B.Sc, M.Sc in Audiology; UCT, SA Noise induced hearing loss (NIHL) in Zimbabwe- An ethical consideration Dr Clemence Chidziva MBChB (UZ) FC ORL (SA) Tinashe Nhokwara B.Sc, M.Sc in Audiology; UCT, SA

Issues Most industries (entertainment, manufacturing, mining) in Zimbabwe do not comply with the hearing occupational health and safety act. Is hearing as part of the OHS Act being implemented in Zimbabwe and for those who do, is it being done properly? Malingering patients with NIHL. Ethical practice related to compensation.

Occupational Health & Safety (OHS) Act The generally accepted standard regulation in most countries is that a noise level of more than 85dBA for an 8- hour daily exposure is potentially damaging.

Definition of NIHL Permanent Hearing Loss Prolonged Exposure High levels of Noise Noise induced hearing loss (NIHL) is within the top five occupational illnesses in Zimbabwe. Chadambuka et al 2013

Prevalence of NIHL Not known in Zimbabwe Chadambuka et al mine study of 2013 Sixty two (36.7%) workers had NIHL. NIHL increased as a function of age Observed workers took heed of noise warnings. There was no documented hearing conservation program at the mine. Chadambuka et al. (2013)C

Implementation of OHS Act for NIHL Legistlative framework - CONSTITUTION Monitoring and Enforcement – NSSA Enabling Environment – ECONOMY Conflict of interest – NSSA Sound Engineering – EMA Ear Plugs/Ear Muffs – COMMS IN NOISE CUSTOM MADE HEARING PROTECTIVE DEVICES PHARMACOLOGICAL HEARING PROTECTIVE DEVICES

Malingering patient and compensation NSSA act chapter 17:04 5.1 .68 (1990) This Statutory Instrument (SI) deals with the compensation issues to workers. Every worker in Zimbabwe contributes to NSSA in monthly subscriptions from his/her pay when the worker gets injured in an accident at work or gets a disease at work he/she is compensated by NSSA using the above instrument.

NSSA Act The SI provides for the promotion of the accident prevention program at the work place and ensures that safety and health of all workers are covered by work compensation insurance fund. A worker will receive compensation and rehabilitation services of injuries at work.

Malingering Patient Case Mr X was initially referred in June 2014 and presented with a bilateral, asymmetrical, severe to profound, SNHL. (Right ear being worse) He came in March 2015 with referral from NSSA and did not show any difficulty when communicating with him during the case history as indicated by his previous audiogram. Repeat audiograms where conducted during his visit as his responses were inconsistent.

Malingering Patient Case Audiogram findings in June2014

Malingering Patient Case Audiogram 1 findings in March 2015

Malingering Patient Case Audiogram 2 findings in March 2015

Malingering Patient Case ASSR findings in March 2015

War vet case-ethical practice I DIED FOR THIS COUNTRY AND I AM PREPARED TO DIE FOR IT AGAIN.

Lessons Learnt Need to strengthen the governing bodies in implementing the OHS Act through research on prevalence of NIHL. Involvement of relevant healthcare professionals to ensure adherence and continual monitoring of hearing conservation programme.

Recommendations Hearing conservation programmes put in place. National Institute for Occupational Safety and Health (NIOSH 1996) calculates that 15% of workers exposed to noise levels of 85 dB(A) LAeq,8h will develop hearing impairment over their lives.

What it entails Baseline audiograms for all workers exposed to noise levels at or above the time-weighted average for eight hours (TWA) of 85 dB(A) , which is preceded by a 12-hour period of no exposure to loud occupational or other noise. NIOSH recommends an annual test for workers whose exposure levels are less than 100 dB (A) LAeq, 8h and testing every six months for those workers who exposure levels are equal to or greater than 100 dB(A) LAeq,8h.

What it entails Each worker’s annual audiogram is compared to his or her baseline audiogram to check for changes in hearing that might have been related to the noise exposure OSHA sets no time limit from administering the annual hearing test to comparing the results to the baseline audiogram. OSHA requires that if a change of hearing of sufficient magnitude has occurred, the employer must take certain actions to avoid further worsening of hearing for the worker.

References Chadambuka, A., Mususa, F. & Muteti, S. (2013). Prevalence of noise induced hearing loss among employees at a mining industry in Zimbabwe. South African Health Sciences, 13, 899 – 906. doi: http://dx.doi.org/10.4314/ahs.v13i4.6 Jambwa, M. & Chitongo, L. (2013). Challenges of implementation of occupational health and safety measures in the Marondera Municipality Department of Works. International Journal of Economy, Management and Social Sciences , 2, 304-309. National Social Security Act 1990. Zimbabwe Government. Statutory Instrument 68/1990; Government Printers; 1990.

References Occupational Safety and Health Administration (OSHA) (1981). Occupational Noise Exposure: Hearing Conservation Amendment. Fed. Regist. 46, 4078-4181. The NSSA Act Chapter 17:04;5.1 and 68. (1990) The Occupational Health and Safety Act (1994). Zimbabwe Government, author. Factories and Works Act Chapter 14:08. Government Printers; 1996.

NOISE INDUCED HEARING LOSS - NIHL STOP IT!!