i 

 

SCHOOL OF PUBLIC HEALTH, COLLEGE OF 

HEALTH SCIENCES, UNIVERSITY OF 

GHANA, LEGON 

 

 

 

 ASSESSMENT OF HEALTH RISKS 

ASSOCIATED WITH WASTE HANDLING 

AMONG SANITATION WORKERS AT 

PRAMPRAM 

 

 

BY 

 

 

PAULINE MANZA AMICHIA (10395254) 

 

 

THIS DISSERTATION IS SUBMITTED TO 

THE UNIVERSITY OF GHANA, LEGON IN 

PARTIAL FULFILMENT OF THE 

REQUIREMENT FOR THE AWARD OF 

MASTER OF PUBLIC HEALTH DEGREE 

 

 
JULY, 2013 

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DECLARATION 

 
This thesis is composed of my original work. It is the result of an independent 

investigation under the supervision of Dr Mawuli Dzodzomenyo. Where my work is 

indebted to those of others, I have made acknowledgements. I declare that this work has 

not been accepted in substance for any other degree nor is it concurrently being submitted 

in candidature for any other degree. 

 

 

 

 

 

PAULINE MANZA AMICHIA 

MPH CANDIDATE 

 

 

 

 

 

 

DR MAWULI DZODZOMENYO 

ACADEMIC SUPERVISOR 

 

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DEDICATION 

This work is dedicated all Sanitation workers at Prampram, to my family and all those 

who supported me during the course of the project. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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ACKNOWLEDGEMENT 

I would like to acknowledge God Almighty for seeing me through this challenging 

experience. 

My heartfelt gratitude goes out to my supervisor Dr Mawuli Dzodzomenyo for his 

unflinching support and kindness. In the midst of uncertainties and doubt he was there to 

guide me. 

My sincere gratitude also goes to Mr Michael Owusu Antwi for his support and 

encouragement during the entire project. 

 I am thankful to SUSA for providing financial support for this study. I am grateful to Dr. 

Justice Novignon and Dr. Priscilla A Nortey for their useful suggestion and comments 

during the initial stages of this work. 

The invaluable contributions and support of Mr. James Paul Kretchy cannot be over 

emphasized. 

I am thankful to the entire staff of the department of Biological, Environmental, 

Occupational Health especially Miss Hannah Addo for their support and words of 

encouragement. 

The immense contribution of the staff of Prampram Health Center cannot go 

unmentioned especially the records department. 

I cannot adequately thank Mr Gordon Ansah, Mr Ebenezer Ofori Darkwa, for the 

invaluable support given me.  

To all the numerous contributors to this work who have not been mentioned and to the 

respondent in the communities I say a special thank you. 

 

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ABSTRACT 

Introduction 

Waste is produced from households, municipal sources, commercial and industrial 

organizations as well as construction and demolition. Waste can also be produced 

uncontrollably through agriculture, mines and quarries activities. Waste management 

involves lot of activities including sweeping.   

Aim and Methods 

To assess some aspects of the health risks associated with waste handling, a cross- 

sectional study was carried out at Prampram, a peri- urban community a district in the 

Greater Accra Region. 183 sanitation workers were enrolled for the study through the 

snow ball method. A focus group discussion and a structured questionnaire were used to 

interview sanitation workers after obtaining their informed consent. An observational 

checklist was used to observe their usage of personal protective equipment.  

Results  

Almost all the respondents (98.4%) believed that their physical contact with waste was a 

health risk and almost all of them (98.4) claim they cleaned themselves after work. The 

odds of getting higher health risk in those who use PPE before waste handling is reduced 

by 65% (95% CI 0.144, 0.85) as compared to those who do not use PPE before waste 

handling. Those who use PPE during waste handling are 9.59 (95% CI 2.214, 10.492) 

times less  likely to have health risk as compared to those who do not use PPE during 

waste handling. 

 

 

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Recommendations  

These findings suggest that the use of personal protective equipment and perceived health 

risk are associated with an increased risk of having a health outcome. This investigation 

may help reduce the health risk of sanitation workers by providing Personal Protective 

Equipment and education. It may also help in policy making concerning the Sanitation. 

 

 

 

 

 

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TABLE OF CONTENT 

Contents 
DECLARATION .................................................................................................................................. ii 

DEDICATION .................................................................................................................................... iii 

ACKNOWLEDGEMENT .............................................................................................................. iv 

ABSTRACT ......................................................................................................................................... v 

TABLE OF CONTENT ...................................................................................................................... viii 

LIST OF TABLE .................................................................................................................................. xi 

LIST OF FIGURES ............................................................................................................................. xii 

LIST OF ABBREVIATIONS ................................................................................................................xiii 

DEFINITIONS ................................................................................................................................... xiv 

CHAPTER ONE .................................................................................................................................. 1 

1.0 INTRODUCTION .......................................................................................................................... 1 

1.1 Background ............................................................................................................................ 1 

1.2 The Conceptual framework of the study ............................................................................... 4 

1.3  Problem Statement ............................................................................................................... 5 

1.4 Justification ............................................................................................................................ 7 

1.5 Objectives .............................................................................................................................. 9 

CHAPTER TWO ................................................................................................................................. 9 

2.0 LITERATURE REVIEW ................................................................................................................ 10 

2.1  Waste and its Management ................................................................................................ 10 

2.2 Hazardous substances involved with Waste ........................................................................ 12 

2.3 Health Risks and Perception ................................................................................................ 14 

2.4 The Global Sanitation situation ............................................................................................ 16 

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2.5 Sanitation situation in Africa ................................................................................................ 18 

2.6  Sustainable sanitation ............................................................ Error! Bookmark not defined. 

2.7 Sanitation situation in Ghana............................................................................................... 19 

CHAPTER THREE ............................................................................................................................. 21 

3.0 METHOD ................................................................................................................................... 22 

3.1 Study Area and justification for selection ............................................................................ 22 

3.2 Study Design......................................................................................................................... 24 

3.3 Study population .................................................................................................................. 24 

3.4 Sampling ............................................................................................................................... 24 

3.4.1 Sample Size Determination for Sanitation workers .......................................................... 24 

3.4.2 Sampling Procedure .......................................................................................................... 25 

3.5 Data collection techniques .................................................................................................. 26 

3.5.1 Data collection tools ......................................................................................................... 26 

3.6 Data Processing and Analysis ............................................................................................... 26 

3.7 Quality Control ..................................................................................................................... 27 

3.8 Ethical considerations .......................................................................................................... 28 

3.9 Prestesting ........................................................................................................................... 28 

CHAPTER FOUR .............................................................................................................................. 30 

4.0 RESULTS ................................................................................................................................... 30 

4.1 Background, Socio-demographic Characteristics of the Study Participant ......................... 30 

4.2 Experiences of sanitation workers ....................................................................................... 32 

4.2.1 Daily routines .................................................................................................................... 34 

4.2.2 Challenges ......................................................................................................................... 35 

4.2.3 Motivation......................................................................................................................... 38 

4.3.1 Type of PPE ....................................................................................................................... 43 

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4.3.2 Use of PPE ......................................................................................................................... 43 

4.3.3 Inconveniencies ................................................................................................................ 45 

4.4 Perceived health risk of sanitation Workers ........................................................................ 47 

4.4.1 Health risk ......................................................................................................................... 49 

4.4.2 Behavior of sanitation workers ......................................................................................... 50 

4.4.3 Helming infection .............................................................................................................. 51 

CHAPTER FIVE ................................................................................................................................ 55 

5.0 DISCUSSION .............................................................................................................................. 55 

6.0 CONCLUSION AND RECOMMENDATIONS ................................................................................ 60 

6.1 Conclusions .......................................................................................................................... 60 

6.2 Recommendations ............................................................................................................... 61 

REFERENCES ................................................................................................................................... 62 

APPENDICES ................................................................................................................................... 66 

Appendix 1: Sample Informed Consent Form ............................................................................ 66 

Appendix 2: Focus Group Guide ................................................................................................ 68 

Appendix 3: Questionnaire ........................................................................................................ 68 

Appendix 4: Observational Checklist ......................................................................................... 73 

 

 

 

 

 
 

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LIST OF TABLE 

 

Table 1: Demographic Characteristics of waste handlers in Prampram  

 

Table 2: Experiences of Sanitation Workers at Prampram 

 

Table 3: Personal Protective Equipment 

 

Table 4: Knowledge on Personal Protective Equipment 

 

Table 5: Perceived Health Risk associated with waste handling 

 

Table 6: Bivariate analysis of health risk associated with waste handling personal 

protective equipments and health risk as the dependent variable 

 

Table 7: Results of Multiple Logistic Regression of when do respondents wear  

 

 

 

 

 

 

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LIST OF FIGURES 
 

Figure 1: The conceptual framework of the study 

Figure 2: Study Area Comprising Four Townships (SUSA-Ghana)  

Figure 3:  A graph showing the frequency of the various signs and symptoms. 

 

 

 

 

 

 

 

 

 

 

 

 

 

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LIST OF ABBREVIATIONS 

DHRC                   Dodowa Health Research Centre 

DSS                        Demographic Surveillance System  

IWM           Integrated Waste Management 

JMP              Joint Monitoring Programme 

MDG                   Millennium Development Goals 

PAH                  Polycyclic Aromatic Hydrocarbons 

PCB                    Polychlorinated biphenyls 

PM10                      Airborne Particulate Matter 

PPE                    Personal Protective Equipment  

SUSA                 Sustainable Urban Sanitation 

UK                       United Kingdom 

UNICEF               United Nations Children‟s Emergency Fund 

SO2                              Sulfur Dioxide 

WHO                    World Health Organization 

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DEFINITIONS 

Experience: This refers to what waste handlers through, the hardship they face and 

stigmatization. 

