Environmental Health and WASH, Health System and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Bangladesh.
ITN-BUET Centre for Water Supply and Waste Management, BUET, Dhaka, 1000, Bangladesh; Department of Civil Engineering, BUET, Dhaka, 1000, Bangladesh.
Int J Hyg Environ Health. 2024 Jan;255:114288. doi: 10.1016/j.ijheh.2023.114288. Epub 2023 Nov 22.
Waste and sanitation workers in South-Asian countries are vulnerable to injuries and diseases, including COVID-19. In Bangladesh, an intervention was implemented during COVID-19 to lower these workers' occupational health risks through training and PPE distribution. We assessed how the intervention affected their occupational health behaviors using a randomized cluster trial in 10 Bangladeshi cities, including seven intervention and three control areas. We conducted 499 surveys (Control-152, Intervention-347) and 47 structured observations (Control:15, Intervention:32) at baseline and 499 surveys (Control:150, Intervention:349) and 50 structured observations (Control:15, Intervention:35) at endline. To evaluate the impact of intervention at the endline, we used the difference in difference (DID) method. Compared to control, workers from intervention areas were more likely to have increased knowledge of using/maintaining PPEs (adjusted DID: 21%, CI: 8, 33), major COVID-19 transmission causes (adjusted DID: 27%, CI: 14, 40), and preventive measures (adjusted DID: 12%, CI: -0.6, 25), and improved attitude about using PPEs (adjusted DID: 36%, CI: 22, 49), washing PPEs (adjusted DID: 20%, CI: 8, 32). The intervention was more likely to improve workers' self-reported practice of taking adequate precautions after getting back from work (adjusted DID: 37%, CI: 27, 47) and changing/cleaning masks every day (adjusted DID: 47%, CI: 0.03, 94), and observed practices of maintaining coughing etiquette (DID: 20%, CI: 0.2, 40) at workplace and handwashing before wearing PPEs (DID: 27%, CI: 2, 52), after finishing work (DID: 31%, CI: -7, 69) & during work intervals (DID: 30%, CI: -33, 93). There was not much improvement in observed practices of mask use (DID: 1%, CI: -40, 42), handwashing before meals (DID: 2%, CI: -61, 65), and after toilet (DID: 7%, CI: -41, 55). This intervention has improved the knowledge, attitude and practice of the workers about critical occupational risk mitigation, which may be replicated in similar settings. Future interventions need to address occupational health-related injuries and health complications, introduce regular health checkups/insurance for the workers, create a balance between the quality and comfort of the PPEs and ensure a mechanism to ensure a regular supply of PPEs.
南亚国家的废物和卫生工作者容易受伤和患病，包括 COVID-19。在孟加拉国，在 COVID-19 期间实施了一项干预措施，通过培训和个人防护设备（PPE）的分发来降低这些工人的职业健康风险。我们在孟加拉国的 10 个城市进行了一项随机群组试验，评估了该干预措施如何影响他们的职业健康行为，其中包括 7 个干预区和 3 个对照区。我们在基线时进行了 499 次调查（对照组：152 次，干预组：347 次）和 47 次结构观察（对照组：15 次，干预组：32 次），在期末进行了 499 次调查（对照组：150 次，干预组：349 次）和 50 次结构观察（对照组：15 次，干预组：35 次）。为了评估干预措施在期末的效果，我们使用了差异中的差异（DID）方法。与对照组相比，来自干预区的工人更有可能增加对使用/维护 PPE 的了解（调整后的 DID：21%，CI：8，33）、COVID-19 主要传播原因（调整后的 DID：27%，CI：14，40）和预防措施（调整后的 DID：12%，CI：-0.6，25），并改善了对使用 PPE 的态度（调整后的 DID：36%，CI：22，49），以及对 PPE 的清洗（调整后的 DID：20%，CI：8，32）。干预措施更有可能改善工人在工作结束后采取足够预防措施（调整后的 DID：37%，CI：27，47）和每天更换/清洁口罩（调整后的 DID：47%，CI：0.03，94）的自我报告做法，以及在工作场所和戴 PPE 之前保持咳嗽礼仪（DID：20%，CI：0.2，40）和洗手（DID：27%，CI：2，52）的观察做法，工作结束后（DID：31%，CI：-7，69）和工作间隙（DID：30%，CI：-33，93）。观察到的口罩使用情况（DID：1%，CI：-40，42）、饭前洗手（DID：2%，CI：-61，65）和便后洗手（DID：7%，CI：-41，55）没有太大改善。这项干预措施提高了工人对关键职业风险缓解的知识、态度和实践，这可能在类似环境中得到复制。未来的干预措施需要解决与职业健康相关的伤害和健康并发症，为工人提供定期健康检查/保险，在 PPE 的质量和舒适度之间取得平衡，并确保有机制确保 PPE 的定期供应。
