33
The Himalayan Review 35-36 (2004-2005) 33-47
Solid Waste Management Practice and Health Implication:
A Case of Kathmandu Metropolitan City, Nepal
Rishikesh Pandey
itsmehimalaya@gmail.com
Abstract
Waste handling practice in Kathmandu is labor intensive and disposal system does not meet
environmental standard. Mixture of organic to inorganic and hazardous to non-hazardous wastes
is the composition of municipal waste of Kathmandu. Waste management practice has severe
health impact to municipal waste workers. Over the past several generations, people of specific
castes (Pode, Chyame) have been working as municipal waste workers and are entitled
‘kuchikar’ officially. This research examines occupational health problems of these waste
workers. Findings are based on the survey of 61 waste workers of Kathmandu Metropolitan
City.
Key words: Environmental problems, waste management, occupational health, waste workers,
protective measures.
Introduction
Standards of waste handling practice in industrialized countries have reduced occupational
health problems and environmental impacts significantly. Developed countries have established
sanitary landfills and started to use sophisticated machineries to handle waste. Contrary to
that, solid waste is one of the main problems for urban health in developing countries (Birley
and Lock 1999, Pugh 2000, Hardoy et al. 2001, Atkinson 1999). In the cities of developing
countries, waste collectors lift heavy loads often to higher loading location and at busy traffic
with more dust and diesel exhausted pollution. In such working condition back and joint
injuries, respiratory illness, infections can occur to waste worker (Cointreau-Levine n.d.).
Over-population concentration in Kathmandu generate huge amount of waste. With the course
of industrialization and modernization, proportion of non-biodegradable waste has significantly
increased. As a result surrounding environment fail to maintain the balance between waste
supply and waste degradation. At present, waste accumulated in Kathmandu is dumped either
in open space or at the side of water bodies. Such improperly disposed wastes are creating
various environmental and health problems.
In Kathmandu, waste is piled on the street corner or on the ground directly and it is either
shoveled or picked up by bare hands by municipal solid waste workers (hereafter waste
workers). Hazardous wastes are not separated. Waste handling and disposal practice do not
meet environmental protection standards. Sanitary landfills are absent and collected wastes
34
Solid Waste Management Practice and Health Implication
are buried in riverbanks. It deteriorates air quality and pollutes rivers. Similarly, open sewerage,
pile up garbage and open dumping sites, inadequate water supply and poor sanitation are
other environmental problems of Kathmandu. These problems are causing serious health
problems to Kathmanduities. However, the risks are the highest among waste workers, who
are working for solid waste management in the city, since generations. Waste workers, though
they perform essential tasks for city dwellers, remain an utterly neglected section in Kathmandu.
Their work is traditionally regarded as ‘degrading’ and ‘defiled’. The society has always kept
them at a distance despite their ubiquity and the importance of the work they do.
In Nepal, there are no provisions for handling hazardous1 wastes separately, and the country
lacks worker protection system. Waste workers themselves are unaware and do not undertake
protective measures. They live in proximity to the dumpsites and are exposed to potentially
more harmful wastes such as toxic materials, gases and infectious microorganisms. In these
circumstances, waste workers have to bare the highest health risks. However, no thorough
studies have been carried out so far in this issue in Kathmandu. In this context, present study
explores the existing health problems of waste workers of Kathmandu Metropolitan City
(KMC). The first part of this paper introduces the problems, study area and methods used
during the research. Middle part of the paper deals with the existing solid waste management
practices and the health problems experienced by waste workers. Final part of the paper
presents the conclusion.
The Study Area
Kathmandu (KMC), the capital city of Nepal covers an area of about 50.76 sq. km, which is
the home for more than 671 thousand people excluding floating population (CBS 2002). It is
prominent not only for population concentration, energy/resource consumption and economic
activities but also for waste production and pollution. Despite the better health care facilities
and economic condition than in countryside, the Kathmandu has a higher infant mortality rate
of 66.78/1000 (KMC 2001) compared to the country’s average of 64.1/1000 (CBS 2002).
Many expert opine that it is due to air pollution (MOPE), poor coverage of water supply and
sewerage (KMC 2001), degraded environmental conditions including huge amount of solid
waste generation (about 315 metric tons daily: KVMP/KMC 2001), which is neither collected
in time nor dumped in sanitary landfill site.
