ISSN 2454-2806
Social Science Spectrum
Vol. 2, No. 3, September 2016, pp. 195-202
Occupational Morbidity among Municipal Solid Waste Loaders in Mumbai
Pradeep Salve and Dhananjay W. Bansod
Abstract
Municipal solid waste loaders collect and load waste into waste carrying compactor
from different areas of the Mumbai city. Waste loaders are vulnerable to develop
communicable and non-communicable disease due to the nature of work. This paper
attempts to understand the occupation related morbidities and health seeking behavior
of solid waste loaders. A primary survey was conducted with a total 160 municipal
waste loaders in M/East ward of Municipal Corporation of Greatem Mumbai. The
waste loaders are found to have high prevalence rate of low back pain, shoulder pain
and hip/thigh pain in past 12 months. Almost 75 per cent of them reported eye related
problems; two-thirds had breathlessness and 42 per cent workers reported injuries in
past six months. The years of working, smoking, alcohol consumption and chewing
tobacco significantly contribute for raising the prevalence of morbidities. Loaders with
higher age, income and years of working spend more on their health treatment. At the
outset waste loaders have higher prevalence of injury/accident, skin disease
,respiratory disease, eye disease and musculoskeletal disorders. The municipal
corporation should take preventive measures and hold periodical health camps for
minimizing the health risk among the waste loaders.
Key words: Municipal waste loaders, occupational morbidity, treatment seeking, health expenditure.
I. Introduction
Outbursting urbanisation resulted in the monolithic production of solid waste materials in
towns and metropolitan cities in India. Municipal Corporation of Greater Mumbai (MCGM)
generates on an average of 8,500 metric tons of solid waste per day from its 24 administrative
wards. Around 30,000 regular employees are associated with the collection and transportation of
this waste along with a fleet of 983 municipal and private vehicles making 1,396 trips each day to
dispose the waste on landfill areas (Commissioner, 2012; Davis, 2013). Workers physically handle
the decaying carcasses of animals, household garbage, human and animal excreta, gully material,
infectious and hazardous medical waste and other toxic wastes with their bare hands, which leads
to development of communicable as well as non-communicable diseases and disorders among the
loaders. Waste loaders are vulnerable at every step for these diseases due to the exposure they have
during waste collection from field, transportation of waste and recycling or disposal of waste
during working hours.
Past numerous cross-sectional studies in developing countries are evidence that workers
associated with solid waste collection were likely to have high risk for development of various
chronic health problems such as respiratory tract infection, skin diseases, injuries, strains,
contusions, fractures, lacerations and musculoskeletal disorders compared to the general workforce
(Aweng & Fatt, 2014; Hansen et al., 1997; Inyang, 2007; Lora, James, Huren, & Bean, 1999;
Poulsen et al., 1995; Rushton, 2003; Yang et al., 2001). Similarly, studies conducted in India
demonstrated that workers associated with the solid waste collection have potential risk for
development of chronic respiratory diseases, anemia, hypertension, injuries, eye diseases, skin
Pradeep Salve, Doctoral Fellow, Department of Public Health & Mortality Studies, International Institute for
Population Sciences, Mumbai 400 088. E-mail: pradeep8889@gmail.com, pradeep@iips.net
Dhananjay W. Bansod, Associate Professor, Department of Public Health & Mortality Studies, International Institute
for Population Sciences, Mumbai 400 088. Emai: dhananjay@iips.net
The suggestions and comments of anonymous reviewers of this journal greatly helped us to improve this manuscript.
September 2016
Social Science Spectrum
diseases, nail infections and musculoskeletal disorders compared with the general population
(Akolkar et al., 2012; Hambach et al., 2012; Jariwala & Christian, 2013; Jayakrishnan, Jeeja, &
Bhaskar, 2013; Neghab, Khodaparast-Kazerouni, Hassanzadeh, & Ahmadzadeh, 2013; Sabde &
Zodpey, 2008). Municipal solid waste collectors are not only vulnerable to communicable diseases
due to lack of education, poor housing condition and non-availability of proper diet but their daily
substance use habits like tobacco consumption, smoking and regular drinking of alcohol also affect
their immune system. Previous studies suggested that substance use such as smoking and alcohol
consumption is higher among solid waste collectors and drainage cleaners (Mudalige &
Dharmathilake, 2000).
