Health Risks Associated with Occupational Exposure to Ambient Air Pollution in Commercial Drivers: a Systematic Review

Introduction: Ambient air pollution is major global health problem and commercial drivers are particularly exposed to it. No systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population has been carried out. Methods: We conducted a systematic review using a protocol-driven strategy. Papers published from inception to 20th April 2018 in MEDLINE, EMBASE, CINAHL, African journals online, Cochrane library, ISRCTN and WHO ICTRP databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. Results: The initial search retrieved 1454 published articles of which 20 articles were included. 3 Studies reported a significant difference in white blood cells (106/L) among commercial motorcyclists compared to rural inhabitants (5.041±1.209 vs 5.900±1.213,p=0.001), an increased risk of lung cancer (RR=1.6, 95%CI 1.5-1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin’s lymphoma (SMR 2.17, 95%CI 1.19-3.87) compared to white collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. 4 papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. 3 other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were not also homogeneously distributed compared to the controls. Conclusion: There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes but the existing literature is limited with few studies of small sample size, methodological weaknesses and contradictory findings. Further research is recommended

Effects of Results Based Financing Models on Data Quality Improvement in Benin on 2014

Abstract The performances generated by results based financing (RBF) raise questions about the quality of data used to measure them. This study was carried out to evaluate the RBF contribution to the quality improvement of maternal and child health data. Sixty seven health facilities are sampled randomly in three strata (RBF_PRPSS, RBF_PASS, No_ RBF) gathering health zones in Benin. The strata comparison with maternal and child health data for the first halves 2014 and 2011 revealed that timeliness and completeness have improved in the strata exposed to results based financing compared to unexposed (p <0.05). Compared to No_RBF stratum, accuracy deteriorated in RBF_PRPSS stratum, with a 52% decrease in the proportion of concordance reports between 2011 and 2014. In 2014, recorded discrepancies are largely under-reported in the RBF_PRPSS stratum, and over-reported in RBF_PASS stratum. The accuracy of National Health Information and Management System (SNIGS) data compared to RBF's validated data was low, verification factors varying between 30% and 97%. In total, the data quality was globally poor in most areas in Benin and it is not improved by the results based financing models implemented between 2011 and 2014. There is a need to target data quality in RBF models and to use SNIGS as a unique system of reporting

Health Risks Associated with Occupational Exposure to Ambient Air Pollution in Commercial Drivers: A Systematic Review

Ambient air pollution is a major global health problem and commercial drivers are particularly exposed to it. As no systematic assessment of the health risks associated with occupational exposure to ambient air pollution in this population had yet been carried out, we conducted a systematic review using a protocol-driven strategy. Papers published from inception to April 20, 2018 in MEDLINE, EMBASE, CINAHL, African journals online, the Cochrane library, ISRCTN WHO ICTRP, and the Web of Science and Scopus databases were screened for inclusion by two independent reviewers. Original articles with at least an available abstract in English or French were included. The initial search retrieved 1454 published articles of which 20 articles were included. Three studies reported a significant difference in white blood cells (10⁶/L) among commercial motorcyclists compared to rural inhabitants (5.041 ± 1.209 vs. 5.900 ± 1.213, p = 0.001), an increased risk of lung cancer (RR = 1.6, 95%CI 1.5⁻1.8) in bus drivers and an increased standardized mortality ratio (SMR) in bus drivers from Hodgkin's lymphoma (SMR 2.17, 95%CI 1.19⁻3.87) compared to white-collar workers. Other studies also found that drivers had more oxidative DNA damage and chromosome breaks. Four papers failed to demonstrate that the drivers were more exposed to air pollution than the controls. Three other studies also reported no significant difference in lung function parameters and respiratory symptoms. The genetic polymorphisms of detoxifying enzymes were also not homogeneously distributed compared to the controls. There is some evidence that occupational exposure to ambient air pollution among commercial drivers is associated with adverse health outcomes, but the existing literature is limited, with few studies on small sample size, methodological weaknesses, and contradictory findings-thus, further research is recommended.status: publishe