Hazards: any source of potential damage, harm or adverse health effects on something or 

someone under certain conditions at work. 

Health: It is a state of complete physical, mental and social well-being and not merely 

the absence of disease or infirmity‟ (WHO, 1948). 

Improved Sanitation: This refers to the proportion of a population with access to 

facilities that hygienically separates human faeces from human contact. 

Peri-urban:  The transition zone or interaction zone, where urban and rural activities are 

juxtaposed, and landscape features are subject to rapid modifications, induced by 

anthropogenic activity. 

Risk: A situation involving exposure to danger. 

Sustainable sanitation: Sustainable sanitation is one that integrates reliable sanitation 

services with change in sanitation behaviour, whilst raising public awareness of its 

significance. 

Sanitation: According to the joint UNICEF WHO report 2008, sanitation generally 

refers to the provision of facilities and services for the safe disposal of human urine and 

faeces. 

Solid Waste: This refers to any waste that is not fluid (gas or liquid waste). Solid waste 

is generally used as a collective term for garbage, refuse, rubbish, or trash. 

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Sanitation Workers: A person employed, as by a municipality or private company, to 

collect and dispose of garbage. 

Waste management: This refers to the process of waste generation, its collection, 

processing, transport, treatment, reuse and disposal (Rushton L. 2003). Waste 

management is important for public health of a people. The potential health risks of waste 

itself and the consequences of inadequate waste management cannot be overemphasized 

in public health research.  

 

 

 

 

 

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CHAPTER ONE 

1.0 INTRODUCTION 

This chapter gives the background of the study. It presents the background to Health risks 

associated with waste handling by Sanitation workers and the experiences they encounter 

in carrying out their work. It follows up with the conceptual framework, the statement of 

the problem, justification for the study and the research objectives in the study. 

 

1.1 Background  

Sustainable sanitation and waste management are prerequisites for a healthy environment 

and an ultimate requirement for the development of a people, especially in urban and 

Peri-urban poor areas. (Sigauke, 2002) 

Waste is produced from households (municipal solid waste), commercial and industrial 

organizations.(Rushton, 2003) Waste can also be produced uncontrollably through 

agriculture, mines and quarries activities and human beings.  

 Municipal solid waste (MSW) consists of a plethora of things including food and garden 

waste, human waste, paper and cardboard, glass, metals, plastics and textiles. 

Commercial and industrial organizations also produce these things in addition to large 

volumes of chemical and mineral waste depending on the sector. Agricultural waste 

primarily consists of slurry and farmyard manure among others like silage effluent.  Most 

of these waste substances spread on land and are hazardous due to their inherent 

characteristics. (Rushton, 2003) 

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The disposal of wastes has caused concern about possible adverse health effects for 

populations particularly in relation to areas where hazardous waste is deposited. 

Substances, such as cadmium, arsenic, chromium, nickel, dioxins and PAHs are 

considered to be carcinogenic, based on animal studies or studies of people exposed to 

high levels.(Baudouin, Charveron, Tarroux, & Gall, 2002) Evidence that these substances 

cause cancer at environmental levels, however, is often absent. In addition to 

carcinogenicity, many of these substances can produce other toxic effects (depending on 

exposure level and duration) on the central nervous system, liver, kidneys, heart, lungs, 

skin and reproductive system. Hazardous waste substances have been revealed to 

influence the likelihood of developing lung, brain and lung cancer (Dolk et al., 1998). 

For other pollutants such as SO2 and PM10, air pollution studies have indicated that there 

may be effects on morbidity and mortality at background levels of exposure, particularly 

in susceptible groups such as the elderly. Chemicals such as dioxins and organochlorines 

may be lipophilic and accumulate in fat-rich tissues and have been associated with 

reproductive or endocrine-disrupting endpoints.(stevanovic–carapina et al.) 

Waste management involves use of personnel who actively participate in sweeping, 

collection and disposal. A sanitation worker is an employee hired by a public or private 

enterprise to collect and remove refuse and recyclables from residential, commercial, 

industrial or other collection site for further processing and disposal. These individuals 

are exposed to a lot of health hazards in undertaking their activities. They face many 

hardships including stigma, exploitation by middlemen, hazardous working and living 

conditions. (Gauley, 1999) 

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http://en.wikipedia.org/wiki/Waste
http://en.wikipedia.org/wiki/Recycling
http://en.wikipedia.org/wiki/Disposal


3 

 

Handling of waste involves a lot of activities like bending and other activities. One is 

therefore exposed to a lot of ergonomic hazards. Working without the use of personal 

protective equipment allows a direct contact of the individual to waste.  

Some factors that could help in the proper handling of waste include Engineering 

Controls, Administrative Control and Personal Protective Equipment. Engineering 

Controls involves the use of process change, substitution, isolation, ventilation, and 

source modification in order to control worker exposures by reducing the quantity of 

contaminants released into the work space. Administrative Controls includes 

management involvement, training, job rotation, reduction of exposure time, 

preventive/predictive maintenance in an effort to control worker exposures. Personal 

Protective Equipment (PPE) involves the use of devices like gloves, body, eye, face, ear 

protection, respirators designed to protect individuals from hazards in the workplace. 

 

Hazardous waste substances have been revealed to influence the likelihood of sanitation 

workers developing lung, brain and lung cancer (Dolk et al., 1998). Studies have also 

revealed that workers involved with waste handling may have more gastrointestinal 

symptoms, irritation of the skin, eye and throat, respiratory disorders including organic 

dust toxic syndrome (ODTS; toxic pneumonitis) than in other occupations (Poulsen et al., 

1995).  

Helminthiasis is globally caused by worms of different kinds.  Helminthiasis is prevalent 

in developing countries specifically in areas where sanitation is low. Eggs of Helminth   

are the infective agents when they are released in the environment in faeces.  They cause 

diseases when they are ingested through the faeco-oral route. The improper disposal and 

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handling of waste, sludge and faecal sludge(Hays, 1977) pollutes water and food and in 

effect causes disease.  

Other possible health outcomes due to helminth infections are fatigue, headaches, 

psychological problems, musculoskeletal pan, infections and allergies. Proper handling of 

waste prevents a lot of health conditions associated with waste handling. It is therefore 

very important that personal protective equipments are being used as much as possible 

and appropriately to avoid personal contact with waste materials. 

The use of Personal Protective Equipment is very important in order to minimize the 

impact of hazards associated with waste handling (Salkin & Kennedy, 2001).  Items of 

Personal Protective Equipment include helmets (with or without visors), respiratory face 

masks, eye protectors, overalls (usually disposable), industrial aprons, leg protectors or 

industrial Wellington boots, disposable gloves and/or heavy duty gloves.  

 

1.2 The Conceptual framework of the study 

Waste management involves the collection, transport, processing or disposal, managing 

and monitoring of waste materials. Waste management practices are different for various 

countries; for urban, peri-urban and rural areas. In Prampram waste management involves 

sweeping, collection, processing, transport and disposal. Waste is not sorted out into 

hazardous and non-hazardous and so poses a health threat to sanitation workers. There 

are a lot of health effects from inhaling, ingestion or dermal contact of these waste 

materials. A few of these effects are musculoskeletal disease, respiratory symptoms, 

allergies and risk perception. 

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http://en.wikipedia.org/wiki/Waste_collection
http://en.wikipedia.org/wiki/Transport
http://en.wikipedia.org/wiki/Waste_treatment
http://en.wikipedia.org/wiki/Waste
http://en.wikipedia.org/wiki/Urban_area
http://en.wikipedia.org/wiki/Rural_area


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Figure 1: The conceptual framework of the study 

SW- Sanitation Worker CT- Collection and Transport  P- Processing 

T- Treatment D- Disposal I- Inhalation I2 – Ingestion   DC- Dermal Contact 

 

1.3 Problem Statement 

Waste is generated at household and other localities. Since consequences exist for any 

household, community or institution where waste is not collected, attempts are made to 

collect, transport and dispose of waste. Waste handlers therefore are a group of workers 

tasked with the duty to collect waste. Collection of fecal waste is limited due to poor 

urban planning in the township, which limits the access of large trucks. There is no 

 

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facility for fecal waste treatment and no known reuse in the township. Human waste is 

highly intermingled with solid waste, which is indiscriminately dumped at the beach or in 

the bush. (SUSA baseline 2011) Collectors are exposed to physical waste, other exposure 

including helminthes infection etc.  

 These materials may be risky and may lead to some health hazards. A large proportion of 

households in the Prampram community, (77%) have no toilet facility therefore use the 

bush, beach or field for open defecation (SUSA baseline 2011). Garbage is haphazardly 

disposed off in public areas and most of the people defaecate in bushes, beaches and 

other areas. These practices expose those engaged in waste handling to risk associated 

with waste.(Zerbock, 2003) 

In addition, individuals who are occupationally involved in waste management often use 

technologically outmoded or unsafe means of waste handling. In other cases the options 

for waste management is either completely absent, too expensive to purchase or in poor 

condition. Such conditions may compromise the health of persons directly involved in the 

management of waste in the communities as a whole.  

Social status of solid waste management workers is generally low in both developed and 

developing countries, but more so in developing countries then developed 

countries.(Wilson, Velis, & Cheeseman, 2006) This owes much to a negative perception 

of people regarding the work which involves the handling of waste or unwanted material. 

Such people's perception leads to the disrespect for the work and in turn produces low 

working ethics of laborers and poor quality of their work. 

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There is available information on occupational health risks faced by waste handlers in 

North America (Rendleman and Feldstein, 1997) and Brazil (Porta et al., 2004). Though 

there is some information on the prevalence of neck, wrist and back pain among 

professional solid waste collectors in Ghana (personal communication, 2011), none of 

these assessed their experiences and perception about health risks associated with waste 

collection and management and also the use of Personal Protective Equipment (PPE). 