In developing countries not only health affects the human production capacity but at the
same time treatment seeking behaviour leads to financial burden due to high out of pocket
expenditure fot treatment. For instance, a majority of population in developing countries pays for
hospital care facility through out-of-pocket expenses (OPE) which push them into poverty and
OPE is one of the leading factors that causes the burden of health expenditure on an
individual/family. To cope with these expenditures, individuals borrowed money from friends and
relatives or sold/mortgaged their assets (Bhojani et al., 2012; Saksena & Evans, 2011). The solid
waste collectors have a higher burden of health expenditure due to their continuous health
problems and risky profession. Workers adopt a combination of savings, selling/mortgage assets or
borrow money from available sources as coping strategies. Limited studies have been conducted
with municipal solid waste collectors to assess the occupation related morbidities and health
seeking behaviour among municipal solid waste loaders in India. Therefore, the present study
assesses the waste loading associated morbidities and health seeking behaviours of solid waste
loaders in Mumbai.
II. Methods and materials
The primary survey was conducted with 160 waste loaders working in M/East ward of
Municipal Corporation of Greater Mumbai. For in-depth understanding, five in-depth interviews
were conducted with workers who had more than ten years of work experience.The municipal
waste loaders are those who collect and load solid waste into waste carrying compactors from
assigned areas throughout the 24 municipal wards in the city. During the eight working hours,
waste loaders have to collect and load the solid waste from nearly 10 to 15 waste collection spots
such as public markets, community dustbins of slums, residential areas, hotels and industrial zones.
The data was collected with the help of semi-structured questionnaire which covered the
information on demographic, socio-economic and occupational characteristics of waste loaders.
Specifically, it included information on morbidities, treatment seeking behaviour, expenditure on
health and information related to the protective measures. The interviews were conducted during
the working hours at the reporting places of workers (Chowkis) during February to March 2013.
The data entry and analyses were in STATA12 (StataCorp, 2015). The multivariate analyses were
performed to identify the confounders that lead to raising the morbidities. Permission to conduct
the primary survey was obtained from the MCGM and the respondents were assured that the
information would be confidential.
III. Results
The results show that 59 per cent waste loaders working in M/East ward were less than 30
years of age. With regard to education, 63 per cent were educated up to secondary school and 14
per cent were uneducated. Traditionally the cleaning occupation is mainly dominated by socially
weaker categories of people in India. They were systematically forced to perform this menial work
from generation to generation (Ramaswamy, 2005). It was seen that 82 per cent waste loaders in
this study belonged to the scheduled and other backward castes (Table 1). Alcohol consumption
was found to be very high among waste loaders. Almost two-thirds of the waste loaders consumed
alcohol with smoking (51 per cent) and chewing tobacco (44 per cent).
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Salve & Bansod
Table 1: Background characteristics of waste loaders
Characteristics
Per cent
Age
Less than 30
58.7
More than 30
41.3
Mean age
31.8
Education
Non-educated
14.4
Up to secondary
62.5
Secondary and above
23.1
Marital status
Currently married
85.6
Never married
14.4
Religion
Hindu
36.9
Neo-buddhist
50
Others#
13.1
Caste
SC/ST/OBC
82.5
Others
17.5
Years of working
Less than 5 years
33.1
More than 5years
66.9
Mean
8.2
Income in Rs.
Less than 17,000
46.3
Above 17,001
53.7
Mean
15066.9
Household size
Less than 4
35
More than 4
65
Mean
5.1
Substance Use
Smoking
51.2
Tobacco
44.4
Alcohol
65.6
Total
100.0
Municipal Waste Loaders
Number
94
66
23
100
37
137
23
59
80
21
132
28
53
107
74
86
56
104
82
71
105
160
#Others-Muslim and Christian. SC-Scheduled Castes, ST-Scheduled Tribes, OBC-Other
Backward Castes.
In the present study, prevalence rates of injury/accident, skin disease, respiratory disease,
eye disease, gastrointestinal and musculoskeletal disorders were found high among waste loaders
(Table 2). Workers reported pain in nine defined anatomical areas due to continuously physical
activities of pulling, pushing, lifting and loading community dustbins into waste carrying
compactors. Nearly nine out of ten waste loaders reported musculoskeletal disorders in past 12
months. Pain in low back, shoulder and hip/thigh were higher than the other anatomical parts.
