Vigilância em Saúde do Trabalhador e articulações intersetoriais no enfrentamento do trabalho infantil em Diadema, SP, Brasil / Surveillance in Occupational Health and intersectorial articulations in the fight against child labour in Diadema, SP, Brazil

Este artigo visa apresentar uma intervenção desenvolvida no âmbito de atuação do Centro de Referência em Saúde do Trabalhador de Diadema, SP. Os objetivos foram analisar os acidentes de trabalho com adolescentes notificados pela rede municipal de saúde de 2009 a 2019 e relatar as estratégias intersetoriais e as ações de vigilância e prevenção implementadas. Foram analisados os dados do Sistema de Informação de Agravos de Notificação, relatórios técnicos das vigilâncias e registros de reuniões e eventos da equipe. Dos 5.179 acidentes de trabalho graves notificados, 7,5% atingiram jovens entre 14 e 17 anos, sendo 72% do sexo masculino e 28% do feminino. A compreensão do fenômeno de modo ampliado foi favorecida pela discussão intersetorial e pelo matriciamento na saúde. Foram constatadas as dificuldades dos profissionais de saúde em identificar o acidente de trabalho e a negação dos pais sobre as condições adversas de trabalho. Espera-se superar a invisibilidade e subnotificação das situações de trabalho infantil e contribuir para aplicação dos princípios da precaução e da prevenção para construir paradigmas protetivos sobre as crianças e suas famílias no enfrentamento do trabalho infantil

This study aims to show an intervention developed within the scope of the Worker's Health Reference Centre in Diadema. We analysed municipal health network reports of occupational accidents with adolescents from 2009 to 2019 to assess intersectoral strategies and the implemented surveillance and prevention actions. Notifiable Diseases Information System, technical reports from surveillance, and records of our team's meetings and events of were analyzed. Of the 5,179 reported serious work accidents, 7.5% affected young people aged between 14 and 17 years, 72% of which were boys and 28%, girls. Intersectoral discussion and a matrix health support favoured a broader understanding of the phenomenon. We found difficulties of healthcare providers in identifying work accidents and parents' denial about adverse working conditions. We expect to overcome the invisibility and underreporting of child labour and contribute to the application of principles of precaution and prevention to build protective paradigms for children and their working families to combat child labour

Assessment of ergonomic exposure, work-related occupational injuries, and prevention: Child work in the brickfield industry in India.

Child labor is an infraction of fundamental human rights, and it prevents the children's physical, psychosocial, and psychological development. In India, children have been working in different unorganized sectors as paid laborers. Children were found performing a fair amount of manual, rigorous tasks in the brickfield industry due to socioeconomic disadvantages. Child brickfield workers suffered from musculoskeletal pain and injuries due to working with a heavy physical workload, which hampers the overall quality of life. A study had been conducted among these child brickfield laborers from India during 2011-2017. The study found laceration (38.7% male and 36.9% female) as the primary injury followed by sprain and strain, scratches, avulsion, and fractures among child brickfield workers. The study shows that child workers are highly prone to injuries, mainly toe (23.9% male and 28.1% female), hands (22.0% male and 23.4% female), wrists, feet, ankles, and fingers. The injury rate among male and female child brickfield laborers was 7.64 and 9.52 per 1000 workers. The primary source of injuries in brickfields was due to falling from height. Several risk factors, including biomechanical, work stress, may play a key role in work-related injuries among child brickfield laborers.

Prevalence and potential consequences of child labour in India and the possible impact of COVID-19 - a contemporary overview.

Child labour is a global phenomenon occurring predominantly in countries with lower socioeconomic status and resources. Societal and familial poverty, loss or incapacitation/illness of parents, lack of social security and protection, and ignorance about the value of, or limited access to, education are among the myriad reasons for the involvement of children in the workforce. Child labour is a barrier to the development of individual children and their society and economy. Global estimates indicate that 152 million children (64 million girls and 88 million boys) are working, accounting for almost one in 10 of all children worldwide. Currently the COVID-19 health pandemic and the resulting economic and labour market consequences are having a major impact on people's lives and livelihoods. Unfortunately, impoverished families and their children are often the first to suffer, which may push many more vulnerable children into child labour situations. Child labour in India is more prevalent than in many other countries, with approximately 10 million children actively engaged in, or seeking, work. This paper focuses on the issue of child labour, its causes and its ill effects. Further, it also reviews the international legal framework relating to child labour and legislative issues in India. There is clearly an urgent need for this issue to be effectively addressed and resolved.