Today’s any environmental problems faced by the inhabitants of the earth, and its causes are
directly or indirectly linked to urban areas (WRI 1996-97). In this context, Kathmandu is
probably the best place in Nepal to observe urban environmental crises. Though, the population
of Nepal is still predominantly rural (about 86 percent), the country is facing rapid urban
population growth of about 6 percent per year (CBS 2002). Due to the rapid population
1
Special/hazardous wastes include wastes containing toxic, inflammatory, reactive, explosive material and
infectious microorganisms like heavy metals in batteries, pesticides and infectious medical wastes.
Rishikesh Pandey
35
growth, Kathmandu faces urban generated waste disposal problem, which has great impact
on the health of urban residents. Urban Population Survey found unmanaged waste disposal
as the main cause of the environmental problem in the urban areas of Nepal (Mishra and
Kayastha 1998). Among the urban areas of Nepal, Kathmandu faces most critical situation
of solid waste management.
Methods and Materials
KMC has about 2000 solid waste workers. However, only about 200 waste workers work
directly under the administration of KMC Central Office. The rest are working under different
wards’2 administration. In this study waste workers are categorized in three types namely:
sweepers, collectors, and loaders based on the specific work they do. The findings of this
study are primarily based on the information collected from 61 respondents (30 sweepers, 17
collectors and 14 loaders). All of them were working under direct administration of KMC
Central Office. The number of surveyed sweeper is relatively higher than those of collectors
and loaders.
Field survey was carried out in the months of June, July and August 2003, using questionnaire
survey. Because of difficulties in drawing the boundaries between diseases, this study applied
prototype categorization for diseases classification. After obtaining information, all information
was entered in Statistical Package for Social Science (SPSS) database and percentile of
respondents, experienced different health problems, were calculated. Simple statistical
techniques and descriptive approach is widely used in this paper for the interpretation of data.
Waste Management Practice and the Waste Workers
Waste is a product of economic growth and consumption. Cointreau (1982) found that waste’s
amount increases with the increase in living standard and economy of the country. With the
course of urbanization Kathmandu is experiencing changing waste composition (Pandey 2004)
and increasing per capita waste generation (cf. KVMP/KMC 2001). Most recent estimation
of KMC reveals that per capita waste generation in the Kathmandu Valley is 0.42 kg per day
(KMC, Environment Department 2003).
Waste workers of KMC sweep streets, public utilities and collect accumulated wastes lying in
streets and public spaces. Majority of male waste workers involve in uploading and unloading
wastes in vehicles, pulling rickshaw and driving vehicles loaded with wastes. On the other
hand, majority of women waste workers are involved in sweeping and collecting wastes. In
households, hotels and institution level, solid waste is stored in plastic bags, plastic or metal
bins or bamboo basket. Such wastes are collected either by cleaning staff of private sectors
or by community waste workers, in big basket ‘Doko/Thunche’, handcarts, tractors, and
2
Ward is the smallest administrative unit.
36
Solid Waste Management Practice and Health Implication
trucks from source of origin and transported to Teku (waste transfer depot). Privatized and
community based waste management gave better result in some of its wards in KMC.
Therefore, KMC has planned to privatize and emphasized on community based waste
management. Waste collected at Teku are again loaded in trucks, compressors and sent to
Balkhu (dumping site). Wastes at Balkhu are unloaded in ditches created alongside the Bagmati
Riverbank and covered by a layer of soil.
Waste collection and sweeping profession has been traditionally allocated for certain castes
like Pode, Chyame throughout Nepal. A person born under such caste is perceived as
Kuchikars (sweeper) even though he or she is unemployed. Caste has been known as an
element in the social structure of Nepal. Generally, neither the people from other castes work
as waste worker nor the Kuchikar look other jobs. Castes are ranked endogamous divisions
of society in which membership is hereditary and permanent (Berreman 1972) that is the
typical feature of Nepalese caste system.
Ancient Kathmandu (around 700AD) was surrounded by a protective wall and the people
belonging to lower castes called achhut (untouchable) like Pode, Chyame, Kullu and
Harahuru were not allowed to live inside of then city wall. In the regime of Surendra Bikram
Shah (1904-1938 BS) Muluki Ain (civil code) also strictly restricted these castes to reside
inside the city wall. This way, Kuchikars have always been ranked as one of the lowest
castes in the hierarchy of castes. From the long history, they are working as waste workers
and making their housing near garbage dumping sites. Being poverty-stricken and working in
the lowest paid jobs, city dwellers had a tradition to give waste workers the remaining food.