Similarly, due to direct exposure to the collection of solid waste causes higher prevalence of
injury/accident in the past six months. The injury/accident was reported high particularly of
laceration (80.6 per cent) due to needles and glass material, fracture (17.6 per cent) and contusion
(40.6 per cent) in this period. Additionally, waste loading occupation led to the incidence of skin
diseases, respiratory problems and eye infections due to contact with stagnant water, handling
waste with inadequate protective measures, exposure to organic dust containing micro-organism,
vehicles’ exhaust, and irritant gasses during work. The prevalence of respiratory problems was
high among the waste loaders compared with the skin and eye diseases. Specifically, more than
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two-thirds of the waste loaders reported breathlessness (67.5 per cent) and continuous watering
(60 per cent) of eyes during the past six months.
Table 2: Prevalence of disease/disorder by sub-category among waste loaders during past
six months
Prevalence
Morbidities
Number
(per cent)
Injuries/Accident
87.5
140
Fracture
17.6
28
Laceration*
80.6
129
Contusion
40.6
65
Skin disease
73.1
117
Rashes/Infective
52.5
84
Fungal infection
51.6
82
Respiratory disease
78.8
126
Dust allergy
8.8
14
Asthma
8.8
14
Chronic cough
26.3
42
Running nose
42.5
68
Breathlessness
67.5
108
Eye disease
71.9
115
Eye soreness
12.5
20
Redness
53.1
85
Watering
60.0
96
Itching
46.3
74
Gastrointestinal infections
45.0
72
Loose motion
2.5
4
Gastroenteritis
41.9
67
Leptospirosis
1.9
3
Worm infection
3.1
5
Musculoskeletal disorders#
89.4
143
Neck
26.9
43
Upper back
26.9
43
Shoulder
66.2
106
Elbow
22.5
36
Wrist and hand
23.1
37
Low back
71.2
114
Hip/thigh
61.9
99
Knee
33.1
53
Ankle
30.0
48
Total
160
* Laceration with needles and glass material, #reference period past 12 months.
The multivariate logistic regression shows that years of working had significant impact on
development of morbidities among workers (Table 3). Workers working more than five years as
waste loaders five-time (OR=5.06; p<0.01) are more likely to have injury/accident compared with
those worked for less than five years. Similarly, workers working for more than five years are
likely to have four times (OR=4.46; p<0.05) and two times (OR=2.27; p<0.05) higher
musculoskeletal disorders and skin diseases respectively than those working for less than five
years. Substance use among loaders significantly increase the probabilities of morbidness.
Workers who consumed alcohol were fourtimes (OR= 4.32; p<0.01) more likely to have injury/
accident compared with non-alcoholic workers. Similarly, waste loaders with smoking habit were
three times (OR=3.39; p<0.01) more likely to have eye problems. Chewing tobacco also
significantly increased the respiratory, eye and musculoskeletal disorders among waste loaders.
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Municipal Waste Loaders
Table 3: Odds ratio showing association between major morbidities and background characteristics
among waste loaders
Injury/
GastroCharacteristics
Skin
Respiratory
Eye
MSDs#
accident
intestinal
Years of working
Less than 5®
More than 5
5.06***
2.27**
2.06*
1.65
4.46**
1.48
(1.43-17.84) (0.97-5.29)
(0.52-5.13)
(0.68-3.99) (0.69-28.60) (0.67-3.25)
Years of schooling
Less than 10®
10 and above
1.00
1.12
1.31
1.07
0.78
1.35
(0.32-3.08)
(0.49-2.52)
(0.54-3.13)
(0.46-2.48)
(0.16-3.72)
(0.66-2.74)
Smoking
No®
Yes
2.32
1.91*
1.81
3.39***
2.85
0.99
(0.66-8.11)
(0.84-4.36)
(0.74-4.40)
(1.47-7.82) (0.37-21.59) (0.49-1.96)
Alcohol
No®
Yes
4.32***
1.07
1.15
1.66
2.77
1.21
(1.30-14.33) (0.46-2.47)
(0.47-2.80)
(0.73-3.74) (0.46-16.36) (0.58-2.51)
Tobacco
No®
Yes
1.72
2.03*
2.33**
1.91*
7.49***
1.54
(0.55-5.31)
(0.92-4.45)
(0.99-5.49)
(0.86-4.22) (0.82-68.45) (0.79-2.97)
Family size
<4® members
>4 members
0.50
0.84
0.96
2.27**
2.47
1.45
(0.14-1.66)
(0.36-1.89)
(0.40-2.28)
(1.02-5.05) (0.48-12.65) (0.71-2.95)
