Absorbent hygiene products disposal behaviour in informal settlements: identifying determinants and underlying mechanisms in Durban, South Africa.

BACKGROUND: Within South Africa, many low-income communities lack reliable waste management services. Within these contexts, absorbent hygiene product (AHP) waste, including nappies (diapers), are not recycled, and are often dumped, ending up in watercourses and polluting the local environment. The structural barriers to collection which have been well explored, however the behavioural determinants of safe disposal for AHPs remains poorly understood. The purpose of this study is to determine the psycho-social factors driving AHP disposal behaviour for caregivers, while identifying potential underlying mechanisms (such as mental health), which may be influencing disposal behaviour, with the intention of informing a future, contextually appropriate and sustainable, collection system. METHODS: The cross-sectional study was conducted within three low-income communities located within eThekwini Municipality (Durban), South Africa. The study included a pre-study and a quantitative survey of 452 caregivers, utilising the RANAS approach of behaviour change. The quantitative questionnaire was based on the RANAS model to measure psycho-social factors underlying sanitary disposal of AHPs. Mental health was assessed using the Self-Reporting Questionnaire (SRQ-20). Statistical analysis involved regressing psycho-social factors onto disposal behaviour and exploring their interaction with mental health through a moderation model. RESULTS: Our findings suggest that one third of caregivers do not dispose of nappies sanitarily, despite intent (86.9%). Regression analysis revealed ten psycho-social factors which significantly predict the desired behavioural outcome, the sanitary disposal of AHPs. Caregivers with poor mental health were less likely to dispose of AHP sanitarily, which reflects previous research linking poor mental health and the impairment of health-related daily activities, particularly within vulnerable groups. Specifically, several psycho-social factors underlying were moderated by poor mental health, the prevalence of sanitary disposal of AHPs depended on mental condition of caregiver. CONCLUSIONS: Our findings confirmed the link between poor mental health and unsanitary AHPs disposal. This is especially relevant because poor mental health is common within South Africa. Addressing mental health problems within these communities is an essential step to providing sustainable waste management services. The findings informed an intervention strategy to implement a future collection system for these communities, and similar low-income or informal contexts within South Africa.

"It is unbearable to breathe here": air quality, open incineration, and misinformation in Blantyre, Malawi.

Blantyre, Malawi's Queen Elizabeth Central Hospital (QECH), or Queen's, as it's known locally, is the country's largest public hospital. However, Queen's is not served by regular municipal waste collection. Rather, most hospital waste (infectious and non-infectious) is gathered by grounds staff and openly burned, in several constantly smouldering piles, sending up clouds of smoke. Speaking directly to an identified knowledge gap on air quality impacts linked to trash burning and the paucity of African urban dwellers' voices on air quality issues, this study employed a mixed-methods approach to both quantitatively measure the air quality around QECH, and to qualitatively investigate the perceived impacts amongst staff and caregivers. Low-cost sensors measuring particulate matter (PM) with particle sizes less than 10 µm (PM10) and less than 2.5 µm (PM2.5), expressed as the mass of PM per volume of air (µg PMx/m3 air) were recorded every 5 min at 8 locations across the QECH for 2 months. Qualitative data collection consisted of 56 interviews with patients, caregivers and hospital staff (including janitorial and maintenance staff, nurses, doctors, and administrators). Our results show that safe air quality thresholds are consistently exceeded across space and time and that the most problematic air quality surrounds the shelter for caregivers and those receiving treatment for HIV/AIDS. Moreover, staff and visitors are severely impacted by the poor air quality within the space, but feel powerless to make changes or address complaints. Waste management interventions are desperately needed lest the patients who arrive at Queen's leave with more health issues than the ones with which they arrived.

"The rich will always be able to dispose of their waste": a view from the frontlines of municipal failure in Makhanda, South Africa.