This may be due to the fact most of the Sanitation workers are not aware of the risk of 

exposure to waste.  In view of this, not much intervention has been implemented in the 

control of risks to sanitation workers. 

This evidence-based study therefore seeks to assess the experiences and perception of 

risk of exposure to waste among sanitation workers in peri-urban community of 

Prampram. It also seeks to provide additional information on the waste handlers‟ use of 

protective equipment as a way of controlling the impact of exposure to waste.  

1.4 Justification 

Studies on waste management workers may aid in solving the issues of waste 

management. The work of waste collectors involves considerable heavy lifting as well as 

other manual handling of containers. There is also an increased risk of direct contact with 

waste thereby increasing the risk of musculoskeletal problems and other waste related 

infections.  

It has been suggested that increased exposure to bio-aerosols and volatile compounds 

may lead to elevated incidence of work-related respiratory gastrointestinal and skin 

problems in waste collections compared to the general workforce.  

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For these reasons, it is important to seek information on local experience and perception 

of waste handlers with the aim of understanding their own experience and perception of 

health risks in relation to their occupation. This information will help recommend 

specific public health interventions to address specific occupational health needs of 

persons engaged in waste management.  

It has been established elsewhere that the relationship between perceived magnitudes of 

occupational health risks in persons engaged in waste management is likely to be 

influenced by culture and behaviour, level of development of waste management 

technology within a community and level of education (Agbola, 1993;(Gutberlet & 

Baeder, 2008)).  

Even though magnitude of occupational health risk may be attributed to one‟s own 

behaviour, it is often perceived that occupational risk is unavoidable (Mutha et al., 1999). 

Notwithstanding this, the exact magnitude or prevalence of risk factors or generalization 

of findings to other locations cannot be established (Inui, 1996), quantitative and 

qualitative research methods can provide information about perceptions of occupational 

health risks to persons engaged in waste management. 

 Issues to be explored about experience and perception of occupational health risks 

among waste handlers will include, but not limited to perception about physical health, 

perception about risk of exposure to occupational hazards, perception of personal 

protection from occupational health risks as well as access to sanitation. 

 

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1.5 Objectives 

1.5.1 The Main Objectives 

The main objective of this study was to determine the health risks due to physical 

exposure to waste material among sanitation workers. 

1.5.2 Specific Objectives 

1. To describe the experiences of sanitation workers in handling waste. 

2. To determine the use of personal protective equipment among sanitation workers.  

3. To assess the perceived health risk of waste managers.  

 

 

 

 

 

 

 

 

 

 

 

 

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CHAPTER TWO 

2.0 LITERATURE REVIEW 

This chapter presents important literature on sanitation and waste management taking 

into consideration the objectives of the study. The review touches on the global sanitation 

situation, sanitation situation in Africa and in Ghana. It also reviewed what sustainable 

sanitation is, waste and its management and finally the health risk and perceptions of 

sanitation workers.  

2.1 Waste and its Management 

According to the UK Environment Agency, Waste may be classified as either controlled 

waste or non-controlled waste. Controlled waste includes waste generated from 

households (municipal solid waste), commercial and industrial organizations and from 

construction and demolition. Non-controlled waste includes waste generated from 

agriculture, mines and quarries and from dredging operations.  

Based on an estimated population of 24,658,823 and an average daily waste generation 

per capita of 0.45 kg, Ghana generates annually about 3.0 million tons of solid waste. 

Accra, the capital, and Kumasi, the second city, with a combined population of about 4 

million and a floating population of about 2.5 million generate over 3,000 tons of solid 

waste daily. In response to the global mandate for environmentally sound management of 

hazardous, solid and radioactive waste, Ghana has among other things, embarked on a 

life cycle approach to address chemicals and other hazardous wastes management in an 

integrated manner.  

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This involves a broad range stakeholder institutions and organizations including non-

governmental organizations. It is in this light that we need to address issues in relation to 

sanitation workers to help increase their work performance and thus an increase in waste 

management.  

Waste management includes the process of waste generation, its collection, processing, 

transport, treatment, reuse and disposal (Rushton L. 2003).  Waste management systems 

evolved from basic practices designed to protect human health and are now becoming 

more sophisticated and geared towards environmental protection. With the drive in recent 

years towards sustainable development, the need to seek environmental, economic and 

social perspectives to waste management has led to the wider use of IWM. The next step 

is to integrate more fully the management of resources and waste to achieve truly 

sustainable waste management systems. 

There is a central sewage system but much of the population is not connected to it 

because of high connection charges; an estimate in 1985 suggested that only 30 percent 

of the population was connected. New residential areas often use septic tanks for 

sanitation, while in other unconnected areas pan or bucket latrines are used, with their 

contents emptied into night soil containers provided by the city council. These are then 

emptied at a shoreline tipping station. In many poor settlements, there are very few public 

or private sanitation facilities, even in settlements with many thousand households.  

The city‟s open drainage system collects surface runoff, domestic discharges (other than 

sewage), and some industrial discharges (often illegally), and in some areas may also 

(unofficially) receive waste from latrines. 

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The environmental effects of such a quantity certainly would impress upon decision-

makers the need to re-examine the sanitation system on hand. 

Although Ghana has made some progress in the past 10 years of the MDG 

implementation, challenges of inequalities, geographical disparities and sustaining the 

progress still remain. With only 4 years remaining to the MDG deadline, Ghana will have 

to accelerate its efforts towards the achievement of all the MDGs especially those that the 

country if „off-tract in achieving such as MDG target 7c – improving access to basic 

sanitation (MAF – Country Action Plan for Sanitation report, 2011). 

Many residents of low-income urban and rural areas lack access to basic sanitation and 

many more have no access to any kind of facility and practice open defecation. If current 

trends continue, it is estimated that the MDGs target related to sanitation will not be met 

in Ghana until 2100 or beyond. Investing in water and sanitation improves health and 

reduces health care costs, improves productivity and increases the return on investments 

in education (MAF – Country Action Plan for Sanitation report, 2011). 

Sanitation related diseases are one of the most common diseases affecting people in 

developing countries, such as Ghana, resulting in public health problems.  

2.2 Hazardous substances involved with Waste 

A lot of studies has been done on the origins of hazardous substances emanating from 

waste of hence a great deal is known about the types and amount of substances from 

waste. Whichever way waste is being  managed, it is generally believed  that  there are 

usually a large number of different substances and only a few of these are produced in 

any quantity with many being at extremely low levels (Johnson BL, DeRosa CT,1997).  

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Gases emitted from landfill sites, for example, consist principally of methane and carbon 

dioxide, with other gases, such as hydrogen sulphide and mercury vapour being emitted 

at low concentrations, and a mixture of volatile organic compounds (VOCs) comprising 

approximately 0.5% (Zmirou et al 1994).  

Waste incineration also produces a large number of pollutants from the combustion of 

waste, which can be grouped as particles and gases, metals, and organic compounds 

(Harrad ,& Harrison, 1996). 

 According to the Institute of Environmental and Health UK, ten pollutants are known to 

have the greatest potential impact on human health based on environmental persistence, 

bioaccumulation and amount emitted and/or on inherent toxicity. These pollutants are 

cadmium, mercury, arsenic, chromium, nickel and dioxins, PCBs, PAHs, PM10 and SO2. 

Microbial pathogens are a potential source of hazard, particularly in composting and 

sewage treatment but also in landfill. Dust and the production of particulate matter are 

produced in landfill, incineration and composting processes and by road traffic involved 

in all waste management options. Less easily quantifiable hazards, which might 

nevertheless impact on the population near a waste disposal site, include odours, litter, 

noise, heavy traffic, flies and birds.  

A WHO exposure assessment expert group suggested that priority pollutants should be 

defined on the basis of toxicity, environmental persistence and mobility, bioaccumulation 

and other hazards such as explositivity. 

 

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2.3 Health Risks and Perception 

At the various levels of waste handling e.g. picking, weeding, sweeping, burning, 

cleaning, sorting, collection, transportation, disposal, recycle or reuse, there usually exist 

risks that threaten the health of handlers. Frequently it is the manner in which the waste is 

mixed with faecal matter coupled with strenuous body movements and use of waste 

equipments that dictate health risks to waste handlers.  

Health hazards control has become more difficult and complex, necessitating the 

anticipation of hazards during the development of facilities, processes and products. 

There are a lot of literatures on the potential adverse health effects of different waste 

management. A wide range of toxic substances can be released into the environment from 

waste disposal sites.  A lot of research has focused on the health of the general population 

especially people near a waste disposal site, occupational health problems of sanitation 

workers are also important to consider. Many people either over or under-estimate health 

risks associated with particular occupation, usually as a result of lack of information or 

understanding regarding that occupation (Tate et al., 2003). The ultimate ways to 

organise and empower waste handlers is to assess their health risk and educate them on 

practical ways to work effectively. There is however a growing consensus that local 

experience, perceptions and indigenous knowledge should be important elements in 

evaluation of programs aimed at improving public health (Tate et al., 2003). There is a 

large workforce employed in waste collection, sorting and disposal. Workers may be 

exposed to the same potential hazards as the general population, although the amount of 

exposure and risk may differ. The type of work varies between waste management 

options with some, such as landfill and incineration, being more automated than others, 

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such as waste collection, sorting and recycling. The incidence of occupational accidents 

in waste collection workers has been found to be higher than the general workforce. 

