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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.

Para-occupational “take-home” exposure risks among forestry workers and their families in low-and middle-income countries (LMICs) have not been well characterized. This is a concern because research shows an association between chronic low-dose herbicide exposure and adverse health effects. This study explored take-home herbicide residue exposure risks among forestry workers in the Western Cape, South Africa, through the community-based participatory research approach of photovoice. A key finding of the study was the absence of provisions related to take-home exposure in the national legislation and workplace policies, which largely contributed to poor adherence to risk reduction practices at worksites, in addition to workers transporting residues to their homes. This study demonstrated evidence of the key omissions regarding take-home exposure at the policy level (e.g., recommendations for employers to reduce take-home risks among employees, and training of workers and their families on take-home exposure) and take-home herbicide residue exposure among worker’s families, including children.

Introduction: The intersection of health and climate change is often absent or under-represented in sub-national government strategies. This analysis of the literature, using a new methodological framework, highlights priority focus areas for a sub-national government response to health and climate change, using the Western Cape (WC) province of South Africa as a case study. Methods: A methodological framework was created to conduct a review of priority focus areas relevant for sub-national governments. The framework encompassed the establishment of a Project Steering Group consisting of relevant, sub-national stakeholders (e.g. provincial officials, public and environmental health specialists and academics); an analysis of local climatic projections as well as an analysis of global, national and sub-national health risk factors and impacts. Results: Globally, the discussion of health and climate change adaptation strategies in sub-national, or provincial government is often limited. For the case study presented, multiple health risk factors were identified. WC climatic projections include a warmer and potentially drier future with an increased frequency and intensity of extreme weather events. WC government priority focus areas requiring further research on health risk factors include: population migration and environmental refugees, land use change, violence and human conflict and vulnerable groups. WC government priority focus areas for further research on health impacts include: mental ill-health, non-communicable diseases, injuries, poisonings (e.g. pesticides), food and nutrition insecurity-related diseases, water- and food-borne diseases and reproductive health. These areas are currently under-addressed, or not addressed at all, in the current provincial climate change strategy. Conclusions: Sub-national government adaptation strategies often display limited discussion on the health and climate change intersect. The methodological framework presented in this case study can be globally utilized by other sub-national governments for decision-making and development of climate change and health adaptation strategies. Additionally, due to the broad range of sectoral issues identified, a primary recommendation from this study is that sub-national governments internationally should consider a “health and climate change in all policies” approach when developing adaptation and mitigation strategies to address climate change. Keywords: Climate change, Environmental health, Low- and middle-income countries, Adaptation, Sub-national, Climate health impacts

IntroductionEvery year, more than 800 000 people die from suicides of which an estimated 20% are from pesticide ingestion. Multiple studies have estimated that around 77%–80% of these pesticide suicides occur in low/middle-income countries. The full burden of pesticide suicides in African countries remains poorly documented, one reason being the lack of systematic data collection. It is essential to know the number of pesticide suicide cases to guide prevention of further cases occurring. This can be done by informing policy and legislation, and the implementation of targeted bans, as well as raising community awareness around the use of these pesticides, training of healthcare personnel, and influencing the type and level of clinical facility investments into this area of healthcare. The scoping review aims to investigate how pesticide suicide deaths in Africa are recorded by exploring the various surveillance systems in place, as well as highlighting key limitations and data collection barriers.Methods and analysisA scoping review will be carried out with the five-stage methodological frameworks set out by Arksey and O’Malley and the Joanna Briggs Institute. Studies in English that looked at pesticide suicide in African countries will be extracted and screened independently by two reviewers against the inclusion and exclusion criteria of this review. Studies’ data will be extracted, and a descriptive synthesis developed of their main findings, as guided by the approach of Levac and colleagues.Ethics and disseminationEthics approval is not required for this review as no human participants will be involved. The study findings will be distributed in a peer-reviewed publication.Registration detailsThis protocol has been submitted for publication to BMJ Open.