Work Safety Culture of Latinx Child Farmworkers in North Carolina.

Background: Little research has addressed the safety environment of child farmworkers. This analysis examines the work safety culture experienced by Latinx child farmworkers in North Carolina. Methods: Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis included measures of the behavioral, situational, and psychological elements of work safety culture. Results: The work culture on North Carolina farms employing Latinx child farmworkers places limited value on safety. Behaviorally, many did not wear appropriate work clothing (e.g., 47.5% wore gloves, 37.1% wore boots). Situationally, few received safety training for tools (40.6%), machinery (24.3%), or pesticides (26.0%); about one-third (33.7%) had worked piece-rate; and many did not have field sanitation services available (e.g., 37.1% had water for washing, 19.8% had soap). Safety attitudes were mixed, and work safety climate was low, with 21.8% stating that their supervisor was only interested in doing the job fast and cheaply. Greater safety training, field sanitation services, and work safety climate were associated with working in western North Carolina, migrant workers, limited English fluency, and working in tomatoes. Wearing appropriate work clothing, not working piece-rate, fewer unsafe work attitudes were associated with working in eastern North Carolina, seasonal worker, speaking English, and working in tobacco. Conclusions: This research makes it apparent that efforts are needed to improve safety culture wherever child farmworkers are employed. Current policy is not providing a safe environment for children working on farms in the United States.

Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina.

The aim of this study was to evaluate respiratory health problems, including suspected asthma, and healthcare provider utilization among a sample of Latinx hired child farmworkers in rural North Carolina (n = 140). In 2018, a respiratory health questionnaire and breathing tests were collected from Latinx child (11-19 years) farmworkers (35.0% girls and 65.0% boys). Overall, 21.4% of children reported having been told by a medical provider that they had asthma, yet based on a combination of responses to respiratory survey questions, 36.4% or 15% more were identified as having suspected asthma. While 56.4% reported having a regular medical doctor, 38% had not had a medical exam in the past year. Respiratory dysfunction, including suspected, or uncontrolled asthma was prevalent among this group. Latinx children working in agriculture are vulnerable to occupational hazards and exposures and require assurances that they will receive access to high quality healthcare services that include routine respiratory health screenings.

COVID-19: agora mais do que nunca, protejam crianças e adolescentes do trabalho infantil

O dia 12 de junho, Dia Mundial contra o Trabalho Infantil, foi instituído pela Organização Internacional do Trabalho (OIT) em 2002, e desde então, convoca-se a sociedade, os trabalhadores, os empregadores e os governos do mundo todo a se mobilizarem contra o Trabalho Infantil. Em 2020, a campanha tem por objetivo alertar para o risco de crescimento do trabalho infantil motivado pelos impactos da pandemia do novo coronavírus por meio do slogan “Covid-19: agora mais do que nunca, protejam crianças e adolescentes do trabalho infantil”. Assim, a SESA promove LIVE em conjunto com o Ministério Público do Trabalho (MPT), e a Secretaria de Estado da Justiça, Família e Trabalho (SEJUF), com apoio da Superintendência Regional do Trabalho do Paraná (SRTb-PR).

Child Labor Trafficking Essentials for Forensic Nurses.

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Troubling Childhood: The Physical and Health Issues Experienced by Child Labourers.

Childhood is a period when the responsibilities of care and sustenance of an individual are born by others. Hence, the child is exonerated from any labor activity, which could be considered detrimental to the child's growth or development. This study examined the phenomenon of child labor and how it impacts on children's physical and health development. The qualitative research approach was adopted in this study. Eight children between the ages of 7 and 14 years who experienced different physical and health issues due to their engagement in child labor were interviewed. Working children described that their lives are endangered due to their vulnerability to harmful objects and to road accidents, given the constant traffic when working on the streets. The study revealed that child labor activities engender headaches, bodily pains, bruises or cuts to their bodies, fractures and diseases that posed serious threats to their health. The developmental impacts as a result of child labor compromise children's well-being, thereby making it difficult for them to enjoy their childhood, particularly in situations where their lives are threatened. The need to advance social work strategies in order to tackle the phenomenon is expedient.

