Occupational Injuries Among Workers in the Cleansing Section of the City Council's Health Services Department ---Bulawayo, Zimbabwe, 2001--2002

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Elizabeth Gonese,¹ R. Matchaba-Hove,¹ G. Chirimumba,¹ Z. Hwalima,² J. Chirenda,³ M. Tshimanga^3

1Department of Community Medicine, University of Zimbabwe, Avondale, Zimbabwe ²Health Services Department, Bulawayo City Council, Bulawayo, Zimbabwe ³Health Studies Office, University of Zimbabwe, Harare, Zimbabwe

Corresponding author: Elizabeth Gonese, Department of Community Medicine, University of Zimbabwe, Box A 178, Avondale, Zimbabwe. Telephone: 263-91-285965; Fax: 263-4-726803; E-mail: egonese@yahoo.co.uk.

Disclosure of relationship: The contributors of this report have disclosed that they have no financial interest, relationship, affiliation, or other association with any organization that might represent a conflict of interest. In addition, this report does not contain any discussion of unlabeled use of commercial products or products for investigational use.

Abstract

Introduction: During 2001--2002, a total of 97 occupational injuries occurred among workers in the cleansing section of the Bulawayo, Zimbabwe, City Council's Health Services Department. This report describes a study that was conducted to describe the nature of these injuries and determine the associated risk factors.

Methods: A retrospective, descriptive cross-sectional survey was conducted concerning occupational injuries incurred by workers in the cleansing section during 2001--2002. A total of 153 workers who had been in the section as of January 1, 2001, and 23 senior managers and section supervisors were interviewed, the occupational injury register was reviewed, and a walk-through survey was conducted to estimate risk factors.

Results: The occupational injury register indicated that during the study period, 62 workers sustained 67 injuries, including one that was fatal. Of these 67 injuries, 27 (40%) involved workers who sustained cuts inside a box-type refuse removal truck, and 11 (16%) involved workers who had sprained ankles and wrists as a result of improper lifting. Workers aged 18--25 years were more likely to incur an injury than workers aged >25 years. Working as a bin loader and not having received preemployment training were associated with injuries. None of the bin loaders had received preemployment training. Hazards identified during the walk-through survey included use of small jacks in workshops, contact with biologic and chemical materials on trucks and landfill sites, and poor use of protective clothing. Supervisors cited worker negligence as the main cause of injury, whereas 72 (84%) workers cited lack of adequate protective clothing as a source of injury, and eleven (7%) workers cited use of inappropriate equipment.

Conclusion: On the basis of the modifiable risk factors for injury identified in this study, the Bulawayo City Council drafted a new health and safety training manual. New recruits now receive training before starting work on refuse collection trucks.

Introduction

Occupational injuries continue to be a serious but poorly documented problem in both developed and developing countries. The International Labour Organisation estimates that worldwide, workers sustain 250 million unintentional occupational injuries and an additional 330,000 fatalities annually (1). Reducing the number of injuries is one of Zimbabwe's top 10 health priorities (2). The highest numbers of occupational injuries in Zimbabwe occur in the construction, mining, and manufacturing industries. Service industries, including local government authorities, accounted for 1,707 (12%) of the 13,854 occupational injuries reported during 2000 (3).

The Bulawayo City Council Health Services Department (HSD) monitors the city's public health standards, including refuse disposal services provided by the cleansing section. During 2001--2002, a total of 97 injuries occurred among HSD workers, one of which was fatal (4). Of these 97 injuries, 67 (73%) occurred in the cleansing section, including the one fatality. After the City Council and employees expressed concern regarding the high incidence of occupational injuries in the section, a study was conducted to describe the nature of injuries and estimate the associated risk factors.

Methods

Records of injuries that occurred during January 2001--December 2002 were reviewed, and a cross-sectional survey was conducted in the HSD cleansing section during June 2003 to determine demographic and personal risk factors associated with injuries. Of 188 eligible general workers, 153 (84%) were interviewed along with 23 senior managers and section supervisors. Of 62 workers who had an injury during the study period, 51 (82%) were interviewed. All participants were informed that the purpose of the study was to find risk factors and make recommendations to improve the work environment. Persons interviewed gave informed written consent. A walk-through survey of public restrooms, mechanical workshops, a landfill site, and the suburban refuse collection process also was conducted. A checklist adapted from CDC's National Institute of Occupational Health (5) and a form (Occupational Health and Safety Form OHS IAF 2003) created by the National Social Security Authority (NSSA) of Zimbabwe were used to identify environmental risk factors. Data were analyzed using Epi Info 2002 (CDC, Atlanta, Georgia). Univariate analysis, frequencies, prevalence odds ratios, and p values at 95% confidence intervals (CIs) were reported. A result with a value of p<0.05 was considered statistically significant.

