementation of the recommended actions.

Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes.

Background Adverse maternal and child health outcomes due to adolescent pregnancy are central to public health research and practice. In addition, public health has emphasised that the care rendered by healthcare providers plays a pivotal role in the health and well-being of pregnant and parenting adolescents. Healthcare providers may differ in the ways they interpret adolescent pregnancy and parenting and consequently, this may have profound implications for healthcare decision making. The aim of this study was to explore the multiple perspectives of a diverse group of healthcare providers' delivering services and engaging with pregnant adolescents and adolescent mothers at a district hospital in Ugu, KwaZulu Natal, South Africa. Methods This descriptive qualitative study used semi-structured interviews (n=33). Healthcare providers rendering care to pregnant and parenting adolescents were recruited from the maternity, antenatal, paediatrics, psychology, dietetics, physiotherapy and social work departments, as well as from the HIV/AIDS, STIs and TB (HAST) programme. The data were analysed using thematic analysis. Results The healthcare providers acknowledged that adolescent pregnancy is a problematic issue in Ugu district. Furthermore, they felt that the postpartum sexual-related and reproductive health of adolescent mothers was not given priority. In the healthcare providers' view, the problems experienced by pregnant and parenting adolescents were school dropout, financial constraints, breakdown of relationships, abandonment, stigmatisation, parenting and child rearing difficulties, and both physical and mental health problems. Conclusion This study highlights that the issue of sexual- and reproductive-related outcomes of adolescent pregnancy and parenting is not given priority. In addition, the findings also highlighted the need for a multidisciplinary approach to the care of pregnant and parenting adolescents. Multidisciplinary communities of practices as interventions can be used to generate and share knowledge, capacitate healthcare providers and improve clinical practice. The training of healthcare providers, provision of non-judgemental counselling and tailored services for pregnant adolescents and adolescent mothers are essential. When appropriately disseminated, the findings will assist relevant healthcare providers, administrators in healthcare institutions, policymakers, and officials of the Department of Health and the Department of Education in South Africa to address the lack of appropriate care for pregnant and parenting adolescents.

We explored the association between household alcohol use and behavior problems among South-African children, using data from the Asenze study, a population-based cohort of South African children and their caregivers. Household alcohol use and child behavior were assessed when children were 6-8 years old. To examine the association, we performed linear regressions. The sample included 1383 children with complete data under the care of 1251 adults. Children living in a household where self-reported caregiver alcohol use was scored as hazardous (4.6%) had higher levels of problem behavior (β = 1.94, 95% CI 0.06-3.82). There were no statistically significant associations between reported hazardous alcohol use by another member of the household (14.5%) and child problem behavior. Hazardous household alcohol use was associated with child problem behavior and this effect appeared to be mainly driven by primary caregiver use.

South Africa, similar to many other countries in the African continent is still experiencing challenges in its efforts to provide sexual and reproductive health (SRH) care to women and adolescent girls, and it has become clear that the COVID-19 pandemic is the latest threat to universal access to SRH. In the face of this threat, the Sustainable Developmental Goals that call on the global community to -leave no one behind‖ may become a blurred vision unless we adopt a wider lens away from the tunnel vision that currently plagues health systems around the globe. This paper therefore exposes how SRH may become collateral damage in the face of the present COVID-19 pandemic. Previous disease outbreaks diverted attention from critical SRH services, including antenatal care, safe abortions, contraception, HIV/AIDS and sexually transmitted infections. Governments, policy makers, health system gatekeepers and civil society organisations should not allow the COVID-19 phobia to bar women and adolescent girls from accessing SRH services. In fact, the global and South African response to the COVID-19 pandemic must protect everyone's rights, particularly in the health care context. Gender considerations and a human rights approach must be embedded in ensuring the accessibility and availability of SRH services.