Child labor, sex and mental health outcomes amongst adolescent refugees.

INTRODUCTION: Refugee adolescents living in camps and settlements in low and middle-income countries are a vulnerable population who face protection and psychosocial risks. This study explores prevalence of child labor amongst adolescent refugees from South Sudan in two refugee settlements in Uganda, to understand impacts of child labor on mental health outcomes, and examines the influence of sex on these impacts. METHODS: Surveys were conducted in Adjumani and Kiryandongo refugee settlements, Uganda, with 470 adolescents between 13 and 17 interviewed between December 2014-February 2015. Univariate finite mixture modeling identified a two-cluster model of child labor. Logistic regression models assessed the association of child labor and mental health. RESULTS: A two-cluster solution for child labor activity was determined among the 332 adolescents who self-reported engaging in any child labor (Significant child labor: n = 174, 37%; moderate child labor cluster: n = 158, 34%; no child labor cluster: n = 138, 29%. Odds of depression amongst adolescents exposed to significant vs. no child labor was 4.15 (95% CI: 2.01-8.56), in a model examining interaction of sex and child labor and controlling for socio-demographic variables. For the anxiety outcome, girls exposed to significant vs. no child labor are less likely to report higher levels of anxiety (OR: 0.29, 95% CI: 0.09-0.90). CONCLUSIONS: Adolescents living in refugee settlements in Uganda report high levels of participation in child labor. Protection of adolescents from the risks involved with child labor in refugee contexts is an important and often over-looked area of child protection in humanitarian settings.

Work accidents with children and youth in a rural environment in southern Brazil.

OBJECTIVE: to know the prevalence of occupational accidents in children and youth who work with their families in the rural environment and to identify the associated factors. METHOD: exploratory, descriptive and analytical study with quantitative approach, developed in three rural areas. Participants were 211 children and young people who assisted the family in rural work. Data collection was performed using a semi-structured questionnaire. Bivariate analysis was performed using Pearson's chi-square, Fisher's exact, Student's t and Mann-Whitney tests and multivariate analysis using Poisson regression. RESULTS: the prevalence of self-reported occupational accidents was 55%. It was highlighted: insect bites (44%), burns (40.5%), falls (27.6%), injury with a working tool (16.4%), electric shock (15.5 %), burn by animal (8.6%), animal bite (6.9%) and pesticide poisoning (2.6%). These were related to shared housing, leisure activity - riding a motorcycle, product resulting from lettuce cultivation and use of personal protective equipment. CONCLUSION: it is believed that these findings may enhance the development of public policies aimed at preserving the health of these children and young people, regulate working conditions and reduce occupational risks in the rural environment.

Estudo transversal sobre trabalho e comportamentos de risco à saúde entre escolares de zona rural do Rio Grande do Sul, 2010 / Estudio transversal sobre trabajo y conductas de riesgo a la salud entre niños estudiantes en zona rural de Rio Grande do Sul, Brasil, 2010 / Cross-sectional study on work and health risk behaviors among school students in a rural area of Rio Grande do Sul State, Brazil, 2010

Objetivo: avaliar a associação entre trabalho e comportamentos de risco à saúde entre escolares de zona rural. Métodos: estudo transversal com escolares do 5° ao 8° ano do ensino fundamental das escolas municipais de Barão do Triunfo, RS, Brasil, em 2010; utilizou-se questionário autoaplicável; caracterizou-se o perfil de trabalho como 'trabalhadores atuais', 'trabalhadores prévios' e 'não trabalhadores'; revelaram-se comportamentos de risco à saúde o tabagismo, o consumo de álcool, o excesso de peso e a inatividade física (≤300 minutos semanais). Resultados: dos 339 participantes menores de 16 anos (89,9%), 82,3% eram trabalhadores atuais; entre os trabalhadores, predominaram serviços domésticos (39,8%) e agricultura (29,9%); 24,8% estavam com excesso de peso, 51,2% inativos no lazer, 6,6% fumavam; e 27,0% haviam consumido álcool nos últimos 30 dias, principalmente trabalhadores, comparados a não trabalhadores (p=0,02). Conclusão: oito em cada dez escolares trabalhava, e a maioria destes estava em trabalho infanto-juvenil; consumo de álcool foi o comportamento de risco à saúde mais frequente.