Summary Background Reducing suicides is a key Sustainable Development Goal target for improving global health. Highly hazardous pesticides are among the leading causes of death by suicide in low-income and middle-income countries. National bans of acutely toxic highly hazardous pesticides have led to substantial reductions in pesticide-attributable suicides across several countries. This study evaluated the cost-effectiveness of implementing national bans of highly hazardous pesticides to reduce the burden of pesticide suicides. Methods A Markov model was developed to examine the costs and health effects of implementing a national ban of highly hazardous pesticides to prevent suicides due to pesticide self-poisoning, compared with a null comparator. We used WHO cost-effectiveness and strategic planning (WHO-CHOICE) methods to estimate pesticide-attributable suicide rates for 100 years from 2017. Country-specific costs were obtained from the WHO-CHOICE database and denominated in 2017 international dollars (I$), discounted at a 3% annual rate, and health effects were measured in healthy life-years gained (HLYGs). We used a demographic projection model beginning with the country population in the baseline year (2017), split by 1-year age group and sex. Country-specific data on overall suicide rates were obtained for 2017 by age and sex from the Global Burden of Disease Study 2017 Data Resources. The analysis involved 14 countries spanning low-income to high-income settings, and cost-effectiveness ratios were analysed at the country-specific level and aggregated according to country income group and the proportion of suicides due to pesticides. Findings Banning highly hazardous pesticides across the 14 countries studied could result in about 28 000 (95% uncertainty interval [UI] 24 000–32 000) fewer suicide deaths each year at an annual cost of I$0·007 per capita (95% UI 0·006–0·008). In the population-standardised results for the base case analysis, national bans produced cost-effectiveness ratios of $94 per HLYG (95% UI 73–123) across low-income and lower-middle-income countries and $237 per HLYG (95% UI 191–303) across upper-middle-income and high-income countries. Bans were more cost-effective in countries where a high proportion of suicides are attributable to pesticide self-poisoning, reaching a cost-effectiveness ratio of $75 per HLYG (95% UI 58–99) in two countries with proportions of more than 30%. Interpretation National bans of highly hazardous pesticides are a potentially cost-effective and affordable intervention for reducing suicide deaths in countries with a high burden of suicides attributable to pesticides. However, our study findings are limited by imperfect data and assumptions that could be improved upon by future studies. Funding WHO.

There is potential for increased pesticide-related adverse health outcomes in the agricultural sector linked to adaptive increases in pesticide use necessitated, in part, by climate change-related increases in pest populations. To understand the role of adaptation practices in pesticide use and health risks, this study assessed Zimbabwean smallholder cotton farmers&rsquo, adaptive responses linked to their climate change perceptions. In depth interviews were conducted with 50 farmers who had been growing cotton for at least 30 years. The study identified farmers&rsquo, adaptation practices that increased their pesticide use, as well as those that presented opportunities for reducing pesticide use through non-pesticide-dependent adaptation pathways. The findings show that due to perceived climate change impacts, such as a shorter growing season, farmers were adopting a range of adaptive practices. These included changes in pest management practices, such as increasing pesticide spraying frequencies due to keeping ratoon crops, which were increasing farmers&rsquo, overall pesticide use. Such incremental adaptive practices are potentially maladaptive, as they may increase farmers&rsquo, pesticide-related health risks. Other practices, however, such as reducing cotton acreage and diversifying crops, resulting in transformational adaptation, suggest the existence of opportunities for decreasing overall pesticide use or totally eliminating pesticides from the farming system.

Introduction: Over the past 10–15 years there has been increasing attention to the potential impact of extreme weather events (EWE) on children's mental health. Because sub-Saharan Africa (SSA) is experiencing an increase in the frequency and severity of these events, we decided it was necessary to conduct a systematic review. The focus was to examine research findings on the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA to inform protective adaptation strategies and promote resilience. Materials and Methods: In 2020 we conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and a review of the grey literature. The systematic review and grey literature search identified 1342 studies. Results: The titles and abstracts of 858 articles and grey literature were assessed for eligibility (e.g., mental health outcomes for children and adolescents linked to exposure to an EWE in SSA) with 21 articles identified for full-text review. Of these, only two were eligible for full review. Both articles focused on extreme flooding events and associated psychological distress. Several protective factors were identified (e.g., age, sex, encouragement, and shared hardship) that ameliorated the psychological distress. Discussion: There is an alarming lack of research focusing specifically on the mental health of youth exposed to EWE in SSA, where EWE, especially extreme heat, flooding and droughts, continue to increase. The indication is that children and adolescents living in SSA are at risk of mental health impacts such as depression and post-traumatic stress disorder. With the severe shortage of SSA-specific research, SSA decision-makers, planners and adaptation strategy developers are not guided by local and regional evidence and may be missing areas of concern and opportunities for prevention.

Farmers, farmworkers, and other end-users in Low- and Middle-Income Countries (LMIC) are often blamed for causing pesticide poisonings and environmental contamination because of “misusing” pesticides. The pesticide label is generally the main mechanism for communicating risk and use information to end-users. Five factors are presented that pesticide end-users must achieve concurrently in order to understand and apply the information found on a pesticide label. It is argued that end-users in LMIC are unable to fulfil these factors for social, cultural, political, and economic reasons. These factors are: access to the label, appropriate language, adequate literacy level (for reading and comprehension), and access to equipment and facilities. With label information being a poor risk communication vehicle, it is argued that the use of the term “misuse” of pesticides in the literature, and by regulators and industry inappropriately allocates blame of poisonings and environmental contamination to end-users. “Misuse” of pesticides should, therefore, be referred to as “unintended uses” to avoid apportioning undue blame to users who do not have access to risk, health and safety information (i.e., right-to-know) and/or are unable to interpret the messages as scientifically intended (i.e., right-to-comprehend).

