A Mathee

A survey of blood lead levels among young Johannesburg school children

Studies conducted around the world have established beyond doubt that elevated childhood blood lead levels may lead to detrimental health effects. Research has shown that certain groups of South African children are at particular risk of elevated blood lead levels. Johannesburg is the largest urban complex in southern Africa, with a population of around 3 million and extensive industrial and manufacturing activity. Among the challenges posed in the city are rapid urbanization, extensive poverty, and inequity. Little information on the blood lead distribution of Johannesburg children is available. This study was undertaken to determine blood lead levels among children living in three areas of Johannesburg: inner city suburbs and the low-income townships of Alexandra and Westbury to the north and west of the city center, respectively. The results indicated that blood lead levels ranged from 6 to 26 micro g/dL, with a mean level of 11.9 micro g /dL. The blood lead levels of 78% of children equaled or exceeded 10 micro g/dL, the current international action level. Maternal educational status, the presence of smokers in the home, and living in an informal dwelling were among the factors associated with elevated blood lead levels.

Climate change impacts on working people (the HOTHAPS initiative): findings of the South African pilot study

Background: It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases (GHG) in the atmosphere. With the prospect of a warmer world, increased attention is being devoted to the implications for worker well-being and work performance. Objectives: The ‘high occupational temperature health and productivity suppression’ (HOTHAPS) programme is a multi-centre health research and prevention programme aimed at characterising and quantifying the extent to which working people are affected by, or adapt to, heat exposure while working. The main aim of the current South African pilot study was to look at the perceptions of outdoor workers regarding their work environment in hot weather and how this affected their health and productivity levels. Design: A qualitative study utilising focus group discussions was employed in two sites, Johannesburg (which has a temperate climate) and Upington (located in the hottest part of South Africa). Results: In summary, the pilot study demonstrated that especially in Upington, where daily maximum temperatures may reach +40°C, workers reported a wide range of heat-related effects, including sunburn, sleeplessness, irritability, and exhaustion leading to difficulty in maintaining work levels and output during very hot weather. Few, if any, measures were being undertaken by employers to protect health or improve worker comfort. Conclusion: This pilot study has demonstrated that people working in sun-exposed conditions in hot parts of South Africa currently experience heat-related health effects, with implications for their well-being and ability to work and that further research is warranted. In this regard, the pilot study has proved valuable in informing the design, site, sample selection, and logistical planning for a proposed main study on the health and performance aspects of work in hot weather in South Africa.

A study of pediatric blood lead levels in a lead mining area in South Africa

This study aimed to determine the blood lead distributions among young children in the lead mining town of Aggeneys in South Africas Northern Cape Province, and in the comparison community of Pella, about 40 Km away. A further objective of the study was to explore factors associated with elevated blood lead levels. Children aged between 6 and 10 years (average age, 8 years) were studied, 86 from Aggeneys and 68 from Pella. The results showed that blood lead levels among the children of Aggeneys averaged around 16 microg/dL, while in Pella the mean blood lead level equaled 13 microg/dL. Overall, children with raised blood lead levels performed less well at school relative to other children. Within Aggeneys, fathers of high lead children tended to shower at work rather than at home, which may have been insufficient to prevent lead from being transported into the home. In conclusion, more stringent environmental control measures are needed, as well as stricter personal hygiene measures, to prevent childhood lead exposure in the mining community.

Does money matter for mental health? Evidence from the Child Support Grants in Johannesburg, South Africa

Abstract Globally, the poor are consistently at greater risk of suffering from depression and anxiety. Yet in resource-poor countries, mental health remains a neglected topic. This interdisciplinary study explored the potential for a poverty alleviation programme to contribute to breaking the vicious cycle between poverty and common mental disorders (CMD). Quantitatively, beneficiaries of a cash-transfer programme were found to have a lower risk of CMD. Qualitative interviews indicated that Child Support Grants acted as a psychological safety net, but that negative stereotypes of grant recipients could detract from the positive mental health outcomes of the grants. It was concluded that poverty alleviation programmes such as cash transfers could have both positive and negative impacts on mental health. In order to achieve mental health benefits for programme beneficiaries, aspects of programme design and implementation that promote mental health should be enhanced and aspects detrimental to mental health modified.

The health impact of environmental pollutants: a special focus on lead exposure in South Africa

Studies have shown blood lead levels of some children in South Africa at levels of health concern. New studies show even relatively low lead levels to have detrimental effects on cognitive function in young children. Large numbers of South African inner-city and other children have been shown to have unacceptably high blood lead levels. Studies indicate that blood lead levels of children living in South Africas urban areas are higher than those of children in most developed countries, including Great Britain, Europe, and the United States. Although data and reported studies are very sparse, mean blood lead levels of approximately 15 microg/dl have been reported in children. Elevated blood lead levels were associated with socioeconomic status and housing conditions. Key environmental risk factors for elevated blood levels were contaminated soil and dust in the urban environment, and the still large number of automobiles using leaded gasoline. In view of emerging evidence linking lead at increasingly lower levels to adverse effects in children, the South African government is taking actions to reduce lead exposure among vulnerable groups. Currently, South Africa has no national lead surveillance program. The government, therefore, has developed international and regional partnerships to prevent and address the problem of lead exposure.