Background Unemployment among persons with spinal cord injury (PWSCI) is high and often leads to poverty (including their families). Modifiable and unmodifiable factors that influence employment among PWSCI are known and are addressed throughout the rehabilitation process. The overall aim of rehabilitation of PWSCI is quality of life and community integration (including employment). Interventions that seek to improve employment outcomes among PWSCI are well documented. However, no integrated reviews clearly describe the resources utilised, interventions utilised, duration of interventions and the outcomes (and tools used) to improve employment outcomes among PWSCI. Policymakers and rehabilitation professionals require this information to develop models or strategies to improve employment outcomes for PWSCI. This review aims to map evidence on interventions and approaches that aim to enhance the employment of PWSCI. Methodology This review will map evidence on interventions that improve employment outcomes among PWSCI, using the Arksey and O'Malley framework and the Donabedian model as the guiding lens. The first stage includes the development of the research question and will be reviewed throughout the review process. The PCC framework will be utilised to determine the inclusion and exclusion criteria and develop the search terms. Peer-reviewed primary studies will be identified using the Boolean search terms on PubMed, MEDLINE, Ebscohost, Google Scholar, CINAHL, Cochrane databases. Two independent reviewers will identify primary studies and charting data, and one reviewer will act as a supervisor and arbitrator. Data charting tool will be utilised to gather the required information from the selected studies. Nvivo software version 25 will be used to develop themes for summarising and reporting the data. The quality of the courses selected will be evaluated using the Mixed Methods Appraisal Tool (MMAT). DiscussionData from the selected studies will be discussed in relation to the research questions and the Donabedian model. Information gathered from this scoping review will enable policymakers, rehabilitation professionals and other stakeholders to use this as a foundation in an attempt to develop strategies or models that seek to improve employment outcomes among PWSCI. Moreover, a gap in current practice will be identified, and further research needed in the field will be described.

Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.

Background: Tuberculosis remains one of the world’s deadliest communicable diseases despite being preventable and curable. The use of mobile phones has increased worldwide over the past decade and this has created opportunities to use mobile phones as intervention tools in health care including in promoting prevention, treatment and adherence monitoring and evaluation. However, the potential of information and communication technologies (ICTs) to fight TB remains largely untapped. Many countries are still researching further on how to use eHealth and mHealth effectively in the fight against TB. This systematic review protocol seeks to explore the mobile based applications that are being used in TB care globally and will provide crucial information to inform programming for the national TB programme, bringing the focus on interventions that really influence improving TB outcomes.Methods: A systematic review will be conducted through online searches using comprehensive Medical Subject Headings (MeSH) terms in various combinations. Information sources will include the Cochrane Central Register of Controlled Trials, Medline, Google Scholar and PubMed. The review will be done by 2 reviewers who will resolve discrepancies through consensus. Narrative data synthesis will be done.Discussion: Analysis of the selected studies will provide information on the use of the mobile applications in TB care globally. Conclusions will be based on the best available scientific evidence. The results will provide crucial information to inform programming for the national TB programme, bringing the focus on interventions that really influence improving TB outcomes. This will result in the effective use of resources by channelling them where there is the greatest impact in terms of reducing morbidity and mortality due to TB in Zimbabwe. Systematic review protocol registration: PROSPERO CRD42020154793

International audience; Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Objectives: To describe the demographic and socio-economic profiles, and injury related characteristics of people who sustain SCIs in KZN in order to provide baseline information to instigate a model that guides employment outcomes amongst PLWSCI. Design: Retrospective analysis of medical files was done. Setting: King Dinizulu Hospital Spinal Unit (KDHSU), this being the biggest provider of acute care for people who sustain SCI in KwaZulu-Natal and the Eastern Cape Provinces, South Africa was the setting for our study. Participants: Medical files of individuals who sustained SCI between 2009 and 2012 were perused (n = 1049) were perused and 188 met the inclusion criteria. Outcome Measures: Key information from the KDHSU patient’s files were extracted using a tool developed using literature and the international spinal cord injury core data set. Results: The average annual incidence rate was 12.3 per 100 000 population. The male to female ratio was 6:4 with the mean age of 36.69 years, ranging from 16-64. Out of those employed (34%), 72% were working fulltime, mostly in the service industry (31%) and 59% were classified as laborers. The majority (61%) of the participants completed high school. The major cause of SCI was non-traumatic (54%) and 66% were classified as incomplete (ASIA). Furthermore, 80% were classified as paraplegia and 19% tetraplegia. The mean LOS was 42.9 days, ranging from 1-764 days, influenced by level of injury, completeness and classification of injury and surgical intervention. Conclusion: The profile of SCI in KwaZulu-Natal is slightly different when compared to other provinces in South Africa and the rest of Africa. There is a need to use epidemiological information (including factors that influence employment) to develop rehabilitation models to guide employment outcomes amongst people living with spinal cord injuries in KZN.

