The global distribution of epidemiological studies involving waste pickers: A systematic review

Waste pickers, who work with the collection of recyclable materials in search of a source of income, are subject to various risks and diseases that are very well researched. The aim of this systematic review was therefore to identify and analyze the results of epidemiological research on waste pickers over the last 20 years as well as to investigate the geographical distribution and quality of these studies. The studies were selected from the literature by creating search keys with representative keywords in different databases. This systematic review exceptionally includes research qualified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. In total, 61 epidemiological studies with waste pickers were found in 15 different countries, with the largest number of studies carried out in the American continent compared to the African and Asian, respectively. Regarding the quality, 91.80 % were classified as excellent and 8.20 % as good. Although the results show a significant number of epidemiological studies with waste pickers, demonstrating scientific evidence, that there is still a lack of research focusing on waste pickers in different work scenarios, from different health perspectives and in different parts of the world, and it is not possible to highlight the trends in health research for this profession.

A qualitative study understanding immigrant Latinas, violence, and available mental health care

Women from Latin American countries experience high levels of psychological and physical abuse and violence. Immigrant Latina women are often subjected to a patriarchal system in both family and government, which has resulted in a variety of complex and far-reaching outcomes. This qualitative study sought to understand the experiences of immigrant Latina women who were exposed to violence, as well as their access to mental health care. This study used 20 interviews with immigrant Latina women from El Salvador, Guatemala, and Mexico who had accessed mental health services in California. The primary themes that emerged from analysis of the data included motivating factors for seeking services (e.g., motherhood, community, hope, and mental health needs), barriers to accessing services (e.g., fatalism, marianismo, stigma, finances, language barriers, threats, abuse, and systemic insensitivity), and treatment and solutions (e.g., empathy, advocacy, and community approaches). These results appeared to be indicative of the importance of addressing sociopolitical, historical, and cultural trauma as an imperative component of effective treatment. In this context, the authors explore liberation psychology, a concept and approach that promotes social justice values and emphasizes the empowerment of immigrant Latina women in clinical practice. It is recommended that the historical sociocultural abuse of immigrant Latina women be thoughtfully considered and discussed in the therapeutic process to create lasting psychological change. Future research, policy efforts, and program development, including psychotherapeutic treatment modalities, should focus specifically on marginalized groups facing barriers to mental health care in order to increase access and effectiveness of treatment.

Stop treating waste pickers like garbage: An autoethnography on informal waste picking in Brazil

There are almost 8 billion people on the planet with every single one of them producing some type of waste. The cost of recycling and money made by selling recyclable products has created a strong foundation for informal waste picking to exist. Waste pickers sort through garbage to find recyclable material; it is estimated that there are around 20 million waste pickers worldwide. In 2022, I went to experience life as a waste picker in Brasilia, Brazil for a day to understand issues that may continue to exist in this informal industry. I worked in a triage center and used this experience to inform my autoethnography; even though I have worked in waste picker research for almost a decade, this experience led to a different conclusion. The most interesting issue that I found while working as a waste picker was the lack of uniformity in waste picking, which led to people working on the streets or in co-op triage centers. This population is vulnerable which is worsened from exposure to hazards by nature of the informal environment; this situation contributes to ongoing poor working conditions through lack of governmental oversight, policy development, and change. Ultimately, informality needs to be addressed.

Hepatitis B and C prevalence in waste pickers: a global meta-analysis

BACKGROUND

The objective of this research was to use a meta-analysis to understand the prevalence of hepatitis B or C in waste pickers worldwide.

METHODS

Epidemiological studies on hepatitis B and C in waste pickers were included adopting a systematic review with meta-analysis. Each selected article had its quality scored by all authors, evaluated according to the Loney's criteria, and evaluated for quality and bias verified with a funnel plot.

RESULTS

After employing Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, there were 12 studies used for this meta-analysis. The rate of hepatitis B seropositivity was 0.15 (95% CI 0.10-0.20), and hepatitis C was 0.08 (95% CI 0.04-0.12). This information suggests that waste pickers are exposed to many risks associated with poor quality of life working conditions as well as low health literacy rates.

CONCLUSION

The results of this meta-analysis confirm the vulnerability of waste pickers to hepatitis B and C infection and reinforce the importance of using personal protective equipment and immunizing workers.

