A systematic review of the risk management frameworks for potentially toxic chemical elements.

In the last 50 years, various frameworks have been used to control and manage potentially toxic chemical risks; however, these chemicals continue to negatively impact environmental and human health. This work was intended to provide a systematic review of the literature on essential aspects of current risk management frameworks for potentially toxic chemicals. The frameworks were reviewed using Organisation for Economic Co-operation and Development (OECD) principles that focus on elements, successes, shortcomings, similarities, and dissimilarities premised on the experiences of many countries. Keywords such as heavy metals, health risk, industrial chemicals, potentially toxic elements, chemical pollutants, and risk management framework were utilised to search the literature from databases and other sources. Ten risk framework documents selected from an initial yield of 1349 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow processes met the inclusion criteria. The key elements of risk frameworks that were identified included the risk assessment paradigm, iteration, tiered approach, weight of evidence, uncertainty analysis, and multi-criteria decision analysis among others. Notable gaps in risk frameworks that required improvements to effectively manage health risks posed by potentially toxic chemicals were identified. While existing risk frameworks have made significant contributions to human health and environmental protection, new and comprehensive frameworks are needed to address the novel and dynamic risks posed by toxic industrial chemicals. Also, there is a need to promote the use of risk management frameworks in developing countries through technology transfer and the provision of financial assistance to improve environmental and public health protection from toxic chemicals.

Health risk management framework for heavy metals and cyanide in Kwekwe city of Zimbabwe: a mixed-method study protocol.

BACKGROUND: According to WHO, in 2015, over 35% of ischaemic heart disease, the leading cause of death and disability worldwide, and about 42% of strokes, the second largest contributor to global mortality, could have been prevented by reducing or removing exposure to chemical pollutants. Heavy metal and cyanide pollution are prevalent in developing countries, especially in sub-Saharan Africa where the effects of industrial pollutants are more severe, partly due to poor regulation. In Zimbabwe, the mining industry alone contributed to 25% of occupational conditions and injuries in 2020. Therefore, to mitigate these problems, this study seeks to develop a health risk management framework for heavy metals and cyanide pollution in the industrial city of Kwekwe. METHODS: The convergent parallel mixed-method study design will be utilised. Qualitative and quantitative data will be collected, analysed, and merged in order to inform the development of the risk framework. An analytical cross-sectional survey would be used to determine levels of heavy metals in surface water, soil, and vegetables. Free cyanide will be determined in surface water samples only. The phenomenological qualitative inquiry will be used to investigate health events and risks associated with potentially toxic pollutants (heavy metals and cyanide) to describe or interpret participants' lived experiences. The qualitative and quantitative results will be used to develop and validate the framework to manage identified health risks. For data analysis, statistical analysis will be used in the quantitative study, while thematic analysis will be used in the qualitative study. The study was approved by the University of Venda Ethics Committee (Registration Number FHS/22/PH/05/2306) and the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2944). All ethical principles will be adhered to throughout the study in accordance with the Helsinki Declaration. DISCUSSION: While existing risk management frameworks have significantly contributed to human and environmental health protection, novel and comprehensive frameworks need to be developed to counter the ever-dynamic and evolving risks associated with chemical pollutants. If the management framework is successfully developed, it could offer an opportunity for the prevention and control of potentially toxic elements.

In Zimbabwe, just like most developing countries, the problem of environmental pollution continues to threaten and endanger public health. Current pollution management measures seem insufficient in combating the problem to the extent that communities living in or near industrial areas continue to suffer from associated acute and chronic health conditions. Kwekwe city is an industrial and mining area with several abandoned and active mines and processing plants. Artisanal mining is widespread in the area, and many parts of the city's landscape are littered with open mining pits, dumps, and abandoned tailings. Most of these facilities are potential sources of heavy metals and cyanide and pose risks to human health. This study, therefore, seeks to develop a health risk management framework to address problems, which are associated with anthropogenic pollutants such as heavy metals and cyanide. The study will be conducted in two phases, that is, the first phase would involve the collection and analysis of empirical data from environmental samples, residents, and key stakeholders on heavy metal and cyanide pollution and associated health risks. The second phase would utilise findings from the first phase to develop a regulatory framework and to manage identified health risks. The developed framework would be validated through stakeholder and expert participation. The developed health risk management framework could be useful in the prevention and control environmental contamination, hence assisting to improve non-communicable diseases' outcomes in Kwekwe city.

Development of a growth monitoring and promotion index to improve child health in Zimbabwe.

