52 research outputs found
Framework for assessing occupational health risks of municipal solid waste handlers for use by local government structures
No full textThesis (PhD)--University of Pretoria, 2017.Past studies have reported various occupational risks to municipal solid waste handlers (MSWHs). However, no generic framework has been developed for assessing the risks. Therefore, this thesis’ aim sought to develop a framework that local government structures can use for such purposes. To accomplish this task, the following objectives were formulated. The first objective was to review available literature regarding human health risks associated with municipal solid waste management operations. The PubMed literature search was used to identify relevant articles, published in the years 1995-2014. Also, references of potential articles were assessed to identify additional papers that conformed to the criteria for inclusion. 379 studies were found but only 72 met the concerned criteria. Methodological shortcomings such as usage of cross-sectional designs, small sample sizes, not enrolling reference groups, enrolling smaller reference groups, and not controlling possible confounders, were the major limitations of the studies. The proposed framework encourages local government structures to engage in or utilise methodologically sound studies that can yield valid and reliable findings. The second thesis objective determined the workplace hazards of MSWHs. Exposure assessments were done on various workplace hazards. Findings show that MSWHs are occupationally exposed to bioaerosols, chemicals, infectious material, physical and mechanical hazards. In light of the higher summer exposures of MSWHs to ultra-violet radiation and the reported health complaints, the study recommended: i) waste collection to be done at night or early morning and ii) regular breaks, rest and rehydration of MSWHs with oral fluids. A publication to disseminate these findings was made in an accredited open access journal. The findings partly constitute phase 1’ output 1 in the framework. The third thesis’ objective assessed the risky job actions of MSWHs. Postural measurements were performed using the Rapid Upper Limbs Assessment method. The findings indicate that MSWHs use unsafe work postures when performing the bin lifting, carrying and emptying tasks. The study recommended: i) mechanisation of refuse bin collection, where feasible, ii) training MSWHs on safe working postures and iii) supervision of waste collection tasks. Also, under phase 1’s output 1, the framework stresses the need to examine ergonomic risks of waste collection services. The findings on objective 3 were disseminated in form of a publication. Objectives 4-7 sought to develop, validate, refine and compile a framework for assessing occupational health risks of MSWHs. An SWOT analysis of available human and environmental risk assessment frameworks was done and the findings were used as a base for the draft framework. The developed draft framework validated and revised through iteration workshops in small, medium and large local government structures. This thesis proves that Mr Ncube is conversant with the nature and purpose of this relevant investigation. From his thesis Mr Ncube has published 3 articles in peer reviewed journals.School of Health Systems and Public Health (SHSPH)PhDUnrestricte
The distribution of fluoride in South African groundwater and the impact thereof on dental health
No full textDissertation (MSc (Water Utilization))--University of Pretoria, 2006.The most appropriate and widely used source of drinking water for the rural populations of South Africa is groundwater. Pilot studies and surveys conducted by the Department of Water Affairs and Forestry (DW AF) indicated that there are a number of boreholes across the country that contain apart from fluoride, levels of nitrate, some heavy metals, total dissolved solids, sulphates and faecal coliform (in isolated regions) that could pose a health risk if the water is used for drinking purposes. Very few boreholes have been tested for heavy metals or toxic organic substances. However considering the levels of fluoride, in general, groundwater is of acceptable quality except for some provinces in which elevated levels of natural groundwater fluoride occurs. Very high levels of fluoride, >4 mg/l occur in some groundwater sources in all nine provinces of South Africa, especially in the Limpopo, North-West, Eastern Cape, Northern Cape, Western Cape and KwaZulu Natal provinces. A superficial inspection reveals that most of the local people in those areas suffer from dental fluorosis at varying degrees. The main aim of this study is to determine the distribution of the fluoride ion concentration levels in South African groundwater and the impacts thereof on dental health. The available data is used to assess the distribution of the various fluoride ion concentration levels in some national groundwater sources. Areas of particularly high or low fluoride levels are identified. Results from an epidemiological survey carried out by the National Department of Health (NDOH) are used concurrently with the fluoride data to determine the percentage morbidity of dental fluorosis in each area The results are compared in order to determine if any relationship exists between the occurrence of fluoride in drinking water and the incidences of dental fluorosis. Vegter's lithostratigraphy and the simplified geology of South Africa are used to interpret the results and assess the role of surface geology in the release and distribution of fluorides in groundwater. The role of other factors such as climate and the interactions of the fluoride ion and other water quality parameters in aqueous media are also assessed.Chemical Engineeringunrestricte