We describe the demographic profile, aetiology, management and surgical outcomes in women with genital tract fistula presenting to a tertiary urogynaecology unit. This retrospective audit included 87 patients managed in our unit between 2008 and 2015. Frequencies and means with standard deviations are presented for categorical and continuous data. Continuous dependent variables are categorized as above or below the median for bivariate analyses performed using the chi-squared test (α = 0.05). The mean age of the women was 34.7 years, 64.4% were Black African, 70.2% were multiparous, 49.4% were married, 82.8% were employed, and 21.8% were HIV-infected, with 47.4% on antiretroviral treatment. Vesicovaginal (47.1%) and rectovaginal (41.4%) fistula were the most frequent injuries. The majority of the injuries (67.8%) were obstetric, with 26.4% occurring during caesarean delivery. Repair had been attempted previously in 43.7% of patients. In 63.2% of the repairs the approach was vaginal and in 35.6% abdominal. Interposition grafts were used in 23% of repairs. In 85.1% of patients the initial repair at our centre was successful. Patients with multiple repairs were more likely to have complications (p = 0.03). HIV infection was not significantly associated with complications. A high rate of successful repair was found, with previous unsuccessful repairs associated with poorer outcomes, highlighting the need for centralized management.

Metal exposure remains a significant public health problem, particularly in the informal sector. The rise in informal foundries to cast scrap metal into artisanal cookware is widespread in low- and middle-income countries. The main aim of this study was to characterize metal exposure in artisanal cookware makers working in informal foundries in South Africa by measuring lead (Pb) in blood as well as sample metal concentrations on hands before and after work. The blood Pb distribution of the artisanal pot makers ranged from 1.1 to 4.6 μg/dl with the median blood Pb level being 2.1 μg/dl (IQR 1.7-2.5). The median blood Pb level in artisanal pot makers was 1.0 μg/dl higher compared with the non-exposed community members (p 0.0001). Before-and-after handwipe sampling revealed a median increase in all 22 elements. Pre and post aluminum (Al) load on the handwipes revealed a 7.3 factor increase (0.53 and 3.9 mg Al/handwipe respectively) (p = 0.003). Hand Pb load before and after pot making revealed a 3.5-fold increase (median increase of 6.2 μg Pb/handwipe). An increase in backyard informal foundries may be linked to increased exposure to toxic metals for workers, family members and communities.

Background Adolescent pregnancy and motherhood has been a controversial and much disputed subject within the field of public health. Early childbearing is not only characterized as a physical body experience but also embodies the experiences and perceptions of the social norms, discourses, conflict and moral judgement. There is an increasing concern that the psychosocial challenges facing adolescent mothers remains in the background since research in this field has mainly focused on the medical and physical complications of early childbearing. The aim of this qualitative study was to explore adolescent pregnancy and motherhood in order to understand this phenomenon from the perspective of adolescent mothers and to gain insight into their future aspirations. Methods This descriptive qualitative study was based on data from four focus group discussions with adolescent mothers utilising healthcare services at a district hospital in Ugu district, KwaZulu Natal, South Africa. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results Some adolescent mothers’ partners were in denial and rejected them and the child while others’ partners were happy and supported them during their pregnancy. Families’ reactions to the pregnancies ranged between anger and disappointment to abandonment, the silent treatment, and acceptance and forgiveness. The psychological issues experienced by some of the adolescent mothers included suicidal ideation, guilt, loneliness, anxiety, and stress. They also experienced financial constraints, difficulty in returning to school, and stigmatisation in society. The participants envisioned completing their education, focusing on their dream careers, and contributing positively to society. Conclusion Experiences of adolescent pregnancy and parenting are multifaceted and the healthcare needs of pregnant and parenting adolescents extend beyond information and knowledge. A multidisciplinary approach is required in the care of adolescent mothers. A key policy priority should encompass the collaboration of different professionals from various healthcare sectors to assist adolescent mothers in achieving better health and psychosocial and socio-economic outcomes as steps to securing a better future for them.

In the era of HIV/AIDS, repeat pregnancies among adolescents indicate the growing problem of high-risk sexual behavior and the status of reproductive health services. A cross sectional survey was conducted to establish the prevalence and risk factors of repeat pregnancies among South African adolescents. A total of 326 adolescents participated in this study at a district hospital in, KwaZulu-Natal, South Africa from June 2017 to November 2017. Data was analysed using R Software. Out of the 326 adolescents, 19.9% had experienced a repeat pregnancy. The risk factors associated with adolescent repeat pregnancy included a history of spontaneous abortion (p0.001) and previous contraceptive use (p0.001). A higher level of education (p0.001) and emotional support from family (p=0.007) were found to be significant protective factors against adolescent repeat pregnancy. These findings have implications for future interventions aimed at reducing repeat pregnancy among adolescents.

