Heavy metal exposure and renal impairment: A systematic review of observational studies

Background: Environmental exposure to toxins has been strongly implicated in its multi-faceted etiology of chronic kidney disease, a serious public health problem affecting individuals, families, and communities. There is a need to synthesize available studies on the effect of heavy metal exposure on renal function, considering the rising global burden of kidney disease. The objective of this study is to determine the association between exposure to heavy metals and renal disease. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) were used to conduct the review. A comprehensive independent search, title, abstract, and full-text screening of available literature on Google Scholar, PubMed, and OAREScience was done between March 2021 and May 2021. The criteria for study inclusion were full-text articles published in English language in the last 20 years (2001-2020), and observational primary human studies reporting the association between heavy metal exposure and renal disease. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies. Results: A total of 552 studies were identified following the search from the different databases. A total of 13 studies were finally included in the review. Heavy metals implicated in the studies include cadmium, lead, mercury, and arsenic, with ten studies showing environmental exposure as the primary source. Ten (10) studies showed an association between heavy metal exposure and renal impairment (p<0.05) while only 3 studies reported no association. Conclusion: Environmental monitoring is needed to stem the tide of heavy metal exposure in view of the growing burden of chronic kidney disease.

Occupational health and safety challenges among artisanal and small-scale diamond miners in Kimberley, South Africa

Background: Artisanal and small-scale mining (ASM) is a laborious process often executed with rudimentary low-technology mining equipment. It exposes miners to a myriad of occupational hazards, which may increase health and safety disparities between them and formally employed mine workers. Objectives: The objectives of the study were to identify workplace hazards and the associated risks; and to assess the effects of mining activities on the health and environment of artisanal diamond miners in Kimberley, Northern Cape province. Methods: This was an interdisciplinary observational ethnographic study. A workplace assessment was undertaken at seven sites in Kimberley. Participants were conveniently selected; snowballing was used to recruit additional participants. Field notes were recorded from observations. Interview questions included those about the duration of artisanal mining, and the risks faced in the workplace. Data collection included photographic documentation. An inductive and deductive process was used to analyse the data and thematic analysis was conducted. Results: The observed occupational hazards included physical (ultraviolet radiation exposure, injuries due to trauma), respiratory (silica dust exposure), biomechanical (heavy lifting, repetitive movement), and psychological (work-related stress, anxiety) hazards. There was a paucity of access to, and use of, personal protective equipment (PPE). Workers improvised ways to protect themselves, e.g. by using cloths as masks. There was no recourse to formal occupational health services and social safety networks. Conclusion: Occupational health and safety challenges included physical, biomechanical, respiratory, and psychosocial hazards. The mining activities had a detrimental impact on the environment.

Lessons from COVID-19 pandemic: teaching midwifery at the national level in Sierra Leone in the pandemic and post pandemic

The contents of this article are drawn from personal experiences and National response by the Ministry of Health and Sanitation during the COVID-19 pandemic in the midst of teaching in a midwifery training school. Teaching Midwifery in COVID-19 Pandemic and Post Pandemic periods impacted on the way student midwives were taught. Contextual issues are highlighted during the COVID-19 Pandemic in the Midwifery Education profession. But more speciacally, the impact of Covid-19 on midwifery education basically around the way students were taught, classroom spacing rearrangement and institutionalizing national protocols and guidelines on prevention of COVID-19 spread among staff and students.

Relation entre exposition professionnelle des manipulateurs de déchets d'équipements électriques et électroniques et problèmes respiratoires à Bamako en 2019 / Relationship between occupational exposure of waste electrical and electronic equipment handlers and respiratory problems in Bamako in 2019

Introduction: les déchets d'équipements électriques et électroniques (D3E), avec leurs enjeux sanitaires et environnementaux, sont devenus un problème de santé publique exposant les travailleurs aux composés d'éléments toxiques responsables de (2ème expertise) troubles respiratoires. Objectif: Etudier la relation entre l'exposition professionnelle aux D3E et la survenue des problèmes respiratoires à Bamako en 2019. Matériel et Méthodes : Il s'agissait d'une étude transversale, analytique de 6 mois, menée dans la ville de Bamako en 2019 et concernait 159 manipulateurs de D3E. Les données ont été collectées sur tablette et les analyses univariées et multivariées réalisées sur SPSS version 22 au seuil de significativité de 0,05 avec présentation des Odds Ratio (OR) et leurs intervalles de confiance à 95% (OR[IC95%]). Résultats : La prévalence en général des troubles respiratoires était de 67,3% chez les manipulateurs des D3E. On notait que le retrait du revêtement des fils électroniques (OR[IC95%] =25,93[2,30;291,53]), la perte de poids récente en dehors d'un régime (OR[IC95%] =7,43[1,68;32,85]) et la rareté de lavage des mains avec du savon après les toilettes (OR[IC95%] =11,50[2,07;63,89]) représentaient un risque plus élevé de problèmes respiratoires. Conclusion :Ces résultats montrent que les manipulateurs de D3E ont beaucoup de comportement à risque des problèmes respiratoires. Cette étude pourrait servir à la mise en œuvre de stratégies visant à réduire l'impact des D3E

