The the global deaths from injuries occur in

The Health and Safety Executive (HSE) of UK defined an accident as “any unplanned vent that resulted in injury or ill health of people, or damage to materials or equipment, plant, environment or a loss of business opportunity.”The Occupational Safety and Health Administration (OSHA) recently modified the definitions of work- related injury and illness. Using the new definitions, the Bureau of Labor Statistics reported that there were 4.7 million nonfatal injuries and illnesses in private-industrial sectors occurred in 2002.This was equivalent to a rate of 5.3 cases per 100 full-time workers. Worldwide, the average estimated number of fatal accidents was 350,000 in 1998. Although two-thirds of the global deaths from injuries occur in the developing world consuming substantial health sector resources, lethal occupational accidents are still underreporting in developing countries. They are usually reported by the insurance systems, which provide only partial coverage. Industrial sectors’ fatality rate ranged from 13.4 to 26.4 in different regions in the world.In Sudan, this rate was 15.9. The comparison between developing and developed countries might be misleading, since developing countries rates are under estimated.Figures of accidents in developing countries are not based on a convenient accident recording system.A study in the USA has illustrated that between 33% and 69% of all occupational injuries were missed from the reported injuries.Injuries result in major financial and productivity losses to nations while inflicting tremendous personal burden on the injured and their families.A variety of factors have been found to be responsible for accidents, either directly or indirectly. Unsafe acts such as failing to use protective devices or bypassing safety devices have caused most injuries according to National Safety Council.Consequently, safety training and reviewing rules and regulations have been largely effective when enforced.In an effort to reduce work-related injuries, many organizations have implemented behavior based safety processes. Safe working conditions are a part of the normal quality and production management.Providing safe work is an investment in the human resources and skills of the work force at the enterprise in quality and productivity.Sustainable and cost-effective improvement of working conditions has to be based on cooperation between employers and workers at the enterprise.Accident analysis is a tool, which can be used to obtain accurate and objective information about the types and causes of the previous accidents that when fixed, prevent recurrence ofsimilar events. The process of recording and documenting work-related injuries, are carried out mainly for the purpose of identifying unsafe and unhealthy working conditions and establishing program priorities.The aim of this study was to explore causes, factors, and out-comes of the occupational accidents that occurred during 2005-2007 in various industrial sectors of Khartoum State, Sudan.Data from this study might be a valuable resource to design OSH programs in different Sudanese industries to prevent recurrence of similar accidents.A brief geographical and economic review of the Sudan has been attempted. Occupational health problems of the present and future have been outlined. The potential and intended functions of an occupational health unit are defined. The importance of teaching, surveying industry, and research isStressed.The Sudan is a zone of steppe extending west of the River Nile to rise in the extreme west as volcanic hills of Jebel Marra, 5,000 to 6,ooo feet high, and to form the Red Sea Hills in the east which are part of the Rift Valley and link up with the EthiopeanHighlands.The climate differs in each region. In the Red Sea Hills the winter is wet and the humidity high.In the northern region desert conditions prevail;there are two seasons only–hot, dry summers and cold, dry winters. The southern part is a region of tropical forests which has a long wet season from March to November. The central region, which includes Khartoum, has a sub-tropical, continental type of climate with four seasonal changes, and the temperature varies throughout the year between500 and 105’F.The climate influences the type of vegetation and agricultural crops. Of the 6oo million acres, 120 million are suitable for agriculture and another 8o million for stock-raising; however, only I5 million acres are under cultivation.In 1951 the Sudan was divided into nine provinces each with its own elected council. The provinces are further divided into districts, each having a rural district council or a town council.In the last io-year plan the economic growth was estimated at between 7% and 8%, which is fair for a developing country provided it can keep pace with the population growth. The average income is low but varies greatly for persons in different occupations.Primary Sector This includes activiare mainly concerned with the direct expl1natural resources whether renewable or ninclude agriculture, animal husbandry,fishing, mining, and quarrying.Secondary Sector This includesamong which the main purpose is the trtion of primary or partly finished matefinished or nearly finished products. Thethe manufacturing industries of arts andin addition construction, food processingrefinement of raw materials.Tertiary Sector In this group