A cohort study of graphite workers in Sri Lanka

A cohort of workers from a graphite mine in Sri Lanka was studiedin 1987, 1990 and 1993. Radiographic lesions were found in 8.5%,8.9% and 4.1% of the workers in these respective rounds. Whenworkers with radiographic lesions were clinically examined,a total of 18 cases of graphite pneumoconiosis and seven casesof active pulmonary tuberculosis were detected in the threerounds. The prevalence of both these diseases showed a declinein 1993 when compared to 1987. This favourable situation wasprobably the result of dust control measures introduced in themine after 1972. Five workers developed graphite pneumoconiosisin the course of the study. They had worked in the mine forart average of 22.6 years. The right lung appeared to be morevulnerable than the left.     

A study of tuberculosis, malnutrition and gender in Sri Lanka

This study assesses the nutritional status of tuberculosis (TB) patients in Sri Lanka and differences in the nutritional presentation between males and females. In May-June 2002, cases from Colombo hospitals and controls from both the Sri Lankan Air Force Base and audience members at a 'better health' presentation in Colombo were assessed for nutritional status using a modified Standard Global Assessment. Fifty cases and 49 controls were recruited. Nutritional examinations revealed the cases to have significantly lower nutritional values than the controls (body mass index 16.2 vs. 24.0 kg/m(2); arm circumference 20.7 vs. 28.4 cm; muscle wasting [temple 56% vs. 0%; shoulder 46% vs. 0%]). The nutritional history revealed the cases to have higher levels of anorexia, vomiting, nausea and diarrhoea within the preceding fortnight. Differences between the genders were minimal other than an increase of 23 and 19% in the frequency of female cases having suffered with vomiting and nausea respectively. Consequently, both male and female TB patients in Sri Lanka are significantly malnourished. It is recommended that patients receive nutritional support during their treatment, with studies of the exact nutritional deficiencies at the micronutrient level and their effect on the immune system being required.     

Changing roles of grass-root level health workers in Kerala, India

OBJECTIVE: Multipurpose health workers (MPWs) are envisioned as key personnel in the delivery of primary health care. We evaluated their role and participation in implementing different national health programmes in Kerala, INDIA: DESIGN: Cross-sectional, community-based survey. PARTICIPANTS: We selected three out of the 14 districts in KERALA: Three-hundred and twenty-six MPWs (95 male and 231 female) from 44 randomly selected primary health centres from the three districts were questioned using a structured pre-tested questionnaire that sought information regarding the provision of health services by the MPWs to eligible beneficiaries in the community. We randomly selected 90 subcentres (30 from each district) and 750 households using a cluster sampling technique, and conducted household surveys to compare the actual delivery of services at the doorstep with that reported by the MPWS: Work sampling of MPWs was also performed to examine the fieldwork time spent by them on implementing individual national health programmes. These data were supplemented with focus group discussions and personal interviews of MPWs and household members. RESULTS: MPWs consistently 'over-reported' their performance when self-reported information was compared with that obtained from household surveys. Male MPWs concentrated on the National Malaria Eradication Programme and health education while female workers focused on the family welfare and immunization programmes. Key national health programmes (such as for tuberculosis and acute respiratory infection) were neglected by all MPWS: MPWs were aware of health problems of the elderly, but were not adequately trained nor officially expected to deliver any services in these fields. CONCLUSIONS: Grass-root level workers apportion more time to select national health programmes to the detriment of other health programmes, thereby negating their multipurpose role. Our study emphasizes the need for interventions to derive 'multipurpose benefits' from the MPWS:     

Ventilatory function in brass workers of Gadaladeniya, Sri Lanka

A cross sectional study was conducted to determine the respiratoryhazards of brass workers. The study group was selected randomly.The control group was selected from the general population matchedfor age by cluster sampling. There was a total of 154 pairsfor the final analysis. A questionnaire was administered todetermine the prevalence of respiratory symptoms. Forced vitalcapacity (FVC), forced expiratory volume in the first second(FEV_1.0), forced expiratory flow rate in the mid 50% of theFVC(FEF_25%–75%) and peak expiratory flow rate(PEFR) weremeasured. Chest radiography was performed on those with 5 ormore years of service. Cough, phlegm, chronic bronchitis anddyspnoea were significantly higher among brass workers. Theventilatory capacity was significantly lower in all the indicatorsexcept FVC. Smoking had no significant effect and a dose responserelationship could not be demonstrated after inclusion of agein the regression model. Five point five per cent had evidenceof septal lines while 6.4% had emphysema.     

