Health, safety, and ecological implications of using biobased floor-stripping products

The main objective of the study reported here was to investigate the ecological, health, and safety (EHS) implications of using biobased floor strippers as alternatives to solvent-based products such as Johnson Wax Professional (Pro Strip). The authors applied a quick EHS-scoring technique developed by the Surface Solution Laboratory (SSL) of the Toxics Use Reduction Institute (TURI) to some alternative, biobased products that had previously performed as well as or close to as well as the currently used product. The quick technique is considered an important step in EHS assessment, particularly for toxics use reduction planners and advocates who may not have the resources to subject many alternative products or processes at once to detailed EHS analysis. Taking this step narrows available options to a manageable number. (Technical-performance experiments were also conducted, but the results are not discussed or reported in this paper). The cost of switching to biobased floor strippers was assessed and compared with the cost of using the traditional product, both at full strength and at the dilution ratios recommended by the respective manufacturers. The EHS analysis was based on a framework consisting of five parameters: volatile organic compounds (VOCs); pH; global-warming potential (GWP); ozone depletion potential (ODP); and safety scores in areas such as flammability, stability, and special hazards, based on ratings from the Hazardous Material Classification System (HMIS) and the National Fire Protection Association (NFPA). Total EHS scores were calculated with data derived from the material safety data sheets. For most cleaning products previously investigated by the TURI SSL, the investigators have demonstrated that the five key parameters used in the study reported here can successfully be used for quick screening of the EHS impacts of cleaning alternatives. All eight biobased, or green, products evaluated in the study had better EHS-screening scores than did Pro Strip. One product, Botanic Gold, had a screening score of 49 out of a possible 50. This score was much higher than the score of 26 achieved by Pro Strip. The other biobased floor strippers had EHS-screening scores of > or =37, which is the average value of solvent-based cleaning solutions. These results indicate that biobased cleaning products capable of floor stripping are potentially better than traditional products with respect to the five EHS parameters used. The cost of switching to biobased floor strippers at their full strength ranged from a minimum of U.S. $15.50 per gallon ($4.10 per liter) for Eco Natural Floor Stripper (WPR) to about $59.00 per gallon ($15.61 per liter) for Botanic Gold. At 25 percent volume by volume (v/v), the recommended dilution ratio for the traditional product, the cost of the Botanic Gold was $14.75 per gallon ($3.90 per liter), or about five times more than that of Pro Strip, which was $2.48 per gallon ($0.65 per liter). Since these figures do not reflect all of the EHS costs, such as disposal and recycling fees, it is likely that use of Botanic Gold could be cost-effective in the long run. The authors therefore recommend that detailed EHS analysis be conducted on this alternative biobased floor stripper. It is also recommended that large field trials be conducted and that janitors' or consumers' perceptions be determined. For detailed assessment of eco-toxicological properties of the biobased floor strippers, investigations of the common additives in the Botanic Gold formulation should be conducted through use of databases on the World Wide Web such as Toxnet. Finally, the current policies, regulations, and standards that promote biobased products should be investigated to determine their strengths and weaknesses. This would encourage a broader public debate about the future of the biobased industry in the context of sustainability.     

The hypoxic ischaemic encephalopathy score in predicting neurodevelopmental outcomes among infants with birth asphyxia at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Hypoxic Ischemic Encephalopathy (HIE) score may be used to predictneurodevelopment outcome in infants with birth asphyxia. A totalof 140 infants who had a 5 min Apgar score of <7 at birthhad detailed motor and neurodevelopment assessment. Outcomemeasures were grouped as normal or abnormal with morbidity (convulsions,abnormal muscle tone and delayed development) or death. Thepositive predictive value (PPV) for mortality was 42.3% formoderate HIE and 93.8% for severe HIE. For severe HIE the PPVwas 100%. Thirteen infants had delayed development, the scorehad PPV of 63.6% for moderate HIE and 100% for severe HIE. Thebest correlation with outcome was the peak score of 15 or higherhad a PPV of 100%. Specificity was found to be 100% and sensitivityof 14%. The HIE scoring system is a useful predictor of neurodevelopmentoutcome at 6 months of age in a resource poor setting.     

