Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study

Background: Coffee processing causes organic dust exposure which may lead to development of respiratory symptoms. Previous studies have mainly focused on workers involved in roasting coffee in importing countries. This study was carried out to determine total dust exposure and respiratory health of workers in Tanzanian primary coffee-processing factories. Methods: A cross sectional study was conducted among 79 workers in two coffee factories, and among 73 control workers in a beverage factory. Personal samples of total dust (n = 45 from the coffee factories and n = 19 from the control factory) were collected throughout the working shift from the breathing zone of the workers. A questionnaire with modified questions from the American Thoracic Society questionnaire was used to assess chronic respiratory symptoms. Differences between groups were tested by using independent t-tests and Chi square tests. Poisson Regression Model was used to estimate prevalence ratio, adjusting for age, smoking, presence of previous lung diseases and years worked in dusty factories. Results: All participants were male. The coffee workers had a mean age of 40 years and were older than the controls (31 years). Personal total dust exposure in the coffee factories were significantly higher than in the control factory (geometric mean (GM) 1.23 mg/m³, geometric standard deviation (GSD) (0.8) vs. 0.21(2.4) mg/m³). Coffee workers had significantly higher prevalence than controls for cough with sputum (23% vs. 10%; Prevalence ratio (PR); 2.5, 95% CI 1.0 - 5.9) and chest tightness (27% vs. 13%; PR; 2.4, 95% CI 1.1 - 5.2). The prevalence of morning cough, cough with and without sputum for 4 days or more in a week was also higher among coffee workers than among controls. However, these differences were not statistically significant. Conclusion: Workers exposed to coffee dust reported more respiratory symptoms than did the controls. This might relate to their exposure to coffee dust. Interventions for reduction of dust levels and provision of respiratory protective equipment are recommended.publishedVersio

Noise Exposure and Self-reported Hearing Impairment among Gas-fired Electric Plant Workers in Tanzania

Background: Gas-fired electric plants are equipped with heavy machines, which produce hazards including noise pollution. Exposure to high level of noise of above 85dB(A) is known to bring about Noise-Induced Hearing Loss (NIHL). This study aimed to assess noise exposure level and reported prevalence of noise-induced hearing loss among workers in gas-fired electric plants. Material and Methods: This cross-sectional study was conducted in three gas-fired electric plants in Dar es Salaam (Plant A, Plant B and Plant C) from July to August 2017. A noise logging dosimeter was used to measure personal noise exposure level. A questionnaire was used to collect information on managerial factors, individual factors, socio-demographic factors and history of the participants. A short screening validated questionnaire was used to obtain noise exposure score. Frequency distribution, Chi-square test and Regression analyses were done using SPSS version 20. Results: One hundred and six participants were involved in the study. Noise exposure level among gas-fired electric plant workers was above 85dB(A), n = 37. The equivalent sound level (LAeq) measured over 8 hours was (98.6 ± 9.7) dB(A). The mean noise peak level was (139.5 ± 9.4) dB(A). Plant C had higher mean noise exposure level (TWA) of (96.9 ± 5.1) dB(A) compared to plant B 96.4 ± 3.7dB(A) and plant A 78.7 ± 11.9dB(A). Participants in both operation and maintenance had higher equivalent sound level (LAeq) measured over eight hours of 101.980 ± 3.6dB(A) compared to maintenance alone 98.5 ± 12.4dB (A) or operation 97.7 ± 8.8dB (A). Proportion of participants with reported hearing loss was 57(53.8%) where 44(41.5%) participants reported difficulty hearing people during conversations. Hearing protective devices (HPDs) were reported to be used by a majority, 101(95.3%). Conclusion: Workers in gas-fired plants are exposed to high noise levels that could damage their hearing. Hearing conservation programs should be established and maintained in this work environment

Personal Exposure to Dust and Endotoxin in Robusta and Arabica Coffee Processing Factories in Tanzania

Introduction: Endotoxin exposure associated with organic dust exposure has been studied in several industries. Coffee cherries that are dried directly after harvest may differ in dust and endotoxin emissions to those that are peeled and washed before drying. The aim of this study was to measure personal total dust and endotoxin levels and to evaluate their determinants of exposure in coffee processing factories. Methods: Using Sidekick Casella pumps at a flow rate of 2l/min, total dust levels were measured in the workers’ breathing zone throughout the shift. Endotoxin was analyzed using the kinetic chromogenic Limulus amebocyte lysate assay. Separate linear mixed-effects models were used to evaluate exposure determinants for dust and endotoxin. Results: Total dust and endotoxin exposure were significantly higher in Robusta than in Arabica coffee factories (geometric mean 3.41 mg/m³ and 10 800 EU/m3 versus 2.10 mg/m³ and 1400 EU/m³, respectively). Dry pre-processed coffee and differences in work tasks explained 30% of the total variance for total dust and 71% of the variance for endotoxin exposure. High exposure in Robusta processing is associated with the dry pre-processing method used after harvest. Conclusions: Dust and endotoxin exposure is high, in particular when processing dry preprocessed coffee. Minimization of dust emissions and use of efficient dust exhaust systems are important to prevent the development of respiratory system impairment in workers