Health and health services on plantations in Sri Lanka

Sri Lanka is an example of a country which has achieved impressiveimprovements in health status since Independence despite itslow income per head. However, the improvement has been uneven,with plantations consistently lagging behind. Most of the estateworkers in Sri Lanka are Indian Tamils who have traditionallybeen economically disadvantaged and politically isolated, apattern which began under the colonial pattern of recruitmentand management Poverty, overcrowding, poor water and sanitationand health services were all reflected in the low health statusof estate workers and their families. However, since nationalizationin 1975, there has been considerable investment on estates and,with the introduction of a uniform health policy designed tomeet the needs of estate workers, the health status of workersand their families has dramatically improved. Interventionshave included components on housing, water supply and sanitationas well as health and child care and have been planned withthe involvement of the workers. The components which have broughtabout the improvements were specificially designed to meet theneeds of plantation workers and developed within a structurequite different from that which applies in rural peasant areas.It is possible that a separate structure responsive to the specialproblems on estates is needed if Health for All is to be a realityin plantations.     

Advocacy and opportunity--planning for child mental health in Sri Lanka

Planning for mental health can be seen as low priority by policymakers and planners in developing countries. The article describesexperiences which led to the implementation of a child mentalhealth programme within primary care in Sri Lanka. It highlightsaspects of the planning process which may be relevant for theintroduction of any new programme proposals within country situationswhere multiple demands are made on available resources, andservice expansion is restricted due to scant funding and limitedprofessional resources.     

Utilization of primary health care workers for early detection of oral cancer and precancer cases in Sri Lanka

Oral cancer presents a serious public health problem in south-east Asian countries. In Sri Lanka and India 35-40% of all cancers are reported to be oral cancers, which are curable if detected in the early stages. The idea that, in developing countries, one of the few practical approaches to early detection of these cases could be through the utilization of primary health care workers was tested in a field study carried out in Sri Lanka. In a control area the subjects with oral lesions were identified by medical/dental officers. In the study, 34 primary health care workers were able, alongside their routine duties, to examine the oral cavity of 28 295 subjects during a period of 52 weeks; 1220 subjects were detected with lesions needing re-examination. The performance of these primary health care workers was very satisfactory in terms of the number of cases detected and the accuracy of their diagnoses, which were verified by re-examination at a specially designated referral centre. The clinical diagnoses of the three categories of lesions detected were as follows: stage 1 lesions for observation (homogeneous or ulcerated leukoplakia), stage 2 lesions for investigation (speckled leukoplakia, erythroplakia, or submucous fibrosis), and stage 3 lesions for treatment (cancer). There was 89% correspondence between the stage 1-3 diagnoses by the health workers and the clinical diagnoses made at the referral centre. However, compliance by patients was low because only 50% of the cases detected in the field attended the referral centre. The cost-effectiveness of this approach to cancer control has been demonstrated.     

Fungal air-borne spores as health risk factors among workers in alimentary industries

A survey to evaluate the occurrence of air-borne fungal spores in two different food industries, dairies and bakeries, was conducted. Our data revealed considerable fungal pollution in the environments of both industries, as well as some differences in the distribution of the genera of fungi recovered.Noteworthy was the frequent finding of numerous fungi frequently responsible for allergic rhinitis, asthma and other diseases, or well-known for their production of mycotoxins in foods or characterized by their degradative activity against various substances. Aspergillus, Candida, Fusarium, Geotrichum, Mucor and Penicillium were the most common genera identified in dairies while Alternaria, Aspergillus, Botrytis, Candida, Cladosporium, Penicillium and Saccharomyces occurred more frequently in bakeries.The survey showed that fungi can play a significant role in allergic and non-allergic diseases in modern working environments.     

