Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
Department of Environmental Design, Health and Nutritional Sciences, Allama Iqbal Open University, Islamabad, Pakistan.
Trop Med Int Health. 2022 Jul;27(7):606-618. doi: 10.1111/tmi.13787. Epub 2022 Jun 21.
To estimate the effect of improving waste collection services on waste disposal behaviour and exposure to environmental risk factors in urban, low-income communities in Pakistan.
We enrolled six low-income communities in Islamabad (Pakistan), four of which received an intervention consisting of a door-to-door low-cost waste collection service with centralised waste processing and recycling sites. Intervention communities underwent community-level and household-level mobilisation. The effect of the intervention on waste disposal behaviour, exposure to waste and synanthropic fly counts was measured using two cross-sectional surveys in 180 households per community.
Intervention communities had less favourable socio-economic indicators and poorer access to waste disposal services at baseline than control communities. Use of any waste collection service increased from 5% to 49% in the intervention communities (difference 44%, 95% CI 41%, 48%), but the increase was largely confined to two communities where post-intervention coverage exceeded 80% and 90%, respectively. An increase in the use of waste collection services was also found in the two control communities (from 21% to 67%, difference 47%, 95% CI 41%, 53%). Fly counts decreased by about 60% in the intervention communities (rate ratio 0.4, 95% CI 0.3, 0.4) but not in the control communities (rate ratio 1.52, 95% CI 1.1, 2.2). The decrease in fly counts was largely confined to the two high-coverage intervention communities.
Introduction of a low-cost waste collection service has the potential for high uptake in low-income communities and for decreasing the exposure to waste and synanthropic flies at household level. Intervention success was constrained by low uptake in half of the intervention communities.
评估改善废物收集服务对巴基斯坦城市低收入社区废物处理行为和环境风险因素暴露的影响。
我们在伊斯兰堡（巴基斯坦）招募了六个低收入社区，其中四个社区接受了一项干预措施，包括提供低成本的上门废物收集服务，以及设立集中的废物处理和回收点。干预社区进行了社区和家庭层面的动员。使用两个横断面调查，在每个社区的 180 户家庭中，测量了干预对废物处理行为、接触废物和共生蝇类数量的影响。
干预社区在基线时的社会经济指标较差，获得废物处理服务的机会较差，而对照社区则较差。在干预社区中，任何废物收集服务的使用率从 5%增加到 49%（差异为 44%，95%CI 为 41%，48%），但这种增加主要局限于两个社区，干预后覆盖率分别超过 80%和 90%。两个对照社区的废物收集服务使用率也有所增加（从 21%增加到 67%，差异为 47%，95%CI 为 41%，53%）。干预社区的蝇类数量减少了约 60%（率比为 0.4，95%CI 为 0.3，0.4），而对照社区则没有（率比为 1.52，95%CI 为 1.1，2.2）。蝇类数量的减少主要局限于两个高覆盖率的干预社区。
在低收入社区引入低成本的废物收集服务有可能得到很高的采纳率，并减少家庭层面的废物和共生蝇类暴露。一半的干预社区采纳率低，限制了干预的成功。
