Project description:Often with minimal formal training and protections, informal welders face significant occupational health and safety (OSH) risks. This cross-sectional study of 219 adult informal welders at 70 informal welding sites in Mwanza City, Tanzania aimed to: 1) capture knowledge and awareness of occupational risks and safety precautions, training, and self-reported work-related injuries and illness and 2) observe worker use of personal protective equipment and site safety. We hypothesized that knowledge, awareness, and site inspections would improve use of PPE and that improved safety and site inspections would reduce self-reported injuries and illness. A generalized linear model (GLM) was used to model all relationships. Robust standard error estimation was used to avoid overestimation of parameters. Having a post-secondary education (aβ = 1.01, 95% CI: 0.962, 1.061; p = 0. 0679), having training in OSH (aβ = 0.927, 95% CI: 0.872, 0.984, p = 0.014), increased knowledge of occupational risks (aβ = 1.305, 95% CI: 1.143, 1.491; p<0.001), and knowledge of safety measures (aβ = 1.112, 95% CI: 0.881, 1.404; p = 0.372) increased PPE use by 1%, 7.3%, 30.5%, and 11.2% respectively. Workers who used PPE were less likely to experience fire explosions (AOR = 0.149, 95% CI: 0.029, 0.751; p = 0.02), radiation exposure (AOR = 0.097, 95% CI: 0.016, 0.579, p = 0.01) or electric shocks (AOR = 0.012; 95% CI: 0.001, 0.11, p<0.001). Having increased knowledge of safety practices also decreased the odds of fire explosions (AOR = 0.075, 95% CI: 0.018, 0.314; p<0.001). Those with higher knowledge of occupational risk (aβ = 1.57, 95% CI: 1.404, 1.756; p<0.001) and safety measures (aβ = 1.628, 95% CI: 1.34, 1.978; p<0.001) were more likely to have more positive attitudes towards safety practices. Our findings suggest that comprehensive targeted interventions including increased knowledge of occupational risks, safety practices, and occupational health law through training, along with enforcement and inspection by government officials, would benefit the environmental and occupational health for informal welders.

Project description:BackgroundRoutine adolescent health screening aiming at the detection of unnoticed medical problems may increase awareness among policy makers and contribute to improved health in this population. Research is needed to inform the World Health Organization (WHO) and national health programs to provide evidence-based guidance on whether public health systems should offer comprehensive adolescent health screening, what should be included in different contexts, and how it should be delivered. We conducted formative research to define the content and delivery strategies for health check-ups to be performed in young (10-14 years) and older (15-19 years) adolescents, and to assess whether such services are likely to be acceptable and feasible in Tanzania.MethodsAs part of a collaborative research program coordinated by WHO in Chitungwiza, Zimbabwe; Mwanza City, Tanzania; and Cape Coast, Ghana a series of key informant interviews were conducted from April to July 2020, using a semi-structured guide with purposively selected stakeholders from government departments, non-governmental and community-based organisations, schools and health facilities. Data transcripts were coded using NVivo 12 software and thematic analysis was performed.ResultsWe report results from 31 key informant interviews to address four main domains: proposed health conditions for routine health check-ups, health interventions to be combined with such check-ups, preferable venues, and the mode for delivering such screening activities. Stakeholders were supportive of introducing routine health check-ups among adolescents. They recommended focusing on non-communicable diseases, physical disabilities, common mental health problems, reproductive health problems, specific communicable diseases, and hygiene-related problems. They also recommended combining counselling and family planning information with these check-ups. Three venues were proposed: schools, community settings (to reach out-of-school adolescents), and youth-friendly health facilities (for conditions requiring a high level of confidentiality).ConclusionsStakeholders were supportive of the proposed routine health check-ups for adolescents, recommending specific health conditions to be screened for in both community and school settings. Based on the above, we plan to conduct implementation research to determine the number of new treatable conditions detected, and the costs of offering such services. In the longer term, evaluation of their health impact and cost-effectiveness will be required to guide policy.