青海省典型行业女职工生殖健康状况调查

采用横断面调查方法,对青海省冶金、化工、铁路、制酒及其他行业3 848名女职工进行生殖健康问卷调查.妇科疾病、月经异常和不孕是女职工主要的生殖健康问题,以制酒和铁路行业发病率较高.接触职业有害因素、不良体位、工作负荷大等是影响女职工生殖健康的重要因素.应加强职业卫生防护和健康教育,改善工作模式,保护女职工身心健康.     

Adolescents perception of reproductive health care services in Sri Lanka

Background  

Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery.     

Is health insurance an option for Sri Lanka?

In the face of rising health care costs and the reductions imposedby budgetary cuts many governments in developing countries areconsidering options other than general tax revenue to financetheir health services. Health insurance models that introducethe concept of ‘risk sharing’, and which are currentlybeing used by developed countries, are critically reviewed inthe light of some of the experiences of developing countriesin Asia. Factors to be considered when selecting options are: the existinghealth system, the state of economic development, the availabilityof facilities and manpower, the demand for quality care, thetechnical and managerial knowledge of insurance and the existingresource gap for health services. In the case of Sri Lanka, if health insurance is to be a viableoption certain changes to the existing comprehensive healthservice, provided by the government free to all citizens, wouldfirst need to be introduced. It is argued that, in terms ofinsurance options, Sri Lanka would most benefit from a socialinsurance model where a health insurance fund would be establishedwith contributions made statutory by law. This fund should remaina financial source separate from general tax revenue, and servicesshould be supplied utilizing the existing infrastructure - withsufficient control vested in the ministry of health to safeguardthe poor and to control cost escalation.     

个体民营企业职工职业卫生问卷调查分析

目的了解《职业病防治法》颁布实施3周年以来在个体民营企业的贯彻实施情况及个体民营企业存在的职业卫生问题。方法从湖南省6个市州中抽取411名个体民营企业职工进行问卷调查,资料收集后进行统计分析。结果企业没有和职工签订劳动合同和履行危害告知义务的情况仍很普遍,职工对《职业病防治法》的知晓率不高,职工职业健康监护无保障,职业病防护设施不到位。结论《职业病防治法》在个体民营企业的贯彻实施很不得力,尚需进一步加强。     

How gender roles influence sexual and reproductive health among South African adolescents

Although the literature on Africa increasingly adopts a gendered approach to sexual and reproductive health issues, few studies have addressed adolescent pregnancy and parenthood in such a framework. This article examines links between gender ideology or gender roles and the social impact of adolescent childbearing in the lives of rural and urban adolescents in KwaZulu/Natal, South Africa. It employs a triangulated research methodology (focus-group discussions, narrative role playing and discussions, and questionnaires and in-depth interviews) to inform an analysis of adolescents' notions of male and female gender ideals. This analysis forms the basis for an exploration of the potential influence of adolescent childbearing on young peoples' lives and factors that shape their sexual and reproductive well-being. Results indicate that gender ideals are grounded in traits that reinforce poor sexual negotiation dynamics and behavioral double standards and that place adolescents at risk for early pregnancy and other sexual and reproductive health complications. Overall, adolescent parenthood is viewed negatively by participants of both sexes because it compromises personal, professional, and financial aspirations. Compared with its effect on boys, parenthood has a disproportionate (and highly negative) impact on girls that is directly linked to gender-based inequities. The article addresses the research and policy implications of these findings.     

