African Newsletter. Accident prevention - a safe workplace O N O C C U P A T I O N A L H E A L T H A N D S A F E T Y. Volume 19, number 1, April 2009

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1 African Newsletter O N O C C U P A T I O N A L H E A L T H A N D S A F E T Y Volume 19, number 1, April 2009 Accident prevention - a safe workplace

2 African Newsletter on Occupational Health and Safety Volume 19, number 1, April 2009 Accident prevention - a safe workplace Published by Finnish Institute of Occupational Health Topeliuksenkatu 41 a A FI Helsinki, Finland Editor in Chief Suvi Lehtinen Editor Marianne Joronen Linguistic Editing Sheryl S. Hinkkanen Layout Liisa Surakka, Kirjapaino Uusimaa, Studio The Editorial Board is listed (as of January 2008) on the back page. A list of contact persons in Africa is also on the back page. This publication enjoys copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts of articles may be reproduced without authorization, on condition that source is indicated. For rights of reproduction or translation, application should be made to the Finnish Institute of Occupational Health, International Affairs, Topeliuksenkatu 41 a A, FI Helsinki, Finland. The African Newsletter on Occupational Health and Safety homepage address is: The next issue of the African Newsletter will come out at the end of August The theme of the issue 2/2009 is Planning of occupational health and safety activities. Photograph of the cover page: M. Crozet, International Labour Organization Finnish Institute of Occupational Health, 2009 Printed publication: ISSN On-line publication: ISSN Contents 3 Editorial H.I. Kitumbo TANZANIA Articles 4 System for collection and analysis of occupational accidents data S. Machida ILO 6 Chemical safety and accident prevention P.W. Makhonge KENYA 8 Factors influencing the reporting of needlestick injuries among nurses at Mulago Hospital N.F. Mangasi UGANDA 12 A role of safety culture in preventing accidents in the workplace H.M. Kiwekete SOUTH AFRICA 14 Meetings in Nairobi and Kampala S. Lehtinen FINLAND 15 Profile of woodwork-related accidents in Gabon P. Comlan, F. Ezinah, A. Mouanga, E. Kendjo, J. Roy, B. Obiang Ossoubita GAMBIA 18 The impact of globalization on occupational health services: A case of developing countries L. A. Abongomera UGANDA 20 Improving Working Conditions through Microfinance Programming R. Carothers, CANADA M. Foad, EGYPT J. Denomy, CANADA 22 ICOH2009 in Cape Town S. Lehtinen The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office, World Health Organization or the Finnish Institute of Occupational Health of the opinions expressed in it..

3 Accident prevention a safe workplace Accidents! Accidents! Accidents! this is the cry of the world. Everyone complains about the consequences of accidents. Governments worldwide, employers, employees and the public at large all complain. Unfortunately, everyone is very active in complaining rather than in taking measures to prevent accidents. The prevention of accidents at workplaces would have a considerable effect on reducing costs. The number of accidents could be reduced considerably through enhancement of safety and health prevention measures. We are witnessing a gradual increase in economic activities to cater for the rapid growth in the global population. Even though the increase in economic activities is a desirable development, in most cases these activities are associated with numerous occupational safety and health hazards. Each person is entitled to safe and healthy conditions at the workplace, resulting in worker safety and overall good health. This, in turn, would result in increased productivity and well-being for our enterprises and an enhanced world economy. Such progress can only be achieved through prevention a tool both for reducing the direct and indirect costs of occupational accidents and for eliminating unnecessary human suffering. It is therefore high time that we now proceed quickly from complaints to preventive measures. A Safe and Healthy Workplace is a Wealthy Workplace! Hamisi Iddi Kitumbo, Engineer Chief Inspector, Occupational Safety and Healthy Authority (OSHA) Tanzania Afr Newslett on Occup Health and Safety 2009;19:3 3

4 Seiji Machida ILO System for collection and analysis of occupational accidents data Decent work SafeWork The magnitude of the global impact of occupational accidents and diseases, as well as major industrial disasters, in terms of human suffering and related economic costs, has been a long-standing source of concern at workplace, national and international levels. Although significant efforts have been made at all levels to come to terms with this problem, ILO estimates that about 2.3 million workers die each year from work-related accidents and diseases, and that globally this figure is on the increase. Occupational Safety and Health (OSH) has been a central issue for the ILO ever since it began operations in 1919 and continues to be a fundamental requirement for achieving the objectives of the Decent Work Agenda. In pursuing the creation of safe and healthy workplaces, a strategic and systematic approach through the development of targeted action plans (national programme on OSH) has been promoted in recent years. The collection and analysis of relevant data are critical in developing action plans. This paper discusses the importance of sound systems for collecting and analysing data on occupational accidents. Systems approach to OSH The Global Strategy on Occupational Safety and Health adopted by the 2003 International Labour Conference underlined the importance of creating preventive safety and health culture and the management systems approach. In 2001, the ILO developed Guidelines on Occupational Safety and Health Management Systems (ILO-OSH 2001), which are the principal international standard on the subject. They provide guidance on the systems to be developed at the enterprise level, based on the concept of continual improvement of performance through the application of the PDCA cycle ( plan-do-check-act ). A follow-up to the Global Strategy, the new Promotional Framework for Occupational Safety and Health Convention (No. 187) and Recommendation (No. 197) were adopted by the International Labour Conference in June These new international standards aim at placing OSH high on national agendas, promoting preventive safety and health culture, applying a systems approach to OSH at the national level, and promoting the application and ratification of other ILO Conventions on OSH. Key elements include the development of national OSH policy, national OSH programmes and national OSH systems by the government, in consultation with social partners. The texts of these instruments are available at: These instruments promote the systems approach to OSH at the national level. The main steps in developing such a management approach at the national level include the following: Firstly, national policy on OSH should be formulated in consultation with representative organizations of employers and workers, as laid down in the 1981 Occupational Safety and Health Convention, (No. 155). Secondly, a national system for OSH should be developed, which contains the infrastructure to implement the policy and national programmes on OSH. Thirdly, a national OSH programme should be developed, based on the analysis of the OSH situation, which preferably should be summarized as a national profile on OSH, and implemented over a specific period of time. Finally, at its conclusion, such a programme should be reviewed, and be replaced by a new national programme on OSH. National programmes on OSH and national accident data A key element in making a management systems approach operational at the national level is the formulation and development of national OSH programmes. These programmes are strategic programmes with a predetermined time frame (for example five years) that focus on specific national priorities for OSH, based on analyses of the situations in the countries concerned, which should preferably be summarized as national profiles on OSH. Each programme should be developed and implemented following tripartite consultation between government, employers and workers, and endorsed by the highest government authorities. While such programmes need clear objectives, targets and indicators, they should overall also aim to strengthen the national system for OSH, to ensure the sustainability of improvements, and to build and maintain a national preventive safety and health culture. The collection and analysis of data on occupational accidents and diseases are critical in formulating national programmes. Because of its nature, the data on occupational diseases are difficult to collect and analyse as many factors affect the data, such as latency period after exposure and difficulties in diagnosis. While the data of occupational accidents are simpler, many countries still have difficulties in collecting comprehensive and accurate data. Table 1 below is a summary of occupational fatalities and injuries of selected African countries available in the ILO Yearbook of Labour Statistics. This table contains two kinds of data, namely the accidents reported to authorities based on legal reporting requirements, and the accidents claimed on the insurance schemes. It seems evident that insurance schemes collect more cases than the legal reporting requirements. This trend is also true for the countries in other regions. The accident rates calculated based on the number of accidents (reported or claimed) and the employment figures show that the accident rates are higher in countries 4 Afr Newslett on Occup Health and Safety 2009;19:4 6