Health Problems
Health is ‘a state of complete physical, mental and social well-being’ (cf. Gatrell 2002). Health
determines physical and mental ‘fitness’ and enables functioning effectively for the good of the
society. Therefore, health is someone’s physical and mental situation that can be transformed
into economy and welfare. Structuralists claim that underlying causes of diseases are
embedded in political and economic system. Existing inequalities in society, social structure,
human activities and access to health care affect health (Gatrell 2002).
Health depends on environmental conditions. According to WHO, poor environmental quality
is estimated to be directly responsible for a quarter of preventable ill-health in the world
today. Absence of basic infrastructures and services for sewers, drainage, drinking water and
regular service of waste collection and its safe disposal create numbers of disease causing
agents (Cointreau-Levine n.d.). Leach of uncollected waste seeps into the drinking water
supply system that results in chronic health problems (Birley and Lock 1999). The waste
workers suffer highly from neighborhood health problems since the hazardous sites are the
only places where they can build or rent shelters. Moreover, their high health risky works
expose them various work-place-related health hazards, since environment at work place is
Rishikesh Pandey
37
often ignored in developing countries (Phoolchand 1995). In this background, waste workers
of KMC are suffering from different health problems like physical injuries, poisoning, respiratory
tract disease as well as gastrointestinal diseases.
Physical Injuries
Significantly high proportions of waste workers are experiencing varieties of physical injuries.
Cuts, bruises and ruptures in the body, back pain, joint pain, elbow injury, wrist pain and
other physical pains and aches are some examples of physical injuries. Unsorted inorganic
wastes and labor-intensive waste handling practices are the leading causes of high rate of
physical injuries. Poor protective measures and absence of first aid in time of injury is intensifying
the problem. The problem differs among the waste workers by activity (Annex A). Collectors
and loaders use their feet to push spade into the pile of garbage. Sometimes they wipe waste
and put it in spade using feet or hand. While doing so, the probability of cut, bruises and
ruptures is high. Falling of broken glass and metals on one hand can injure and the other hand
uploading heavy load on trucks can develop dislocations and physical ache to loaders. Probably,
this is why the highest proportion of loaders is suffering from the problems of cut, bruises and
ruptures. Although the highest proportion of loaders are experiencing cuts, bruises and ruptures
the weekly frequencies of each injury problems is relatively lower to them (Table 1).
Problems of physical injuries are not only the problems of the waste workers of Kathmandu
but also the problem of other cities of the world. Problem of musculoskeletal disorder are
found 4 times higher among the waste workers than among general laborer in US, (Poulsen et
al. 1995b). Significant physical hazards such as wrist, elbow and back injuries and low back
pain among waste workers is also found in Japan (Brosseau and Golden 2000, Koda et al.
1997). In Denmark by Poulsen et al. (1995a and b) identified muscle aches, joint pains and
frequent occupational accident among waste collectors. The case of Kathmandu and examples
provided in other studies indicate that waste workers have higher injury risks anywhere in the
world.
Table 1. Frequency of Physical Injury Among Waste Workers
Weekly frequency of physical injuries
Work type
4 or more than 4 times
2-3 times
Once
Less than once
Sweepers
20 (67)
6 (20)
1 (3)
3 (10)
Collectors
11 (65)
0 (0)
2 (12)
2 (12)
Loaders
6 (42)
0 (0)
4 (29)
4 (29)
Total
37
6
7
11
Source: Field survey, 2003.
Figures within parenthesis indicate percentage
38
Solid Waste Management Practice and Health Implication
Allergies
Allergies are serious health problems among the waste workers in Kathmandu. Skin rashes,
itching, irritations, swelling lips or eyelids, eye irritations are few of the allergies reported in the
study (Annex A). Skin irritation and eye irritation in the waste collectors is also observed in
Denmark (Poulsen et al. 1995a and b).
Table 2 shows annual suffering period for waste workers of allergic diseases. Some activitywise differences are observed on the suffering duration. The highest proportion of collectors
followed by sweepers and loaders are experiencing irritation problem for long period of time.
Despite relatively lower proportion of loaders is experiencing the problem of swelling, they
are experiencing for longer period than the others. Contrary to that, problem of eyelid burning
is lasting for longer time among collectors.
