Esophageal and Head and Neck Cancer Patients Attending Ocean Road Cancer Institute in Tanzania from 2019 to 2021: An Observational Study.

BACKGROUND: Cancer in Africa is an emerging public health problem that needs urgent preventive measures, particularly in workplaces where exposure to carcinogens may occur. In Tanzania, the incidence rate of cancer and mortality rates due to cancers are increasing, with approximately 50,000 new cases each year. This is estimated to double by 2030. METHODS: Our hospital-based cross-sectional study describes the characteristics of newly diagnosed patients with head and neck or esophageal cancer from the Ocean Road Cancer Institute (ORCI), Tanzania. We used an ORCI electronic system to extract secondary data for these patients. RESULTS: According to the cancer registration, there were 611 head and neck and 975 esophageal cancers recorded in 2019-2021. Two-thirds of these cancer patients were male. About 25% of the cancer patients used tobacco and alcohol, and over 50% were involved in agriculture. CONCLUSION: Descriptions of 1586 head and neck cancer patients and esophageal cancer patients enrolled in a cancer hospital in Tanzania are given. The information may be important for designing future studies of these cancers and may be of value in the development of cancer prevention measures.

Status of Occupational Health and Safety and Related Challenges in Expanding Economy of Tanzania.

INTRODUCTION: Occupational health and safety is related with economic activities undertaken in the country. As the economic activities grow and expand, occupational injuries and diseases are more likely to increase among workers in different sectors of economy such as agriculture, mining, transport, and manufacture. This may result in high occupational health and safety services demand, which might be difficult to meet by developing countries that are prioritizing economic expansion without regard to their impact on occupational health and safety. OBJECTIVE: To describe the status of occupational health and safety in Tanzania and outline the challenges in provision of occupational health services under the state of an expanding economy. FINDINGS: Tanzania's economy is growing steadily, with growth being driven by communications, transport, financial intermediation, construction, mining, agriculture, and manufacturing. Along with this growth, hazards emanating from work in all sectors of the economy have increased and varied. The workers exposed to these hazards suffer from illness and injuries and yet they are not provided with adequate occupational health services. Services are scanty and limited to a few enterprises that can afford it. Existing laws and regulations are not comprehensive enough to cover the entire population. Implementation of legislation is weak and does not protect the workers. CONCLUSIONS: Most Tanzanians are not covered by the occupational health and safety law and do not access occupational health services. Thus an occupational health and safety services strategy, backed by legislations and provided with the necessary resources (competent experts, financial and technological resources), is a necessity in Tanzania. The existing legal provisions require major modifications to meet international requirements and standards. OHS regulations and legislations need refocusing, revision, and strengthening to cover all working population. Capacities should be improved through training and research to enable enforcement. Finally the facilities and resources should be made available for OHS services to match with the growing economy.

Respiratory symptoms, exhaled nitric oxide, and lung function among workers in Tanzanian coffee factories.

OBJECTIVE: To compare chronic respiratory symptoms, fractional exhaled nitric oxide (FENO), and lung function between Robusta and Arabica coffee workers and a control group. METHODS: Chronic respiratory symptoms were assessed by a questionnaire (n = 138 coffee workers and n = 120 controls). The FENO was measured by NIOX MINO device (Aerocrine AB, Solna, Sweden). Lung function was examined by a portable spirometer. RESULTS: Coffee workers had higher prevalence of chronic respiratory and asthma symptoms than controls. Robusta coffee workers were exposed to higher levels of endotoxin and had more asthma symptoms than Arabica coffee workers (38% vs. 18%). Coffee workers had reduced lung function associated with cumulative exposure to total dust and endotoxin. CONCLUSION: Work in coffee factories is associated with small but significant lung function impairment. These changes were not associated with the level of FENO.

Personal exposure to dust and endotoxin in Robusta and Arabica coffee processing factories in Tanzania.