5 Table 1. Summary of occupational accident data for selected African countries (Source: ILO Yearbook of Labour Statistics) Country Case of accidents Employed Accident rate Data source Year of Fatal Non-fatal Total per 1000 data (x1000) workers Algeria Insurance 2004 Egypt Reported 2003 Ethiopia Reported 1999 Mauritius Insurance 2007 Nigeria N.A. - Reported 2004 Namibia Insurance 2001 Rwanda N.A. - Insurance 2000 S. Africa Reported 2000 Togo N.A. - Insurance 2004 Tunisia Insurance 2004 Zimbabwe N.A. - Insurance 2007 in which accident cases are counted based on insurance schemes. However, higher accident rates should not be interpreted as more dangerous. These countries merely have better information on accident cases (better reporting) and their accidents rates are not necessarily higher than other countries. In other words, countries which have a compulsory work accidents insurance scheme, and in which accident data are collected through the insurance schemes, have a better basis for analysing accident trends and situations. National profiles on OSH and accident data The new ILO approach promoted by the Promotional Framework for Occupational Safety and Health Convention (No. 187) and its accompanying Recommendation (No. 197) call for the preparation of a national profile on OSH. A national profile on OSH summarizes the existing OSH situation, including national data on occupational accidents and diseases, high-risk industries and occupations, and the description of national systems for OSH and capacity. The elements of information to be compiled as national profile on OSH are described in the Recommendation. National profiles on OSH also facilitate a systematic review of the improvements in the national systems for OSH and programmes. Among the information to be contained in the profile, data on occupational accidents and diseases are the key information for assessing the national OSH situation, planning for priority actions, and reviewing the progress. National systems for OSH National systems for OSH are infrastructures which provide the main framework for the implementation of national programmes on OSH. In turn, one of the main aims of national OSH programmes should be to strengthen national OSH systems. For the competent authority, it is not enough just to establish OSH legislation and to make arrangements for its enforcement. While tripartite collaboration, inspection and enforcement are still vital components of any national system for OSH, there is a need to develop other elements of the system covering specific functions. For example, most employers, particularly those of small enterprises, need various supports just to comply with the legislation, such as providing OSH training to workers handling hazardous substances, conducting technical inspection of dangerous machines and carrying out medical surveillance. Article 4 of Convention No. 187 describes the components of the national OSH system. One of the system components listed is the mechanism for the collection and analysis of data on occupational accidents and diseases. In this connection, it should be noted that provisions for collaboration with relevant insurance schemes covering occupational accidents and diseases are also listed as a component of the national OSH system in view of its importance in the use of the data from insurance as well as other linkages. ILO Code of Practice In the field of data collection and analysis, the ILO code of practice on Recording and Notification of Occupational Accidents and Diseases (http://www.ilo.org/public/english/ protection/safework/cops/english/download/ e pdf) provides useful guidance for action at enterprise and national levels. Data collection and analysis are an essential element for the systematic approach to OSH at these levels. First of all, the code calls for the establishment of a system for recording occupational accidents, occupational diseases, commuting accidents, dangerous occurrences, and incidents. Dangerous occurrences are readily identifiable events to be defined by national legislation and include events such as the release of toxic chemicals or fires without injuries to workers. Incidents are unsafe occurrences during the course of work without injuries to workers, and include events such as materials falling but not hitting workers and are sometimes called near misses. All these occurrences have to be recorded at each enterprise with a view to preventing future recurrences. The complied records could be analysed in various ways such as types of accidents and materials involved. The collection and analysis of records on incidents (near misses) are becoming popular, though they are usually not required by law. In general, these incidents happen more frequently than occupational accidents, and the development of prevention measures against them will result in the reduction of occupational accidents and diseases. For the development and functioning of an enterprise system for recording of accidents and incidents, active participation of all workers, based on proper training, is essential. These records at enterprises provide valuable information for the development of a strategic approach to prevention at the national level. Therefore, there is a need for establishing mechanisms for compiling and analysing the information at the national level. It is most common that reporting (notification) to the OSH authorities is required by an OSH Act or similar legislation, such as the Factories Act. The following represent the minimum information required for notification according to the ILO code of practice and are to be included in the forms prescribed: (a) enterprise, establishment and employer: (i) name and address of the employer, and his or her telephone and fax numbers (if available) (ii) name and address of the enterprise (iii) name and address of the establishment (if different) (iv) economic activity of the establishment (v) number of workers (size of the establishment) (b) injured person: (i) name, address, sex and age (ii) employment status (iii) occupation (c) injury: (i) fatal accident (ii) non-fatal accident (iii) nature of the injury (e.g. fracture, etc.) (iv) location of the injury (e.g. leg, etc.) (d) accident and its sequence: (i) geographical location of the place of the accident (usual workplace, another workplace within the establishment or outside the establishment) Afr Newslett on Occup Health and Safety 2009;19:4 6 5

6 (ii) date and time (iii) action leading to injury type of accident (e.g. fall, etc.) (iv) agency related to the accident (e.g. ladder, etc.). The code also provides further guidance on the notification of occupational diseases and dangerous occurrences. Chemical safety and accident prevention Pius W. Makhonge Kenya Conclusions At the beginning of this paper, an ILO estimate of 2.3 million fatalities due to workrelated accidents and diseases is mentioned. This estimate was made as the ILO does not have comprehensive data from the information provided by the ILO Member States due to various reasons, including limited scope of the national reporting systems in terms of coverage and under-reporting. Data on occupational accidents and diseases play important roles in two ways: 1) as the basis for planning with a view to setting priorities, and 2) as the indicators for measuring progress. The national OSH programmes promoted by Convention No. 187 require the setting of targets and indicators. The data on occupational accidents and diseases are commonly used as main indicators. Without assurance for the reliability of data, it is difficult to use them as indicators for progress. Thus there is a need for continuously improving the mechanisms for the collection of data on occupational accidents and diseases in all countries. The government should examine the comprehensiveness and accuracy of the compiled data with a view to obtaining better information to analyse the national OSH situation. The arrangements for the collection of additional data by conducting special surveys on OSH at workplaces or other means should be considered to obtain more accurate and indepth information. Such surveys should preferably also cover small enterprises and selfemployed persons. Calculating the estimated figures of occupational accidents and diseases by each country might be considered in order to obtain a comprehensive national picture of occupational accidents and diseases. It is important to exchange information on the national experience in collecting and analysing data on occupational accidents, including improvements in the data collection systems and supplementary measures such as special surveys. Seiji Machida Coordinator, Occupational Safety and Management Systems SafeWork, ILO CH-1211 Geneva 22 Switzerland Introduction Chemicals are used, among other things, as fertilizers to increase food production, as pesticides for crop protection and postharvest food protection, as paints and solvents, fuels, lubricating oils, and additives, in the manufacture of various products, and as medicines for both animals and humans. In spite of their value, chemicals are known to have caused occupational diseases and accidents. The definition of an accident that has been suggested is: An accident is an unexpected, unplanned event in a sequence of events that occurs through a combination of causes and that results in physical harm (injury or fatality) to an individual, damage to property, a near miss, a loss, or a combination of these effects. The term chemical accident therefore would refer to an event involving chemicals which harms human health and/or the environment. Such events include fires, explosions, leakages or release of toxic or hazardous substances that can cause illness, injury, disability or death among people and damage to property and environment. Chemical accidents are not only restricted to the industrial sector; they can occur whenever toxic material are stored, transported or used. The effects can range from minor burns, irritation of the skin, irritation of the upper and lower respiratory tract and oxygen starvation to immediate death or serious health effects, or even to death long after the exposure. According to the International Labour Organization (ILO), about 400,000 deaths are caused by exposure to chemicals annually. The non-fatal accidents due to chemicals may be several times more frequent than fatal accidents. Historical perspective and causes of chemical accidents Analysis of past accidents shows that they have been caused by a combination of several factors. Failure to respond effectively to the emergencies arising in consequence of accidents has clearly demonstrated a lack of preparedness. It appears that the underlying cause of accidents has in most cases been associated with flaws in management systems. The following are some of the accidents involving chemicals recorded in history and the findings of the subsequent investigation. The Bhopal disaster in India in 1984 killed more than 3,000 people and left many disabled. The investigation cited deficiencies in design, large-scale storage (more than 40 tonnes) of methyl isocyanate (MIC) gas situated in a densely populated area, poor management of plant safety, lack of skilled operators, poor plant maintenance and inadequate emergency response planning. The Flixborough disaster at the Nypro factory in England that occurred in June 1974 killed 28 workers and injured 36 employees and 53 non-employees. The causes were a result of maintenance modifications and lack of skilled process personnel. The official investigation recommended that any modification should be designed, tested and maintained to the same standards as the original plant. The Phillips 66 tragedy in Pasadena, Texas, USA in 1989 led to 23 deaths and some 300 people were injured. The cause was a massive leakage of flammable gas (over 40 tons) from the reactor. The investigation revealed shortcomings in well-established and understood procedures. The Molo (Sachagwan) fuel tank disaster near Nakuru, Kenya, in 2009 killed 110 people and 178 were injured; most of them were mothers and children who had gone to see what was happening or to get a little of the petrol. Apparent contributing factors were ignorance of the hazard among the community and lack of safe procedures for use in such a situation. The Libra House accident in Nairobi, Kenya in 2005 left 10 dead from a fire involving solvents and paint. Poor safety management, storage of large volumes of organic solvents (over 4 tonnes) for paint manufacture, and compromising safety in exchange for security were contributing factors. In many other cases, employees have died in confined spaces, such as sewers, silos and tanks, and in explosions of gas cylinders or of drums during welding. Investigation of such cases has revealed ignorance about safety and lack of safe work procedures or shortcomings in safety procedures. 6 Afr Newslett on Occup Health and Safety 2009;19:4 6