In Zimbabwe, growth monitoring and promotion as conducted by community health workers are part of the nutritional surveillance system. This study seeks to develop a new index which will combine both caregiver behaviours, attitudes and CHW growth monitoring and promotion activities. An explanatory sequential mixed method design will be conducted in three phases. Phase one will comprise a scoping literature review. The second phase will comprise a needs analysis through quantitative data collection using two surveys of community health workers and caregivers of children under five years. Thereafter, qualitative data will be collected from caregivers of children under five years. The quantitative data will be analysed using SPSS while qualitative data will be collected and analysed using Atlas-ti. Phase three will be the development phase for the growth monitoring and promotion Index. The growth monitoring and promotion Index will be used to classify the GMP performance of districts through the DHIS2 thus strengthening the quality of growth monitoring and promotion. Recommendations on the findings and the adoption of the Index will be shared with the Ministry of Health and Child Care and key stakeholders implementing maternal, newborn and child health programmes in Zimbabwe for adoption and use in growth monitoring and promotion programming.

I lack 'me-time': The experiences of family caregivers of elders with Diabetes Mellitus in a selected village in South Africa.

Background: Family caregiving is common in African countries where the family plays a crucial role in caring and supporting a family member in need of care. Most older people who suffer from chronic diseases, including Diabetes Mellitus, stay at home where family members and relatives are responsible for their day-to-day care. Aim: The purpose of this study was to explore the experiences of family caregivers of older people living with Diabetes Mellitus in a rural village in South Africa. Setting: This study was conducted in a village located in the Thulamela municipality of the Vhembe district, in the Limpopo province. Methods: A qualitative exploratory, descriptive research design was used. Purposive sampling was used, and data were collected using a semi-structured interview guide. Data saturation occurred after interviewing 17 participants and were analysed using thematic analysis. Trustworthiness was ensured through strategies of credibility, dependability, conformability, and transferability, and ethical principles were applied. Results: Three themes emerged: participants sacrificed time for work, time for self-care, and devised coping strategies. These findings revealed that family caregivers of older adults diagnosed with Diabetes Mellitus sacrificed their time in order to provide care. However, the findings further revealed that family caregivers devised strategies to cope through prayer and acceptance. Conclusion: The study revealed several challenges experienced by family caregivers of older people living with Diabetes Mellitus. Contribution: The National Department of Health, together with the civil society would gain an in-depth understanding of the burden of Diabetes Mellitus in the family setting and develop strategies to improve the situation.

Occupational health and safety hazards among solid waste handlers at a selected municipality South Africa.

Background: Solid waste management is one of the most dangerous occupations in the world because of its potential harm from the waste to the environment and the public. Therefore, the protection of human health and the environment is a challenge that all countries are facing. Aim: The study explored occupational health and safety hazards among waste handlers at a selected municipality in Limpopo Province. Setting: The study was conducted in one municipality in the Vhembe District. Methods: The study used a qualitative, explorative and contextual design to explore occupational health and safety hazards among participants. Participants were sampled using purposive sampling. Data were collected through in-depth individual interviews that lasted between 40 min and 45 min. The sampled size comprised 18 participants and was determined by data saturation. Tesch's open coding was used to analyse data, where the main theme, categories and sub-categories emerged. Results: The findings revealed the main theme, namely municipal waste handlers experience occupational health and safety hazards. Four categories emerged from the main theme, namely physical, psychosocial, biological and chemical hazards. The categories were further divided into sub-categories such as exposure to extreme weather conditions and musculoskeletal injuries. Conclusion: Solid waste handlers experienced preventable physical and chemical occupational health and safety hazards that are inherent to their job. It is recommended that workers be provided with adequate suitable protective equipment to reduce the level of occupational health hazards. Contribution: The findings in this study will help in closing the gaps by the municipality for failing to prioritise working conditions for municipality waste handlers.

Alcohol consumption and cigarette smoking: a health-risk behaviour among secondary school learners in South Africa.

Background: Health-risk behaviours such as tobacco smoking and alcohol are now identified among adolescents in most of the secondary schools of South Africa. Objective: The study investigated the prevalence of smoking and alcohol use as health risk behaviours among secondary school learners in Thembisile Hani municipality of Mpumalanga province in South Africa. Methods: A quantitative descriptive research design was used for the study. A simple random sampling was employed in the selection of schools and proportional stratified sampling was used to select learners from each school according to grades. Closed-ended questionnaires were used to collect data from learners in their schools. Data were analysed using SPSS version 26.0. Results: Out of 385 learners, 64.4% have drank alcohol whilst 64.7% have smoked cigarette in the school premises. The socio-economic status of many learners such as the employment and income of the family was found to be one of the factors exposing them to alcohol and tobacco use. Conclusions: There was high prevalence of alcohol use and smoking among learners in secondary schools. Excessive use of alcohol and smoking could affect the health of learners in their late life and therefore community collaboration to curb the problem is crucial.

Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa.

BACKGROUND: Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. OBJECTIVES: The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa. METHOD: A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study. RESULTS: Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes. CONCLUSION: The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.

Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa

Background: Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. Objectives: The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa.Method: A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study.Results: Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes.Conclusion: The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs

Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe.

BACKGROUND: Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. PURPOSE: The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. METHODS: The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15-29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. RESULTS: Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). CONCLUSION: Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.

Self-reported impact of caregiving on voluntary home-based caregivers in Mutale Municipality, South Africa.

BACKGROUND: The establishment of home-based care (HBC) programmes in developing countries has resulted in a shift of burden from hospitals to communities where palliative care is provided by voluntary home-based caregivers. AIM: The study investigated the impact of caregiving on voluntary home-based caregivers. SETTING: The study was conducted at HBC organisations located in Mutale Municipality of Limpopo Province, South Africa. METHODS: A quantitative cross-sectional descriptive survey design was applied to investigate the impact of caregiving on voluntary home-based caregivers. The sample was comprised of (N = 190) home-based caregivers. Home-based caregivers provide care to people in need of care in their homes, such as orphans, the elderly and those suffering from chronic illnesses such as tuberculosis, HIV and/or AIDS, cancer and stroke. Self-administered questionnaires were used to collect data which were analysed descriptively using the Statistical Package for the Social Sciences software, Version 20. RESULTS: The results showed that 101 (53.2%) participants were worried about their financial security because they were not registered as workers, whilst 74 (39.0%) participants were always worried about getting infection from their clients because they often do not have protective equipment. CONCLUSION: Voluntary home-based caregivers have an important role in the provision of palliative care to people in their own homes, and therefore, the negative caregiving impact on the lives of caregivers may compromise the provision of quality palliative care.

Home-based carers' perceptions of health promotion on sexual health communication in Vhembe District.

BACKGROUND: The introduction of home-based care in rural communities in the 1980s contributed immensely toward the upliftment of the personal and environmental health of communities. Women's groups provided health promotion skills and health education to communities and made a difference in health-related behaviour change. OBJECTIVE: The purpose of the study was to explore and describe the home-based carers' perception regarding health promotion concerning sexual health communication in Vhembe district, in the context of HIV, amongst communities still rooted in their culture. METHOD: A qualitative, explorative and descriptive design was used in order to understand home-based carers' perceptions regarding health promotion on sexual health communication amongst rural communities which may adversely impact on health promotion practices. The population were home-based organisations in Vhembe. The sample was purposive and randomly selected and data were gathered through semi-structured face-to-face interviews and focus groups which determined data saturation. Open coding was used for analysis of data. RESULTS: The results indicated that sexual communication was absent in most relationships and was not seen as necessary amongst married couples. Socioeconomic conditions, power inequity and emotional dependence had a negative impact on decision making and sexual communication. CONCLUSION: This study, therefore, recommends that educational and outreach efforts should focus on motivating change by improving the knowledge base of home-based carers. Since they are health promoters, they should be able to change the perceptions of the communities toward sexually-transmitted infections and HIV by promoting sexual health communication.

Views of professional nurses regarding low tuberculosis cure rate in Greater Giyani Municipality, Limpopo Province.

BACKGROUND: Management of patients suffering from tuberculosis (TB) after discharge from hospital plays a critical role in the cure rate of TB. Despite interventions developed by the World Health Organization (WHO) to improve the cure rate, TB remains a worldwide health problem. OBJECTIVE: The purpose of the study was to explore and describe the views of professional nurses regarding the low TB cure rate in primary healthcare facilities of Greater Giyani Municipality in Limpopo Province, South Africa, with the aim of determining strategies that can be used to improve this low rate. METHOD: This study was qualitative, exploratory, descriptive and contextual in nature. The population consisted of professional nurses working in primary healthcare facilities within Greater Giyani Municipality, which has a TB cure rate below the national target of 85%. Data gathering was through individual face-to-face interviews using an interview guide. Open-coding was used to analyse the data in this study. RESULTS: The theme that emerged from data was 'factors contributing to low TB cure rate'. This theme was supported by the following sub-themes: poor referral system, lack of knowledge about TB and its treatment, stigma attached to TB, and cultural and religious beliefs. The professional nurses suggested counselling of TB patients upon diagnosis, advice about patients' responsibilities and the involvement of family members. CONCLUSION: The involvement of community stakeholders in TB prevention, health promotion and education activities devoted to disease spread and cure is vital so that the stigma attached to TB can be eliminated. TB education and awareness programmes should be included in the curriculum of primary schools.