Ethics in occupational health: deliberations of an international workgroup addressing challenges in an African context

Prevalence and Associated Factors of Work-Related Injury Among Municipal Solid Waste Collectors in Hawassa City, Southern Ethiopia: A Cross-Sectional Study

Introduction

Municipal solid waste collectors are at risk of experiencing work-related health problems due to the waste they handle and the physical effort they put in. Work-related injuries among domestic waste collectors have been the subject of scant research in developing nations. Therefore, it is necessary to describe work-related injuries in these subpopulation groups.

Objective

This study aimed to determine the prevalence and associated factors of work-related injury among municipal solid waste collectors in Hawassa city, Southern Ethiopia.

Methodology

A cross-sectional study was conducted from January 11 to 30, 2022, with all the registered municipal solid waste collectors (411). Three diploma environmental health professionals assisted in collecting data using a pretested structured interviewer-administered questionnaire; 1 Bachelor of Science environmental health professional served as a supervisor. Statistical Package for the Social Sciences (SPSS) version 20.0 was used to enter, clean, code, and analyze the data. Associations between independent and dependent variables were assessed, and the strength of the associations was presented by using Adjusted Odds Ratio (AOR) and 95% confidence intervals (CI). According to the bivariable analysis, all independent variables associated with a P-value <.25 were entered into a multivariable logistic regression model. Variables in the multivariable regression analysis were considered significant if their P-value was less than 0.05.

Results

In this study, the prevalence of work-related injuries within the last 30 days was 12.9% (95% CI: 9.5, 16.3), while the prevalence over the last 12 months was 59.4% (95% CI: 54.7, 64.0). After adjusting for possible confounding factors, age 18 to 24 years [AOR = 1.72;95% CI: (1.07, 2.76)], lack of personal protective equipment (PPE) utilization [AOR = 2.30; 95% CI: (1.44, 3.68)], chewing khat (yes) [AOR = 2.32;95% CI: (1.32, 4.08)], drinking alcohol (yes) [AOR = 1.80; 95% CI: (1.003, 3.24)] and job dissatisfaction [AOR = 2.26, 95% CI: (1.44, 3.54)] were shown to be significantly associated with work-related injury.

Conclusion

The prevalence of work-related injuries was high. Age 18 to 24 years, chewing khat, drinking alcohol, lack of PPE utilization, and job dissatisfaction were significantly associated with work-related injury. Based on the findings of this study, we suggest that addressing these risk factors could help to reduce work-related injuries.

The Ethics of Workplace Health Promotion

Companies increasingly offer their employees the opportunity to participate in voluntary Workplace Health Promotion programmes. Although such programmes have come into focus through national and regional regulation throughout much of the Western world, their ethical implications remain largely unexamined. This article maps the territory of the ethical issues that have arisen in relation to voluntary health promotion in the workplace against the background of asymmetric relationships between employers and employees. It addresses questions of autonomy and voluntariness, discrimination and distributive justice, as well as privacy and responsibility. Following this analysis, we highlight the inadequacy of currently established ethical frameworks to sufficiently cover all aspects of workplace health promotion. Thus, we recommend the consideration of principles from all such frameworks in combination, in a joint reflection of an Ethics of Workplace Health Promotion.

Exploring the Role of Shared Decision Making in the Consent Process for Pediatric Genomics Research in Cameroon, Tanzania, and Ghana

Background: It is customarily perceived that in Africa, decisions around research participation may be based not only on individual reflection but also on discussions with others. Some authors have argued that such decision making is reflective of a more traditional communitarian African worldview; one critique of such a perspective is that it is lacking an empirical grounding. In this study, we explore decision making around enrollment in sickle cell genomics research in three countries in Africa, namely, Ghana, Cameroon, and Tanzania. Particularly, we focus on exploring the role of shared decision making with regard to participating in genomic studies. Results: We involved 64 participants in 15 individual interviews or in 49 focus-group discussions with research participants in rural and urban Tanzania (n = 20), Ghana (n = 30), and Cameroon (n = 14). We used a vignette to explore decision making around enrollment of children in sickle cell genomics research. Data were imported in NVivo11 and analyzed using thematic content analysis. Our findings indicate that the majority of the participants from both rural and urban settings prefer to make their own individual decisions and not consult with extended family or community leaders. Shared decision making was only considered necessary for individuals who were perceived to be in some way vulnerable. Conclusion: We found very limited support for shared decision making as the primary process for decision making about research participation. While consultation was considered important to support individual decision making, particularly when parents were perceived as vulnerable, there was no suggestion in our data that shared decision making would be a more important or valuable means of seeking consent for research participation in the African research context.

