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.
Dr. Angelina Mwesige Kakooza, Associate Professor of Paediatrics in the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences (MakCHS) received the 2025 TWAS-Fayzah M. Al-Kharafi Award in Medical Sciences. She was recognised for her research on neurodevelopmental disorders – particularly epilepsy, cerebral palsy, and nodding syndrome – and for advancing policy and research, mentorship, as well as local community interventions to enhance children’s health.
The award was given at the recent 17th General Conference of The World Academy of Sciences (TWAS) held in Rio de Janeiro, Brazil under the theme ‘Building a Sustainable Future: The Role of Science, Technology, and Innovation for Global Development.’ Organized in partnership with the Brazilian Academy of Sciences (BAS) and TWAS, the conference brought together leading scientists, policymakers, and institutional leaders from across the global South and beyond.
In her remarks after receiving the award, Dr. Kakooza said, “This award highlights the importance of neurodevelopmental disorders which are a great health problem worldwide, often diagnosed late and treated poorly,” said Kakooza. “It affirms my contribution to science in Africa, strengthens advocacy for gender equity in science and education and makes me a role model for others, increasing my influence in the scientific community.”
Dr. Angelina Kakooza Mwesige is a Ugandan scholar with over 25years teaching experience whose research focuses on neurodevelopmental disorders in children centred on their epidemiology, early screening, identification and community based interventions in Uganda. Her current areas of research cover studies on early detection and interventions for young infants at high risk of neurodevelopmental delay and disability in Nepal and Uganda; development of community engagement projects to empower adolescents living with epilepsy in Uganda reduce stigma in their communities; as well as development and testing of an interactive epilepsy smart phone application to improve resilience among them.
TWAS is a global merit-based science academy based in Trieste, Italy, and administered as a UNESCO Programme Unit. Read more here: https://twas.org/
In July this year, I joined a study tour to Imvepi Refugee Settlement in Uganda’s West Nile region under the RISK-WASH Project, led by Dr. Richard Mugambe. Established in 2017 in what is now Terego District, Imvepi is one of several settlements created to host people fleeing conflict in neighbouring South Sudan. Now home to more than 60,000 refugees, it reflects Uganda’s progressive refugee policy, anchored in the 2006 Refugee Act, which promotes the integration of displaced families within host communities, allocates land for livelihoods, and ensures access to national services. It remains a model both commendable and instructive for the region.
With nearly two million refugees and asylum seekers, most of whom are women and children, Uganda stands among the world’s leading examples of inclusive, community-based refugee protection. The RISK-WASH Project, implemented by the Makerere University School of Public Health (MakSPH) in collaboration with IHE-Delft, BRAC, and icddr,b, with support from the Dutch Ministry of Foreign Affairs, organised the three-day visit. The project builds evidence for better Water, Sanitation, and Hygiene (WASH) decision-making in humanitarian settings, developing practical tools to assess how exposure to unsafe water, poor sanitation, and environmental hazards affects the health of both displaced and host populations.
In Imvepi, that evidence takes human form. Water points run dry under intense demand or drought; latrines overflow during rains; fragile health systems strain to contain preventable diseases that flourish in such conditions. One nurse may attend to hundreds of patients in a single day, treating malaria, respiratory infections, and diarrhoeal diseases directly linked to inadequate WASH infrastructure. The images linger long after one leaves, especially when reflecting on the media’s role in shaping refugee narratives. What struck me most was how such realities are often reduced to statistics or fleeting headlines that reveal little about the lives behind them. I left Imvepi convinced that we, in the media, must not only report but listen differently.
When we cover refugees, we often begin with numbers. Yet behind every statistic is a heartbeat and a history the news cycle rarely pauses to hear. Refugee health, perhaps the most human measure of displacement, is still too often framed as a crisis rather than a continuum of resilience, policy, and rights. The World Health Organisation’s World Reports on the Health of Refugees and Migrants reminds us that refugees frequently experience poorer health outcomes than host populations, not because they are inherently vulnerable, but because access to care is often obstructed by law, language, and logistics. Health, like truth, then, becomes interestingly dependent on who is allowed to speak and who is heard.
