Sociodemographic and environmental factors associated with diarrhoeal illness in children under 5 years in Uganda, 2016: a cross-sectional study.

BACKGROUND: Uganda is among the 10 countries in the sub-Saharan Africa region that have the highest prevalence of diarrhoeal disease. Evidence suggests that the severity of childhood diarrhoeal disease is escalated through various sociodemographic and environmental factors. OBJECTIVES: To assess prevalence of diarrheal illness in children below the age of 5 years in Uganda in 2016 and associated factors. METHODS: A cross-sectional study was employed that analyzed secondary data from the 2016 Uganda Demography and Health Surveys. Children with and without diarrhea were compared. A logistic regression was used to determine sociodemographic and environmental factors associated with diarrheal illness in children with statistical significance at p < 0.05. RESULTS: The prevalence of childhood diarrhoeal illness for children below the age of 5 years in Uganda was 20.9% (n = 2838/13,753). There was a statistically significant difference when comparing children diarrhoeal with the following sociodemographic factors: caregiver's age, child's age and gender and duration of breastfeeding (p < 0.0001). Children with a caregiver aged between 15 and 24 years (aOR;1.42; 95% CI:1.24-1.62) and 25-34 years (aOR;1.19; 95% CI:1.04-1.37) were more likely to report diarrhoeal disease, compared to those with a caregiver aged 35-49 years. For environmental factors, households using springs water, access to health facility and children who received a dose of vitamin A had a decreased risk of reporting children diarrhoeal. CONCLUSION: Significant factors in the study like caregiver's age, gender and duration of breastfeeding will create the opportunity for all interventions to shift their focus to these factors thus a better evidence-based approach to reducing of diarrhoeal disease will be achieved in the country.

Men and women waste pickers on landfills in Johannesburg, South Africa: divergence in health, and socioeconomic status.

OBJECTIVE: To investigate gender differences in health in informal waste pickers affected by poverty and multiple environmental and work hazards. METHODS: A cross-sectional descriptive study was conducted at two major landfill sites in a large city. Information on health, work hazards and health care access as well as blood pressure, blood glucose, cholesterol and BMI were measured. RESULTS: A total of 361 waste pickers participated in the survey. The women interviewed earned on average 22% less per month than the men waste pickers. The women presented with worse chronic health outcomes (OR 2.69 95% CI 1.51-4.78) and signs of chronic disease (OR 1.73 95% CI 1.02-2.96) compared to men despite showing greater health-seeking behaviours. CONCLUSION: Women waste pickers suffer worse health outcomes, such as lifestyle diseases and HIV. Further research is needed to identify the factors involved. Responsive programs supporting health care, improved working conditions and income for waste pickers may also improve their health.

Ten-year risk of fatal cardiovascular disease and its association with metabolic risk factors among waste pickers in South Africa.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death among non-communicable diseases in South Africa. Several metabolic risk factors contribute to the development of CVD. Informal workers such as waste pickers could be unhealthy lifestyle naive, and most public health research on CVD does not include this understudied population. This study estimated the 10-year risk of fatal CVD and its association with metabolic risk factors in an understudied study population of waste pickers in Johannesburg, South Africa. METHODS: A cross-sectional survey was conducted among waste pickers in two landfill sites in Johannesburg. We used the Systematic Coronary Risk Evaluation (SCORE) risk charts to estimate the 10-year risk of fatal CVD. We then employed ordinary least squares regression to assess the association between the 10-year risk of fatal CVD with metabolic risk factors. Other variables adjusted in the regression model were HIV status, education, income, injuries from work, clinic visits in the previous 12 months, and alcohol consumption. RESULTS: A total of 370 waste pickers were included in this analysis, 265 (73.41%) were males. The mean age of the participants was 34 years. The majority were between the age of 20 and 39 years. More than 55% of the waste pickers did not visit a clinic in the previous 12 months, and 68.57% were smoking. The 10-year survival probability from CVD was more than 99% for both males and females. In the multivariable regression model, elevated blood glucose showed a non-significant increase in the mean percentage of 10-year risk of fatal CVD. Waste pickers who were overweight/obese, and hypertensive had high statistically significant mean percentages of the 10-year risk of fatal CVD compared to those who did not have the metabolic risk factors. CONCLUSIONS: Prevention of 10-year risk of fatal CVD in this understudied population of waste pickers should target the control of obesity, hypertension, and diabetes. Health awareness and education for waste pickers will be an important step in reducing the burden of these metabolic risk factors. We further recommend that health systems should recognize waste pickers as a high-risk group and consider extensive CVDs surveillance.