Background Knowledge and practices of sexual and reproductive healthcare is pivotal to the Safe Motherhood Initiative; however, only a few studies have investigated adolescent mothers’ knowledge of sexual and reproductive health in light of the above initiative. Research should thus focus on the knowledge and attitudes of adolescent girls as well as peer influences related to pregnancy and sexual and reproductive health among adolescents, as the findings may highlight vital health interventions that should be introduced. The aim of this study was thus to determine the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health among adolescents who attended maternal health services in a district hospital in Ugu, KwaZulu-Natal, South Africa. Methods A cross sectional study was conducted. Data were collected from 326 adolescents who accessed maternal health services in a peri-urban district hospital during June 2017 and November 2017. The questionnaire surveyed the knowledge, personal attitudes and peer influences related to pregnancy, sexual and reproductive health. The questionnaire was administered by fieldworkers using mobile devices powered by the Mobenzi Researcher® technology. The completed surveys were uploaded to the Mobenzi server where it was stored and aggregated. The data was analysed using R software. Results Of the 326 participants, 65 (19.9%) experienced repeat pregnancies in adolescence. Overall, only 143 (43.9%) of the participants answered 50% or more of the knowledge questions on pregnancy and HIV/AIDS and STIs correctly, while 183 (56.1%) answered less than 50% of the knowledge questions correctly. There was no relationship between knowledge of pregnancy and HIV/STIs and repeat adolescent pregnancies. Conclusion Adolescents’ knowledge of pregnancy and sexual and reproductive health was deficient as, even with repeat pregnancies, these adolescents were evidently no better informed about pregnancy and sexual and reproductive health. This suggests that social determinants, modes and platforms regarding the delivery of adolescent sexual and reproductive health education are important. An innovative mode to the delivery of sexual and reproductive health education includes the emerging digital platform. The digital platform encompasses social media, multimedia and mobile phones which is growing popular among young people. Electronic supplementary material The online version of this article (10.1186/s12889-019-7242-y) contains supplementary material, which is available to authorized users.

Adolescent pregnancy, sexual and reproductive health questionnaire. (DOCX 69 kb)

Background Spinal cord injury (SCI) often results in complete or partial loss of functioning of the upper and/or lower limbs, leading to the affected individual experiencing difficulties in performing activities of daily living. This results in reduced participation in social, religious, recreational, and economic activities (employment). The South Africa legal framework promotes the employment and assistance of people with disabilities. However, rehabilitation interventions focus mainly on impairments and activity limitations, with few attempts to prepare those with SCI to return to gainful employment. There is therefore a need for a well-coordinated, multidisciplinary rehabilitation initiative that will promote the employment of people living with spinal cord injuries (PLWSCI) in South Africa. Objective This study aims to develop a multidisciplinary model to guide employment outcomes amongst PLWSCI in South Africa. Methods This study will utilize exploratory mixed methods during 3 phases. The first phase will explore the current rehabilitation practices, and the second will establish the factors that influence employment outcomes among PLWSCI. A multidisciplinary team consisting of health care professionals, representatives from the departments of Labour, Education, Social Development, and Health, and nongovernment organizations representing PLWSCI will provide feedback for the model development of phase 3, along with results from the previous 2 phases, using a multistage Delphi technique. Results It is estimated that the results of phases 1 and 2 will be completed 11 months after data collection commencement (November 2015). Phase 3 results will be finalized 4 months after phases 1 and 2. Conclusions Developing a multidisciplinary model to guide the employment outcomes of PLWSCI will ensure a coordinated response to integrate them into a productive life and will assist them to achieve economic self-sufficiency, personal growth, social integration, life satisfaction, and an improved quality of life. This can be achieved by active inclusion of PLWSCI to ensure that their concerns and recommendations are addressed. ClinicalTrial ClinicalTrials.gov NCT02582619; https://clinicaltrials.gov/ct2/show/NCT02582619 (Archived by WebCite at http://www.webcitation.org/6mBgcj6z7)

Occupational and environmental exposures are important contributors influencing the burden of disease in developing countries. It is important to quantify the impact of exposures from working and living environments on individual and population health in order to reduce the burden of related diseases. Despite the tremendous advances made internationally in the field of exposure science, numerous challenges, including low literacy levels, poor organization of work and living, legislative gaps, and limited exposure science capacity, exist in developing countries. In this commentary, these challenges are discussed and recommendations for the exposure science community to help in addressing the challenges are proposed.