Understanding mental health outcomes related to compassion fatigue in parents of children diagnosed with intellectual disability

BACKGROUND

Parenting a child diagnosed with intellectual disability includes a variety of stressors. The degree to which stress affects these parents has been given little emphasis. Compassion fatigue includes experiencing an emotional response to being unable to relieve the suffering of a loved one, burnout, strain and stress on the caregiver. Compassion fatigue develops in parents of children diagnosed with intellectual disability due to their caregiving roles.

METHOD

A phenomenological qualitative study was conducted using 25 semi-structured interviews to understand the mental health outcomes of parents caring for a child diagnosed with intellectual disability.

RESULTS

The results showed that initial emotional reactions after receiving their child's diagnosis was a combination of anxiety, depression and compassion satisfaction. This study's findings suggest that parents of children diagnosed with intellectual disability experience moderate levels of compassion fatigue in the caring of their child.

CONCLUSIONS

This research provides evidence that the caregiving of a child diagnosed with intellectual disability comes with a myriad of stressors that can lead to compassion fatigue.

Healthcare waste generation in hospitals per continent: a systematic review

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

Examining Opportunities, Challenges and Quality of Life in International Retirement Migration

As the world has become more interconnected due to the invention and innovation of communication and transportation technologies, more individuals than ever before have been able to travel long distances. In recent years, a growing number of physically able adults in late adulthood have chosen to move across national borders to less costly countries in order to obtain better quality of life upon reaching retirement age. In light of this under-researched but increasingly popular retirement trajectory, this research aimed to provide more insight into the opportunities and challenges that international retired migrants have encountered while retiring abroad. Through the lens of humanistic theory, this research employed a systematic review of research literature, the majority of which were peer-reviewed studies published within the last five years. The reviewed studies (n = 22) conducted spanned four out of seven continents, with heavy emphasis on Europe, the Americas, and Asia. Research results indicated that many of the international retired migrants took advantage of the opportunities of pleasant weather, lower cost of living, and various amenities offered by their host countries to enhance their quality of life by engaging in an active and meaningful lifestyle. However, language barriers, lack of social support, rising healthcare costs, increases in the cost of living, uncertain political climate, and different healthcare practices in their host countries, presented considerable challenges to many international retirees.

Barriers for homeless with dual diagnosis: lessons learned from intensive mobile psychosocial assertive community treatment program

Purpose

Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis.

Design/methodology/approach

A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis.

Findings

The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis.

Originality/value

This study adds to the growing body of literature showing that patient-centered care allows for more effective treatment and ultimately, improved health outcomes.

Likely Exacerbation of Psychological Disorders from Covid-19 Response

Anxiety and fear felt by people around the world regarding the coronavirus pandemic is real and can be overwhelming, resulting in strong emotional reactions in adults and children. With depressive and anxiety disorders already highly prevalent in the general population (300 million worldwide), depression and/or anxiety specifically because of the pandemic response is likely. Moreover, the current state of panic in the face of uncertainty is apt to produce significant amounts of stress. While this situation has the potential to cause psychological disorders in previously unaffected populations, perhaps more impactful is the exacerbation of symptoms of many existing disorders including anxiety, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and hoarding disorder.

A Qualitative Study on Noncommunicable Diseases in Waste Pickers in Brazil

BACKGROUND

Noncommunicable chronic diseases are associated with multiple risks factors and negative outcomes that are long-lasting and difficult to treat. Some populations may be at greater risk because of their socioeconomic status, lack of healthcare, environment, and poor work and living conditions. Informal waste pickers may experience higher levels of chronic diseases and often do not have access to care to manage symptoms.

OBJECTIVES

The aim of the present study was to understand the prevalence of chronic diseases in waste pickers, along with perceived associated risks and available treatments.

METHODS

A qualitative study was conducted, using interviews with 24 waste pickers who worked at Estrutural dumpsite in Brasilia, Brazil which was historically the second largest open-air dumpsite in the world.

RESULTS

Participants believed their commonly experienced chronic diseases were a result of working in the open-air dumpsite. Chronic diseases commonly noted in the interviews included hypertension, chronic pain, respiratory disease, diabetes, and kidney problems. Participants discussed self-medication or prescribed medication used to treat their conditions. Most participants had varying beliefs regarding prevention strategies to reduce disease; some ideas for prevention focused on religion, fate, and God when discussing outcomes related to illnesses. When answering questions regarding ideal working conditions to help prevent diseases, participants responded by expressing a desire for protective gear (e.g. PPE) which could help mitigate hazards associated with the dump.

