Connect with us

Health

Awareness of occupational biohazards & utilization of PPE among sanitation workers in fecal waste management plants in Uganda

Published

on

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).

Mr. Douglas Bulafu (standing) talking to the research assistants during the training before data collection.
Mr. Douglas Bulafu (standing) talking to the research assistants during the training before data collection.

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.”

Christopher Tumusiime (left) a research assistant being shown by a sanitation worker some of the hazards when working around a septic tank.
Christopher Tumusiime (left) a research assistant being shown by a sanitation worker some of the hazards when working around a septic tank.

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.

Two sanitation workers without all the necessary PPE required during the emptying of a blocked wastewater channel in one of the regions.
Two sanitation workers without all the necessary PPE required during the emptying of a blocked wastewater channel in one of the regions.

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. 

Mak Editor

Health

Makerere Medical Students Honour Their ‘Silent Teachers’

Published

on

Prof. Elisa Mwaka (L) presents a plaque to keynote speaker, Rev. Prof. Dr. Samuel Luboga at the Second Cadaver Commemoration Ceremony on 11th June 2026. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.

For most people, the thought of death evokes grief, fear, or loss. But at Makerere University‘s College of Health Sciences, death became a lesson in gratitude, service, and humanity as students, faculty, and health professionals gathered to honour a unique group of teachers, individuals who continued to educate future doctors long after their passing.

At the Second Cadaver Commemoration Ceremony, on June 11, 2026, organized by the Makerere Students’ Anatomy Society, candles flickered softly as students paid tribute to what they fondly call their “silent teachers”, the human bodies that make it possible for medical students to learn anatomy and develop the skills that will one day save lives.

Standing before fellow students and guests, Chairperson of the Makerere Students’ Anatomy Society, Joseph Mwera, reminded the audience that the ceremony was not about mourning the dead.

“Today, we gather not only to remember those whose bodies have contributed to medical education but also to celebrate their lives,” he said. “Their legacy continues to inspire and serve humanity even after death.”

Prof. Elisa Mwaka (Centre) with Makerere Students' Anatomy Society members. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Prof. Elisa Mwaka (Centre) with Makerere Students’ Anatomy Society members.

For many medical students, the anatomy laboratory is where they first encounter the reality of the profession they have chosen. Behind every lesson on muscles, nerves, blood vessels, and organs is a person who once lived, loved, worked, and contributed to society.

That reality was brought to life by the keynote speaker, Rev. Prof. Dr. Samuel Luboga, a surgeon, anatomist, and priest who spent nearly four decades teaching anatomy at Makerere University.

Reflecting on his own days as a medical student, Prof. Luboga recalled spending long hours in the anatomy laboratory after his classmates had gone home, studying human anatomy in detail.

Many people wondered whether he was afraid to spend so much time among cadavers.

His answer was simple.

“These men and women had lived productive lives. They had raised families, served their communities, and contributed to Uganda’s development. Even in death, they continued to teach us the science and art of medicine. They had earned my admiration, my respect, and my gratitude.”

Rev. Prof. Dr. Samuel Luboga. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Rev. Prof. Dr. Samuel Luboga.

His remarks resonated deeply with the students in attendance.

In a society where discussions about death and body donation remain sensitive, Prof. Luboga challenged participants to view the individuals in anatomy laboratories not as lifeless remains but as people who continue to contribute to humanity through education.

“The silent teachers before us today made learning possible,” he said. “The impact of their contribution is reflected in the doctors you have become and those you are yet to become. It is reflected in the countless patients you will treat and the innumerable lives you will save.”

Legal framework to guide body donation

The ceremony also sparked important conversations about the future of anatomical education in Uganda.

Prof. Elisa Mwaka. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Prof. Elisa Mwaka.

Head of the Department of Anatomy, Prof. Elisa Mwaka, highlighted the need for a national legal framework to guide body donation and anatomical research. While anatomy training in Uganda has traditionally relied on unclaimed bodies obtained through hospitals, he noted that many countries are increasingly embracing voluntary body donation programmes.

According to Prof. Mwaka, building public trust will be essential if Uganda is to establish a sustainable body donation programme.

“We must help the public understand how human bodies contribute to medical education, how they are treated with dignity, and how appropriate legal safeguards can protect donors and their families,” he said.

Prof. Mwaka presents one of the awards. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Prof. Mwaka presents one of the awards.

He revealed that discussions are already underway to develop an Anatomy Act that would provide a modern legal and ethical framework for the use of human remains in medical education and research.

Representing the Deputy Vice Chancellor (Academic Affairs), Prof. Julius Kikooma described the ceremony as much more than an academic event.

“Behind every competent healthcare professional stands an invaluable source of learning that often remains unseen and unheard,” he said. “These individuals taught us without speaking a single word. Though they are no longer able to communicate, their contribution continues to educate, inspire, and shape future generations of healthcare professionals.”