A significant proportion of South African municipalities, who hold the mandate for providing solid waste management (SWM) services for millions of South Africans, appear to be on the brink of collapse. On the frontlines of municipal failure, the city of Makhanda, following two decades of poor governance and mismanagement, has found itself unable to fulfil its mandate, with the state retreating on SWM service provision, and disruptions to waste management services becoming a daily reality. Drawing on embedded, qualitative fieldwork, this article examines how differently placed residents have experienced disruptions to SWM services. This work explores how residents of Makhanda's two halves: the affluent and predominantly white neighbourhoods in the west, and the poor, non-white townships in the east, have (or have not) adapted to manage and dispose of their own waste during periods of disruption. Findings suggest that disruptions to waste management service provision have been broadly experienced by residents. However, the consequences of interruptions to municipal collection have not been evenly borne, as more resourced, western residents have been more successful at managing their own waste disposal, while the residents of Makhanda's townships are less capable of coping, with affected communities coming to resemble a dumping ground, and residents having to adopt unsafe or environmentally harmful disposal practices. These findings are important because they shed light on the challenges of creating cleaner, more equal communities without healthy municipal participation in waste management services, while raising important considerations for a South Africa facing the possibility of widespread municipal collapse.

"You need to dispose of them somewhere safe": Covid-19, masks, and the pit latrine in Malawi and South Africa.

The ongoing Covid-19 pandemic has generated an immense amount of potentially infectious waste, primarily face masks, which require rapid and sanitary disposal in order to mitigate the spread of the disease. Yet, within Africa, large segments of the population lack access to reliable municipal solid waste management (SWM) services, both complicating the disposal of hazardous waste, and public health efforts. Drawing on extensive qualitative fieldwork, including 96 semi-structured interviews, across four different low-income communities in Blantyre, Malawi and Durban, South Africa, the purpose of this article is to respond to a qualitative gap on mask disposal behaviours, particularly from within low-income and African contexts. Specifically, our purpose was to understand what behaviours have arisen over the past year, across the two disparate national contexts, and how they have been influenced by individual risk perceptions, established traditional practice, state communication, and other media sources. Findings suggest that the wearing of cloth masks simplifies disposal, as cloth masks can (with washing) be reused continuously. However, in communities where disposable masks are more prevalent, primarily within Blantyre, the pit latrine had been adopted as the most common space for 'safe' disposal for a used mask. We argue that this is not a new behaviour, however, and that the pit latrine was already an essential part of many low-income households SWM systems, and that within the Global South, the pit latrine fulfils a valuable and uncounted solid waste management function, in addition to its sanitation role.

Narratives of home and neighbourhood within state-subsidised aged housing in Durban, South Africa.

The purpose of this article is to examine the meaning of 'home' and 'neighbourhood' to individuals living within state-subsidised aged housing, and to explore the role that those meanings play in shaping respondent's daily lives and identities. The work is based on an examination of Langeler Towers, a purpose-built housing facility in Durban, South Africa. Drawing on extensive qualitative, participatory fieldwork, including focus groups and creative drawing exercises, the findings suggest that for these individuals 'home' is a deeply personal place attachment that transforms a given place into an expression of an individual's identity, as well as a core element of their concept of self. 'Neighbourhood' can be considered an extension of 'home'- a place of comfort, family, and community. Moreover, these understandings of 'home' and 'neighbourhood' remain largely static throughout the life course and continue to inform residents' identities and expectations during and after their transition into aged housing. However, although residents were willing to negotiate on certain aspects of change during the transition into aged housing, such as their connection to material possessions, social attachments, such as to family, were seen as non-negotiable. For many, being able to maintain a tangible connection to loved ones, either living or deceased, with whom they no longer reside, was the fundamental aspect of 'home' and self-identity. These findings have important ramifications for an increasingly aging and urbanising South African population, and are also relevant for other low or middle-income national contexts.

"This is our next problem": Cleaning up from the COVID-19 response.

The purpose of this discussion is to highlight the essential role that solid waste management must play in a humanitarian response towards disasters, in particular the ongoing Covid-19 pandemic. We highlight a number of potential avenues for scholarly investigation into the waste impacts of our response to Covid-19, but in particular, briefly unpacks the relationship between disasters, consumption and disposability as one potential research topic. The discussion is intended to start a conversation that is, at the moment, critically relevant, and to contribute to a more inclusive, and less normatively Western waste management studies discourse.