Occupational health risks and working conditions of sanitation workers in Nepal: a cross-sectional study

The rapid increase in global consumption has led to a corresponding rise in waste production, intensifying the burden on sanitation workers (SW), whose work is of great importance to public health and prevents environmental pollution by ensuring proper waste disposal. The aim of this study was to assess the working conditions and explore the health status of SW in Nepal, and to identify risk factors associated with occupational health issues.

A cross-sectional study was conducted among 737 SW included by convenience at a health camp for SW performed in five major municipalities of Nepal. A structured questionnaire was employed to collect data on sociodemographic factors, working conditions, and health issues. The SW were categorized into four groups based on type of work they performed, 1) collectors, who collect the garbage from the streets and load onto transport vehicles, 2) sweepers, who sweep the streets with brooms, 3) pickers, who sort through the garbage at the dumping sites, and 4) a reference group, that consisted of drivers and administrative staff without strenuous work or direct exposure to garbage. Data was introduced to STATA 18 and analyzed using Pearson's chi-square test and logistic regression.

The median age of participants was 32 years, and most participants were male, the educational level was low. Compared to the reference group, pickers had less access to personal protective equipment (PPE) and practiced poorer hygiene. Pickers experienced more symptoms related to dental problems and skin cuts, while collectors experienced more skin cuts and musculoskeletal problems. Sweepers reported lower rates of heat stress and occupational training than the remaining groups.

Pickers reported the highest risk of skin cuts and dental problems. Collectors reported higher risk of skin cuts and musculoskeletal problems. Pickers also reported the lowest rates of access to PPE, sanitary materials, and water, while collectors reported greater access to relevant vaccinations. These findings indicate unequal access to preventative measures across all types of SW.