7 Suggestions for improvement of chemical safety Arising from the lessons learned from past accidents, the following can be used to strengthen the management of chemical safety at the workplace. Basic process safety management requirements should be in place. They should include chemical risk assessment, hazard identification, risk analysis to determine the degree of risk reduction and the emergency arrangements available. A safety policy should be defined for and known in each workplace and resources, including leadership, should be allocated to carry out the implementation of the safety policy. There will always be change in the technology used, in procedures and in personnel. Change should be well managed and not taken for granted. All employees, including contractors and customers, should be well prepared to handle any changes at the workplace, through appropriate sensitization and training. Operating procedures should specify the consequences of deviations and steps to avoid or to correct deviations. The best available knowledge and methods should be applied. Safe work practices and permits to work should be developed and implemented for hot work and entry into confined spaces. Refresher, remedial and skill improvement training should be regularly undertaken through employee information and training programmes. Maintenance and mechanical integrity to prevent leakage or explosion should be ensured, based on documented periodic inspection, testing and corrective action. Compliance audits should be conducted to provide a basis for continuous improvement. Self-evaluation through internal safety audits by safety and health committees should be encouraged. A thorough hazard analysis and investigation should be done, using systems such as fault tree analysis and event tree analysis, failure mode and effect analysis. Hazard and operability studies and the Taproot incident investigation system (which uses human reliability or human performance methods) can lead to significant improvements in chemical safety. Occupational health and safety should be mainstreamed at all levels of school education, hence leading to an in-built safety culture in future workers. Emergency planning, preparedness and response in readiness for any eventuality should be essential. The involvement of neighbours and the community is vital for good results. A national emergency response preparedness institution, that will provide leadership in matters of emergency, should be established and strengthened through the allocation of adequate resources, including personnel. Relevant rules and guidelines on chemical safety should be formulated. Apart from the foregoing safety inputs, the following should be applied in the specific highrisk environments indicated below: An inventory of hazardous installations, which include installations with chlorine, ammonia, paint manufacture, organic solvents, petroleum refinery and bulk fuel storage, should be established and the workers and community affected should be sensitized concerning the risks. Safe operating procedures should be prepared and made available to employees, contractors and other stakeholders. The sensitization not only enhances community awareness of chemical risks and preparedness in the event of an accident, but is also in compliance with the right to know principle. Where warehousing of chemicals is undertaken, prior knowledge of the substances and their properties should be available so that incompatible substances are suitably separated or have suitable intermediate firewalls. Fire detection and sprinkler systems are beneficial, provided care is taken not to store water-reactive chemical under sprinklers. Storage of gas cylinders needs to be given prior consideration before the storage is undertaken, and must ensure that gas cylinders are stored upright and checked regularly. Particular attention should be paid to the regulator, in order to minimize cases of leakage. Gas cylinders should be stored away from lifts, stairs, gangways, and underground rooms and in an area that is free from fire risks, sources of heat and ignition. To prevent corrosion of the bottom, they should be stored under cover in a welldrained surface. Installation of automatic gas detectors would be useful. To avoid asphyxiation, cylinders containing nitrogen and carbon dioxide should be stored in a well-ventilated area, and precautions should be taken to ensure that the atmosphere is checked before anyone enters in cases where ventilation appears inadequate. Transportation of hazardous substances within the plant and outside the plant requires adequate instruction and training of drivers. Information on the load being carried and conspicuous labelling are vital. Literature Sanders RE. Chemical Process Safety: Learning from Case Histories. Third Edition; Hellberg H. A right to know but when? New Epidemics in Occupational Health; Finnish Institute of Occupational Health; People and Work. Research Reports 19941;1: Principles for the assessment of risks to human health from exposure to chemicals; environmental health criteria 210. International Programme on Chemical Safety: Occupational Safety and Health Act 2007 (Kenya). ILO Convention on Chemical Safety C.170. Pius W. Makhonge Director Directorate of Occupational Safety and Health Services P.O. Box Nairobi Kenya Photo Suvi Lehtinen Afr Newslett on Occup Health and Safety 2009;19:6 7 7

8 Factors influencing the reporting of needlestick injuries among nurses at Mulago Hospital Nsubuga F. Mangasi UGANDA Background Uganda is a developing country with a high prevalence of medical injections among the population. It is estimated that on average adult receives 5.3 injections per year (1). According to a recent study of injections among the population of Mbarara District, a child under five years receives an average of 10 injections per year (2). The majority of these injections are given for curative reasons (98%), while a small fraction is given for immunization. Most of these injections are considered unsafe because of inconsistent supplies, inadequate doses, an unhygienic work environment, and poor medical waste management. Because injections are common, health care workers, especially the nursing staff, are prone to needlestick injuries. In Uganda, data on occupational exposure to needlestick injuries among health care workers are sparse. This is attributed to poor compliance with reporting needlestick injuries. Lack of reporting makes it difficult to ascertain the incidence and prevalence of such injuries, and difficult to put appropriate control measures into place. One cross-sectional study by DH. Newsom and JP. Kiwanuka (3) carried out at Mbarara Teaching Hospital found an incidence of 1.86 needlestick injuries per health care worker per year. Intern doctors were more likely to be injured than other health care workers. With the ever rising proportion of hospitalized HIV/AIDS patients, there is an increasingly urgent need to investigate the conditions and predisposing factors contributing to needlestick injuries, so that the possibilities of adopting safer working practices can be determined. Reporting of needlestick injuries A number of studies that have been conducted on the reporting of the needle stick injuries have revealed that there is a high proportion of needlestick injuries that occur among health care workers, which are not reported to the occupational health services. For example, a study that was conducted by BH. Hamory (4) among the university employees estimated that over 40% of the injuries that had occurred in the last three months and 75% of the injuries that had occurred in the last year had not been reported to the occupational health services. While the study by McGreer et al (5) on the epidemiology of needlestick injuries among the house officers noted that only less than 5% of the needlestick injuries were officially reported. Also a study by Hettiarattchy and colleagues (6) found that only 17.5% of needlestick injuries among junior Doctors in London had been reported. Other studies on underreporting of needlestick injuries among health care workers include that of Ramsey and Glenn (7) which found that lack of reporting ranged between 20% and 50% among nurses. A retrospective study by Burke and Madan (8) on contamination incidents among doctors and midwives in the Photo International Labour Organization/P. Deloche NHS Trust in the UK found that only 9% of the doctors and 46% of the midwives had reported needlestick injuries to the Occupational Health Department. Although there is a high rate of underreporting, nursing staff are more likely to report needlestick injuries than other medical staff according to McGreer et al (5) and Short et al (9). This has been attributed to the higher number of needlestick injuries that occur among nursing staff as opposed to health care workers in other categories. A number of factors have been identified as stumbling blocks preventing health care workers from reporting needlestick injuries. These include misperception of the risk of getting an infectious disease, unawareness of the reporting procedures, time constraints, absence of a policy on reporting, lack of postexposure prophylaxis programmes, dissatisfaction with the follow-up procedures offered and the long wait for professional services and concern about confidentiality and profession- 8 Afr Newslett on Occup Health and Safety 2009;19:8 11