深圳女性外来务工者健康促进生活方式现状调查及对策研究

目的 了解深圳女性外来务工者健康促进生活方式的现状,并分析其影响因素.方法 采用健康促进生活方式量表-Ⅱ和自行设计的人口学资料问卷对深圳2个大型企业（员工达4000人以上）的非深圳户口、工作达3个月以上的女员工共2000人按照随机抽取的方法进行调查.按人口学特征及健康变化、单位进行分组,比较健康促进生活方式的差异.结果 健康促进生活方式量表得分指标从高到低依次为营养行为、人际关系行为、运动行为和健康职责行为.多个不同人口学特征间外来务工者健康促进生活方式得分差异有统计学意义（P＜0.05）.自觉健康较1年前差的深圳女性外来务工者在健康促进生活方式多个维度得分较低.结论 健康促进生活方式对深圳女性外来务工者的健康状况有积极的影响,改进深圳女性外来务工者的健康促进生活方式应从多个方面采取积极措施.     

中国九个典型行业女职工月经异常状况及影响因素分析

目的调查研究不同行业女职工月经异常及其影响因素。方法采用横断面调查方法,于2016年5—11月对我国医药卫生、石油化工、冶金、铁路、机械制造、电子等9个行业51 075名女工进行调查。利用《女工生殖健康调查问卷》收集人口学、职业及生殖状况等数据。采用χ~2检验进行影响月经异常的单因素分析;利用Logistic回归模型进行多因素分析。结果 9个行业女职工的月经异常率为35.85%,其中月经周期异常占15.12%,月经量异常18.59%,月经持续时间异常和痛经分别为7.18%和9.88%。金融行业女工月经异常率最高(OR=1.49,95%CI:1.31～1.70),其次是石油化工行业(OR=1.50,95%CI:1.32～1.71);经常加班(OR=1.14,95%CI:1.09～1.19)、轮班(OR=1.12,95%CI:1.07～1.17)、长时间坐位工作(OR=1.30,95%CI:1.25～1.36)、暴露于化学物质(OR=1.31,95%CI:1.23～1.39)等均是月经异常的相关影响因素。结论行业、经常加班、轮班、长时间坐位、职业暴露化学有害因素等是女职工月经异常的影响因素。     

Practices related to sharps disposal among diabetic patients in Sri Lanka

Background

Patients with diabetes on insulin therapy use sharps (e.g., needles) on a regular basis and a considerable proportion of them, within their home environments. These sharps and other bloodstained materials, if not disposed of appropriately has the potential to be a public health hazard.

Objective

Our objective was to explore the practices related to sharps disposal among patients with diabetes from North Colombo Teaching Hospital (CNTH), Ragama, Sri Lanka.

Methods

We conducted a cross-sectional study on 158 patients with diabetes from the CNTH. Patients had to use sharps for the daily management of their disease for inclusion into the study group. Data were collected on sharps disposal practices using an interviewer-administered questionnaire. Clinic records were also used as a secondary data source.

Results

Most patients, 153/158 (96.8%) used syringes to inject insulin. Forty-three patients (27%) involved others (e.g., family) when disposing of sharps. Used sharps were commonly disposed to the household garbage bin by 66 participants (41.7%). Other methods used for sharps disposal were: sharps container, toilet pit, household garbage dump and indiscriminate measures. Importantly most patients, 147 (93%) had received no information on how to dispose of sharps after usage.

Conclusion

Patients commonly used unsafe practices in home-based sharps disposal. These included disposing of in the household garbage bin, burning sharps in the household garbage dump and disposing of into the common garbage dump of the community. Being male and being >?60 years of age was associated with a higher dependence on family members for sharps disposal. Patient education and public resources for sharps handling can help improve this situation.

     

Acute poisoning: a major health concern in Sri Lanka.

The importance of acute poisoning as a cause of morbidity and mortality in many developing countries has been highlighted in recent times. This study discusses the utilization of routinely collected data from hospitals for background information required in planning and implementing preventive programs. The high prevalence of poisoning and its distribution countrywide were highlighted by the routinely collected data, while the retrospective study of hospital admissions identified the wide range of toxic agents and age and sex differentials in the pattern of poisoning. Even though the overall case fatality rate was 7.6%, there was wide variation among the different toxic agents.     

Stress at work and mental health status among female hospital workers

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.