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  Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 25  |  Issue : 3  |  Page : 169-177
 

A cross-sectional study on occupational health and safety of municipal solid waste workers in Telangana, India


School of Medical Sciences, University of Hyderabad, Telangana, India

Date of Submission21-Jan-2021
Date of Decision07-Jul-2021
Date of Acceptance12-Jul-2021
Date of Web Publication9-Oct-2021

Correspondence Address:
Dr. C T Anitha
School of Medical Sciences, University of Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.ijoem_21_21

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  Abstract 


Background: The occurrence of workplace hazards, occupational diseases, and deaths contribute significantly to the increase in the global burden of diseases. The Municipal Solid Waste (MSW) workers experience occupational stressors throughout the process of waste management that affects their well-being and results in high rates of occupational health problems. It is vital to understand the workplace practices and occupational morbidities of the MSW workers to ensure their safety and well-being. In this context, the study aimed to explore the occupational health and safety practices at the place of work among the MSW workers in Karimnagar and Hyderabad in Telangana, India. Methodology: A cross-sectional study was conducted in two cities of Telangana. A total of 394 MSW workers were surveyed. The number of MSW workers in Karimnagar and Hyderabad were 152 and 194, respectively. A pre-tested questionnaire was administered to the MSW workers to study the occupational morbidities and workplace safety practices. Focused group discussions were conducted among the MSW workers in both cities. In-depth interviews of sanitary supervisors in Karimnagar were conducted. Semi-structured questionnaires and interview guides were used with questions on sociodemographic characteristics, health status, work environment, protection strategy, and healthcare utilization. MS Excel and NVivo-12 were used for data analysis. Results: Musculoskeletal problem was the major reported morbidity among the MSW workers (76.6%). Injuries were reported more among the MSW workers in Hyderabad (39.7%) along with a fear of being hit by vehicles while working on the main roads. About 88.7% of the MSW workers had less than secondary education. There was a wage difference between the contract and permanent MSW workers. There was a lack of provision of personal protective equipment and poor working conditions, overall. Lack of basic amenities such as the provision of drinking water and toilets apart from inadequate social security and healthcare facilities was reported. Conclusion: This paper highlights the unsatisfactory working environment and high-occupational morbidities among the MSW workers in Telangana. There was a lack of basic amenities at the workplace making it difficult for the MSW workers. A comprehensive approach which focuses on the health and safety with social security for the MSW workers is required.


Keywords: India, morbidities, municipal solid waste workers, occupational health, public health, workplace safety


How to cite this article:
Ramitha K L, Ankitha T, Alankrutha RV, Anitha C T. A cross-sectional study on occupational health and safety of municipal solid waste workers in Telangana, India. Indian J Occup Environ Med 2021;25:169-77

How to cite this URL:
Ramitha K L, Ankitha T, Alankrutha RV, Anitha C T. A cross-sectional study on occupational health and safety of municipal solid waste workers in Telangana, India. Indian J Occup Environ Med [serial online] 2021 [cited 2021 Nov 28];25:169-77. Available from: https://www.ijoem.com/text.asp?2021/25/3/169/327914





  Introduction Top


Work-related safety and health hazards are major public health concerns worldwide. The occurrence of workplace hazards, occupational diseases, and deaths contribute significantly to the increase in the global burden of non-communicable diseases (NCDs).[1] As per the World Health Organization (WHO), one-third of adult life is spent at the workplace where risky exposures are often several times greater than in any other environment.[2] The International Labour Organization (ILO) estimates that every day a 1,000 people die globally from accidents at the workplace and 6,500 from occupational diseases while about 65% of this global work-related mortality is reported annually in Asia.[1] NCDs, injuries, and infectious diseases contribute 70, 22, and 8%, respectively, to the total disease burden from the occupational health risks according to the WHO.[3] This should not be overlooked as many workers are persistently challenged by occupational safety and health risks.[1]