CONCLUSIONS

Recyclable collectors were aware of occupational hazards to which they were exposed and associated noncommunicable chronic diseases but lacked education on the importance of preventive measures and access to healthcare services. The findings of the present study confirm the need to strengthen intersectoral actions to protect and uphold the health rights of this vulnerable population.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016.

COMPETING INTERESTS

The authors declare no competing financial interests.

A mixed methods study reviewing consumer experiences for oral health treatment in Medicaid-eligible children in Florida

OBJECTIVES

Oral health is essential to a person's overall health, well-being, and dignity; unfortunately, dental caries, which can cause pain and difficulty eating, affect approximately 50 percent of children between 6 and 8 years old. This is in part because Medicaid-eligible children face numerous obstacles obtaining dental care. To date, there are 74 million Americans who do not have dental coverage or access to dental services, which is strongly associated with race, class, gender, and ethnicity. The objective of this research was to identify barriers to accessing and utilizing children's Medicaid oral health care and services, to evaluate care delivery and quality, and to assist in establishing a more consumer-driven approach.

METHODS

A mixed methods study was conducted throughout the state of Florida, using qualitative and quantitative data collection to seek answers to these questions. There were 422 surveys and 39 interviews distributed to Medicaid-eligible families and individuals across the state; data collection focused on experiences with oral health care, gaps in current access to Medicaid dental care, and concerns when utilizing care.

RESULTS

Our study shows the majority of barriers parents face when accessing Medicaid oral health care are due to logistical access issues, such as cost, appointment wait-times, and confusion surrounding which dental providers accept specific insurance plans. The findings also highlight how location, race, language, and ethnicity impact families who lack preventive dental health services access and how, in turn, families view their own access to dental services.

CONCLUSION

Ultimately, there exists an avenue to implement programs and policies that address existing disparities in oral health to improve health outcomes by increasing access to care and reducing cultural and socioeconomic barriers.

A systematic review on informal waste picking: Occupational hazards and health outcomes

Informal waste picking is a common way for people to earn an income, especially in low-income countries; unfortunately, there are various occupational hazards and health outcomes associated with waste picking. This study focused on comprehensively identifying and exploring occupational hazards and health outcomes associated with informal waste picking. A systematic review of available relevant and peer-reviewed literature was completed to exhaustively analyze the full scope of these hazards and outcomes associated with informal waste picking; 58 papers were included. The results from this study provided insight and information related to the most common occupational hazards and negative health outcomes associated with informal waste pickers outlined in available literature. The most common reported occupational hazards were physical (77.6%), social (70.7%), biological (65.5%), chemical and safety (53.4%), ergonomic (34.5%) and mechanic (25.9%). Health outcomes appeared to include epidermal (50.0%), communicable disease (46.6%), musculoskeletal (44.8%), respiratory disease (41.4%), non-communicable diseases (39.7%), physiological (34.5%), gastrointestinal (31.0%) and waterborne diseases (17.2%). Physical hazards were often associated with slips, trips, and falls, which makes sense because of the unstable environment where waste pickers work. Health outcomes related to these hazards included bruises, cuts, and lacerations. This information also aligns with health outcomes, as epidermal outcomes were most reported in waste pickers (50.0% of data). It is clear that moving forward, additional research related to these occupational hazards and health outcomes associated with informal waste picking is needed to help create change in this affected population, as well as finding effective solutions to mitigate these hazards and outcomes. These hazards can be mitigated by simple, common control measures, like providing safety equipment, reducing hazards from the outside environment (e.g., less time in sun, breaks, etc.), and placing barriers between waste pickers and the hazards (e.g., covered stations, flat ground, etc.) or more complex engineering, administrative or work controls. Because of the breadth of health problems faced by workers, more research is needed to correctly assess health outcomes (e.g. use of health practitioners) in waste pickers across time to ensure accurate data and a focused answer to the far-reaching problem.

