Online Program

Heat stress intervention to prevent Chronic Kidney Disease (CKD) in El Salvador

Tuesday, November 3, 2015 : 8:30 a.m. - 8:46 a.m.

David Wegman, MD, MSc, Department of Work Environment, University of Massachusetts Lowell, Cambridge, MA
Theo Bodin, MD, PhD, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
Ilana Weiss, MA, MPH, La Isla Foundation, Ada, MI
Ramón García Trabanino, MD, MSc, Association of Nephrology and Hypertension of El Salvador, San Salvador, El Salvador
Jason Glaser, BA, La Isla Foundation, Ada, MI
Emmanuel Jarquin, MD, AGDYSA S.A. DE C.V., San Salvador, El Salvador
Catharina Wesseling, MD, PhD, Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
The epidemic of CKDnT (non-Traditional causes) is taking a huge toll on Central American agricultural communities. El Salvador has been identified as one of the hotspots of this epidemic. There is consensus that sugarcane workers are the most affected population and that heat stress and dehydration play an important role. This project’s pilot phase addresses and implements work environment improvements according to international standards and evaluates kidney and productivity effects in El Salvador during the 2014-2015 harvest.  Initial adoption by worker participants as well as the sugarcane producer is encouraging, as is interest demonstrated by labor ministries of El Salvador and Costa

During the harvest, improvements in working conditions of ~70 sugarcane cutters working at 380-400 meters above sea level was implemented mid-harvest and worker exposures were evaluated in relation to heat stress. The intervention plan broadly follows OSHA’s Water-Shade-Rest program for workers in hot occupations, and includes efforts to improve cutting efficiency to develop methods for scaled-up interventions. The method development and evaluation take into account environmental heat, hours of labor, tons cut, cutting techniques, intake of hydration solutions, time in shade, symptoms, estimated core temperature, heart rate, intake of pain killers, blood pressure, weight pre and post shift, height, and blood and urine samples for measuring hydration. Based on the experiences, up-scaled interventions for the following harvest will be planned.

During the first (coolest) months of the harvest average daily maximum WBGT values were >31oC.  Preliminary results of biomedical and exposures variables will be presented and discussed.

Learning Areas:

Chronic disease management and prevention
Environmental health sciences
Occupational health and safety

Learning Objectives:
Describe the epidemic of chronic kidney disease (CKD) in Mesoamerica Evaluate evidence for heat stress causing CKD in sugar cane workers Discuss the potential of heat stress reduction and productivity enhancement to address the CKD epidemic among sugar cane workers

Keyword(s): Climate and Health, Occupational Health and Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a physician, epidemiologist, emeritus professor and the Principal Investigator of the study that is being reported
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.