African Newsletter

O N O C C U PAT I O N A L H E A LT H A N D S A F E T Y

Volume 19, number 1, April 2009

Accident prevention
- a safe workplace

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-00250 Helsinki, Finland
Editor in Chief
Suvi Lehtinen
Editor
Marianne Joronen
Linguistic Editing
Sheryl S. Hinkkanen
Layout
Liisa Surakka, Kirjapaino Uusimaa, Studio

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

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.

12 A role of safety culture in preventing accidents in the workplace

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-00250
Helsinki, Finland.

14 Meetings in Nairobi and Kampala

The African Newsletter on Occupational Health and

Safety homepage address is:
http://www.ttl.fi/AfricanNewsletter

18 The impact of globalization on occupational health services:

A case of developing countries

The next issue of the African Newsletter will come

out at the end of August 2009. 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 0788-4877
On-line publication: ISSN 1239-4386

H.M. Kiwekete
SOUTH AFRICA

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

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..

Accident prevention
a safe workplace

ccidents! 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

Seiji Machida
ILO

System for collection and analysis of

occupational accidents data
Finally, at its conclusion, such a programme
should be reviewed, and be replaced by a
new national programme on OSH.

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
2006. These new international standards aim
at placing OSH high on national agendas, promoting preventive safety and health culture,
4 Afr Newslett on Occup Health and Safety 2009;19:46

National programmes on OSH

and national accident data

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: http://www.ilo.org/public/english/protection/safework/promoframe.htm.
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.

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

Table 1. Summary of occupational accident data for selected African countries (Source: ILO Yearbook of Labour Statistics)
Country
Algeria
Egypt
Ethiopia
Mauritius
Nigeria
Namibia
Rwanda
S. Africa
Togo
Tunisia
Zimbabwe

Case of accidents
Fatal
Non-fatal

Total

697
110
11
1
1
10
406
493
10
155
62

40423
26994
2650
2743
53
628
1381
5950
397
43317
5516

39726
26884
2639
2742
52
618
978
5457
297
43162
5454

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 com-

Employed
(x1000)
7798
18119
24897
502
N.A.
407
N.A.
12338
N.A.
2855
N.A.

Accident rate
per 1000
workers
5.2
1.5
0.1
5.5
1.5
0.5
15.2
-

ponents 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/
e962083.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 ana-

Data source

Year of
data

Insurance
Reported
Reported
Insurance
Reported
Insurance
Insurance
Reported
Insurance
Insurance
Insurance

2004
2003
1999
2007
2004
2001
2000
2000
2004
2004
2007

lysed 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;19:46

(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.).

Chemical safety and

accident prevention

The code also provides further guidance

on the notification of occupational diseases
and dangerous occurrences.

Pius W. Makhonge
Kenya

Conclusions

Introduction

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.

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.

Seiji Machida
Coordinator,
Occupational Safety and Management Systems
SafeWork, ILO
CH-1211 Geneva 22
Switzerland
6 Afr Newslett on Occup Health and Safety 2009;19:46

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.

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

Photo Suvi Lehtinen

Suggestions for improvement

of chemical safety

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 reg-

ularly. 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; 2005.
Hellberg H. A right to know but when? New
Epidemics in Occupational Health; Finnish Institute of Occupational Health; People and Work.
Research Reports 19941;1:2214.
Principles for the assessment of risks to human
health from exposure to chemicals; environmental health criteria 210. International Programme
on Chemical Safety: 1999.
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 34120 - 00100
Nairobi
Kenya
Afr Newslett on Occup Health and Safety 2009;19:67

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

Photo International Labour Organization/P. Deloche

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

8 Afr Newslett on Occup Health and Safety 2009;19:811

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-

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.