# Musculoskeletal disorders in past 12 months; the model additionally adjusted for sge, marrital status and caste.
Workers were not only vulnerable for developing occupational morbidities but at the same
time burdened by out of pocket expenditure while seeking treatment. Table 4 provides treatment
seeking behaviour and mean expenditure of waste loaders by socio-economic and occupational
characteristics. The mean health expenditure of workers was positively associated with age, years
of working, income and household size. For seeking health treatment at the young age workers
prefer to visit private health facilities but with increase in age their place of treatment changes. For
instance, more than 50 per cent workers aged less than 30 years visited private health facility
compared with the 47 per cent workers of more than 30 years. The expenditure on health treatment
increases with increase of age. Similarly, with increase in working years, waste loaders prefer the
government facility for seeking treatment compared with the private facility. Waste loaders
working for more than five years in the solid waste department spend three times higher for
treatment seeking compared with those who had less than five years of working experience. The
analysis also shows that among workers who had above Rs. 17,000 of monthly salary, 53.5 went to
private facilities and spent more than Rs. 3,000 on treatment in the past six months. No difference
was found while considering the health expenditure of loaders who were habitual to substance use.
IV. Discussion
In the present study, the mean age of waste loaders was 32 years along with mean eight
years of working experience. Majority of the workers were educated upto the secondary education,
whereas about 15 per cent were non-literate. The Municipal Corporation of Greater Mumbai has
institutionlized the age-old practice of cleaning where selected castes were enforced to do this
menial cleaning. This system is sustained form generation to generation due to the caste based
process of recruitment as a municipal worker. In the present study, more than 80 per cent of waste
loaders were belong to the scheduled castes. The work of solid waste loading is highly associated
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Social Science Spectrum
with the substance use. The alcoholism and smoking habits are found to be more common, and
they work as anesthesia during the working hours. Due to the exposure of waste loading work,
workers were vulnerable to the developemnt of communicable as well as non-communicable
diseases/disorders.
Table 4: Treatment seeking behaviour and mean health expenditure of waste loaders by
socio-economic and occupational characteristics.
No
Govt.
Private
Mean expenditure
Characteristics
Number
treatment (per cent) (per cent)
Rs. (SD)
Age
Less than 30 years
8.5
39.4
52.1
1543 (2384)
94
More than 30 years
3.0
50.0
47.0
4201 (10982)
66
Education
Non-educated
0.0
60.9
39.1
3682 (7807)
23
Up to secondary
7.0
44.0
49.0
2989 (8472)
100
Secondary & above
8.1
32.4
59.5
1045 (1326)
37
Marital status
Currently married
5.1
44.5
50.3
2887 (7894)
137
Never married
13.0
39.1
47.8
1161 (2217)
23
Religion
Hindu
8.5
40.7
50.8
2158 (4338)
59
Neo-Buddhist
6.2
45.0
48.7
3225 (9648)
21
Others#
0.0
47.6
52.4
1761 (2641)
80
Caste
SC/ST/OBC
7.6
43.1
49.2
2827 (8005)
132
Others
0.0
46.4
53.6
1757 (2854)
28
Years of working
Less than 5 years
11.3
35.8
52.8
1050 (2056)
53
More than 5years
3.7
47.6
48.6
3426 (8807)
107
Income
Less than Rs. 17,000
9.5
44.6
45.9
1699 (4081)
74
Above Rs. 17,001
3.5
43.0
53.5
3448 (9270)
86
Household size
Less than 4 members
5.4
46.4
48.2
1865 (2768)
56
More than 4 members
6.7
42.3
50.9
3056 (8906)
104
Substance use
No addiction
15.4
30.8
53.8
2869 (6461)
26
Any one
9.7
51.6
38.7
2037 (3805)
31
Two and above
2.9
44.7
52.4
2763 (8373)
103
Total
6.3
43.7
50
160
#Others-Muslim and Christian; SD-Standard Deviation; Substances- Tobacco, Smoking and Alcohol; SC-Scheduled
Castes, ST-Scheduled Tribes, OBC-Other Backward Castes, Govt.-Government
The study furhter highlights the high prevalence rate of occupation associated morbidities
among waste collectors in given reference period. Mainly waste loaders were more vulnerable to
the development of musculoskeletal disorders due to the continuous physical activities. Almost 90
per cent workers reported pain in nine defined anatomical areas during past 12 months.