Overcrowding and health in two impoverished suburbs of Johannesburg, South Africa.

BACKGROUND: Rapid urbanization, unmatched by an associated supply of housing, has resulted in overcrowding in the cities of many developing countries, including in Johannesburg, South Africa. Household overcrowding has been associated with a range of ill-health outcomes, including acute respiratory infections and diarrhoeal diseases. The aim of this study was to describe the levels of household crowding, and examine associations with respiratory and gastrointestinal symptoms in selected two low-income neighbourhoods in Johannesburg. METHODS: Questionnaire data from a panel study conducted over an 11-year period between 2006 and 2016 were extracted to conduct the analyses. Structured questionnaires, designed to collect information on housing conditions, socio-economic and health status were administered to adult representatives of households occupying the primary dwelling on pre-selected study sites. RESULTS: Over the 11-year study period, levels of overcrowding remained unchanged. Around 57.6% of dwellings in the study neighbourhoods were determined to be overcrowded in relation to international guidelines. Results from the multiple logistic regression analyses indicated that crowded dwellings were associated with elevated levels of acute respiratory and gastrointestinal symptoms, as well as fever/chills. CONCLUSION: Respondent perceptions varied from objective measures of overcrowding. Crowded dwellings were associated with elevated reports of acute respiratory and gastrointestinal symptoms, as well as fever/chills.

A study protocol to determine the association between lifetime lead exposure and violent criminal behaviour in young males in conflict with the law.

BACKGROUND: Low-level lead exposure has harmful and persistent effects on behaviour. Recent studies have linked environmental lead exposure and the development of aggressive, violent and criminal behaviour. This protocol is designed to study an association between lifetime (bone) lead levels and violent criminal behaviour among young males in conflict with the law in Gauteng youth development centres. METHODS: This paper describes a study to determine a link between lifetime lead exposure and violent criminal behaviour. Lifetime lead exposure will be measured using bone lead measurement, while blood lead levels will be observed for current exposure. Thereafter, criminal records of participants will be reviewed whereas violent behaviour and risk factors will be observed using a questionnaire. The study focused on young males in conflict with the law in three centres within Gauteng Provence, South Africa. After stratifying the centres, we randomly selected participants. The researcher shall adhere to ethical requirements throughout the study. Data will be analysed for descriptive and inferential analysis using Statistical Package for Social Science (SPSS). DISCUSSION: The study will provide a strong foundation for an improved understanding of the relationship between environmental contamination from lead exposure and aggression/violent criminal behaviour. Beyond the health sector, the study findings may be able to inform new approaches to crime prevention through environmental action with an emphasis on the role of non-health sectors.

Usefulness of occupation and industry information in mortality data in South Africa from 2006 to 2015.

BACKGROUND: There is no population based occupational health surveillance system in South Africa, thus mortality data may be a cost effective means of monitoring trends and possible associations with occupation. The aim of this study was to use deaths due to pneumoconiosis (a known occupational disease) to determine if the South African mortality data are a valid data source for occupational health surveillance in South Africa. METHODS: Proportions of complete occupation and industry information for the years 2006-2015 were calculated for working age and retired adults. Deaths due to pneumoconiosis were identified in the data set and mortality odds ratios calculated for specific occupations and industry in reference to those who reported being unemployed using logistic regression. RESULTS: Only 16.1% of death notifications provided a usual occupation despite 43.1% of the population being employed in the year. The MORs for occupation provided significant increased odds of pneumoconiosis for miners (9.04), those involved in manufacturing (4.77), engineers and machinery mechanics (6.85). Along with these jobs the Mining (9.8), Manufacture (2.2) and Maintenance and repair industries (6.0) have significantly increased odds of pneumoconiosis deaths. The data can be said to provide a useful source of occupational disease information for surveillance where active surveillance systems do not exist. CONCLUSION: The findings indicate valid associations were found between occupational disease and expected jobs and industry. The most useful data are from 2013 onwards due to more detailed coding of occupation and industry.

Environmental health practitioners potentially play a key role in helping communities adapt to climate change.