In poorly resourced countries children may face multiple health risks associated with environmental hazards and under-development. It is estimated that exposure to harmful environmental factors (e....

Background Chemical hazard communication (e.g., label) is intended to alert users of the potential hazards of chemicals. Apart from the fact that hazard information needs to be understood, it is also important that it is recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required. Methods A cross-sectional study investigating associations between the recall of chemical safety information on labels and safety data sheets among 402 participants including 315 workers (industry, transport and agriculture sectors) and 87 consumers in two provinces of South Africa was conducted. The recall of label information by participants was tested using two modules from a Hazard Communication Comprehensibility Testing (CT) Tool developed by the Centre for Environmental and Occupational Health Research at the University of Cape Town for the UN Institute for Training and Research (UNITAR). Results Respondents were predominantly male (67.7%), the median age was 37 years (IQR: 30–46 years) and less than half of the participants completed high school (47.5%). The skull and crossbones symbol was the label element most recalled, both freely without prompting (79.6%) and recognition after prompting (94.8%). Whereas, the first aid and treatment measures were the least frequently freely recalled (least frequent item 6.0%; most frequent item 29.9%). Multivariate analysis identified the following positive associations with the recall of all the label elements listing the strongest association: call appropriate services and industrial vs. consumer sector (OR = 2.4; 95% CI: 1.2; 4.6); call appropriate services and transport vs. consumer sector (OR = 4.4; 95% CI: 1.2; 16.0); flammable symbol and male vs. female gender (OR = 2.3; 95% CI: 1.0; 5.3); flammable symbol and home language English vs. African languages (OR = 6.6; 95% CI: 2.1; 21.2); any hazard statement and home language Afrikaans vs. African languages (OR = 14.0; 95% CI: 3.6; 54.2), any first aid statement and further education vs. none (OR = 3.3; 95% CI: 1.3; 8.0), correct chemical name and industry blue collar workers vs. non-industry blue collar workers (OR = 2.6; 95% CI: 1.1; 6.1), correct chemical name and non-industry white collar occupations vs. non-industry blue collar workers (OR = 2.7; 95% CI: 1.0; 7.1). Conclusion The study found a number of potential positive associations that influence recall of label elements of which some (e.g., sector, gender, occupation) suggest further research. Relevant policies in South Africa should ensure that the safety information on chemical labels is clearly visible to read and understandable which aids recall and the reduction in harmful chemical exposures.

Occupational exposure to heat and solar ultraviolet radiation (UVR) threatens the health and wellbeing of outdoor workers. These threats are likely to increase as a result of climate change. This study examined the perceptions of occupational heat and sun exposure and health risk prevention among forestry workers removing alien invasive vegetation in the Western Cape, South Africa. The linkages between workers&rsquo, perceptions of heat, solar UVR, and herbicide exposure and impacts under the current climate were investigated to better understand potential adaptation needs under a changing climate. Using focus group discussions and participatory risk mapping, heat stresses identified by workers were either environmental (e.g., lack of shade) or work-related (e.g., wearing required personal protective equipment). Several heat and solar UVR health impacts were reportedly experienced by workers, local indigenous knowledge and coping mechanisms, such as wearing ochre for sun protection, were used to prevent these impacts. Despite workers&rsquo, current efforts to protect their health, existing gaps and opportunities to improve working conditions were identified. Institutional structures for improved reporting of adverse events are imperative, together with awareness and education campaigns about the risks associated with working in hot and sunny environments.

Climate change vulnerabilities are key environmental and social determinants of health, particularly in sub-Saharan Africa where public health and other infrastructure are not yet geared towards counteracting the potential impacts of changing climates. Health-related climate change adaptation research for sub-Saharan Africa is limited and existing research is not effectively translated into practical advice for decision makers. A World University Network (WUN) collaboration project was started in 2016 to investigate climate change impacts on non-communicable diseases (NCDs). This interdisciplinary collaboration, established through the Healthy-Polis International Consortium for Urban Environmental Health and Sustainability focuses on the intersection of health, climate and sustainability within urban environments through innovative research methods, co-production of knowledge, capacity building and intervention. NCDs like cancers, asthma, diabetes, cardiovascular disease and mental health are on the increase in sub-Saharan African urban areas and can be further aggravated by climate change. If NCDs and the climate nexus are unaddressed, they will undermine achieving several of the Sustainable Development Goals (SDGs). Principally, we highlight climate-sensitive NCDs impacts on vulnerable populations, i.e. women, children, elderly, immune compromised and people with low socio-economic status, throughout their life course. We argue that interventions need to target disciplinary and sector ‘intersections’ for effective adaptation strategies. These interventions should be specifically linked to four SDGs, namely, SDG 3 (Good Health and Well-Being), SDG 7 (Affordable and Clean Energy), SDG 11 (Sustainable Cities and Communities) and SDG 13 (Climate Action). We conclude with capacity development and policy guidance to strengthen sub-Saharan African countries ability to address climate-sensitive NCDs.