Overcoming fieldwork challenges in urban health research in developing countries: a research note

With rapid growth in the global urban population over the next two decades, health will increasingly have an urban bias. The picture of public health is particularly complex in African cities, where rates of urbanisation, poverty and inequity are high. This paper identifies the main data collection problems encountered within a panel study in low‐income areas of Johannesburg, with special emphasis on sampling, access and partnerships. The paper will be of relevance to anyone considering research in the cities of developing countries, especially in Africa.

Poor housing, good health: a comparison of formal and informal housing in Johannesburg, South Africa

ObjectivesThis study aimed to investigate the relationship between housing, demographic, socio-economic, social factors and health, in poor urban communities in Johannesburg, South Africa.MethodsData were drawn from a survey of 1,427 households in Johannesburg. The outcome health variable was a composite measure of chronic ill-health. Housing variables included type of housing, tenure and access to services. Multivariate regression analysis assessed the relationship between housing and health, after adjustment for demographic, socio-economic and social factors.ResultsThe prevalence of chronic health problems was 25.1% (95% CI 22.8–27.6%). Factors independently associated with the risk of chronic ill-health among household heads included older age (OR, 3.06 [2.37–3.95]), female gender (OR, 2.83 [2.01–3.97]), long-term residence (OR, 2.01 [1.10–3.67]), unemployment (OR, 0.49 [0.36–0.67]), and living in formal housing (OR, 0.66 [0.45–0.98]).ConclusionsThe health of the household heads residing in informal housing was significantly better than in formal housing. Explanations for this counter-intuitive finding include the fact that the informal housing dwellers were younger and recent migrants (the ‘healthy migrant’ phenomenon). Policy implications of the results are identified.

Potential risk factors for asbestos exposure amongst six-month-old infants living in the township of Soweto, South Africa

During recent years there has been increased attention paid to public exposure to asbestos in the non-occupational environment. As part of a longitudinal cohort study of urban child health and development (the Birth to Ten Project) undertaken in Soweto-Johannesburg, environment and health conditions were assessed, including the potential for exposure to asbestos in low-income housing settlements. Respondents from Soweto reported that 52% of a sample of 1488 six-month-old infants, were living in asbestos-roofed houses. Analyses in relation to the asbestos-roofed houses, showed that more than 63% were older than 20 years, and that ceilings were absent in 62% of such houses. Leaking roofs, water damage and flaking interior paint in 17%, 13% and 14% of asbestos-roofed houses, respectively, indicated considerable infrastructural decay. In 6% of houses, household members themselves had undertaken work involving cutting or sawing the asbestos roofs, during the six-month period prior to the interview. Only 10% of respondents thought that asbestos could adversely affect their health, or that of their children. The study indicated a need for vigilance in relation to the potential for current and future community exposure to asbestos in low-cost, ageing housing settlements in South Africa.

Inequity in poverty: the emerging public health challenge in Johannesburg

In 2005, in recognition of the role of social factors in increasing health inequities, the World Health Organisation established the Commission on the Social Determinants of Health. South Africa is among the most unequal societies in the world. It faces serious public health challenges, including an elevated burden of chronic disease, and high levels of violence. This paper presents data from a cross-sectional study of socio-economic and health status conducted in five Johannesburg housing settlements in 2006. The findings paint a picture of health inequities across and within the study sites, and socio-environmental conditions that undermine the prospects of protecting and promoting health. The authors suggest the need for a new approach to public health in areas of urban impoverishment in Johannesburg and elsewhere.

The Extent, Nature and Environmental Health Implications of Cottage Industries in Johannesburg, South Africa

Cottage industries comprise a sub-group of informal sector income generation activities which are conducted in the home environment and organized around families or households. Cottage industry workers may be at risk of exposure to harmful substances associated with their work, and given the lack of separation of cottage industry activities from living spaces, their families and neighbors may similarly be at risk of exposure. This study was undertaken to determine the extent and nature of cottage industries in five neighborhoods in Johannesburg (South Africa) A cross-sectional survey was conducted across five communities in Johannesburg in 2012. Data on metal-related cottage industry activities were collected through the administration of a pre-structured questionnaire. Metal-related cottage industry activities were defined as car repairs, spray painting, scrap metal recycling, electrical appliance repairs, welding, hairdressing and metal jewelry making. One fifth of the households interviewed were operating one or more cottage industries associated with the use of toxic substances. Therefore, the potential exists for associated ill health effects in a considerable proportion of the population. Further research is needed to fully assess exposure to the harmful aspects of cottage industry, as are scaled up campaigns to increase awareness of the risks and correct handling of toxic substances.