3 research outputs found
Cases of occupational asthma assessed at the National Institute for Occupational Health - Occupational Medicine Clinic from 1997-2007
Research report in partial fulfillment for the degree of MMed (Occupational Medicine)Background
Occupational asthma is one of the most commonly reported occupational respiratory diseases
in industrialized countries. Literature suggests that about 15% of all adult-onset asthma is
caused by workplace exposures. It is potentially preventable and the prognosis is good with
early diagnosis and adequate treatment. However, occupational asthma is under-diagnosed
and under-reported. Identification of common causative agents and employment of
preventative measures are necessary for proper management and control.
Objectives
1. To characterize occupational asthma cases assessed at NIOH Occupational Medicine
Clinic from 1st January 1997 to 31st December 2007 in terms of:
• types of industries, occupations and agents
• duration of exposure prior to onset of occupational asthma
• time from onset of symptoms to diagnosis
• nature of exposure e.g. intermittent, daily, etc.
2. To investigate factors influencing latency period in cases of sensitizer-induced asthma
3. To investigate factors influencing lag time to diagnosis in cases of sensitizer-induced
asthma
Methods
A record review of a series of cases of occupational asthma was done. All cases of occupational
asthma diagnosed from 1st January 1997 to 31st December 2007 by NIOH doctors were
identified from the Clinic’s electronic database. All the records of patients who had a final
diagnosis of occupational asthma were assessed using a standard data capture sheet. Doubtful
cases were presented at the NIOH Occupational Medicine clinical discussion meeting for a
consensus decision as to whether they qualified to be included in the study or not. Ethical
approval was granted by the University of the Witwatersrand Human Research Ethics
Committee (Medical).
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Results
One hundred and forty two cases of occupational asthma were identified. Of these, 131 were
sensitizer-induced and 11 were irritant-induced asthma. Low molecular-weight agents were in
the majority with isocyanates, welding fumes, vanadium being the most common. Within the
high molecular weight category, wheat was the most common. The majority of cases emanated
from the Engineering, Chemical, Smelter and Food industries. Latency period from first
exposure to development of symptoms was surprisingly long: a mean of 9.8 years and a
median of seven years. The time from onset of symptoms to diagnosis was also long (mean of
4.9 years and median of three years). Younger cases had a shorter latency period and a longer
delay in diagnosis. Agents and jobs for irritant-induced asthma cases varied widely and some
came from unexpected industries.
Discussion
This review of asthma referrals to the NIOH Occupational Medicine Clinic has highlighted
causative industries and identified exposure agents implicated in cases of occupational asthma.
The very wide range of industries, occupations and agents associated with these cases is
suggestive of a wide-spread occupational asthma problem in the region referring cases to the
Clinic. The long latency period and delay in diagnosis are of concern since prompt diagnosis
and removal from exposure is associated with a better prognosis. Irritant-induced asthma is
infrequently reported in the local literature, but the range of agents and jobs is possibly
indicative of under-diagnosis.
Conclusion
Occupational asthma is potentially preventable. New cases still arise particularly in poorly
controlled workplaces which are capable of employing basic measures to control exposures.
Medical surveillance, prompt diagnosis, proper medical management and application of
workplace preventative measures are essential in decreasing the burden of disease and impairmen
Review of Occupational Health and Safety Organization in Expanding Economies: The Case of Southern Africa
Background: Globally, access to occupational health and safety (OHS) by workers has remained at very low levels. The organization and implementation of OHS in South Africa, Zimbabwe, Zambia, and Botswana has remained at suboptimal levels. Inadequacy of human resource capital, training, and education in the field of OHS has had a major negative impact on the improvement of worker access to such services in expanding economies. South Africa, Zimbabwe, Zambia, and Botswana have expanding economies with active mining and agricultural activities that pose health and safety risks to the working population. Methods: A literature review and country systems inquiry on the organization of OHS services in the 4 countries was carried out. Because of the infancy and underdevelopment of OHS in southern Africa, literature on the status of this topic is limited. Results: In the 4 countries under review, OHS services are a function shared either wholly or partially by 3 ministries, namely Health, Labor, and Mining. Other ministries, such as Environment and Agriculture, carry small fragments of OHS function. The 4 countries are at different stages of OHS legislative frameworks that guide the practice of health and safety in the workplace. Inadequacies in human resource capital and expertise in occupational health and safety are noted major constraints in the implementation and compliance to health and safety initiatives in the work place. South Africa has a more mature system than Zimbabwe, Zambia, and Botswana. Lack of specialized training in occupational health services, such as occupational medicine specialization for physicians, has been a major drawback in Zimbabwe, Zambia, and Botswana. Discussion: The full adoption and success of OHS systems in Southern Africa remains constrained. Training and education in OHS, especially in occupational medicine, will enhance the development and maturation of occupational health in southern Africa. Capacitating primary health services with basic occupational health knowledge would be invaluable in bridging the current skills deficit. Introducing short courses and foundational tracks in occupational medicine for general medical practitioners would be invaluable
Review of Occupational Health and Safety Organization in Expanding Economies: The Case of Southern Africa
oai:repository.up.ac.za:2263/52509BACKGROUND Globally, access to occupational health and safety (OHS) by workers has remained at
very low levels. The organization and implementation of OHS in South Africa, Zimbabwe, Zambia, and
Botswana has remained at suboptimal levels. Inadequacy of human resource capital, training, and education
in the field of OHS has had a major negative impact on the improvement of worker access to such services in
expanding economies. South Africa, Zimbabwe, Zambia, and Botswana have expanding economies with
active mining and agricultural activities that pose health and safety risks to the working population.
METHODS A literature review and country systems inquiry on the organization of OHS services in the
4 countries was carried out. Because of the infancy and underdevelopment of OHS in southern Africa,
literature on the status of this topic is limited.
RESULTS In the 4 countries under review, OHS services are a function shared either wholly or partially
by 3 ministries, namely Health, Labor, and Mining. Other ministries, such as Environment and Agriculture,
carry small fragments of OHS function. The 4 countries are at different stages of OHS legislative
frameworks that guide the practice of health and safety in the workplace. Inadequacies in human
resource capital and expertise in occupational health and safety are noted major constraints in the
implementation and compliance to health and safety initiatives in the work place. South Africa has a
more mature system than Zimbabwe, Zambia, and Botswana. Lack of specialized training in occupational
health services, such as occupational medicine specialization for physicians, has been a major drawback
in Zimbabwe, Zambia, and Botswana.
DISCUSSION The full adoption and success of OHS systems in Southern Africa remains constrained.
Training and education in OHS, especially in occupational medicine, will enhance the development and maturation of occupational health in southern Africa. Capacitating primary health services with basic occupational
health knowledgewould be invaluable in bridging the current skills deficit. Introducing short courses
and foundational tracks in occupational medicine for general medical practitioners would be invaluable.http://www.journals.elsevier.com/annals-of-global-healtham2016School of Health Systems and Public Health (SHSPH