Awareness of Occupational Health Hazards among Street Sweepers and Garbage Collectors at Beni-Suef City , Egypt : A Cross-Sectional Study

Street sweepers and garbage collectors play an important role in maintaining health and hygiene in the communities. However, they usually work at risky environments that expose them to various morbid conditions. In this study, we aimed at evaluating awareness and attitudes of Egyptian street sweepers and garbage collectors regarding the occupational risks they are exposed to and its preventive measures. Therefore, in a descriptive study, 70 randomly-selected street sweepers and garbage collectors from Beni-Suef city, Egypt were randomly selected and approached through direct interviews with a semi-tailored questionnaire. Our results indicated that street sweepers and garbage collectors were aware of occupational health hazards and diseases, to which they are exposed and may encounter at work. Nevertheless, during the past 12 months, 41.4% of them experienced a job-related health problem. They sweep streets and collect garbage directly with unprotected hands and without using any personal protective equipment. Additionally, their attitudes towards taking preventive measures while working did not match their knowledge about their jobrelated health hazards. We conclude that street sweepers and garbage collectors should be treated as a vulnerable group that requires pre-placement and in-service orientations, health education, vaccinations, medical check-ups, with close monitoring of their attitudes and practice.

Bull High Inst Public Health Vol.39 No. 4 [2009]   clean streets and collect garbage from houses by a door-to-door method.
However, not all the wastes are disposed properly by the residents; and a considerable percentage of it remains on streets or discarded on road sides.This contributes to environmental pollution and creates various health problems. (2)erefore, garbage collectors have additional daily tasks of sweeping streets besides garbage collection.
Because of their work environment, street sweepers and garbage collectors are exposed to a variety of risks or hazards that lead to notable morbidities. (3)They are mainly exposed to dust, biodegradable trashes, bio-aerosols, volatile organic matters and mechanical stress, which make them susceptible to a wide range of occupational diseases. (4)Moreover, in many settings they collect bio-hazardous wastes discarded by health care facilities that are located within their working zones; adding another range of infections and hazards to these workers' health.
Many reports showed that the commonly detected morbid conditions in those workers include diseases of the respiratory system, eye problems, accidents, injuries, infections and skin problems ..etc. (1,5,6) developing countries; including Egypt, those workers clean streets and collect wastes, manually, with little, if any, protective measures against direct dust exposures, wastes' contact and injuries at their workplaces. (1,7)ough studies addressing the occupational health hazards among them or investigations regarding their knowledge and attitude towards their occupational hazardous exposures are very scarce.
In this study, we aimed at evaluating the awareness and attitudes of street sweepers and garbage collectors regarding the occupational risks they are exposed to and the preventive measures they take to avoid their job-related hazardous exposures.

METHODS:
The study was conducted in Beni-Suef -Knowledge about the occupational hazards of street sweeping and garbage collection.
-Attitude towards preventive measures such as vaccination and use of personal protective equipment.
-Their institute administration, if it offers them training or provides them with personal protective clothes and equipment.
-Attending health education, first aid training or lectures about safety practice.
-Receiving vaccinations against the possible work-related infections.
-Present history of physical and medical complaints.
The investigators observe those street sweepers and garbage collectors and take pictures for them.
The collected data were then analyzed with Statistical Package for Social Sciences (SPSS) version 13.

Street sweepers and garbage collectors
in Beni-Suef city, were found to perform tasks of street sweeping and garbage collection as part of their daily job activities.
They worked 8 hours/ shift daily for 6 days, with one day off taken alternatively after arrangements with other groups of workers.

DISCUSSION
Poor sanitation is a multidimensional problem that comprises a wide variety of infrastructural and daily human activities including improper waste disposal.In developing countries, the wastes and refuse still comprise a major public health threat; and many of the health problems experienced by residents of different communities are traceable to the poor sanitary environment. (8) Beni-Suef city, since there are no designated areas for waste collection, some households bring their mixed wastes to the garbage collectors when they knock their doors.Others leave their wastes in a container or plastic bags in front of their apartments.Some may put their garbage on the road side or a street corner, which is not usually a designated pick-up point.
Stray animals or some scavengers may diet, and poor housing conditions. (7)e present study was performed to assess the awareness and attitudes of street sweepers and garbage collectors regarding the risks and occupational hazards they are exposed to while performing their daily work activities.
Results indicated that all street sweepers and garbage collectors (100%) were aware of the health hazards they are exposed to, such as volatile organic matters or dust inhalations, contact with dangerous substances, infections, injuries, toxins and microorganisms.Nevertheless, a 100% of them reported that they sweep streets and collect garbage directly with unprotected hands without using any gloves, head covers or masks; and the temporary contractors (75%) said that their administration did not provide them any special clothes, work shoes or personal protective equipment (Table 2).
Therefore, it was clear that the workers' attitudes towards taking preventive measures while working do not match their knowledge about their jobrelated health hazards.For example, they were aware of the different hazards they are exposed to, but all of them (100%) never use protective gloves, masks, shoes or head covers.They excused non-usage of protective measures by saying their administration did not offer any and they think it is also, not suitable to use while working since it limits working abilities (Tables 2,3).Though health education and personal protective equipment are the most widely used preventive measures against work-related risks. (14)re than three-quarters of the workers returned home while wearing the same clothes, which they wore during street sweeping.Most of the workers do not refrain from eating, drinking or smoking during their work shifts; and a considerable percentage of them do not seriously clean their hands before taking food or smoking or even after finishing work (Table 3).
Such poor-hygienic attitudes and practices are augmenting the risks and hazards to which these street sweepers and garbage collectors are exposed.
Regarding immunization, all workers (100%) reported that they have not received any vaccination against the common infectious diseases; and they wish to receive vaccines and be immunized and protected against infections.However, their administration told them that the institute is not responsible for any payment for vaccination; and if any worker wants to be vaccinated, he has to visit the hospital and pay the vaccinations costs by himself.