Syphilis and other sexually transmitted infections among waste pickers in Brasilia, Brazil

There are millions of waste pickers worldwide that are predominantly located in low- and middle-income countries. They survive on sorting and selling reusable orrecyclable materials discarded by society.While sorting, they are exposed to occupational risks and hazards, including cuts from sharp objects and medical wastes, that could be contaminated by infectious diseases. Because of these exposures, a study was conducted to determine the prevalence of syphilis and other sexually transmitted infections (STI's) among waste pickers. A cross-sectional study using a semi-structured questionnaire and blood samples for serological tests were collected. A total of 1,025 waste pickers were interviewed. Most participants were women (67.54%), without a partner (70.11%), were an average of 40 years old, and had between 3 and 4 children. There were 755 samples collected for syphilis, 791 for HIV, 866 for hepatitis B, and 859 for hepatitis C. Of these samples, 28 (3.70%) waste pickers had reagent serology for syphilis, 6 (0.75%) for HIV; 6 (0.69%) for acute hepatitis B and 1 (0.11%) for hepatitis C. Overall, this study identified the serological status of waste pickers; this information can be used to encourage waste pickers to seek health treatment for STIs and receive education to understand the risks associated with being exposed to medical waste or syringes.

Water quality index and sanitary and socioeconomic indicators in Minas Gerais, Brazil

Minas Gerais is one of the 27 federative units of Brazil; it is the fourth state with the largest territorial area and the second in number of inhabitants. Since 1997, the monitoring of the surface water quality of the State of Minas Gerais has been carried out. In this study, generalized regression models were constructed to determine the correlation between the Water Quality Index (WQI) and the sanitary and socioeconomic variables: Municipal Population, Human Development Index (HDI), Gini Index, Percentage of Vulnerables to Poverty (Poverty), Monthly Per Capita Income, Percentage of Inadequate or Poor Sanitation. In addition to the sanitary and socioeconomic variables listed, it also used year of water quality monitoring, altitude of the monitoring point, and distance from the monitoring point to the urban center of the municipality. The results from the generalized models showed that the variables year, altitude, Gini Index, monthly per capita income, and poor sanitation variables were positively associated with WQI. In other words, high values of each variable increased WQI, while population variables HDI and poverty were negatively related to WQI, that is, a high population value, HDI, or poverty implies a low WQI value. Socioeconomic variables such as HDI, Gini Index, poorness, or poor sanitation percentage present the coefficients with the largest modulus. Thus, among the socioeconomic variables studied, these are the ones that most contribute to the variability of WQI. The year and altitude variables have positive regression coefficients, indicating that when these variables increase, WQI also increases. The positive correlation with the year shows that the surface water quality of Minas Gerais improved during the monitoring years.

Virulence, antimicrobial resistance and phylogenetic analysis of zoonotic walking pneumonia Mycoplasma arginini in the one-humped camel (Camelus dromedarius)

In the scientific literature, a small amount of information is found concerning mycoplasmosis in camel species. A variety of pathogens could be causative agents for pneumonia, but walking pneumonia is mostly caused by Mycoplasma with slow development and mild symptoms. The aim of this study was to identify mycoplasmas from camels (Camelus dromedarius) and extending the arsenal of factors implicated in pathogenicity of M. arginini to shed light on the current knowledge gap. 460 lung samples (pneumonic; n=210 and apparently healthy; n=250) were randomly collected from the one-humped camels (C. domedarius) that have been imported from Sudan and slaughtered at Cairo Slaughterhouse. 48 out of 210 isolates (22.9%) recovered from the pneumonic lungs were recorded as M. arginini. Positive PCR results were obtained for all 48 isolates. On the other hand, infection with the organism was not detected in the apparently healthy lungs. Hemolysis and hydrogen sulphide (H2S) production, a compound that has previously not been identified as a virulence factor in M. arginini, was evident in 100% of the isolates. The 48 M. arginini isolates were weak in their ability to form biofilm on polystyrene surfaces. All isolates were 100% susceptible to florfenicol and streptomycin and 100% resistant to ciprofloxacin. Resistance to lincomycin, spiromycin, tylosin, doxacyclin and erythromycin was observed at different frequencies. 13 different combinations of antibiotics representing one to four classes were evident with the Macrolide erythromycin being the most represented. It also should be noted that the ciprofloxacin, doxacyclin, lincomycin, erythromycin combination was the most noted in 21/48 isolates. Surprisingly, none of the virulence genes (vsp, uvrC and gapA) and quinolone resistance genes (parC and gyrA) were detected by PCR.

