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.
On August 20, 2025, Makerere University School of Public Health (MakSPH) convened a timely workshop on Strengthening Equitable Partnerships in International Research Collaboration in Uganda. Held at the MakSPH Auditorium, the event brought together researchers, policymakers, and institutional leaders to reflect on how Uganda, and indeed the wider region, can engage more effectively and derive greater benefit from global research collaborations.
Delivering the keynote address, Prof. David Musoke Serwadda, a Professor Emeritus at Makerere University and a globally recognised HIV researcher and epidemiologist, urged a rethinking of how international research partnerships are structured. A former head of the Institute of Public Health (IPH) and later Dean of the School, serving between 2003 and 2009, Serwadda is also the founding director of the Rakai Health Sciences Programme (RHSP), which is one of Uganda’s most influential research initiatives on HIV. While acknowledging the many benefits Uganda has gained from global research collaborations, he cautioned that too many times, these partnerships remain transactional, shaped by donor priorities, bound to project cycles, and offering limited long-term value to local institutions once projects close.
Prof. Serwadda, himself a globally recognised and well-accomplished researcher, with over four decades of experience and numerous awards for his contributions to science and global health, observed that Ugandan partners are many times included in research projects for visibility rather than substance, often excluded from core roles such as Principal Investigators or from influencing agenda-setting, budget control, and authorship. “Partnerships are not an end in themselves; they exist to help us achieve mutually agreed objectives built on shared responsibility and reciprocal obligations. Too often, Southern institutions are brought into projects late, simply for optics. That is not equitable collaboration,” he insisted.
During his talk, he stressed that this imbalance undermines both research quality and sustainability, noting that normally, when local researchers are sidelined, studies often fail to align with national priorities or build capacity that endures. By contrast, partnerships that are grounded in mutual respect, fair resource sharing, co-design, and shared decision-making have the impact of producing knowledge that is globally relevant and locally impactful.
“Equity in partnerships is about fairness, ensuring that all partners, regardless of context, can contribute meaningfully. This also requires responsibility on our part in the Global South. We must insist on involvement from project conception, negotiate fair terms, and strengthen our own systems to manage collaborations effectively,” Prof. Serwadda advised, emphasising that strong institutions, clear strategy, agenda and objectives are key for local institutions to engage in mutually fair and beneficial research collaborations at the global and continental stage.
As Director and later Dean of MakSPH, Prof. David Serwadda spearheaded numerous research collaborations and attracted substantial grants that elevated the School and the University’s global standing. Today, MakSPH is recognised as Makerere University’s flagship unit for its wide-ranging partnerships and robust research management systems. Since its beginnings as a small Department of Preventive Medicine in 1954, through its transformation into the first Institute of Public Health in sub-Saharan Africa in 1975, its elevation to School status in 2007, and most recently its reinstatement as a standalone School with college status within Makerere University in January 2025, a status first granted in 2001, MakSPH has built a 70-year legacy of advancing public health through research, training, and policy engagement.
The School’s evolution, as often couched by its leadership, has been anchored on strategic and strong partnerships. These collaborations, be they local, regional or global, have driven health systems innovation, strengthened capacity, and informed policy, making partnerships the cornerstone of the School’s past achievements and future ambitions. At the celebration of the School’s 70th Anniversary, marked in December 2024, Makerere University Vice Chancellor Prof. Barnabas Nawangwe hailed MakSPH’s research output, community impact, and strong partnerships cultivated throughout the years. The Mak VC cited the School’s pioneering role in the HIV response led by Prof. Serwadda in the 1980s, the establishment of nutrition centres such as the Mwana Mugimu Unit at Mulago Hospital and across Uganda by the late Prof. John Kakitahi in the 1990s with support from Rotary International, and community projects like Kasangati Health Centre along Gayaza Road with support from the Rockefeller Foundation in the late 1950s, which advanced public education on healthy environments and wellness.
“The School of Public Health brings in almost half of all research grants at Makerere University, both in number and value, and these partnerships have been central to tackling Uganda’s public health challenges. From pioneering HIV/AIDS work that shaped global prevention strategies to interventions in maternal health, malaria, and infectious diseases, MakSPH has consistently combined academic excellence with community service. Its leadership during the COVID-19 pandemic further showed its ability to respond to national health emergencies with evidence-based solutions that directly benefit the people,” Prof. Nawangwe said with gratitude for the work done by the School through collaboration.
In 2024, the School had over 350 peer-reviewed publications in high-impact international journals as a result of this wide network and partnerships. MakSPH currently maintains a strong mix of North–South and South–South collaborations. Within the continent, the School is actively working in more than 25 countries, often partnering with multiple institutions within individual countries to advance research, capacity building, and policy influence. One such recent collaboration is the Partnership to Enhance Technical Support for Analytical Capacity and Data Use in Eastern & Southern Africa (PERSuADE) Project, funded by the Global Fund. Under PERSuADE, MakSPH, the prime grant recipient, hosted the secretariat led by Dean Prof. Rhoda Wanyenze as Principal Investigator, tasked with overall coordination across 12 countries, while a Steering Committee chaired by Prof. David Serwadda provided oversight.