INTRODUCTION: Endotoxin exposure associated with organic dust exposure has been studied in several industries. Coffee cherries that are dried directly after harvest may differ in dust and endotoxin emissions to those that are peeled and washed before drying. The aim of this study was to measure personal total dust and endotoxin levels and to evaluate their determinants of exposure in coffee processing factories. METHODS: Using Sidekick Casella pumps at a flow rate of 2l/min, total dust levels were measured in the workers' breathing zone throughout the shift. Endotoxin was analyzed using the kinetic chromogenic Limulus amebocyte lysate assay. Separate linear mixed-effects models were used to evaluate exposure determinants for dust and endotoxin. RESULTS: Total dust and endotoxin exposure were significantly higher in Robusta than in Arabica coffee factories (geometric mean 3.41 mg/m(3) and 10 800 EU/m(3) versus 2.10 mg/m(3) and 1400 EU/m(3), respectively). Dry pre-processed coffee and differences in work tasks explained 30% of the total variance for total dust and 71% of the variance for endotoxin exposure. High exposure in Robusta processing is associated with the dry pre-processing method used after harvest. CONCLUSIONS: Dust and endotoxin exposure is high, in particular when processing dry pre-processed coffee. Minimization of dust emissions and use of efficient dust exhaust systems are important to prevent the development of respiratory system impairment in workers.

Respiratory inflammation among workers exposed to airborne dust with endotoxins in a coffee curing factory.

OBJECTIVE: To study dust exposure and inflammatory reactions in the respiratory tract among coffee curing workers in Tanzania. METHODS: A cross-sectional study was conducted in a Tanzanian coffee curing factory. Coffee workers (n = 15) were compared with unexposed controls (n = 18); all workers were nonsmokers. Exhaled nitric oxide was examined using an electrochemistry-based NIOX MINO device. Personal air samples were analyzed for total dust and endotoxins, using gravimetric analysis and the chromogenic Limulus amebocyte lysate endpoint assay, respectively. RESULTS: Total dust levels ranged from 0.2 to 27.9 mg/m, and endotoxin levels ranged from 42 to 75,083 endotoxin units/m. Concentrations of exhaled nitric oxide, analyzed by linear regression and adjusted for age (ß = 0.57; 95% confidence interval, 0.08 to 1.06; P = 0.02), was higher among coffee workers than among the control group. CONCLUSION: The results indicate a relationship between the coffee dust and signs of respiratory inflammation.

Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study.

BACKGROUND: Coffee processing causes organic dust exposure which may lead to development of respiratory symptoms. Previous studies have mainly focused on workers involved in roasting coffee in importing countries. This study was carried out to determine total dust exposure and respiratory health of workers in Tanzanian primary coffee-processing factories. METHODS: A cross sectional study was conducted among 79 workers in two coffee factories, and among 73 control workers in a beverage factory. Personal samples of total dust (n = 45 from the coffee factories and n = 19 from the control factory) were collected throughout the working shift from the breathing zone of the workers. A questionnaire with modified questions from the American Thoracic Society questionnaire was used to assess chronic respiratory symptoms. Differences between groups were tested by using independent t-tests and Chi square tests. Poisson Regression Model was used to estimate prevalence ratio, adjusting for age, smoking, presence of previous lung diseases and years worked in dusty factories. RESULTS: All participants were male. The coffee workers had a mean age of 40 years and were older than the controls (31 years). Personal total dust exposure in the coffee factories were significantly higher than in the control factory (geometric mean (GM) 1.23 mg/m3, geometric standard deviation (GSD) (0.8) vs. 0.21(2.4) mg/m3). Coffee workers had significantly higher prevalence than controls for cough with sputum (23% vs. 10%; Prevalence ratio (PR); 2.5, 95% CI 1.0-5.9) and chest tightness (27% vs. 13%; PR; 2.4, 95% CI 1.1-5.2). The prevalence of morning cough, cough with and without sputum for 4 days or more in a week was also higher among coffee workers than among controls. However, these differences were not statistically significant. CONCLUSION: Workers exposed to coffee dust reported more respiratory symptoms than did the controls. This might relate to their exposure to coffee dust. Interventions for reduction of dust levels and provision of respiratory protective equipment are recommended.

Quartz exposure and increased respiratory symptoms among coal mine workers in Tanzania.