Aim Studying the effects of rare exposures in relation to rare diseases is challenging. In this session we will discuss problems and benefits with pooling data in epidemiological studies. We will show different examples of different types of pooling projects as well as results from those, and point to the contrasts with meta-analyses and multi-centre studies. Eero Pukkala 1 , Deborah Glass 2 , Maria Leon Roux 3 , Hans Kromhout 4 , Ann Olsson 3 , Ingrid S. Mehlum 5 1 Finnish Cancer Registry – Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland 2 Monash University Centre for Occupational and Environmental Health, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia 3 International Agency for Research on Cancer, Lyon, France 4 Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands 5 National Institute of Occupational Health (STAMI), Oslo, Norway

INTRODUCTION: Dental education, one of the most stressful fields of study, is associated with many occupational health hazards. Clinical training is focussed on patient care and occurs under the supervision of a qualified practitioner, and is thus the most appropriate time to educate students about the prevention of occupational health problems. The study aimed to report on the reflections of dental graduates on their undergraduate training from the perspective of occupational health. METHODS: This cross sectional, descriptive study used both quantitative and qualitative methods in the collection of data from a study population comprising dentists, dental therapists and oral hygienists in KwaZulu-Natal, South Africa. RESULTS: The response rate was 41% (n=169), 80% (n=138) and 40% (n= 46) for dentists, dental therapists and oral hygienists respectively. There was little focus (77.7%) on health and well-being of students and self-care in their dental training. Clinical work had started in the first year for 30% of the participants, and in the third year for 54.4% of the students. Undergraduate training lacked modules on occupational health, practice/business management, posture training, ergonomics and stress management. CONCLUSION: The perceptions of this study population indicated a need for the inclusion of occupational health training in undergraduate dental curricula.

The study was conducted to report on the scope and prevalence of occupational health related-problems experienced by dentists, dental therapists, and oral hygienists in their practice of dentistry. Background Professional practice and dental training have many risk factors, and the dental team should be able to recognize these factors to protect themselves. The prevalence of conditions related to the musculoskeletal system, stress, percutaneous injuries, ears, and eyes are of concern. The dental team should also not forget hepatitis B, hepatitis C, and HIV as risks in practice. Dental practitioners should protect themselves by self-recognizing risk factors and by maintaining proper working conditions. Methods The study targeted all empirical research, case studies, and systematic literature reviews written in English. All articles selected were subjected to a data analysis process. Data were captured on an Excel spreadsheet and reported in a comprehensive table. Results The literature addressing occupational health among dental practitioners included mainly cross-sectional studies and review papers (2001-2016). Forty-nine studies were included in the review. Musculoskeletal disorders remain the most researched occupational health-related problems in dentistry. Eye protection compliance was low among practitioners. Percutaneous injuries especially among young dentists and students were still a concern. Conclusion Occupational health-related problems are still prevalent in current dentistry practice, despite changes in equipment and surgery design. The reported prevalence of occupational related-health problems and other findings of investigative studies highlight the need for continuous professional education and a need to improve clinical practice aspects of dentistry curricula.

Background: Adolescent repeat pregnancy is of importance in public health because the birth of a second child to an adolescent mother compounds the adverse medical, educational, socioeconomic and parenting outcomes. Repeat pregnancy in adolescence is not only an international phenomenon but also a local concern as it also occurs in South Africa. The prevalence of adolescent repeat pregnancy in Durban, KwaZulu-Natal, was reported as 17.6% in 2013. Aim: This review aimed to gather relevant information from national and international sources to inform practice and to provide an understanding of what is known about the risk factors of and the interventions for adolescent repeat pregnancy. Methods: A scoping review was undertaken using the Arksey and O’Malley framework. An electronic search was conducted using PubMed, Medline, Science Direct, Ebscohost, Sage and Wiley Online and Google Scholar. Results: The search identified 3032 citations. After a review of the full text articles, 26 articles met the inclusion criteria. Risk factors pertaining to adolescent repeat pregnancy are categorised according to individual factors, partner relationship factors, family factors, peer factors, and social and community factors. Interventions to reduce adolescent repeat pregnancy have been largely influenced by the ecological framework. Across studies, adolescent mothers who received medical, psychosocial, educational, and family planning support experienced lower rates of repeat pregnancy. Conclusion: A single ‘one-size-fits-all’ intervention for adolescent repeat pregnancy prevention is unlikely as different strategies were employed by the intervention programmes in this scoping review.