In low-income townships, pests are rife, a nuisance and are vectors of disease. Although alternatives are available, chemical means of pest control is often the first resort due to lack of knowledge of other methods, convenience and presumed efficacy. The demand for chemical pest control has created a unique business opportunity for informal vendors in South Africa servicing predominately low socio-economic communities. That is the selling of 'street pesticides', which are either containing agricultural pesticides too toxic for domestic use or illegally imported products. Poisonings from street pesticide exposures, particularly in children, are increasingly common and, along with pest-related diseases, creates a double burden of disease. Solutions are needed to decrease these incidences and to develop pest control strategies that are low- or non-toxic. It is imperative that, for sustainable problem-solving, all stakeholders, including vendors, be part of the solution in tackling this public health issue. This manuscript outlines an engaged scholarship approach for developing a sustainable resolution for reducing street pesticide use. This cyclical and iterative approach encompasses: the establishment of relationships, co-creation of solutions, co-implementation, co-monitoring, co-evaluation, co-reflection and co-re-design. The significance of the research and proposed engagement are discussed, as are anticipated challenges.

How do migrant women navigate their food environment during pregnancy? Foods are imbued with new meanings in a new place, and in low-and-middle-income countries including South Africa, a changing food environment leaves the poor, including many migrants, vulnerable to malnutrition. Thus, one of the ways economic and social vulnerability may be experienced and reproduced is via the foods one consumes. Examining food perceptions in the context of pregnancy offers a potentially powerful lens on wellbeing. Methods Nine focus group discussions (N = 48) with Somali, Congolese, and Zimbabwean men and women, and 23 in-depth interviews with Congolese, Somali and Zimbabwean women living in Cape Town were conducted, exploring maternal and infant nutrition. We used thematic analysis to guide analysis. Results (1) Participants described longing for self-categorised “traditional” foods, yet had limited access and little time and space to prepare these foods in the manner they had back home. (2) Sought-after foods available—and even celebratory—for migrants in Cape Town during pregnancy tended to be calorie-dense, nutrient poor fast foods and junk foods. (3) The fulfilment of cravings was presented as the embodiment of health during pregnancy. (4) Iron-folic acid supplementation was perceived as curative rather than preventive. (5) While participants did not describe hunger during pregnancy, food scarcity seemed possible. Discussion Food perceptions during pregnancy reflected migrants’ orientation towards home. Fast foods were widely acceptable and available during pregnancy. These foods were not perceived to have negative health consequences. Nutrition interventions targeting migrants should consider the symbolic nature of food, the increasingly globalised food environment in urban LMIC settings, as well as the contexts in which health perceptions evolve.

In Africa, urbanization and urban growth are dramatically restructuring the nature of cities. The growing majority of urban dwellers now live in informal conditions that, without access to basic services or public amenities, expose residents to greater health risk, and health-care systems are unable to provide affordable or comprehensive cover. The differential exposure to these urban conditions is compounded by social and economic vulnerability, resulting in health inequities. Yet despite pressing needs driven by Africa’s considerable and complex burden of disease and high levels of health inequity, urban health and urban health equity have not yet emerged as major research and policy priorities in Africa, and as such South Africa, like many other African countries, lags behind in addressing these issues. This commentary presents a conceptual framework, using a public health approach, for interdisciplinary research aimed at contributing to the understanding and mitigation of urban health issues and challenges in Africa (Fig. 1). This approach identifies downstream and upstream factors, based on published literature, associated with key determinants in each theme. In other words, in addition to the individual level risk factors, the figure summarizes factors associated with each theme at the community, experiential, environmental, and structural policy levels. It represents a collective effort by interdisciplinary academics from public health; anthropology; civil engineering; architecture, planning and geomatics; human biology; psychiatry and mental health; medicine; pathology; and paediatrics, from the Research Initiative for Cities and Health (RICHE), University of Cape Town (UCT), to generate African perspectives on urban health and urban health equity. A workshop to tackle the urban health research agenda in August 2015 was attended by 40 RICHE members with extensive global and local urban health experience. In line with the co-production philosophy advocated for African urban contexts 1, additional contributions came from representatives from the Western Cape Department of Health. The process of identifying themes and gaps was as follows: First existing urban health research in Africa was presented. The workshop participants, who have a wide range of experience in urban health in Africa presented what work was ongoing or planned. Through this iterative process, the key components of research questions identified were then thematically classified into six distinct focus areas. Using a public health, socio-ecological model, these themes were then classified into different levels from the individual to policy levels. Gaps in research were then identified qualitatively by the same iterative process from which unanswered priority research questions were identified. Three cross-cutting principles for African urban health research were also identified in the process, based on methodological and technical requirements for the successful conduct of the proposed research themes (Table ​(Table11). FIG. 1 Conceptual framework of public health approach to urban health research themes in Africa. TABLE 1 Urban health research focus areas and priority research questions Six Focus Area Themes Urban Context as a Tool for Health Promotion and Disease Prevention The health and well-being of urban residents is intricately linked to the natural, built, and institutional elements of the urban context. As such, all dimensions of urbanization and urban living, including socio-environmental determinants of health need to be considered 2. The Commission on the Social Determinants of Health 3 and the Hidden Cities4 reports identify addressing urban health as a key priority in the global South. Thus, investigation of the interaction between health and the urban determinants of health (social and policy environments, health services, the built, physical housing and recreational environments, food systems, crime/security, access to potable water, air quality, transport, vector and pest management, community resilience, psycho-social support structures) is essential 5. Understanding these interactions could facilitate developing, implementing, and evaluating interventions that aim to harness these aspects of the urban context as tools for health promotion and prevention of infectious and vector-borne diseases, non-communicable diseases, and injuries, which in South African cities account for 20 % more mortality than in rural areas 6. This understanding could be gained via research paired with “natural experiments” and randomized evaluations, such as urban upgrades, housing developments, and integrated transport system routes, to assess the impact on health behaviors and health outcomes.

