Abstract
This paper examines the occupational health and safety problems faced by the waste-pickers of Dhaka City. An extensive field survey and physical examinations of the waste-pickers have been used to collect the necessary primary data. The paper tracks down the health problems to their roots with the help of an impact-pathway based analysis. The study finds that the most prevalent types of occupational risks include: bites from insects and rats, cuts and bruises, skin disease, respiratory and gastro-intestinal tract problems, eye irritation, body aches, general weakness, and frequent fever.

Keywords: solid waste, health impact, risk factor, confounding factor, prevalence rate, morbidity index.

1 Introduction

Every day, some 4000-4500 tons of solid waste is generated in Dhaka City by its 10 million inhabitants. About half of this waste is collected by the Dhaka City Corporation (DCC) and disposed at the central landfill site at Matuail. The rest are dumped in open fields, ditches and along street sides creating a major civic health problem. The situation is made worse by fact that the there is no separate system of collection and disposal for clinical and industrial waste in the city, all the hazardous clinical and industrial wastes are dumped in the same municipal bins used for household waste disposal; eventually most of the hazardous wastes also end up in the landfill site. In this backdrop, what is perhaps the most serious health concern is that there are a few thousand human scavengers in the city, who collect reusable and recyclable materials from garbage bins and landfill sites. Due to marginal and impoverished social status, these workers are being compelled to work in the most unhygienic conditions without any protective measures whatsoever.

As a result of such exposure and negligence, the waste pickers frequently suffer from acute and chronic illnesses and injuries. This study will develop an in-depth understanding of these health problems from an epidemiological perspective. Specifically, the study will estimate the point and period prevalence rates of the health problems through a comparative cross sectional study, and investigate the association between the health problems with the risk and confounding factors (physical, socio-economic, environmental).

2 Materials and method

2.1 Study design and data collection

During literature survey, no study could be identified (done in Bangladesh or elsewhere) that directly dealt with the health issues faced by urban waste pickers from epidemiological point of view. This study is primarily based on data and information collected through structured questionnaire survey, interview and physical examination of the respondents. Secondary information from various reports and published sources has also been used as appropriate.

2.2 Sample design

The paper is based on a comparative epidemiological study that used waste pickers as a study group from a different neighborhood with similar socio-economic and environmental profiles. Study group was selected by random sampling method, where the strata constituted groups of waste pickers of different age and sex. 41 randomly selected waste pickers were surveyed.

Table 1 shows the major socioeconomic and environmental parameters of the study group.

Attribute | Result | Sample size | 41 | Male: female | 1:1 | Average age | 11 | Avg. years of schooling | 4 | Family size | 6 | Monthly expenditure (Taka) | 4500 | Access to safe water (%) | 100% | Sanitary latrine at home (%) | 88% |

3 Environmental health impacts

3.2 Most frequent impacts

A number of recent studies have examined the occupation health hazards faced by the waste pickers of Dhaka. The waste pickers face a whole range of health risks from minor on-site problems such as insect bite to major health concerns such as bronchitis, hepatitis, and physical injury. It was found that in most cases, no medication is used or doctor consulted. The waste pickers resort to over-the-counter medicine or take a day-off only if they suffer from grave and debilitating ailments. Stressors and sources of the most common health problems faced by the waste pickers as summarized in table 2.

Health problem | Stressor | Source | General health (weakness,nausea, loss of appetite etc.) | Pungent smell | Exposed organic waste | Aches and body/joint pain | Long working hourswithout rest | Poor work environment | Skin disease and allergy | All types of waste | All waste sources | Respiratory and eye problems | Dust, fume, smoke | Burning of plastic, tire,incineration | Gastro-intestinal problemsand worms | Drinking water, dirtyhand or utensils | Lack of sanitation; poorpersonal hygiene | Cuts and bruises, infection,physical injury | Sharp / pointedobjects, heavymachineries | Hospitals and healthcentres, households,landfill machineries | Pain and inflammation | Insect / mosquito bites Bare foot/hand | Bare foot/ hand | Fever (infection, viral,malaria, dengue etc.) | Cold, infection,mosquito bite | Poor landfill conditions | TB, bronchitis, hepatitis,AIDS etc. | Clinical waste | Hospitals and healthcentres | Sore, metabolic disorders,cancer | Corrosive, toxic andradioactive chemicals | Industrial or clinical waste |