are aswhich the use of materials, whether raw4627I5Medical Services and Health Problems4 The Under-Secretary in the Ministry of HealthIOO is responsible for all health services throughout theSudan including the training of local medical andhealth personnel.pulation is As mentioned before, the country is divided intoinistry Of nine provinces, in which the Province Medicalthe age of Officer of Health (P.M.O.H.) is responsible for thed 25 years health services. Every province is divided intot 85% in districts; each district has a hospital and satellitedeveloping dispensaries. The Medical Inspector in the.d and the districts is responsible to the P.M.O.H. for all healthe ratio of problems in his district (see Figure)..y active is The Sudan still depends on medical auxiliariesicome and who represent the front line of this medical service.Although statistics are not well kept the figuresription of below are mainly quoted from the Annual Reportswer in the of the Ministry of Health of Sudan.headings The average doctor: population ratio is I:20,000,ranging from i:I,ooo in Khartoum to I:40,000 inthe rural areas. The number of hospital beds isI-2 per i,ooo, ranging from 3-5 per I,000 in urbanMANPOWER areas to o-8 per I,000 in certain rural areas. TheTRIES* budget is meagre and the annual expenditure perTertiary head on health does not exceed nine shillings. Most(%) is spent on the curative side, while prevention takesonly Io%.Medical Training As the Sudan depends mainly on medical auxiliaries, several schools have been developed for their training. The School for Medical Assistants, which runs the dispensaries, was established in I9I8; a three-year training is which given. The School of Hygiene was established inof I932 to train Public Health Officers; the diploma ofiot. They the Royal Society of Hygiene is given at the end offorestry, three years’ training. Other schools have been established for ophthalmic assistants, theatre attendants, laboratory technicians, radiographers, activities dental mechanics, and dispensers. For women aansforma- Midwifery School was established in Omdurman in erials into I920, followed by a Health Visitors’ School. Theinclude Nursing College was founded only a few years ago crafts and in the late fifties. The School of Medicine started J, and the in 1924 and is discussed below.Health Problems Health problems in the activities in Sudan are great and diverse. The infant mortality or partly rate is 93 per i,ooo, ranging from 25 per I,OOO in the Khartoum Province to I85 per I,OOO in other areas.The major causes of death are pulmonary tuberculosis and other respiratory diseases, malaria, and enteritis. Among the communicable Among the communicable and en-demic diseases,malaria tops the list, being endemic all over the Sudan while bilharzia is endemic in Gezira. Diseases due to poor sanitation are pre-valent. Gastro-enteritis is the main cause of death of children, especially when complicated by measles or a secondary respiratory infection.The Sudan has many public health problems which are exacerbated by the large size of the country. Moreover, the long frontier with eight neighbouring countries coupled with the nomadic habits of a large section of the population, makes the control of these diseases very difficult. However, future planning and the help of international organizations, especially the World Health Organiza-tion (W.H.O.), makes the eradication of these diseases feasible. There are certain projects assisted by W.H.O. which must be mentioned. These are the B.C.G. campaigns; a T.B. Pilot Project at Wa Medani which depends on group examination and case finding; a malaria eradication project; the Nursing College; and the Orchocerciasis Pilot Pro-ject. High hopes are entertained of the outcome ofthese schemes.The School of Medicine The School of Medicine started in I924 with an intake of four students and was affiliated to the University of London. In 1958 the Faculty of Medicine in the University Khartoum offered its own degree of M.B., B.S. The annual intake has risen gradually to 6o, and the faculty has expanded in all its departments.The Department of Public Health The department was run by an English professor until I959 when he retired and was succeeded by a Sudanese. There are four lecturers in thedepartment, one of whom is also responsible for the Student Health Service. The department is expanding continuously.The teaching of public health starts in the second year of the medical course. An average of I50 to 200 hours is devoted to public health, spread over the three years that it is taught; much practical work and field work are given.The students are also taken on public health tours all over the Sudan during the vacations to help them understand the real health problems of the country. The department has its own laboratory with three laboratory technicians but still lacks a statistician. The relationship of the department to other departments is good, and a close relationship is being created with the Ministry of Health. The Occupational Health Unit, which has been recently created, will be part of the Public Health Department for a long time to come. Undergraduate teaching will be one of the major functions of the Unit. Before dis-cussing the structure and functions of the Unit, it is necessary to consider the industries in the Sudan and those around Khartoum.Industrial development in the Sudan has