Social vulnerabilities of female waste pickers in Brasília, Brazil

Worldwide, waste pickers are exposed to adverse health effects resulting from hazards at work. This study aimed to identify possible gender disparities among waste pickers. A quantitative cross-sectional epidemiological study, using semi-structured data was conducted in Estrutural's dumpsite, Brasília, Brazil. It included 1,025 waste pickers, with 67% being female. Most of them lived without partners (73.7%), have 3 to 4 children (47.8%), and have a lower monthly income (62.6%<USD 125) when compared to men (p < 0,001). Women also suffered from worse health outcomes than men: hypertension- 26.3%; 16.2% (p < 0.001), bronchitis- 16.4%; 9.7% (p 0,003), diarrhea- 28.3; 17.0 and worms- 16.0; 5.5% (p < 0,001), respectively. This study highlighted the existence of gender differences among waste pickers, which suggests a greater vulnerability of the female population who need policies, programs and awareness of society to ensure safe working and living conditions both for them and their children.

Vector-borne diseases in waste pickers in Brasilia, Brazil

Solid waste management is a challenge in developing countries. The Structural dump in Brasilia, Brazil, was the largest Latin American open-air dump until its closure in 2018. Thus, this study sought to investigate the prevalence of self-reported dengue, Zika and Chikungunya arbovirus infections in waste pickers who worked at the dumpsite and assess its association with the sanitary conditions in their residences and workplaces. This research used a mixed methods study using a questionnaire for the quantitative method and semi-structured interviews for the qualitative portion. A cross-sectional, observational, epidemiological study along with a phenomenological study were carried out to characterize socio environmental, occupational and health-related aspects to vector-borne diseases in Structural dumpsite in Brazil. Of the 1,025 respondents, 301 (29.2%) reported to have gotten sick from dengue, Zika or chikungunya fevers. We found significant associations between place of residence of waste pickers (p = 0,003) and the work conditions, use of personal protective equipment (p < 0.001) and weekly workload (p = 0.04) and occurrence of vector-borne disease. Results were confirmed by qualitative data and geo-referencing, in relation to location of their homes and proximity to the dumpsite, as well as through the vulnerability due to their working conditions. This research confirms that waste pickers are highly susceptible to vector-borne diseases; this situation that needs to be immediately addressed by interdisciplinary and intersectoral approaches in waste management and public health. This information confirms vulnerability of waste pickers to diseases transmitted by Ae. aegypti mosquito as a result of sanitary conditions at their residence and workplace.

Vancomycin and florfenicol resistant Enterococcus faecalis and Enterococcus faecium isolated from human urine in an Egyptian urban-rural community

Multidrug resistance is one of the top three threats to global public health. Understanding resistance of bacteria is important to help decrease resistance and improve the development of novel antimicrobial agents or other alternative tools to combat public health challenges. Thus, the goal of this study was to investigate the vancomycin and florfenicol resistance genes of five E. faecalis and 15 E. faecium isolated from patients with urinary tract infections. There were 20 Enterococcus obtained from the library collection of randomly selected private hospitals located in the city of El Qanater El Khayreya; these samples were isolated during 2017. Samples were evaluated for their phenotypic characterization of virulence factors, antimicrobial resistance and PCR was conducted to detect the prescence of the vancomycin vanABC and florfenicol resistance genes encoding the catAB, fexAB and cfu. There were six different antibiotic resistance profiles observed. The 20 isolates showed resistance to clindamycin, oxytetracycline and gentamycin. Resistance was evident to ciprofloxacin, norfloxacin and florfenicol in the absence of the cfr gene in all of the 20 Enterococcus isolates. In addition, all isolates produced biofilms and were classified as extensive drug resistant. MAR_indices of the isolates were >0.6. The MAR_index of human isolates of enterococci suggest these pathogens originate from a high-risk source of contamination where antibiotics are often used. This information highlights a possible public health concern to the Egyptian community. The results also suggest the emergence of a linezolid sensitive-vancomycin resistant E. faecium and E. faecalis in the absence of the cfr gene.