Dust Exposure, Fractional Exhaled Nitric Oxide and Respiratory Symptoms among Volcanic Rock Miners in Kilimanjaro, Tanzania

Volcanic rock for use as building material is mined extensively in the North Eastern Region of Tanzania. Dust emitted from the rock may contain harmful elements such as crystalline silica, arsenic (As), cobalt (Co), boron (B) and mercury (Hg) which might contribute to severity and onset of health symptoms. Objective: This study assessed respiratory symptoms and fractional exhaled nitric oxide as a marker for respiratory inflammation in relation to dust exposure among workers in different job sections in volcanic block mining. Materials and Methods: A cross-sectional study assessed a total of 135 workers in which 70 were exposed and 65 none exposed. The mining activities are mainly manual, and include cutting of blocks underground, transporting blocks to the shaping area, shaping blocks, loading blocks and aggregates (Murom) to vehicles and clearing or expanding the site. Respiratory health questionnaires were administered through face–to-face interviews. A total of 28 samples of “total” dust were collected around the breathing zone of the workers using SKC Sidekick pump (model 224–50) with a flow rate of 2.0 l/min. FENO assessed respiratory system inflammation using a portable electrochemistry-based sensor (NIOX MINO). Findings: The overall arithmetic mean concentration of personal total dust exposure among the workers was 4.37 mg/m3 (range 0.15-20.84). The prevalence of acute cough and red eyes were significantly higher among exposed than among non exposed (35% vs 10% and 45% vs 14%, respectively). The ANOVA Boniferroni test showed a significant difference in mean FENO between stone cutters and none exposed (P = 0.005). Conclusions: This study suggests the strong association between working as a stone cutting and shaping with respiratory inflammation. There is a need for respiratory mask type P2 use to protect workers from the exposure. There is also need for the follow up study involving cohorts of all workers happened to be in the mine

Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study

Coffee processing causes organic dust exposure which may lead to development of respiratory symptoms. Previous studies have mainly focused on workers involved in roasting coffee in importing countries. This study was carried out to determine total dust exposure and respiratory health of workers in Tanzanian primary coffee-processing factories. A cross sectional study was conducted among 79 workers in two coffee factories, and among 73 control workers in a beverage factory. Personal samples of total dust (n = 45 from the coffee factories and n = 19 from the control factory) were collected throughout the working shift from the breathing zone of the workers. A questionnaire with modified questions from the American Thoracic Society questionnaire was used to assess chronic respiratory symptoms. Differences between groups were tested by using independent t-tests and Chi square tests. Poisson Regression Model was used to estimate prevalence ratio, adjusting for age, smoking, presence of previous lung diseases and years worked in dusty factories. All participants were male. The coffee workers had a mean age of 40 years and were older than the controls (31 years). Personal total dust exposure in the coffee factories were significantly higher than in the control factory (geometric mean (GM) 1.23 mg/m3, geometric standard deviation (GSD) (0.8) vs. 0.21(2.4) mg/m3). Coffee workers had significantly higher prevalence than controls for cough with sputum (23% vs. 10%; Prevalence ratio (PR); 2.5, 95% CI 1.0-5.9) and chest tightness (27% vs. 13%; PR; 2.4, 95% CI 1.1-5.2). The prevalence of morning cough, cough with and without sputum for 4 days or more in a week was also higher among coffee workers than among controls. However, these differences were not statistically significant. Workers exposed to coffee dust reported more respiratory symptoms than did the controls. This might relate to their exposure to coffee dust. Interventions for reduction of dust levels and provision of respiratory protective equipment are recommended

Rapid Resuscitation with Small Volume Hypertonic Saline Solution for Patients in Traumatic Haemorrhagic Shock

