SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.MethodsWe used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).FindingsBetween 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DA...

Summary Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5–89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and t...

The horticultural sector has undergone tremendous growth in Kenya and is now the second largest foreign income earning sector in the country. Lake Naivasha is the hub of large scale horticultural farming in Kenya. This growth coupled with increased use of pesticides, may increase the possibility of pesticide exposure and its associated risks to workers and residents of the region. The purpose of this study was to assess the symptoms commonly experienced by residents of Naivasha town and their possible association to pesticide exposure. Purposive sampling of residents from Kamere, Kwa Muia, Kioto and Karagita was performed, as these residential areas have significant numbers of flower farm workers. By random selection, a total of 801 community members were recruited to participate in the study and data was collected by completing the prepared questionnaire and from clinical examinations. Results indicate that several residents exhibited respiratory; skin, joints and bones; and nervous system symptoms. We found a higher frequency of symptoms among planters, weeders, harvesters than in sprayers working in horticultural farms. We recommend training to planters, weeders, harvesters who are mainly women (61.6%) in this study concerning pesticide use as do sprayers; and second, longer reentry times between the last spraying of pesticide and entry of these workers is warranted, particularly in greenhouses. In this regard, reentry times for greenhouses and fields established for specific pesticides in Europe, North America, Japan or Australia should be adapted by Kenya, and these guidelines enforced by P. F. Tsimbiri et al. 25 the Government of Kenya to reduce exposure to pesticides within this vulnerable work group. These workers should also use protective clothing including gloves and masks at all times while handling chemicals or recently sprayed plants or flowers. It would also be prudent for flower farm owners to introduce an integrated pest management regime to reduce pesticide use andworker exposures. Further research is required both to identify validated biomarkers that can reliably be used to identify pesticide exposure prior to the occurrence of acute toxicity; and to follow up individual cases of known exposures for chronic health effects.

Companies have a legal and social responsibility to ensure the safety of its workers, all persons lawfully present at the workplace and the surrounding community. This requires laid down procedures and routing process which aims at identifying, eliminating, minimizing and control the work-related hazards and decrease the risks. To be effective, the Occupational Safety and Health Management Systems (OSHMS) need to be integrated within the organization’s safety policy and objectives. Therefore, this explains why OSHMS has continued to play a pivotal role in the decision making process in most companies. This study aimed at assessing occupational health and safety management systems in place and their compliance. The sampling unit was petrol stations and the study employed use descriptive study design. The purposive sampling was employed to select thirty two (32) petrol stations in Njoro Molo and Nakuru Municipalities of Nakuru County with a special focus on petrol stations which have dispenser pumps, car servicing bay and Front Office section. Data was collected using purposive sampling, stratified and simple random where interviews, observations and questionnaire survey. Descriptive statistics which involved frequency tables and percentages was used to analyze the data. The findings of this study shows that more than half of the petrol stations lacked defined Occupational Safety and Management systems. There is need of Occupational Safety and Health Management System to be integrated within petrol stations policy in order to reduce the operations mistakes, costs of reducing problems and level of risks while ensuring that they comply with laws and regulations.

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