A Bottom-Up Approach Addressing Patient Care and Differential Diagnosis Amidst the Covid-19 Response

Patient care often refers to the broad spectrum of care, prevention, and treatment that a provider delivers, while the point of a differential diagnosis is to make a distinction between 2 or more conditions that share similar signs or symptoms. A broad differential should be considered for every single patient who is currently ill (eg, all patients with respiratory illnesses); without it, there will likely be an increase of misdiagnosis, unnecessary patient suffering, and an influx of patients to the emergency department. The COVID-19 response has forced many of these basic medical values aside, like providing differential diagnosis or practicing bedside manner through social interaction, while physicians struggle to continue care for patients. As a result, newly formed hospital and clinical policies may have dangerously traded everyday diagnosis and treatment of patients for the pandemic and quarantine recommendations. This type of assumptive medicine is based on a singular differential that can be detrimental to patients, who are more likely affected with more common illnesses, like bronchitis or pneumonia—or perhaps, even more threatening illnesses, like a pulmonary embolism, COPD exacerbation, congestive heart failure and even lung cancer. Although these new policies and reactions to COVID-19 are proactive, these actions could be at the cost of providing quality patient care for people who have not contracted COVID-19.

Waterborne diseases in waste pickers of Estrutural, Brazil, the second largest open-air dumpsite in world

Brazil was home to the second largest open-air dump in the world, Estrutural, which officially closed in January of 2018; however, many dumpsites throughout the country continue to operate informally. Prior to government-recognized closure, there were about 1200 waste pickers working at the dump. These workers were subject to a myriad of occupational and environmental risks; one primary hazard involved exposure to contaminated water, which significantly affects health and quality of life. As part of the official closure plan for Estrutural, a study was conducted to determine the occurrence of waterborne diseases and rates of intestinal worms among the workers. A convergent parallel mixed methods approach, using a cross-sectional study and semi-structured interviews, sought to uncover answers to these objectives. There were 1025 waste pickers used in this study. Data confirmed waste pickers experienced continuous bouts of waterborne disease cases through episodic diarrhea (24.9%), intestinal worms (12.6%), hepatitis A (1.7%) and leptospirosis (0.7%). People who lived in unregulated areas (favelas) had increased risk of diarrhea (OR = 1.72) and those who did not use filtered water were at increased risk of intestinal worms (OR = 1.87) and diarrhea (OR = 1.5). Qualitative and quantitative data confirmed that many workers suffered from waterborne diseases, and that women were at greater risk than men. These findings highlight unsanitary and poor occupational health conditions for waste pickers at dumpsites, which likely continue despite official dumpsite closures. Moreover, this data provide evidence of supplemental occupational hazards to assess at dumpsites worldwide, especially for women.

Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil

BACKGROUND

Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers.

OBJECTIVES

The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks.

METHODS

A qualitative study was conducted, using interviews with 34 participants at Estrutural.

RESULTS

Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care.

CONCLUSIONS

Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016.

COMPETING INTERESTS

The authors declare no competing financial interests.

Lessons learned from implementing alternative rites in the fight against female genital mutilation/cutting

Introduction

historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions appear to be only partially effective and sometimes yield unintended results, such as actually strengthening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper.

Methods

desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other non-governmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C.

Results

risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase into womanhood not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion.

Conclusion

changing a culturally embedded practice such as FGM/C is inherently complex. Because the cultural meanings ascribed to this practice are also evolving, any intervention that is effective at present might become superfluous in the future. A holy grail approach to change simply does not exist. Change needs to be levered in a variety of ways while working on the alignment of all these efforts by regular and thorough quantitative and qualitative assessments of effects and side-effects and reflections on lessons learned.

Ineffective waste site closures in Brazil: A systematic review on continuing health conditions and occupational hazards of waste collectors