Background: Haemorrhagic shock is a major cause of morbidity and mortality worldwide. Trauma and its complications account for one in ten deaths worldwide and are the leading cause of death in those below 45 years of age in developed countries. Survival of the shocked patient is influenced by the speed and efficiency with which resuscitation is carried out. Rapid infusion of a small volume of 7.5% hypertonic saline (HSS) has been shown to result in immediate restoration of circulating volume and tissue perfusion but results of investigation of its use remain inconclusive. The objective of this study was to determine the clinical outcomes of infusing locally made 7.5% HSS in patients with haemorrhagic shock.Methods: During a six-month period, all adult trauma patients coming to the casualty with haemorrhagic shock were enrolled into the study. A detailed clinical assessment was performed, and respiratory and cardiovascular vital signs were recorded. Five millilitres of venous blood was drawn for determination of Haematocrit, haemoglobin, serum electrolytes and creatinine. A rapid infusion of 250mls of HSS was given intravenously followed three to five minutes later by recording the vital signs again and drawing another 5 mls of blood for a repeat of the laboratory tests. Recovery from shock was followed by standard fluid infusion. Additional or alternative resuscitation and other therapeutic measures were taken as indicated. Recording of the vital signs was continued at four hourly intervals for 24 hours. The data were entered into a computer data base and analysed.Results: Forty five patients were enrolled and resuscitated with 250 mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock immediately after being infused with 7.5% HSS. Of patients with a single injury, 96.6% recovered from shock whereas only 75% of those with multiple injuries recovered. Eighty percent of patients survived beyond 24 hours post resuscitation. While 93.1% of patients with a single injury survived beyond 24 hours, only 56.3% of those who sustained multiple injuries did so.Conclusion: Rapid resuscitation with HSS has demonstrated clinical benefits in initial treatment of traumatic hemorrhagic shock in patients admitted to the emergency room. Further investigation of the effects of HSS resuscitation is warranted

Dust exposure and respiratory health among Tanzanian coffee factory workers

Introduction: Exposure to organic dust may cause detrimental effects to the respiratory system of exposed workers. Organic dust is commonly contaminated with microbes and their derivatives such as bacteria and endotoxin, fungi, moulds and beta glucan. Few studies on exposure and health effects have been performed in primary coffee factories. The studies showed that processes in primary coffee factories cause emission of high dust levels. Work in coffee factories has been associated with respiratory health impairment. Coffee beans are of two main types; Arabica and Robusta. Before coffee is brought to the factory it is processed at the farm. At the farms the harvested Robusta coffee cherries are mostly dried under the sun (called dry pre-processing) while Arabica coffee cherries are depulped using water (called wet pre-process) and then dried as parchment coffee. At the end of harvest season, remaining Arabica coffee cherries are dried without being depulped (dry processed). The processes in primary coffee factories involves the pre-cleaning of coffee beans, the mechanical removal of the mesocarp and endocarp layers to get green coffee beans (GCB), the grading of the GCB, mixing them to produce a homogenous mixture by a process known as bulking and then packing in 60 kg bags. Loading and unloading of unprocessed coffee (parchment or coffee cherries) is done manually. For some processes, the machines are fed manually by production workers. Objective: The aim of this research was to determine dust exposure levels and to assess respiratory health of the production workers in Robusta and Arabica primary coffee factories. Materials and Methods: The research was conducted in Tanzania (in the Kilimanjaro and Kagera regions) in four primary coffee factories (factories; A, B, C and D) in three studies (in 2008 2009, and 2010). In the first study (2008) personal total dust (n=44) was sampled at a rate of 2 L/min from the breathing zone of the worker using side kick Casella pumps connected to closed-faced 25 mm conductive cassettes fitted with cellulose acetate filters. The samples were analysed gravimetrically. In addition, five samples were taken on glass fibre filters as pilot samples for analysis of endotoxin. We also assessed respiratory symptoms using an American Thoracic Society (ATS) standardized questionnaire among the production workers (n= 79) in comparison with a control group from a beverage factory (n=71). In the second and third studies personal total dust (n= 149) was sampled by same methods as in 2008, using closed-faced 37 mm plastic cassettes which were fitted with polycarbonate filters. Dust samples were gravimetrically measured and further analysed for endotoxin. Airway inflammation was assessed using NIOX MINO device in both studies. In the third study, lung function and respiratory symptoms were assessed among production workers (n=138) in four primary coffee factories and two control factories (n=120). A portable spirometer was used for lung function testing. Results: Personal total dust levels ranged from 0.25 to 36 mg/m³; geometric mean GM = 2.50mg/m³. Seventeen per cent of the samples were above the occupational exposure limit. There was a high correlation between total dust and endotoxin (r = 0.62). Endotoxin levels were higher when processing dry pre-processed coffee (mainly Robusta GM=10,800 EU/m³) than when processing wet pre-processed Arabica (GM=1,350 EU/m³). All endotoxin samples exceeded the health-based recommended value of 90 EU/m³. Using a mixed model analysis dry pre-processing was shown to increase the total dust and endotoxin levels by a factor of 2.5 and 7.2, respectively. Chronic respiratory symptoms were higher among coffee workers than controls. Having at least one asthma symptom was higher among the coffee workers compared to controls with odds ratio (OR) of 4.3 (95% CI; 1.9 – 9.9). Robusta coffee workers had higher prevalence of asthma symptoms (38%) than Arabica coffee workers (12%) (OR; 3.5, 95% CI; 1.4 – 9.0). Lung function parameters were not significantly different between coffee workers and controls. Nevertheless, in a linear regression model, controlling for age, height and type of coffee, there was a decrease in FEV1 and FEV1/FVC ratio related to an increase in cumulative total dust and endotoxin. In second study (2009) coffee workers had higher FENO levels than the controls, however, this was not found in the subsequent year 2010. Conclusion: This study revealed that work in coffee factory is associated with high dust and endotoxin exposure which may be associated with impairment of respiratory health. Processing dry pre-processed coffee increases the exposure levels significantly. Reduction of dust exposure is recommended