Framework for selection and use of appropriate rural sanitation technologies in low-income settingsINGS
No full textThesis (PhD (Public Health))--University of Pretoria, 2022.Access to safely managed sanitation remains low in rural communities of low- and middle-income countries. Inappropriate technology options, lack of community participation and not fully considering social factors in the local context result in failure of sanitation interventions. Demand-driven approaches considering alternatives in the local context are perceived to improve access to sanitation services. A comprehensive procedure is needed to aid the selection of appropriate options. The impact of sanitation interventions on health outcomes were investigated by a systematic review of randomised controlled trials (RCTs) from 2000 to 2019 based on the PRISMA checklist. 15 of the 746 records from six electronic databases were included. Results indicated that RCTs that showed significant positive impact were: 1/10 for prevalence of disease, 2/8 for child growth and 3/9 for infestation of parasites. Findings were suggestive and inconclusive prompting the need for further trials. The strengths and limitations of available frameworks (2000 - 2019) to select appropriate technologies (ASTs) for rural communities in low- and middle-income settings (LMISs) were critically reviewed. Findings from 12 of the 953 included records that were assessed on 22 criteria indicated that frameworks did not fully address criteria on sanitation demand and behaviour, framework limitations, and flexibility, among others. These shortcomings are used to inform future framework development. A mixed method research design was used to understand how households in a rural district of Zimbabwe adapted their sanitation needs to the Blair ventilated improved pit (BVIP) latrine. A questionnaire survey (790 households) and six focus group discussions (FGDs) were used in a rural district of Zimbabwe to understand how households which could not afford a standard household Blair ventilated improved pit (BVIP) latrine design met their sanitation needs. Households constructed incomplete or poor quality BVIP latrines, considered alternatives, shared latrines or practised open defaecation. Alternative options are needed with government support. Drivers and barriers to sustained use of the BVIP latrine, and how rural households adapt it to climate change were studied among 238 households with BVIP latrines in a rural district of Zimbabwe. Drivers for sustained latrine use were technological, social and public health factors. Barriers included latrine design (e.g., distance from the home or poorly/incomplete construction) and social (e.g., presence of extended family, bad smell and security) factors. Adaptation of the BVIP latrine to effects of climate change were odour and erosion control, adding wood ash, alternative options, and constructing raised and conventional designs. Alternative options are needed for equity and universal access. An integrated multi-criteria decision analysis (MCDA) framework was developed based on the nine steps of the simple multi-attribute rating technique (SMART). Data from literature reviews and household surveys were used. Stakeholders participated in evaluating and weighting criteria, scoring alternatives and validating the procedure. A ranking of alternatives based on total utility values indicated that the urine diverting dry latrine had the highest value (72.54) followed by the BVIP latrine (67.10). The framework was verified to follow a laid down methodology, considered robust based on criteria changes and reasonable based on expert opinion.University of Pretoria Postgraduate BursarySchool of Health Systems and Public Health (SHSPH)PhD (Public Health)Unrestricte
Framework for mitigating the risk of waterborne diarrheal diseases in peri-urban areas of Lusaka district Zambia
No full textThesis (PhD (Public Health))--University of Pretoria, 2023.Waterborne diarrheal diseases are a public health problem in developing countries including Zambia. Despite implementing various interventions, the diseases have persisted in Zambia. This study aimed to develop a framework for identifying appropriate interventions for mitigating the risk of waterborne diarrheal diseases in peri-urban areas of Lusaka district Zambia.