It was in this spirit that, on October 3, 2025, we convened the Media Training Workshop on Refugee Health and Migration Reporting at MakSPH. The one-day seminar brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts. Our goal was not to add another humanitarian angle to the news but to rethink how the media can report with depth, ethics, and empathy. Working with partners such as Africa Humanitarian Action, Emesco Development Foundation, and Farmamundi, we explored the subtle power the media wields to either dignify or diminish, to clarify or distort, the lived realities of refugees, particularly in the realm of health.
During my session, “Refugee Health Reporting as Empowerment: Negotiating Accuracy, Dignity, and Context,” I invited participants to view journalism through the lens of Paulo Freire, the celebrated Brazilian transformative educator who wrote the Pedagogy of the Oppressed while in exile in 1970. Through his influential work, Freire argued that oppression persists when those in power control language and narrative, when others are spoken for rather than heard. Liberation begins, he said, when people “name their world.” That principle remains profoundly relevant to our craft as journalism and communications practitioners. Refugees must not remain objects of our storytelling; they are its subjects. Journalism, in its truest public function, becomes liberating only when it is dialogic, when we report with people, not merely about them.
This transformation begins with accuracy. In Uganda, refugees share the same health system as host communities, one already strained by staff shortages, drug stock-outs, and donor fatigue. Yet many stories stop at official statements or NGO press releases. Limited access, shrinking newsroom budgets, and bureaucratic gatekeeping tempt journalists to rely on polished humanitarian narratives. But when we do, we risk becoming megaphones for the powerful. Accuracy demands courage, the willingness to verify, to cross-check, and to step beyond curated camp tours. In refugee reporting, truth is not just a professional standard; it is an act of respect.
Still, truth without dignity can harm. Too often, images of refugees serve as shorthand for despair—dust, hunger, tents. Such imagery may evoke sympathy, but it often strips away humanity. From practice, I have seen journalists lower their lenses before asking names. I have also seen how a small shift in approach, say seeking consent, giving space, and listening before photographing, can restore dignity to both subject and story. Words matter too. Calling someone an “illegal immigrant” or describing an “influx” of refugees turns people into problems. Language should humanise, not flatten. To describe refugees as mothers, health workers, or students is to reassert their agency and affirm our shared humanity, something Freire would have deeply valued today.
And no story exists in isolation. Every health headline in a settlement echoes across systems of policy, climate, economics, and gender. A cholera outbreak in Kyangwali is not merely a medical event or isolated incident; it may be showing broken sanitation infrastructure and the politics of aid, which may result in a national disease outbreak. Context is the soul of credibility. Without it, even accurate stories can mislead. In Imvepi, I saw first-hand that refugees’ health challenges are inseparable from Uganda’s own development journey, from how budgets are made to how global partners value African hospitality. The more connections we draw, the closer we come to the truth.
By the close of the workshop, it was evident that empowerment in journalism is not a slogan but a discipline. It demands patience, humility, and persistence. It calls for the co-production of stories, revisiting them, verifying them, and allowing refugees to narrate their realities. It also calls on institutions to invest and fund field reporting, train correspondents in trauma-sensitive and peace journalism, and protect journalists pursuing uncomfortable truths. Without such support, even good intentions dissolve into soundbites.
I often return to Freire’s words of wisdom: “To speak a true word is to transform the world.” This means that words are not just passive descriptions but powerful tools for action and social change, especially when they are paired with critical reflection and a commitment to praxis (work and action). Refugee health journalism, at its best, is precisely that kind of speech: accurate, dignified, and deeply contextual. It is not merely charity reporting; it is solidarity reporting. For anyone, given the wrong circumstances, can become a refugee. And solidarity, unlike sympathy, does not look down; it stands beside. When we write from that conviction, our stories do more than inform. They humanise, connect, and remind us that telling the truth well is, in itself, an act of justice.
Health
Professor Nakimuli awarded at FIGO Congress for outstanding contribution to Women and Child Health
-
General5 days agoCall for Applications: Government Sponsorship 2026/27
-
General2 weeks agoVice Chancellor Updates Media on DVC AA Appointment, Acquisitions, Research & Various Issues
-
General2 weeks agoStrengthening Collaboration between Makerere University and the University of Groningen
-
Computing & IS2 weeks agoICT Bootcamp for Vacists (P7, S4 & S6), Students & Professionals
-
General2 weeks agoMakerere and Nelson Mandela University Move to Actualize Existing MoU