Waste is generated from human activities which is inevitable in any habitation.[4] Management of all such waste is vital globally but the handling of the waste is associated with physical, chemical, and psychosocial hazards,[5] which involves dominance of manual-handling tasks. The Municipal Solid Waste (MSW) workers in the developing countries are at more risk than those in the developed countries where direct handling of the waste is limited to enhance process efficiency and ensure worker protection.[6] In developing countries like India, waste is picked from households and industries and dumped at landfill sites[4] for which the city municipalities employ a large number of MSW workers. These MSW workers experience occupational risks and morbidities throughout the process of waste collection, management, and disposal depending on the equipment they use and the waste material they handle.[7] This diverse group of occupational morbidities though preventable might not be properly addressed and treated adequately due to limited attention and healthcare access.[6]

Most of the countries have concerns about waste generation, management, and its impact on the environment[8] without much consideration for occupational safety. Policies and legislations focus on minimizing the waste and its reutilization but the occupational health risks among the MSW workers received little attention in a rush to adopt the technologies for waste management.[9] Globally, occupational morbidities are a major public health concern but are under-researched in low- and middle-income countries[6] though the need for protection and promotion of health and safety at workplaces has been the focus in a number of policy documents, such as the ILO Promotional Framework for Occupational Safety and Health Convention, the WHO Declaration on Workers Health.[10],[11],[12] It is vital to understand the practices and morbidities of the MSW workers to ensure their safe means of earning a livelihood.[13]

MSW workers face innumerable hardships in the course of their work such as injuries, respiratory diseases, skin infections,[14],[15] cuts and infection from sharps, and hazardous smoke from the burning waste.[16] Studies have reported that 73.2–90% of the MSW workers suffered occupational injuries.[17],[18] Occurrence of infections was three to six times higher and respiratory problems were 1.4–2.6 times more among the MSW workers than for the general population.[16] In an unfavorable working environment without proper protective wear, they search through waste and may come upon sharps and infected waste[19] risking and spreading infectious diseases.[20] MSW workers also have unhealthy lifestyle habits such as smoking, alcohol use, tobacco chewing, and unhealthy diets that mount up their health risks.[13]

In addition to health risks and morbidities, the MSW workers face job insecurity, unsafe working conditions, poor health, poor income, and few alternate livelihood options[21],[22] because of which they are gripped in inter-generational poverty.[22] As a result, their quality of life is affected leading to job losses, economic implications arising out of occupational health problems, and increased economic burden.[23] Despite such morbidities, the occupation of the MSW workers greatly contributes to public health by reducing the incidence of diseases in the urban conglomerate[24] and promoting public health.

Telangana is one of the new and rapidly growing states of India with a fast-transforming urban landscape in Hyderabad followed by Warangal, Nizamabad, and Karimnagar.[25] More complex wastes are generated due to rapid urbanization and if not well-managed, they may have adverse impacts on the environment and public health. The MSW workers are engaged in waste management and handle the bulk of the waste exposing themselves to health risks and occupational injuries. In Telangana, trainings were conducted by the Environment Protection Training and Research Institute (EPTRI) on sanitation and Municipal Solid Waste Management for all MSW workers of the urban local bodies to bring about behavioral change. About 90% of the MSW workers in Karimnagar and Ranga Reddy districts attended the training.[26] As per the WHO, the health workers particularly are expected to have knowledge and skills on waste management in order to protect themselves, prevent environmental and other health hazards.[27] The study aimed to explore the occupational health and safety practices and morbidities among the MSW workers in Karimnagar and Hyderabad in Telangana, India.


  Methodology Top


A cross-sectional study was undertaken among the MSW workers under the urban local bodies in Karimnagar and Hyderabad, Telangana, India [Figure 1] from December 2019 to February 2020. Hyderabad is the most populated city though it has the smallest geographical area compared to the other districts in the Telangana state. As per Census 2011-India, Hyderabad has a population of around 39,43,323; while it is 10,05,711 in Karimnagar.[28] Ethical clearance for the study was obtained from the Institutional Ethics Committee of the University of Hyderabad, India. Permission was obtained from the respective Municipal Commissioners and written informed consent was obtained from each participant after explaining the study purpose.
Figure 1: Map showing districts of Hyderabad and Karimnagar of Telangana, India