Since human and animal excreta are always present in municipal waste of Kathmandu, handling
such waste results in number of allergic reactions to waste workers. Leach of waste-tips
dissolved in the water or disease vectors and pathogens transferred through clothes and body
parts help to develop allergies.
Table 2. Duration of Allergic Problems Lasting to Waste Workers
Respondent Alergic Problems
Duration (one year)
A week
1 month
3 months
Skin rashes
6 (20)
3 (10)
6 (20)
Irritation
1
(3)
4
(13)
5 (17)
Sweepers
Swelling
10 (33)
3 (10)
0 (0)
Eyelid burning
2 (7)
6 (20)
6 (20)
Skin rashes
6 (36)
0 (0)
0 (0)
Irritation
4 (24)
2 (12)
0 (0)
Collectors
Swelling
2 (13)
0 (0)
0 (0)
Eyelid burning
1 (6)
1 (6)
2 (12)
Skin rashes
1 (7)
3 (21)
0 (0)
Irritation
1 (7)
5 (5)
0 (0)
Loaders
Swelling
0 (0)
1 (7)
0 (0)
Eyelid burning
4 (28)
2 (14)
1 (7)
Half year
1 (3)
6 (20)
0 (0)
1 (3)
3 (18)
5 (29)
0 (0)
3 (18)
2 (14)
2 (14)
1 (7)
1 (7)
Source: Field survey, 2003.
Figures within parenthesis indicate percentage
Allergic diseases are intense due to poor protective measures, lack of enough water for
proper sanitation and personal hygiene. Out of the total (61) respondents, only 11 percent
waste workers bathe daily and none of them change their clothes daily (Table 3). Diseases
like eye and ear infections, skin diseases, scabies, lice and fleas are very difficult to control
Rishikesh Pandey
39
without adequate supply of water (Hardoy et al. 2001). Water scarcity is a serious problem
of Kathmandu. The waste workers who live in poor service areas are compelled to use either
groundwater or water from streams for bathing and washing (sometimes even for cooking
and drinking too). Use of very low quality of water causes bad personal hygiene.
Table 3. Habit Among Waste Workers
S. No.
Frequency of Involvement
1
2
3
4
5
6
Weekly
2 Times a Week
3 Times a Week
4 Times a Week
Daily
Total
No. of Respondents by Habits
Cloth Change
Bathing
45 (74)
4 (7)
6 (10)
15 (25)
5 (8)
25 (41)
5 (8)
10 (16)
0 (0)
7 (11)
61 (100)
61 (100)
Source: Field survey, 2003.
Figures within parenthesis indicate percentage
Poisoning
Numbers of poisoning problems can occur while handling rotten wastes. Although the problems
like headache, nausea, fatigues and fits might be the outcome of other factors, they are perceived
as symptoms of poisoning in this study, because the respondents claim that when they go
away from working sites, they feel normal again. Some waste workers also believe that
headaches are caused by intense heat during the sunny days and nausea and fatigue are due to
weakness.
Dumping site conflict, waste workers’ strikes and other political issues frequently disrupts
organized collection of garbage in Kathmandu. Garbage waiting for collection and wastes
dumped in non-sanitary dumping emit poisonous gases. Methane emitted from dumping site
can cause poisoning (Birley and Lock 1999). Not separating toxic materials and container of
poisonous gases from wastes also create poisoning problems. The use of mask might help to
reduce the poisoning problems. But waste workers do not do so. Among different poisoning
problems, headache and nausea are found more intense among sweepers (Annex A).
Respiratory Tract Diseases
In Kathmandu, vehicular emission exceeded the minimum standard. Plying such vehicles in
dusty roads makes air quality very bad. The concentration of total suspended particles (TSP)
and particulate matters of 10 micrometer (PM10) are the major causes of air pollution in
Kathmandu (Pandey 1997). Because of poor air quality urbanities of Kathmandu are
experiencing number of respiratory problems. However, situation of waste workers was
observed very bad, because they expose daily to poor air quality and come to contact with
numbers of pathogenic and nonpathogenic microorganism. Symptoms of respiratory tract
40
Solid Waste Management Practice and Health Implication
diseases are observed on very high proportion of waste workers (Annex A). Breathlessness,
chest pain, cough, fever and sputum with sneezing, headache, running nose, and nasal congestion
are few of the associated symptoms of respiratory tract ailments in waste workers. Rhinitis/
sinusitis, pharyngitis, tonsillitis, bronchitis, pneumonia, tuberculosis, Chronic Obstructive
Pulmonary Disorder (COPD) and asthma are some respiratory tract diseases those identified
in waste workers of Kathmandu. However, being common symptoms of number of respiratory
tract diseases, it is difficult to draw clear boundary among different respiratory tract problem
without clinical examination and laboratory test.