Rapid Resuscitation with Small Volume Hypertonic Saline Solution for Patients in Traumatic Haemorrhagic Shock.

Background: Haemorrhagic shock is a major cause of morbidity and mortality worldwide. Trauma and its complications account for one in ten deaths worldwide and are the leading cause of death in those below 45 years of age in developed countries. Survival of the shocked patient is influenced by the speed and efficiency with which resuscitation is carried out. Rapid infusion of a small volume of 7.5% hypertonic saline (HSS) has been shown to result in immediate restoration of circulating volume and tissue perfusion but results of investigation of its use remain inconclusive. The objective of this study was to determine the clinical outcomes of infusing locally made 7.5% HSS in patients with haemorrhagic shock. Methods: During a six-month period, all adult trauma patients coming to the casualty with haemorrhagic shock were enrolled into the study. A detailed clinical assessment was performed, and respiratory and cardiovascular vital signs were recorded. Five millilitres of venous blood was drawn for determination of Haematocrit, haemoglobin, serum electrolytes and creatinine. A rapid infusion of 250mls of HSS was given intravenously followed three to five minutes later by recording the vital signs again and drawing another 5 mls of blood for a repeat of the laboratory tests. Recovery from shock was followed by standard fluid infusion. Additional or alternative resuscitation and other therapeutic measures were taken as indicated. Recording of the vital signs was continued at four hourly intervals for 24 hours. The data were entered into a computer data base and analysed. Results: Forty five patients were enrolled and resuscitated with 250 mls 7.5% HSS. Among the studied patients, 88.9% recovered from shock immediately after being infused with 7.5% HSS. Of patients with a single injury, 96.6% recovered from shock whereas only 75% of those with multiple injuries recovered. Eighty percent of patients survived beyond 24 hours post resuscitation. While 93.1% of patients with a single injury survived beyond 24 hours, only 56.3% of those who sustained multiple injuries did so. Conclusion: Rapid resuscitation with HSS has demonstrated clinical benefits in initial treatment of traumatic hemorrhagic shock in patients admitted to the emergency room. Further investigation of the effects of HSS resuscitation is warranted

Dust Exposure and Respiratory Health Among Workers in Primary Coffee Processing Factories in Tanzania and Ethiopia

Introduction: In primary coffee factories the coffee beans are cleaned and sorted. Studies from the 80- and 90-ties indicated respiratory health effects among the workers, but these results may not represent the present status. Our aim was to review recent studies on dust exposure and respiratory health among coffee factory workers in Tanzania and Ethiopia, two major coffee producing countries in Africa. Methods: This study merged data from cross-sectional studies from 2010 to 2019 in 4 and 12 factories in Tanzania and Ethiopia, respectively. Personal samples of “total” dust and endotoxin were taken in the breathing zone. Chronic respiratory symptoms were assessed using the American Thoracic Society (ATS) questionnaire. Lung function was measured by a spirometer in accordance with ATS guidelines. Results: Dust exposure among male production workers was higher in Ethiopia (GM 12 mg/m3; range 1.1–81) than in Tanzania (2.5; 0.24–36). Exposure to endotoxins was high (3,500; 42–75,083) compared to the Dutch OEL of 90 EU/m3. The male workers had higher prevalence of respiratory symptoms than controls. The highest symptom prevalence and odds ratio were found for cough (48.4%; OR = 11.3), while for breathlessness and wheezing the odds ratios were 3.2 and 2.4, respectively. There was a significant difference between the male coffee workers and controls in the adjusted FEV1 (0.26 l/s) and FVC (0.21 l) and in the prevalence of airflow limitation (FEV1/FVC < 0.7) (6.3 vs. 0.9%). Among the male coffee workers, there was a significant association between cumulative dust exposure and the lung function variables FEV1 and FVC, respectively. Conclusions: The results suggest that coffee production workers are at risk of developing chronic respiratory symptoms and reduced lung function, and that the findings are related to high dust levels. Measures to reduce dust exposure should be targeted to factors identified as significant determinants of exposure