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Based on the feasibility, Karimnagar and Hyderabad were the two cities selected for the study. Uppal Circle covering areas of Uppal, Ramanthapur, Nagole, and Habsiguda were chosen for the study at Hyderabad. Uppal circle had 400 workers under the purview of Greater Hyderabad Municipal Corporation (GHMC) and the workers were divided into four divisions with a total of 50 permanent workers. The rest were employed on a contractual basis. The sample size calculated for the survey was 108 in each city based on the prevalence of the occupational health problems reported in the previous studies using the formula, n = 4 pq/L2. A total of 346 MSW workers (152 workers in Karimnagar and 194 workers in Hyderabad) were surveyed. Four Focus Group Discussions (FGD) among the MSW workers (two in Karimnagar and two in Hyderabad) were conducted with 6–8 participants in each FGD to explore issues related to their job of waste handling. The participants for FGD were selected from the homogenous group of the surveyed MSW workers. Five in-depth interviews (IDI) among the sanitary supervisors were conducted in Karimnagar.

The MSW workers aged 21–60 years, both the sexes, and those who were into the job of waste handling for at least 1 year were included. Other workers in the Municipal Corporation who were not dealing with wastes were excluded. Pregnant women and individuals with disabilities were excluded.

Mixed methods were used for data collection done by two public health researchers with the same training and used the same data collection tools among the MSW workers in Karimnagar and Hyderabad. There were different areas of attendance points such as temple premises, community halls, and GHMC parks for the MSW workers, details of which were collected at the respective municipal offices. After obtaining the required permissions and information on where to consult the MSW workers, the researchers went 3–4 times a week during the study period until the sample size was reached. The MSW workers were contacted at the attendance points allotted for them. In Karimnagar, the working hours were from 5.00 am to 10.00 am followed by a break. In the afternoon, work resumed from 1.00 pm to 5.00 pm. On average, around 25 MSW workers per day were surveyed; 15 in the morning and around 10 workers in the afternoon. In Hyderabad, the working hours were from 6.00 am to 1.00 pm and around 20–25 workers were surveyed per day at the last working hour. Quantitative data were obtained by using a pre-tested, semi-structured questionnaire. The questionnaire was administered by the researchers by providing clarification to the MSW workers if they had doubts. The questionnaire was in English and no translation was done. The local language 'Telugu' was used by the researchers to communicate the questions to the MSW workers.

Qualitative data was obtained by the FGD and IDIs conducted at the attendance points based on the mutual convenience of the researchers and MSW workers and supervisors. The IDIs with sanitary supervisors were carried out in Karimnagar. FGDs with MSW workers were guided with question leads regarding the workplace, waste handling practices, access to healthcare, and morbidities since their recruitment into this occupation. Both FGDs and IDIs were audio-recorded with permission to transcribe and analyze at a later point. Completed questionnaires and note-taking forms from the FGDs and IDIs were secured by the researchers maintaining the confidentiality of the data collected. The transcripts were prepared from the qualitative data obtained.

Data analysis

Quantitative data collected were entered in MS Excel. Descriptive analysis of the data variables was done using proportion and mean with standard deviation. The Chi-square test (Goodness of fit test and test of independence) and Fischer's exact test were used in the analysis of the data variables at a statistical significance value of P ≤ 0.05. NVivo-12 was used for coding qualitative data for content analysis.


  Results Top


In this study, a total of 346 MSW workers (152 in Karimnagar and 194 in Hyderabad) were surveyed whose mean age was 41.6 ± 5.3 years with a mean work experience of 12.4 ± 6.3 years. Sociodemographic details of the MSW workers surveyed are given in [Table 1]. There were more female MSW workers in Hyderabad in contrast to a majority of male MSW workers in Karimnagar. The Goodness of fit test showed that statistically there was no significant difference in the number of males and females MSW workers in Karimnagar (P = 0.26). There was a statistically significant difference in the number of males and females MSW workers in Hyderabad (P < 0.001). There was a statistically significant difference in the proportion of males and females MSW workers across both the cities (P < 0.001). The gender difference in the levels of education was also significant among the MSW workers in individual cities as well as in the whole sample (P < 0.001).
Table 1: Sociodemographic characteristics of the MSW workers

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About 80.9% of the MSW workers were working on a contract basis while only 19% were permanent workers. The job of sweeping was mostly done by the female MSW workers; 85.1% (57/67) of the MSW workers involved in garbage collection in Hyderabad were women. About 80% of the male MSW workers were solely dependent on the municipal job for their livelihood; the remaining 20% reported to work as auto drivers, an alternate income-generating activity alongside their current job.