Respiratory tract diseases are not typical only in the waste workers of Kathmandu. The
studies of Poulsen et al (1995 b) in Geneva and Denmark, and Roy at al in USA present some
example of respiratory tract related disease even in the developing countries.
Annex A provide evidences of waste workers experience about the symptoms of respiratory
tract diseases. Activity-wise differences are clearly observed in the proportions of suffering
respondents especially of tuberculosis, COPD and asthma. Symptoms of these diseases are
found only in sweepers. It might be because of their higher exposure to dust and vehicular
emission while sweeping streets. Activities wise differences are noted not only in the proportion
of respondents experiencing the symptoms but also in the annual suffering period of respondents
from different respiratory tract diseases. Annual suffering period from all types of respiratory
tract diseases are found longest in loaders (Table 4). Symptoms of some respiratory tract
diseases namely: tuberculosis, COPD, and asthma traced at lower occurrence on the
respondents because symptoms of these diseases develop slowly and have long-term impact.
It needs clinical examination and laboratory testes to identify them categorically.
Respiratory problems to sweepers, who generally are female, have higher respiratory problems.
It is probably due to their responsibility of household cooking in poorly ventilated house and
spending significant time in kitchen, sweeping in dusty and smokey streets.
Gastrointestinal Diseases
Gastro intestinal diseases are the product of parasitic infection and pathogenic microorganisms
(Birley & Lock 1999). Gastrointestinal diseases are common to almost all urban poor of
Kathmandu. The waste workers, who have to spent longer durations to handle waste, have
serious gastrointestinal problems, because of their exposure to number of diseases vectors.
Since qualities of urban basic services provided by authorities are of very low quality and the
waste workers cannot afford the services provided by private sectors, they suffer the most.
Diseases like dysphagia, heartburn, regurgitation, dyspepsia, flatulence, vomiting, water
brash, anorexia, gastritis, peptic ulcer, food poisoning, giardiasis, worm infestation,
ameobiasis, dysentery, cholera, typhoid, and diarrhoea are some of the gastrointestinal
diseases reported by waste workers. Among these diseases, the symptoms of diarrhoea,
ameobiasis, dysentery, giasdiasis and food poisoning are found among significant proportions
of respondents (Annex A).
Rishikesh Pandey
41
Table 4. Percentage of Waste Workers Suffering from Respiratory Tract Diseases and Its
duration
Percentage of Suffered Waste Workers
Diseases
Annual Suffering
No. of
No. of
No. of
Period
Sweepers(30) Collectors (17) Loaders (14)
1 week
3
6
1
2 weeks
0
12
0
20
12
14
Rhinitis/Sinusitis 3 weeks
1 month
54
41
14
3 months
3
0
0
6 months
3
0
14
1 week
10
0
0
2 weeks
30
18
7
Pharyngitis
3 weeks
13
6
0
1 month
27
18
42
3 months
0
0
7
1 week
20
12
0
2 weeks
23
35
21
Tonsillitis
3 weeks
0
12
7
1 month
0
0
7
3 months
0
0
7
1 week
13
0
0
2 weeks
13
12
29
Bronchitis
3 weeks
10
12
21
1 month
0
0
7
Source: Field survey, 2003.
Numbers in parenthesis are total number of respondents
Gastrointestinal diseases are acute among sweepers than those of collectors and loaders. The
highest proportions of sweepers are experiencing the symptoms of heartburn, regurgitation/
water brash, dyspepsia/anorexia/vomiting, cholera, and flatulence. The highest proportions
of loaders are experiencing the symptoms of gastritis, giardiasis, worm infestation,
ameobiasis and typhoid. Symptoms of worm infestation are found only in loaders, the
symptoms of flatulence are found only in sweepers. Among these three sub-groups, sweepers
are the most suffering group followed by loaders and collectors (Annex B).