(Poulsen et al, 1995)  

The World Health Organization (WHO) estimates that 7% of the world‟s deaths and 8% 

of the global disease burden is caused by diseases related to unsafe sanitation (WHO, 

2008). It is estimated that 80% burden of sickness of the world can be traced to poor 

sanitation and hygiene (Talbot, 2005). The improper handling and disposal of waste 

frequently cause microbial diseases and contamination, particularly in locations with no 

or inadequate infrastructure to properly handle waste.  

While the type of sanitation facilities does have an impact on health, there are many other 

factors related to sanitation that have much greater impacts on health. The containment of 

faeces (e.g., whether or not there is open defecation in the neighborhood) and the number 

of households sharing sanitation facilities have been both found to exhibit higher 

correlations with illness than sanitation technologies used (Benneh 1993; Greed 2006). 

Each year about 5 billion cases of diarrhoea occur in developing countries, responsible 

for 16% of the deaths among children under five years of age in sub-Saharan Africa 

(WHO, 2009). Sanitation experts explain that improved sanitation has a direct positive 

effect in reducing morbidity due to diarrhoea. Watkins (2006) suggest that just by 

providing access to toilet facilities the global risk of diarrhoea could be reduced by 50% 

if each household uses flush toilet or by 30% if pit latrines are used.  “Still progress in 

improving sanitation for almost half the world‟s population remains slow and diarrhoea 

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from unsafe water, sanitation and lack of hygiene causes 1.8 million deaths per year, 90 

% of which are children under 5 years age” (SIWI, 2005).  

Agbola (1993) and Gutberlet (2008) have established that the relationship between 

perceived magnitudes of occupational health risks in waste handlers is likely to be 

influenced by culture and behaviour, level of development of waste management 

technology within a community, and level of education.  

Occupational health risk may be attributed to one‟s own behaviour; others perceive that 

occupational risks are unavoidable (Mutha et al., 1999). Specific issues that need to be 

explored about experience and perception of health risks among waste handlers in 

Prampram include, but not limited to perception and experience about physical health, 

exposure and personal protection from health risks as well as access to sanitation and 

hygiene facilities. It is also imperative that indigenous experience and perceptions about 

waste handling should be incorporated in evaluation of programs aimed at reducing 

health risks and improving public health (Tate et al., 2003). 

 

 2.4 The Global Sanitation situation 

Even though the Millennium Development Goals (MDGs) has its goal number seven to 

ensure environmental sustainability and to halve the proportion of people without access 

to basic sanitation, global access to basic sanitation is still not sufficient to achieve the 

target by 2015 (JMP, 2008; JMP, 2010). The lack of access to basic sanitation, globally, 

rose from 2.1 billion in 2004 to 2.6 billion, a situation which has not seen much 

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improvement since then (JMP, 2010). About 1.1 billion people around the globe still 

practice open defecation. The WHO reports that whilst 62% of the global populations 

have access to improved sanitation, the lowest rates of access to improved sanitation are 

found in Southern Asia (33%) and Sub-Saharan Africa (31%) (WHO, 2009).  

Though improved sanitation is generally increasing across the globe due to increased 

awareness creation, more than one third of the global populations still lack access to 

improved sanitation (WHO/UNICEF JMP, 2010). The coverage of improved sanitation 

varies widely in different countries. The national coverage of improved sanitation in 

Nepal is about 30%, whilst that in Uganda, Malawi and Sri Lanka is 48%, 56%, and 91% 

respectively. Meanwhile it has been reported that with this current low rates of improved 

sanitation coverage, the MDG target on sanitation will not be met globally until 2049 

(WHO/UNICEF/JMP, 2010).  

Improved sanitation is widely acknowledged to be an essential foundation for better 

health, welfare and economic productivity. Nevertheless in Africa and other developing 

countries with high poverty levels, about half of the populations do not have access to 

basic toilet facilities (WHO/UNICEF/JMP, 2010). Therefore the progress to improve 

health and reduce the burden of sanitation related diseases, in Africa and other 

developing countries remains slow. Globally, the insufficient sanitation problem coupled 

with poor personal hygiene contributes to an estimated 2.2 million annual deaths related 

to these essential services.  

The World Health Organization report on World Health and MDG (WHO, 2010) showed 

that, health implications due to poor sanitation facilities are considered very serious. The 

same report estimated that in 2008 over 2.5 billion people were not using proper 

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sanitation facilities resulting in high level of environmental contamination and exposure 

to risks of microbial infections. Death caused by non-communicable diseases or injuries 

in developing countries totaled in 2004 to 33 million. The absence of adequate healthcare 

systems will still adversely affect the public health conditions. Health problems caused 

by poor hygienic and sanitation conditions require improving and upgrading 

infrastructure for waste management and introducing the integrated management 

approaches. 

2.5 Sanitation situation in Africa 

About 62% of the African population lack access to improved sanitation 

facilities.(Kirigia et al., 2009). Of the 54 African countries, only five 5 are on track to 

meet the MDG target for sanitation(Bryce et al., 2006) . It is estimated that for Africa to 

meet its MDG target for sanitation, the number of persons reached with sanitation 

facilities must double from 350 million to 700 million by 2015(van der Hoek et al. 2010). 

Even if this is achieved, about 200 million people will still be left without sanitation 

facilities.  

Even countries in Africa, whose sanitation programmes are being supported by European 

countries such as Denmark still have relatively low coverages;,  Benin (19%), Burkina 

Faso (10%), Niger (5%), Ghana (31%), Kenya (43%), Uganda (58%) and Zambia (13%) 

still have low sanitation coverage(van der Hoek et al., 2010).  (Salifu and Doyen, 2001) 

state that in Africa rapid urbanization is largely taking place through the expansion of 

informal and peri–urban settlements.  

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Whilst urbanization is not a new phenomenon in Africa, the current rate of uncontrolled 

and unplanned urbanization in Africa has given rise to a huge amount of liquid and solid 

wastes being produced, so much so that these wastes have long outstripped the capacity 

of city authorities to collect and dispose of them safely and efficiently ((Porter et al., 

1997):(Demanya, 2006):(Wetherall et al., 2003)).  

This rapid urbanization in African countries and by the same logic, a rapid accumulation 

of garbage has been likened to “a monster that has aborted most efforts made by city 

authorities, urban planners, states and federal governments”, to manage or at least contain 

it (Onibokun & Kumuyi, 1999). Nevertheless, if waste is poorly managed it becomes a 

danger to health, a nuisance, and possibly a major social problem. The problem of 

wastewater disposal is serious in most of sub-Saharan countries. Currently thousands of 

tonnes of untreated faecal sludge are improperly disposed into open urban and rural 

spaces(Vodounhessi, 2006).  

2.6 Sanitation situation in Ghana 

According to the UN report, Southern Asia has made some progress in attaining some 

Millennium Development Goals (MDGs). Eastern Asia and South-Eastern Asia have met 

most of the MDG targets. Individual African countries are trying to attain many of the targets 

and a growing group of countries such as Ethiopia, Rwanda, Uganda, Tanzania, Burkina Faso 

Malawi and Ghana are making significant progress towards multiple goals. 

Sanitation in Ghana is poor and statistics on access to improved sanitation by the 

population is conflicting. The MDG mid-term assessment report in 2002 estimates 58% 

access by Ghanaians to improved sanitation, whilst WHO/UNICEF Joint Monitoring 

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Programme (JMP), 2006, estimates only 18%. This disparity is attributed to the fact that 

large percentage of Ghanaians use shared toilet facilities (WHO/UNICEF, 2004).  

Since the criteria for improved sanitation exclude use of shared facilities, the percentage 

of Ghanaians with access to improved sanitation substantially reduced. The Ghana 

Demographic and Health Survey (Ghana Statistical Service, 2003) reports that 78.5% of 

urban Ghanaians share sanitation facilities with at least one other household. However, 

for Ghana to achieve its MDGs for sanitation, the number of people who use shared 

facilities will have to decrease significantly. Currently, Ghana is not on course for 

attaining the MDG for sanitation. In order for the country to attain this, it has to raise its 

national sanitation coverage from 18% as at 2006 to 54% by 2015 (WHO/UNICEF, 

2010). 

 Solid waste collection services cover less than 20 percent of residents and much garbage 

is dumped in open heaps or open drainage channels. It is left unattended to and in effect 

they become hazardous. Only 30 percent of the population in Accra are connected to the 

central sewage system.(Economic Commission for Africa, 1996). Most urban households 

especially slum dwellers depend on public latrines where they are face with long queues 

and unhygienic conditions.  

Another sanitation situation faced in Ghana is defecation in the open. This situation is 

common, especially in rural and peri-urban communities of Ghana. Though the 

percentage of people engaged in this act reduced by 25%, a large percentage of the 

population still practices open defecation (WHO/UNICEF, 2008). Lack of access to 

public toilets is the number one reason cited for open defecation in Ghana (Benneh et al., 

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1993). It was against this background that the CLTS Concept was introduced, with the 

aim of creating awareness of the negative impact of open defecation and stimulates 

communities enough to make them change their behaviour towards the practice. 

 Notwithstanding some communities in Ghana have been declared Open Defecation Free 

(ODF) by various Regional and/or District Environmental Health Directorates, several 

others including Prampram are still noted for open defecation practices.  

The main problems regarding sanitation in Ghana are the deficient government financial 

support in this area and that the attention has gone from preventive to remedial 

approaches. The lack of funding, education and planning is responsible for the growing 

propagation of waterborne diseases, with children being the most affected part of the 

population.  

Also, the lack of law enforcement has led to the improper disposal of human waste 

generated in public toilets and to the use of drain water and untreated faecal sludge for 

irrigation and cultivation (United Nations Department of Economic and Social Affairs – 

UNDESA, 2004;(Tettey-Lowor, 2008)). The wastewater disposal and treatment 

infrastructure is not sufficient to cope with the amount of human excreta generated within 

the cities, which has lead to heavy contamination of open spaces (Boadi & Kuitunen, 

2003). 

