Workers’ occupational health surveillance systems in low- and middle-income countries: a scoping review protocol

Abstract

Objective: 

The aim of this scoping review is to describe the characteristics of occupational surveillance systems available in low- and middle-income countries.

Introduction: 

Well-established workers’ health surveillance systems provide important data to guide public health decision-making. A previous review on occupational health surveillance systems in developed countries found that insufficient collection of information and resources affects the work of policymakers and researchers. Identifying the characteristics of existing systems in low- and middle-income countries can assist in decision-making in these countries.

Inclusion criteria: 

This review will consider studies on occupational health surveillance systems used in both public and private health services in low- and middle-income countries, which describe, implement, analyze, or evaluate surveillance systems on workers’ health and working conditions.

Methods: 

Primary studies, government documents, and other records focusing on information systems of occupational and work-related diseases, occupational accidents, or injuries, published in English, Portuguese, Spanish, or Italian will be retrieved from seven databases, including LILACS, Scopus, PubMed, CINAHL, and Embase, among others. Various sources of gray literature, such as low- and middle-income countries’ government websites, will also be searched. After title and abstract screening, relevant articles will be analyzed in full. Data extracted will be presented in tables and narrative form to provide comprehensive information.

Introduction

Under-reporting of occupational exposure or work-related illness, injury, or death represents a major problem for workers’ health surveillance systems. Well-established workers’ health surveillance systems, as well as other public health surveillance systems, provide important data to guide public health decision-making. Public health decisions in areas such as disease prevention; the planning, management, and implementation of occupational health services; health promotion; quality; and resource allocation rely on these systems to respond to health needs_.¹

An occupational health surveillance system comprises the collection, analysis, and dissemination of occupational data. These systems refer to “activities at the individual, group, enterprise, community, regional and country levels to detect and assess any significant departure from health caused by working conditions, and to monitor workers’ general health.”^2(p.22)

Occupational health surveillance involves surveillance of the health of workers and the work environment. Workers’ health surveillance “involves producing and examining indicators of mortality, work disability/ability, occupational diseases and injuries, other work-related diseases, work absenteeism, occurrence of symptoms, life-style factors, etc.”^3(p.12) Surveillance of the work environment “includes the identification and evaluation of environmental factors which may affect the workers’ health.”^3(p.12)

A previous review conducted on occupational health surveillance systems in developed countries found 24 systems operating in the following countries and regions: Denmark (4), Europe (1), Finland (8), Germany (1), Quebec (1), Singapore (1), Sweden (1), UK (2), USA (3), and two systems that operate in collaboration between Denmark, Finland, Iceland, and Sweden (2). The review highlights the significant role of the continuous maintenance of surveillance system databases. In the United Kingdom and the United States, it has been identified that insufficient collection of information and resources affects the work of policymakers and researchers. On the other hand, in Scandinavia and Germany where data is continuously collected, information added to databases is regularly updated to inform practice.⁴

Literature in this area highlights that surveillance systems may be able to provide an indication of the relationship between work and health. This is dependent on, among other things, how health services inform health problems and injuries that affect workers.⁵

The literature stresses the importance of implementing a broad health surveillance system, which enables an analysis of health hazards affecting workers, thereby providing data to assist in the development of interventions. The WHITE (Workplace Health Indicator Tracking and Evaluation) program is an example of a comprehensive database. The program comprises five modules: incident investigation, case management, employee health, health and safety, and early intervention/return to work. Therefore, the WHITE database will be used as a reference to inform data collection concerning descriptive epidemiology, monitoring health risk factors, and evaluating interventions.⁶

This scoping review intends to bring to light the reality of occupational health surveillance systems currently existing globally. It is also expected to supplement previous reviews on occupational health surveillance systems in developed countries and highlight possible differences. This scoping review aims to provide a description of the characteristics of occupational health surveillance systems in low- and middle-income countries (LAMICs) in order to contribute relevant data to policymakers seeking to implement occupational health surveillance systems. In addition, the review will identify gaps in the literature in this area.³

A preliminary search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, and PubMed was conducted, and no current or in-progress scoping reviews or systematic reviews on the topic were identified.

Review questions

• i) What systems are available for the notification of workers’ health problems/diseases and surveillance of working conditions LAMICs?
• ii) What are the characteristics of workers’ health and occupational surveillance systems in LAMICs?

