title: Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1.
abstract: BACKGROUND
  Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America.
  
  
  OBJECTIVE
  (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity.
  
  
  METHODS
  Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records.
  
  
  RESULTS
  Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3 tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes.
  
  
  CONCLUSIONS
  A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health.
authors.affiliation: Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Bodin
authors.affiliation: Association of Nephrology and Hypertension of El Salvador, San Salvador, El Salvador.
authors.forename: R
authors.initials: R
authors.lastname: García-Trabanino
authors.affiliation: La Isla Foundation, Ada, Michigan, USA.
authors.forename: I
authors.initials: I
authors.lastname: Weiss
authors.affiliation: Agency for Development and Agricultural Health (AGDYSA), San Salvador, El Salvador.
authors.forename: E
authors.initials: E
authors.lastname: Jarquín
authors.affiliation: La Isla Foundation, Ada, Michigan, USA.
authors.forename: J
authors.initials: J
authors.lastname: Glaser
authors.affiliation: Department of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Jakobsson
authors.affiliation: School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
authors.forename: R A I
authors.initials: RA
authors.lastname: Lucas
authors.affiliation: Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Wesseling
authors.affiliation: Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Hogstedt
authors.affiliation: Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Wegman
mesh_terms: D000293:Adolescent; D000328:Adult; D060766:Drinking Water; D004526:Efficiency; D004544:El Salvador; D006804:Ergonomics; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000379:methods*; D018882:Heat Stress Disorders / Q000517:prevention & control*; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control*; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D012146:Rest; D031786:Saccharum; D013395:Sucrose; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D060766:Drinking Water; D013395:Sucrose
keywords: Chronic kidney disease; Dehydration; Heat Stress; Intervention; Mesoamerican nephropathy