Prevalence and factors associated with occupational injuries among medical waste handlers at three National Referral Hospitals in Kampala, Uganda.

Abstract

Background: Occupational injuries still remain one of the most important public health challenges, killing over 360,000 workers worldwide each year. Research has demonstrated that medical waste handlers, especially in developing countries, are disproportionately affected due to a dominance of manual handling tasks and inadequate segregation of waste. In Uganda, like many developing countries, manual handling and inadequate waste segregation are still prevalent; however, there is little published information on the occupational injuries that medical waste handlers experience. Thus, our study aimed at determining the prevalence and associated risk factors for occupational injuries among medical waste handlers in three National referral hospitals. Methods: A facility-based mixed methods design comprising a cross-sectional survey followed by focus group discussions was conducted between February to April 2020 among waste handlers working at Mulago, Kawempe and Kiruddu National Referral Hospitals. Data were collected through an interviewer-administered questionnaire uploaded into Open Data Kit (ODK) software that was installed on smartphones. Completed questionnaires were downloaded from the server as a Microsoft Excel spreadsheet, and imported into STATA version 14.2 for Windows. Bivariate and multiple regression analyses were performed using modified Poisson regression to identify factors associated with occupational injuries. Respondents in focus group participation were sampled purposively, and thematic analysis was used to analyze qualitative data on barriers and facilitators to reporting occupational injuries. Results: One hundred and sixty-eight of the total 197 eligible participants completed the interviews, yielding a response rate of 85.3%. Among the waste handlers, 67.9% reported experiencing at least one injury during the preceding twelve months. Significantly increased risks were identified for job type (APR-1.72; 95%CI: 1.03-2.89), and employment duration (APR-2.07; 95%CI: 1.31-3.28), while protective factors included marital status (APR-0.60; 95%CI: 0.37-0.96). and perceived worker safety priority (APR-0.66; 95%CI: 0.45-0.98). Identified barriers to reporting workplace injuries included factors associated with the reporting process; management support and feedback; and beliefs and attitude of the workers. Reported facilitators included relationships with healthcare professionals, maintaining a track record of exposure in case of complaints and repercussions, and perceived injury severity. Conclusion: This study showed a high prevalence of occupational injuries among medical waste handlers in the three national referral hospitals. Mandatory occupational safety training and reinforcement of personal protection measures for medical waste handlers might improve injury reporting and reduce the prevalence of occupational injuries.