3.3 Analysis

Many waste pickers surveyed said that they had back pain which was attributed to the constant bending motion required to search for waste. Other major health problems reported were coughs and headaches. A few people cited stomach aches, sore muscles and itchy skin/rashes. Nearly all of the waste pickers had suffered cuts to their hands, feet and limbs (Table 3). All of the waste pickers had been bitten by mosquitoes.

Table 3: Prevalence of health problems on waste pickers Health problem | Number of Times Reported (n=41) | Percent of Total (%) | Headache | 11 | 28 | Ache and pain | 29 | 73 | Skin | 1 | 3 | Respiratory | 6 | 15 | Gastro-intestinal | 7 | 17 | Stomach ache | 8 | 20 | Cough | 21 | 53 | Fever | 3 | 8 | Mosquito bite | 41 | 100 | Hearing Problem | 0 | 0 | Unclear Vision | 4 | 10 |

4 Discussions and Conclusion

The waste pickers in Dhaka are uneducated and have no opportunities to break away from their occupation. Their days are characterized by an endless cycle of sleep and work. Although the income accrued through waste picking is stable, this is countered by an unhealthy nocturnal lifestyle accompanied by many physical dangers and risks to their health. Waste pickers in Dhaka work at landfill sites that are wrought with danger. Many occupational safety hazards exist at these dumpsites which would be considered unacceptable to solid waste workers in developed countries. As the waste pickers rush toward the garbage trucks to begin sorting through the fresh waste that has just been unloaded, some have either been buried under garbage or run over by these trucks. These conditions make it difficult to avoid illness and disease. Perceptions of personal health were identified in the study. The majority of younger waste pickers perceived their health as being comparable to others their age while older waste pickers believed their health was relatively poor. The major health complaints involved back pain, cough and headache. This study lends support to the observation that there is a great amount of direct physical contact between waste pickers and waste. Many of the waste pickers do not wear protective clothing and although a few wear gloves, these gloves consist of thin fabric. Consequently, this population is at high risk for parasitic, enteric and, perhaps, viral infections (e.g., HIV, hepatitis). High levels of bacterial infections and diseases are also expected in this population, since rainfall that runs over solid waste (i.e., leachate) contains high numbers of fecal bacteria. Many injuries such as collection and disposal injuries, injuries from vehicular traffic and injuries from the unstable settlement of waste were also identified.

5 Recommendations

Although, there is numerous health hazards associated with waste picking, it provides income for many in the poorer social groups. Prohibiting waste picking will not provide a solution to the health dilemma. A more plausible, potential solution to alleviating the dangers associated with this line of work is to decrease the health risks to this population. Most of the occupational health and injury problems that confront waste pickers could be minimized by implementing simple and cost-effective safety procedures. Waste pickers would benefit significantly if a few modest steps were taken to protect their health:

* Provide clean drinking water and sanitation facilities. * Prohibit the entry of children and domestic animals to the landfill site. * Enforce the physical separation of trucks and waste pickers during the movement and unloading of garbage. * Provide education on personal hygiene and on the safe feeding of domestic livestock. * Restrict the consumption and vending of food on the landfill site. * Provide protective clothing, goggles, boots, gloves, and face masks for respiratory protection. * Register all waste pickers and encourage participation in a regular vaccination and health examination program. * Develop training materials at the appropriate educational level for waste pickers the on occupational and environmental health issues associated with solid waste handling. * Encourage local and international medical schools and occupational health institutes to study the health of waste pickers in Dhaka and to gather relevant epidemiological data.