BACKGROUND: Vulnerable population groups in South Africa, especially those living in poverty, young children, women, the elderly and people with pre-existing diseases, are susceptible to new or exacerbated health threats resulting from climate change. Environmental Health Practitioners (EHPs) can play an important role in helping communities adapt to climate change health impacts, however, effective coordination of this requires further understanding of their roles in implementing climate change-related adaptation actions in communities. METHODS: A cross-sectional survey using convenience sampling was undertaken at the January 2017 conference for EHPs hosted by the South African Institute of Environmental Health in Cape Town. All EHPs who attended the conference were invited to complete a study questionnaire that requested information on participant demographics, as well as climate change related-knowledge, practices and perceptions. RESULTS: Majority of participating EHPs (n = 48; 72.8%) had received formal or informal training on climate change and health. Thirty-nine percent of EHPs indicated that they had a climate change and health-related committee / working group in their department, a policy or strategy (41.0%) and budget allocated for climate change and health-related work (51.5%). A total of 33.3% had participated in climate change-related projects. Majority (62.2%) of EHPs believed that they should play a supportive role in addressing climate change while 37.8% believed that EHPs should play a leading role. CONCLUSIONS: Recognising the need for raising awareness about climate change adaptation as well as implementing appropriate interventions to combat climate-related ill health effects, especially among vulnerable groups, EHPs are well-placed to adopt significant roles in helping communities to adapt to climate change.

Concentrations of arsenic and lead in residential garden soil from four Johannesburg neighborhoods.

The 2017 Lancet Commission on Pollution and Health identified soil as an important, daily route of public exposure to a variety of pollutants. Lead and arsenic are two potential soil contaminants associated with serious health effects including reductions in intelligence, behavioral effects and aggressive or violent behavior (lead), as well as skin changes, cancer of the skin, bladder, liver and lungs and developmental delays (arsenic). In this study soil samples were collected, using US EPA methods, from gardens in four Johannesburg neighborhoods, and analyzed for lead and arsenic content using a portable X-ray fluorescence spectrometer. The results showed widely varied concentrations of arsenic and lead in soil collected across the four neighborhoods. Concentrations of lead (range: 0.1-2141.0 mg/kg; mean: 241.7 mg/kg (SD 282.8); median 158.1 mg/kg) exceeding local and international reference levels were found in an inner city suburb, while raised arsenic concentrations (range: 0.1-65.3 mg/kg; mean: 18.3 mg/kg (SD 11.7); median: 19.1) were found in the gardens of a suburb located very close to a mine tailings facility. This study confirms the potential for high levels of exposure to toxic metals in residential gardens in an urban African setting. There is a pressing need for scaled up attention to the public health implications of exposure to soil pollution in developing countries.

Exposure to lead in South African shooting ranges.

INTRODUCTION: Lead exposure in shooting ranges has been under scrutiny for decades, but no information in this regard is available in respect of African settings, and in South Africa specifically. The aim of this study was to determine the blood lead levels in the users of randomly selected private shooting ranges in South Africa's Gauteng province. METHODS: An analytical cross sectional study was conducted, with participants recruited from four randomly selected shooting ranges and three archery ranges as a comparator group. RESULTS: A total of 118 (87 shooters and 31 archers) were included in the analysis. Shooters had significantly higher blood lead levels (BLL) compared to archers with 36/85 (42.4%) of shooters versus 2/34 (5.9%) of archers found to have a BLL ≥10µg/dl (p<0.001). CONCLUSION: Shooting ranges may constitute an import site of elevated exposure to lead. Improved ventilation, low levels of awareness of lead hazards, poor housekeeping, and inadequate personal hygiene facilities and practices at South African shooting ranges need urgent attention.

Lead exposure in young school children in South African subsistence fishing communities.

BACKGROUND: Lead is an established toxic substance, with wide-ranging health effects, including neurodevelopmental decrements and behavioural problems, even at low levels in blood. Anecdotal reports of lead melting to make fishing sinkers in South African subsistence fishing communities prompted the conduct of an epidemiological study in two South African fishing villages to investigate the extent of lead melting and the associated risks in children. OBJECTIVES: The objectives of the study were to determine the extent of lead melting, and the blood lead distributions and associated risk factors in children. METHODS: Cross-sectional, analytical studies were undertaken among 160 young school children in the fishing villages of Struis Bay and Elands Bay located along the south-eastern and western South African coastline, respectively. Blood samples were collected for lead content analysis, and anthropometric and hemoglobin measurements were taken. Questionnaires were administered to obtain information about socio-economic status and risk factors for lead exposure. RESULTS: Blood lead levels ranged from 2.2 to 22.4 µg/dl, with the mean blood lead level equalling 7.4. Around 74% of the children had blood lead levels ≥5 µg/dl and 16% had blood lead levels ≥10 µg/dl. Socio-economic factors, and lead melting practices were strongly associated with elevated blood lead levels. CONCLUSIONS: Blood lead levels in these remote subsistence fishing communities were unexpectedly elevated, given the absence of local lead industries or other obvious sources of lead exposure. Lead exposure and poisoning is an important, yet neglected, public health concern in South African subsistence fishing communities, and potentially on the entire African continent.

