Risks and risk mitigation in waste-work: A qualitative study of informal waste workers in Nepal

Objectives To explore how informal waste workers (IWWs) working in Kathmandu Valley perceive risks associated with waste work and what they do to mitigate them. Study design Qualitative Study Design. Methods A mix of one-to-one semi-structured interviews (n ​= ​18) and focus group discussions (n ​= ​4) with IWWs were undertaken. Participants were recruited purposively using snowball sampling. All interviews and discussions were audio-recorded, transcribed verbatim, translated and subsequently analysed thematically. Results The IWWs perceived discrimination and health risks as the main risks associated with waste work. IWWs reported considerable stigma and discrimination not only from the wider society but also from family members and within their own profession. Similarly, the occupational risks most frequently recognized were physical injuries and cuts from working with waste. However, the potential risks from hazardous chemicals present in or generated from waste were not articulated by participants. Mitigation strategies to combat the risks included avoidance, greater care and the use of informal means of “protection”. Awareness of the importance of personal protective equipment (PPE) was limited. The key barriers to the use of PPE identified included costs, the lack of easy availability of PPE and the inconvenience of working with PPE. Conclusions The vulnerability of informal waste workers in Nepal is multifaceted. A range of policy and regulatory measures, along with interventions that promote greater social inclusion and occupational support are needed to promote IWW’s health and safety

The health risks of informal waste workers in the Kathmandu Valley: a cross-sectional survey

Objective: To describe the health and occupational risks of informal waste workers (IWWs) in the Kathmandu Valley and explore the factors associated with not using personal protective equipment (PPE). Study design: This is a cross-sectional survey of IWWs. Methods: Data were collected on the health and occupational risks of adult IWWs working on waste sites in the Kathmandu Valley and in the adjacent Nuwakot district, Nepal, in November 2017, through convenience sampling. Using a standardized health assessment questionnaire, face-to-face interviews were undertaken to record sociodemographic data, indicators of general and occupational health, data on healthcare access and use, physical risks, perception of occupational risks and use of PPE. Associations between use of PPE and gender, age, education, country of origin, injury and perception of occupational risks were examined using multivariate logistic regression analyses. Results: In 1278 surveyed IWWs, prevalent physical risks included injuries (66.2% in the previous 12 months), and the main reported symptoms were respiratory in nature (69.9% in the previous 3 months). Most prevalent injuries were glass cuts (44.4%) and metal cuts (43.9%). Less than half of the IWWs (46.8%) had been vaccinated against tetanus and 7.5% against hepatitis B. The work was considered as ‘risky’ by 72.5% of IWWs, but 67.6% did not use PPE. Non-use of PPE was independently associated with male gender (odds ratio [OR] 2.19; P < 0.001), Indian origin (OR 1.35; P = 0.018), older age (OR 2.97 for more than the age of 55 years; P = 0.007) and low perception of occupational risks (OR 2.41; P < 0.001). Low perception of occupational risk was associated with older age (55 + years) and the lack of receipt of information on the risks. Conclusions: IWWs are at increased risk of injury in their work, yet are poorly protected in relation to vaccine-preventable infections and workwear. The results suggest that information is important in relation to perception of occupational risk, which in turn is associated with the use of PPE. There is a need for policymakers and public health practitioners to have a robust understanding of the needs and vulnerabilities of this group, as well as identify effective interventions that can be taken to safeguard the health and welfare of IWWs

Mental health risks among informal waste workers in Kathmandu Valley, Nepal

Informal waste workers are a vulnerable population group who are often socio-economically marginalized and disadvantaged, with more likelihood of experiencing ill health than the general population. To explore the determinants of mental ill health in this group, we conducted a cross-sectional survey of 1278 informal waste-workers in Nepal in 2017, using a demographic health assessment questionnaire and a modified Patient Health Questionnaire (PHQ-9). We looked at the potential associations between various exposure factors and mental health outcomes and found that 27.4% of waste-workers had depressive symptoms, more likely to be reported by female (OR 2.290), older person (OR 7.757), divorced/separated (5.859), and those with ill health (OR 2.030), or disability (OR 3.562). Waste-workers with access to social protection (OR 0.538) and financial savings (OR 0.280) were less likely to have depressive symptoms. There are key risk factors that may enable identification of particularly vulnerable persons within this group and also protective factors that may help improve their mental health resilience