Specifically, pain in the low back (71.2 per cent), shoulder (66.2 per cent), and hip/thigh (61.9 per
cent) were higher than the other musculoskeletal regions. Similarly, almost nine out of ten waste
loaders suffered with injury/accident in past six months. Laceration due to needles and glass
material dumped in open community dust bins were found to be common among waste loaders
than fracture and contusion. Manul handiling of solid waste and exposure of various pollutants
causes skin disease, respiratory problems and eye infection among workers. The problem of
breathlessness was observed to be very high among waste loaders compared with the other health
concerns. This may be due to the direct exposure to toxic gasses released from the garbage
200
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Municipal Waste Loaders
compactors while loading and compressing waste. While loading the solid waste into garbage
compactors, a loader has to stand behind the vehicle closely where compactor constrict the waste
material which emits various gasses. This process causes various problems including redness,
itching and continuous watering of eyes. The multivariate logistic regression analysis shows that
the years of working and substance use had significant impact on development of morbidities
among workers. As the prevalence of morbidities were high among waste loaders, the expenditure
on the health seeking involved financial burden. The health expenditure was increasing with age,
years of working, income and household size of waste loaders. For instance, waste loaders working
for more than five years in the solid waste department tend to spend higher on treatment compared
with those who had less than five years of working experience.
There are studies to show that municipal workers associated with solid waste collection
and disposal tend to develop higher morbidities compared with the general population. The survey
conducted among solid waste collectors in Ghana studied the pre- and post- effect of joining work
in the solid waste department and suggested that in the post joining period 88 per cent reported
neck pain and 79 per cent developed the low back pain compared with the 12.4 per cent and 21per
cent respectively (Friedrich, Cermak, & Heiller, 2000). Likewise, the cross-section study
conducted with 313 solid waste workers in Kerala highlighted that the higher prevalence of
accident (22 per cent), injury (73.2 per cent), respiratory and eye diseases (ranged from 21 per cent
to 47 per cent) (Jayakrishnan et al., 2013).
Initially the mechanization of solid waste management department helps to reduce the
workload of workers, but at the same time it increases the risk of accident and injuries among
them. The non-service vehicles like garbage compactors and mini-trucks were one of the main
reason for injuries and accidents according to the waste loaders. The finding suggests that,as waste
loaders were more habitual for substance use like alcohol consumption, smoking and chewing
tobacco, the municipal corporation must take the initiative to reduce the substance use through
taking preventive measures and introducing awarness programmes. Additionally, the municipal
corporation may provide mobile medical service at the work places throughout the 24 municipal
wards in Mumbai which can help to increase the accessibility of the treatment seeking behaviour.
At the outset, the Municipal Corporation has to develop some policies and programmes to
minimize the health risk and to improve the life standard of waste loading workers. The health of
municipal workers continuously deteriorated after the service which leads to the long-term
disability in post-retirement age causing premature death. In addition, further research may extend
to explore the issues of out-source workers in solid waste collection work. Compared to the formal
municipal employees, the heath of contract workers is worse. Out-sourced workers are mainly
from Non-Government Organization (NGOs) working without job security at low wages. While
hiring the out-source labours, the Municipal Corporation leaves out the responsibilities for
providing necessary services such as protective measure, medical care and minimum salary for
contract workers.
Limitations of the study
In this study, diseases and morbidities are mainly self-reported which may have been overor under-reported. There may be a seasonal variation in the prevalence rate of morbidities as the
nature of waste loading occupation changes according to the seasons.The survey was conducted in
one out of 24 municipal wards in Mumbai and hence the result may be generalised with caution.
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