followed the pattern seen in the other developing countries which possess little mineral wealth, namely the processing of agricultural products. Cotton ginning and the manufacture of cotton textiles are well established, the production of vegetable oils from seed pressing is undertaken, and sugar refining is important. Transport is being developed, and railways, roads, and ports are being established while electricity undertakings have grown apace.Rapid industrialization has been the aim of successive governments and a political slogan of all parties. The general policy has been to distribute the industries equally, but concentration has occurred mainly around Khartoum since it provides the best consumer market. As petroleum has not yet been discovered in the Sudan, the only cheap source ofpower is hydro-electric schemes. During dam building many disasters have occurred which indicate the need for efficient medical services. So far these have not been planned with sufficient foresight.The natural resources of the country have not yet been fully exploited.Copper, manganese, mica, gold, and iron are mined on a very small scale. The mechanization of agriculture and proper care of livestock are still in their infancy.As well as Khartoum, other foci of industry are the Gezira area, where all cotton ginning takes place, the Geneid area, where there are tobacco factories, sugar refineries, cardboard factories, and glass factories, and Atbara where there are railway workshops and the cement industry; in Port Sudan oil refining, oil pressing, and the textile industry are found in addition to the activities of a busy port.The industries in Khartoum Province are con-centrated mainly the industrial estates in Khartoum North, Omdurman, and Khartoum. According to the classification of occupation adopted above, only 33% in Khartoum are occupied in the primary sector, 30% in the secondary sector, and 37% in the tertiary sector. Although Khartoum Province has one-twentieth of the Sudanese man-power, it contains about one quarter of the men engaged in the secondary and tertiary sectors.A cross-section of industries is concentrated around Khartoum; the textile industry, employing 5,ooo workers; the chemical industry, for example with branches of I.C.I. and Chloride Batteries; paints; oil and soap industries; beer, alcohol, and other distilleries; glass, sweets, and all consumer needs; hundreds of small workshops, foundries, and light engineering. Most of these are privately owned although most of the big factories belong wholly on in large part to the government.society with far-reaching effects on all its members. It involves the transformation of a peasant society into a community dependent on factories, and demands migration. Whole communities leave the settled country life to live in or near an industrial town, and the man who is a craftsman in his own right becomes a cog in a machine. These migrant workers may be subjected to insanitary living and factory conditions. They may contract new com-municable diseases-thus the incidence of tubercu-losis will rise. Accidents will become more frequent and the incidence of tetanus may rise. The agri-cultural population cannot readily handle themodern machines efficiently nor do they master the new techniques easily. It is not easy for them to adapt to the new factory discipline with fixed hours and mass production methods, and they miss their free and easy rural habits.The same problems are to be expected in the Sudan as have occurred elsewhere in Africa. Over-crowding of the industrial estates will be a problem; malnutrition and venereal diseases may affect the unmarried and separated. Family ties will be weakened and many social and psychological prob-lems may arise. Moreover, under the slogans of rapid industrialization, shabby, unhealthy factories and workshops may be built. Workers are apt to be exploited and may be asked to handle dangerous materials without the necessary precautions being taken to protect them. How to cope with all these problems and matters is the future task of the occupational health service. In a developing country like the Sudan this will be a part of the work of the public health expert.Labour Legislation Labour legislation in the Sudan consists of two chief categories: that dealing with the conditions of employment, and that govern-ing the formation and registration of trade unions and the regulations of industrial relations. In the first category are theEmployers and Employed Per-sons Ordinance I948; the Workshops and Factories Ordinance 1949; the Wages Tribunal Ordinance I952; and the Employment Exchange Ordinance I955. These ordinances have been borrowed freely from similar laws in Great Britain.The Labour Department was started in I947 and consists of the following sections: (i) Labour Inspectorate;(2) Factory Inspectorate;(3) Industrial relations;(4) Training-within-industry;(5) Wages tribunal;(6) Housing of workers;(7) Industrial Standards Board;and (8) Employ-ment bureau.The Factory Inspectorate section is manned by only six inspectors, none of whom is medically qualified; a medical inspectorate has not yet been developed. Section I5 of the Workshops and Factories Ordinance I949 gives power to the Medical Officer of Health to carry out medical inspections of a workshop or factory or employed person as may be necessary.


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