 

                                                                                                                                           
 

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CHAPTER THREE 

3.0 METHOD 

This chapter presents the method of the study. It includes the following areas; the study 

site, the study design, study population, sample size and sampling procedure, data 

collection and ethical issues. Data management, analysis and quality assurance is also 

included. 

3.1 Study Area and justification for selection 

The study was carried at Prampram, the district capital of the Dangme West of the 

Greater Accra Region of Ghana. It is located in the east of Accra, Ghana‟s capital. 

PramPram township is the largest community in the Dangme West District. As a coastal 

community, the primary occupations of the people are fishing and fish selling, but  there 

are also small farmers and artisans.   

The District Assembly serves as the local government authority in collaboration other 

Ministries Departments and Agencies (MDA) like the District Health Directorate and the 

Dodowa Health Research Centre.  The community has three health centres and a district 

hospital is located in Dodowa, the District Capital, and a 45 minute drive away. This 

locality was picked for several reasons. This rural area has seen a very rapid rate of 

urbanization over the last 10 years. This is as a primary result of industrialization. Ghana 

has seen an increase in the economy which is projected in industries. The Tema Industrial 

Area, barely 30 minutes from the capital, Accra, is home to one of Ghana‟s main harbors, 

several industrial plants and the import/export industry. The increased need for skilled 

workers in these areas led to an influx of young blue-collar workers. The inability to 

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reside in the Tema and Accra municipality due to high cost of living and over population, 

many have settled on the outskirt communities, of which Prampram is one. This provides 

a low cost of living, while enabling the opportunity for many to participate in building the 

economy.  

 

Fig.2 Study Area Comprising Four Townships (SUSA-Ghana)  

 

Another reason for selecting Prampram is its present participation in the DRCH‟s DSS. 

Being part of the catchment area for the DSS, a bi-annual demographic socio-economic 

data is collected. This provides existing and current data to utilize in determining criteria 

for selecting townships. Finally, sanitation workers from the four townships selected are 

truly reflective of the entire sanitation workers. Four out of ten townships were selected for 

the project, Kley, Lower East, Lower West and Olowey. 

  

 

 

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3.2 Study Design 

The study design was cross-sectional in nature. A mixed method was used in gathering 

data to achieve the objectives of the study. This study provide a snapshot of the frequency 

and characteristics of the health risk among the Sanitation workers at a particular point in 

time. Data on their experience, the use personal protective equipment and their health risk 

were obtained from the study subjects one at a time. Background information such as age, 

sex, marital status, level of education, occupation, religion etc was obtained.  

 

3.3 Study population 

The study population included sanitation workers employed by Waste Management 

Companies in Prampram, working in the four townships namely Kley, Olowe, Lower 

East and Lower West of Prampram. Respective respondent in charge of sanitation 

workers in Prampram were also interviewed. 

 

3.4 Sampling 

3.4.1 Sample Size Determination for Sanitation workers 

The sample size for the study was calculated using the following formula:  

   

n =    Z
2
 x PQ 

     _________ 

            d
2 

Where:  

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n = desired sample size  

Z = the standard normal deviation, set at α = 0.05 based on a 95% confidence level 

P = the estimated proportion of sanitation workers. As a rule of thumb 0.5 will be 

used since this estimate is not available in literature.  

Q = 1 - P  

d = the allowable error = 0.05  

      Therefore n is 384 

But S = n / (1 + n / population) 

       S = 384 / (1+ 384 / 320) 

       S = 174.5 

Therefore a minimum of 175 sanitation workers were to be allowed for the estimation of 

the health risk associated with waste handling. A 9.5% was added for non-response 

making the total number of 183 waste handlers. 

 

3.4.2 Sampling Procedure 

The number of sanitation workers was obtained from the Waste Management Companies 

operating in Prampram. After compiling a list of all workers, the respondents for the 

quantitative study were purposively sampled after an initial assessment of their level of 

exposure. Respondent for the focus group discussion were sampled using the snow ball 

method. 

 

  

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3.5 Data collection techniques 

A structured questionnaire with both open and close-ended questions was developed to 

gather quantitative data from the selected waste workers. After getting approval from the 

participants through informed consent, the research assistants administered the questions 

to the respondents, one at a time, face to face and in their preferred language.. For the 

qualitative aspect of the study, a focus group guide was developed for the focus group 

discussions for female and male sanitation workers at Prampram. An observational check 

list was used to gather data on waste management practices, experience and preferences 

from Sanitation workers. Their health history was also taken at the Prampram Health 

Center to check if sanitation workers were reporting to the hospital with conditions 

relating to the sanitation work. 

3.5.1 Data collection tools 

Tools which were employed in the collection of the data included observational checklist, 

structured questionnaires, in depths interview guide and a focus group guide. 

3.6 Data Processing and Analysis 

 Data collected from the field in the form of answered questionnaires and checklists were 

stored in files whilst awaiting analysis. Computer software Statistical Package for Social 

Science (SPSS) version 16.0 and an Excel page was used for the data entry and analysis. 

The data from the questionnaire were coded and fed into the computer for onward 

analysis based on the study objectives and the main study variables. 

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Data from the focus group guide was analysed using a thematic network analysis. The 

data were grouped into basic themes, organizing themes and global themes. The global 

themes were formed by considering certain organizing themes, which best describe them 

under that theme. Further, under each global theme, the codes were grouped under 

common organizing themes that describe them and are related to the global theme.  

 

3.7 Quality Control  

 The following steps were taken to ensure the quality and validity of the data. 

 The research assistants were recruited from people with health background and given 

adequate training. The content of the training included the purpose and objectives of 

the study, data collection techniques and tools to be used, translation of 

questionnaires into the various local dialects, actual data collection and ethical issues 

or considerations. 

 The principal Investigator was part of the team during the interviews to ensure that 

the relevant information was collected. 

 Questionnaires returned were checked for mistakes and completeness. Errors and 

omissions detected were discussed with the respective assistants and asked to go back 

and make the necessary corrections. 

 All data collected were entered twice by two different qualified personnel to ensure 

validity 

  

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3.8 Ethical considerations 

 Ethical clearance was sought from the Ghana Health Service Ethical Review Board.  

The study subjects were adult heads of households or their representatives. Written 

informed consent was sought from all study subjects and the study was explained to all 

respondents. The potential risks of the project were the respondents‟ time and privacy. 

The study would be beneficial to the participants since information from them will to 

improve on health intervention and promotion activities in the area and also add up to 

existing knowledge. There was compensation for participants. The data collected was 

used for analysis, soft copies were password protected and hard copies stored in locked 

cabinets. Only the researcher had access to the data. Potential study participants were 

made to understand that their participation in the study was entirely voluntary. Their 

decisions not to enter the study, failure to answer any question or termination of the 

interview were respected. The study was funded by the Sustainable Urban Sanitation – 

SUSA Ghana. There were no issues of conflict of interest.  

 

3.9 Prestesting 

Data collection tools and observation checklist were pre-tested at Abia, a neighbouring 

rural community of Prampram for reliability before actual data collection. 20 people were 

used for the pre-testing. 

 

 

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Measured Variable 

The following variables were collected and analyzed as described in the analysis section 

below to meet the objectives of the study. 

Dependent Variable:  

Health Risk – Helminthiases, Musculoskeletal Disease, Respiratory Symptoms, 

Allergies and risk perception. 

  

Independent Variable:  

 Age 

 Sex 

 Level of education 

  Sanitation activity 

 Hours per shift 

 opinion about this job 

 Stigma 

 Waste Handling 

 Perceived Health Risk 

 

 

 

 

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CHAPTER FOUR 

4.0 RESULTS 

This chapter presents the findings of the study. The assessment of the health risk of waste 

handlers among sanitation workers at Prampram was analysed under three major global 

themes, which form the keywords of this study: Experience, Protective personal 

equipment and Health perception.  

 

4.1 Background, Socio-demographic Characteristics of the Study Participant 

Table 1 describes the demographic characteristics of the respondents. In all, 183 

respondents were interviewed. Majority of the respondents were females representing 

about 73.1% and the remaining 27.5% males.  For the age groups of these respondents: 

21.3% were between the ages of 31 to 35, 16.4% between ages 36 to 40, ages 41 to 45 

represented 13.7%, ages 46 to 50 made up 13.1%, 7.7% were between 51 to 55, with the  

remaining 4.4% taken up by respondents who were less than 25 years old. 

Almost half (47.5%) of the respondents  had no education, 27.9% having completed 

Middle School. 24% and 0.5% of the 183 respondents have had Senior Secondary 

Education and Vocational Training respectively. Furthermore, it was realized that about 

three-quarters (71%) of the respondents were married.  

Majority (88%) were Ga – Adangbes, with Ewes making up 10.4% and the remaining 

1.6% being Akans. Almost all respondents were Christians and they represented 91.8% 

of the 183 respondents interviewed. 

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In addition, it was realised that 45.4% of respondents lived in family houses, 35.5% lived 

in the own homes, and 18% and 1.1% lived in rented or shared houses. 

