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

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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. 

Health

METS Newsletter May 2024

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The newly appointed CDC Uganda Country Director, Dr. Adetinuke Mary Boyd (7th from left) met with country implementing partner Executive Directors to get insights on ongoing projects, discussed leveraging of partnerships as well as strategizing for how best to strengthen health systems. Infectious Diseases Institute (IDI)-McKinnell Knowledge Centre, Makerere University, Kampala Uganda, East Africa.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS May 2024 Newsletter

  • Enhancing Response to Sexual and Gender-Based Violence
    • Responding to and preventing Sexual and Gender-Based Violence (SGBV) and Violence Against Children (VAC) are critical components of Uganda’s national HIV prevention program. METS developed a new app designed to improve support for SGBV survivors. This followed an assessment in December 2022, that revealed gaps in service access and coordination in Fort Portal and Kampala Regions.
    • The METS team, in collaboration with regional implementing partners, is scaling up the app’s use in pilot districts such as Masaka, Kiryandongo, Fort Portal, and Mubende. The team visited facilities and police stations to install the app and train selected focal persons on its use.
  • Assessing Readiness for Integrated HIV and NCD Care Services
    • METS supported the Ministry of Health to conduct a site readiness assessment for integrated delivery of HIV and Non-Communicable Diseases (NCD) services from 22nd to 26th April 2024, in collaboration with the US Centers for Disease Control and Prevention (CDC), and various implementing partners. The activity was conducted in selected health facilities in Acholi, Mubende, Kayunga, and Rwenzori regions to determine their feasibility for participating in a comprehensive NCD evaluation.
    • The 48 facilities visited have already integrated NCD services (mental Health, diabetes, and hypertension). Of these, 78% have integrated mental health services in their PMTCT clinics. 40% of the facilities have a dedicated NCD services physicians /doctor in the ART Clinic, 29% have doc have dedicated physicians in the PMTCT clinics. 90%. Most of the facilities have clinical and nurses in the ART than PMTCT facilities but more nurses offering NCD services in PMTCT sites.
  • Digitalizing the health sector through strategic partnerships
    • In collaboration with CDC and METS, the MoH organized a national Electronic Medical Records (EMR) stakeholders meeting to orient stakeholders on the national EMR agenda and transition towards a comprehensive digital health facility package. Key actions discussed included expanding the rollout of the EMR and Community Health Information System (eCHIS) and urging development partners to support prioritized health information and digital health investments.
    • The introduction of electronic medical records (EMRs) in health facilities aims to improve the quality of health service delivery by providing real-time accountability transparency, and traceability of medical supplies, monitoring health worker absenteeism, enhancing patient satisfaction through efficient care provision, reducing unnecessary or duplicate diagnostic tests, and offering easy access to management reports for decision-making. Additionally, EMRs will lay the foundation for the implementation of national health insurance.
  • UgandaEMR+ Implementation Showcased at Kisenyi HCIV
    • METS and Reach Out Mbuya (ROM) showcased the implementation of UgandaEMR+ to representatives from the USG and the Ministry of Health (MoH) at Kisenyi HCIV. The visit was aimed at providing a clear understanding of the system’s functionality at the health facility, which serves over 1,200 outpatients daily and supports over 1600 clients on ART.
    • Dr. Peter Akonyera, the ART Clinic In Charge shared positive end-user experiences, noting simplified data use and analysis, efficient data retrieval, and the system’s popularity among users despite existing challenges. He appreciated METS’ support in maintaining system synchronization. The data visualization tools have been particularly useful for clinicians to manage patient schedules and workload distribution effectively, ensuring timely and efficient healthcare delivery.
  • METS Showcases Research at INTEREST 2024 Conference in Benin
    • The International Conference on HIV Treatment, Pathogenesis, and Prevention Research (INTEREST) brought together global scientists to share cutting-edge knowledge in HIV diagnosis, treatment, and prevention. The conference also aimed to build a community of African physicians and scientists to develop local solutions for managing HIV and preventing its transmission.
    • METS submitted an abstract titled “Enhancing HIV Case Identification through a National HIV Testing Services (HTS) Continuous Quality Improvement” based on support to the Ministry of Health (MoH) in designing, implementing, and evaluating initiatives to increase the identification of HIV-positive clients, crucial for achieving the global target of 95% of people living with HIV (PLHIV) knowing their status.
  • Gallery
    • New CDC Director meets Country implementing partner Executive Directors
    • UgandaEMR+ support supervision at Kisenyi HCIV visit
    • EMR Stakeholders meeting
    • CBS guidelines meeting
    • INTEREST 2024 conference – Benin
    • Key Populations assessment – Ishaka district