He commended the medical students for organizing what remains the only cadaver commemoration ceremony of its kind in Uganda, noting that the initiative reflects the values of compassion, professionalism, and respect for human dignity that are at the heart of medicine.

Part of the audience as seen from the gallery. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Part of the audience as seen from the gallery.

The event concluded with recognition of past and present leaders of the Department of Anatomy whose contributions have shaped anatomical education at Makerere University over the decades. Students also honoured exceptional educators who have inspired generations of future health professionals.

Yet the most powerful tribute of the day was reserved for those who could not be present to receive awards or applause.

The silent teachers

Individuals whose names may never appear in textbooks, whose stories may never be fully known, but whose gift continues to echo through hospital wards, operating theatres, and communities across Uganda.

Students perform during the Second Cadaver Commemoration Ceremony. Second Cadaver Commemoration Ceremony organized by the Makerere Students' Anatomy Society under the Department of Anatomy, College of Health Sciences (CHS) on June 11, 2026 at Makerere University School of Public Health Auditorium, Main Campus, Eastern Gate, Kampala Uganda, East Africa.
Students perform during the Second Cadaver Commemoration Ceremony.

Every doctor trained, every surgery performed, and every life saved carries a small part of their legacy.

And for one day at Makerere University, students paused to say the words that are rarely spoken aloud: Thank you.

Betty Kyakuwa
Betty Kyakuwa

Continue Reading

Health

Call for Applications: Master’s Sponsorship in Genomics and Bioinformatics for Pediatric HIV

Published

on

SURGE Project Call for Applications: Master’s Sponsorship in Genomics and Bioinformatics for Pediatric HIV. Photo: Gemini.

Makerere University in partnership with Baylor College of Medicine (BCM) and in collaboration with Baylor Foundation Uganda (BFU) is pleased to invite applications for a one-year Master’s sponsorship under the Scaling Up advanced genomics and bioinformatics Research training in Pediatric HIV/AIDS in Uganda (SURGE) project. This opportunity, funded by the National Institutes of Health (NIH) USA, is open to students currently enrolled in the Master’s Degree programme with a specialization in Genomics and Bioinformatics at Makerere University College of Health Sciences (MakCHS).

The SURGE programme aims to train the next generation of Ugandan scientists, supporting selected students through their dissertation year with a focus on pediatric HIV. You can find full details regarding this opportunity in the attached file.

Why Apply?

  • Support for dissertation research during the final year of your programme.
  • A monthly stipend for the 12-month duration of the sponsorship.
  • Hands-on training and mentorship in genomics, bioinformatics, scientific communication, and career planning.
  • Access to extensive host genetic datasets from African children infected with HIV and support for publishing research findings.

Eligibility:

This sponsorship is open to Ugandan nationals currently in their penultimate year (Year 1 or 2) of a Master’s programme with a specialization in Genomics and Bioinformatics at Makerere University. Candidates must have a cumulative GPA of at least 3.8 and a strong interest in pediatric HIV research.

How to Apply:

Please review the specific documentation requirements and formatting guidelines outlined in the attached file. Applications must be submitted as a single PDF file to surge.ug2030@gmail.com. Additionally, a reference letter from a person familiar with your academic work must be sent directly to the same email address by the referee.

The application deadline is June 30, 2026, at 5:00 pm EAT.

For any additional information, please contact the Program Manager at surge.ug2030@gmail.com. We look forward to receiving your applications.

Mak Editor

Continue Reading

Health

The silent teachers: why body donation matters

Published

on

Assoc. Prof. Erisa Sabakaki Mwaka, Consultant Orthopaedic Surgeon and Chair, Department of Anatomy, College of Health Sciences (CHS). Makerere University, Kampala Uganda, East Africa.

By Assoc. Prof. Erisa Mwaka and Joyce Nabukalu-Kiwanuka

In every hospital, there is a moment when knowledge becomes a matter of life and death. A doctor must know where to place an incision, how to avoid damaging major organs, how to identify a nerve, how to deliver a baby safely, how to interpret a scan, or how to explain disease to a worried family. That knowledge does not begin in the operating theatre, it begins much earlier, in the anatomy laboratory.

For generations, the study of the human body has been the foundation of medical education. The regular use of human bodies for medical training purposes began in the late Middle Ages and spread during the 18th and 19th centuries. Initially, anatomists depended on gallows, poor houses, mental asylums, or jails as sources of bodies. However, the 1960s and 1970s saw the emergence of wilful body donation. Before students become doctors, surgeons, dentists, nurses, physiotherapists, radiographers, and other health professionals, they must first understand the human body in its real form. They must learn not only from books and diagrams, but from the body itself. This is why cadavers, though silent, remain the most important teachers in medical education. In simple terms, a cadaver is a dead human body used by health professions students to study anatomy; and Anatomy is the study of the physical structure and organization of the human body, both at macroscopic and microscopic levels.