Objetivo: evaluar la asociación entre el trabajo y los comportamientos de riesgo a la salud entre los escolares de zona rural. Métodos: estudio transversal con estudiantes de quinto a octavo grado de primaria en las escuelas municipales de Barão do Triunfo, RS, Brasil, en 2010; en cuestionario autoaplicable, se caracterizó el perfil de trabajo como 'trabajadores actuales', 'trabajadores previos' y 'no trabajadores'; los comportamientos de riesgo a la salud fueron el tabaquismo (sí; no) y el consumo de alcohol (sí; no) en el último mes, exceso de peso e inactividad física. Resultados: entre los 339 participantes menores de 16 años (89,9%), el 82,3% eran trabajadores; entre los trabajadores, predominaron los servicios domésticos (39,8%) y la agricultura (29,9%); 24,8% de los estudiantes tenía sobrepeso, 51,2% estaba inactivo en el tiempo libre, 6,6% fumaba y 27,0% consumió alcohol en los últimos 30 días; este consumo fue mayor entre los trabajadores que entre los no trabajadores (p=0,02). Conclusión: ocho de cada diez escolares trabajaba, y la mayoría fue de niños y adolescentes; el comportamiento de mayor riesgo entre ellos fue el alcohol.

Objective: to evaluate association between work and health risk behaviors among rural schoolchildren. Methods: this was a cross-sectional study with 5th to 8th grade elementary and middle school students attending municipal schools in Barão do Triunfo, RS, Brazil in 2010; a self-administered questionnaire was used; their work profile was characterized as 'current workers', 'former workers', and 'non-workers'; health risk behaviors examined were smoking, alcohol consumption, overweight, and physical inactivity (≤300 minutes per week). Results: of the 339 participants under 16 years old (89.9%), 82.3% were current workers; their predominant work was domestic services (39.8%), and farming (29.9%); 24.8% of students were overweight, 51.2% were inactive during leisure, 6.6% smoked, and 27.0% had consumed alcohol in the last 30 days; alcohol consumption was higher among workers than non-workers (p=0.02). Conclusion: eight out of ten schoolchildren worked, most of them as child labor; the most frequent health risk behavior was alcohol consumption.

Children at Work, Child Labor and Modern Slavery in India: An Overview.

There is a large child work force in India reported to be about 40 million. Child labor is being regarded as a form of modern slavery, as children are forced to work or have no choice to refuse work. Children are employed in a variety of occupations, many of which are hazardous. Exposure to machinery, pesticides, dust in agricultural work and fumes, chemicals, acids, cotton and wool fiber in other forms of work is detrimental to health. A large number are held in bonded servitude. In urban areas, children are employed as domestic helpers and engaged in eateries and auto-repair work. Trafficking and trading of children for work and sexual slavery are also major concerns. Poverty and illiteracy are root causes of child labor, but iniquitous societal attitudes are responsible for abuse and exploitation. Working children are deprived of proper health care and education, and lose their childhood and dignity. Several legal measures exist to prevent child labor and protect them from harm, but are thwarted by the distressing socioeconomic conditions. Although child labor would be difficult to abolish, exploitation can be prevented with concerted efforts of the government agencies, professional bodies and the civil society.

Reports and Victims of Sex and Labor Trafficking in a Major Midwest Metropolitan Area, 2008-2017.