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

Age (years)

Job titles

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 AprilMay 2008.
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%) didnt answer this

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

Departments

Years in nursing practice

Number of patients attended to per day

Hours worked per week

Night shifts worked per

month

Male
Female
Unspecified
2029
3039
4049
50+
Unspecified
Senior nursing officer
Nursing officer
Enrolled midwife
Enrolled nurse
Nursing aide
Others
Unspecified
Obstetrics & Gynaecology
Surgery
Internal medicine
Paediatrics
Unspecified
<5
610
1115
1620
2125
2630
> 30
Unspecified
< 20
2140
4160
6180
> 81
Unspecified
< 20
2140
4160
6180
> 81
Unspecified
None
15
610
1115
1620
> 21

Number (total=526)
47
463
16
107
235
100
42
42
20
322
56
70
35
20
3
198
124
97
104
3
117
123
87
65
35
33
33
33
136
158
105
43
52
32
53
243
183
23
3
21
188
132
157
35
12
2

Percentage
8.9
88.0
3.0
20.3
44.7
19.0
8.0
8.0
3.8
61.2
10.6
13.3
6.7
3.8
0.6
37.6
23.6
18.4
19.8
0.6
22.2
23.4
16.5
12.4
6.7
6.2
6.2
6.2
25.9
30.0
20.0
8.2
9.9
6.1
10.1
46.2
34.6
4.4
0.6
4.0
35.7
25.1
29.8
6.7
2.3
0.4

Table 2. Selected characteristics of the respondents

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

Minimum
21
0.25
0.42
1
6
0
0

Maximum
60
34
39
100
84
22
15

Mean
36.21
9.23
12.74
41.79
41.27
4.80
1.43

SD
8.29
8.45
8.89
26.93
13.75
4.73
2.99

40

4.18

7.73

80

13.36

21.15

Afr Newslett on Occup Health and Safety 2009;19:811

after the procedure, and eight were caused by some other

procedure, especially being cut by glass when breaking a
drug vial or ampoule.
50

Table 3. Reasons for reporting needlestick injuries in the last 12 months

Want to get counselling

To seek treatment
Filing for compensation
Responsibility to report
Other reasons

49.8

% of respondents

40

% those who specified

37.7
31.2
4.3
14.3
12.5

Analysis was done on those (231) who responded to the question item
295 responded did not specify

(1)

30
30

Table 4. Reasons for not reporting needlestick injuries

17.3

16.6
10
0

Frequency of response
N = 2311
87
72
10
33
29

10.9
4.5
table beside corner or next room
another table

next ward

No support given
Dont 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

not
available

Location of safety box

Figure 1. Location of the injection safety box when the last needlestick injury occurred
50

49.9

Frequency of response
N = 261
128
110
22
14
10
10
24
9
1

Percentage
49.0
42.1
8.4
5.4
3.8
3.8
9.2
3.4
0.4

% of respondents

40
Table 5. Support given to those who reported a needlestick injury in the last year
32.5

30

Frequency of those
who had reported
(N=93)1

30
10

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

11.3
5.9

never

sometimes

most of
the time

all of the
time

Frequency of reporting
Figure 2. Reporting of needlestick injuries frequency

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.

64.1

% of respondents

50
40
30
20
16.2

10
0

4.9

8.1

4.2

occupational nurse departmental accident and other

health
manager
head
emergency
services
room

Where reported
Figure 3. Reporting of needlestick injuries unit of officer receiving the report.

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 casu10 Afr Newslett on Occup Health and Safety 2009;19:811

74.6
16.1
5.0
7.5
30.1
33.3
15.0

Only 93 had reported the incidence

Table 6. Factors influencing the reporting needlestick injuries

YES
NO
Frequency of
response (260
respondents)

70
60

47
15
5
7
28
31
14

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

Percentage

Frequency
of response
(260 respondents)
190

Percentage

70

26.9

73.1

77

29.6

183

70.3

230
35

88.5
13.5

30
225

11.5
86.5

3.5

251

96.5

21

8.1

239

91.9

17

6.5

243

93.5

23

8.85

237

91.15

236

90.8

24

9.2

Photo Nsubuga F. Mangasi

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.