Results

Results from Register of Occupational Injuries

The register of occupational injuries indicated that 62 workers were injured at least once during the study period; of 67 injuries that occurred, one was fatal (Table 1). The death occurred when a bin loader slipped and was run over by the back wheels of a refuse truck. Injuries occurred throughout the week with no association to day of week or hour of day. Of the 51 injuries for which interviews could be conducted, 13 (25%) injuries were classified as major because they resulted in permanent scars and in loss of >3 working days, and 38 (74%) were minor. Only three of the 13 workers with major injuries received any compensation, and the amount they received was negligible (average: <$1 U.S. per month). Data regarding whether the family of the deceased worker was receiving compensation were not available. HSD management is responsible for the initial assessment and forwarding of necessary documentation and referral of workers to NSSA for payment of compensation. Neither workers nor management appeared to understand the compensation system.

Personal Risk Factors

The section workforce included 147 (96%) men and six (4%) women. Risk factors associated with suffering an injury were age 25 years (odds ratio [OR] = 3.2; CI = 1.6--9.2), working as a bin loader (OR = 3.6; CI = 1.1--4.8), not having received preemployment training (OR = 3.1; CI = 1.3--7.5), and subsequently rating the job as difficult to perform (POR = 2.9; CI = 1.1--7.7) (Table 2). Potential environmental hazards cited by workers included inappropriate equipment (cited by 30 [22%] workers), dust (22 [14%]), biologic material (20 [13%]), sharp objects (17 [11%]), and chemicals (15 [10%]). A total of 72 (84%) workers said provision of adequate personal protective equipment (PPE) would help in the prevention of injury. Another 11 (7%) workers said that provision of appropriate equipment could help in injury prevention. A total of 29 (20%) workers could not name any potential hazards.

Environmental Hazards

A walk-through inspection revealed human waste on restroom floors. Workers were at risk for splashes into exposed eye and mouthparts because they did not wear goggles or face masks during cleaning of restrooms. Workshops were overcrowded, with dirty vehicles under repair. All workers wore overalls, but none wore gloves to avoid contamination from materials left in refuse trucks. Mechanics used small jacks to lift trucks and were at risk for injury as a result of heavy equipment falling.

Two types of trucks were used for refuse collection: an old box-type truck and a modern hydraulic-compactor refuse-collection truck (Figure). The compactor has side steps on which bin loaders stand, and workers do not come into contact with rubbish. However, workers loading the box-type truck must lift bins above their shoulder level, and workers inside the truck come into direct contact with hazardous materials and are at risk for sustaining cuts to their legs, feet, or fingers while spreading out rubbish. Use of PPE was limited. Of 62 bin loaders observed during the bin-collection process, 27 (44%) had worn-out footwear, and 22 (32%) had overalls in bad condition. Only 17 (28%) wore respirator masks, and none wore head protection, although both are necessary to prevent injury. Workers are issued two pairs of overalls and a pair of boots twice annually. Heavy-duty gloves are issued every 2 weeks, and face masks are issued on demand.

Poor disposal habits of medical practitioners resulted in needles and bandages being present in refuse collection trucks, and uncovered biologic and chemical materials were observed at the landfill. Scavengers were observed at the dump site, which could cause unintentional injuries. Another hazard was that dust and noise were generated during the compacting process.

The presence of the hazards identified in the walk-through survey was confirmed by 23 senior managers and supervisors, who attributed injuries to the need for manual labor and to workers being careless and failing to follow the departmental safety protocol However, no written documented safety protocol was identified. Supervisors also said that workers sold their allocation of work clothes.

Section supervisors who were directly responsible for the workers said that not much could be done in the section because of poor communication in the department and that directors did not welcome requests, especially those involving capital expenditure. Supervisors said risk could be reduced by providing modern equipment and adequate PPE and by reducing the workload.

Discussion

Workers aged 18--25 years were more likely to suffer an injury than workers aged >25 years. Among workers in all industries, frequency of injuries has been demonstrated to decline with age (6). Younger workers might be more prone to injury because of their lack of experience and an inclination to take unnecessary risk.

Bin loaders were more likely to be injured than toilet or street cleaners. The absence of training at the beginning of employment was also identified as a risk factor. Bin loading involves handling of heavy loads and working with moving trucks. Workers should be trained in good lifting techniques and how to avoid vehicular accidents. Incidence of back injuries has been reduced substantially after training in proper lifting techniques (7).

The findings in this report are subject to at least two limitations. First, a walk-through inspection might not have identified all hazards. Second, interview data were missing for 18% of persons with injuries and for 19% of persons without injuries. If these persons represent different distribution of risk factors than persons included in the study, ORs might be underestimated or overestimated.

Conclusion

This report indicates the importance of keeping accurate records of the causes of injury so appropriate interventions can be made to prevent future injuries. Injuries that occurred in the cleansing section during 2001--2002 could have been reduced or, in some instances, avoided by implementing appropriate interventions. As a result of these findings, the Bulawayo City Council has compiled a health and safety manual for use in the department. New recruits in the bin loading section are now trained before they start work. HSD was advised to provide proper jacks in its mechanical workshops and to devise a plan to gradually phase out the old refuse removal trucks. To reduce the risk for injury, small jacks and old box trucks should be replaced with modern hydraulic trucks, and proper use should be made of PPE.

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