OBJECTIVE: The objective of this study was to determine the number, risk factors, and demographic characteristics of potential human trafficking victims from tips reported to a social services agency in a major Midwest metropolitan area from 2008 through 2017. METHODS: The agency, comprising 90 employees serving more than 10 000 persons annually, received federal funding to raise awareness about trafficking and to identify and support persons who are at risk for trafficking through training, coalition building, direct outreach and service, and case management. We, the authors, counted the numbers of tips and potential victims reported to the agency by year, type of trafficking, economic sector, sex, region of origin, and age and looked for new risk factors for trafficking. RESULTS: Data were available for 213 tips received from September 1, 2008, through June 30, 2017, and for 82 potential victims identified from July 1, 2011, through June 30, 2017. Labor trafficking (126 tips, 57 potential victims) was more common than sex trafficking (59 tips, 17 potential victims). The number of tips varied during the study period. Tips and potential victims were diverse and included male and female children and adults. Most victims were from Mexico (n = 68), the United States (n = 47), Asia (n = 31), and Central and South America (n = 23). Potential victims were exploited in several industries including agriculture, construction, commercial sex, and landscaping. New risk factors for trafficking were exploitation within marriage and work in the sales industry. CONCLUSIONS: Domestic and foreign-born men, women, and children are all at risk for labor and sex trafficking. Direct outreach to foreign-born victims should be a priority. The new risk factors should be explored.

History of abuse and neglect and their associations with mental health in rescued child labourers in Nepal.

OBJECTIVES: Little is known about rates of childhood maltreatment in low-income countries, particularly among marginalised sectors of society. Economic hardships mean that in such countries, many children and young people are exploited in the labour force and/or are trafficked, placing them at greater risk for being exposed to other forms of maltreatment. Cultural norms endorsing the use of physical and emotional acts to discipline children further exacerbate this risk. Here, we assessed the rates of childhood victimisation experiences and associated mental health problems in Nepalese youth rescued from illegal child labour including trafficking. METHODS: One hundred and three young people aged 12-18 years living in out-of-home care institutions and rescued from child labour/trafficking completed translated versions of selected modules from the Juvenile Victimisation Questionnaire, the Youth Inventory and the Strength and Difficulties Questionnaire. Care-home employees responsible for looking after the young people completed the Adolescent Symptom Inventory and the Strength and Difficulties Questionnaire. Analysis described maltreatment frequencies and compared individuals who had and had not experienced any form of maltreatment on the presence/absence of psychiatric diagnoses. RESULTS: Seventy-two percent of participants experienced some form of maltreatment in their lifetime. Rates for each maltreatment type were 46.6% for physical abuse, 40.77% for emotional abuse, 27.2% for sexual abuse and 33% for neglect. Symptoms indicative of anxiety disorders and trauma were commonly reported especially in victims of childhood maltreatment. CONCLUSIONS: Our estimates of physical abuse in this at-risk juvenile sample were commensurate to those reported in general-population youth samples in Nepal, but sexual and emotional abuse rates were somewhat lower. The potential presence of anxiety and trauma in this sample that may result from maltreatment requires replication, but underscores an urgent need for routine mental health screening in rescued child labourers during rehabilitation efforts.

Engaging Youth Advocates in Community-Based Participatory Research on Child Farmworker Health in North Carolina.

BACKGROUND: Wake Forest School of Medicine (WFSM) investigators and Student Action with Farmworkers' (SAF) Levante Leadership Institute, a farmworker youth program, are collaborating on a community-based participatory research (CBPR) study. OBJECTIVES: 1) Describe the collaborative process between WFSM investigators and the Levante advisory board during the strategic planning and implementation phase and 2) highlight practices that support the collaboration and project success. METHODS: The longitudinal Hired Child Farmworker Study examines the health and safety of hired Latino child farm-workers in North Carolina. Two Levante alumni co- investigators lead research-related activities with the Levante advisory board. LESSONS LEARNED: Challenges to CBPR with youth are overcome by the longstanding partnership between WFSM and SAF, attention to logistical details, power sharing, building on shared values, and assessment of youth preferences. CONCLUSIONS: The partnership between WFSM and Levante demonstrates the mutual benefit of CBPR and will continue during the upcoming study phases.

Prevalence and risk factors for child labour and violence against children in Egypt using Bayesian geospatial modelling with multiple imputation.