Shale gas exploration involving hydraulic fracturing (fracking) has been on South Africa's energy agenda since 2010 as a potential alternative to coal. Internationally, the desirability of fracking has been under debate, due to increasing evidence of associated environmental and health risks. There is limited research related to the public's knowledge and risk perceptions of fracking, and none whatsoever from South Africa. This cross-sectional study explored, through a household survey, knowledge of, health risk perceptions of, and information sources related to fracking of 102 Central Karoo residents. Our results indicated that 40% of the participants do not know what fracking is or the potential risks and benefits thereof. The media is participants' main information source (59.8%), and only half of the participants trust their information sources. Those with more trust in their information sources perceived fracking as posing a greater risk. Those believing fracking poses a low risk were more likely to ...

Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.

This article focuses on the devastating hidden perils of agricultural pesticides repurposed by informal sellers in urban South African townships to kill rats and other unwanted pests. Drawing on collaborative research techniques, we investigate the causal relationship between child poisoning episodes and the household use of illegal street pesticides. Such pesticides are used to safeguard homes from pests in an attempt to protect children from the harmful consequences of rodent bites and vectorborne diseases. Here, we consider the social injustice and economic inequality of episodes of child pesticide poisoning in the Western Cape from three disciplinary perspectives: public health, medical anthropology and fine art. We ultimately seek to demonstrate the complex relationship between the political economy of sanitation, waste removal and insecure housing, and the proliferation of rodents and other pests in urban townships. As a contribution to the medical humanities, the paper leans into different disciplines to highlight the toxic layering at play in a child pesticide poisoning event. The public health perspective focuses on the circulation of illegal street pesticides, the anthropologists focus on the experiences of the children and caregivers who are victims of poisoning, and the fine artist centres the rat within a broader environmental context. While non-toxic methods to eliminate rats and household pests are critical, longer term structural changes, through environmental and human rights activism, are necessary to ameliorate the suffering caused by poisoning. The medical and health humanities is well poised to highlight creative ways to draw public attention to these challenges, as well as to bridge the divide between science and the humanities through collaborative research efforts. With this paper we set the stage for discussing and balancing perspectives when addressing pest control in poor urban communities.

Background: Mobile health is a fast-developing field. The use of mobile health applications by healthcare professionals (HCPs) globally has increased considerably. While several studies in high income countries have investigated the use of mobile applications by HCPs in clinical practice, few have been conducted in low- and middle-income countries. The University of Cape Town developed a pesticide notification guideline which has been adapted and embedded into a South African Essential Medical Guidance mobile application. This study evaluated the usefulness of the guideline within a mobile application for improving the ability of HCPs to diagnose and notify on acute pesticide poisonings (APPs). Methods A descriptive online questionnaire, with 15 open- and 20 closed-ended questions, was completed by 50 South African emergency medicine physicians and registrars (i.e. medical doctors training as specialists) between December 2015 to February 2016. Descriptive statistics were used to calculate response frequencies and percentages using SPSS version 23. Texts from the open-ended questions were thematically analysed. Fisher’s exact test was applied to determine associations. Results A significant association was found between participants’ knowledge that APP is a notifiable condition, and ever reporting the poisoning to the National Department of Health (p = 0.005). Thirty four percent of the participants were aware of the guideline within the Essential Medical Guidance application despite only seven participants having used it. Those who used the guideline found it provided useful information for the identification of unlabelled pesticides products and promoted reporting these cases to the National Department of Health for surveillance purposes. In addition, it appeared to facilitate the prompt diagnosis and treatment of APP cases, and most intended to continue using it for training and educational purposes. Conclusions Mobile health applications appear to support overburdened medical education programmes and promote better patient care. However, since most participants were not aware of the existence of the pesticide guideline within the studied essential medicine application, there is potential for the use of healthcare applications to play a more central role in healthcare systems and medical training. Furthermore, the field of medical informatics could support HCPs through mobile applications in improving reporting of APP.