Among all the MSW workers surveyed, 65.6% of them reported smoking and chewing tobacco and 26% of them consumed alcohol. The occupational morbidities among the MSW workers are presented in [Table 2]. Musculoskeletal problem was the most commonly reported morbidity (76.6%) and was high among the sweepers who comprised 95.8% (158/165). Cuts with sharps (26.9%) were the second most reported occupation-related injury. The injury with sharps was higher in Hyderabad with 95.5% (64/67) of the garbage collectors having experienced cuts/injuries in the past year.
Table 2: Reported prevalence of occupational health morbidities among the MSW workers

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About 96.1% reported no job training and 59.2% of them were aware of waste handling guidelines; 75% of the MSW workers reported that they suffered from diarrhea during the monsoon season. About 80.9% were aware of personal protective equipment (PPE) but only 3.9% were using it. In the event of severe injury or health issues, 74.3% of the MSW workers reported approaching private hospitals and 25.6% of them reported going to the government hospital. There was no significant association of the levels of education with the choice of public or private hospital (P = 0.82) or with the use of PPE (P = 0.62). About 74.3% of the MSW workers reported that they were looked down on (disrespected) by people; 55.9% opined that the nature of their work itself was a reason for the lack of respect and discrimination.

The qualitative results from the FGDs among the MSW workers in Karimnagar and Hyderabad endorsed the quantitative findings of this study and are presented under the following themes.

Theme 1: Gender and occupation

Men were holding concurrent part-time jobs as auto drivers but women were restricted only to their current job of sweeping. Women had no time to get engaged in other part-time jobs like men because of their household chores.

“We are involved only in sweeping; other work will be done by men.”—Female MSW worker from Karimnagar.

Theme 2: Income and years of work experience in this occupation

The mean years of work experience was 12.4 ± 6.3 years. Some MSW workers had worked as contractual workers for a minimum of 10 years and one of them has been working for the past 22 years. Despite several years of working as contractual workers, their monthly income ranged between Rs. 7000 and 10,000. The wage disparity among the contractual and permanent MSW workers was huge as the permanent workers in the Karimnagar area had a monthly income of Rs. 34,000. The increase/hike in wages was minimal despite several years of work experience.

Theme 3: Working environment of the MSW workers

The regular point of collection was from households, restaurants, and general waste from hospitals. The MSW workers were not trained for their job but were just explained their role of work like sweeper, garbage collector, etc., and the sweepers got daily instructions regarding the geographic area they had to cover as the day's/week's work.

The MSW workers when unwell reported that they would send their family member to work as a substitute for them. Most female MSW workers were not satisfied with their work environment and reported a lack of basic amenities like drinking water and toilets to relieve themselves. They relied on private commercial places such as hotels for drinking water and relieved themselves in the open behind bushes and trees. Their working hours ranged from 6.00 am to 1.00 pm in Hyderabad while in Karimnagar they had to report early morning and work up to 5.00 pm with a break from 10.00 am to 1.00 pm.

“We are not having any office and no washroom facility so we have trouble going.”—Female MSW worker from Karimnagar.

It was reported that the MSW workers were often looked down upon by the general public due to their job roles.

“We are also humans only right …Only because we do sweeping, we become that cheap to you??”—MSW worker from Hyderabad.

Theme 4: Safe practices at the workplace

Adherence to safety practices was found to be poor among the MSW workers. In Karimnagar, the MSW workers knew about the benefits of PPE but were not provided kits for waste handling. They used towels to cover their nose and mouth while at work. In case of injury, the workers informed their supervisor who in turn took them to the hospital. In Hyderabad, the PPEs provided to the MSW workers were barely protective enough to work in hazardous working conditions. They said that the masks and gloves were being given to them once in a year, and that too, when some officials were visiting for inspection. Seasonally, they were being given coats and boots that were heavy and difficult to use.

“It becomes difficult to walk… single shoe will be 1-kilo weight…”—MSW worker from Hyderabad.

The contractual MSW workers demanded soaps, oils, and towels which were distributed only to permanent workers.