Rodent control in urban communities in Johannesburg, South Africa: from research to action.

INTRODUCTION: Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings. METHODS: The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level. RESULTS: Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp. CONCLUSION: Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.

Contribution of wastewater to antimicrobial resistance: A review article.

OBJECTIVES: Antimicrobial resistance (AMR) is a global challenge that has raised concern globally, owing to its detrimental effects on the health and economy of countries. The ever-growing threat of AMR and sources of AMR are still being investigated. Wastewater plays an important role as a habitat for bacteria and an environment conducive to gene transfer. The primary aim of this review was to highlight the contribution of wastewater to AMR. METHODS: Evidence of AMR in wastewater was drawn from literature published in the last 10 years, from 2012 to 2022. RESULTS: Wastewater from agricultural practices, pharmaceutical manufacturing plants, and hospital effluents was established to promote AMR. Furthermore, stress factors such as the presence of antibiotics, heavy metals, pH, and temperature initiate and propagate AMR in bacteria living in wastewater. AMR in bacteria from wastewater was established to be either natural or acquired. Wastewater treatment techniques such as membrane filtration, coagulation, adsorption, and advanced oxidation processes have been used to remove resistant bacteria with varying success levels. CONCLUSION: Wastewater is a major contributor to AMR, and an understanding of its role in AMR is necessary to find a lasting solution. In this regard, the spread of AMR in wastewater should be considered a threat that requires a strategy to stop further damage.

Strengthening Social Compact and Innovative Health Sector Collaborations in Addressing COVID-19 in South African Workplaces.

Workplaces are nodes for Severe Acute Respiratory Syndrome Coronavirus 2 transmission and require strategies to protect workers' health. This article reports on the South African national coronavirus disease 2019 (COVID-19) strategy that sought to ensure workers' health, protect the economic activity, safeguard livelihoods and support health services. Data from the Occupational Health Surveillance System, Surveillance System of Sentinel Hospital Sites, and government databases (public sector health worker and Compensation Fund data) was supplemented by peer-reviewed articles and grey literature. A multipronged, multi-stakeholder response to occupational health and safety (OHS) policy development, risk management, health surveillance, information, and training was adopted, underpinned by scientific input, through collaboration between government, organized labour, employer bodies, academia, and community partners. This resulted in government-promulgated legislation addressing OHS, sectoral guidelines, and work-related COVID-19 worker's compensation. The OHS Workstream of the National Department of Health provided leadership and technical support for COVID-specific workplace guidelines and practices, surveillance, information, and training, as well as a workplace-based vaccination strategy.

Impact of the macro-environment on the reporting of occupational injuries and illnesses by low-income workers compared to middle-income workers in South Africa: a mixed-methods study protocol.

INTRODUCTION: Construction workers, mineworkers and manufacturing employees in South Africa must report occupational injuries and illnesses to their employer as stipulated in section 14 of the Occupational Health and Safety Act and section 22 of the Mine Health and Safety Act. However, under-reporting of workplace injuries and illnesses is common globally.This protocol seeks to ascertain if macro-environment factors impact reporting of workplace injuries and illnesses and compare reporting between low-income and middle-income workers. METHODS AND ANALYSIS: To achieve the objectives of the study, a sequential mixed-methods research design will be adopted. A questionnaire will be distributed among low-income and middle-income workers from nine companies in Gauteng from the construction, mining and manufacturing sectors to establish macro-environment factors that impact their reporting. In addition, a data extraction sheet will be submitted to compensation fund administrators who receive and process workers' compensation claims to determine reporting patterns by low-income and middle-income workers. In-depth interviews will be conducted with occupational health and safety subject matter experts in South Africa to ascertain their opinion regarding factors that impact reporting. Data will be analysed using SPSS V.27. ETHICS AND DISSEMINATION: Prior to the commencement of the study, ethical approval and permission will be obtained from the University of Johannesburg Faculty of Health Sciences Research Ethics Committee. The researcher intends to publish the results of the study in peer-reviewed journals and present research papers at scientific conferences and provide feedback to employers and employees across all three industries. The study shall determine associations in reporting between the manufacturing, mining and construction sectors and establish interventions employers can implement for workers to report injuries and illnesses.