Parasitic infections are most serious problem among the solid waste workers of third world
cities. A study made during the 1970s in 33 Indian cities showed 98 percent of solid waste
collectors had positive symptoms of parasitic infection. Poulsen (Poulsen et al. 1995a and b)
pointed frequent gastrointestinal problems like diarrhea and dyspnoea among waste collectors
of Denmark. Hordoy (Hardoy et al. 2001), Sandra (Cointreau-Levine n.d.) and Stephens
42
Solid Waste Management Practice and Health Implication
(1999) found that numbers of waste workers of different cities of the world are experiencing
serious gastrointestinal problems.
Conclusion
Waste workers are waste workers by birth in Nepalese social structure. Certain castes like
Podes, Chyames have the responsibility of handling waste throughout Nepal, which is typical
feature of Nepalese caste system. For survival, since long past, Podes and Chyames are
working as waste workers in health threatening environment. They are experiencing numerous
health problems. Mixture of inorganic and special wastes in municipal waste and labor-intensive
waste handling practice are the leading causes of health problems. Just by separating inorganic
waste and sharp objects from municipal waste, by establishing separate provision for hospital
and other hazardous waste management, and by mechanization of waste handling practice,
health problems of waste workers can be reduced in significant level. In the same manner,
establishment of waste workers welfare (under KMC), making waste workers aware of
health impact and encourage them to use protective measures properly, making trained waste
workers to handle hazardous waste, regular monitoring of waste workers’ health status and
providing them necessary treatment could bring remarkable change in waste workers’ health.
Health has significant impact on a person’s economy. In existing waste management practice,
waste workers of Kathmandu are losing numbers of working days because of their poor
health. This has reduced daily income on the one hand and has increased daily expense on the
other. If this situation is not controlled, they could not come out of the poverty trap.
Solid waste management in Kathmandu is very complex because of ‘the politics’ in waste
management. Kathmandu gets higher amount of waste for disposal because of noninstitutionalized material recovery system and lack of compost plant. The conflict among different
interest groups has shelved a sanitary landfill site proposed a decade earlier. Policies in separate
management of hazardous waste, waste separation provision, and working environment are
inadequate and there is a wide gap between policy and practices. Therefore, policies for
separate handling of hazardous waste and its immediate implementation, institutionalization of
material recovery, establishment of compost plant, and development and use of proposed
sanitary landfill site are immediate needs to improve waste workers’ health, to make working
environment healthier, and to reduce wide environmental implication of solid waste management
in Kathmandu. These practices further increase working capacity of waste workers and help
them to secure their livelihood earnings.
Rishikesh Pandey
43
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Rishikesh Pandey
45
Annex A. Health Problems Among Waste Workers
Diseases
Collectors (17) Loaders (14) Sweepers (30) Waste workers
Physical Injuries
No
No
No
Total
Back and waist pain
13 (76)
12 (86)
29 (97)
54 (89)
Elbow injury
11 (65)
6 (43)
27 (90)
44 (72)