“Contract only amma … We don't get soaps, oil, we don't have anything and with our bare hands we pick up every dirty thing that is on the road. If we should be in good health, they say to wash hands with soap after work … but we don't have anything then how should we?”—MSW worker from Hyderabad.

“You see how the roads are … They do bathroom, latrine everything on the road. We only pick up all of it with our hands … so we need to wash our hands with soap after that.”—MSW worker from Hyderabad.

Theme 5: Health risks and vulnerability of the MSW workers

The MSW workers reported that their work schedule was the same every day. But since the inception of the Swacch Bharat campaign, their workload had increased and their working hours extended.

“This time we did well the entire month … without food or anything.”—MSW worker from Hyderabad.

Women said they would skip breakfast and come directly for work to be on time. The food intake of the waste workers was affected due to altered timings.

“Some of us…we will not eat and come so we feel giddy sometimes.”—Female MSW worker from Karimnagar.

The MSW workers faced problems handling waste as residents would not segregate the waste into dry or wet. They would segregate the waste themselves at times. Skin-related problems, body and neck pain were mentioned by most MSW workers. Those involved with sweeping reported that dust would go into their lungs and they had cough frequently. In addition to these, 16.7% of the MSW workers in Karimnagar reported that they consumed alcohol before entering a dump yard or before getting into the drains in order to bear the stink of the waste. This was to overcome any inhibition and to bear the stench on opening the drainage manholes.

In Hyderabad, accidents were commonly reported. They referred to this as 'hit and run' and every day they worked with the fear of accidents and death but have got habituated now.

“We keep sweeping and vehicles come at full speed … We also get scared.”—MSW worker from Hyderabad.

“They should put barricades. If they put those and make us clean, it will be better because those who are sweeping won't be seen when suddenly bikes and cars come. Recently, same thing happened to one lady.”—MSW worker from Hyderabad.

“Fear will be there in this job for us … Because we never know what will come from which end of the road.”- MSW worker from Hyderabad

Theme 6: Healthcare access and health insurance

The MSW workers were not in receipt of any vaccines, specifically, hepatitis vaccines. In Karimnagar, health camps were conducted twice a year and in Hyderabad, annually. The MSW workers in Karimnagar were allotted a private nursing home for seeking healthcare services.

All permanent MSW workers were beneficiaries under the Employees' State Insurance Corporation (ESIC) but were not happy with the services provided as they incurred out-of-pocket expenditure.

“If we have good healthcare services it will be good because the hospital we were allotted is not providing proper healthcare and our amount is getting deducted for ESIC services.”—MSW worker from Karimnagar.

Though all of them have ESIC cards, only a few avail of the services due to non-convenience and having to roam around as the hospital staff did not guide them properly. If there was an urgent need for consultation or tablets, the MSW workers frequently preferred private hospitals.

“Government hospital staff treats us badly… because we can't read, they speak to us badly”—MSW worker from Hyderabad.

“If we go today, they'll say come tomorrow … for tablets come some other day … we do not have tablets”—MSW worker from Hyderabad.

Perspectives of sanitary supervisors through in-depth interviews

Sanitary supervisors in Karimnagar reported that the MSW workers were often recruited on a contract basis and most of them informed: we will not do any medical tests before joining.” And they give instructions only for allotting the area of work. “No, we will not train them especially because women are involved in sweeping and men who go to the drainage are already experienced and new employees will be assisted by them.” They were not provided with vaccination before or after joining. One of the supervisors mentioned that if any of the MSW workers was unable to turn up for work, they would send their respective family member to cover for them at work. Two of the sanitary supervisors responded that the discrimination occurred due to the nature of work. There was no first-aid kit available and one of them reported an accidental cut of the finger of the MSW worker handling a manhole lid. They informed that most of the MSW workers were not using protective equipment while working, “Sweepers will use towels to cover their mouth and nose, if we ask them to use PPE, they will ask us to provide. But we are not able to provide them. It should come from the higher officers.”—Supervisor.