The study employed a sequential mixed methods design. The first step of the study involved a systematic review to determine interventions for mitigating risk of waterborne diarrheal diseases. This was followed by a longitudinal study to investigate trends of diarrheal diseases over a 10 year period (2010 to 2019) using secondary data from the Health Management Information System in 15 health care facilities of Lusaka district. A scoping review was then conducted to identify frameworks for mitigating risk of waterborne diarrheal diseases. These frameworks were analyzed using Strength, Weakness, Opportunity, and Threat analysis to identify gaps and used as a basis for drafting the framework. Finally, the draft framework was validated by health workers and other WASH experts for correctness of information and acceptability, after which the refined framework was developed.
Under the systematic review, the study found 56 studies that met the inclusion criteria reporting several interventions including: vaccines for rotavirus disease (Monovalent, Pentavalent and Lanzhou lamb vaccine); enhanced water filtration for preventing Cryptosporidiosis, Vi polysaccharide for typhoid; cholera 2 dose vaccines, water supply, water treatment and safe storage, household disinfection and hygiene promotion for cholera outbreaks. The longitudinal study revealed a decrease in trends of diarrheal diseases with non-bloody and bloody diarrhea being the main cause of morbidity and mortality, respectively. The highest number of cases were recorded in 2016 and lowest 2019 with more cases in children under five years. Notably, most cases were recorded during the rainy season. First level hospitals recorded the highest number of cases and deaths compared to other health facilities. The scoping review found five frameworks for mitigating risk of diarrheal diseases including hygiene improvement framework, community led total sanitation, global action plan for pneumonia and diarrhea, participatory hygiene and sanitation transformation, and sanitation and family education. None of these frameworks was specific for waterborne diarrheal diseases. These frameworks were used to propose a draft framework. Validation of the draft framework helped to improve the tool as the health workers and experts suggested several issues included in the final framework. The final framework consisted of the following elements: problem identification; identification and quantifying of risks; identification of evidence-based intervention(s); assessment of intervention(s) in target community; selection and adoption of intervention(s); implementing selected intervention(s); monitoring and evaluation; sustainability and system support factors.
The developed framework is envisaged to help mitigate risk of waterborne diarrheal diseases in peri-urban areas of Lusaka Zambia if implemented and ultimately improving public health in Zambia and related settings.National Research FoundationSchool of Health Systems and Public Health (SHSPH)PhD (Public Health)Unrestricte
Selection and prioritization of organic contaminants for monitoring in the drinking water value chain
No full textThesis (PhD)--University of Pretoria, 2010.The occurrence of organic contaminants in the drinking water value chain (from source to tap) is a growing concern for the Drinking Water industry and its consumers given the high risk these contaminants can cause to the general public. These adverse health effects include such as endocrine disruption, toxicity teratogenicity, mutagenicity and carcinogenicity. Some of these organic contaminants are included in national and international drinking water quality guidelines or standards. However, although there are similarities in the list of organic contaminants used by each organization or country, the organic contaminants are never the same given the local conditions. There are also noticeable differences in the concentration limits set as targets or criteria for organic contaminants for public health protection via the use of drinking water. A further question requiring the response from drinking water regulators was whether the standards listed in the international literature would be applicable in other countries like South Africa. Complicating this decision is the fact that the South African National Drinking Water Standard (SANS 241) does not adequately address this component of drinking water quality management. The current standard only provides for dissolved organic carbon (DOC), total trihalomethanes (TTHMs) and phenols. However, the standard contains a statement which specifies that if there is a known organic contaminant, that may pose a health threat, it should be included in the monitoring programme and evaluated against World Health Organization (WHO) guidelines. To safeguard Drinking Water industry customers, it was deemed necessary to investigate this matter and establish a tool to assist with the identification of a list of organic contaminants to be monitored in the drinking water value chain. To achieve this a specific procedure/protocol needed to be developed, hence the aim of this study which was to develop a generic protocol for the selection and prioritization of organic contaminants for monitoring in the drinking water value chain (from source to tap). To achieve this, a critical evaluation and synthesis of the available literature on the approaches for the selection and prioritization of organic variables of priority to the drinking water industry was undertaken as a first step. From the literature review it was evident that there are currently many selection and prioritization approaches which are characterized mainly by the purpose for which the exercise has been conducted for. Approaches that prioritize chemicals according to their importance as environmental contaminants have been developed by government agencies and private