A reflection on ethical and methodological challenges of using separate interviews with adolescent-older carer dyads in rural South Africa

Background

This article discusses our reflections on ethical and methodological challenges when conducting separate interviews with individuals in dyads in the uMkhanyakude district, South Africa. Our work is embedded in an ethnographic study exploring care relationships between adolescents and their older carers in the context of a large-donor funded HIV programme. We use these reflections to discuss some of the challenges and present possible management strategies that may be adopted in conducting dyadic health research in resource-poor settings.

Methods

Drawing from the relational agency, three rounds of separate interviews and participant observation were undertaken with dyads of adolescents aged between 13 and 19 and their older carers aged 50+ from October 2017 to September 2018. A reflexive journal was kept to record the interviewer's experiences of the whole research process. We identified methodological and ethical challenges from these data during the thematic analysis.

Results

A total of 36 separate interviews were conducted with six pairs of adolescent-older carer dyads (n = 12 participants). Five themes emerged: recruitment of dyads, consenting dyads, confidentiality, conducting separate interviews with adolescents and older carers, and interviewer-dyad interaction. We also illustrated how we dealt with these challenges.

Conclusions

Results from this study can guide the recruitment, consenting and collecting data for health studies that employ a similar form of enquiry in LMICs. However, ethical and methodological challenges should be recognised as features of the relationships between cross-generation dyads rather than weaknesses of the method.

Commentary on the Organisation of Occupational Health and Safety in Southern Africa, the International Labour Organization and Policies in General

BACKGROUND

The design and implementation of sound occupational health and safety (OHS) programmes require understanding of the main issues that need attention. This article highlights key issues regarding the (i) organisation of OHS services in southern Africa, (ii) role of the International Labour Organization (ILO) in the provision of OHS services and (iii) implementation of policies in general.

METHODS

Relevant peer-reviewed journal articles, ILO conventions and policies were identified and discussed.

RESULTS

Inadequacies that exist on the organisation of OHS services in southern Africa include (i) lack of some critical categories of OHS practitioners, (ii) no emphasis on the surveillance of the work environment (iii) disregard of the worker's right to refuse to work in unsafe work environments and (iv)non-coverage of some sectors of the economy. Further research is needed to identify additional efforts that the ILO requires to effectively discharge its OHS promotion mandate.

CONCLUSION

Responsible authorities need to attend to the shortcomings of the national OSH laws and intergovernmental pacts.

Implementation of a National Workplace Wellness Program for Health Workers in Botswana

The Botswana workplace wellness program (WWP) for health care workers (HCWs) was initiated in 2007. WWP implementation was assessed using a sequential, explanatory, mixed methods design including a national implementation assessment (27 health districts) and in-depth interviews (n = 38). Level of implementation varied across districts with health screening, therapeutic recreation, and health promotion implemented more frequently than occupational health activities and psychosocial services. Facilitators to WWP implementation included establishment of a dedicated, diverse WWP committee; provision of administrative support, and integration of activities into organizational culture. Barriers included competing priorities related to delivery of health services to clients, limited technical ability to deliver occupation health activities and psychosocial support, receipt of health services from colleagues, and limited appreciation for personal wellness by some HCWs. Ensuring the well-being of HCWs is critical in reaching international health goals.

Giving voice to African thought in medical research ethics

In this article, I consider the virtual absence of an African voice and perspective in global discourses of medical research ethics against the backdrop of the high burden of diseases and epidemics on the continent and the fact that the continent is actually the scene of numerous and sundry medical research studies. I consider some reasons for this state of affairs as well as how the situation might be redressed. Using examples from the HIV/AIDS and Ebola epidemics, I attempt to show that the marginalization of Africa in medical research and medical research ethics is deliberate rather than accidental. It is causally related, in general terms, to a Eurocentric hegemony derived from colonialism and colonial indoctrination cum proselytization. I end by proposing seven theses for the critical reflection and appraisal of the reader.

Prevalence and associated factors of occupational injuries among municipal solid waste collectors in four zones of Amhara region, Northwest Ethiopia

Background

Refuse collectors are at a high risk for fatal and non-fatal occupational accidents. This is more intensified in developing countries, like Ethiopia, due to physically demanding nature of the job. However, information on occupational injuries and related factors are almost non-existent in Ethiopia. Thus, the aim of this study was to assess the prevalence of occupational injuries and its associated factors.