Occupational and environmental pesticide use is prevalent in several developing communities. Due to the extensive use of pesticides in environmental vector control and the informal agriculture sector exposure of individuals and communities is poorly understood and difficult to assess. Further the unregulated sale of pesticides exposes non-agricultural communities. The potential for infant and adult pesticide exposure in most developing communities exists. Assessing pesticide exposure remains a challenge despite modern advances. This presentation will draw on experiences from work in South Africa to explain pathways for pesticide exposure in developing communities and the current methods being used for assessing pesticide exposure among individuals and in communities. It will further highlight the inherent challenges researchers and health personnel face at an individual, community and a systems level in attempting to establish pesticide exposure in developing communities.

Background Dichlorodiphenyltrichloroethane (DDT) has been the centre of debate for several decades with a global call for a ban on its use, while organophosphates (OP) and pyrethroids are used extensively in agriculture. Both DDT, OPs and pyrethroids are being used extensively in South Africa in malaria control and small-scale agriculture. There is limited information from Africa on the adverse associations between DDT, OPs, pyrethroids and reproductive and neurobehavioural health outcomes. Aim The aim of this study is to identify the impact of DDT, OP and pyrethroid exposure on the reproductive health of pregnant women and the neurobehavioural health outcomes of their offspring. Method This longitudinal study with a 3 year follow-up period is being conducted in the uMkanyakude (exposed population) and uMgungundlovu (unexposed population) districts of KwaZulu-Natal, South Africa. A total of 350 pregnant women attending antenatal clinics at the district hospital and respective primary health clinics will be recruited (February – December 2016) and followed for 3 years. Maternal interviews (demographic, exposure and health data), and biomonitoring of exposure to pesticide (urine and blood) will take place at recruitment and annually for the duration of the study. Infant clinical and neurobehavioural assessments together with direct home observations to assess child development will take place. Biomonitoring of exposure to DDT, OPs and pyrethroids will take place at birth and annually for the duration of the study. Results and discussion Data is currently being collected and information from the baseline recruitment interviews will be presented for the available women. Demographic, occupational and environmental pesticide exposure together with reproductive histories will be presented for the recruited cohort. This study will contribute knowledge on the relationship between DDT, OPs, pyrethroids and reproductive and neurobehavioural health outcomes in an African population.

Background: Spinal cord injury (SCI) often results in complete or partial loss of functioning of the upper and/or lower limbs, leading to the affected individual experiencing difficulties in performing activities of daily living. This results in reduced participation in social, religious, recreational, and economic activities (employment). The South Africa legal framework promotes the employment and assistance of people with disabilities. However, rehabilitation interventions focus mainly on impairments and activity limitations, with few attempts to prepare those with SCI to return to gainful employment. There is therefore a need for a well-coordinated, multidisciplinary rehabilitation initiative that will promote the employment of people living with spinal cord injuries (PLWSCI) in South Africa. Objective: This study aims to develop a multidisciplinary model to guide employment outcomes amongst PLWSCI in South Africa. Methods: This study will utilize exploratory mixed methods during 3 phases. The first phase will explore the current rehabilitation practices, and the second will establish the factors that influence employment outcomes among PLWSCI. A multidisciplinary team consisting of health care professionals, representatives from the departments of Labour, Education, Social Development, and Health, and nongovernment organizations representing PLWSCI will provide feedback for the model development of phase 3, along with results from the previous 2 phases, using a multistage Delphi technique. Results: It is estimated that the results of phases 1 and 2 will be completed 11 months after data collection commencement (November 2015). Phase 3 results will be finalized 4 months after phases 1 and 2. Conclusions: Developing a multidisciplinary model to guide the employment outcomes of PLWSCI will ensure a coordinated response to integrate them into a productive life and will assist them to achieve economic self-sufficiency, personal growth, social integration, life satisfaction, and an improved quality of life. This can be achieved by active inclusion of PLWSCI to ensure that their concerns and recommendations are addressed. ClinicalTrial: ClinicalTrials.gov NCT02582619; https://clinicaltrials.gov/ct2/show/NCT02582619 (Archived by WebCite at http://www.webcitation.org/6mBgcj6z7) [JMIR Res Protoc 2016;5(4):e238]