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 didnt 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. 2003.
2. Priotto G, Ruiz A, Kyobutungi C (2003)
inPilot-Testing the Who Tools to Assess and
Evaluate Injection Practices: A Summary of 10
Assessments Coordinated by WHO in Seven

Countries (2000-2001) [WHO/BCT/03.10], eds

Gisselquist D, Hutin Y (WHO, Geneva), p 134.
3. Newsom DH, Kiwanuka JP. Needle-stick injuries
in a Ugandan teaching hospital. Annals of
Tropical Medicine & Parasitology 2002;96:517
22.
4. Hamory BH. Underreporting of needlestick
injuries in a university hospital. Am J Infect
Control 1983;11(5):1747.
5. McGeer A, Simor AE, Low DE; Epidemiology of
needlestick injuries in house officer; J Infect Dis.
1990 Oct;162(4):9614.
6. 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. 1998
Nov;80(6):43941.
7. 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. 1996 Mar;44(3):12937.
8. Burke S, Madan I. Contamination incidents
among doctors and midwives: reasons for nonreporting and knowledge of the risk. Occup
Med 1997;47:35760.
9. Short L et al. Underreporting of needle-stick
injuries among health care workers. Infect
Control Hospital Epidemiol. 1994.
10. 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. 1991 Jan;90(1):8590.
11. Adegboye AA et al. The epidemiology of
needlestick and sharp instrument accidents in
a Nigerian hospital; infect control hosp epidemiology 1994;15(1):2731.
12. Whitby RM, McLaws ML. Hollow-bore needlestick injuries in a tertiary teaching hospital l:
epidemiology, education and engineering. Med
J Aust. 2002 Oct 21;177(8):41822.

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 256 414 256374
Email nsubuga@mglsd.go.ug
Afr Newslett on Occup Health and Safety 2009;19:811

11

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)

What is a safety culture?

Photo Suvi Lehtinen

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 2008. 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 (N187) as a priority. (1)
This article focuses on the role of a
safety culture in preventing accidents
12 Afr Newslett on Occup Health and Safety 2009;19:124

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?
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)

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 organizations employees and stakeholders, is
bound to be fruitless. There should
be a shared sense of desirable values
and attitudes to which the organization subscribes.

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 organizations 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 organizations 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 organizations 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 Kingdoms
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 peoples 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 emer-

gencies 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
organizations 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 OHSAS 18001:2007, occupational health and safety
management systems standard, contained in
clause 4.4.3.2, 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;19:124

13

 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 consulta-

tion 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. http://www.ilo.org/public/english/protection/
safework/cis/oshworld/news/decl_seoul09.htm
accessed on 5 February 2009.
2. http://www.rospa.co.uk/aboutrospa/info/Safety_Rospa_guide.pdf accessed 19 January 2009.
3. http://www.labour.gov.za/legislation/acts/occupational-health-and-safety/occupational-healthand-safety-act-and-amendments accessed on 17
February 2009.

4. http://www.commerce.wa.gov.au/WorkSafe/PDF/
SafetyLine/Safety_and_health-issue4.pdf accessed
on 19 February 2009.
5. BS OHSAS 18001:2007 Occupational health and
safety assessment series (4).
6. http://www.hse.gov.uk/pubns/indg345.pdf accessed on 17 February 2009.
7. 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) 11960 2366
Fax + 27 (0) 11 960 2402
Cell + 27 (073) 315 4191
E-mail: hope.kiwekete@transnet.net
http://www.transnet.net

The East African Regional Programme

on Occupational Health and Safety
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 2526
September in Arusha, Tanzania.

Two technical meetings

Photos Suvi Lehtinen

14 Afr Newslett on Occup Health and Safety 2009;19:14

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.

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 2008. 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 2008. 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 20072008, 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 2008. 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;19:157

15

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.

Discussion

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 20072008.

Medical unit

Month of the injury

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 1150 days).

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.

Time of the accident

The largest number of accidents related to
woodwork occurred at 10:45 am.

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%).

16 Afr Newslett on Occup Health and Safety 2009;19:157

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, Europes wood and wood products industry suffered around 90 000 work accidents involving
more than three days absence from work. Accidents rose by 5.0% in the period 199698.
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-

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
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.

Recent studies
indicate that
accident risk
may be a
function of
hour at work
and time of
day.

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 1996.
2. 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;17:447.
3. 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, N18.
5. 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;54:426.
6. Hnecke K, Tiedemann S, Nachreiner F, GrzechSukalo 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 3:438.