A potential role of cockroaches in the transmission of pathogenic bacteria with antibiotic resistance: A scoping review.

INTRODUCTION: The role of cockroaches in the cause of disease or human infections is not immediately obvious. The present study aimed to review the currently available research on the potential role of cockroaches in the transmission of pathogenic bacteria and bacteria with antibiotic resistance. METHODOLOGY: A scoping review included the studies published for a period between January 2001 and December 2020. A search was performed through five databases, namely, PubMed, Sage, Springer, Sabinet, and Science Direct. A search strategy used was conducted according to the principles of Preferred Reporting Item for Systemic Reviews and Meta-Analyses (PRISMA). From 97 studies identified, 32 studies were included in the scoping review. RESULTS: The findings indicate that cockroaches may be a potential vector for a diverse range of pathogenic bacterial agents. Most bacterial agents isolated are antidrug-resistant and antibiotic-resistant which is considered the greatest threat to public health in the current period. CONCLUSIONS: Cockroach infestation should be considered as a serious concern, given the possible role of cockroaches as reservoirs of antibiotic-resistant bacteria. Further research is needed which can provide a comprehensive understanding of the role of cockroaches in transmitting human infections.

The effect of a hand hygiene intervention on the behaviour, practices and health of parents of preschool children in South Africa.

INTRODUCTION: Diarrhoea and upper respiratory diseases are a leading cause of child mortality in children under 5 years of age both in South Africa and worldwide. Hand hygiene (HH) interventions play a critical role in reducing HH-related diseases, and the inclusion of all stakeholders in such interventions has improved the success of such interventions. The purpose of this study is to determine the effect of an HH intervention on the behaviour, practices, and health of parents of preschool children. METHODOLOGY: Seventeen preschools were randomly selected and placed into intervention (IG = 8) and control groups (CG = 9). Parents (N = 191) were requested to complete questionnaires both pre- and postintervention. An intervention was applied to IG preschool respondents. The data were analysed and compared pre- and postintervention between IG and CG. RESULTS: Parents of IG showed a significant difference pre- and postintervention in HH practices such as washing hands after coughing and sneezing, and after using the toilet while parents in CG also indicated significant differences in HH practices of washing hands after coughing and sneezing, and after wiping children's noses. Postintervention, IG families reporting runny tummies were significantly less than pre-intervention and a decrease in doctor's visits. There was a 5% improvement of all HH practices in both IG and CG. CONCLUSION: Over 90% of parents in both groups washed hands after using the toilet, both pre- and postintervention. All HH practices for both groups showed increases both pre- and postintervention. By making use of available resources and regular communication with parents of preschoolers they are able to make the small changes necessary to improve their HH and that of their families.

Elevated soil and blood lead levels with increasing residential proximity to a mine tailings facility in Soweto, South Africa.

Mining has long been associated with the release of a range of toxic metals including lead, elevated levels of which have been found in land surrounding mine dumps as far afield as Spain, India, Macedonia and Nigeria. Mining has been a key pillar of economic development in South Africa for around a century and a half, and has left a legacy of major environmental contamination, with the poorest experiencing the highest burden of exposure. The current study was undertaken to ascertain the concentrations of lead in soil and in the blood of adults and children residing at increasing distances from a cluster of large tailings facilities (MTFs) in greater Johannesburg, South Africa. Through a cross-sectional survey data on household characteristics were collected through a questionnaire survey, and supplemented with samples of soil from household gardens, together with blood samples from child-adult pairs from all households included in the study. Soil lead concentrations decreased significantly (median = 35.7 mg/kg closest to the mine tailings facility (MTF) and 8.6 mg/kg at the furthest point in the study site) with increasing distance from the MTF. Blood lead levels were highest in both adults (median = 3.0 µg/dL) and children (median = 4.0 µg/dL) who lived closest (≤500 m) to the MTF, and lowest (1.4 µg/dL in adults and 2.5 µg/dL in children) in those who lived furthest away (4-5 km). The study findings point to a need for greater emphasis on the precautionary principle in environmental health and for health impact assessments to inform decisions on planning, especially with regard to the location of human settlements relative to major, polluting development initiatives.

Disease Severity and Comorbidities among Healthcare Worker COVID-19 Admissions in South Africa: A Retrospective Analysis.