PERSuADE was implemented in two phases between 2018 and 2023. The project brought together 12 universities and 12 Ministries of Health in East and Southern Africa to strengthen analytical capacity and promote data use in national health programmes, cascading skills to districts and lower facilities. In its second phase, the project trained over 1,500 health staff, including 934 at the sub-national level, in data analysis and use, and generated more than 80 analytical outputs on HIV, TB, and malaria. These informed National Strategic Plans in seven countries and improved programme strategies in all 12. Sixteen in-service staff from seven countries received specialised training in HIV key population surveillance, health information systems, and data use. The project also piloted the Maturity Index Model in five countries, helping ministries track progress in institutionalising data-driven decision-making.
In Uganda, the PERSuADE project was implemented in Kiboga, Buikwe, Kasanda, Mukono, and Mityana districts, selected by the Ministry of Health. According to the Principal Investigator, Prof. Rhoda Wanyenze, strengthening data analysis and use has greatly enhanced the capacity of Ministries of Health to deliver targeted interventions that directly benefit communities. She noted that improved analytical skills at national and subnational levels now enable ministries to identify disparities in HIV, TB, and malaria burdens, while district and facility health workers can use data to strengthen local service delivery. “With better data, districts can plan more efficiently, allocate medicines, and implement tailored prevention campaigns to address specific risks, raise awareness, and reduce new infections,” she said, emphasising the role of equitable collaboration as a key success factor in Uganda and across the continent for this partnership.
Indeed, during a learning visit to Uganda in September 2024, Dr. Estifanos Biru Shargie, Senior Specialist for Monitoring, Evaluation, and Country Analysis at the Global Fund, commended the PERSuADE Project for strengthening local capacity and fostering sustainable health system improvements through South-South partnerships among schools and ministries. “The impact has been significant. In Kiboga, I was impressed by how teams mapped gaps in services and addressed them over four years, using data to inform decisions and monitor progress. Working with Makerere University School of Public Health has been an honour. The School blends academic excellence with practical implementation, backed by strong financial management and a long-standing relationship with the Ministry of Health. Their coordination, networking, and efficiency have been exemplary,” Dr. Shargie said.
Another currently ongoing initiative at the School is the African Leadership and Management Training for Impact in Malaria Eradication (ALAMIME) program, led by MakSPH with ten participating institutions across nine malaria-endemic countries, funded by the Bill & Melinda Gates Foundation. Co-led by Prof. Elizeus Rutebemberwa and Prof. Dosithée Ngo Bebe, ALAMIME is cultivating the leadership Africa needs to defeat malaria by strengthening institutions, building capacity, and fostering regional networks. In 2024 alone, the program trained over 250 participants, nearly half women, from national malaria programs, ministries, and NGOs. Through structured training, alumni-led webinars, and cross-country exchanges, the program has demonstrated how equitable, multi-country partnerships translate investment into sustainable systems and shared momentum toward malaria elimination.
For nearly 15 years now, MakSPH has also hosted the NTU–Mak Partnership, a collaboration between Makerere University and Nottingham Trent University, first conceived in 2010, with Assoc. Prof. David Musoke and Prof. Linda Gibson as the Uganda and UK Co-Leads. One of the key reasons for the success of this partnership is equity, and it has since attracted over £1.4 million in grants, trained more than 900 Village Health Teams in Wakiso District, supported over 350 practitioners in antimicrobial stewardship, and facilitated exchanges for more than 200 students and faculty. It has also equipped community health workers to respond to non-communicable diseases, antimicrobial resistance, and the COVID-19 pandemic, while generating over 30 peer-reviewed publications and convening global platforms such as the first International Community Health Worker Symposium, held in Kampala in 2017.
Dr. Musoke, the Co-Principal Investigator for the project on strengthening equitable research collaborations in Uganda, described the NTU-Mak partnership as a model North–South partnership that has produced both joint scholarship and lasting institutional ties. He noted that its success has inspired wider collaborations, as the current project on equitable partnerships builds on this foundation. Emerging from a British Academy regional workshop in Nairobi in 2024, MakSPH extended its engagement to Mountains of the Moon University (MMU), Uganda Martyrs University (UMU), and the National Agricultural Research Organisation (NARO). Together with Nottingham Trent University, these institutions are now advancing reforms to embed equity in research partnerships across Uganda’s research ecosystem.
Health
Mak and UNICEF Uganda Sign MoU to Strengthen Child Rights through Research, Training, and Innovation
Makerere University (Mak) and United Nations Children’s Fund (UNICEF) Uganda have signed a Memorandum of Understanding that launches a two-year, renewable partnership aimed at advancing child rights and well-being through rigorous research, capacity building, and policy-driven innovation.
The agreement was signed on Thursday, 14 August 2025, by Makerere Vice Chancellor Professor Barnabas Nawangwe and UNICEF Uganda Representative Dr. Robin Nandy in the Vice Chancellor’s Boardroom at Makerere’s Main Building.