P. Comlan, F. Ezinah,
Dpartement de Pathologie
Facult de Mdecine
Universit des Sciences de la Sant
BP 4009, Owendo, Gabon
A. Mouanga
Service de Psychiatrie
Centre Hospitalier et
Universitaire de Brazzaville
BP 32, Brazzaville, Congo
E. Kendjo
Service Statistique
Dpartement de Parasitologie Mycologie
Facult de Mdecine,
Universit des Sciences de la Sant,
BP 4009, Owendo, Gabon
Jee Roy
Service de Mdecine du Travail
Polyclinique Mdico-sociale Gisle Ayoun
Caisse Nationale de Scurit Sociale
BP 134, Libreville, Gabon
B. Obiang Ossoubita
Dpartement de Sant au Travail
Facult de Mdecine
Universit des Sciences de la Sant
BP 4009, Owendo, Gabon.
Correspondance et tirs part:
Dr Pearl COMLAN
BP 4009 Libreville, Gabon
Fax +241 731629
pearlcomlan@yahoo.co.uk

Afr Newslett on Occup Health and Safety 2009;19:157

17

The impact of globalization

on occupational health services:
The case of developing countries

Photo Suvi Lehtinen

L. A. Abongomera
Uganda

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?

18 Afr Newslett on Occup Health and Safety 2009;19:189

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.

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 2007.
5. Annual Health Sector Review, Financial Year
2007/2008, October 2008, Ministry of Health,
Kampala.
6. Annual Performance Review 20052008, Ministry of Gender, Labour and Social Development,
Kampala.
7. Social Development Sector Strategic Investment
Plant 20032008, 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;19:189

19

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 EACID (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 EACIDs 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 EACIDs 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 EACIDs case the additional funds from the dual
purpose loan could be used to purchase safer

20 Afr Newslett on Occup Health and Safety 2009;19:2022

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
EACIDs 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

Photo Mamdouh Foad

Ergonomic hazards
Biological hazards
Workplace conditions
Socio / psychological hazards

Effectiveness
MOST

See also Table 1 for more detail on these

categories of hazards.
Hazards are then ranked according to
their severity and frequency or likelihood.
Generally, hazards that are found to be severe and frequent are prioritized for mitigation, but the cost of mitigation and the readiness of individual business owners to make
a particular change influence the starting
point. EACID has found that change happens incrementally and over time by working through a collaborative process with
business owners. It is often important for
loan officers to begin the hazard mitigation
process with smaller, easily solvable issues in
order to gain the business owners support
for workplace safety improvement.
Once a particular hazard has been
Hazard Type

Examples of Hazards in Various Business Sectors

Accident

Machines (cuts or lacerations, limbs caught in moving or intake parts)

Misuse of cutting tools resulting in injuries
Misuse of power tools resulting in injuries
Falls, trips, slips
Falling objects causing injuries
Becoming trapped in isolated spaces (e.g., behind doors, machines or furniture)

Chemical

Exposure to crop dust, fibres in textile industry, paper manufacturing

Exposure to mineral dust in glass factories, mines, car brake manufacturing
Exposure to toxic chemical agents via inhalation, skin absorption or ingestion
Exposure to exhaust or fumes from engines or other production equipment

Physical

Heat and cold (direct-indirect)

Electricity (dynamic-static)
Noise
Vibration
Lighting
Ventilation
Radiation (ionized-non ionized)
Gases under pressure

Ergonomic (Musculoskeletal)

Lifting, carrying or moving heavy objects

Repetitive movements
Awkward postures, especially over long periods
Poorly designed tools which require poor posture
Poorly sharpened tools which require more effort

Working Conditions

Long working hours

Income security, job security
Poor sanitation and housing
Lack of health care
Isolation
Stress
Physical abuse

Biological

Contact with biological wastes or fertilizers

Contact with domestic or wild animals
Contact with harmful plants

Socio /psychological

Humiliation
Verbal abuse
Sexual abuse
Isolation
Lack of learning / lack of career as part of future plans
Encouragement to take risks