industries such as the Health Canada’s Canadian Environmental Protection Agency (CEPA), the United Kingdom’s Institute for Environmental Health (IEH), the European Community’s Oslo and Paris (OSPAR) convention exercise for the protection of the Northeast Atlantic marine environment and the European Union (EU)’s combined monitoring based and modelling based priority setting scheme (EU-COMMPs). A few approaches such as ones published by the United States Environmental Protection Agency (USEPA), address the needs of the Drinking Water industry and there is no generic approach to the selection, prioritization and monitoring of organic contaminants in the drinking water value chain. From the review of selection and prioritization approaches, a generic model was developed. The model consists of three main steps, the compilation of a “pool of organic contaminants, the selection of relevant parameters and criteria to screen organic contaminants and finally the application of criteria to select priority organic contaminants. It was however realized that these steps were not enough if the protocol to be develop will serve its purpose. Selection and prioritization approaches are typically intended to be fairly simple and quick methods for determining the health and environmental hazards posed by the use and release of chemical substances into different environmental systems. This was taken into account during the development of the current protocol. Understanding that a protocol is a predefined written procedural method in the design and implementation of tasks and that these protocols are written whenever it is desirable to standardize a method or procedure to ensure successful reproducibility in a similar set up, a generic protocol was developed based on the model. The protocol developed in this study, operates as a multidisciplinary contaminants management and proactive protocol, thus exchanges toxicological, water quality, agricultural, chemical and public health information. The protocol uses previous or readily available information as a point of departure. It seeks to address the challenge facing the water industry in managing the current and emerging organic contaminants that are relevant to public health protection via the use of drinking water. Once the protocol was developed, it was validated in a prototype drinking water value chain. The exercise comprised of testing each step of the protocol from the selection of the “pool of organic contaminants (Step I) to recommending the final priority list of organic contaminants (Step VII). The implementation was successfully conducted in the Rand Water drinking water value chain. Emphasis of expert judgment was made as each step was validated and the opinion of key stakeholders used to shape the process. During Step III of the protocol, an intensive literature review was conducted to determine organic contaminants that have been identified in ground and surface water systems across the world. As a result of this review, major groups of organic contaminants that have been found to occur in source water resources across the world were identified. The identified groups of organic contaminants include, pesticides, polynuclear aromatic hydrocarbons, per and polyfluoroorganic compounds, polycyclic aromatic hydrocarbons, alkanes and alkenes, C10-C13 Chloroalkanes, pharmaceuticals and personal care products [PPCPs], surfactants, benzotriazoles, cyanotoxins and Carbon-based engineered nanoparticles. The risk profile of the identified organic contaminants was established using the persistence, bio-accumulation and toxicity criteria and the development of water quality monographs as an information dissemination tool. A conceptual framework for the implementation of the protocol by water utilities and relevant institutions has been developed from the experiences learnt during the validation exercise and a priority list of organic contaminants for the monitoring in the drinking water value chain to be used by Rand Water and other water utilities was identified. Some of the organic contaminants on this are currently being analyzed for in The Rand Water’s routine organic monitoring programme. During the validation exercise, the following were noted, During the identification of the “pool of organic contaminants” from the consulted information sources such as the WHO guidelines for drinking water quality, Health Canada drinking water quality guidelines, the USEPA drinking water quality standards, the New Zealand drinking water quality standards, USEPA IRIS database, the PAN-UK list of registered pesticides for South Africa, the IARC list for recognized carcinogens and the Department of Agriculture pesticides manuals duplications were observed. The time allocated could not allow for the development of water quality monographs for all organic contaminants of concern but for a few selected contaminants whose information was inadequate to allow for decision-making. The determination of concentration levels of organic contaminants in fish, sediment and water samples could have been limited by the failure of current analytical instruments to go down to lower levels at which they occur in the drinking water value chain. Only two events could be planned, during the wet season (high flow) and dry season (low flow) based on time and budget constraints. Although various experts were consulted and invited to attend workshops in order to validate the process, the attendance could not be extended to all nine provinces given the time and budget constraints. Based on the above, recommendations were made for the dissemination and use of the products emanating from this study. For example, it is recommended that the current protocol be made available to water utilities and the process of revising the current priority list be repeated every 5 years. Further research should be conducted to obtain