UNLABELLED: Quartz has been an inevitable composition of different type of coal mined. The quartz exposures among coalmine workers has been attributed to activities such as cutting the adjacent rock, the roof, the floor and the intrusions. OBJECTIVE: The aim of the study is to determine the associations between quartz exposures and respiratory health in a labour intensive coal mine. METHODS: 239 randomly selected men participated in the study. A respiratory questionnaire was used, collected information and data were analysed by SPSS version 15. The criterion for significant association was 0.05 and below. RESULTS: Logistic regression controlling for age, smoking status and duration of employment showed a significantly increased odds ratio for breathlessness in the high exposed group (OR = 3.9 (95%CI: 1.4, 10.7). In addition there were significantly increased odds ratio in the highest cumulative quartz group for cough day and night (OR: 3.6), cough for four days or more in a week (OR: 6.7), cough with sputum in day and night (OR: 6.5) and dyspnoea (OR: 10.9) (Table 4). CONCLUSION: The results from this study provide important information for targeting prevention program for reducing exposure at mine workplace. Improvements in the work environment where exposures are higher than the TLV for respirable silica, ought to be performed.

High prevalence of respiratory symptoms among workers in the development section of a manually operated coal mine in a developing country: a cross sectional study.

BACKGROUND: Few studies of miners have been carried out in African countries; most are from South Africa, where the working conditions are assumed to be better than in the rest of Africa. Several studies have focused on respiratory disorders among miners, but development workers responsible for creating underground road ways have not been studied explicitly. This is the first study assessing the associations between exposure to dust and quartz and respiratory symptoms among coal mine workers in a manually operated coal mine in Tanzania, focusing on development workers, as they have the highest exposure to coal dust. METHODS: A cross-sectional study was carried out among 250 production workers from a coal mine. Interviews were performed using modified standardized questionnaires to elicit information on occupational history, demographics, smoking habits and acute and chronic respiratory symptoms. The relationships between current dust exposure as well as cumulative respirable dust and quartz and symptoms were studied by group comparisons as well as logistic regression. RESULTS: Workers from the development group had the highest dust exposure, with arithmetic mean of 10.3 mg/m3 for current respirable dust and 1.268 mg/m3 for quartz. Analogous exposure results for mine workers were 0.66 mg/m3 and 0.03 mg/m3, respectively; and for other development workers were 0.88 mg/m3 and 0.10 mg/m3, respectively. The workers from the development section had significantly higher prevalence of the acute symptoms of dry cough (45.7%), breathlessness (34.8%) and blocked nose (23.9%). In addition, development workers had significantly more chronic symptoms of breathlessness (17.0%) than the mine workers (6.4%) and the other production workers (2.4%). The highest decile of cumulative exposure to respirable dust was significantly associated with cough (OR = 2.91, 95% CI 1.06, 7.97) as were cumulative exposure to quartz and cough (OR = 2.87, CI 1.05, 7.88), compared with the reference consisting of the group of workers with the lowest quartile of the respective cumulative exposure. CONCLUSION: The development workers in a coal mine had more acute and chronic respiratory symptoms than the mine and the other production workers. In addition, there was an association between high cumulative coal dust and respiratory symptoms.

Airflow limitation among workers in a labour-intensive coal mine in Tanzania.