The MoU enlists a focused collaboration on generating child-focused data and research to inform policy and program design, analyzing how health, nutrition, education, and protection initiatives affect children, and strengthening the social sector workforce through targeted training, curricula, and performance standards.
It also emphasizes knowledge management, wide dissemination of findings to stakeholders, policy and legislative advocacy for child rights, and active student engagement through internships, skilling opportunities, and communities of practice. The renewed partnership is designed to bolster evidence-based policy-making and drive program improvements that contribute to Uganda’s progress toward the Sustainable Development Goals by 2030.
“The signing of this MoU deepens Makerere’s long-standing commitment to the well-being of Uganda’s children and Africa’s future,” said Vice Chancellor Nawangwe. “I thank Dr. Nandy for his leadership and for the continued collaboration that will expand our capacity to deliver research with immediate, practical benefits for communities.”
UNICEF’s Dr. Nandy stressed that the partnership reflects UNICEF’s global mission to protect and promote every child’s rights while translating research into policy and action. He highlighted Makerere’s proven strength in research leadership as a critical asset in the effort to generate robust evidence for government decision-making and resource allocation.
“This partnership shows our commitment to combine academic knowledge with practical results,” said Dr. Nandy. “Using Makerere’s research skills to create important information about child welfare issues and solutions, making sure that every project we start is based on solid data and aims to safeguard and support children’s basic rights.”
The partnership builds on Makerere University’s established research strengths and UNICEF’s global mandate to protect children. It complements longstanding collaborative work through Mak’s School of Public Health (MakSPH) and other faculties, reinforcing a broader university-wide commitment to evidence-based policy and community impact.
Since 2016, Makerere has participated in more than 30 UNICEF-supported research projects, which emphasize a deep mutual trust and shared mission. The Vice Chancellor noted that this history laid a robust foundation for the new MoU while also underlining opportunities to broaden collaboration beyond the health sector.
Among the notable prior initiatives is MakSPH’s joint work with UBOS and UNICEF, supported by EU funding, on the first comprehensive Food Security and Nutrition Assessment in ten districts of Northern Uganda and the West Nile region (2019). The findings of this work informed targeted nutrition programs and strategies to combat malnutrition among vulnerable populations, shaping policy directions at local and national levels.
In 2023, MakSPH, in collaboration with the National Planning Authority (NPA) and UNICEF, along with FHI360 and the Ministry of Health, produced an updated Situation Analysis of Newborn Health in Uganda. The document has guided the ministry’s national strategy development, including costed investments to improve newborn health across the country.
Professor Rhoda Wanyenze, Dean of MakSPH, hailed the partnership as a continuation of a long-standing relationship, noting that UNICEF’s support was instrumental in establishing the Makerere University Centre of Excellence for Maternal Newborn & Child Health (MNCH) in 2013.
“It’s such a delight, a great honor to finally get to this event where we can formalize our partnership with UNICEF. The partnership between UNICEF and Makerere has been a long-standing one, and we have worked together for decades, which has driven critical research and informed national policies,” she said. She emphasized that both institutions share a passion for tackling adolescent health challenges, particularly early pregnancies and marriages, which remain persistent barriers to progress.
The MoU extends collaboration beyond the School of Public Health. The Vice Chancellor noted productive partnerships across other departments, including the Department of Journalism and Communication and the College of Humanities and Social Sciences, emphasizing how diverse disciplines can contribute to evidence-based policy and community well-being.
Another important example is the Caring for the Caregiver (CFC) intervention led by the Makerere Institute of Teacher Education and Research (MITER) in the College of Education and External Studies (CEES). This was implemented in partnership with the Ministry of Health, UNICEF Uganda, and international partners. The evaluation examined caregiver emotional wellbeing, social support, and parenting stress in rural Uganda, contributing to the growing evidence base for nurturing care in resource-constrained settings.
Also, the School of Statistics and Planning in the College of Business and Management Sciences (CoBAMS) has partnered with UNICEF to tackle urgent socio-economic and public health challenges. A key example is the Socio-economic Impact Assessment of the 2022 Ebola Virus Disease outbreak in Mubende and Kassanda districts, which examined household-level shocks, community coping strategies, and the wider disruption of livelihoods. The study’s findings have informed national policy dialogue and action planning, emphasizing that there must be stronger preparedness measures.
According to the Vice Chancellor, the university’s broader engagement with UNICEF as a driver of research, innovation, and community outreach benefits children and families throughout Uganda.
For Dr. Nandy the partnership will support student involvement in real-world operational and programmatic work, creating pipelines for young scholars to contribute to child welfare initiatives.
Both parties expressed a shared vision of translating research findings into concrete actions that strengthen child protection and opportunities for learning and development. The collaboration is expected to yield new efforts for effective interventions, sharpen the policy dialogue, and catalyze scalable innovations that improve the daily lives of Uganda’s children.
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