full coverage of organic contaminants impacting on source water quality in all ground water and surface water systems used as sources for drinking water production. Another major recommendation is the investigation of potential analytical methods that current chromatographic methods with high resolution mass spectrometry to ensure that organic contaminants can be detected at the ng/l to pg/l using a single enrichment method in order to make sure that those organic contaminants that occur at very low concentration in environmental samples can be detected. For example, the realisation that compounds such as synthetic organic polymer residues, emerging disinfectant by-products, detergent metabolites, chlorinated benzenes, alkyl phenol, polyethoxylates, their metabolites and cyanotoxins are continuously discharged into the environment via wastewater and industrial effluent discharges which increases their concentration in aquatic environment and concomitantly their potential to exert adverse health effects in water used as source for the production of drinking water necessitates that each of these groups be added to the current monitoring programme. The current water quality monographs can be used for the benefit of the Drinking Water industry. It is also recommended that a training manual on the production and use of water quality monographs is produced to facilitate their dissemination. CD-ROMs on the water quality monographs can be produced and distributed with the manual.School of Health Systems and Public Health (SHSPH)PhDUnrestricte
A systematic critical review of epidemiological studies on public health concerns of municipal solid waste handling
No full textAIMS : The ultimate aim of this review was to summarise the epidemiological evidence on the association between municipal solid waste management operations and health risks to populations residing near landfills and incinerators, waste workers and recyclers. To accomplish this, the sub-aims of this review article were to (1) examine the health risks posed by municipal solid waste management activities, (2) determine the strengths and gaps of available literature on health risks from municipal waste management operations and (3) suggest possible research needs for future studies.METHODS : The article reviewed epidemiological literature on public health concerns of municipal solid waste handling published in the period 1995-2014. The PubMed and MEDLINE computerised literature searches were employed to identify the relevant papers using the keywords solid waste, waste management, health risks, recycling, landfills and incinerators. Additionally, all references of potential papers were examined to determine more articles that met the inclusion criteria. RESULTS : A total of 379 papers were identified, but after intensive screening only 72 met the inclusion criteria and were reviewed. Of these studies, 33 were on adverse health effects in communities living near waste dumpsites or incinerators, 24 on municipal solid waste workers and 15 on informal waste recyclers. Reviewed studies were unable to demonstrate a causal or non-causal relationship due to various limitations. CONCLUSION : In light of the above findings, our review concludes that overall epidemiological evidence in reviewed articles is inadequate mainly due to methodological limitations and future research needs to develop tools capable of demonstrating causal or non-causal relationships between specific waste management operations and adverse health endpoints.http://pph.sagepub.comhb2017School of Health Systems and Public Health (SHSPH
Postural Analysis of a Developing Country’s Municipal Solid Waste Handlers and a Reference Group of Hospital General Hands using the RULA Method
No full textBACKGROUND: Municipal solid waste handlers perform various work activities which may contribute to the onset of work-related musculoskeletal disorders (WRMDs). This study conducted a postural analysis of these workers and a reference group of hospital general hands in order to identify unsafe working postures requiring correction. METHODS: The Rapid Upper Limb Assessment (RULA) methodology was used for postural analysis to 30 municipal solid waste handlers (MSWHs) and a reference group of 30 hospital general hands (HGHs) involved in similar work activities. Field observations and photography were used to collect data. Collected data was analysed using STATA version 13.RESULTS: The Mann-Whitney test was used to compare the two groups. Results showed significant differences (p < 0.05) for lifting, carrying and emptying activities. For both groups, the mean postural scores for pushing, pulling and standing activities were mainly in the low risk category and not statistically significant (p > 0.05).CONCLUSION: Results of the present study show unsafe RULA postural scores to MSWHs with regard to lifting, carrying and emptying of refuse bins. Such scores are suggestive of an elevated risk to developing WRMDs in these workers compared to the reference group.</jats:p
Effect of sanitation interventions on health outcomes : a systematic review of cluster-randomized controlled trials in rural communities of low- and middle-income countries
No full textTable S1: Assessment of risk of bias for 15 RCTs used to determine
the impact of sanitation on health outcomes (Adapted from The Cochrane Collaboration’s tool for
assessing risk of bias).A systematic review of published literature (2000–2019) evaluating the impact of sanitation
interventions on the prevalence of disease, parasite infestation, and/or child growth using randomized
controlled trials (RCTs) was done according to the PRISMA checklist. Earlier reviews indicated
mixed evidence citing relatively poor quality evidence from mixed designs. Public health policy and
practice appear to rely on evidence from RCTs. Records were searched in six electronic databases.