Setting Primary health clinics in KwaZulu-Natal, South Africa. Objective To assess and describe current practices in infection control at local government primary health clinics. Design A descriptive study using a standardised tool to assess adherence to recommended infection control policies in 51 primary health clinics in 2009-2010. Administrative policies, engineering controls and personal respiratory protection were assessed by observations and interviews at the clinics. Results Of 51 clinics, 11 (22%) had infection control policies, 13 (26%) triaged coughing patients and 16 (31%) had a dedicated nurse and a dedicated consulting room for treating tuberculosis (TB) patients. Study clinics treated a median of 99 patients (range 3-331) daily and a median of 15 TB patients (range 2-73) monthly. Of the rooms in the clinics, all of which rely on natural ventilation, half (149/284) had ≤12 air changes per hour. Eleven (22%) of 51 clinics had N95 masks available for staff use. Conclusion Limited infection control practices exist in clinics in a high TB burden setting in KwaZulu-Natal, South Africa. These practices need to be implemented more widely to minimise the spread of TB to non-infected patients and health care workers in primary health clinics.

Tuberculosis (TB) is a global public health concern and the epidemic in southern Africa has not stabilised. In South Africa, since 1994, there have been significant political reforms including tran...

BACKGROUND Bullying behavior in schools can lead to psychosocial problems. School-based interventions are important in raising student awareness, developing their skills and in planning to reduce bullying behavior. METHODS A randomized controlled trial, using a school-based educational intervention to reduce verbal bullying, was conducted among grade 10 students in 16 urban and rural schools in KwaZulu-Natal, South Africa in 2013. Baseline and postintervention questionnaires, developed using the Integrated Model for Behavior Change theoretical model, were used to assess changes in verbal bullying. RESULTS Postintervention there were reduced verbal bullying experiences. Improved social norms and awareness of verbal bullying were associated with reduced verbal bullying experiences and behavior. Although less likely to bully others verbally, girls were more likely to experience verbal bullying. Students with no living father were more likely to bully others verbally. CONCLUSIONS The study findings indicate that a school-based intervention can positively impact on verbal bullying experiences and behavior.

Background : Chronic diseases of lifestyle are detrimentally affecting South Africans. National Health Insurance, which is intended to improve care, requires capacity building for nurses at primary care clinics to ensure appropriate service provision. Objective : This study’s objective was to evaluate the impact of the ‘Primary Care 101’ chronic disease management guideline and training on nurses’ knowledge of chronic diseases management. Method : A population-based, unblinded, stratifid cluster randomised controlled trial with intervention ( n = 20) and control clinics ( n = 10) in three South African districts was conducted over six months in 2012. Nurses in the clinics participated in surveying knowledge on management of tuberculosis, human immunodefiiency virus infection, mental health, epilepsy, diabetes, hypertension and asthma and chronic obstructive pulmonary disease (COPD). All nurses were surveyed at baseline and six months later. Intervention clinic nurses were also surveyed immediately after training and three months post-training. Data were analysed using SPSS version 19 (SPSS Inc., Chicago, IL).Total mean knowledge percentage scores were calculated for each chronic disease. Mean knowledge percentage score changes between baseline and six months amongst all nurses and between intervention and control clinic nurses were compared using the paired samples t -test and independent samples t -test respectively. Results : There were signifiant improvements in nurses’ knowledge of hypertension and diabetes management over six months. Knowledge about asthma and COPD management decreased in all districts and nurse categories. Conclusion : The improvements in nurses’ knowledge can ensure improved patient management, but attention to asthma and COPD management is required. Agtergrond : Chroniese lewenstylsiektes beinvloed Suid-Afrikaners nadelig. Die nasionale gesondheidsversekering, wat ten doel het om sorg te verbeter, vereis kapasiteitsbou vir verpleegsters by primere-sorg-klinieke om sodoende toepaslike dienslewering te verseker. Doelwitte : Hierdie studie se doel was te evalueer wat die impak van die ‘ Primary Care 101 ’ chroniese siekte bestuursriglyn, asook opleiding is op verpleegsters se kennis van hoe om chroniese siektes te bestuur. Metode : ’n Bevolkingsgebaseerde, onverblinde, ewekansige gekontroleerde trossteekproef met ingrypings- ( n = 20) en kontrole-klinieke ( n = 10) is oor ’n tydperk van ses maande in 2012 in drie Suid-Afrikaanse distrikte uitgevoer. Verpleegsters in hierdie klinieke het deelgeneem aan ’n opname oor hul kennis oor die bestuur van tuberkulose, menslike immuniteitsgebreksvirus-infeksie, geestesgesondheid, epilepsie, diabetes, hoe bloeddruk, asook asma en chroniese obstruktiewe longsiekte (COPD). Alle verpleegsters is by die basislyn ondervra en ses maande later. Intervensie kliniekverpleegsters is ook ondervra onmiddellik na die opleiding en drie maande post-opleiding. Data is ontleed met behulp van SPSS, weergawe 19 (SPSS Inc, Chicago, IL). Totale gemiddelde kennis persentasietellings is vir elke chroniese siekte bereken. Veranderinge in die gemiddelde kennis persentasietellings tussen die basislyn en ses maande later is onder alle verpleegsters, asook tussen ingrypingsen kontrole-kliniekverpleegsters vergelyk met behulp van die gepaarde steekproef t -toets en die onafhanklike steekproef t -toets onderskeidelik. Resultate : Daar was ’n aansienlike verbetering in verpleegsters se kennis oor die bestuur van hoe bloeddruk en diabetes na ses maande. Kennis oor die bestuur van asma en COPD het in alle distrikte en verpleegster-kategoriee afgeneem. Gevoltrekking : Die verbetering in die verpleegsters se kennis kan verbeterde pasientbestuur verseker, maar die bestuur van asma en COPD vereis verdere aandag.

