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Objective-To evaluate two diVerent techniques for assessing dermal exposure to 4,4'-methylene dianiline (MDA) in a field study. The results were used to test the applicability of a recently proposed quantitative dermal occupational exposure limit (DOEL) for MDA in a workplace scenario. Methods-For two consecutive weeks six workers were monitored for exposure to MDA in a factory that made glass fibre reinforced resin pipes. Dermal exposure of the hands and forearms was assessed during week 1 by a surrogate skin technique (cotton monitoring gloves) and during week 2 by a removal technique (hand wash). As well as the dermal exposure sampling, biological monitoring, measurement of MDA excretion in urine over 24 hours, occurred during week 2. Surface contamination of the workplace and equipment was monitored qualitatively by colorimetric wipe samples. Results and conclusions-Geometric means of daily exposure ranged from 81-1762 µg MDA for glove monitoring and from 84-1783 µg MDA for hand washes. No significant diVerences, except for one worker, were found between exposure of the hands in weeks 1 and 2. Significant diVerences between the mean daily exposure of the hands (for both weeks and sampling methods) were found for all workers. The results of the colorimetric wipe samples indicated a general contamination of the workplace and equipment. Excretion of MDA in 24 hour urine samples ranged from 8 to 249 µg MDA, whereas cumulative MDA excretion over a week ranged from 82 to 717 µg MDA. Cumulative hand wash and MDA excretion results over a week showed a high correlation (R 2 =0.94). The highest actual daily dermal exposure found seemed to be about 4 mg (hand wash worker A on day 4), about 25% of the external DOEL. Testing of compliance by means of a biological limit value (BLV) led to similar results for the same worker. It is concluded that both dermal exposure monitoring methods were applicable and showed a compatible performance in the present exposure scenario, where the exposure relevant to dermal absorption is considered mainly restricted to hands. The concept for a DOEL seemed to be relevant and applicable for compliance testing and health surveillance in the situation under investigation. (Occup Environ Med 1998;55:805-811)

In the predominantly rural Hewu district of Ciskei 54% of infant deaths are diarrhoea-related. The aim of this study was to determine whether village health workers (VHWs) could teach mothers to safely prepare homemade sugar-salt solutions (SSS). VHWs from 11 villages were selected for training while 11 randomly selected villages acted as controls. VHWs selected for training were taught to prepare SSSs and to teach mothers with children under 5 years about the use of such solutions. A card illustrating the main points was given to all mothers. Six weeks after training, randomly selected mothers in control villages (n = 320) and experimental villages (n = 327) were interviewed and asked to prepare SSS. Experimental and control villages had similar children's diarrhoeal disease rates (using a 2 week recall period). In experimental villages 81.5% of mothers compared to 29.7% in control villages had received SSS cards (i.e. been visited). Of recently occurring diarrhoeal-episodes 76.6% were initially treated with a SSS (correct formula used in 81% of cases) in experimental villages compared to 50.5% (correct formula used in 48% of cases) in control villages (P less than 0.05 for SSS use). Greater use of enemas and home remedies occurred in control villages (P less than 0.05). Of solutions made in experimental villages 7% had sodium concentrations over 100 mmol/litre compared to 36% in control villages. Results show that VHWs can effectively train mothers to safely prepare SSS and the VHW program has been expanded to other areas.

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