‘Misuse’ of pesticides by agricultural workers assumes that these workers have access to the relevant risk information, are able to read the information, and are able to comprehend and apply this information. The main source of risk, health and safety information for workers is the pesticide label. Research conducted with South African farm workers highlights that health and safety label information is often not noticed and mis-interpreted from the expert intended meanings since workers have limited access to comprehension mechanisms. The Globally Haromonized System of Classification and Labelling of Chemicals (GHS) has been presented as a mechanism for improving label comprehension, but so far research has indicated that label information (e.g., in the form of icons/pictograms and colour codes) despite being harmonised is not understood to provoke the intended safety behaviours. With label information being a poor risk communication vehicle, it is argued that the Hierarchy of Control (HoC), originating from occupational hygiene, should be applied to the use of pesticides and for protecting the health and safety of workers to reduce hazardous exposures. The stages of the HoC are presented (i.e., elimination, substitution, engineering, administrative, behaviour and personal protective equipment) in order of effectiveness for protecting workers and examples applied. The United Nations Food and Agricultural Organisation (FAO), in conjunction with the WHO, are promoting the identification and management of Highly Hazardous Pesticides (HHPs). The eight criteria for identifying HHPs appear to be an effective approach to eliminating pesticides too hazardous for workers unable to understand label information to be exposed to. ‘Misuse’ of pesticides, it is argued, should therefore be referred to as ‘unintended uses’ to avoid blaming workers who do not have access to risk, health and safety information (i.e., right-to-know) and/or are unable to interpret the messages as scientifically intended (i.e., ‘right-to-comprehend’).

Purpose: This chapter aims to demonstrate how medical educators can use e-collaborative tools to collaborating internationally and cross-institutionally towards designing environmental sustainability and health (ESH) education. The main focus of the chapter is on sustainable medical curricula. Methodology: The chapter uses a case-study approach to bridge these broader e-collaborative principles with the specifics of implementation driven and supported by e-collaboration. Findings: The case study describes the evolution of the Sustainable Healthcare Education (SHE)-network into a network collaborative. Finally, the chapter discusses e-collaboration for education development through an illustrative case. The case concerns an UK-Greek University e-collaboration aimed at combating obesity and promoting climate literacy. Research implications: E-collaboration is central at all levels of the ESH curriculum design process from forming a network collaborative around the curriculum process, alignment of assessment and learning activities with objectives, discussing and agreeing on a vision to the actual implementation plan. Practical implications: E-collaboration aids the curriculum design process such that people feel that their participation and interests are valued, as well as providing resources and input to resource stressed academics and institutions. E-collaboration is not an end in itself, but a means of enabling a global network collaborative to address an issue that suits this type of collaboration towards sustainable healthcare education. Originality: This chapter is inventive in showing how the promotion of climate literacy can be a component of a sustainable medical curriculum and how this process is facilitated with e-collaborative tools. The chapter demonstrates how health education should educate climate literate health professionals who are able to address and reduce public health impacts of climate change.

Aim We aim to use the Canadian CAREX (CARcinogen EXposure) tool, adapted for local context, as a method to assess prevalence and level of exposure to priority occupational carcinogens in South Africa. Methods The work entails first understanding the CAREX tool, and adapting it as well as reviewing its use in other countries (phase 1). Once the tool and database are prepared, we will gather publicly available data (i.e. Census data, information on chemical use, trade data, published and grey literature, expert consultation, etc.) on occupational exposure to carcinogens as well as exposure monitoring data (phase 2). We will consider all occupational health and safety legislation and its regulations regarding occupational exposure limits, and those carcinogens prioritised locally and internationally, for example by the International Agency for Research on Cancer. All data will be used to estimate the number of South African workers occupationally exposed to carcinogens (and where possible, their level of exposure) (phase 3). Ultimately, this will help guide the development of appropriate health promotion and worker protection programmes, among other resources aimed at cancer prevention (phase 4). Results Here we will present the experience of the team during phase 1 of the project, including challenges and opportunities encountered. Expected outcomes Key future outcomes include prevalence of exposure to occupational environmental carcinogens in the South African workplace; also proportions of the workforce in various occupational groups exposed to specific carcinogens; key occupational groups in need of protection; data and information that can be used to guide prevention programs.

Background Communication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation. Methods As part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically. Results Zimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters. Conclusion Although there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation.