Introduction: waste electrical and electronic equipment (WEEE), with its health and environmental issues, has become a public health problem exposing workers to toxic compounds causing respiratory problems. Objective: To study the relationship between professional exposure to WEEE and the occurrence of respiratory problems in Bamako in 2019. Material and Methods: This was a 6-month cross-sectional, analytical study carried out in the city of Bamako in 2019 and involved 159 WEEE manipulators. Data were collected using a tablet (2). Univariate and multivariate analyzes were performed using SPSS version 22 with the significance level of 0.05. Odds Ratio (OR) were presented with their 95% confident interval (OR [95%CI]). Results: The overall prevalence of respiratory disorders was 67.3% among WEEE handlers. It was noted that the removal of the coating of electronic wires (OR [95%CI] =25.93[2.30;291.53]), recent weight loss outside of a diet (OR [95% CI] =7,43[1.68;32.85]) and the infrequent hand washing with soap after the toilet (OR [95% CI] =11.50[2.07; 63.89]) represented a higher risk of (2) breathing problems. Conclusion: These results show that D3E handlers have a lot of risky behavior for respiratory problems. This study could be used to implement strategies to reduce the impact of D3E

Carcinome épidermoïde conjonctival invasif: à propos de 2 cas / Invasive squamous cell carcinoma: about 2 cases

Les tumeurs conjonctivales sont fréquentes dans les zones tropicales,où l'exposition aux rayons ultraviolets est forte et quasi permanente. Les tumeurs malignes sont assez rares et la plus représentée est le carcinome épidermoïde de la conjonctive.Nous rapportons deux cas de carcinome épidermoïde invasif de la conjonctive reçus dans le service d'ophtalmologie de l'hôpital Sominé Dolo de Mopti au Mali. Il s'agissait de deux patientes de 25 et 51 ans, vivant en zone rurale et désertique exposées aux rayons solaires et à la poussière. Elles présentaient une masse développée dans l'aire de la fente palpébrale, envahissant la cornée et empêchant l'occlusion palpébrale. La masse était en relief, multi lobulée, bien circonscrite, de couleur blanc nacré et d'aspect papillomateux avec une dilatation des vaisseaux nourriciers. Une exérèse chirurgicale large à 4 - 5 mm des berges de tissu sain a été réalisée avec examen anatomopathologique de la pièce qui a confirmé un carcinome épidermoïde différencié mature et invasif de la conjonctive. Le bilan d'extension et la sérologie HIV étaient négatifs. L'évolution était favorable à moyen terme sans récidive

Conjunctival tumors are common in tropical areas, where exposure to ultraviolet radiation is high and almost permanent. Malignant tumors are quite rare and the most represented is conjunctival squamous cell carcinoma. We report two cases of invasive squamous cell carcinoma of the conjunctiva received in the ophthalmology department of the Sominé Dolo hospital in Mopti, Mali. The patients were 25 and 51 years old, living in a rural desert area exposed to sunlight and dust. They presented with a mass developed in the area of the palpebral fissure, invading the cornea and preventing palpebral occlusion. The mass was raised, multi-lobulated, well circumscribed, pearly white in color and papillomatous in appearance with dilation of the feeder vessels. A wide surgical excision at 4 - 5 mm from the healthy tissue edges was performed with anatomopathological examination of the specimen, which confirmed a mature and invasive differentiated squamous cell carcinoma of the conjunctiva. The extension workup and HIV serology were negative. The evolution was favorable in the medium term without recurrence

Environmental factors influencing the distribution and prevalence of Schistosoma haematobium in school attenders of ILembe and uThungulu Health Districts, KwaZulu-Natal Province, South Africa

