A Rest-Shade-Hydration-Hygiene program reduces acute kidney injury and increases production at a sugar mill in Nicaragua, an economic analysis
Authors: Schlader Zachary J. , Boswell Thomas , Prince Heath , Wesseling Catarina , Amorim Fabiano A. , Neupane Dinesh , Arias Esteban , Poveda Scarlette , Hansson Erik , Lucas Rebekah A.I. , Jakobsson Kristina , Wegman David H. , Glaser Jason 
Published: February 2025

AbstractBackgroundOccupational heat stress mediated acute kidney injury (AKI) has been linked to the development of chronic kidney disease of non-traditional causes (CKDnt) in agriculture workers. Rest-shade-hydration-hygiene (RSHH) programs are promising interventions for preventing CKDnt. An obstacle to the implementation of RSHH programs is the concern that the reduced work time associated with these programs may reduce productivity and earnings. This case study analyzes the economic impact of an RSHH program implemented at a sugar mill in Nicaragua.ApproachData were obtained from the sugar mill over a six-year, five-harvest period (Harvest 1: 2017-18 through Harvest 5: 2021-2022). Data included health and productivity metrics, and RSHH program costs. During Harvest 1 existing heat mitigation strategies were in place but were not optimal. Thus, 2017 was considered the pre-RSHH (baseline) period. Over subsequent harvests progressively improved RSHH programs were implemented.AnalysisA cost-benefit analysis was conducted to estimate the return on investment of the RSHH program. The analysis considered both fixed and variable costs associated with the program, including electrolyte beverage production, costs for AKI treatment and worker training. Benefits were calculated based on productivity improvements, including reductions in absenteeism, and reductions in AKI cases.ResultsAs soon as 2020, the costs of implementing the RSHH program were offset by savings resulting from increased productivity (i.e., reduced absenteeism and increased worker production) and reduced cases of AKI. The RSHH program yielded a positive return on investment from 2020 and onward. The average return on investment over the five-year period was 0.02 (or a return of $1.02 for every $1.00 invested), which takes into consideration the first two years of the intervention in which there was a negative return on investment. In 2022, every $1.00 invested in the RSHH program saw a return of $1.60.DiscussionThis case study provides evidence that implementing an RSHH program can provide both economic and health benefits, particularly in locations where climate change is increasing the already present risk and burden of occupational heat stress.Teaser messageA rest-shade-hydration-hygiene intervention program at a sugar mill in Nicaragua produced a positive return on investment after five years by improving both health and productivity outcomes.Key findings and implicationsA positive average return on investment of $1.60 USD for every $1.00 invested was identified after a five-year period following implementation of a rest-shade-hydration-hygiene (RSHH) program at a sugar mill in Nicaragua.Three years after implementation, the costs of implementing the RSHH program were offset by savings resulting from increased productivity (i.e., reduced absenteeism and increased worker production) and reduced cases of acute kidney injury.This case study provides evidence of the health and economic benefits of promoting an easily applicable workplace intervention that addresses current risks as well as the rising threat of climate change induced occupational heat stress.