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SIMCS-Trial Vacancy Announcement: Twenty-Five (25) Research Assistants

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An elevated shot of the School of Health Sciences and School of Medicine Building, College of Health Sciences (CHS), Makerere University. Mulago Campus, Kampala Uganda, East Africa.

Makerere University College of Health Sciences School of Medicine in collaboration with Baylor College of Medicine received funding from US National Institutes of Health – Fogarty International Center to carry out a study on “Development and evaluation of an information management and communication system for population-wide point of-care infant sickle cell disease screening (SIMCS-Trial)”. The program seeks to recruit 25 research assistants at its study sites. 

Roles and responsibilities  

  • Identify and screen participants for possible enrolment into the study according to the Study Protocol.
  • Obtain informed consent from caregivers of eligible participants as per protocol accordance with GCP and HSP principles.
  • Counsel and explain study procedures to the caregivers of study participants using the mobile app.
  • Enrol eligible participants into the study to meet the study accrual targets.
  • Complete study CRFs, correctly and accurately in compliance with trial procedures/ SOPs and GCP standards.
  • Ensure study participants’ safety and privacy, data integrity and confidentiality.
  • Participate in collection of appropriate study samples/specimens from the participants as per protocol and SOPs as well as performing the test.
  • Carry out any other duties as assigned by superiors in line with your work.

Required Qualification and experience 

  • A degree in any health-related discipline, and registered with the relevant national bodies.
  • Knowledge and familiarity with Microsoft word, Excel, PowerPoint and Access as well as basic internet applications 
  • Skills in using common relevant computer packages and mobile technology for data collection
  • Previous work in a research environment is added advantage.
  • Basic knowledge of clinical research regulatory procedures. 
  • Good Clinical Practice (GCP) training and Research Ethics training skills and knowledge
  • Excellent command of English (written and oral) as well as the local languages (Luganda or Lusoga)
  • Excellent interpersonal skills to develop relationships with participants.
  • Experience of living and or working both in urban and rural environment.
  • Team-working skills to work effectively as part of a multidisciplinary healthcare team 
  • Time management skills and ability to handle multiple tasks simultaneously.
  • Highly organized, detail-oriented and self-motivated/driven. 
  • Ability to handle multiple tasks simultaneously. 
  • Ability to professionally communicate in writing, verbally or other means deemed appropriate. 

Reports to: The SIMCS Co-Investigator/SIMCS Trial Coordinator 

Expected start date: July 2024

How to apply: 1-page type written application letter addressed to the Principal Investigator SIMCS Trial MakCHS SOM together with current CV, copies of academic certificates, and recommendation letters from two past employers should be e-mailed as ONE PDF DOCUMENT to makimpact22@gmail.com

Deadline for receiving applications: Friday 20th June 2024 at 5:00 pm

Only shortlisted candidates will be invited to the interview. 

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CTCA Call for Proposals: Enhance Tobacco Control Institutional Capacity in Africa

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Call for Proposals - Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339. Deadline 30th June 2024, by 5pm EAT. The Centre for Tobacco Control in Africa (CTCA), School of Public Health, College of Health Sciences (CHS), Makerere University, Kampala Uganda, East Africa.

Project Title: Enhance Tobacco Control Institutional Capacity in Africa; Grant #339

Introduction:

The Centre for Tobacco Control in Africa (CTCA) received funding from the African Capacity Building Foundation (ACBF) for the 2024-2026 to implement a project on institutional capacity. The project investments are geared towards sustaining human resource capacity and knowledge generation to reduce use of all forms of tobacco products in Africa. Specifically, the project aims to:

  1. Enhance training opportunities for African governments and relevant actors in tobacco control in
    the continent
  2. Increase access to knowledge for guiding tobacco use prevention and control in Africa
  3. Reinforce the institutional development of CTCA for an optimal performance of its functions
    and processes.