The methodological quality of RCTs was assessed using the Cochrane collaboration risk of bias tool.
Fifteen records (2.0%) were included for review. Impact trials were done in rural communities of
African and Asian countries. The significant effect of sanitation-focus interventions was found in
one trial for the prevalence of childhood diarrhea (14.3%), three trials for parasite infestation (37.5%),
and two trials (25.0%) for child growth. Results indicate mixed quality evidence from RCT designs.
Evidence is limited and suggestive of the impact of sanitation on parasite infestation and child
growth. Further rigorous sanitation intervention trials under varying settings are needed to show
what really works and under what settings. Future work may explore sanitation behavior change
strategies and latrine options to address the challenges of poor latrine use under high sanitation
coverage.https://www.mdpi.com/journal/ijerpham2022School of Health Systems and Public Health (SHSPH
Adapting Sanitation Needs to a Latrine Design (and Its Upgradable Models): A Mixed Method Study under Lower Middle-Income Rural Settings
No full textRural households have latrine preferences and unique sanitation needs. An assessment of how rural households adapt their sanitation needs to a nationally encouraged latrine design was done. A cross-sectional survey was conducted among 790 households in a rural district of Zimbabwe from November 2020 to May 2021. Data were analysed using logistic regression. Qualitative data were collected using focus groups and analysed using thematic analysis. Analyses were done in STATA 16 and considered significant at p < 0.05. There was low adoption of the Blair ventilated improved pit latrine and its upgradable models. Significant predictor variables of BVIP latrine adoption were mainly contextual and psychosocial at the individual and household levels. They included source and level of household income, residence period, nature of homestead, number of cattle owned, knowledge of sanitation options and perceived high latrine cost. The latrine design was considered not a pro-poor option as it was unaffordable by many rural households resulting in its non-completion, poor-quality designs, alternative options, sharing and open defaecation. Poverty appears the main barrier for latrine ownership. However, a window of opportunity to improve access to sanitation in rural Zimbabwe exists by considering alternative sanitation options and financial investment mechanisms
Association between exposure to drinking water disinfection byproducts and adverse pregnancy outcomes in South Africa
No full textCurrently, there is contradictory evidence for the risk of adverse pregnancy outcomes associated with maternal exposure to disinfection byproducts (DBPs). We examine the association between maternal exposure to trihalomethanes (THMs) in drinking water and adverse pregnancy outcomes, including premature birth, low birth weight (LBW) and small for gestational age (SGA). In total, 1,167 women older than 18 years were enrolled at public antenatal venues in two geographical districts. For each district, we measured the levels of residential drinking water DBPs (measured in THMs) through regulatory data and routine water sampling. We estimated the individual uptake of water of each woman by combining individual water use and uptake factors. Increased daily internal dose of total THMs during the third trimester of pregnancy significantly increased the risk of delivering premature infants (AOR 3.13, 95% CI 1.36–7.17). The risk of premature birth was also positiviely associated with exposure to total THMs during the whole pregnancy (AOR 2.89, 95% CI 1.25–6.68). The risk of delivering an SGA and LBW infant was not associated with maternal exposure to THMs. Our findings suggest that exposure to THMs is associated with certain negative pregnancy outcomes. The levels of THMs in water should be routinely monitored
- …