There are approximately 15 million people engaged in waste collection or recycling activities in the world. Some of these dump sites are informal and people work in environments that are labor-intensive, unregulated, unregistered, low-paid, unrecorded, and environmentally hazardous. A systematic review was conducted to assess consequential health conditions and occupational risks that affect waste collectors in Brazil. The search was limited to Brazil because although the government closed dump sites, open-air dumping-the worst type of waste disposal-still occurs in about half of the country; moreover, Brazil is the only country to systematically collect data on the occupation, with an estimated 229,568 recyclable collectors of all types country-wide, which offers relevant and pertinent data on the topic. The results of the search indicated that nearly every region has individuals that work as recyclable collectors. As expected, the sites are full of occupational hazards to the workers that can include: long working hours; exposures to physical, chemical, mechanical, biological, ergonomic and social agents; and frequent work accidents. Exposure to these risks can result both in physical and psychological illnesses. In view of these findings, public policies could be strengthened by supporting and providing incentives to municipalities, schools, universities, health professionals, and all others who will contribute to the closure of open-air waste or poor waste disposal systems. Moreover, an improved awareness should be provided to the general population about environmental education and correct disposal of garbage. The goal of healthy waste disposal conditions ultimately decreases environmental and public health effects, while improving the working conditions, quality of life, and health outcomes for recyclable collectors.

AIDS-Affected Orphans in Sub-Saharan Africa: A Scoping Review on Outcome Differences in Rural and Urban Environments

Currently, there are more than 11 million AIDS-affected orphans that suffer from various adverse effects, most of whom reside in sub-Saharan Africa. The difference between whether a child resides in a rural or urban environment can have a significant role in a child's education, health status and access to healthcare, and social or family relationships. A scoping review was conducted in order to understand any possible environment-based differences on orphans directly affected by HIV/AIDS in sub-Saharan Africa. There were 233 sources used for this review; however, 164 manuscripts focused more so on a general review of orphans within a rural or urban environment. Thus, after eliminating for various factors, 69 manuscripts were removed, which focused primarily on the social aspect of orphans due to HIV/AIDS. Rural environments provided more family support, while urban environments generally had more resources available to orphans (e.g. school fees). Unfortunately, both rural and urban environments were found to be fairly non-supportive of orphans and their development. This scoping review found, in general, that orphans in both urban and rural environments continue to suffer from the consequential effects of low parental support due to AIDS mortality. These conclusions suggest that specific support to orphans through school and social relationships encourage better development outcomes in sub-Saharan Africa.

A systematic review on the management and treatment of mercury in artisanal gold mining

Artisanal gold mining (AGM) continues to be a pervasive global health issue. While there are various problems associated with AGM, mercury exposure is the primary hazard contributing to adverse health effects in exposed human populations. Over the last several decades, many interventions have been developed and implemented to curb mercury emissions and releases, notwithstanding a comprehensive review of context specific effectiveness. A systematic review was conducted in order to specifically assess the impact of current mercury interventions within the AGM sector worldwide. To aid in this review, a resource pool of information on AGM and mercury, treatment and management of emissions and releases, and interventions was assembled through a search conducted via multiple search engines. This search determined that there have been many strategies used to reduce or eliminate mercury, through interventions or programs focusing on education, processing centers, or mercury alternative techniques. Education has focused on environment or health awareness or more specifically on cleaner or alternative techniques. Processing centers offered artisanal miners rudimentary equipment for grinding and amalgamation that extract less than 30% of the gold as an exchange for their tailings. Some techniques reduced mercury releases including retorts, mill leaching, vat-leaching, and others replaced mercury from the process such as magnets, direct smelting, sluices, and borax. There are both positive and negative outcomes associated with every intervention. Novel and comprehensive strategies-including mercury removal technology, miner education on mercury hazards, economic gains, and policy-are needed to address mercury public health issues associated with AGM.

A Qualitative Study on the Interconnected Nature of HIV, Water, and Family

Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

Access to water provides economic relief through enhanced relationships in Kenya

Introduction

Sub-Saharan Africa is comprised of low- and middle-income countries subject to the residual effects of chronic poverty. Poverty contributes to health disparities and social inequities. Public health strategies and solutions seek to remedy the effects of poverty. Providing access to quality water is one priority public health project that alleviates adverse health effects, but may have additional outcomes. Previous research has not thoroughly reviewed the economic relief and relationship changes from implemented water interventions.

Methods

A qualitative phenomenological approach used 52 semi-structured interviews to understand relationship experiences among primary water gatherers and their families after implemented water interventions in a community. This study took place throughout the historically semi-arid eastern region in Kitui, Kenya, where community members have been beneficiaries of various water interventions.