Schistosoma haematobium infection is reported to facilitate the development of urogenital diseases. Its symptoms include haematuria, dysuria and tiredness, and it may cause cognitive decline in children. The prevalence of S. haematobium infection needs to be known in endemic areas and a mass treatment programme against the disease implemented. The aim of this study was to investigate the prevalence and intensity of S. haematobium infection in ILembe and uThungulu health districts, using the major symptom, haematuria, as an indicator. A total of 6 265 urine samples, from 96 rural schools, was collected for analysis using dipsticks. The prevalence of haematuria in the ILembe health district was 37% (95% CI, 35­39%) for boys and 39% (95% CI, 37­41%) for girls. The prevalence of haematuria in the uThungulu health district was 56% (95% CI, 53­59%) and 53% (95% CI, 50­56%) for girls and boys, respectively. Light-intensity infection was the most common infection level in both health districts. A negative relationship was observed between prevalence and altitude (r = −0.262, p = 0.009); whereas, we found a slight, though significant, positive association with mid-summer temperatures (r = 0.234, p = 0.021). Associations between prevalence and distance of school to the nearest river were non-significant

A South African database of samples analysed for the presence of asbestos

Background: Asbestos mining and other activities have left a legacy of environmental contamination. Asbestos was used in a large number of manufactured products but little is documented about the nature and location of these products. Compliance with asbestos regulations depends on accurate identification of the presence of asbestos. The National Institute for Occupational Health (NIOH) has been identifying asbestos for regulatory purposes since 2003. Objective: To analyse a database of samples submitted for asbestos analysis to the NIOH. Methods: Asbestos was identified using scanning electron microscopy and energy dispersive spectroscopy. The data were analysed using STATISTICA version 11. Results: From 2003 to 2012; 1514 samples were analysed. Asbestos was identified in 59.9 of the bulk samples and crocidolite was present in 45.4 of these. Information about samples containing asbestos; including their origin and associated activities; are described. Conclusions: Although asbestos is no longer mined or used in South Africa; workers remain at risk of exposure due to asbestos-containing materials which persist in the environment. Knowledge of these materials gained from routinely collected data may assist in the safe removal of asbestos and prevent further adverse health =effects

Dermal exposure and changes in skin barrier function of base metal refinery workers co-exposed to cobalt and nickel

Refinery workers are exposed to many metals; including cobalt and nickel; both of which are skin sensitisers; causing allergic contact dermatitis. Dermal exposure; and changes in skin barrier function [skin hydration; transepidermal water loss (TEWL) and skin surface pH] from start to end of shift; of base metal refi nery workers co-exposed to cobalt and nickel; were assessed. Changes in SH were inconsistent; while TEWL generally increased and SS-pH decreased. The decrease in SS-pH is most likely due to direct skin contact with sulphuric acid. Dermal exposure was variable even though workers wore personal protective gloves; highlighting the limitations of personal protective clothing in controlling exposure. None of the workers presented with allergic contact dermatitis (ACD). The small sample size of this study limits the interpretation of the absence of ACD; but the healthy worker effect and ethnic differences in skin structure and function may be contributing factors

Magnitude and variation of traffic air pollution as measured by CO in the city of Addis Ababa, Ethiopia

Background: Air pollution level in Addis Ababa is presumed to be high due to the prevalence of old vehicles and substandard road infrastructures. This study assessed CO concentration as a measure of traffic air pollution. Materials and methods: a total of 80 road side and 24 on-road daily traffic air samples during wet and dry seasons of 2007 and 2008; respectively; were taken using CO data logger. A structured checklist was used to document related data. Downloaded data from the CO sampler was used to generate summary statistics and data presentations. Data quality of CO measurement was ensured using calibration checks. Results: The mean for 15 minutes CO concentration was 2.1 ppm (GM=1.3) and 2.8 ppm (GM=2.2) for wet and dry seasons; respectively. The concentrations from season to season varied statistically. The CO temporal and spatial profiles among the two seasons were similar. The overall mean on-road CO concentration was 5.4 ppm (GM=5.3). Fifteen percent of roadside samples and all on-road samples exhibited more than 50of the 8-hr CO WHO guideline.. Daily CO maxima were observed in early mornings and late afternoons. Conclusions: The consistency in spatial and temporal profiles and the variation on both on-road and road side traffic lines imply that vehicles are the main source of traffic air pollution. There is a concern that the CO 8-hr World Health Organization guideline might be exceeded in future. [Ethiop. J. Health Dev. 2010;24(3):156-166]

Occupational and environmental lead exposure in Port Harcourt, Nigeria: analysis of its association with renal function indices