Table 1. Categories of hazards

Mitigation
1. Eliminate hazards through
system design

2. Engineering out the hazard

or reduce risks by
substituting less hazardous
methods or materials

3. Provide warning systems

or administrative controls

4. Provide personal protective

equipment

LEAST

identified for mitigation, the loan officer

works with the business owner, and at times
with other local technical experts, to develop
a strategy for eliminating or mitigating the
hazard. A tool to examine the hierarchies
of interventions is used to help identify the
most effective type of intervention that is possible for the specific business that is being
examined. In some instances, it is possible
to change the production process to elimi___________________________________________________________________
nate the hazard altogether (as was the case
PPIC-Work Capacity Building Series: Hazard Assessment and Risk Mitigation
for Soumaia and Samaa). In other instances,
33 processes and
safer machines or production
materials can reduce the level of risk within
the workplace. In the family restaurant business shown below both Ahmed and his older brother had lost fingers in accidents with
unsafe equipment. Low cost safety upgrades
now reduce the level of risk involved. When
hazards remain, then warning systems and
administrative controls over how equipment
is used reduce the level of risks as much as
possible. Administrative controls are those
instituted by business owners, such as restricting specific machines or processes to
personnel who are trained and able to operate the equipment safely. Personal protective
equipment is also used, although this is considered to be the least effective way of mitigating hazards and is used when other approaches are not feasible or only partially effective.
The training of workers themselves in occupational health and safety issues, as well
as workers rights within the workplace, has
been an important part of improving working conditions. When workers are aware of
hazards and understand the code of conduct,
they can and do initiate discussions with business owners that result in positive changes
within the work environment. An innovative
initiative in the training of young workers has
come through the development of a computer
game called Baalty, or My Shop in Egyptian Arabic. The game is available on the internet (www.baalty.org) and teaches young
people about entrepreneurship and business
ethics, including the importance of creating
a safe workplace.

Afr Newslett on Occup Health and Safety 2009;19:202

21

Photos Carl Heibert

ICOH2009
in Cape
Town

The use of simple guards and tools will help prevent further injuries in the restaurant business run by
Ahmeds family.

Impacts
A recent externally conducted impact assessment found that over 90% of EACIDs
clients were actively involved in improving
safety within their workplaces while none of
the businesses in a non-EACID control group
were aware of or active in improving workplace safety. The majority of workers within
EACIDs businesses was aware of the code of
conduct and had experienced changes within
their work (such as shorter working hours) as
a result of the code of conduct. Young workers found the Baalty computer game to be
both a fun and an interesting way of learning about workplace safety. Workers also felt
that the monthly visits of EACID staff, along
with the code of conduct, encouraged them
to negotiate with their business owners for increased safety and other improvements within
the workplaces.
EACID has found the dual purpose loans
to have comparable repayment rates to other
loans and the time for the MFI to administer
loans is only marginally higher than normal
loans. EACID expects to be able to sustain
this type of programming over the long term
and sees these interventions as positive for
the organizations reputation, both locally and
internationally. The programming enhances
its social impact, improving the branding of
its services within local communities and increasing its opportunities for attracting loan
fund capital from ethical or socially oriented
investment funds.

Sharing experience
A series of training manuals on childrens
rights, workplace safety and hazard identification and mitigation have been developed
and are now being used to train other microfinance institutions that are interested in improving working conditions within the work-

places and businesses that they serve. With

close to one million active clients of microfinance programmes in Egypt, and approximately 200 microfinance institutions that provide lending services, the potential exists for
the EACIDs experience to reach large numbers of businesses and workplaces.
Richard Carothers
President, Partners in Technology Exchange Ltd
(PTE) (and Director of the Promoting and Protecting the Interests of Children who Work Project)
25 St Anne Ave,
St Agatha, Ontario
Canada, N0B 2L0
Fax: +1 519 746 0906
E-mail: richardcarothers@rogers.com
Mamdouh Foad
Executive Director
(and Associate Director of
the PPIC-Work project)
Egyptian Association for Community
Initiatives and Development
(EACID)
P.O. BOX 130
Aswan, Egypt
Email: mamdouh_foad@hotmail.com
Jennifer Denomy
Senior Consultant / Project Manager
(and Project Manager of the PPIC-Work Project)
Mennonite Economic Development Associates (MEDA)
155 Frobisher Dr
Suite I - 106
Waterloo, Ontario
Canada N2V 2E1
Fax: +1 519 725 9083
E-mail: jdenomy@meda.org