Table 1: Demographic Characteristics of waste handlers in Prampram (N=183) 

Demographic Characteristics Frequency Percent (%) 

Sex     

Male 50 27.5 

Female 133 73.1 

Age     

≤25 8 4.4 

26-30 23 12.6 

31-35 39 21.3 

36-40 30 16.4 

41-45 25 13.7 

46-50 24 13.1 

51-55 14 7.7 

56+ 20 10.9 

Level of education     

Never 87 47.5 

MSLC 51 27.9 

Secondary 44 24.0 

Vocational 1 0.5 

Marital status     

Single 10 5.5 

Married 130 71.0 

Separated/Divorced 14 7.7 

Widowed 29 15.8 

Ethnicity     

Ewe 19 10.4 

Ga/Adangbe 161 88.0 

Akan 3 1.6 

Religion     

Christian 168 91.8 

Muslim 4 2.2 

Traditional  5 2.7 

Other/Specify 6 3.3 

     

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Current residence 

Own home 

Rented 

Family House 

Shared house 

65 

33 

83 

2 

35.5 

18.0 

45.4 

1.1 

    

4.2 Experiences of sanitation workers  

The experiences of sanitation workers are reported in Table 2. When respondents were 

asked their reasons for being involved in sanitation work, majority of them (37.2%) said 

it was for money. 30.4% of the 183 respondents claimed it was due to the lack of other 

available means of employment. It was only 21.3% who loved their involvement is the 

sanitation field. 7.9% and 3.2% of the respondents claimed they did not want to be idle 

and other reasons respectively. 

Moreover, 37.1% were of the opinion that the job was rewarding.  36.7% claimed that 

they were respected, 12.9% believed that they were satisfied with being a sanitation 

worker. However, 7.9% said being a sanitation worker was difficult, 2.9% claimed it was 

unhygienic and 1.8% believed it was embarrassing. Moreover, 94% of the 183 

respondents did not feel bad working with waste 

A whopping number (93.4%) of the 183 respondents interviewed disclosed that they were 

not being stigmatized as a result of their involvement in the sanitation field. Furthermore, 

50.8% of the respondents were likely to change their jobs. 

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Table 2: Experiences of Sanitation Workers at Prampram 

Experience of sanitation 

workers Frequency Percent (%) 

Why are you involved with 

Sanitation Work?     

I enjoy it 54 21.3 

For Money 94 37.2 

I can't get any other work 77 30.4 

Don't want to be idle 20 7.9 

Other 8 3.2 

Total 253 100.0 

Opinion about this job     

Unhygienic 8 2.9 

Embarrassing 5 1.8 

Respected 102 36.7 

Difficult 22 7.9 

Rewarding 103 37.1 

Satisfactory 36 12.9 

Other 2 0.7 

Total 278 100.0 

Feel bad working with waste     

Yes 11 6.0 

No 172 94.0 

Total 183 100.0 

Stigmatized     

Yes 12 6.6 

No 171 93.4 

Total 183 100.0 

Change of jobs     

Yes 93 50.8 

No 90 49.2 

Total 183 100.0 

 

Three main organizing themes were identified under the experiences of sanitation 

workers which is the global theme: daily routines, challenges and motivation. 

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4.2.1 Daily routines 

The experiences of the waste handlers were explored by considering their daily routines. 

Four major codes were developed from the quotes under this organizing theme: activity, 

duration auxiliary job s and team work. The code activity considers the types of work the 

waste handlers engage in. The work among the waste handlers seemed to be gender-

assigned; while the males acknowledged performing certain kinds of work such as 

weeding and digging, the females were involved in duties such as sweeping and 

collecting of rubbish. See the quotes below: 

“We sweep, we collect rubbish…we bury the rubbish too…we collect the shit here too” 

(FGD females) 

“We weed…we sweep and dig and bury the toilet and the rubbish there… Some of us 

sweep the gutter… we rake the rubbers and burn it” (FGD males) 

 

Despite the gendered duties among the workers, there is some form of collaboration that 

depicts team work. Thus there may be times where both sex may consider performing the 

duties of the other: 

“Even two people cannot weed this entire place that is why we asked the women to be at 

the beach so that we can also clean here” (FGD males) 

 

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The number of months or years spent as waste handlers was also explored: duration. It is 

noted that the males had worked for longer periods as sanitation officers and hence may 

have much experience compared to the females.  

“for about 4 months now, we are starting the 5
th

 month” (FGD females) 

“When we started 4 years ago” (FGD males) 

The experience of the males as waste handlers had made them consider certain auxiliary 

jobs aside their main work.  

“Many of us have our own jobs, I am an electrician so when I close I will go and do my 

private job you see…..most of us from here we have other jobs that we are going to 

do”(FGD males) 

 

4.2.2 Challenges  

From the analysis, there were some difficulties mentioned by the sanitation officers. 

Eight codes were used to describe the organizing theme challenges. These were 

stigmatization reaction, poor administration, bitter job, poor remuneration, worry, 

dangers, lack of jobs and recalcitrant inhabitants. In these challenges are bound to 

happen considering the different length of work experience.  

Stigmatization and bitter job: this refers to the event where sanitation officers experience 

unpleasant moments in the course of their work. The analysis shows that sanitation 

workers are mocked and even intimidated. These experiences have the tendency of 

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affecting or influencing the level at which the workers attend to their duties or impact 

negatively on their outputs, in spite of the good will and the good nature ascribed to the 

work. With respect to the quotes below: 

“We are stigmatized and the job is also rejected because of the toilet we are cleaning … 

They talk and tell us we sweep toilet or we clean toilet… It is because of the toilet we 

have been cleaning at the beach … some of them, if they have a problem with your child 

then they will tell him your mother cleans shit.” (FGD females) 

“yes we are stigmatized very well. They tease us. When you are even go to talk with 

someone they say you, you work at Zoom Lion or Zoil … now the banks too when we go 

there they don’t want to give us overdraft again they say our money do not come on time 

but our pay passes there and that we don’t understand” (FGD males) 

“Again what is killing us is when we wake up in the morning; we buy water and pay for 

where we go to toilet, the only thing we get for free is urinating behind someone’s 

house…it was nice but now it is bitter.”(FGD males) 

 

Poor administration and poor remuneration: Two related challenges and most mentioned 

among the challenges have a great negative impact on the waste handlers socially and 

mentally.  Sanitation officers expressed their dissatisfaction for the remuneration 

received: late payments and insufficient salary, however they acknowledged trying to 

manage the little amount they received. This they attributed to the delays in the reports of 

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some of their administrators hence resulting in the late payments and thus appealed to the 

government to see to the early payments: see the quotes below. 

“The only thing is our pay that is what is worrying us … We have school going children, 

we get sick and that is what we use some to pay our bills. So they should look at that for 

us they should not keep our money they should pay us at the end of the month… so they 

should increase our money for us a little” (FGD females) 

“the pay is the only problem; it does not come early… Although the salary is not good it 

is better than sitting at home idle so we will take it like that.” (FGD males) 

“Sometime when we talk they say our coordinators who were supposed to bring the 

report did not bring it on time…we are pleading with the government to let the money 

come though small it should come and we shall mange and work.” (FGD males) 

 

One of the effects of the challenges they face is worry. Both females and males expressed 

their worry over buying on credit and thus related to the poor remuneration received. 

Worry can bring about depression and have adverse effect on their health. 

“When you wake up in the morning you will not even eat then you will come and be 

looking at shit” (FGD females) 

“We go and credit everything and every day people will be knocking at our doors for 

their money.” (FGD males) 

 

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Recalcitrant inhabitant and reaction: The challenge experienced by the sanitation 

officers is also partly due to actions of the residents in their areas of work. For instance, 

sanitation workers complain of repeated work at places where person repeatedly litter 

which reveals that the continual actions of the inhabitants have the tendency of affecting 

the work of the waste handlers. These actions may spear up reactions from the waste 

handlers: 

“Yesterday they did it we went to sweep, today too the same and we have cleaned that 

also.” (FGD females) 

“like you will slap the person in the face” (FGD males) 

“it is those coming to shit here…yes is those who come to shit here…we will laugh at 

them now” (FGD females) 

There were also dangerous events that are met by the workers on some daily basis: 

„dangers‟. In as much as these dangers put the workers at risk, they are also cautious of 

the kinds of explanations that could explain the deaths of some of their colleagues: see 

quotes below 

“Recently we heard they are been attached by snakes.” (FGD males) 

“Four people have died that we don’t even know the cause of their death.” (FGD males) 

4.2.3 Motivation 

Waste handlers expressed their motivation behind the kind of work they perform as the 

following amidst the challenges faced: good will, good job, understanding, divine 

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intervention, knowledge of work, self-perception and. praise. The males uttered their 

desire for the upkeep of the community to be driven by their own good will, for instance 

the quotes below reveals the fact that sanitation officers are determined to work in order 

to curtail the number of cases of illnesses that are linked to dirt. Similarly the intention to 

work as a sanitation officer is important to promote tourism: 

“But because I want the town to be clean to avoid sickness that is why…It is like 

communal labour and it is good. I want the town to be neat …we want the town to be neat 

so that we don’t fall sick. We want everywhere to be neat so that when someone comes 

the person will see that we are neat that is why we are doing it” (FGD males) 

The motivation to work is the fact that working as sanitation officer is a good job. The 

workers expressed their joy and appreciation for the work and the fact that it has 

contributed to solving the problem of unemployment. In that vein some of the sanitation 

workers mentioned of continuing to remain in the service as sanitation workers: 

“we like it and enjoy it … we like this, the Zoom Lion job is what we like not any other 

thing…we shall continue to do this one.” 

