PERI-URBAN ENVIRONMENT, SANITATION AND HEALTH - ASSOCIATED HEALTH RISKS IN WASTE HANDLING IN PRAMPRAM, GHANA.

ABSTRACT The peri-urban community of Prampram is characterized by filthy and choked open drains, indiscriminate waste disposal and open defecation. Waste handlers engage in different types of activities such as sweeping, collection, transportation and disposal with little or no personal protection and thus are often confronted with serious public health problems related to their work. The purpose for this study was to assess the different degrees of health risks associated with different activities in waste handling in the peri-urban community of Prampram, Ghana. This study used a mixed method design to quantitatively investigate 280 waste handlers with respect to the activities performed, exposure surfaces to waste, use of personal protective working gear and self reported health outcomes. A qualitative phase of the study involving 22 waste handlers explored the perceptions about health risks associated with waste work. The rationale 'or including the qualitative phase was to triangulate and complement the quantitative phase of the study. Laboratory methods were also used to investigate faecal contamination of hands by the detection of faecal indicator E. coli/Coliforms as well as to determine the incidence rate and intensity of helminthes infections 3 and 6 months post-treatment. The most common self-reported health problems were bodily pains (56.4%), headache (38.6%), fever (35.7%) and diarrhoea (I1.4%). There was an association between working with smelling/odorous wasle material and reported fever (p < 0.05) as well as contact of exposed bodily surfaces to waste with reported skin disease (p < 0.05). The perception about reporting health problems due to working with smelling waste material was corroborated by one 3S-years old female waste handler who collected human faeces from the beach each morning when she explained how inhalation of 'bad air' could lead to health problems such as nausea. Waste handlers whose hands were directly exposed to waste material were 4.2 times (9So/oCI: AOR 1.4-10.0) more probable to report cough symptoms than those whose hands were not exposed. The odds of reporting upper back pain among waste handlers who performed three activities a day (sweeping, collection and disposal) was 4.1 times (95%CI AOR: 1.6-11.0) greater than those who only swept every day. Waste handlers who swept every day have 70% less risk of developing upper back pain compared to those who performed two activities per day (disposal and collection). The odds of reporting upper back pain was 2.2 times (95%CI AOR: 0.6-8.0) higher among those who transport waste compared to those who sweep. There was a significant difference (p < 0.0001) in the level of faecal contamination of the hands of waste handlers before and after engaging in waste handling activities, by detection of both indicator E. coli and Colifonns. The proportion of waste handlers that tested positive to faecal indicator E. coli was 23.2% (950/oCl: 18.4-28.8) The mean log concentrations/level of indicator E. coli among waste handlers was 0.079 ± 1.6 CFUl50ml. There was also a significant difference (.J! = 18.8, p = 0.0086) in the mean log concentration/level of faecal indicator E. coli among the types of waste handling activities. There was a significant difference (p = 0.0083) in the level of faecal indicator E. coli among aste handlers who only engaged in sweeping every day and those who performed two or more waste management activities such as sweeping, collection and disposal.