  Discussion Top


This study assessed the occupational morbidity and workplace practices along with the immediate work environment of the MSW workers in Hyderabad and Karimnagar in Telangana. More women than men in this study were relegated to jobs such as sweeping and clearing garbage, in contrast, to the study findings by Thakur et al.[23] This could be attributed to the significant gender difference in literacy levels borne by this study. According to the Periodic Labour Force Survey (PLFS) 2017–2018, India; more proportion of women than men in urban areas were engaged in elementary occupations (division 9 as per National Classification of Occupation [NCO]), and also this proportion was more than the other divisions of NCO for women.[29] Most of the women working in the waste management sector struggle to find alternative work with regular and better salaries.[22]

Factors like gender and caste are non-modifiable. It is the education that primarily affects the availability of decent work, especially for women.[30] The huge proportion of the MSW workers with less than secondary education in this study might be due to their economic status. The wages for contractual MSW workers reported in this study were meager to support their living, especially to survive in urban areas. A vast discrepancy in wages among the permanent and contract MSW workers was similar to findings of a study by Thakur et al.[23] in Himachal Pradesh and a participatory research conducted among sanitation workers in India.[30] Similar to a study by Ravindra et al.,[17] the MSW workers would send their family member as a substitute in their place if they were unable to turn up for work. Both their living and working conditions were causing additional danger to the MSW workers. The dignity of labor was a far cry as the study found discriminatory practices because of the nature of their work, similar to the finding from a study by Mberu et al.[31]

Many health-risk behaviors like smoking, alcohol consumption, chewing tobacco, altered dietary patterns, lack of proper handwashing, lack of PPE use, etc., were reported by the MSW workers. Women MSW workers were skipping their meals to report to work at early hours in the morning. Since their work started early in the morning, they had to cook for their family before leaving for work. They were deprived of adequate food and sleep which result in nutritional deficiencies and health problems like headache, gastric acidity, nausea, musculoskeletal problems, and stress that affects their capacity to work.[32] Similar to a study by Ravindra et al.,[17] most of them were not satisfied with their work environment. There exists a lack of basic amenities like clean drinking water, restrooms, and workspace. Casual workers were forced to clean with bare hands and there was no provision of soaps, oil, and handwash facilities depriving them of supplies that permanent workers get. The risk of contracting illness reduces by practicing basic personal hygiene which is vital for the MSW workers.[33] But, there was a dearth of access to basic hygiene and hygiene products among the contractual MSW workers which could be one of the reasons for the reported diarrhea episodes among 75% of the MSW workers during monsoon.

The present study showed that the MSW workers had no training before/after getting into the job. This finding is in contrast to the State of Environment Report—Telangana, 2015, that stated 90% of the public health workers from Karimnagar and Ranga Reddy districts attended the training and awareness program by EPTRI on solid waste management for municipal functionaries.[26] Gebremedhin found in his study that 42.6% had prior training before getting into the job as solid waste collectors in Ethiopia.[34] The mundane, monotonous nature of work could be the cause of musculoskeletal problems reported more among the MSW workers similar to the studies by Reddy and Yasobant[35] and Patil and Kamble.[14] Long-handled broom, shovel, and handcart were the most commonly used equipment by the sweepers[36] to prevent body aches and pain. Inappropriate tools might be one of the reasons for the high musculoskeletal problems among sweepers in this study. The high percentage of musculoskeletal problems reported among the sweepers and the high percentage of injuries among the garbage collectors was similar to a study by Salve.[15] In general, injuries by sharps reported among the MSW workers are relatively less in this study compared to the results of Jayakrishnan et al.[18] Injuries while handling waste by the garbage collectors were reported more in Hyderabad than Karimnagar which might be due to the difference in the nature of the waste generated. The prevalence of respiratory and skin problems was less in our study compared to the findings of Patil and Kamble.[14]