22 Afr Newslett on Occup Health and Safety 2009;19:202

The 29th ICOH International Congress,

ICOH2009, was successfully hosted on 2227
March 2009 in Cape Town, South Africa. This
was the first time ever that an ICOH Triennial
Congress took place in Sub-Saharan Africa. A
total of about 1,400 experts from 81 countries
attended a most fruitful Congress.
About 100 participants from 40 developing and transitory countries received financial
support enabling them to attend.
The 1,292 presentations of the ICOH2009
Congress were distributed evenly: 406 oral
presentations in special sessions, 443 oral presentation in topic sessions, and 443 posters.
In addition, on every day of the Congress,
the programme began at 8:00 a.m. with three
keynote lectures.
ICOH gave its first Student Presentation
Award, which went to Ntombizodwa Ndlovu
of South Africa for her presentation Damaged Goods Return to Sender: A Review of
the Records of Migrant Gold Miners in South
Africa: 1904-1913.

Opening Ceremonies
The Congress was opened on Sunday afternoon, 22 March 2009. In addition to the welcoming addresses of the ICOH President, Professor Jorma Rantanen, and the ICOH2009
Congress President, Professor Daan Kocks,
the participants were bid welcome by Dr.
Maria Neira of WHO and Dr. Sameera AlTuwaijri of ILO, both through video presentations. The two international organizations
emphasized the importance of occupational
health and safety in meeting the Millennium Goals and provided their strong support
for collaboration with ICOH in further development of working conditions and workers health throughout the world. Dr. Lindiwe
Ndelu of the Ministry of Health of South Africa brought the greetings of the Government
of South Africa.
In addition, the sister organizations of
ICOH represented by Professor David Caple, President of the International Ergonomics Association (IEA), Mr. Tom Grumbles,
President of the International Occupational
Hygiene Association (IOHA), and Mr. HansHorst Konkolewsky, Secretary General of

Photo Suvi Lehtinen

the International Social Security Association

(ISSA), Geneva - as well as Dr. Jukka Takala,
Director of the European Agency on Safety
and Health at Work, all brought their greetings to the Congress participants.
The Opening Keynote lecture was given
by Sir Michael Marmot. It discussed in depth
the social inequities in the globalizing world of
work. He challenged all of us to work for better
occupational health for all, and to fight against
the misery caused by inequities in health.
The abstracts of all presentations of
ICOH2009 will be available on the ICOH
website in due course, at http://www.cdldevoto.it/icohdb/.

Works of Dr. Bernardino

Ramazzini in English
Professor Sergio Iavicoli, Professor Antonio
Bergamashi and Professor Paul Blanck introduced the first English edition of the collection of the complete works of Bernardino
Ramazzini. The two-volume book was distributed to all participants of the ICOH2009
Congress.

Good participation from

developing countries and
countries in transition
ICOH Congresses have traditionally facilitated the participation of experts from developing countries and countries in transition. In
April 2008, after the Board meeting held in
Hamburg, the ICOH President established a

working group on fund-raising, the aim being to ensure that as many experts as possible from developing countries would be able
to attend with partial financial support provided by ICOH.
The following organizations supported the
ICOH2009 Congress participation of members from developing and transitory countries:
Arbor Occupational Medicine, HealthSpan
International, USA
Consorzio ISPESL - Clinica Del Lavoro,
Italy
Executive Committee of the ICOH2009
Congress
Finnish Association of Occupational Health
Nurses, Finland
Finnish Association of Occupational Health
Physicians, Finland
Finnish Institute of Occupational Health,
Finland
Institute for Science of Labour, Japan
Liberty Mutual Research Institute for Safety, USA
Prevent Sweden
US National Institute for Occupational
Safety and Health, NIOSH/The University of North Carolina at Chapel Hill, USA.

ported from these funds. Their distribution

among the continents was as follows:
Asia
24
Africa
19
Latin America and the Caribbean 17
Transitory countries
15

ICOH is most grateful for this support,

which enabled the participation of members
who otherwise would not have been able to
attend. The support contributed substantially to the development of occupational health
expertise in the respective countries of the
participants.
A total of 75 experts were partially sup-

Forthcoming ICOH Congresses

In addition, the organizers of ICOH2009

allocated financial support to 23 experts,
mostly from Southern Africa.

