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.
Through a European Union (EU) funded initiative, Makerere University and Mulago Hospital are hosting a German oncology reconstruction specialist Professor Dr. Thiha AUNG. AUNG is a surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany.
With his international expertise in oncology and medical management roles at his home institution, his visit is a valuable addition to Uganda’s capacity building efforts in medical advancement.
Prof. Aung who arrived in Uganda in late September 2026 and has since then conducted free identified patient specialised surgeries and training for locals. These are expected to span two weeks. For the period, his service intersects medical expertise and humanitarian efforts.
This is not Prof. Aung’s first time in the country; his first major visit was in 2023, when he performed life-changing free surgeries on early patients. He then made medical history in June 2024 when he arrived to perform Africa’s first-ever lymph node transplant at Mulago Hospital.
It was against this background that the Makerere Public Relations Office engaged him in an exclusive interview to share his philosophy on medical service, his experiences in oncology reconstruction, and his unwavering belief that passion and dedication rather than just resources are the true drivers of sustainable medical progress.
Transforming Lives Through Oncology Reconstruction
At the heart of his mission through the ERASMUS – Oncology/Lymphedema project, is the treatment of lymphedema, a condition often referred to as elephantiasis.
In Europe, such surgeries can cost between 80,000 and 100,000 euros, making them inaccessible to many.
Thankfully, Professor and his team, including some of his post graduate students like Anna Friedrich (B.Sc) and Sophia Waser (B.Sc., PA) from the Institute of Medical Science and Engineering, have once again brought this specialised care to Uganda pro bono.
He highlights the story of a teacher who, after receiving surgery, regained her quality of life and returned to the classroom. For him, the impact is exponential. “You change one life, but this person changes a lot in the community.”
This shift from individual surgery to the long-term wellbeing of the community, reinforces the local impact of these services.
Professor AUNG’s Personal Conviction
The professor confessed that inherently, he commands himself that beyond knowledge, true progress is driven by passion and will rather than resources.
He does not agree with those that think money and resources are the sole prerequisite for change in the medical world, stating, “you cannot change with money only.” Rather, he upholds the importance of personal decision and commitment.
When discussing the challenges of working in resource-limited settings, he maintains a simple, direct explanation “it’s always beyond the money.”
Ultimately, the Professor believes that if he can provide the spark, his students and patients can carry through with the same flame for significant change.
Motivation to Serve in Uganda
When asked about his inspiration for entering the field and now volunteering to work in Uganda, he explained that his primary goal was always to serve others. “That’s why I finished my medical school to help as many people as possible with my skills.”
He views his medical expertise not as a tool for the privileged, but as a universal resource., “People are all the same, their anatomy is the same. So, I can help all these people pretty well,” Prof AUNG remarked.
His approach is motivated by a pay it forward dogma where treating a single patient creates a broader societal benefit. He illustrates this through his work with patients who, after surgery, are able to return to their professions like the teacher earlier mentioned.
Tips for Medical Professionals working in Uganda
As a foundation for professional growth, the Professor advised medical professionals working in Uganda to prioritise genuine interest in their work because he believes it is “the most important…” for “if you are interested, you will go far in the profession.”
He further reinforced the human capacity point, noting, “no matter what kind of equipment you have… it all depends on the people operating them and the patient.”
Professor AUNG concluded by encouraging doctors to overcome resource fears through action, stating, “If you want to create impact or change, you do.”
Dr. AUNG is part of the Lymphoedema Warriors Association (LWAU) in Uganda. He describes it as a grassroots organisation and commends them for “leveling the grond”. He reiterated his commitment to work with the organisation in reviewing patient reports to determine the best course of treatment.
Makerere University’s School of Public Health (MakSPH) showcased research, training and international partnerships supported through European Union funding during the EU Uganda Research and Study Fair 2026 held at Makerere University.
The fair brought together students, researchers, academics, government representatives and development partners to explore opportunities in education, research, innovation and international collaboration, while celebrating 50 years of partnership between Uganda and the European Union.
Through its exhibition, MakSPH highlighted research and capacity building initiatives addressing public health challenges including infectious diseases, non communicable diseases, health systems, climate change and pandemic preparedness.
18 EU funded projects supported at MakSPH
Prof. Rhoda Wanyenze, Dean of Students, School of Public Health, said the School has benefited from 18 EU funded projects over the past five years, supporting research and training across several areas of public health.
She said the projects have contributed to the training of PhD researchers and the development of research addressing infectious diseases and prevention, non communicable diseases, health systems, climate change and health.
Prof. Wanyenze also highlighted a new five year programme which started in 2021 that is aiming at strengthening capacity for research on pandemic preparedness and response, including outbreaks such as Ebola.
Another programme being undertaken with the Ministry of Health and Karolinska Institute focuses on improving maternal health while also addressing adolescent pregnancy and the health of mothers and children.
She described partnerships as critical to advancing science and innovation, noting that collaboration allows researchers in Africa and Europe to share knowledge and strengthen the impact of research on communities.
Research partnerships strengthen innovation
Prof. Robert Wamala, Director of the Directorate of Research, Innovation and Partnerships at Makerere University, said the exhibition provided an opportunity to showcase EU funded projects across the University.
He noted that the School of Public Health alone has more than 18 such projects, while other colleges also have several EU supported initiatives.
One of the projects showcased was PREPARE TID, a partnership aimed at developing rapid diagnostic technologies for emerging and re emerging infectious diseases.
Prof. Julius Okuni, Associate Professor of Veterinary Pathobiology and Molecular Diagnostics at Makerere University, said the project brings together universities, industries and other organisations from Africa and Europe.
The project is working to develop technologies that can quickly identify pathogens responsible for outbreaks such as Ebola, Rift Valley fever and Crimean Congo haemorrhagic fever.
According to Prof. Okuni, Makerere is involved in field and laboratory work to test and refine the technologies before they can be delivered to end users.
Fair provides platform for research visibility
For researchers at MakSPH, the fair also provided an opportunity to increase the visibility of ongoing research and create new connections with researchers, policymakers and potential funders.
Dr. Raymond Tweheyo, Honorary Lecturer and Senior Research Fellow in the Department of Health Policy, Planning and Management, said such exhibitions allow researchers to share their work and identify others working on related challenges.
He cited the CONNECT for Health project, which focuses on transforming non-communicable disease care in Uganda through collaboration with partners across several countries.
Dr. Tweheyo said exhibitions can help researchers connect with policymakers, civil society organisations and other partners who can contribute to translating research into practical solutions.
Assoc. Prof. Angelina Kakooza Mwesigye, Associate Professor and Child Neurologist at Makerere University College of Health Sciences, also emphasised the importance of exposing young people to international research opportunities.
She said the long standing Uganda Europe partnership provides opportunities for the next generation of researchers to learn, build networks and prepare for future research collaborations.
The School of Public Health’s participation highlighted the role of international partnerships in strengthening research capacity, supporting innovation and developing evidence based responses to Uganda’s public health challenges.
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