Project description:BackgroundWith increasing demand for red meat in Tanzania comes heightened potential for zoonotic infections in animals and humans that disproportionately affect poor communities. A range of frontline government employees work to protect public health, providing services for people engaged in animal-based livelihoods (livestock owners and butchers), and enforcing meat safety and food premises standards. In contrast to literature which emphasises the inadequacy of extension support and food safety policy implementation in low- and middle-income countries, this paper foregrounds the 'street-level diplomacy' deployed by frontline actors operating in challenging contexts.MethodsThis research is based on semi-structured interviews with 61 government employees, including livestock extension officers/meat inspectors and health officers, across 10 randomly-selected rural and urban wards.ResultsFrontline actors combined formal and informal strategies including the leveraging of formal policy texts and relationships with other state employees, remaining flexible and recognising that poverty constrained people's ability to comply with health regulations. They emphasised the need to work with livestock keepers and butchers to build their knowledge to self-regulate and to work collaboratively to ensure meat safety. Remaining adaptive and being hesitant to act punitively unless absolutely necessary cultivated trust and positive relations, making those engaged in animal-based livelihoods more open to learning from and cooperating with extension officers and inspectors. This may result in higher levels of meat safety than might be the case if frontline actors stringently enforced regulations.ConclusionThe current tendency to view frontline actors' partial enforcement of meat safety regulations as a failure obscures the creative and proactive ways in which they seek to ensure meat safety in a context of limited resources. Their application of 'street-level diplomacy' enables them to be sensitive to local socio-economic realities, to respect local social norms and expectations and to build support for health safety interventions when necessary. More explicitly acknowledging the role of trust and positive state-society relations and the diplomatic skills deployed by frontline actors as a formal part of their inspection duties offers new perspectives and enhanced understandings on the complicated nature of their work and what might be done to support them.

Project description:Background:Machines, processes, and tasks in the iron and steel factories may produce noise levels that are harmful to hearing if not properly controlled. Studies documenting noise exposure levels and related determinants in sub-Saharan Africa, including Tanzania are lacking. The aim of this study was to document noise exposure and to identify determinants of noise exposure with a view to establishing an effective hearing conservation programme. Methods:A walk-through survey was conducted to describe the working environment in terms of noise sources in four metal factories (A-D) in Tanzania. Noise measurements were conducted by both personal, full-shift noise measurements (8 h) using dosimeters and area measurements (10-s measurements) using a sound level meter. A total of 163 participants had repeated personal noise measurements (Factory A: 46 participants, B: 43, C: 34, and D: 40). Workers were randomly selected and categorized into 13 exposure groups according to their job. Linear mixed effects models were used to identify significant determinants of noise exposure in the furnace section and the rolling mill section. Results:The average personal noise exposure in the four factories was 92.0 dB(A) (range of job group means; 85.4-96.2 dB(A)) (n = 326). Personal exposure was significantly higher in the rolling mill section (93.0 dB(A)) than in the furnace section (89.6 dB(A)). Among the job groups, the cutters located in the rolling mill section had the highest noise exposure (96.2 dB(A)). In the furnace section, furnace installation (below the ground floor), manual handling of raw materials/billets/crowbars, and billet weighing/transfer were significant determinants explaining 40% of the total variance in personal noise exposure. In the rolling mill section, the size of the cutting machine, steel billet weight and feeding re-heating furnace explained 46% of the total variance in personal noise exposure. The mean noise level of the area measurements was 90.5 dB(A) (n = 376). Conclusion:Workers in the four iron and steel factories in Tanzania were exposed to average noise of 92.0 dB(A), without using hearing protection, implying a high risk of developing hearing loss. Task and factory level determinants were identified in the furnace and the rolling mill sections of the plant, which can inform noise control in factories with similar characteristics.

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Perceived occupational health risks, noise and dust exposure levels among street sweepers in Mwanza City in Northern Tanzania

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