Title : Prevalence and factors associated with infectious diseases among waste and sanitation workers of Dhaka City, Bangladesh
Abstract:
Essential workers in cities and towns, waste and sanitation workers are on the front lines of urban environmental management; at the same time, their occupational conditions often require repeated exposure to biological hazards and contaminated materials. In low- and middle-income settings, lack of access to protective equipment, together with suboptimal workplace hygiene, may render workers more vulnerable to infectious and work-related diseases. There is limited evidence regarding the health status of sanitation workers in Dhaka. This study aimed to estimate the prevalence of infectious disease-related symptoms and identify occupational and behavioural factors associated with such conditions among waste and sanitation workers in Dhaka city.
Methods: A cross-sectional study was performed on 400 waste and sanitation workers aged ≥18 years in Dhaka city; they were recruited from residential areas, commercial zones, transfer stations and landfill sites by convenience sampling. Data were gathered using interviewer-administered semi-structured questionnaires including socio-demographic information, occupational exposures, the use of personal protective equipment (PPE), lifestyle factors and health symptoms. Adjusted multivariable logistic regression analyses were conducted; factors associated with respiratory, gastrointestinal and dermatological symptoms were assessed, controlling for age, gender, body mass index (BMI), smoking status, substance abuse and comorbidities.
Results: The participants’ mean age is 37.23±10.40 years and 64.75% of participants are men. The mean occupational duration of workers is 13.2±9.31 years and the mean daily exposure to waste is 7.24±1.29 hours. Reported respiratory symptoms include the following: difficulty of breathing (31.25%), chronic cough (31.25%), sputum (23%), and congestion (22.5%). Reported gastro-intestinal symptoms include diarrhea (29%) and heartburn (27%). Reported dermato-logical symptoms include itching (49%), redness (36.75%) and rashes (23%), also dermato-logical symptoms are highly reported. A considerable interaction between daily exposure duration and years of work experience is a risk factor for respiratory symptoms (difficulty of breathing AOR=1.04, p=0.011; chronic cough AOR=1.04, p=0.017). There is a positive association between handling construction waste and chronic sputum production (AOR=3.20, p=0.033) and there is a positive association between sewage exposure and heartburn (AOR=2.02, p=0.009) and rash (AOR=2.65, p<0.001). Chronic cough AOR=0.13, p<0.001 is the only respiratory symptom that consistent use of a mask is associated with.
Conclusions: The sanitation and waste management workers in Dhaka carry a huge burden of work-related and exposure-related infectious symptoms due to insufficient exposure management, lack of protective measures, and behavioral risks. Strengthening intervention measures by specifying and regulating the provision of employer-funded PPE, improving infrastructure for workplace hygiene, and instituting routine health monitoring will protect this at-risk workforce and promote sustainable urban public health.
Keywords: Occupational Health; Sanitation Workers; Infectious Diseases; Waste Exposure; Protective Equipment