In 2020, CTCA developed a Tobacco Control Research Agenda (TCRA) with the aim of providing a guide for generating local evidence to drive tobacco control policy formulation and implementation in Africa.

Therefore, CTCA with support from ACBF is seeking researchers across the African continent to be awarded 6 small grants of USD 5000 to implement research that aligns with the TCRA thematic areas below:

  1. Patterns and trends of tobacco use and exposure for all tobacco products including the new
    products at country and regional levels (sex, age, region, types of products, new products).
  2. Effects of tobacco use and exposure on sustainable development (poverty, education, culture, food security, environment, HIV, TB, reproductive health, NCDs).
  3. Tobacco use and populations at risk (youth, young adults, women/gender, elderly, residents
    of urban areas, miltary, prisoners, mental health patients, populations in low socio-economic
    dwellings like slums).
  4. Tobacco control policy research and analysis (smoke free, TAPS, GHWs, ceasation) of cost
    effectiveness, impact, drivers, enablers, innovation, challenges, communication and advocacy
    for tobacco control.
  5. Sociocultural context of tobacco use
  6. Tobacco industry and tobacco control policy
  7. Tobacco production, alternative livelihoods and environment (distribution, value chain,
    environmental impact, historical and determinants of tobacco production)
  8. The economics of tobacco and tobacco control (product, pricing, illicit tobacco trade,
    taxation)

The full research Agenda can be accessed in English and in French.

Submissions

We are pleased to invite submissions from researchers based in Africa. Successful proposals should align with any of the 8 thematic areas of the CTCA Research Agenda. Innovative proposals that address critical issues and contribute to evidence-based policy and practice in the respective areas to inform Tobacco control in Africa are particularly encouraged.

Requirements

These grants will fund work that relates to the CTCA Research Agenda. Activities will include
proposal development, data collection and analysis, report writing and dissemination. All research to be implemented will be approved by the institutional review board and published in peer reviewed journals. These grants are intended for; 1) Researchers based in Tobacco Control Programs/Response; 2) post graduate students who would like to complete their research projects aligned to this call and 3) early and middle career researchers. It is required that this research is executed, and the report completed within 12 months. The applicant should have a mentor in an established institution.

Eligibility

Eligibility is restricted to Africa-based researchers. This refers to individuals who are (a) currently studying at a university or research institute in Africa, and/or b) currently working within a university, research institute, or in tobacco control in Africa. All persons associated with tobacco industry will not be funded and therefore should not apply. Successful applicants will be required to sign a declaration of interest that they do not have any relationship with tobacco industry.

Evaluation criteria

Proposals will be reviewed by a group of experts and researchers. Projects will be assessed against six, equally weighted evaluation criteria:

  • Knowledge contribution in respect to policy, strategy, and evidence to answer local
    challenges:
    Does the study articulate the research gap? Does study make a significant
    contribution toward advancing knowledge in the tobacco control field? Does it answer
    new questions or introduce novel methods, measures, or tobacco control interventions? Is
    it aligned to the WHO FCTC and tobacco control local context requirements? Does the
    study add to the existing body of research?
  • Policy relevance: Will results from the research have generalizable implications? How,
    if at all, will the “lessons learned” have relevance beyond the study? Will the study
    outcomes influence decisions in tobacco control?
  • Technical design: Do the methods appropriately answer the objectives and the questions
    outlined in the proposal? Is the proposed study feasible in one year?
  • Project viability: Are there any other logistical or political obstacles that might threaten
    the completion of the study, for example, government authorization or Human Subjects
    review, civil strife, social cultural sensitivity?
  • Value of research: Is the cost of the study commensurate with the value of expected
    contributions to policy? Are the planned activities justified and coherent?
  • Ethics: Reviewers will consider whether there are any risks of harm to research
    participants, what the proposed risk mitigation strategies are, and how the possible
    benefits of the research compare to the possible harms.

Application Process

Apply HERE not later than 30th June 2024, by 5pm EAT. Applicants are required to provide a
recommendation/support letter from their supervisors or heads of department.

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