9 al discrimination (8,10,11). Thus, in order to improve the reporting of needlestick injuries, health care workers concerns and the obstacles to reporting have to be addressed. For example, in their prospective study on the implementation of a universal protection programme, Whitby and co-workers (12) found a clear improvement in reporting following an educational programme and the provision of rigid containers for sharps. For a reporting system to be effective, it should include a readily accessible expert for consultation as well as safeguards protecting the confidentiality of the exposed health care worker. The reporting system should also be facilitated by educational programmes, by the availability of post-exposure management facilities and by a non-punitive employer response. How the study was done? This cross-sectional study was conducted at Mulago National Hospital to assess the factors that influence reporting of needlestick injuries among nurses. A self-administered recall questionnaire eliciting demographic characteristics and work-related factors that influence the reporting of needlestick injuries was sent out to nurses to be completed anonymously. The questionnaire was distributed to nurses and midwives directly involved in patient treatment and management at Mulago Hospital, a national referral hospital in Kampala. Mulago Hospital complex employs over 1,000 nursing staff, of whom 800 were eligible for inclusion in the study. Participation in the study was voluntary. The research protocol was approved by the ethical research committee. The study was carried out in April May A total of 530 questionnaires were returned, giving a response rate of 66%. Four questionnaires were excluded from further analysis because they were less than 50% completed and two of them were virtually identical apart from the ID number. In all, 526 returned questionnaires were included in the data analysis. The responses of the completed questionnaires were entered into a computer and analysed using SPSS computer software. The data were analysed for response rates, accident frequencies and factors influencing the reporting of needlestick injuries among the nursing staff. Results Out of the 526 respondents, 187 (35.5%) reported having experienced at least one needlestick injury in the last month, 335 (63.7%) had no needlestick injury in the last month, 301 (57.2%) respondents reported having experienced at least one needlestick injury in the last year, and 4 (0.8%) didn t answer this question. A total of 2,072 needlestick injuries were reported by the 526 respondents in the last one year, giving an annual incidence rate of 3.94 per person. Among the needlestick injuries experienced in the past year, 97 occurred while in the process of injecting a patient, 92 when Table 1. Distributions of the respondents Gender Number (total=526) Percentage Male Female Unspecified Age (years) Unspecified Job titles Senior nursing officer Nursing officer Enrolled midwife Enrolled nurse Nursing aide Others Unspecified Departments Obstetrics & Gynaecology Surgery Internal medicine Paediatrics Unspecified Years in nursing practice < > Unspecified Number of patients attended to per day < > Unspecified Hours worked per week < > Unspecified Night shifts worked per month Table 2. Selected characteristics of the respondents inserting an intravenous line, 69 during the process of needle disposal, 28 when recapping the needle, 27 during cleaning after the procedure, ten were due to accidental injury by colleagues, especially when carrying an exposed needle in their hands, eight were caused by a needle that had been left unattended to None > Minimum Maximum Mean SD Age (years) Years working at Mulago Hospital Years in nursing practice Number of patients attended to daily Hours worked per week Night shifts worked per month Number of needlestick injuries in the last month Number of needlestick injuries in the last year Number of needlestick injuries in the entire career Afr Newslett on Occup Health and Safety 2009;19:8 11 9

10 after the procedure, and eight were caused by some other procedure, especially being cut by glass when breaking a drug vial or ampoule. % of respondents table beside corner or another table next room next ward not available Location of safety box Figure 1. Location of the injection safety box when the last needlestick injury occurred Table 3. Reasons for reporting needlestick injuries in the last 12 months Frequency of response % those who specified N = Want to get counselling To seek treatment Filing for compensation Responsibility to report Other reasons (1) Analysis was done on those (231) who responded to the question item 295 responded did not specify Table 4. Reasons for not reporting needlestick injuries Frequency of response Percentage N = 261 No support given Don t know why reporting is necessary Injury not dangerous Forgot I will be reprimanded It was my mistake Needlestick injury is part of the job Time-consuming Already immunized for hepatitis B virus % of respondents Table 5. Support given to those who reported a needlestick injury in the last year Frequency of those who had reported (N=93)1 Percentage About half of the respondents who had sustained a needlestick injury had never reported it. About a third of the respondents sometimes reported a needlestick injury. Only a little over one in ten respondents always reported a needlestick injury. % of respondents occupational health services 64.1 nurse departmental manager head 4.2 accident and emergency room other Of those who reported needlestick injuries, only 14 reported to the staff clinic, 182 reported to the ward manager, 23 to the head of the department, 12 reported to the casu Where reported Figure 3. Reporting of needlestick injuries unit of officer receiving the report never sometimes most of the time Frequency of reporting Figure 2. Reporting of needlestick injuries frequency 11.3 all of the time None Follow-up of the needlestick injury incident Given the day off work The cause was investigated Laboratory tests were done Counselling Free HIV drugs for post-exposure prophylaxis Only 93 had reported the incidence Table 6. Factors influencing the reporting needlestick injuries YES Frequency of response (260 respondents) Percentage NO Frequency of response (260 respondents) Percentage Awareness of the policy on needlestick injury Knows the reporting procedure Knows where to report Has received training on needlestick injury Training on universal precautions Training on measures to take after needlestick injury (first aid) Knowledge of postexposure prophylaxis Training on safe handling and disposal of used needles Concerned about needlestick injury Afr Newslett on Occup Health and Safety 2009;19:8 11

11 alty/accident and emergency room and 47 reported the needlestick injury to others, mainly colleagues and friends. Table 6 illustrates some of the factors influencing underreporting of the needlestick injuries by the nurses at Mulago Hospital. The majority of those who answered this question (190 out of 260) were not aware of the hospital policy on needlestick injury and 183 out of 260 respondents did not know the reporting procedure to follow. Photo Nsubuga F. Mangasi Limitations of the study The study was a cross-sectional survey that involved a self-administered questionnaire. Self-administered questionnaires are prone to recall bias. Some questionnaires were filled in only partially and because of the respondents anonymity, those whose answers were incomplete could not be traced. Thus if more than half of the questionnaire was completed, the other variables were recorded as missing, but if less than half of the questionnaire was completed, it was excluded from the study. The study coincided with the period when medical workers were threatening to go out on strike because they considered themselves underpaid. Some of the responses may therefore have been exaggerated, in an attempt to demonstrate their risk and unsatisfactory working conditions and to justify for their demand for better pay. Discussion The study demonstrated that there is still a high prevalence of needlestick injuries among the nurses working at Mulago Hospital, and that the majority of needlestick injuries are not being reported. The causes for not reporting needlestick injuries are lack of awareness of the policy on needlestick injury and lack of knowledge about the reporting procedure. Lack of knowledge about the reporting procedure was attributed to the lack of formal training on needlestick injuries. The lack of a policy and the absence of training on needlestick injuries depicted lack of commitment by the management to address such injuries at the workplace. Although most of the nurses were concerned about needlestick injuries, they felt neglected and thought that no one seemed to take charge of the issue; thus they saw no reason to report needlestick injuries. Even those who endeavoured to report needlestick injuries claimed that they didn t get the proper support that they deserved. Recommendations Management should ensure that all hospital staff are aware of the policy and reporting The study demonstrated that there is still a high prevalence of needlestick injuries among the nurses working at Mulago Hospital, and that the majority of needlestick injuries are not being reported. procedure for needlestick injuries. Nursing staff should receive training in management of needlestick injury reporting and in prevention of needlestick injuries. Management should institute measures to reduce the occurrence of needlestick injuries. Such measures should include risk assessment, setting of standards and protocols that address safety, risk reduction, post-exposure follow-up and first aid. In addition, occupational risks can be reduced by introducing measures to prevent or reduce stress, to maintain an optimum workload, to orientate new staff and to provide education and supervision. References 1. Millogo J. Assessment of Injection Practices (Report). Government of Uganda Ministry of Health, Uganda National Injection Safety Task Force Priotto G, Ruiz A, Kyobutungi C (2003) in Pilot-Testing the Who Tools to Assess and Evaluate Injection Practices: A Summary of 10 Assessments Coordinated by WHO in Seven Countries ( ) [WHO/BCT/03.10], eds Gisselquist D, Hutin Y (WHO, Geneva), p Newsom DH, Kiwanuka JP. Needle-stick injuries in a Ugandan teaching hospital. Annals of Tropical Medicine & Parasitology 2002;96: Hamory BH. Underreporting of needlestick injuries in a university hospital. Am J Infect Control 1983;11(5): McGeer A, Simor AE, Low DE; Epidemiology of needlestick injuries in house officer; J Infect Dis Oct;162(4): Hettiaratchy S, Hassall O, Watson C, Wallis D, Williams D. Glove usage and reporting of needlestick injuries by junior hospital medical staff. Ann R Coll Surg Engl Nov;80(6): Ramsey PW, Glenn LL; Nurses body fluid exposure reporting, HIV testing, and hepatitis B vaccination rates: before and after implementing universal precautions regulations; AAOHN J Mar;44(3): Burke S, Madan I. Contamination incidents among doctors and midwives: reasons for nonreporting and knowledge of the risk. Occup Med 1997;47: Short L et al. Underreporting of needle-stick injuries among health care workers. Infect Control Hospital Epidemiol Mangione CM, Gerberding JL, Cummings SR; Occupational exposure to HIV: frequency and rates of underreporting of percutaneous and mucocutaneous exposures by medical housestaff; Am J Med Jan;90(1): Adegboye AA et al. The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital; infect control hosp epidemiology 1994;15(1): Whitby RM, McLaws ML. Hollow-bore needlestick injuries in a tertiary teaching hospital l: epidemiology, education and engineering. Med J Aust Oct 21;177(8): Dr Nsubuga Fred Mangasi Occupational Physician Ministry of Gender, Labour and Social Development Department of Occupational Safety and Health P.O. Box 7136, Kampala, Uganda Fax Afr Newslett on Occup Health and Safety 2009;19:

12 What is a workplace? The South African Occupational Health and Safety Act No. 85 of 1993, under the jurisdiction of the Department of Labour, defines a workplace as being any premises or place where a person performs work in the course of his employment. (3) Hope Muggagga Kiwekete SOUTH AFRICA The role of a safety culture in preventing accidents in the workplace The increasing importance of health and safety in the workplace is prompting organizations to devise means of accident prevention at work. The XVIII World Congress on Safety and Health at Work was held in Seoul, Republic of Korea from 29 June to 2 July The Seoul Declaration, approved with a strong unanimous endorsement, was signed at the World Summit by a total of 46 leaders. The Seoul Declaration states that the right to a safe and healthy working environment should be considered as a fundamental human right, and it encourages governments to consider ratification of the ILO Promotional Framework for Occupational Safety and Health Convention, 2006 (N 187) as a priority. (1) This article focuses on the role of a safety culture in preventing accidents in the workplace. It will appeal to organizations that have already embarked on programmes of accident prevention as well as to organizations that would like to start such programmes. What is an accident? Photo Suvi Lehtinen It will not be ideal to suggest on accident prevention measures in the workplace without looking at definitions of an accident and a workplace. The Royal Society for the Prevention of Accidents of the United Kingdom defines an accident as any unforeseen, adverse event causing harm or having the potential to cause harm. (2) What is a safety culture? A good safety culture in a workplace exists when safety and health is understood to be, and is accepted as, a high priority. Safety and health does not exist in a vacuum isolated from other aspects of organizations, such as people and financial management. Safety culture is an integral part of the overall corporate culture. (4) The development and application of management systems standards, such as the British Standard Institute (BSI) OHSAS 18001:2007, Occupational health and safety (OH&S) management systems requirements, requires the top management of organizations to outline an OH&S structure committed to the prevention of accidents and ill health in the workplace. (5) Section 7 of the South African Occupational Health and Safety Act No. 85 of 1993 refers to health and safety policy. In this instance, (1) the chief inspector may direct (a) any employer in writing and (b) any category of employers by notice in the Gazette, to prepare a written policy concerning the protection of the health and safety of his employees at work, including a description of his organization and the arrangements for carrying out and reviewing that policy. (2) Any direction under subsection (1) shall be accompanied by guidelines concerning the contents of the policy concerned. (3) In the workplace, at a place where employees normally report for service, an employer shall prominently display a copy of the policy referred to in subsection (1), signed by the chief executive officer. A policy that is not built on a sound safety culture promoting occupational health and safety, as well as the well-being of the organization s employees and stakeholders, is bound to be fruitless. There should be a shared sense of desirable values and attitudes to which the organization subscribes. 12 Afr Newslett on Occup Health and Safety 2009;19:12 4

13 Promotion of a safety culture Promotion of a safety culture with a view to preventing accidents in the workplace needs to be set out in the seven values. These values are described by the word culture: Communication and consultation Understanding workplace hazards Leadership that is visible Taking responsibility Understanding potential emergencies Risk assessment Employee involvement and participation. Communication and consultation There are several ways in which organizations may provide health and safety messages in the workplace. At the onset, during the induction process for new employees, critical elements of an organization s health and safety programmes are discussed, to make employees aware of existing company safety policies. They are told about potential hazards and risks that pertain to their work environment. They are also made aware of correct operational procedures that help prevent accidents while carrying out their duties. Depending on the availability of funds, inhouse publications, calendars, posters, stickers; and bulletin boards indicating, for example, time lost due to injuries in the workplace, can be used to promote occupational health and safety. These are vital forms of communication, as they highlight an organization s goals in its accident prevention efforts. Toolbox talks or meetings can be held. These are meant to be brief, usually 10 or 15 minutes. The topic of the day is normally facilitated by a shift supervisor, the aim being to introduce or remind workers of the potential occupational health and safety risks of their jobs. Understanding and recognizing hazards Through the promotion and implementation of the organization s occupational health and safety policy, management should make employees aware of both potential and actual hazards in the workplace. A job hazard analysis procedure should be applied, in order to ensure that the concerned employee is aware of the dangers inherent in each job step. This will also promote the acquisition and use of the necessary guards for machines, in order to safeguard the machine operator, for instance. On-the-job training may not entirely fulfil the trainind needs. The United Kingdom s Health and Safety Executive suggests that some employees may have particular needs. For example: new recruits need basic induction training in how to work safely, including arrangements for first aid, fire and evacuation people changing jobs or taking on extra responsibilities need to know about any new health and safety implications young employees are particularly vulnerable to accidents. Their needs require particular attention, and so their training should be a priority. It is also important that new, inexperienced or young employees are adequately supervised some people s skills may need updating by means of refresher training. (6) Leadership that is visible As we have seen in the commitments set out in the health and safety policy, the culture of an organization is set by its leaders. The management and their representatives have an obligation to the safety of their employees. At planned and unannounced intervals, they must check that the workplace is free of any unsafe situations. Moreover, they need to keep an eye on employees unsafe behaviours so that timely action can be taken to eliminate any hazards. Expression of safety leadership may take the form of allocation of resources, planning for potential emergency situations, as well as provision of training for employees and supervisors. Taking responsibility Both employees and employers have a role to play in the prevention of accidents in the workplace. In the South African Occupational Health and Safety Act No. 85 of 1993, for example, Section 8, The general duties of employers to their employees, requires that every employer shall provide and maintain, as far as is reasonably practicable, a working environment that is safe and without risk to the health of his employees. Furthermore, Section 14 deals with the general duties of employees at work, requiring that every employee shall at work take reasonable care for the health and safety of himself and of other persons who may be affected by his acts or omissions. (3) Understanding potential emergencies Although it is hard to predict when accidents will happen, employees and employers need to ensure that they understand potential emergencies such as explosions and spillages of hazardous substances, to mention but a few in order to reduce risks. An emergency preparedness and response procedure should be developed that will address the resources needed to deal with emergencies once they occur and the type of training needed by emergency response personnel. The location of hazardous materials must be known to all personnel, including external emergency response personnel for example, the fire brigade. The availability of equipment for emergency response must be known, and equipment must be tested. Evacuation plans or exit maps must be clearly marked and must remain unobstructed. (7) The emergency procedure should also ensure that the alarm and public address systems are periodically tested for their functionality. It must also be verified that the personnel is aware of what each signal means. Risk assessment There is a notion that every workplace accident is preventable. For this to be realized, the organization s occupational health and safety management systems need to be proactive. They should not wait for accidents to happen. A procedure for risk assessment must be implemented to prompt a periodical assessment of potential risks. Employees whose activities might have an impact on the health and safety of others need to be trained in the process of assessments. For example, the workstation layout as well as the duties being performed should be checked for any ergonomics-related risk factors. Attention can also be paid to awkward positions that may cause painful ergonomic injuries, especially if they are frequent, in order to assess whether any potential occupational overuse syndromes might arise. Training should be able to empower personnel by providing them the skills they need to identify hazards within the workplace and those that originate outside the workplace, to assess the risks associated with the identified hazards, and to take appropriate control measures into consideration. (8) Employee involvement and participation The involvement and participation of employees in matters pertaining to health and safety can improve morale and promote a culture of confidence that solicits initiatives contributing to methods on preventing workplace accidents. Involvement and participation of employees in health and safety matters also encourages a sense of ownership. The revised OH- SAS 18001:2007, occupational health and safety management systems standard, contained in clause , Participation and consultation, requires that the organization shall establish, implement and maintain a procedure or procedures for: a) the participation of workers by their: Afr Newslett on Occup Health and Safety 2009;19:

14 appropriate involvement in hazard identification, risk assessments and determination of controls appropriate involvement in incident investigation involvement in the development and review of OH&S policies and objectives consultation where there are any changes that affect their OH&S epresentation on OH&S matters. Workers shall be informed about their participation arrangements, including the naming of their representative(s) on OH&S matters. b) consultation with contractors in situations where there are changes that affect their OH&S. (4) Conclusion For organizations to prevent accidents in the workplace effectively, there is a need to ensure an appropriate safety culture that is based on sound values of communication and consultation and an understanding of workplace hazards. It is necessary to ensure that the leadership is visible and committed to safety programmes and that there is a mandate of joint responsibility for workplace safety from both employees and employers. Potential emergency situations should be understood, risk assessments should be conducted, and every employee should be involved and actively participating in order to promote a high morale at work. Therefore, the approach towards accident prevention should been seen as the pursuit of continuous safety improvement. References 1. safework/cis/oshworld/news/decl_seoul09.htm accessed on 5 February accessed 19 January accessed on 17 February SafetyLine/Safety_and_health-issue4.pdf accessed on 19 February BS OHSAS 18001:2007 Occupational health and safety assessment series (4). 6. accessed on 17 February Prevention of Major Industrial Accidents, Geneva, International Labour Office, 1991 (pg 59). 8. Kiwekete HM, 2008 An Insight into the identification of hazards, assessment of risks and risk control LexisNexis, Health and Safety in SA issue 3. Hope Mugagga Kiwekete Manager Integrated Management Systems Transnet Freight Rail - Central Region ROE Building, Room 12 1 Durant Road, Sentrarand P.O. Box 8216 Putfontein, 1513 South Africa Tel + 27 (0) Fax + 27 (0) Cell + 27 (073) The East African Regional Programme on Occupational Health and Safety Suvi Lehtinen Photos Suvi Lehtinen Introduction The Finnish Institute of Occupational Health has been working together with its East African sister institutions for more than three decades. During this time, different collaborative efforts have been made and various joint activities carried out. We are now in the middle of the planning period for a programme for the next four years. The launching meeting of the Regional Programme was held on September in Arusha, Tanzania. Two technical meetings The First Technical Meeting for planning the programme was held in Nairobi at the beginning of February, and the Second Technical Meeting in Kampala at the beginning of April. The countries have prepared several brief analyses in order to provide an overview of where we are now. During the meeting discussions we have tried to analyse what would be the best way to prioritize the most urgent and important activities. A draft programme is expected by the end of May. The Stakeholder Meeting will discuss the plan in mid-august. The East African Community has been a central player in facilitating the arrangements for the meetings. 14 Afr Newslett on Occup Health and Safety 2009;19:14

15 Profile of woodwork-related accidents in Gabon P. Comlan, F. Ezinah, A. Mouanga, E. Kendjo, J. Roy, B. Obiang Ossoubita GABON From 2007 through 2008, there were 825 traumatic work-related accidents reported by the National Social Security Bureau in Libreville, the capital of Gabon. The Occupational Health Service collects information on work-related accidents through a survey of occupational injuries and an accident assessment and evaluation programme. The survey of occupational injuries was initiated by the Department of Occupational Health to collect an accurate count of work-related fatalities. The accident assessment and evaluation programme is administered by The Social Security Bureau of Labor in collaboration with the Service of Occupational Health of the Faculty of Medicine (University of Medical Sciences, Owendo, Gabon). The programme began collecting data on work-related fatalities on 1 January 2007 to identify contributing factors and develop injury prevention strategies. This article provides information on the accidents identified for 2007 and Although forestry and wood processing constitute a key sector for the Gabonese economy, it is not possible to obtain statistics on occupational health issues and accidents in the sector. The purpose of these programmes is to identify factors that contribute to occupational accidents in order to implement effective traumatic injury prevention/intervention strategies with a focus on woodwork. Information gathered for each occupational accident includes employment characteristics, such as industry type and size, ownership and occupation of employee; the accident and its circumstances, such as the nature of injury, the affected part of the body, and demographic characteristics including race and sex. The actual occupational accident form does not present items on the age, the workplace, the equipment or machinery involved or the source of occupational injuries. These data are not gathered and cannot be taken into account. Data were entered using Microsoft Office Excel 2007 and analysed with Epi Info 3.4 (French version, CDC Atlanta). Occupational injuries, 2007 and 2008 A total of 825 work-related accidents occurred in Gabon between 2007 and 2008, of which 368 (44.6%) occurred in 2007 and 457 (55.4%) in The majority of occupational accidents involved men (89.5%), the majority of whom were Gabonese. Wage-earners and salaried workers represented the largest percentage of occupational accidents (96.1%); less than 5% of injured workers were self-employed or working in a family business. Transportation accidents represented 8.4% of other occupational accident events, accounting for 44% of occupational accidents. The largest percentage of work-related accidents occurred in public utility industries (30.1%), wood processing enterprises (21.5%) and commerce (16.8%). The Service of Occupational Health of the National Social Security Bureau did not provide any information on work-related deaths during this period. Events and exposure During the period , accidents involving contact with objects or equipment exceeded all other events, accounting for 64.1% of traumatic occupational accidents (Figure 1). Approximately a quarter (24.6%) of these accidents occurred among woodworkers. Accidents and injuries in wood processing enterprises Out of a total of 825 injuries, the proportion of injuries linked to wood processing was 21.5%. In this group, 24.2% of woodworkers were injured in 2007 and 19.3% in Accidents were reported by 26 wood-processing enterprises. How the data were collected The data examined in this article originated from occupational accidents that occurred as the result of traumatic injuries between January 2007 and January 2009 in Gabon. A traumatic injury is defined as any unintentional or intentional wound or damage to the body resulting from acute exposure to energy such as heat or kinetic energy from a crash or a fall or from the absence of such essentials as heat or oxygen caused by a specific event, incident, or series of events within a single workday or shift. Cases involving heart attacks or strokes are considered injuries if a traumatic work injury was listed as a contributory or underlying cause of death on the death certificate or other medical report (1). Figure 1. Distribution of occupational injuries by event/exposure Libreville 2007 and 2008 Afr Newslett on Occup Health and Safety 2009;19:

16 Nature of occupational injuries and disorders In terms of the nature of the work-related injuries and disorders, we found open wounds (48.6%), other traumatic injuries (29.9%), bone, nerve and spine injuries (17.5%) and multiple traumatic injuries (7%). Psychosocial care and support The work-related accident victims did not receive any psychosocial care or support. Figure 2. These figures represent the percentages of occupational injuries in the wood sector by month. Figure 3. Percentage distribution of occupational injuries by part of the body, in the wood sector in Medical unit There was a medical unit with a nurse at 14.7% of the wood enterprises. Half of these structures employed a medical doctor and one of them an occupational health specialist. The mean number of days absent was 19.6 days (SD 26.3; range days). Time of the accident The largest number of accidents related to woodwork occurred at 10:45 am. Month of the injury Figure 2 presents the percentage of occupational injuries in the wood sector by month. Accidents occurred during the dry season or the third trimester of the year. Parts of the body Figure 3 represents data on the body part affected by occupational injuries. The largest percentages affected the upper extremities (41.2%), the head and neck (21.5%) and the lower extremities (20.9%). Discussion From 2007 through 2008, the authors examined the data collection on work-related accidents of the National Social Security Bureau in Libreville, Gabon. The aim of this study was to identify contributing factors and develop injury prevention strategies. Wood processing in Gabon is a dangerous occupation and involves more than 30% of the active population (2). The programme gathers epidemiological information to help us understand more about what happens when accidents linked to wood processing occur. We use these facts to aid us in our prevention and education efforts. We found that woodworkers were the most affected occupational group during the 2-year period. Despite the development of plastics and other synthetic materials, the demand for wood products continues unabated. Woodworkers are helping to meet this demand. All woodworkers are employed at some stage of the process through which logs of wood are transformed into various finished products. Traumatic occupational injuries in the wood sector represent a significant public health concern. Work-related accidents induce enormous emotional and financial costs to both families and society (3). In 1998, Europe s wood and wood products industry suffered around work accidents involving more than three days absence from work. Accidents rose by 5.0% in the period In Italy, the woodworking trade in general industry rates as one of the most hazardous occupations. Rotating devices, cutting or shearing blades, in running nip points, and meshing gears are examples of potential sources of workplace injuries, while crushed hands, severed fingers, amputations, and blindness are typical woodworking accidents (4). In Africa, Comlan in Gabon (2) and Rongo in Tanzania (5) have made similar observations. The largest number of occupational injuries reported in the wood sector occurred around 10:45 am. The woodworkers consistently worked longer than scheduled and for extended periods. Longer work duration in- 16 Afr Newslett on Occup Health and Safety 2009;19:15 7