坦桑尼亚一家三级医院耳鼻喉科咽喉反流性疾病的患病率与临床特征

目的咽喉反流性疾病(LPRD)是一种非特异性疾病.晚期可导致恶性肿瘤。在坦桑尼亚耳鼻喉科的患者中,LPRD的患病率和临床特征尚未明确。方法本研究是一项基于医院的描述性横断面研究,在坦桑尼亚莫西比利国立医院耳鼻喉科的病房和门诊进行。将有咽喉反流性疾病症状的患者纳入本研究。通过问卷和临床检查表收集数据,使用SPSS软件处理和分析数据。结果研究纳人256例患者,其中男性131例(51.2%)。年龄41.38+13.94岁。咽喉反流性疾病的患病率为18.4%.男女无明显差异。常见症状是咽异物感(95.79%6)、声嘶(88.1%)和过度清嗓(83.0%),见的体征是喉内黏液附着(9.9%),声带水肿(88.6%)和部分喉室消失(72.7%)。饭后2 h内平卧和辛辣食物是该病的危险因素。高血压和2型糖尿病是与咽喉反流性疾病相关的最常见合并症。结论LPRD在坦桑尼亚莫西比利国立医院耳鼻喉科就诊者中患病率高。所有具有LPRD相关症状的患者应尽早诊断和治疗。     

Impact of ALSO training on the management of prolonged labor and neonatal care at Kagera Regional Hospital, Tanzania

Objective

To evaluate the management of prolonged labor and neonatal care before and after Advanced Life Support in Obstetrics (ALSO) training.

Methods

Staff involved in childbirth at Kagera Regional Hospital, Tanzania, attended a 2-day ALSO provider course. In this prospective intervention study conducted between July and November 2008, the management and outcomes of 558 deliveries before and 550 after the training were observed.

Results

There was no significant difference in the rate of cesarean deliveries owing to prolonged labor, and vacuum delivery was not practiced after the intervention. During prolonged labor, action was delayed for more than 3 hours in half of the cases. The stillbirth rate, Apgar scores, and frequency of neonatal resuscitation did not change significantly. After the intervention, there was a significant increase in newborns given to their mothers within 10 minutes, from 5.6% to 71.5% (RR 12.71; 95% CI, 9.04-17.88). There was a significant decrease from 6 to 0 neonatal deaths before discharge among those born with an Apgar score after 1 minute of 4 or more (P = 0.03).

Conclusion

ALSO training had no effect on the management of prolonged labor. Early contact between newborn and mother was more frequently practiced after ALSO training and the immediate neonatal mortality decreased.     

Substandard emergency obstetric care – a confidential enquiry into maternal deaths at a regional hospital in Tanzania

Objective (i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections on causes of substandard care. Methods A CE into maternal deaths was conducted based on information available from written sources supplemented with participatory observations and interviews with staff. The compiled information was summarized and presented anonymously for external expert review to assess for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in‐depth interviews with staff about the underlying causes of substandard care were performed. Results The causes of death were infection (40%), abortion (25%), eclampsia (13%), post‐partum haemorrhage (12%), obstructed labour (6%) and others (4%). The median time available for hospital staff to manage the fatal complication was 47 h. The CE identified major substandard care in 46 (74%) of the 62 cases reviewed. During the same time period MDA identified substandard care in 18 cases. Staff perceived poor organization of work and lack of training as important causes for substandard care. Local MDA was considered useful although time‐consuming and sometimes threatening, and staff dedication to the process was questioned. Conclusion Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE.     

Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania

BackgroundMuch of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health.ObjectivesOur study investigates the role of bone setting in Tanzania through patient utilization and perspectives.MethodsWe surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method.ResultsOf all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-administered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67).ConclusionOur study found lower bone setting utilization than expected considering the reliance of Tanzanians on traditional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.     

The pattern of mucocutaneous disorders in HIV – infected children attending care and treatment centres in Dar es Salaam, Tanzania

Background  

HIV/AIDS is associated with a wide range of mucocutaneous disorders some of which are useful in the clinical staging and prognosis of the syndrome. There is paucity of information regarding the prevalence and pattern of mucocutaneous disorders among HIV infected children attending paediatric Care and Treatment Centres (CTC) in Dar es Salaam. Objective To determine the prevalence and pattern of mucocutaneous disorders among HIV infected children attending public paediatric 'Care and Treatment Centres' in Dar es Salaam.     

