Respiratory symptoms related to flour dust exposure are significantly high among small and medium scale flour mill workers in Ethiopia: a comparative cross-sectional survey

BACKGROUND@#International Labour Organization (ILO) report indicates more than 2.4 million workers die from work-related diseases and accidents each year. Work-related respiratory ailments related to airborne particulate matter such as flour dust are responsible for about 386,000 deaths and 6.6 million illness-adjusted life years. Even though exposure to flour dust together with the extreme expansions of flour mill sectors is a priority health concern, extent of the problem is little investigated in Ethiopia. The aim of this study was to evaluate the magnitude and risk factors of work-related respiratory symptoms among flour mill workers in Bahir Dar City, Ethiopia.@*METHODS@#This study employed a comparative cross-sectional survey of 560 samples (280 exposed group from flour mill workers and 280 unexposed group from office workers) with a stratified random sampling technique. The study was conducted from March to April 2019 in Bahir Dar City, Northwest Ethiopia. We used the British Medical Research Council (BMRC) questionnaire to assess work-related respiratory symptoms. The questionnaire was pretested and interview administered to collect data. Binary logistic regression analysis was fitted to evaluate significant factors of respiratory symptoms at a < 0.05 p value. Adjusted odds ratio (AOR) with a confidence interval (CI) of 95% was calculated to determine a strength of association.@*RESULTS@#All the sampled participants had fully responded to the interview. The median age of exposed and unexposed groups was 28.5 interquartile range (IQR, 20) and 31 (IQR, 15) years, respectively. The prevalence of work-related respiratory symptoms among flour mill workers was substantially higher than that of among controls, 63.9% and 20.7%, respectively (Χ@*CONCLUSION@#Respiratory symptoms emanating from exposure to various flour dusts were significantly higher among flour mill workers than among the control group. Therefore, we recommend the need to effectively implement health and safety programs that account for the reduction of dust at a source, use of engineering controls (e.g., provision of adequate ventilation systems), use of administrative measures (e.g., training program and health surveillance) and provision of a suitable personal protective equipment (PPE). Furthermore, it is vital to integrate workplace health and safety programs to the wider public health policies and strategies to effectively mitigate the burden of work-related respiratory conditions. We also encourage future studies to evaluate concentration of flour dusts combined with physical examinations to establish plausible associations of respiratory symptoms with dusts of flour mill-related origin.

The Prevalence of Iron Deficiency Anemia (IDA) and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: In Ethiopia, there are no data which reflect the current prevalence of iron deficiency (ID) or iron deficiency anemia (IDA) at national or regional levels. The 2014 Ethiopia National Micronutrient Survey (ENMS) will estimate the national and regional prevalence of ID and IDA among children 6-59 months old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The prevalence of ID will be determined by measuring serum ferritin (SF) and soluble transferrin receptor (sTfR) from venous blood samples using an automated electrochemiluminescence immunoassay (ELISA) and immuno-turbidimetry technique. Iron deficiency will be defined by SF<12.0 μg/L and sTfR>6.0 mg/L for children 6-59 months of age and SF<15.0 μg/L and sTfR>5.33 mg/L for non-pregnant women. Acute phase proteins alpha-1-acidglycoprotein (AGP) and C-reactive protein (CRP) will be measured to account for the effects of inflammation. The prevalence of anemia will be determined from hemoglobin levels in venous blood samples using a Hemocue® photometer. Anemia will be defined as hemoglobin <11.0 and <12.0 g/dL for children 6-59 months of age and non-pregnant women, respectively. IDA will be defined as either: 1) low serum ferritin levels and low hemoglobin (anemia) or 2) elevated sTfR (iron deficiency) and low hemoglobin (anemia). Results: The national and regional prevalence of iron deficiency and IDA will be presented with and without inflammation among children 6-59 months and non-pregnant women 15-49 years of age in Ethiopia. Conclusions: This survey will provide national and regional data for anemia control and fortification programs in Ethiopia.

The Prevalence of Vitamin A Deficiency (VAD) and Associated Factors among Vulnerable Populations in Ethiopia.

Objectives: There are no data which provide information on the current prevalence of VAD at the national and regional levels in Ethiopia. The 2014 Ethiopia National Micronutrient Survey (ENMS) will provide these estimates among children 6-59 months old and non-pregnant women 15-49 years of age in Ethiopia. Methods: The ENMS is a cross-sectional household survey designed to produce national and regionally representative estimates of vitamin A deficiency. The retinol concentration of venous blood serum will be determined by HPLC. Mild VAD will be defined as a serum retinol concentration <0.70 μmol/L and severe VAD as <0.35 μmol/L. Acute phase proteins alpha-1-acidglycoprotein (AGP) and C-reactive protein (CRP) will be measured by immunoassay technique to account for the effects of inflammation when interpreting VAD. Results: The national and regional prevalence of vitamin A deficiency will be presented among children 6-59 months and non-pregnant women 15-49 years of age with and without inflammation in Ethiopia. Conclusions: This survey will provide national and regional data for vitamin A supplementation and fortification programs in Ethiopia.

Implementation of Micronutrient Supplementations in Community-Based Nutrition Program in Ethiopia after Integrated Refresher Training (IRT).

Objectives: Community-Based Nutrition (CBN) is important component of National Nutrition Program, designed to build upon the Health Extension Program packages to improve nutritional status of under-five children, pregnant and lactating women. Therefore, this study was conducted to assess CBN program implementation after IRT. Methods: The study was conducted from October to November, 2012 in four agrarian regions. Institutional based cross-sectional study with both qualitative and quantitative data collection approach at 56 kebeles were used. Results: Some of the Health Extension Workers (HEWs) were not delivering GMP in a quality way as they were trained on IRT. For HEWs it was difficult to follow the procedure of GMP service properly. The gap in skill was higher in the new CBN woredas. Task shifting from VCHWs to HDAs didn't occur in most kebeles of Amhara region. In most regions it was observed that supportive supervision and review meetings are offered but it is not regular and consistent. It was observed that some new programs contradict with CBN service like new community health management information system. Based on the information gathered, all health post of study areas were conducting Community Health Day services for micronutrient supplementations in every three months regularly except very few. Conclusions: Factors which affect the implementation of CBN are: lack of training for both HEWs and HDAs, work load for HEWs. Training should be given as it helps to improve competencies/refresh the already trained and trainees those who didn't get it. Strengthening the CBN service can be achieved by increasing the manpower.

Effects of Governance Structures in Ethiopia on Implementation of Nutrition Interventions.

Objectives: 1. Assess factors that enhance or constrain implementation of nutrition interventions at national and sub national levels. 2. Analyze how direct nutrition interventions and multi sector approaches are implemented at national, regional, zonal and woreda levels. 3. Identify models of effective governance for nutrition interventions. Methods: Key informants were interviewed using a structured questionnaire. National level interviews from the agricultural, health, education, finance, economic development, social protection sectors and UN agencies, civil society and donors were included. Parallel interviews were conducted in four regions - Amhara, Oromia, SNNPR and Tigray - and 16 woredas for a total of 312 interviews at the subnational level. Results: While there was general awareness of the Government's activities as part of the SUN movement, key individuals at the national level were, in general, not able to identify specific actions that had been launched as a result of the 2013 National Nutrition Programme. Linkages between policy and program initiatives between national and sub national levels varied. The vertical and horizontal collaborations were most active where a specific, coordinating body or mechanism had been established. Several models of effective implementation are identified and most often originate outside the health sector. Conclusions: Two dominant models of implementing a multi pronged strategy to alleviate malnutrition exist in Ethiopia. The appropriateness of these models and factors associated with each are discussed.