Methods

A cross-sectional study was conducted among municipal solid waste collectors in four zones of Amhara region from February to May 2015. Computer generated simple random sampling technique was used to select the samples. Interviewer administrated questionnaires were used for the data collection process. Binary logistic regression was used to assess the association between outcome variables and explanatory variables.

Results

In this study, the annual prevalence of at least one occupational injury among solid waste workers was 34.3 % (95 % CI: 29.52, 39.10). Of these, 50.7 % of them were visited health facility to receive health care. The independent predictors of at least one occupational injury were shorter service years, low monthly salary, history of job related stress, and sleeping disturbance related to the job. Being illiterate, having lower monthly income, and those who reported sleeping disturbance were significantly and positively associated with severe occupational injuries of solid waste collectors.

Conclusion

The magnitude of occupational injuries among municipal solid waste collectors is lower than other similar studies conducted in Ethiopia. Based on the finding of this and other studies, job rotation among work components, improvement of employees’ income, job specific guideline regarding maximum production limits, and replacement of bags and bins with wheeled containers are an interventions expected to cope with the problem. There is also a need of specific periodic health surveillance (PHS) for refuse collectors to detect early signs of work related complaints and to monitor work ability.

Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals

INTRODUCTION

Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon.

MATERIALS AND METHODS

In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding), giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data.

RESULTS

Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information", "interpersonal, relational and behavioral issues", "psychological strain of individuals", and "scarce resources"; B) meso level: "structural issues of medical institutions", "issues with private clinics", "challenges connected to the family", and "issues of education, training and competence"; and C) macro level: "influence of society, culture, religion and superstition", "applicability of western medicine", "structural issues on the political level", and "legal issues".

DISCUSSION

Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon.

Ethical violations in the clinical setting: the hidden curriculum learning experience of Pakistani nurses

Background

The importance of the hidden curriculum is recognised as a practical training ground for the absorption of medical ethics by healthcare professionals. Pakistan’s healthcare sector is hampered by the exclusion of ethics from medical and nursing education curricula and the absence of monitoring of ethical violations in the clinical setting. Nurses have significant knowledge of the hidden curriculum taught during clinical practice, due to long working hours in the clinic and front-line interaction with patients and other practitioners.

Methods

The means of inquiry for this study was qualitative, with 20 interviews and four focus group discussions used to identify nurses’ clinical experiences of ethical violations. Content analysis was used to discover sub-categories of ethical violations, as perceived by nurses, within four pre-defined categories of nursing codes of ethics: 1) professional guidelines and integrity, 2) patient informed consent, 3) patient rights, and 4) co-worker coordination for competency, learning and patient safety.

Results

Ten sub-categories of ethical violations were found: nursing students being used as adjunct staff, nurses having to face frequent violence in the hospital setting, patient reluctance to receive treatment from nurses, the near-absence of consent taken from patients for most non-surgical medical procedures, the absence of patient consent taking for receiving treatment from student nurses, the practice of patient discrimination on the basis of a patient’s socio-demographic status, nurses withdrawing treatment out of fear for their safety, a non-learning culture and, finally, blame-shifting and non-reportage of errors.

Conclusion

Immediate and urgent attention is required to reduce ethical violations in the healthcare sector in Pakistan through collaborative efforts by the government, the healthcare sector, and ethics regulatory bodies. Also, changes in socio-cultural values in hospital organisation, public awareness of how to conveniently report ethical violations by practitioners and public perceptions of nurse identity are needed.

Neurotoxicology and development: human, environmental and social impacts

The 12th International symposium of the Scientific Committee on Neurotoxicology and Psychophysiology, International Commission on Occupational Health was held in Cape Town, South Africa on March 24-27, 2013. Reflecting the meeting aiming to build greater focus on challenges facing working populations and communities in developing countries, the Symposium theme was Neurotoxicology and Development: Human, Environmental and Social Impacts. A total of 23 countries were represented with strong participation from 5 African countries. In addition to the more traditional topics of these Symposia, like metal, solvents and pesticides neurotoxicity, the conference embraced several new themes including affective disorders arising from chemical exposure, neurodevelopmental impacts in early life and novel approaches to genetic and epigenetic biomarkers for the assessment of neurotoxic impact. The theme of the conference prompted extensive discussions, which have laid the basis for a number of new directions for research, advocacy and capacity building to prevent and manage chemical neurotoxicity in workplace and community settings across the globe.