Background: In spite of the high risk of lead exposure in Nigeria, there is a paucity of data on the occupational and environmental burden of lead exposure and its impact on human health especially its nephrotoxic effects. This study aims to assess the degree of occupational and environmental lead exposure in Port Harcourt Nigeria and the relationship between lead exposure and indices of renal function. Methods: A cross sectional comparative study of 190 adult subjects with occupational lead exposure and 80 matched controls. Blood lead was used as the biomarker of lead exposure. Serum urea, creatinine, uric acid, urine albumin and glomerular filtration rate were the renal function indices measured. Results: Occupationally lead exposed subjects had higher mean blood lead 50.37±24.58 ug/dl, than controls 41.40±26.85 ug/dl (p= 0.008). The mean values of serum urea, creatinine and uric acid were significantly higher in study subjects compared to controls 3.06±0.81 mmol/L vs. 2.7±0.84 mmol/L (p = 0.002), 87.2±14.30 umol/L vs. 80.68±14.70 umol/L (p = 0.001) and 271.93±71.18 umol/L vs. 231.1±62.70 umol/L (p = 0.000) respectively. Creatinine clearance was significantly lower in subjects compared to controls 98.86±21.26 ml/min/1.72m2 vs.108.18±25.16 ml/mi /1.72m2 (p = 0.002). Blood lead correlated positively only with blood urea [r = .031, r2 = .017, p = .031] and negatively [r = -.144, r2 = .021, p = .018] with serum phosphate. Conclusion: The level of environmental and occupational lead exposure in Port Harcourt, Nigeria is high, with occupational lead exposure increasing the risk of lead toxicity and renal function impairment

Clinical Waste Management in the Context of the Kanye Community Home-Based Care Programme; Botswana

This study examines clinical waste disposal and handling in the context of a community home-based care (CHBC) programme in Kanye; southern Botswana . This qualitative study involved 10 focus group discussions with a total of 82 HIV/AIDS primary caregivers in Kanye; one-to-one interviews with the five nurses supervising the programme; and participant observation. Numerous aspects of clinical or healthcare waste management were found to be hazardous and challenging to the home-based caregivers in the Kanye CHBC programme; namely: lack of any clear policies for clinical waste management; unhygienic waste handling and disposal by home-based caregivers; including burning and burying the healthcare wastes; and the absence of pre-treatment methods; inadequate transportation facilities to ferry the waste to clinics and then to appropriate disposal sites; stigma and discrimination associated with the physical removal of clinical waste from homes or clinics; poor storage of the healthcare waste at clinics; lack of incinerators for burning clinical waste; and a high risk of contagion to individuals and the environment at all stages of managing the clinical waste

Environmental Factors Affecting Malaria Parasite Prevalence in Rural Bolifamba; South-West Cameroon

The impact of some environmental factors on malaria parasite prevalence was investigated in rural Bolifamba; Cameroon. The study population comprised 1454 subjects aged 0 - 65 years. Malaria parasite prevalence was higher in the rainy (50.1) than in the dry season (44.2) with a significant difference (P=0.001) in mean parasite density between seasons. Individuals 15 years old; had significantly higher malaria parasite prevalence (55.5) than those 15 years (37.4). Malaria parasite prevalence (P=0.001) and parasite density (P=0.03) were higher in the individuals of wooden plank houses than those of cement brick houses. Inhabitants of houses surrounded by bushes or garbage heaps and swamps or stagnant water showed higher malaria parasite prevalence and densities compared with those from cleaner surroundings. Anopheles gambiae (63.8) and A. funestus (32.8) were associated with perennial transmission of malaria. Our data indicates that poor environmental sanitation and housing conditions may be significant risk factors for malaria parasite burden in Bolifamba

Lead exposure in urban and rural school children in Ghana

Human exposure to lead in non industrial urban areas is commonly ascribed to vehicular combustion of leaded gasoline. This belief is based on results of studies in societies with high vehicular density which show emission of lead fumes into the air by automobiles that use gasoline with high lead content. To assess this view; blood lead levels were evaluated in 11 to 15-year old school children in urban and rural communities of the Greater Accra Region; Ghana. Blood lead levels was significantly higher in all the urban children studied (mean +/-SD: 8.3+/- 12.7g/dl) than in their rural counterparts (4.0+/-7.2g/dl) (P0.002). The trend was the same when only those who tested positive for blood lead were considered (24.1+/- 9.2g/dl; urban compared with 14.6+/- 5.8g/dl; rural). The prevalence of lead exposure was; however; not significantly different between the two groups (34.3. percent; urban and 27.1 per cent; rural). The presence of anaemia and/or increased urine total protein levels was unrelated to the blood lead levels in the children form both communities. Although a set goal to achieve lead free gasoline is desirable; the closeness of the prevalence rate of lead exposure obtained in the study indicate that factors other than leaded gasoline may be important determinant in exposure to lead in the Ghanaian community