Health
Awareness of occupational biohazards & utilization of PPE among sanitation workers in fecal waste management plants in Uganda
By: Bulafu Douglas, Niyongabo Filimin, James Baguma, Bridget Nagawa Tamale, Namakula Lydia & Lesley Rose Ninsiima
In many Sub-Saharan African countries such as Uganda, rapid urban growth is attributed to increased industrialization, commercialization, employment opportunities, and rural-urban migration. With the current rapid urban population growth of 25%, Uganda is projected to be among the most urbanized countries in Africa by 2050. The growing urban population has led to an increased need for on-site sanitation technologies which require functioning fecal waste management systems and institutions to operate.
A sanitation worker is a person who is responsible for addressing any challenges along the sanitation chain. Sanitation workers are involved in emptying of pits and septic tanks; cleaning toilets, sewers and manholes; and operating pumping stations and treatment plants. Although sanitary workers provide a fundamental environmental health service to society, their occupation exposes them to extreme health and safety hazards including social discrimination and stigma. This study was carried out to establish awareness of occupational biohazard risks and utilization of personal protective equipment among sanitation workers in fecal waste management plants in regional cities in Uganda.
This study involved both quantitative and qualitative methods conducted among 417 sanitation workers in fecal treatment plants in Uganda’s nine regional cities of: Arua in West Nile; Lira and Gulu in northern Uganda; Mbale and Jinja in Eastern Uganda; Masaka and Kampala in central Uganda; and Fort Portal and Mbarara city in western Uganda. In addition, 17 key informant interviews (KIIs) were conducted among key stakeholders such as the officials at the fecal waste management plants, National Water and Sewerage Corporation, Public Health departments in the selected cities, and the Ministry of Health (MOH).
Findings from the study showed that, among the 417 sanitation workers, most (95%) were males, majority (46.5%) were 30 years old and below, and 44.8% had secondary education as their highest level of education. Only 32% of the workers reported to have spent more than 5 years working at the plant, 46% worked for more than the recommended 8 hours shift, and 26% worked in both day and night shifts. Of the different roles played at the treatment plants, 51% were involved in collection, 62% in emptying, 45% in transportation, 22% in treatment, and 32% in disposal of fecal waste. Sanitation workers reported being exposed to various occupational risks that could lead to injuries, illnesses, and death. These risks included exposure to fecal pathogens, strenuous labour, working in confined spaces, exposure to poisonous gases, and the use of hazardous chemicals.
The participants identified fecal waste collection points and points of fecal waste treatment especially at screening level as the most at-risk for occupational hazards for sanitation workers. Participants acknowledged that exposure to occupational hazards increases chances of disease-causing pathogen transmission to the public in addition to causing adverse health outcomes to them. The event of an occupational incident also reduced the productivity, efficiency and effectiveness of plant performance at the sewage treatment plants and the sanitation workers who earn a living on daily basis. One of the officials interviewed was quoted saying “We had a case were two people died in a septic tank. They were trying to empty it and what killed them were the gases inside the septic tank which caused suffocation.”
Although Personal Protective Equipment (PPE) such as gloves, masks, water proof boots, and overalls ought to be provided to employees working in a fecal sludge establishment, about 61% reported that they bought their own, and only 68% said that they always wore the availed PPE when working. However, of the respondents that did not use PPE, 61% said that PPE was not provided to them, and 55% said that PPE was hard to get and expensive to buy.
Results showed that PPE use was 32% higher among workers who had knowledge about any occupational health and safety guidelines related to sanitation work than those who not knowledgeable. At the fecal management plants that reported the presence of occupational health and safety personnel, PPE use was 25% higher than the plants without. The prevalence of PPE use among respondents who reported that it was mandatory to use PPE at their workplace was 14% higher than those were it was not mandatory. The prevalence of PPE use among respondents who reported the availability of PPE at their workplace was 53% higher than those did not have PPE at their work places.
From the study, several recommendations were suggested in relation to improved use of PPE. Employers and managers in fecal waste private companies and fecal waste treatment plants were urged to regularly avail PPE to their sanitation workers and provide refresher trainings to reduce exposure to occupational hazards in their work places. These stakeholders were also encouraged to establish, review and strengthen safety policies at sanitation work places.
In addition, study participants expressed their plea to policy makers and other stakeholders to amend the present acts and regulations regarding safety of sanitation workers for easy implementation and enforcement of the such laws. “The Public Health Act needs to urgently be updated because you can find that something about excreta management safety is not clearly specified hence very hard to implement,” said a manager at one of the treatment plants. Participants further emphasized the need for communication of safety regulations for awareness of sanitation workers. One of the sanitation workers said “There should be mass dissemination of these guidelines and the Act so that people know them. Even workers will be able to demand for their rights if they are made aware,”
Some of the managers interviewed said there was inadequate financial support hence the need for increasing funding in occupation health and safety to effectively implement safety activities such as supervision and procurement of necessary equipment. “Another thing is more funding towards occupational health and safety management is needed including for supervision. If there are more trainings for these people [sanitation workers], and there are more resources given to the provision of adequate PPEs, I think we can do better,” said a manager.
This research study was conducted by a team of researchers from Makerere University School of Public Health led by Dr. David Musoke and Mr. Douglas Bulafu from the Department of Disease Control and Environmental Health. This project was made possible through a research grant from WaterAid.
Health
Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet
By Joseph Odoi
A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.
This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.
Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”
‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.
Innovation details
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
“While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.
HOW THE SAFEBANGLE TECHNOLOGY WORKS
The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.
All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.
Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.
A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)
| Key Findings | Lessons learned |
| Prevalence of GBV. – Overall prevalence: 34.1% of women and girls reported experiencing GBV. – Among adolescents (15-19 years): Over 50% reported experiencing GBV. | – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors. – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises. – Economic independence proved crucial, enabling women to leave abusive environments. – Involving men and boys as allies in GBV prevention efforts is essential. |
| Age-related trends | – GBV prevalence tends to decrease with increasing age. |
| Physical and health consequences. | – Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access. – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS. |
| Social and economic impact. . | – GBV contributed to family breakups, strained marriages due to financial stress. – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation. – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations. – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment. |
| Psychological effects | – Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse. |
| Long-term effects | – Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues. |
Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.
Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.
One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).
Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.
Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.
Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.
Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.
Lessons learned
The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.
Recommendations
To address GBV against women and girls, the researchers recommend the following moving forward;
- There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
- Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
- Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
- Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
- Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
- Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
- Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
- Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
- Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
- Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
- A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
- Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.
MORE ABOUT THE STUDY
The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof. Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.
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