BACKGROUND: The incidence of child labour, especially across developing nations, is of global concern. The use of children in employment in developing economies constitutes a major threat to the societies, and concerted efforts are made by the relevant stakeholders towards addressing some of the factors and issues responsible. Significant risk factors include socio-demographic and economic factors such as poverty, neglect, lack of adequate care, exposure of children to various grades of violence, parental education status, gender, place of residence, household size, residence type or size, wealth index, parental survivorship and household size. Egypt is the largest country in Africa by population. Although UNCIF 2017 reported that the worst forms of child labour in Egypt are concentrated in domestic work, forced begging and commercial sexual exploitation, the situation has received little attention. There are still very few studies initiated specifically to look at child labour in domestic service in Egypt and those that exist have been limited in the scope of their methodology. Geographical coverage and research for child labour in Egypt is also limited, as are accurate statistics and data. There was, therefore, a strong case for looking again at the domestic child labour phenomenon in Egypt, especially after the Demographic Health Survey (DHS) released the first data about child labour in Egypt in 2014. This study builds on the few findings of earlier work, and broadens coverage by including advanced methods and geographical effects of this problem. OBJECTIVES: This study focuses on identifying socio-demographic, economic and geospatial factors associated with child labour participation. METHODS: We used the 2014 Egypt Demographic and Health Survey (EDHS) from the Ministry of Health and Population in Egypt, with the record of 20,560 never-married children aged 5-17 years engaging in economic activities, in and out of their home. The data focused on demographic and socio-economic characteristics of household members. Multivariate Bayesian geo-additive models were employed to examine the demographical and socio-economic factors for children working less than 16 hrs; between 16 and less 45 hrs; and over 45 hrs weekly. RESULTS: The results showed that at least 31.6% of the children in the age group from 5-10 were working, 68.5% of children aged 11-17 years were engaged in child labour for a wage, and 44.7% of the children in the age group from 5-10 were engaged in hazardous work. From the multivariate Bayesian geo-additive models, female children (with male children as reference category) working at least 16 hrs (OR: 1.3; with 95% CI: 1.2-1.5) were more likely to be engaged in child labour than girls working 16 to 45 hrs (OR: 1; 95% CI: 0.3-1.5). Children born to women without formal education, in non-hazardous jobs, irrespective of the hours spent at work, were more likely to be involved in child labour (52.9%, 56.8%, 62.4%) compared to children of mothers with some level of education. Finally, children who have experienced psychological aggression and physical punishment are more likely to be used as child labour than those without such experience across the job types and hours spent. North-eastern Egypt has a higher likelihood of child labour than most other regions, while children who live in the Delta are more engaged in hazardous work. CONCLUSION: This study revealed a significant influence of socio-demographic and economic factors on child labour and violence against children in Egypt. Poverty, neglect, lack of adequate care and exposure of children to various grades of violence are major drivers of child labour across the country. The spatial effect suggests the need to give more attention to some areas that have high rates of child labour, such as the Nile Delta, Upper Egypt, and North-eastern Egypt.

Children's Environmental Health in South and Southeast Asia: Networking for Better Child Health Outcomes.

Children are particularly vulnerable to environmental hazards because they receive higher doses of pollutants in any given environment and often do not have equitable access to social protection mechanisms such as environmental and health care services. The World Health Organization established a global network of collaborating centres that address children's environmental health (CEH). The network developed a focus on low- and middle-income countries (LMICs) and is broadening its reach by conducting regional workshops for CEH.Objective: This paper reports on the outcomes of a workshop held in conjunction with the 17th International Conference (November 2017) of the Pacific Basin Consortium for Environment and Health, focused on the state of CEH in South and Southeast Asia as presented by seven countries from the region (India, Bangladesh, Nepal, Bhutan, Vietnam, Thailand, Sri Lanka).Workshop outcomes: Country reports presented at the meeting show a high degree of similarity with respect to the issues threatening the health of children. The most common problems are outdoor and household air pollution in addition to exposure to heavy metals, industrial chemicals, and pesticides. Many children still do not have adequate access to clean water and improved sanitation while infectious diseases remain a problem, especially for children living in poverty. Child labour is widely prevalent, generally without adequate training or personal protective equipment. The children now face the dual burden of undernutrition and stunting on the one hand and overnutrition and obesity on the other.Conclusion: It is evident that some countries in these regions are doing better than others in varying areas of CEH. By establishing and participating in regional networks, countries can learn from each other and harmonise their efforts to protect CEH so that all can benefit from closer interactions.