Effectiveness of Interventions

To Reduce Flour Dust Exposures

in Supermarket Bakeries in
South Africa (2014)
Umer Arif Esbhani
521044
Flour dust: why is it a problem?

• Dust coming from finely milled or otherwise processed cereal

• WHO, 1999: Flour dust as an example of hazardous dusts in the
workplace (1)
• Mechanisms of exposure to flour dust (2):
i) Total inhalable flour dust acting as an irritant
ii) Atopic or sensitized (due to previous exposures) having an allergic
response at lower levels
• Occupational and Dust-related Diseases: Asthma, Respiratory Illnesses,
Baker’s Asthma

• Critique: well written introduction; crisp and to the point; does a

good job at highlighting the need to conduct an interventional study 
Background

• Burden: 10%–28% of workers were sensitized to cereal flour allergens,

while the prevalence of baker’s asthma was reported to be between
5% and 17% according to previous exposure studies
• Positive causal relationship between exposure to flour and bakery
enzymes and specific sensitization or occupational asthma established
• Goal: Reduction of flour dust allergens by around 10-fold
• Hypothesis: Exposure Reduction

• Critique: evidence of prevalence is well established – gives purpose 

Objective

• The aim of this study was to evaluate the effectiveness of

different control measures to reduce airborne flour dust
exposure using a randomized design

• Critique: clearly specified 

 Methodology: Study Design

• This study was part of a larger

intervention study: follow-up
exposure
• Group-randomized design
• “Associated with a large
supermarket chain store?”

• Critique: The description of the

setting/design is insufficient on its
own; it only makes sense if the
previous exposure assessment article
is studied alongside it 
Methodology: Study Population

• Stratification:
i) Small: ≤ 14 Employees and ≤7504 production output in units
per week
ii) Medium: 15–21 Employees and 7505–10 868 production
output in units per week
iii) Large: >21 Employees and >10 868 production output in units
per week
• Random selection of equal number of bakeries from each stratum
into either the intervention or the control group

• Critique: sampling technique is good; random  less bias 

Methodology: Intervention Development

• Data from baseline study evaluated by research team, including the

multi-disciplinary experts
• Variables:
i) Presence and type of ventilation system
ii) Use of personal protective equipment
iii) Education and training activities
iv) Number of mixing tubs in each bakery
v) Various work practices
• Interventions:
i) Redesigned lid for mixer tubs
ii) Dust Control Training: Work practices, process controls, hygiene
procedures, PPEs
• Critique: evaluated by experts; interventions explained well 
 Methodology: Intervention Application

• Three groups: 1) lids + training, 2) training only, 3) control

• Time duration of intervention: 1 year
• Unannounced random checks of all bakeries
• Use and implementation of interventions conducted twice during prior to the
post-intervention dust and allergen measurements; feedback to bakery managers
• Checklist to make sure intervention was being followed correctly
• Post-intervention Survey after 1 year and personal environmental evaluation
• Flour dust and wheat allergen analysis and quantification
• Critique: Checklist was a questionnaire; there was no real way of confirming 
Data Analysis

• Data analysis through StataV.11 and SAS V.9.1.

• Stratification by job titles and intervention groups
• Distribution of exposure: SAS PROC UNIVARIATE Tool
• Results as post-to-pre ratios, exposure calculated from here
• P-value of 0.10 considered to highlight the best model

• Critique: tools explained in detail

Results
Results
Results
Conclusion

• Targeted interventions can have substantive effect on flour dust

exposure in bakeries
• Need long term studies to establish sustainability of these
interventions for both exposure and outcomes
 Critique

Strengths Weaknesses

• Repeatedly specified what and how ▪ Sample of workers compromised due

they were adding to literature to turnover movement
• Results well explained with ▪ Shifting of managers affected the
reasoning control group (funny)
• Study is a pioneer – the first to
introduce interventions in bakeries
and effectively reduce dust exposure
Is this problem present in Pakistan?

• Poor agricultural and industrial practices in Pakistan; no regulations

• Cross-sectional study in Islamabad at the Sihala flour mill (3)
i) Flour dust as hazardous, led to chronic respiratory illnesses
ii) Proper PPEs, but there was presence of flour dust and prevalence of
asthma was present, however mild
Possible interventions in Pakistan

• Workers’ health not focused in industries; face occupational hazards (4)

• A systematic review in Dera Ismail Khan
i) Lack of knowledge, attitude and behavior on the part of employees,
employer and regulating bodies in developing countries.
ii) Regulations and interventions required to provide better quality of
care to the employees
• Following the methodology of this article at primary level in Pakistan
can help solve this issue
References

▪ 1. World Health Organization. (2019). Hazard prevention and control in the work environment: Airborne
dust (WHO, 1999).

▪ 2. Safe Environments. (2019). FlourDust Exposure | Safe Environments.

▪ 3. Rasheed S, Khan Z. OCCUPATIONAL HEALTH AND SAFETY ISSUES IN SIHALA FLOUR &
GENERAL MILLS (PVT.) LIMITED IN I-9 INDUSTRIAL ZONE, ISLAMABAD: A CASE STUDY.
Islamabad: Pakistan Engineering Congress, 71st Annual Session Proceedings; 2012 p. 575-598.

▪ 4. Ahmed I, Sattar A, Nawaz A. OCCUPATIONAL HEALTH AND SAFETY IN INDUSTRIES IN

DEVELOPING WORLD. Gomal Journal of Medical Sciences. 2016;14(4):223-228.