RESUMO
Background: In Ethiopia, industrial parks that specialise in garment production are increasing in number and have created job opportunities for more than 45 000 workers. However, healthcare services, including occupational safety and health (OSH), are not commensurate with the growth and needs of the industry. Objectives: We assessed the supply and demand, barriers, governance, and regulation of health services and OSH at Hawassa Industrial Park, the largest industrial park in Ethiopia. Methods: Qualitative and quantitative data were collected via interviews with 260 randomly selected workers, focus group discussions with workers and health professionals, and key informant interviews with industrial park management, and government and non-government stakeholders. Ethiopian OHS polices, regulations, guidelines, directives, and strategies were also reviewed. Results: Hawassa Industrial Park hosts 21 globally known companies and more than 23 000 workers. Of the 260 workers interviewed, most (83.1%) were aged 18-24 years. Findings included that the delivery of OSH and primary healthcare is inadequate to ensure safety and meet workers' needs. Use of personal protective equipment is erratic; conditions in the cafeteria are unsanitary, as is the water; use of bathrooms is restricted; workers work long shifts with short breaks; wages are low; and healthcare is expensive, increasing the risk of occupational injuries and diseases. Workers have no OSH committee or trade unions, and Ethiopian Government regulations and enforcement are weak. There is no collaboration between the Park and the Ministry of Health to provide primary healthcare services for the workers. Conclusion: The workers in Hawassa Industrial Park urgently need improved access to, and coverage for, primary healthcare, including OSH; higher wages; and empowerment to exercise their right to organise. All stakeholders need capacity building to enable them to implement OSH.
Assuntos
Saúde OcupacionalRESUMO
OBJECTIVES: To assess the performance of the GenoType MTBDRsl v1, a line-probe assay (LPA), to exclude baseline resistance to fluoroquinolones (FQs) and second-line injectables (SLIs) in the Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB 1 (STREAM 1) trial.METHODS: Direct sputum MTBDRsl results in the site laboratories were compared to indirect phenotypic drug susceptibility testing (pDST) results in the central laboratory, with DNA sequencing as a reference standard.RESULTS: Of 413 multidrug-resistant TB (MDR-TB) patients tested using MTBDRsl and pDST, 389 (94.2%) were FQ-susceptible and 7 (1.7%) FQ-resistant, while 17 (4.1%) had an inconclusive MTBDRsl result. For SLI, 372 (90.1%) were susceptible, 5 (1.2%) resistant and 36 (8.7%) inconclusive. There were 9 (2.3%) FQ discordant pDST/MTBDRsl results, of which 3 revealed a mutation and 5 (1.3%) SLI discordant pDST/MTBDRsl results, none of which were mutants on sequencing. Among the 17 FQ- and SLI MTBDRsl-inconclusive samples, sequencing showed 1 FQ- and zero SLI-resistant results, similar to frequencies among the conclusive MTBDRsl. The majority of inconclusive MTBDRsl results were associated with low bacillary load samples (acid-fast bacilli smear-negative or scantily positive) compared to conclusive results (P < 0.001).CONCLUSION: MTBDRsl can facilitate the rapid exclusion of FQ and SLI resistances for enrolment in clinical trials.