HIV counseling and testing of pregnant women in sub-Saharan Africa: experiences from a study on prevention of mother-to-child HIV-1 transmission in Dar es Salaam, Tanzania.

The aim of this study was to determine the acceptability of HIV counseling and testing and participation in a mother-to-child HIV-1 transmission intervention study using antiretroviral therapy in Dar es Salaam, Tanzania, one of the sites for the Joint United Nations Program on AIDS (UNAIDS) multicenter Petra trial. HIV testing was offered to all pregnant women who visited three prenatal clinics in Dar es Salaam before 34 weeks' gestation. Group or individual pretest counseling was performed by trained midwives. Laboratory diagnosis of HIV infection was based on two sequential anti-HIV enzyme-linked immunosorbent assays. Posttest counseling was given 2 weeks later to women who wished to know their HIV status. HIV testing was offered to a total of 10,010 pregnant women from June 1996 to May 1998, of whom 76.4% (7647 of 10,010) agreed to be tested. The prevalence of HIV-1 infection was 13.7% (1050 of 7647). Overall, 68.1% (5205 of 7647) returned for their results. Of the HIV-1-seropositive respondents, 27.4% (288 of 1050) agreed to participate in the Petra trial after fulfilling the eligibility criteria. Only 16.7% (48 of 288) of the enrolled women disclosed their positive HIV serostatus to their sexual partners. The main reasons for not disclosing the HIV serostatus were fear of stigma and divorce. Sixty percent (29 of 48) of the informed sex partners agreed to be tested for HIV and 69% (20 of 29) tested HIV seropositive. Pregnancy recurrence rate was 4.4 per 100 women years (18 pregnancies during 408 women years of follow-up) with 10 of 18 (55.6%) women not wanting to carry the pregnancy to term. In conclusion, this information is useful in planning intervention programs for prevention of mother-to-child HIV-1 transmission and it shows that improvements are required in counseling.     

Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra Study

OBJECTIVE: To investigate the possibility of reducing mother-to-child transmission (MTCT) of HIV-1 through breast-feeding by prophylactic antiretroviral (ARV) treatment of the infant during the breast-feeding period. DESIGN: An open-label, nonrandomized, prospective cohort study in Tanzania (Mitra). METHODS: HIV-1-infected pregnant women were treated according to regimen A of the Petra trial with zidovudine (ZDV) and lamivudine (3TC) from week 36 to 1 week postpartum. Infants were treated with ZDV and 3TC from birth to 1 week of age (Petra arm A) and then with 3TC alone during breast-feeding (maximum of 6 months). Counseling emphasized exclusive breast-feeding. HIV transmission was analyzed using the Kaplan-Meier survival technique. Cox regression was used for comparison with the breast-feeding population in arm A of the Petra trial, taking CD4 cell count and other possible confounders into consideration. RESULTS: There were 398 infants included in the transmission analysis in the Mitra study. The estimated cumulative proportion of HIV-1-infected infants was 3.8% (95% confidence interval [CI]: 2.0 to 5.6) at week 6 after delivery and 4.9% (95% CI: 2.7 to 7.1) at month 6. The median time of breast-feeding was 18 weeks. High viral load and a low CD4 T-cell count at enrollment were associated with transmission. The Kaplan-Meier estimated risk of HIV-1 infection at 6 months in infants who were HIV-negative at 6 weeks was 1.2% (95% CI: 0.0 to 2.4). The cumulative HIV-1 infection or death rate at 6 months was 8.5% (95% CI: 5.7 to 11.4). No serious adverse events related to the ARV treatment of infants occurred. The HIV-1 transmission rate during breast-feeding in the Mitra study up to 6 months after delivery was more than 50% lower than in the breast-feeding population of Petra arm A (relative hazard=2.61; P=0.001; adjusted values). The difference in transmission up to 6 months was significant also in the subpopulation of mothers with CD4 counts>or=200 cells/microL. CONCLUSIONS: The rates of MTCT of HIV-1 in the Mitra study at 6 weeks and 6 months after delivery are among the lowest reported in a breast-feeding population in sub-Saharan Africa. Prophylactic 3TC treatment of infants to prevent MTCT of HIV during breast-feeding was well tolerated by the infants and could be a useful strategy to prevent breast milk transmission of HIV when mothers do not need ARV treatment for their own health.