17 creases the risk of errors and near errors, and decreases workers vigilance. Recent studies indicate that accident risk may be a function of hour at work and time of day. Further evidence has to be sought for these suggestions, along with an answer to the question of whether accident risk can be conceived as an interaction between hours at work and time of day. (6) We support recommendations to minimize the use of 12-hour shifts and to limit workers work hours to no more than Recent studies indicate that accident risk may be a function of hour at work and time of day. 12 consecutive hours during a 24-hour period. The authors noted that the largest number of woodwork-related accidents happened during the dry season or the third trimester of the year. This period is also when the 3-month school holiday period occurs. Various factors may be associated with this period. With fewer people at work, many employees will have to work longer hours with fewer breaks. The problem of the overuse syndrome usually develops from a combination of factors, such as carrying out repetitive tasks and working in awkward positions or in an uncomfortable environment. Casual or seasonal workers not used to carrying out certain tasks are more at risk. Environmental factors linked to the dry weather may be one cause (aridity, dehydration, dust, colder temperatures ). Family factors could also intervene; possible influences could be children at home on holidays, rest hours that are modified, or separation from the rest of the family who have left to spend the holidays in the home village. Occupational accidents, incidents and deaths are, however, preventable in all sectors and throughout the year. Data generated from the program, such as those presented in this report, will be used by health and safety professionals to ameliorate the occupational accident recording form of the National Social Security Bureau in order to develop strategies for the prevention of both fatalities and serious injuries in the future in all sectors, including the wood sector. Information regarding cause of accident, type of industry, and type of occupation are useful in the development of priorities for public health programme in the coming years. Data can also be used to set target conditions. In cooperation with the Department of Occupational Health of the Faculty of Medicine, the Service of Occupational Health of the National Social Security Bureau is studying traumatic work-related fatalities and accidents by collecting information on factors leading to all injuries. This is done with the objective of proposing recommendations for the prevention of future accidents and to distribute the recommendations to employers, workers, and other organizations interested in promoting workplace safety. The staff evaluates occupational accidents, giving special priority to any accident involving machinery or within the wood sector. These target conditions will be subject to change as other occupational health priorities become apparent. Wood processing must be taken into consideration when developing intervention programmes to address workplace incidents, accidents or deaths in the future. It is essential to note that no death was reported to the Service of Occupational Health of the National Social Security Bureau during the last two years. As deaths must be taken into consideration, data on fatalities where either parts and material or trees and logs were involved were missing. Recommendations and suggestions Prepare and implement a hazard communication programme for enterprises: The first step in preventing work-related accidents and injuries is risk assessment. Implementation of occupational risks prevention must follow. All employers in Gabon should be required to carry out risk assessments. Risk assessment helps employers understand the action they need to take to improve workplace health and safety. Report all types of occupational accidents, incidents and deaths: This should be compulsory for managers. Change the approach to the prevention of occupational risks: It is important to educate actors at different levels health and safety professionals, managers, registrars and statisticians. The approach is multidisciplinary, involving medical, psychological, social and legal measures. The National Social Security Bureau should provide employers and employees with a risk communication guideline for a better compliance with occupational health and safety rules and regulations. Create a network to develop new criteria for collecting and analysing data on workplace risk factors and accidents. Complete the occupational accident form of the National Social Security Bureau with data concerning age, workplace, equipment or machinery. References 1. U.S. Department of Labor, Bureau of Labor Statistics. Census of Fatal Occupational Injuries State Operating Manual. March Comlan P, Ezinah F, Nambo Wezet G, Anyunzoghe ES, Obiang Ossoubita B. Occupational health and safety problems among workers in wood processing enterprises of Libreville, Gabon. Afr Newslett on Occup Health and Safety 2007;17: Balsari P, Cielo P, Zanuttini R. Risks for the health workers in plywood manufacturing: a case study in Italy. Journal of Forest Engineering July 1999;10(2). 4. Boy S. Safety of woodworking machinery benefiting from workers experience. TUTB Newsletter, March 2002, N Rongo LMB, Barten F, Masmanga GI, Heederik D, Dolmans WMV. Occupational exposure and health problems in small-scale industry workers in Dar es Salaam, Tanzania: a situation analysis. Occupational Medicine 2004;54: Hänecke K, Tiedemann S, Nachreiner F, Grzech- Sukalo H. Accident risk as a function of hour at work and time of day as determined from accident data and exposure models for the German working population. Scand J Work Environ Health. 1998;24 Suppl 3:43 8. P. Comlan, F. Ezinah, Département de Pathologie Faculté de Médecine Université des Sciences de la Santé BP 4009, Owendo, Gabon A. Mouanga Service de Psychiatrie Centre Hospitalier et Universitaire de Brazzaville BP 32, Brazzaville, Congo E. Kendjo Service Statistique Département de Parasitologie Mycologie Faculté de Médecine, Université des Sciences de la Santé, BP 4009, Owendo, Gabon Jee Roy Service de Médecine du Travail Polyclinique Médico-sociale Gisèle Ayouné Caisse Nationale de Sécurité Sociale BP 134, Libreville, Gabon B. Obiang Ossoubita Département de Santé au Travail Faculté de Médecine Université des Sciences de la Santé BP 4009, Owendo, Gabon. Correspondance et tirés à part: Dr Pearl COMLAN BP 4009 Libreville, Gabon Fax Afr Newslett on Occup Health and Safety 2009;19:

18 The impact of globalization on occupational health services: The case of developing countries L. A. Abongomera Uganda Photo Suvi Lehtinen Introduction Globalization may be defined as the merging together of the borders of the various states. This means that the whole world has now become one state. This can be illustrated by communication and the spread of information, which have become surprisingly easy. A serious event happening in the USA, for instance, can be observed live in Uganda within minutes. We now live in one world. We are therefore likely to develop over time a new culture for the new world, called the state of globalization. Occupational health is very important because it is concerned with the health of workers as well as employers and their properties. It is the workers who are responsible for the economic growth achieved through high productivity of goods and other services. Poor working conditions and sick workers become a burden to industry. Sick workers require care in hospitals, which in turn needs finances. In the event of an accident, a worker may file for compensation. Property such as the machines used in the workplace, which are the building blocks for work must be protected from accidents, fire and other damages, otherwise the workplace will close down. All these can be prevented if sound basic occupational health services are in place. Unfortunately, work-related accidents and diseases continue to be serious problems in the whole world. The human and economic costs of occupational accidents and diseases remain very high and require concerted efforts to handle. The ILO estimates that more than 2 million workers die each year from work-related accidents and diseases, and this is probably an underestimate. The ILO also estimates that workers suffer 270 million accidents every year, and there are at least 335,000 fatal injuries caused by accidents at work. Avoidable occupational diseases affect 160 million people every year. International concern and awareness of the importance of the problem of occupational diseases and accidents remain modest. Action, especially in the developing world, is hampered by inadequate knowledge, a shortage of information and lack of political will. Occupational health services in the globalizing world are needed more than ever. Some 90 million people work and live outside their country of nationality and their number is growing rapidly in some regions, because of worsening imbalances in incomes and employment opportunities. Arrangements for managing migration that had been effective in the past, such as the conclusion of bilateral agreements, no longer cover much of the current migration situation. A large share of contemporary migration is organized by profit-oriented commercial agents and takes place under clandestine conditions. As concerns Uganda, over 18,000 people work outside the country. About half of them have migrated officially, but the rest have gone through individual arrangements. Justification Globalization will mean free movement and mixing of people. People will move from one part of the world to take work on the other side of the world. Over time, the behaviour, attitude and culture of the immigrants will become different from their past outlook. This paper attempts to analyse the possible impacts and outcomes of this free mixing as far as occupational health is concerned. How should basic occupational health services be organized so that there are occupational benefits from working in any part of the world? What international standards should be in place? And how should these standards be enforced and monitored? Objectives The main objective of this paper is to determine how globalization impacts on occupational health services in developing countries. Other objectives comprise: To determine the factors required for proper delivery of occupational health services that may be influenced by globalization. To find out how occupational health services are organized in developing countries. To investigate how occupational health services are delivered in developing countries. A literature search was carried out, covering the papers presented during seminars and conferences organized on occupational safety and health within and outside Uganda. Some ILO documents and pamphlets were reviewed. Supervision reports that had accumulated within the Department of Occupational Safety and Health, and those in the Planning Department of the Ministry of Health in Uganda, were reviewed. I personally have a long experience in management of the health sector and occupational safety and health. As the Head of the Occupational Safety and Health Department, I have acquired experience in this field and have made a number of observations on occupational health activities, especially during industrial inspections and discussions with both workers and employers. 18 Afr Newslett on Occup Health and Safety 2009;19:18 9