Results

Prior to the water intervention, relationships were strained because of economic hardships. Households experienced economic difficulties in paying for children's school fees, buying bricks for housing structures, having water for house gardens, trees for shade in the compound, crops and providing water for their animals. After receiving access to water, relationships improved, because families were able to discuss and address economic challenges. Additional financial revenue was gained and used to pay for water to make bricks to sell or use on housing structures, expand on house gardens and agricultural crops, build new businesses, purchase water for animals, and construct local water spouts near the household.

Discussion

Access to water improved relationships, which encouraged economic growth. This information provides a critical component in understanding the interconnected nature between access to water, poverty and family relationships. Ultimately, this research suggests an increased need for access to quality water worldwide to improve both economic situations and relationships in low- and middle-income countries.

Confirmed low prevalence of Listeria mastitis in she-camel milk delivers a safe, alternative milk for human consumption

She-camel milk is an alternative solution for people allergic to milk; unfortunately, potential harmful bacteria have not been tested in she-camel milk. Listeria monocytogenes is one harmful bacterium that causes adverse health effects if chronically or acutely ingested by humans. The purpose of this study was to estimate the prevalence, characterize the phenotypic, genetic characterization, virulence factors, and antibiopotential harmful bacteria resistance profile of Listeria isolated from the milk of she-camel. Udder milk samples were collected from 100 she-camels and screened for mastitis using the California mastitis test (46 healthy female camels, 24 subclinical mastitic animals and 30 clinical mastitic animals). Samples were then examined for the presence of pathogenic Listeria spp; if located, the isolation of Listeria was completed using the International Organization for Standards technique to test for pathogenicity. The isolates were subjected to PCR assay for virulence-associated genes. Listeria spp. were isolated from 4% of samples and only 1.0% was confirmed as L. monocytogenes. The results of this study provide evidence for the low prevalence of intramammary Listeria infection; additionally, this study concludes she-camel milk in healthy camels milked and harvested in proper hygienic conditions may be used as alternative milk for human consumption.

Prevalence, pathogenic capability, virulence genes, biofilm formation, and antibiotic resistance of Listeria in goat and sheep milk confirms need of hygienic milking conditions

Goat and sheep milk is consumed by human populations throughout the world; as a result, it has been proposed as an alternative, nutrient-rich milk to feed infants allergic to cow's milk. Unfortunately, potentially harmful bacteria have not been thoroughly tested in goat or sheep milk. Listeria monocytogenes is a harmful bacterium that causes adverse health effects if ingested by humans. The purpose of this study was to estimate the prevalence and characterize the phenotype, genotype, virulence factors, biofilm formation, and antibiopotential of Listeria isolated from the milk of goat and sheep. Udder milk samples were collected from 107 goats and 102 sheep and screened for mastitis using the California mastitis test (CMT). Samples were then examined for the presence of pathogenic Listeria spp; if detected, the isolation of pathogenic Listeria (L. monocytogenes and Listeria ivanovii) was completed using isolation and identification techniques recommended by the International Organization for Standards (ISO 11290-1, 1996), in addition to serological, in vitro and in vivo pathogenicity tests. The isolates were subjected to PCR assay for virulence associated genes (hlyA, plcA, actA, and iap). Pathogenic Listeria spp. were isolated from 5·6% of goat and 3·9% sheep milk samples, with 33·3 and 25% of these selected samples respectively containing L. monocytogenes. The results of this study provide evidence of the low-likelihood of contamination leading to the presence of L. monocytogenes in raw goat and sheep milk; however, this study also confirmed a strong in vitro ability for biofilm formation and pathogenic capability of L. monocytogenes if discovered in the milk. L. monocytogenes may be present in goat and sheep milk and in order to reduce the exposure, hygienic milking conditions must be employed for the milk to be considered a safe alternative for human consumption.

The maladies of water and war: addressing poor water quality in Iraq

Water is essential in providing nutrients, but contaminated water contributes to poor population health. Water quality and availability can change in unstructured situations, such as war. To develop a practical strategy to address poor water quality resulting from intermittent wars in Iraq, I reviewed information from academic sources regarding waterborne diseases, conflict and war, water quality treatment, and malnutrition. The prevalence of disease was high in impoverished, malnourished populations exposed to contaminated water sources. The data aided in developing a strategy to improve water quality in Iraq, which encompasses remineralized water from desalination plants, health care reform, monitoring and evaluation systems, and educational public health interventions.