Accessing Occupational Health Services in the Southern African Development Community Region

Factors associated with TB screening among agricultural workers in Limpopo Province, South Africa

BACKGROUND

Tuberculosis (TB) continues to be a public health issue of concern in South Africa. Workers in the agricultural sector are generally at increased risk of TB due to multiple interacting factors such as exposure to silica dust, co-worker infection, and occupations falling within the lower socio-economic sectors.

OBJECTIVE

This study investigates factors associated with TB screening uptake for agricultural workers in Limpopo Province, South Africa.

METHOD

This cross-sectional study targeted a study population of 16,787 agricultural workers across 96 agricultural worksites in South Africa. A two-stage cluster random sampling design identified 24 agricultural worksites and a potential 2500 participants. The outcome variable was self-reported TB screening. Descriptive statistics and unadjusted and adjusted logistic regression analyses were performed to determine factors associated with TB screening. A literature review informed the selection of covariates as possible confounders.

RESULTS

The final study sample comprised 2144 workers across 24 sites, with 55% being women. TB screening uptake was 1155 (56.3%). Factors such as living with human immunodeficiency virus (HIV) (AOR 3.16, 95% CI: 2.44-4.09), accessing health services in the workplace (AOR 1.94, 95% CI: 1.09-3.46), and having prior TB knowledge (AOR 18.45, 95% CI: 9.8-34.74) were positively associated with TB screening. Participants in the age group 36-49 years had significantly higher odds of self-reporting TB screening, compared with those aged 18-25 years (AOR 1.37, 95% CI 1.07-1.77). Migrant workers from Mozambique (OR 0.52, 95% CI: 0.34-0.79) and Zimbabwe (OR 0.71, 95% CI 0.57-0.89) were significantly less likely to self-report TB screening compared to their South African counterparts.

CONCLUSION

The findings underscore the importance of workplace health services in achieving end-TB targets. We recommend programs and interventions for preventing TB in South Africa that target the agricultural sector in general, and in particular migrant workers.

Enterprise-Based Participatory Action Research in the Development of a Basic Occupational Health Service Model in Thailand

Various basic occupational health services (BOHS) are provided, particularly in-plant BOHS; however, it might be necessary to start expanding BOHS. The current study focuses on BOHS model development using participatory action research (PAR) at a large-sized enterprise in northeastern Thailand. The PAR began with a situation analysis using ILO Convention C161, problem and cause analysis, the development of an action plan, observation and action, evaluation, and replanning. The research tools included interviews, focus group discussions (FGDs), and participant observations. The participants included managers, human resource staff, safety officers, and workers. Both inductive and deductive thematic analyses were undertaken. The results showed that (1) education and learning experience led to the workers detecting work-related diseases early by themselves and the implementation of medical surveillance programs; (2) the workers' occupational health needs led to return-to-work assessments and first aid room system development; (3) the employer's experience led to appropriate fit-for-work examinations and emergency preparedness; and (4) the feedback from BOHS providers led to a hospital-to-in-plant return-to-work conversion. The study concluded that the enterprise could develop fit-for-work and return-to-work assessments as per the ILO Convention C161 under the policy; however, medical surveillance and the first aid room system need to be developed through counseling at the hospital's occupational medicine clinic.

A Repository for Publications on Basic Occupational Health Services and Similar Health Care Innovations

Background

Occupational health services are not available for more than 80% of the global workforce. This pertains especially to informal workers, workers in agriculture and in small enterprises, and self-employed. Many are working in hazardous conditions. The World Health Organization, the International Labor Organization, the International Commission on Occupational Health, and the World Organization of Family Doctors promote as part of a solution, basic occupational health services (BOHS) integrated in primary or community health care. Quality information on this topic is difficult to find. The objective of this study is to develop an open access bibliography, a repository, referring to publications on BOHS and similar innovations, to support progress and research.

Methods

The database design and sustaining literature searches (PubMed, Google Scholar, SciELO) are described. For each publication selected, basic bibliographic data, a brief content description considering copyright restrictions, and a hyperlink are included.

Results

Searches resulted in a database containing 189 references to publications on BOHS such as articles in scientific journals, reports, policy documents, and abstracts of lectures. A global perspective is applied in 43 publications, a national or regional perspective is applied in 146 publications. Operational and evaluative research material is still scarce. Examples of references to publications are shown.

Conclusion

The repository can inspire pioneers by showing practices in different countries and can be used for reviews and in-depth analyses. Missing publications such as from China, Russia, Japan, Republic of Korea, and Spanish/Portuguese speaking countries, can be added in the future, and translated. Search functions can be developed. International collaboration for the promotion of occupational health coverage for all workers must be intensified.

A SWOT analysis of contemporary gaps and a possible diagnostic tool for environmental health in an upper-middle income country: a case study of South Africa

This study evaluated the state of environmental health in the Republic of South Africa using the strengths, weaknesses, opportunities, and threats (SWOT) analysis framework. The internal and external factor evaluations were conducted by reviewing existing literature searched using a combination of keywords and boolean functions. The weighted score for the strengths and weaknesses was 0.79 and 1.04, respectively. The external factor evaluations findings revealed that environmental health has an equal amount of threats and opportunities, however, the threats outweigh the opportunities. The total weighted score for the internal and external factor evaluations was 1.83 and 2.25, respectively, which were below the average value of 2.5. The internal-external factors matrix indicated that environmental health in the Republic of South Africa needs to be refocused and re-aligned to public health protection. Failure to address the weaknesses and threats and optimise the strengths and opportunities may further weaken the provision of environmental health services.

Integration of basic occupational health services into primary health care in Thailand: Current situation and progress

BACKGROUND

Informal workers are high-risk groups for getting occupational diseases. They also have difficulties in accessing occupational health services (OHSs). The Basic OHS (BOHS) program integrates BOHS activities into existing primary health care. The study aims to describe how the BOHS program has been developed and to update the situation of BOHS in Thailand.

METHODS

Four steps for the development of the program include (1) preparation, (2) model development, (3) implementation and expansion, and (4) quality assurance (QA). The program started with the study of the situation of OHS in primary care units (PCUs) and identification of the gap for OH practice among PCUs' staff. The pilot study was conducted in 19 PCUs. After that, expansion of the model and quality assurance of the services have been implemented until now.

RESULTS

In 2019, 84% of PCUs (8242) provided BOHS, but the number decreased to 22% (2123 PCUs) in 2020. The target groups were mainly farmers. The OHS activities include an arrangement of farmers' clinics and conducting outreach activities in the field. The latest health surveillance program for farmers reported that 40.5% of 862,585 farmers had high pesticide exposure by field-kit testing. Regarding the QA audit, 75% of PCUs were certified for basic or higher levels of BOHS standards.

CONCLUSIONS

Integration of OHS into the PCUs is feasible, successful and replicable. Its sustainability requires policy support, continued empowerment of staff, and resource allocation.