OBJECTIVES: To describe the relationship between cumulative respirable dust and quartz exposure and lung functioning among workers in a labour-intensive coal mine. METHODS: The study population comprised 299 men working at a coal mine in Tanzania. Lung function was assessed using a Vitalograph alpha III spirometer in accordance with American Thoracic Society recommendations. Multiple linear regression models were developed to study the relationship between forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC) and FEV(1)/FVC and the cumulative dust or quartz exposure while adjusting for age, height and ever smoking. To evaluate trends for dose response, cumulative exposure concentrations for respirable dust and quartz were ranked and categorized in quartiles and the highest decile, with the first quartile as the reference group. Logistic regression models were used to determine odds ratios for FEV(1)/FVC < 0.7 and FEV(1)% < 80 for categories of cumulative dust or quartz exposure. RESULTS: The prevalence of FEV(1)/FVC < 0.7 among the workers was 17.3%. Workers in the development team (20.5%) had the highest prevalence of FEV(1)% < 80%. The estimates of the effects of cumulative exposure on FEV(1)/FVC were -0.015% per mg years m(-3) for respirable dust and -0.3% per mg years m(-3) for respirable quartz. In logistic regression models, the odds ratios for airway limitation (FEV(1)/FVC < 0.7) for the workers in the highest decile of cumulative dust and quartz exposure versus the referents were 4.36 (95% confidence interval: 1.06, 17.96) and 3.49 (0.92, 13.21), respectively. The upper 10% of workers by cumulative dust and quartz exposure also had higher odds ratios for predicted FEV(1)% < 80% than the reference group odds ratio: 10.38 (1.38, 78.13) and 14.18 (1.72, 116.59), respectively. The results must be interpreted with caution due to a possible healthy worker effect and selection bias. CONCLUSION: Exposure to respirable coal mine dust was associated with airway limitation as measured by FEV(1)/FVC and predicted FEV(1)%.

Variability of exposure and estimation of cumulative exposure in a manually operated coal mine.

This study aims at estimating variability in exposure to respirable dust and assessing whether the a priori grouping by job team is appropriate for an exposure-response study on respiratory effects among workers in a manually operated coal mine in Tanzania. Furthermore, estimated exposure levels were used to calculate cumulative exposure. Full-shift personal respirable dust samples (n = 204) were collected from 141 randomly chosen workers at underground and surface work sites. The geometric mean exposure for respirable dust varied from 0.07 mg m(-3) for office workers to 1.96 mg m(-3) for the development team. The analogous range of respirable quartz exposure was 0.006-0.073 mg m(-3). Variance components were estimated using random effect models. For most job teams the within-worker variance component was considerably higher than the between-worker variance component. For respirable dust the estimated attenuation of the linear exposure-response relationship was low (5.9%) when grouping by job team. Grouping by job team was considered appropriate for studying the association between current dust exposure and respiratory effects. Based on the estimated worker-specific mean exposure in the job teams, the arithmetic mean cumulative exposure for the 299 workers who participated in the epidemiological part of the study was 38.1 mg* yr m(-3) for respirable dust and 2.0 mg* yr m(-3) for quartz.

High exposure to respirable dust and quartz in a labour-intensive coal mine in Tanzania.

Labour-intensive mines are numerous in several developing countries, but dust exposure in such mines has not been adequately characterized. The aim of this study was to identify and quantify the determinants of respirable dust and quartz exposure among underground coal mine workers in Tanzania. Personal respirable dust samples (n = 134) were collected from 90 underground workers in June-August 2003 and July-August 2004. The development team had higher exposure to respirable dust and quartz (geometric means 1.80 and 0.073 mg m(-3), respectively) than the mining team (0.47 and 0.013 mg m(-3)), the underground transport team (0.14 and 0.006 mg m(-3)) and the underground maintenance team (0.58 and 0.016 mg m(-3)). The percentages of samples above the threshold limit values (TLVs) of 0.9 mg m(-3) for respirable bituminous coal dust and 0.05 mg m(-3) for respirable quartz, respectively, were higher in the development team (55 and 47%) than in the mining team (20 and 9%). No sample for the underground transport team exceeded the TLV. Drilling in the development was the work task associated with the highest exposure to respirable dust and quartz (17.37 and 0.611 mg m(-3), respectively). Exposure models were constructed using multiple regression model analysis, with log-transformed data on either respirable dust or quartz as the dependent variable and tasks performed as the independent variables. The models for the development section showed that blasting and pneumatic drilling times were major determinants of respirable dust and quartz, explaining 45.2 and 40.7% of the variance, respectively. In the mining team, only blasting significantly determined respirable dust. Immediate actions for improvements are suggested to include implementing effective dust control together with improved training and education programmes for the workers. Dust and quartz in this underground mine should be controlled by giving priority to workers performing drilling and blasting in the development sections of the mine.