Made available in DSpace on 2018-11-26T17:40:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-01-01 Background: Global environmental change is associated with significant health threats. The medical profession can address this challenge through advocacy, health system adaptation and workforce preparedness. Stewardship of health systems with attention to their environmental impacts can contribute to mitigation of and adaptation to negative health impacts of environmental change. Medical schools have an integral role in training doctors who understand the interdependence of ecosystems and human health. Yet integrating environmental perspectives into busy medical curricula is not a simple task.Content: At the 2016 Association for Medical Education in Europe conference, medical educators, students and clinicians from six continents discussed these challenges in a participatory workshop. Here we reflect on emerging themes from the workshop and how to plan for curricular change. Firstly, we outline recent developments in environmental health and associated medical education. Secondly, we reflect on our process and outcomes during this innovative approach to international collaboration. Thirdly, we present learning objectives which cover core content for environmentally accountable medical curricula, developed through a reflective process of international collaboration integrating current literature and the workshop outcomes.Conclusions: International collaboration can bring together diverse perspectives and provide critical insights for the inclusion of environmental health into basic education for medical practitioners. Univ Hull, Hull York Med Sch, Kingston Upon Hull, N Humberside, England Med Sans Frontiers, Kinshasa, DEM REP CONGO Univ East Anglia, Norwich Med Sch, Publ Hlth, Norwich, Norfolk, England Univ Melbourne, Nossal Inst Global Hlth, Melbourne, Vic, Australia Univ Tasmania, Sch Med, Hobart, Tas, Australia Univ British Columbia, Dept Family Practice, Fac Med, Vancouver, BC, Canada Georgetown Univ, Med Ctr, Dept Family Med, Washington, DC 20007 USA Kings Coll London, Dept Primary Care & Publ Hlth Sci, London, England Aarhus Univ, Ctr Hlth Sci Educ, Aarhus, Denmark Univ Edinburgh, Edinburgh, Midlothian, Scotland Univ Estadual Paulista, Med Sch Botucatu, Publ Hlth Dept, Sao Paulo, Brazil Univ Cape Town, Sch Publ Hlth & Family Med, Div Environm Hlth, Rondebosch, South Africa Univ Estadual Paulista, Med Sch Botucatu, Publ Hlth Dept, Sao Paulo, Brazil

The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audience's varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.

Viele Alltagsprodukte wie Korperpflegemittel enthalten Gefahrstoffe. Gut informierte Anwender konnen damit so umgehen, dass sie ihre Gesundheit und die Umwelt nicht gefahrden. Wie gut taugen die geltenden Regelungen zur Risikokommunikation fur den Schutz der Konsumenten und der Umwelt?

i nfo Article history: Available online xxxx abstract Chemical hazard communication is a key strategy to prevent illness and disability from exposures to potentially hazardous chemicals. The Globally Harmonised System of Classification and Labelling of Chemicals (GHS) was developed to strengthen national capacities for safe management of chemicals. In this paper we present the results of a descriptive study on comprehensibility of chemical hazard com- munication elements. The study of 402 respondents, including 315 workers in the manufacturing, trans- port and agricultural sectors and 87 consumers was conducted in 2003 to provide data on chemical hazard communication comprehensibility as part of a feasibility study into the possible adoption of the GHS in South Africa. Data were collected using an interviewer-administered instrument developed for the International Labour Office (ILO) to support GHS implementation. Less than half of respondents reported any training in their current jobs in health and safety, and only 34% on labels. Agricultural workers were far less likely to have received any training. In general, compre- hension of hazard communication labels and safety data sheets (SDSs) was low. Symbols such as the skull and crossbones (98%) and the flammable (93%) symbol were relatively well understood (either correct or partly correct responses), but the majority of hazard symbols were of moderate to poor comprehensibil- ity (less than 75% correct or partly correct responses). Significant levels of critical confusions (5% or more) occurred with symbols for corrosive and compressed gas. Co-workers and supervisors were identified as

Background Infant feeding recommendations are of health importance, yet the extent to which migrant communities in low- and middle-income countries know or implement these recommendations is poorly understood. This study explores the perspectives of infant feeding amongst cross-border migrants in Cape Town, South Africa. Methods Between February and October 2013, semi-structured in-depth interviews (n = 23) were conducted face-to-face with Congolese, Somali and Zimbabwean mothers living in Cape Town. To assess commonly identified narratives of infant feeding, nine focus group discussions (three with men and six with women) were conducted with migrant Somalis, Congolese, and Zimbabweans. Results Three dominant themes framed infant feeding. 1) Pragmatism in feeding choices drove responses to baby’s cues, including cries, sleeping patterns, and weight gain (2). Formula feeding was normative in the South African context, whereas lack of commercial infant milk back home was described in terms of expense (3). Low rates of breastfeeding were explained in terms of work responsibilities including household work and lack of breastmilk supply resulting from stress and poor diet. However, women participants typically did not consider their feeding choices to negatively affect their baby’s health. Conclusions The reasons for early introduction of both commercial infant milk and solid foods were complex. Breastfeeding was not prioritized despite an awareness of medical recommendations. Rather than emphasizing specific breastfeeding intentions, participants favoured an approach that reacted to their baby’s perceived changing needs. The practical challenges of breastfeeding described by cross-border migrant women reflect one way in which socio-economic and health inequalities may currently be perpetuated for marginalised populations.