19 Main factors affected by globalization The main factors likely to be influenced by globalization are: Laws and regulations Many developing countries currently have no standard laws and regulations. Some countries have drafts for laws and others do not even have drafts. Countries with laws and regulations cannot use the laws to compare the delivery of occupational health services from one country to another, since there are many variations within the laws of different countries. Safety and Health Management System In developing countries, the Department of Occupational Health and Safety is situated in different ministries. In Uganda, the Department is situated in the Ministry of Gender, Labour and Social Development. Elsewhere, the corresponding Department is within the Ministry of Health in some countries and within the Ministry of Home Affairs or Social Services in other countries. In still other countries, as in Tanzania, the Occupational Safety and Health Agency is autonomous. Tools, machinery and technology Most developing countries lack proper instruments and equipment required for proper delivery of occupational health services. For instance, most countries do not have the equipment required for measuring the flow of air into and out of the lungs or for analysing blood samples taken from a person suspected of suffering from toxicity due to organic or metallic substances. There is a minimum of proper diagnosis of occupational diseases; in the worst of cases, there is no attempt to diagnose occupational diseases. Information and networking In many Departments of Occupational Safety and Health, the records kept are inadequate or there is even no recordkeeping. Most countries do not even know which occupational diseases are the most common among their workforce or what the leading causative factors of accidents are. Collaboration with the ILO-CIS in many developing countries is very poor. Beliefs and culture of the local people Some people believe that occupational diseases are caused by witchcraft and therefore such diseases are not likely to respond to prevention or modern treatment. There is a tendency not to consult a physician because the individual believes that he/she has been bewitched by fellow workers. Discussion The analysis above presents the main factors which will be impacted upon by the process of globalization. It will not be appropriate to say that we are living in one world if our countries have different laws, regulations and policies on occupational health. It will be prudent for developing countries to ensure that laws and regulations on occupational health are harmonized. Those countries without laws will be forced to develop their legislation according to the standard that may be required by globalization. The harmonized laws, policies and regulations will enable the various countries to compare the activities of delivery of occupational health services across the developing world. The East African Community is now working on ensuring that there should be a separate Ministry for Labour in each member state. This is to avoid having Departments of Occupational, Safety and Health in various Ministries, as this affects the comparison of occupational health service activities across the member countries. This means there should be a similar Safety and Health Management System if the developing countries are to be considered as one community. Each country will have to develop systems similar to those in other countries. This will be one impact of globalization. Globalization may force the industrialized countries to assist the developing countries in acquiring the minimum tools, equipment and instruments that will make it possible to investigate chronic occupational diseases. If globalization means that even people from the industrialized world are to come to the least developed countries, it will be necessary for them, in addition to their skills and expertise, to take some tools, equipment and instruments along with them to developing countries. This will involve, among others, equipment required for measuring the flow of air into and out of the lungs and equipment for analysing blood samples taken from a person suspected of suffering from toxicity due to organic or metallic substances. Information and networking is another area where the industrialized countries will have to step in so that the whole world can share information on occupational health services. Collaboration with the ILO-CIS and the establishment of Productivity Centres will require support from the industrialized world. Success in information networking will have a great impact on the globalization on occupational health. As countries move towards one another, beliefs and culture considering occupational disease to be caused by witchcraft and bewitchment will start to fade. Conclusion and recommendations Globalization will improve the delivery of occupational health services by influencing the factors that are necessary for proper delivery of occupational health. As the world evolves into one community, it will be necessary to have similar structures and systems, in order to enable ease of work and comparison of activities delivering occupational health services across the globe. Developing countries will be forced by globalization to develop systems and structures of occupational safety and health management similar to those in other countries. Globalization will require that, in addition to their skills and expertise, industrialized countries will provide some assistance in the form of tools, equipment and instruments to the developing world so that even personnel from the industrialized world can practise occupational health in the developing world. It is probable that industrialized countries will assist in strengthening the ILO-CIS and Productivity Centres in order to facilitate the sharing of information on occupational health in the globalized world. Over time, the practices and acceptance of witchcraft and bewitchment will gradually disappear. The main recommendation of this study is that someone somewhere should take it upon himself/herself to sensitize the developing world on what globalization is and how the developing world stands to gain from it. Literature 1. XVIII World Congress on Safety and Health at Work, Global Forum for Prevention, June 29 July 2, 2008, COEX Convention Center, Seoul, Korea. 2. ILO what is it? What it does. International Labour Organization (ILO), Department of Communication, Switzerland 3. World of Work Report 2008, International Labour Organization (ILO), Switzerland. 4. Basic Occupational Health Services, Prof. Jorma Rantanen, MD, PHD, Specialist in Occupational Health and Suvi Lehtinen, Finnish Institute of Occupational Health, September Annual Health Sector Review, Financial Year 2007/2008, October 2008, Ministry of Health, Kampala. 6. Annual Performance Review , Ministry of Gender, Labour and Social Development, Kampala. 7. Social Development Sector Strategic Investment Plant , Ministry of Gender, Labour and Social Development, Kampala. Dr Liri A. Abongomera MBCHB, DPH, MBA Health Commissioner, Occupational Safety and Health Ministry of Gender, Labour and Social Development P.O. Box 7136 Kampala Uganda Afr Newslett on Occup Health and Safety 2009;19:

20 Improving working conditions through microfinance programming Richard Carothers, Mamdouh Foad and Jennifer Denomy CANADA, EGYPT Photo Carl Heibert Introduction As young teenage girls, Soumaia and Samaa used to head off to the local market each morning to bring back supplies of vegetables and help prepare their family grocery store for the arrival of customers. We used to have to get up very early and the loads we carried were heavy. Some people used to bother us on the way to the market as it was still dark and the traffic was always a worry. But Soumaia and Samaa and their father Khaled were clients of a microfinance programme run by EAC- ID (the Egyptian Association for Community Initiatives and Development) and they were about to negotiate a new loan. In a conversation with the EACID loan officer they realized that if they were able to increase their loan size from USD 1,000 US to USD 1,400 they would have enough cash on hand to negotiate with the wholesaler for home delivery of vegetables. Since Khaled had a good credit history with EACID, and the business was doing well, the loan officer agreed to increase the loan size. Now Soumaia and Samaa unload the donkey cart that arrives outside their shop each morning. Their work has become much easier, they are both able to spend more time on schoolwork and plan to become computer operators. EACID along with its Canadian partners PTE (Partners in Technology Exchange) and MEDA (Mennonite Economic Development Associates) have developed a series of intervention tools to improve working conditions within micro-enterprises that are part of EACID s microfinance programme. This work has been supported by the Canadian International Development Agency (CIDA) and grew out of earlier CIDA support programmes that helped women and poor families in Upper Egypt start and sustain micro and small businesses. EACID had found that although it was able to successfully manage a loan fund, and its clients were expanding their businesses and improving family incomes, the quality of work within the businesses was not always safe or healthy. In addition, children often worked alongside adults as the family businesses grew and required additional labour. EACID was concerned about the social impact of its programmes and felt it needed to do more for its clients. Interventions EACID realized early on that by making credit available to business owners it was well placed to influence the type of work that was taking place within these businesses. EACID had: a positive and supportive relationship with business owners through its loan officers, who make regular visits to businesses to follow up on their loans the ability to provide resources through its loans to improve business performance through existing processes, and also to change these processes to improve working conditions for workers within businesses frequent and on-going contact with business owners and a mechanism to provide advice and ongoing monitoring of the effects loans have on working conditions a self-financing microfinance programme that can continue to reach large numbers of businesses over time. Improving working conditions through the lending process required the introduction of a new dual purpose loan product that would allow EACID s loan officers to provide larger loans to meet normal financial needs as well as provide some additional funds to cover the costs of improving working conditions. Dual purpose loans are generally those loans that help improve business profitability while also having a positive social effect. In EAC- ID s case the additional funds from the dual purpose loan could be used to purchase safer machinery, improve production line layouts, upgrade electrical installations, address lighting or ventilation problems or support other agreed workplace health and safety improvements. In all cases, the loans still had to meet EACID s normal lending requirements, and business owners had to continue to maintain good repayment records. EACID worked with business owners and workers to develop a code of conduct that now governs working conditions within the business and has become part of the loan contract. The first draft of the code of conduct was developed through a participatory process with the business owners themselves and then reviewed and revised with workers, including working children. The final code of conduct emerged through a consensus reached between business owners and workers and now governs working hours and training on equipment, as well as other safety and health issues. Copies of the code of conduct are posted on workshop walls. To support its loan officers, EACID also developed a training programme on the identification, analysis and mitigation of workplace hazards. Loan officers are taught to first identify and classify workplace hazards into several categories: Categories of hazards Accidents and injuries Chemical hazards Physical hazards 20 Afr Newslett on Occup Health and Safety 2009;19:20 22

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