Wrist injury
13 (76)
8 (57)
26 (87)
47 (77)
Cuts, bruises and ruptures
13 (76)
12 (86)
14 (47)
39 (64)
Joint pain
11 (65)
10 (71)
21 (70)
42 (69)
Allergies
Skin rashes
9 (53)
6 (43)
16 (53)
31 (51)
Irritation
11 (65)
8 (57)
16 (53)
35 (57)
Swelling
2 (12)
2 (14)
13 (43)
17 (28)
Eyelid burning
7 (12)
8 (57)
15 (50)
30 (49)
Poisoning
Headache
13 (76)
12 (86)
30 (100)
55 (90)
Nausea
9 (53)
12 (86)
30 (100)
51 (84)
Faintingness
6 (35)
4 (29)
13 (43)
23 (38)
Fits
4 (24)
4 (29)
6 (20)
14 (23)
Respiratory Tract
Diseases
Rhinitis/ Sinusitis
12 (71)
6 (43)
25 (83)
43 (70)
Pharyngitis
7 (41)
8 (57)
24 (80)
39 (64)
Tonsillitis
10 (59)
6 (43)
13 (43)
29 48)
Bronchitis
4 (24)
8 (57)
11 (37)
23 (38)
Pneumonia
0 (0)
0 (0)
0 (0)
0 (0)
TB
0 (0)
0 (0)
2 (7)
2 (3)
COPD
0 (0)
0 (0)
2 (7)
2 (3)
Asthma
0 (0)
0 (0)
9 (30)
9 (15)
Gastrointestinal
Diseases
Dysphagia
4 (24)
2 (14)
4 (13)
10 (16)
Heart burn
9 (53)
4 (29)
20 (67)
33 (54)
Regurgitation/Water brash
8 (47)
10 (71)
25 (83)
43 (70)
Dyspepsia/Anorexia/
Vomiting
8 (47)
7 (50)
25 (83)
40 (66)
Flatulence
0 (0)
0 (0)
10 (33)
10 (16)
Gastritis
7 (41)
8 (57)
13 (43)
28 (46)
Food poisoning/Diarrhea
12 (71)
9 (64)
28 (93)
49 (80)
Giardiasis
3 (18)
4 (29)
8 (27)
15 (15)
Worm infestation
0 (0)
2 (14)
0 (0)
2 (3)
Ameobiasis
2 (12)
4 (29)
7 (23)
13 (21)
Dysentery
0 (0)
6 (43)
5 (17)
11 (18)
Cholera
3 (18)
2 (14)
12 (40)
17 (28)
Typhoid
2 (12)
4 (29)
3 (10)
9 (15)
Source: Field Survey, 2003. Figures within parenthesis indicate percentage
46
Solid Waste Management Practice and Health Implication
Annex B. Percentage and Annual Frequency of Waste Workers Suffering from
Gastrointestinal Disease
Disease
1
2
3
Annual Frequencies
4
5-12
13-24
25-50
times
times
times
%
%
%
%
0
0
0
0
7
26
10
0
0
40
10
0
0
27
6
0
10
6
0
0
7
0
0
0
10
3
0
0
0
0
0
0
10
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
More than
50 times
%
0
0
0
0
0
0
0
0
0
0
0
0
0
Sweepers (30)
%
%
%
Dysphagia
0
2
7
Heart burn
0
10
13
Regurgitation/Water brash
7
13
13
Dyspepsia/Anorexia/Vomiting
10
13
27
Flatulence
0
10
7
Ameobiasis
0
7
10
Gastritis
0
13
17
Food poisoning/ Diarrhea
7
43
43
Giardiasis
0
7
7
Worm infestation
0
0
0
Dysentery
0
10
7
Cholera
27
13
0
Typhoid
10
0
0
Collectors (17)
Dysphagia
0
18
0 0
0
0
0
Heart burn
6
18
12 12
12
0
6
Regurgitation/Water brash
0
0
18 12
17
0
0
Dyspepsia/Anorexia/Vomiting
0
0
6 12
12
0
11
Flatulence
0
0
0 0
0
0
0
Ameobiasis
0
0
0 0
0
0
6
Gastritis
6
12
0 6
6
0
6
Food poisoning/ Diarrhea
0
41
6 12
12
0
0
Giardiasis
12
6
0 0
0
0
0
Worm infestation
0
0
0
0
0
0
0
Dysentery
0
0
0 0
0
0
0
Cholera
6
0
12
0
0
0
0
Typhoid
0
0
0 0
0
0
0
Loaders (14)
Dysphagia
0
0
14
0
0
0
0
Heart burn
0
0
0 14
14
0
0
Regurgitation/Water brash
0
14
29 14
14
0
0
Dyspepsia/Anorexia/Vomiting
0
21
0 8
14
7
0
Flatulence
0
0
0 0
0
0
0
Ameobiasis
14
7
7 0
0
0
0
Gastritis
0
14
0 7
36
0
0
Food poisoning/ Diarrhea
57
0
0 0
0
0
7
Giardiasis
0
14
7 0
7
0
0
Worm infestation
7
7
0 0
0
0
0
Dysentery
0
29
7 0
7
0
0
Cholera
14
0
0 0
0
0
0
Typhoid
7
7
0 0
14
0
0
Source: Field Survey, 2003. Figures within parenthesis indicated total number of respondents.
0
6
0
6
0
6
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Rishikesh Pandey
47
Annex C. Pictures Associated with Waste Management Practice in KMC
Plate 1. Teku, waste transfer depot
Plate 2. Household waste collector carrying waste
in rickshaw
Plate 4. Sweeper at work
Plate 3. Sweeper collecting waste in rickshaw at
Jamal (experiencing irritation)
Plate 5. Bagmati River, ditch making at the bank
and pile of waste ready to bury
Plate 6. Ditch filled by waste at Balkhu