(FGD females) 

“we see it as a good job because there is no job” (FGD males) 

“there is no job so we are managing this for our daily bread, that is why we are doing it”  

(FGD females) 

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Three important codes „understanding‟, „knowledge of work‟ and „self-perception‟ 

explain how sanitation officers appreciate their work and also for them not to focus on 

the discouraging comments made by people who observe them. Therefore, sanitation are 

admonished to have good perception about themselves and as well as their work: 

“one thing is that you as a worker if you don’t understand what you are doing then you 

will be worried or feel  bad but if you understand your work that will not discourage 

you.”(FGD males) 

“we don’t feel bad or useless that we are working with Zoil or ACI, we are proud of 

working ACI or Zoil…Zoil is positioned under the Ministry of Tourism” (FGD males) 

 

Furthermore, there were instances where sanitation workers are acknowledged or 

received praise for their work, despite the challenges about the stigmatization of the 

work. This tends to encourage them in performing their daily duties as keeping the city 

clean: 

“they praise us for the good work we are doing, because our presence is making the 

beach very clean” (FGD females) 

In meeting their plight for higher income and early monthly payments, the sanitation 

workers also resorts to God. The trust in God‟s provision has the tendency of reducing 

the worry over the main problem of poor remuneration: 

“we are hungry and we are begging in the name of God.” (FGD males) 

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4.3 Use of Personal Protective Equipment 

Results from Table 3 shows that most of the respondents (91.3%) interviewed wore 

Personal Protective Equipment (PPE).  The majority of them (66.5%) wore them before 

they had handled waste, though 7.2%% of them wear the PPE after and 26.3% during 

handling of waste. With the type of PPE worn, out of the 475 responses generated: 34.4% 

used over-all coats/aprons as a protective tool, 19.2% used gloves and 18.3% used 

wellington boots. 14.1% used nose mask/mouth cover for protection, helmets or 

headgears were used by 13.2% of respondents and the remaining 0.7% being other 

protective tools. 

It was also realized that 54.5 % of the 16 responses generated did not wear personal 

protective equipment because it felt uncomfortable. A further 27.3% had their personal 

protective equipment spoilt and were yet to be replaced, 18.2% were not provided by 

their employers and the remaining did not see the need for it. 

 

 

 

 

 

 

 

 

 

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Table 3: Personal Protective Equipment 

Personal protective Equipment  Frequency 

Percent 

(%) 

Wear personal protection equipment     

Yes 167 91.3 

No 16 8.7 

Total 183 100.0 

When is PPE worn(n=167) 

  Before Waste handling 111 66.5 

During Waste handling 44 26.3 

After Waste handling 12 7.2 

Total 167 100.0 

Protective tool do you see(n=167)     

Headgear/Helmet 60 13.2 

Nose mask/mouth cover 64 14.1 

Over-all coat/ apron 156 34.4 

Wellington boot Glove 83 18.3 

Glove 87 19.2 

Other/Specify 3 0.7 

Total 475 100.0 

Do Not Wear personal protective 

equipment (n=16)     

Reasons 

  Makes me feel uncomfortable 6 54.5 

It is spoilt and hasn't been replaced 3 27.3 

The company does not provide it 2 18.2 

Total 11 100.0 

 

Under Personal Protective Equipment as a global theme, three main organizing themes 

were under listed: type, use, and inconveniencies. These themes were developed in order 

to explore and assess the protective personal equipments used by the sanitation officers. 

 

 

 

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4.3.1 Type of PPE 

This organizing theme is made up of one code „working gear‟. The types of the working 

gear used by the waste handlers were described here. Examples of some of the working 

gears were mentioned as the boots, dress or uniform, helmet, goggles and nose cover. 

Also it can be said that the females patronized the use of the gears more than the males: 

“the dress you wear to work… Like the boots they gave us and the uniform that is what 

we use and people will know that this is where you work that is why we like wearing it … 

like the nose cover we use it to cover our nose so we put it inside our bags and wear it 

when we are working” (FGD females) 

 

4.3.2 Use of PPE 

The use of the equipments is assessed using these codes: utilize, training, education, 

importance and identity. First of all the sanitation officers acknowledged the utilization 

of the equipments during working hours, although that was mentioned by the female 

group. In this regard it is expected that there will be fewer cases of females reporting of 

ailments that are related to the lack of use of the equipments. Below is a quote that 

signifies the use of the PPE: 

“yes we do wear them” (FGD females) 

In spite of the fact that sanitation officers acknowledged the use of the equipments, they 

did that at their own experiments. This means that there were either no or adequate 

training or education on the use of them. This probably may have influence on the proper 

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use of the PPE‟s and their lifespan, since their improper use may render them getting 

spoilt quickly. See quotes below: 

“no we were not given any training, after written our names  there and then they brought 

our brooms to us …we were asked if we can do the work and also if we can collect the 

toilet at the beach and we said yes we can. They wrote our names and gave us the 

uniform but no training” (FGD females)  

“we were not trained, they just brought it to us and just told us the purpose of using that 

it is for our safety … we did not go for any training at all” (FGD males) 

“for ACI the only training they were given is that the helmet will save your head when a 

coconut falls from above, (safety) and goggles so that sand will not enter your eyes and 

the boot so that you will not step on a nail or broken bottle to get hurt.” (FGD males) 

 

Importance and Identity: Notwithstanding the inadequacy of the training in the use of the 

equipments, the sanitation workers had devised a way of using them and hence are able to 

share their experiences on the use of the PPEs. In the first instance the PPE is known to 

be good for their use since it protects them from getting hurt. It is also mentioned that the 

PPEs identifies them as waste handlers of the ZOIL Company which they appreciate very 

much. 

“yes it is good for us ”(FGD females) 

“Interviewer: when you walk with boots and you mistakenly step on a broken bottle… 

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Respondents: we always wear foot wear so something like that has never happened to us 

before” (FGD females) 

“when we wear we are seen as workers of ZOIL … well when you are coming to work 

you will wear it so that people will know where you are working” (FGD females) 

 

4.3.3 Inconveniencies 

The unpleasant experiences about the use of the PPEs are described under the organizing 

theme “inconveniencies”. Four main codes are identified: unpleasantness, warmth, late 

arrival of equipments and lack of equipments.  

Unpleasantness and warmth: These are codes that explain the problems with using the 

PPEs. Both males and females experienced the inconveniencies and hence call for the 

attention in reviewing the type of working gear produced as well as considering 

educating the sanitation officers before using the equipments. Apart from the warmth, 

some of the uniforms were described as oversized and difficult to use. Below are the 

quotes: 

“the dress for the women for the sake of urinating we prefer the top and down to the 

overall, we have to remove everything before you can pass urine and you know that 

women have to cover themselves too…because we are not working at home but in public 

… for me my uniform is too big for me so I tie it before wearing it” (FGD females) 

“walking with it [boots] in the sand is very difficult” (FGD females) 

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“For the Wellington boots we can’t wear them in the sand it is very difficult using it 

there” (FGD males) 

“yes as we are here now it is very warm inside but we wear it,” (FGD females) 

“Again the working gears, when the sun is setting the overall become very warm so we 

don’t use it” (FGD males) 

 

Part of the inconveniencies center on late arrival of equipment and lack of equipment. 

The late arrival of the equipment results in the lack of the equipments. This has the 

tendency of discouraging sanitation workers from using the old equipments and hence 

puts them at risk of accidents or illnesses related to waste handling.  

“they bring us uniform but for one and half years now the tools are not coming, the 

women use their own money to buy the brooms and the shovel we use to dig is also not 

coming and we need the tools to work so they should look at that for us… Again the tools 

are not coming for us to use, the standing broom is now 2cedis so they should look at that 

thing also for us.” (FGD females) 

“We don’t have tools to work with; they have to give us cutlass and the machine, they are 

using over there (mower). Look, my palm is red from the weeding … they brought boots 

but it was not enough for all of us” (FGD males) 

 

Table 4 shows the result on the knowledge of Personal Protective Equipment. All 

respondents affirmed the importance of the personal protective equipment and also its 

importance in preventing health risks. It was also realized that almost all the 183 

respondents (96.2%) had been trained on the use of the PPEs. 

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Table 4: Knowledge on Personal Protective Equipment 

Personal Protective Equipment  Frequency Percent (%) 

Importance of PPE 183         100.0 

Yes 183 100.0 

Prevention of health risk     

Yes 183 100.0 

Trained on the use of PPE     

Yes 176 96.2 

No 7 3.8 

Total 183 100.0 

 

 

4.4 Perceived health risk of sanitation Workers 

Table 5 tabulates the perceived health risks associated with waste handling by the 

respondents. Almost all the respondents (98.4%) believed that their physical contact with 

waste was a health risk and almost all of them (98.4) claim they cleaned themselves after 

work. In addition, 37.2% said they had been ill since starting works as sanitary workers, 

29.5% have never been ill. Also, 15.8% had been ill several times and 13.7% on more 

than one occasion. 2.2% and 1.6% could not remember and stated other reasons 

respectively. Less than half (43.2%) of them perceived their sicknesses to be related to 

the work as sanitation workers.  45.9% had visited the Prampram Health Centre  

 

 

 

 

 

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Table 5: Perceived Health Risk associated with waste handling 

Waste handling and Perceived 

health risk Frequency Percent (%) 

physical contact with waste as a 

risk     

Yes 180 98.4 

No 3 1.6 

Total 183 100.0 

  

clean yourself after Sanitation 

Work     

Yes 180 98.4 

No 3 1.6 

Total 183 100.0 

Frequency of illness as a 

Sanitation Worker     

Never 54 29.5 

Once 68 37.2 

More than once 25 13.7 

Several times 29 15.8 

Can't remember 4 2.2 

Other/Specify 3 1.6 

Total 183 100.0 

 

Perception of  sickness related 

to sanitation work      

Yes 79 43.2 

No 104 56.8 

Total 183 100.0 

Visit to Prampram Health 

Centre     

Visit 84 45.9 

No Visit  99 54.1 

Total 183 100.0 

 

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Three major organizing themes were formed under the global theme health perception. 

They are health risk, behavior, and helming infection. The various organizing themes 

were built under codes from the transcript. 

 

4.4.1 Health risk 

Concerning health risk, the respondents mentioned the following codes: illnesses and 

symptoms and causes of the illness that mostly surround their work. 