As the Department of Anatomy at Makerere University College of Health Sciences  prepares to commemorate the “silent teachers” whose bodies are used for medical education on June 11, 2026,  Uganda is invited to reflect on a subject that is rarely discussed in the public domain, willed body donation. Body donation simply means a person willfully donates their body for educational purposes after death, and consent to it in life. This is a sensitive topic, but it is also a deeply human one. It touches our beliefs, families, culture, understanding of death, and responsibility to future generations.This commemoration ceremony is not symbolic but, it is a public statement that the contribution of silent teachers is sacred, educational, and deeply appreciated.

To donate one’s body after death is not an ordinary decision; it is an altruistic act of extraordinary generosity. It is a final gift to society. It allows health professions students to learn and appreciate the human body before they treat living patients. Cadavers are therefore not “specimens”, they are silent teachers and partners in medical education who continue to serve humanity even after death. Learning anatomy using a cadaver helps students to understand and appreciate the complexity of the human body, appreciate its natural variations, and develop the confidence and competence needed to serve the public. Students are also taught laboratory etiquette that emphasises dignity, empathy, and utmost respect for the cadavers, which attributes they carry into the clinical years when they interface with hospital patients.

In Uganda, where the demand for health workers continues to grow, medical education must be strengthened at every level. Our country needs well-trained doctors and health professionals who can serve in hospitals, health centres, universities, research institutions, and communities. But good training requires good teaching resources. One of these resources are the silent teachers who never complain, but impart immeasurable knowledge to future health professionals. Modern technology has introduced many useful tools into medical education. Students can now learn from videos, computer applications, digital images, plastic models, three-dimensional models, and virtual platforms. These tools are important and should be embraced, however, they cannot completely replace learning from the real human body. A cadaver teaches what a diagram cannot fully show; the true position of organs, the texture of tissues, the relationship between structures, and the natural differences that exist from one person to another. More importantly, cadaver-based learning teaches respect. It reminds students that medicine is not simply a technical profession, it is a calling rooted in human dignity. The first lesson students learn in the anatomy laboratory is that the body before them belonged to a person who had a name, a family, a story, and a life. That lesson shapes how they later treat patients.

Currently, most, if not all universities in Uganda, and similar settings in Africa use unclaimed bodies for learning Anatomy. The use of cadavers in Uganda is governed by the Penal Code (Anatomy Rules) of 1957 that permits public hospitals to transfer bodies unclaimed for at least 14 days to a medical training institution like Makerere University. Unfortunately, these cadavers are used without the consent of the deceased because most of them are unknown and with no known relatives to claim them. Many opponents to the use of unclaimed bodies opine that the practice is unethical. There is a global push toward ethical use of cadavers in medical education, where a person consents and bequeathes his/her body for medical education when still alive. For this practice to be sustainable, there is a need for a well regulated body donation program. Unfortunately, the concept of willful body donation is still not well understood by many people, and neither has it been a topic of public debate. Further, there are lots of myths surrounding death and dying in Africa, including Uganda that have hindered the establishment of successful body donation programs. Willingness to donate bodies for medical education is however, influenced by several factors including cultural and religious beliefs, respect for the dead and the need to fulfil burial rites, fear for mutilation and disrespect, to mention a few. These concerns are real and should not be dismissed. But they should be addressed with accurate information, openness, and utmost respect.

It is important to understand that body donation does not mean that a person is forgotten. On the contrary, it creates a legacy. A body donor may teach hundreds of future health professionals, in that way, one person’s final act of generosity can touch and save countless lives.  This is kind of patriotism is largely unkown in Uganda and we do not speak about enough. We often talk about serving our country through leadership, business, farming, teaching, parenting, or community service. But there is also service beyond life. Body donation is one way of saying: “Even when I am gone, let me contribute to the health of my people.”

Currently, Uganda now has more than 15 universities training medical students and the demand for cadavers for learning anatomy is on the rise. Actually, the supply of cadavers cannot fulfil the demand, and medical educationists need to find alternative source of cadavers. Wilful body donation is the answer. 

Uganda needs a national conversation on body donation. There is a need for deliberative public engagement involving various stakeholder including the public, religious and cultural leaders, civic leaders, the media, educationists, health professionals, medical training institutions, etc. 

This commemoration ceremony will involve inter-denominational prayers for the silent teachers, and a reflection of their contribution to healthcare in Uganda. We hope this ceremony will provoke public debate on a subject that is hitherto considered a taboo by many. We talked about some of these issues last year, in the first ever such ceremony in Uganda, and have received several requests for more information on the procedure for donating one’s body for teaching purposes upon death. Like President Obama’s said, “yes we can”, an the dialogue starts from you and me. You are all invited for the commemoration ceremony at 9.00 am on June 11, 2026, at the Makerere University School of Public Health auditorium on main campus. 

To donate one’s body is to give a final lesson, a final service, and a lasting gift to the nation.

View on CHS

Mak Editor

Continue Reading

Trending