Evaluation of occupational health and safety intervention for the waste and sanitation workers in Bangladesh during COVID-19.

ABSTRACT

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 (Control15, Intervention32) at baseline and 499 surveys (Control150, Intervention349) and 50 structured observations (Control15, Intervention35) 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.