Objectives The present study describes latex sensitisation and allergy prevalence and associated factors among healthcare workers using hypoallergenic latex gloves at King Edward VIII Hospital in KwaZulu-Natal, South Africa. Design Cross-sectional study. Setting A tertiary hospital in eThekwini municipality, KwaZulu-Natal, South Africa. Participants 600 healthcare workers were randomly selected and 501 (337 exposed and 164 unexposed) participated. Participants who were pregnant, with less than 1 year of work as a healthcare worker and a history of anaphylactic reaction were excluded from the study. Primary and secondary outcome measures Latex sensitisation and latex allergy were the outcome of interest and they were successfully measured. Results The prevalence of latex sensitisation and allergy was observed among exposed workers (7.1% and 5.9%) and unexposed workers (3.1% and 1.8%). Work-related allergy symptoms were significantly higher in exposed workers (40.9%, p

South Africa's land policies have increased women's participation in agriculture, but limited information exists about their agricultural activities. We surveyed 911 women working on the Makhatini Flats in Northern KwaZulu-Natal in 2006, gathering data on demographics, agricultural activities, crop production and pesticide use in both irrigated and Dryland areas. Average age of participants was 41.9, with Drylands women slightly older. Education levels were low among both groups, but lowest in the Drylands. Drylands women were more likely to engage in reported agricultural activities, including pesticide spraying. Use of World Health Organization class I and II pesticides was reported in both areas. Farm ownership, age

Objectives This study examined associations of demographics and occupational factors with spontaneous miscarriages and infant deaths among women working in agriculture in KwaZulu-Natal, South Africa. Method This cross-sectional study in 2006 described and compared reproductive outcomes among 911 women working in agriculture in two distinct areas (ie, the irrigation scheme and drylands) of the Makhatini Flats, KwaZulu-Natal, South Africa. Associations between demographics, agricultural activities, physical load, pesticide spraying and self-reported “spontaneous miscarriage” and “infant death” (death in the first year) were explored using univariate and multivariate analyses. Results Women (N=887) reported 4796 pregnancies, 322 spontaneous miscarriages, 137 infant deaths. Adjusting for age, education, and length of recall of pregnancy, spraying pesticides during the first three months of a pregnancy was associated with spontaneous miscarriage [irrigation scheme odds ratio (OR) 2.8, (95% CI) 1.1–7.2; drylands OR 2.5, 95% CI 1.2–5.6]. Irrigation scheme women aged ≥40 years were more likely to report spontaneous miscarriage (OR 3.1, 95% CI 1.2–8.2). Owning one’s farm or working a family farm among irrigation scheme women (OR: 2.3; 95 % CI 1.2–4.4) and working for ≥10 years among drylands women (OR 2.1, 95 % CI 1.1–4.3) were associated with infant death. Weeding was inversely associated with infant death among irrigation scheme women (OR 0.4, 95 % CI 0.2–0.7). Conclusion This study found that women reporting spontaneous miscarriage were more likely to have sprayed pesticides during pregnancy, and those reporting infant death were more likely to have owned their farms and worked longer in agriculture.

Adolescent pregnancy, sexual and reproductive health questionnaire. (DOCX 69 kb)