Inclusion criteria

Participants

This review will consider studies that include public and private institutions that have monitoring systems. There will be no limitations on size or type/focus of institutions, as private and public sectors can add different angles to the surveillance systems.

Concept

This review will consider all studies that describe, implement, analyze, or evaluate worker health monitoring systems. For the purpose of this review, two types of monitoring systems will be considered: i) worker health surveillance systems,³ and ii) systems for monitoring working conditions.³ These monitoring systems do not need to be mutually exclusive, but will be analyzed if integration with other management information systems occurs (e.g. geographical information systems, census data).⁷

Context

The review will focus on the context of LAMICs, as defined by the World Bank country classification⁸; therefore, it will consider studies that include any LAMICs in any work environment (e.g. rural, business, public services, private services).

Types of sources

This scoping review will consider for inclusion quantitative, qualitative, and mixed method study designs and all other types of studies that focus on occupational and work-related diseases, occupational accidents or injuries information systems, published in English, Portuguese, Spanish, or Italian, using any methodology. In addition, gray literature such as texts and opinion papers, as well as theses and dissertations will be included. Official government websites from different countries will be searched for unpublished information. International guidelines on occupational health available online or in print will also be searched and reviewed. Articles published from the inception of the databases will be included.

Methods

The proposed scoping review will be conducted in accordance with JBI methodology.^9,10

Search strategy

The search strategy will locate both published and unpublished primary studies, reviews and text and opinion papers. A three-step approach is proposed, based on the methodology recommended in the JBI Reviewer's Manual.⁹ An initial limited search of CINAHL and MEDLINE databases was undertaken to identify articles on the topic. An analysis of the keywords, titles, abstracts, and index terms of the documents found in this search was used to inform the terms used to develop a full strategy for PubMed (Appendix I). The search strategy, including all identified key words and index terms, will be adapted for each included information source. A search in the reference list of all selected articles for full text review will be performed, as well as a search for unpublished studies (gray literature). The process of conducting a scoping review requires a reflexive approach as researchers become familiarized with the literature. Therefore, it is possible that other appropriate terms for the search will be developed during this process.^9,10

Information sources

The databases to be searched will include LILACS (VHL Regional Portal), MEDLINE (PubMed), CINAHL (EBSCO), Embase (Elsevier), PsycINFO (APA), Scopus (Elsevier), Ovid (Ovid Technologies), and Health System Evidence. The search for unpublished dissertations and theses will include ProQuest Dissertations and Theses, CAPES Thesis and Dissertation Portal (Coordination for the Improvement of Higher Education Personnel - CAPES), and EThOS (British Library Theses online service), Google Scholar, WHO Library, OpenGrey (SIGLE), and Google (government websites).

Study selection

Following the search, all identified documents will be collated and uploaded into EndNote V7.7.1 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers (EMGG, AGV) for assessment against the review's inclusion criteria. Potentially relevant papers will be retrieved in full and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers (EMGG, AGV) and reported in the scoping review. Reasons for the exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the scoping review. Any disagreements that arise among reviewers at each stage of the study selection process will be resolved through discussion or with a third reviewer (CBS). The results of the search will be reported in full in the final scoping review report and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.¹¹

Data extraction

Data will be extracted from papers included in the scoping review by two independent reviewers, using a data extraction tool developed by the reviewers. The data extracted will include specific details about workers’ surveillance systems in LAMICs, methods, and key findings relevant to the review questions. The following characteristics of the systems will be extracted: name/title, institution, nature, aims, public availability, data storage on working conditions, characteristics of the target population, morbidity, mortality, maintenance, geographical range, report frequency, and data exportation (see Appendix II). The use of the extraction form will initially be tested by two reviewers on three articles, from which the indicated changes will be made. However, it is acknowledged that additional refinements may be made to cover any data not initially included but that becomes relevant during the extraction process. Data from all included studies will then be mapped by the first reviewer and the extraction verified by the second reviewer. Any disagreement will be resolved through discussion or with a third reviewer. Reviewers will contact the authors of the primary studies or government agencies to request missing or additional information, where required.

Data presentation

The extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review. Data will be organized to better present a mapping of workers’ health/occupational surveillance systems found in LAMICs. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review's objective and questions.