The Solid Waste Management Rules, 2016, India, has stated that all the MSW workers handling solid waste should be provided with PPEs including uniforms, fluorescent jackets, gloves, boots, and masks along with social benefits like health checkups and medical care. The MSW workers, either contractual or permanent, should have access to facilities like toilets and storage space for their belongings.[36] Despite the National Policy on Safety, Health, and Environment at the workplace that recommends safe, just, and humane working conditions[37]; the MSW workers had inadequate provision of PPEs exposing them to occupational hazards. In this study though, they were aware of PPE, only 3.9% reported using it and some were using a cloth to cover the nose and mouth. Such non-compliant use of PPE or lack of its provision at the workplace has been reported in studies across many countries.[23],[34],[38] The MSW workers had not received any vaccination before or after getting into this occupation and reported experiencing injuries with sharps which is alarming as it carries the risk of contracting diseases like hepatitis, tetanus, etc., Jayakrishnan et al.[18] reported that only a minute proportion of waste workers received Hepatitis-B (HBV) vaccine in Kerala while a study in Nepal reported a comparatively huge proportion of waste workers having received tetanus toxoid and HBV vaccination.[7]

Frequent hit and run accidents could be attributed to the dense population and increased vehicular transportation in a more urbanized city like Hyderabad. The safety and health of the MSW workers seem to be of less concern to the authorities and even to the MSW workers themselves as there are competing priorities for food, livelihoods, and survival. Due to discourtesy at government hospitals, the study noted underutilization of health insurance services in spite of the MSW workers being beneficiaries of ESIC.

Generally, cleaning jobs like sweeping and garbage collection were considered as traditional job roles for lower-caste groups as per the sociocultural value systems in the Indian sub-continent.[38] The Indian Constitution ensures the Right to Equality of opportunity in employment—Article 16 and the Right to Freedom to practice any job—Article 19 (1)(g).[39] The study demonstrated violation of many such fundamental rights stated in the Indian Constitution such as the Right to Just and Humane Work Environment, Right to Health, etc., This was borne out in the discussions with the MSW workers in the study which needs further exploration. The aspect of caste and job as an MSW worker is not explored in this study. The study found the need for an adequate supply of PPEs and healthcare resources to improve the MSW workers' health. Lack of concern, apathy from the authorities and government, non-availability of health information along with other rooted traditional occupational practices contributed to poor health, access, and utilization of health services.[40] Illiteracy was one of the reasons limiting the MSW workers to demand their right to decent standards of living, safe work, and the workplace.[41] Although the laws and guidelines for waste management practices exist in India, the safety and health of the MSW workers are seldom addressed. Countries like India need an effective Occupational Safety and Health (OSH) data collection system for reliable data reporting and analysis.[1] Worker health surveillance, which is the periodic assessment of workers' environment and health risks, is crucial in the practice of occupational health.[6],[24] Regular screening with the maintenance of health records enables to understand the workplace scenario and related hazards to derive appropriate measures[6] and develop national action plans and activities to promote workers' health.[10] WHO's global plan of action for the workers' health strives to incorporate the health of the workers into other policies[10] like in the policies on employment, socioeconomic development, trade, and environmental protection, which could potentially resolve issues related to the workers' health and safety.[11] The MSW workers are an indispensable part of urban society, so a comprehensive approach which focuses on their health and safety with social security is required.

Limitations of the study

A convenient sampling method was used for the study which could create bias. But the sample size was kept large in an attempt to reduce the bias. The morbidities reported by the MSW workers were subjective and not confirmed with the health records of the MSW workers. The study has geographical limitations as the findings are not applicable to the other districts, other states of India, or other countries.


  Conclusion Top


This paper highlights the unsatisfactory working environment and high occupational health risks among the MSW workers in Telangana. Musculoskeletal pain was the most reported occupational health problem followed by cuts with sharps among them. Ensuring occupational safety of the MSW workers through protective equipment to mitigate risk to their physical and psychosocial health and improving their work environment is of utmost importance. Behavioral change should be aimed through health education and training to encourage the use of PPE and also to reduce alcohol use, tobacco chewing, and smoking. Interventions to enhance ergonomic work processes in this occupation are warranted and should be evaluated by undertaking further research.

More consideration by the government is required in developing policies and recommendations for the MSW workers in general. Human rights activists, researchers, and administrative personnel should work together in order to explore inherent challenges faced by the MSW workers and offer humanitarian aid and welfare schemes. Studies exploring various categories of the MSW workers are recommended that would give a better understanding of their livelihood. It would be worthwhile to undertake a study on occupational practices among the MSW workers during as well as following public health emergencies. Without MSW workers, environmental sanitation and cleanliness remain unattainable. Safeguarding the health, safety, and dignity of the MSW workers needs urgent attention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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