Special Sessions for Africa,

Asia, and Latin America and
the Caribbean
Several special sessions were organized for various geographical areas. In addition, a two-part
session was arranged to discuss occupational
health: our common goal in the global village.
In the African Session, presentations were
made from Tanzania, Uganda, Malawi, Ghana and Kenya. The papers dealt with a systems approach to promoting a preventive
safety and health culture, needlestick injuries
among nurses in Sub-Saharan Africa, exposure to heavy metals in mining communities,
and basic occupational health services.

The ICOH members voted for Seoul, Korea

as the location for the ICOH2015 Congress.
ICOH2012 will be held in Monterrey,
Mexico on 1823 March 2012.
Suvi Lehtinen

Afr Newslett on Occup Health and Safety 2009;19:223

23

Contact persons/country editors

Editorial Board
as of 1 January 2008

Chief Inspector of Factories

Commissioner of Labour and
Social Security
Department of Labour and
Social Security
Private Bag 0072
Gaborone
BOTSWANA

Mrs Ifeoma Nwankwo

Federal Ministry of Labour
and Productivity
Occupational Safety and
Health Department
P.M.B. 4
Abuja
NIGERIA

Samir Ragab Seliem

Egyptian Trade Union Federation
Occupational Health and
Safety Secretary
90 Elgalaa Street
Cairo
EGYPT

Peter H. Mavuso
Head of CIS National Centre
P.O.Box 198
Mbabane
SWAZILAND

Ministry of Labour and Social Affairs

P.O.Box 2056
Addis Ababa
ETHIOPIA
Commissioner of Labour
Ministry of Trade Industry and
Employment
Central Bank Building
Banjul
THE GAMBIA
The Director
Directorate of Occupational
Health and Safety Services
Commercial Street
P.O.Box 34120
Nairobi
KENYA
Noel J. Mkhumba
Information and Documentation
Centre
P/B 344
Capital City Lilongwe 3
MALAWI

Chief Executive
Occupational Safety and
Health Authority
Ministry of Labour,
Youth Development and Sports
P.O.Box 9724
Dar es Salaam
TANZANIA
Paul Obua
Occupational Health and
Hygiene Department
Ministry of Labour
P.O.Box 4637
Kampala
UGANDA
Tecklu Ghebreyohannes
Director of Labour Inspection Div.
Ministry of Labour and Human
Welfare
Department of Labour
P.O. Box 5252
Asmara
ERITREA
Mr Mukhtar Mohamed Ali Mukhtar
Environmental Socio-Economic Sustainable
Development Consultant
Dams Implementation Unit
The Presidency of Sudan
SUDAN

Chief Inspector of Factories

Commissioner of Labour and Social Security
BOTSWANA
Mathewos Meja
OSH Information Expert
Ministry of Labour and
Social Affairs
ETHIOPIA
Chief Inspector of Factories
Ministry of Labour and Social Welfare
GHANA
Chief Inspector of Factories
Ministry of Labour and Industrial Relations
MAURITIUS
Chief Inspector of Factories
Ministry of Labour
SIERRA LEONE
Gabor Sandi, Head, CIS
International Occupational Safety and Health
Information Centre
International Labour Office
CH-1211 Geneva 22
SWITZERLAND
Evelyn Kortum
Technical Officer
Occupational Health
Interventions for Healthy Environments
Department of Public Health and Environment
World Health Organization
CH-1211 Geneva 27
SWITZERLAND
Jorma Rantanen
Past President of ICOH
ICOH International Commission
on Occupational Health
Harri Vainio
Director General
Finnish Institute of Occupational Health
FINLAND