Among the illnesses and symptoms described by the workers were pains in the ribs and 

joints, headaches, nausea, malaria, fever and worm infestations. These experiences were 

described as uncomfortable by both males and females. 

“We feel pains at our ribs our waist and joints…the main sickness is our rib waist 

headaches that is it … it makes you feel nausea you are not comfortable” (FGD females) 

 

“There are so many sicknesses; you may get malaria, fever and other… Worms are very 

bad it will make you shrink when they are in your stomach, you will not feel comfortable 

… raking you will feel the pain at your rip and as we have come to weed, your arm will 

be paining you and your waist when you dig.” (FGD males) 

 

The causes of these illnesses were identified to be as a result of the work. For instance, 

walking in the sun, and climbing up and down can make the workers stressed; the heat 

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from the toilets and dirt that results into worm infestations are also identified as causes of 

sicknesses experienced by the sanitation officers. The situation depicts that the sanitation 

officers will not be able to deal with situation since they are working with dirt, always. 

“walking in the sun, climbing up and down” (FGD females) 

“You see, you are going to collect peoples shit … the heat that will come from the toilet is 

what will make us sick … dirt in from our job that is what gives worms … worms is that it 

is caused by dirt and we are also working with dirt” (FGD males) 

 

4.4.2 Behavior of sanitation workers 

The organizing theme behavior explains the how sanitation officers seek for health when 

ill. Three codes are discussed here: health facility, health care and checkups. There is 

different health facilities considered among the sanitation officers. This includes hospitals 

and pharmacies, which are manned by health professionals. Sanitation officers were also 

conscious of the need for frequent visits to the hospital. 

“I go to the main hospital … when you are feeling nausea you go to the drugstore … we 

go there when there is a problem…we go there when we are sick” (FGD females) 

“I went to the hospital and complain my body itches … we describe it to the pharmacist 

then they will give us (FGD males) 

 

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In view of the health consequences, the sanitation officers advocated for some health care 

from their company, in the form of health insurance to cater for their health needs. 

“they have to give us health insurance … it is only the nose cover which is helping us a 

little so they should try and do the health insurance for us so that when we are sick and 

we take to the hospital we me receive treatment” (FGD males). 

 

4.4.3 Helming infection 

Under helming infection, two major codes are discussed:  safety measures and 

medication. The safety measures taken by the sanitation officers in order not to contract 

any diseases are be mindful of how they eat, and then observing personal hygiene. For 

the medications used, both males and females acknowledged the use of de-wormers in 

dealing with worm infestations; it was only among the females where some herbal 

medications were also mentioned to be used for the worm infestations. The quotes below 

are examples: 

“for worms the way you eat, when you are eating you have to clean your stomach... The 

dirt in your stomach is what causes worms… for worm infection sometimes when you 

take purgative … and say you want to de-worm and they will sell it to you … yes if the 

hospital one does not work for you then you use the herbal medicine…the herbal 

medicine helps us a lot” (FGD females) 

“so after work we should get something like detol and a hand washing bowl to wash our 

hands so that when we go home and eat we may not get worms that is all” (FGD males) 

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Figure 3 represents a graph of reported illnesses the waste handlers claimed they have 

been experiencing. 160 experienced aches, 79 had also experienced fever, 44 were 

dizziness, 41 felt nauseous. Diarrhoea was experienced by 38 respondents, 37 felt itchy, 

28 had skin rashes and 27.5 coughed. The graph further reveals that 22 lost appetite, 17 

had runny nose, 16 had anaemia and 11 had itchy anus. 8 had asthma attacks and skin 

diseases, with 3 having sore throats. 

 

 

Figure 3:  A graph showing the frequency of the various signs and symptoms. 

 

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In order to establish association between waste handling and perceived health risk, a 

bivariate analysis was done with a Logistic Regression Analysis 

In the bivariate analysis the only 2 of the covariates that attained significance at p<0.05; 

Wearing PPE Before waste handling and During Waste Handling. Low health risk 

depicts respondents who fall under only one category and high health risk depicts 

respondents who fall within 2 or more category. 

Respondents who wear protective equipment are 0.65 less likely to be at risk than those 

who do not. (CI 0.144, 0.851). In addition, respondents who wear personal protective 

equipment during waste handling are about 10 times more likely to be at a higher risk 

than those who do not (2.214,10.492) 

 

Table 6: Bivariate analysis of health risk associated with waste handling 

Covariates Low Health Risk High Health Risk OR 95% CI P-value 

 
Frequency(%) Frequency(%) 

   Sex 
     Male 9(4.9) 41(22.4) 1 

  Female 27(14.8) 106(57.9) 0.862 0.374,1.988 0.727 

Age 
     ˂ 40 14(7.7) 67(36.6) 1 

  ≥ 40 22(12.0) 80(43.7) 0.76 0.361, 1.600 0.47 

Education 
     Less than secondary 29(15.8) 109(59.6) 1 

  Secondary and Higher 7(3.8) 38(20.8) 1.444 0.585, 3.567 0.426 

Marital Status 
     Married 28(15.3) 102(55.7) 1 

  Not Married 8(4.4) 45(24.6) 1.544 0.653, 3.651 0.322 

Average hours per shift 
    Less than 3 7(3.8) 60(32.8) 1 

  3 or more 29(15.8) 118(64.5) 0.982 0.391, 2.464 0.969 

Stigmatization 
     

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Yes 2(1.1) 10(5.5) 
   No  34(18.6) 137(74.9) 0.806 0.169, 3.850 0.787 

Personal Protective Equipment Worn 
    Before waste handling 
    No 7(3.8) 60(32.8) 1 

  Yes 29(15.8) 87(47.5) 0.35 0.144, 0.851 0.021 

During waste handling 
    No 34(18.6) 94(51.4) 1 

  Yes 2(1.1) 53(29.0) 9.5 2.214, 10.492 0.003 

After Waste Handling 
     No 34(18.6) 138(75.4) 1 

  Yes 2(1.1) 9(4.9) 1.109 0.229, 5.369 0.898 

 

Note: significant p values are in bold, p≤0.05 

 

In the multivariate logistic regression it is seen that respondents who wear personal 

protective equipment during waste handling are about 11 times more likely to be at a 

higher health risk than those who do not. (OR=11.091, CI 2.008, 19.254). 

Table 7: Results of Multiple Logistic Regression of when do respondents wear 

personal protective equipments and health risk as the dependent variable 

Variables in Model B SE 

Odds 

ratio 95% CI of Odds ratio 

P-

value 

    

Lower 

Bound 

Upper 

Bound 

 Before Waste 

Handling 

0.18

9 

0.58

3 1.121 0.386 3.784 0.746 

During Waste 

Handling 

2.40

6 

0.87

2 11.091 2.008 19.254 0.006* 

After Waste 

Handling 

0.24

6 

0.87

9 1.279 0.228 7.163 0.779 

Constant 0.84 

0.55

3         

*p<0.05 

S.E = Standard Error     B = the coefficient 

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CHAPTER FIVE 

5.0 DISCUSSION 

This chapter discusses in detail the finding of the research. It comprises the experience of 

sanitation workers in handling waste, the use of personal protective equipment and the 

perceived health risk of sanitation workers. 

Waste handling is detrimental to the health of individuals hence sanitation workers. The 

study sought to assess health risks associated with waste handling among sanitation 

workers at Prampram. From this study, it can be said that there is an effect on the health 

of sanitation workers in the handling of waste. Most of the respondents perceive that they 

could get sick from handling waste.  Majority of sanitation workers had gotten sick at 

least once since their handling waste. This may be a true reflection of their health status. 

Going through their records at the Prampram Health Centre, it was realized they were not 

visiting the centre but had registered with the centre. Some of them went with symptoms 

and illnesses that were not necessary related to the handling of waste. The majority of the 

sanitation workers suffer from aches all over their body with the least suffering from sore 

throat. This is consistent with a study done in Denmark where it was found that a higher 

incidence rate of musculoskeletal complaints for sanitation workers was reported in 

Denmark than for the total Danish workforce (Poulsen et al. 1995) 

Another study done among municipal workers in Rio de Janeiro depicts the fact that 

80% of all workers had suffered an accident during their employment in waste collection; 

among these, 58% had to be suspended from work for some time (Vellos et al. 1997). 

Sanitation workers are also exposed to deplorable conditions and experience hardships. In 

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a study conducted by Porto et al., (2004) on the health conditions of waste pickers at the 

largest landfill in Rio de Janeiro, it was found that the nature of the working environment 

generates specific kinds of risks and accidents. The majority (71.7%) of the waste pickers 

at this site had already suffered an accident. Of the 267 accidents referred to in the study, 

the majority were related to cuts from glass (37%), followed by perforations due to other 

materials (19%), and falls (15%). In addition, accidents involving informal recyclers and 

the landfill operator‟s machinery are frequent (Porto et al. 2004). 

Sanitation workers handling a mixture of waste  suffer a lot of health risks (Poulsen et al., 

1995).  This was also the case of Prampram as has been found in this study. Many studies 

reveal the risk of having many health effects like respiratory symptoms, allergies, fatigue, 

musculoskeletal, etc among sanitation workers due to their exposure to hazardous 

substances (An et al., 1999; ) (Poulsen et al., 1995). This may be due to handling and 

inhaling toxic substances from waste. The findings of this study also revealed that the 

majority of sanitation workers engage in sanitation work because of money. Their lack of 

education makes sanitation work suitable for them since no certificate is required for 

employment. They are employed in order that they gain a livelihood  Though some  of 

the workers would want to change jobs if the opportunity be given to them, most of the 

workers  are happy they are involvement is the sanitation field. This may due to th