South African low-income communities face many challenges (e.g., insufficient housing, poor service delivery, and abject poverty); additionally, a silent challenge of pest infestation plagues these areas resulting in disease risks, nuisances, and stigma. Consequently, an enterprising urban informal sector business has emerged providing residents with highly toxic, effective, cheap, and illegal “street pesticides.” These pesticides pose acute and chronic health risks for vendors and residents. The economic opportunity provided by the high demand for effective and cheap pest control results in the high risk of health effects being traded for income. Current measures to control and “regulate” the massive street pesticide sales result in toxic stockpiles and government’s “turning a blind eye.” Solutions will only be achieved through open dialog identifying and developing non-toxic pest control strategies while ensuring vendors’ income; and relevant stakeholder recognition that pest infestation is a social and environmental health determinant needing acknowledgement in different government policies.

Pesticide companies and regulators in developing countries use the United Nations Food and Agricultural Organization (FAO) recommended pictograms on pesticide labels to communicate risk information based on toxicological and environmental risk assessment data. The pesticide label not only is often the only access people have to pesticide risk information, but also in many countries is a legally binding document. As a result of the crucial role pesticide labels play in protecting health and the environment and as a legal instrument, pictograms are used to overcome literacy challenges in transmitting pesticide risk information. Yet, this risk communication tool is often prone to misinterpretations of the risk information which results in hazardous exposures to pesticides for farm workers and end-users generally. In this paper, results are presented from a study with 115 farm workers on commercial vineyards in the Western Cape, South Africa, assessing their interpretations of 10 commonly used pictograms. A standardized questionnaire based on four commonly used pesticide labels was administered. Overall, 50% or more of the study farm workers had misleading, incorrect and critically confused interpretations of the label pictograms. Interpretations often reflected farm workers' social and cultural frames of reference rather than the technically intended risk information. For example, the pictogram indicating a pesticide's toxicity requires boots must be worn, evoked interpretations of "dangerous to pedestrians" and "don't walk through pesticides". Furthermore, there was a gender variation in pictogram comprehension whereby males generally had more correct interpretations than females. This is a result both of a lack of training for women who are assumed to not work with pesticides, as well as a lack of pictograms relevant for female exposures. These findings challenge the viability of the United Nations current initiative to globally harmonize pictograms used on all chemical labels under the new Globally Harmonized System for the Classification and Labelling of Chemicals (GHS). Particularly as the GHS pictograms were not piloted prior to adoption of the system and represent complex risk assessment data such as chronic hazards. Public health and pesticide policy, backed by relevant research, need to address developing applicable and effective pesticide risk communication tools, particularly for developing country populations. Merely providing risk assessment derived information in a pictogram does not ensure that an end-user will interpret the message as intended and be able to make risk decisions which mitigate risks from exposures to pesticides or chemicals in general.

The commercial agricultural sector in South Africa has historically been dominated by large-scale operations run by white owners and managers. In redressing this imbalance, black farmers classified as ‘emerging’ are being encouraged to engage in high-input agricultural production in order to obtain ‘commercial’ status. Since existing practices in commercial agriculture rely heavily on pesticides, emerging farmers aspiring to become commercial are pressured to adopt and/or increase the use of pesticides. However, problems of access to land, finances, resources, skills and markets overshadow the health and safety of these farmers and their labour force that may be affected by exposure to pesticides. This paper presents the results of a policy study based on primary interview data with key stakeholders and secondary documentary review data, to illustrate how pesticides are used in an occupational health and safety vacuum because the focus of key institutions is rather on economic productivity.

The high exposure risks of workers to herbicides in low- and middle-income countries is an important public health concern because of the potential resulting negative impacts on workers' health. This study investigated workers' personal protective equipment (PPE) compliance as a risk mitigation measure; particularly workers who apply herbicides for Working for Water (WfW) – a South African invasive alien vegetation control programme. The study aim was to understand workers' low PPE compliance by analysing their risk perceptions of herbicide use, working conditions and socio-cultural context. Research methods included ethnographic observations, informal interviews, visual media, questionnaires and a focus group. Study results indicated that low PPE compliance persists despite workers' awareness of herbicide exposure risks and as a result of the influence from workers' socio-cultural context (i.e. gender dynamics and social status), herbicide risk perceptions and working conditions (i.e. environmental and logistical). Interestingly, teams comprised of mostly women had the highest compliance rate. These findings highlighted that given the complexity of PPE compliance, especially in countries with several economic and social constraints, exposure reduction interventions should not rely solely on PPE use promotion. Instead, other control strategies requiring less worker input for effectiveness should be implemented, such as elimination and substitution of highly hazardous pesticides, and altering application methods.