The health risks of informal waste workers in the Kathmandu Valley: a cross-sectional survey

Objective: To describe the health and occupational risks of informal waste workers (IWWs) in the Kathmandu Valley and explore the factors associated with not using personal protective equipment (PPE). Study design: This is a cross-sectional survey of IWWs. Methods: Data were collected on the health and occupational risks of adult IWWs working on waste sites in the Kathmandu Valley and in the adjacent Nuwakot district, Nepal, in November 2017, through convenience sampling. Using a standardized health assessment questionnaire, face-to-face interviews were undertaken to record sociodemographic data, indicators of general and occupational health, data on healthcare access and use, physical risks, perception of occupational risks and use of PPE. Associations between use of PPE and gender, age, education, country of origin, injury and perception of occupational risks were examined using multivariate logistic regression analyses. Results: In 1278 surveyed IWWs, prevalent physical risks included injuries (66.2% in the previous 12 months), and the main reported symptoms were respiratory in nature (69.9% in the previous 3 months). Most prevalent injuries were glass cuts (44.4%) and metal cuts (43.9%). Less than half of the IWWs (46.8%) had been vaccinated against tetanus and 7.5% against hepatitis B. The work was considered as ‘risky’ by 72.5% of IWWs, but 67.6% did not use PPE. Non-use of PPE was independently associated with male gender (odds ratio [OR] 2.19; P < 0.001), Indian origin (OR 1.35; P = 0.018), older age (OR 2.97 for more than the age of 55 years; P = 0.007) and low perception of occupational risks (OR 2.41; P < 0.001). Low perception of occupational risk was associated with older age (55 + years) and the lack of receipt of information on the risks. Conclusions: IWWs are at increased risk of injury in their work, yet are poorly protected in relation to vaccine-preventable infections and workwear. The results suggest that information is important in relation to perception of occupational risk, which in turn is associated with the use of PPE. There is a need for policymakers and public health practitioners to have a robust understanding of the needs and vulnerabilities of this group, as well as identify effective interventions that can be taken to safeguard the health and welfare of IWWs.