CONCLUSION
We conclude that this working group of street sweepers and garbage collectors should be treated as a vulnerable group that needs a special care.This care can be summarized as providing them preplacement and in-service orientations about their tasks and health education happen to scatter such wastes to the streets while searching for something to eat or recyclable items.Moreover, due to the lack of garbage bins in streets with people's mal-behavior towards their environment, lots of wastes from people's daily activities are being disposed on streets, e.g., biscuits wrappers, nuts' crusts, cigarettes, tissues, papers, foods, etc.Collecting house wastes and cleaning streets is consequently, done by street sweepers and garbage collectors who are considered by the people and government as responsible for this task.Maintaining the health and hygiene of the community is therefore, the role of street sweepers and garbage collectors who work at risky environments that expose them to morbid conditions including diseases of the eyes and respiratory system, injuries, diarrheal diseases, skin infections, allergies,…etc.(9)(10)(11)(12)(13)Industrialized countries have significantly reduced the environmental and occupational health impacts on street sweepers and garbage collectors by applying standardized waste management processes.However, in Egypt as well as in other developing countries, the traditional cultures still categorize street sweeping and garbage collection as a filthy and stumpy occupation.Being ranked as such, those workers are usually having lower self-esteem; and the medical problems, which can be caused by the little protective measures they take against their workrelated hazardous exposures are further complicated or aggravated by various socioeconomic factors such as poverty, illiteracy or inadequate education, poor Being poor and unable to pay for those vaccines, none of the workers (100%) was immunized against the possible infectious diseases that may be encountered from their work environment, such as hepatitis B or C, tuberculosis or tetanus, etc. Regarding training courses for workrelated safety, health education or workshops on occupational hazards control and prevention, the workers' answers were all negative.None of the workers reported receiving any training for work-related emergencies, first aid, safety or preventive measures.They complained that their institute administration had never afforded their pre-placement orientations, pre-or inservice training, health education or work safety lectures to explain methods for infection control or self-protection.All the workers (100%) agreed and expressed their willingness to classify garbage at the source in separate colored bags.However, all of them reported that they do not separate it themselves.They owed non-separation of garbage by themselves to reasons such as; their administration did not instruct them to do so.They argued that if they try to make garbage separations at the source, everything will be mixed up again in the garbage collection end-points; therefore, they do not want to exert efforts to separate and classify garbage while they are sure that it will eventually go in vain at the main collection areas.The real problem of non-separation of garbage is that it is usually undefined garbage which can include wastes of the nearby small hospitals or clinics, syringes, waste medicines "in all its powder, soluble, inhalers, topical, injection forms", as well as patients' biological wastes.Such practices would eventually maximize the hazardous exposure and effects on garbage collectors' health.Because of the low payment from their institutes, street sweepers and garbage collectors usually try to find an additional source of earnings to improve their socioeconomic conditions by having other part-time jobs.They never care or think whether, their part-time jobs are related to food or not, in addition to their apparent carelessness in cleaning hands after finishing their street sweeping work.This study indicates that Egyptian street sweepers and garbage collectors are a working group that needs to be considered and cared about by occupational health professionals.This care can include officially orienting them about their job-related health risks and providing health education, preventive and safety consultations to the workers as well as their institutes.Egypt's occupational health challenges must include preventing harm and extending occupational health services to those workers, improving measures of their safety and health and monitoring actions taken to achieve this goal.This study brought up some messages to be delivered to the administration of street sweeping and garbage collection institute.It is important to value those workers and the work they do, including cleaning which is an essential task that exposes them to particular hazards and risks.These should be assessed and preventive measures should be implemented.The administration should also share health and safety information with workers and regional occupational health authorities.Additionally they have to take measures to ensure that workers are appropriately trained by offering them considerable pre and in-service training, health education, and communicate the risks and hazards with them.
* signficant at P<0.05 + 26 workers from them ended basic education (Primary and preparatory).++ 8 workers from them ended basic education (Primary and preparatory).

Table 1
shows that the participating workers were males and their ages ranged between 20 ~ 59 years with a mean age of 34.3 ± 9.7 years.Ten % of the workers were illiterate and 24.3% of them could read and write or had finished their primary schools, while 65.7% continued attending schools till the level of basic education.part-time jobs that were related to preparing or selling foods, while 65.7% had other jobs that were not related to foods and 1.4% had no additional job.Table 2, indicates that 20% of workers reported that during the past year they have experienced an injury, infection or disease that can be ascribed as occupational and attributed to their job of street sweeping and garbage collection more than one time.Regarding attending