Healthcare workers (HCWs) are among the most vulnerable in regard to contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Comorbidities are reported to increase the risk for more severe COVID-19 outcomes, often requiring hospitalization. However, the evidence on disease severity and comorbidities among South African HCWs is lacking. This retrospective study analyzed the prevalence of comorbidities among HCW hospitalized with COVID-19 and its association with the severity of outcomes. Data from public and private hospitals in nine provinces of South Africa were extracted from the national hospital surveillance database for COVID-19 admissions. A total of 10,149 COVID-19 HCWs admissions were reported from 5 March 2020 to 31 December 2021. The risk of disease severity among HCWs increased with age, with those older (≥60 years) having seven times the odds of disease severity (aOR 7.0; 95% CI 4.2-11.8) compared to HCWs in the younger age (20-29 years) group. The most commonly reported comorbidity was hypertension (36.3%), followed by diabetes (23.3%) and obesity (16.7%). Hypertension (aOR 1.3; 95% CI 1.0-1.6), diabetes (aOR 1.6; 95% CI 1.3-2.0), and HIV (aOR 1.6; 95% CI 1.2-2.1) were significantly associated with disease severity. In conclusion, age, gender, and existing comorbidities were strong predictors of the prognosis of severe COVID-19 among HCWs in South Africa. The information is important in the development of occupational health policies and vulnerability risk assessments for HCWs in light of future COVID-19 waves or similar outbreaks.

Association between Bone Lead Concentration and Aggression in Youth from a Sub-Cohort of the Birth to Twenty Cohort.

BACKGROUND: An association between blood-lead levels and aggression has been demonstrated in children and adolescent youth in South Africa. However, there are limited studies that have assessed aggression as an outcome for cumulative lead exposure using bone lead concentration. This study aims to assess the association between bone lead concentration and aggressive behaviour among a sample of youth in South Africa. METHODS: Bone lead in 100 participants (53 males and 47 females) recruited and followed in the Birth to Twenty (BT20) Cohort were measured using 109 Cd-based, K-shell X-ray fluorescence (KXRF). The Buss-Perry Aggression questionnaire was used to measure aggressive behaviour. Linear regression models were fitted to determine the association between aggression score for physical, verbal, anger and hostility and bone lead, adjusting for known confounders. RESULTS: A one-microgram-per-gram increase in bone lead was found to increase the score for all four scales of aggression, but significantly only for anger (ß = 0.2 [95% CI 0.04-0.370]). Psychosocial factors such as a history of family violence and exposure to neighbourhood crime were significant predictors for aggression. CONCLUSIONS: The study provides a preliminary overview of the relationship between cumulative lead exposure and behavioural problems such as aggression. A larger sample, across exposed communities, may prove more definitive in further investigating the association between these two important public health factors and to maximize generalizability.

Risk factors for problematic alcohol use among male waste pickers and caddies in Johannesburg, South Africa: a cross-sectional study.

Informal workers may be prone to problematic substance use due to many factors, including adverse working conditions and low income. The aim of this secondary analysis was to investigate problematic alcohol use risk factors among male informal workers in Johannesburg, South Africa. Alcohol use among the two groups of informal workers in the analysis y golf caddies and waste pickers was measured using the World Health Organization (WHO) Alcohol Use Disorder Identification Test (AUDIT) tool. The WHO self-reporting questionnaire (SRQ) for common mental health disorders (CMD) was used to assess mental health. A multivariate logistic regression model was used to explore the predictors of problematic drinking in informal workers. The study consisted of 514 participants, of which 48.4% were golf caddies and 51.6%, waste pickers. Most participants were younger than 40 years (50.9%). Over half of the participants (54.7%) were alcohol consumers and 74.1% were smokers. Over 60% of the participants who were alcohol consumers had a probable drinking problem. Unstratified regression results showed that common mental distress (aOR = 1.06; 95%CI: 1.01-1.09), age: 30-40 years (aOR = 2.17; 95%CI: 1.18-3.97), smoking (aOR = 2.25; 95%CI: 1.34-3.79), and other water sources (aOR = 0.2; 95%CI: 0.04-0.99) were associated with a probable alcohol problem. Waste pickers (aOR = 0.33; 95%CI: 0.20-0.70) were less likely to be problematic drinkers compared to golf caddies. Problematic drinking in this study was common in both caddies and waste pickers along with smoking. Problematic alcohol use was associated with caddying, mental distress, age, and smoking. Measures such as providing counseling services to informal workers and improvement of working conditions may help change the behaviors of these vulnerable groups.