Manual Pit Emptiers and Their Heath: Profiles, Determinants and Interventions
The global sanitation workforce bridges the gap between sanitation infrastructure and the provision of sanitation services through essential public service work. Manual pit emptiers often perform the work at the cost of their dignity, safety, and health as their work requires repeated heavy physical activities such as lifting, carrying, pulling, and pushing. This exposes them to occupational and environmental health hazards and risking illness, injury, and death. The study will extend the studies by presenting occupational health risks and suggestions for improvement in informal settlements of Nairobi, Kenya. This is a qualitative study conducted among sanitation stakeholders in Korogocho, Mukuru and Kibera informal settlements in Nairobi. Data were captured using digital voice recorders, transcribed and thematically analysed. The discussion notes were further supported by observational notes made during the interviews. These formed the basis for a robust picture of occupational health of manual pit emptiers; a lack or inappropriate use of protective clothing, and prolonged duration of working hours were described to contribute to the occupational health hazard. To continue working, manual pit emptiers had devised coping strategies which include working in groups, improvised protective clothing, sharing the available protective clothing, working at night and consuming alcohol drinks while at work. Many of these strategies are detrimental to their health. Occupational health hazards among pit emptiers are key for effective working and is as a result of a lack of collaboration amongst stakeholders linked to health, safety and lack of PPE of pit emptiers. Collaborations amongst sanitation stakeholders is paramount for health, safety, and in ensuring the provision and use of personal protective devices.
[1] A. Peal, B. Evans, I. Blackett, P. Hawkins, and C. Heymans, “Fecal sludge management (FSM): analytical tools for assessing FSM in cities,” J. Water, Sanit. Hyg. Dev., vol. 4, no. 3, p. 371, 2014, doi: 10.2166/washdev.2014.139.
[2] O. M. de la Salud, Guidelines on sanitation and health. 2018.
[3] F. O. Gudda, W. N. Moturi, O. S. Oduor, E. W. Muchiri, and J. Ensink, “Pit latrine fill-up rates: variation determinants and public health implications in informal settlements,” pp. 1–13, 2019.
[4] E. Marshall, “‘Slum,’” Notes Queries, vol. s4-XII, no. 308, pp. 413–413, 2018, doi: 10.1093/nq/s4-xii.308.413b.
[5] A. Peal, B. Evans, I. Blackett, P. Hawkins, and C. Heymans, “Fecal sludge management (FSM): Analytical tools for assessing FSM in cities,” J. Water Sanit. Hyg. Dev., vol. 4, no. 3, pp. 371–383, 2014, doi: 10.2166/washdev.2014.139.
[6] D. Kone and S. Peter, “Sandec Training Tool 1.0 - Module 5: Faecal Sludge Management,” p. 35, 2014, doi: 10.1017/CBO9781107415324.004.
[7] Y. Roquelaure, “Promoting a Shared Representation of Workers’ Activities to Improve Integrated Prevention of Work-Related Musculoskeletal Disorders q,” Saf. Health Work, vol. 7, no. 2, pp. 171–174, 2016, doi: 10.1016/j.shaw.2016.02.001.
[8] G. Mansour, C. Oyaya, and M. Owor, “Situation analysis of the urban sanitation sector in Kenya,” Urban Sanit. Res. Initiat. Ghana, no. July, p. 27, 2017.
[9] S. Africa and K. Eales, “Sanitation Partnerships Series: Bringing pit emptying out of the darkness: A comparison of approaches in Durban,” no. April, 2005.
[10] “Review of Manual Pit Emptying Equipment Currently in Use and Available in Freetown and Globally,” no. April, 2016.
[11] S. Chowdry and D. D. Kone, “Business Analysis of Fecal Sludge Management: Emptying and Transportation Services in Africa and Asia,” Bill Melinda Gates Found., no. September, 2012.
[12] Z. Burt, R. Sklar, and A. Murray, “Costs and willingness to pay for pit latrine emptying services in Kigali, Rwanda,” Int. J. Environ. Res. Public Health, vol. 16, no. 23, 2019, doi: 10.3390/ijerph16234738.
[13] N. Kamau and H. Njiru, “Water, sanitation and hygiene situation in Kenya’s urban slums,” J. Health Care Poor Underserved, vol. 29, no. 1, pp. 321–336, 2018, doi: 10.1353/hpu.2018.0022.
[14] K. Eales, “Sanitation Partnerships Series: Bringing pit emptying out of the darkness: A comparison of approaches in Durban, South Africa, and Kibera, Kenya,” no. April, p. 9, 2005.
[15] C. Murungi and M. P. van Dijk, “Emptying, Transportation and Disposal of feacal sludge in informal settlements of Kampala Uganda: The economics of sanitation,” Habitat Int., vol. 42, pp. 69–75, 2014, doi: 10.1016/j.habitatint.2013.10.011.
[16] J. Emina et al., “Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System,” vol. 88, pp. 200–218, 2011, doi: 10.1007/s11524-011-9594-1.
[17] D. Beguy et al., “HDSS Profile HDSS Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS),” pp. 1–10, 2015, doi: 10.1093/ije/dyu251.
[18] B. U. Mberu, T. N. Haregu, C. Kyobutungi, and A. C. Ezeh, “Health and health-related indicators in slum, rural, and urban communities: A comparative analysis,” Glob. Health Action, vol. 9, no. 1, pp. 1–13, 2016, doi: 10.3402/GHA.V9.33163.
[19] J. Corburn and I. Karanja, “Informal settlements and a relational view of health in Nairobi, Kenya: sanitation, gender and dignity.,” Health Promot. Int., no. November 2014, pp. 258–269, 2014, doi: 10.1093/heapro/dau100.
[20] KNBS, 2019 Kenya Population and Housing Census Volume 1: Population by County and Sub-County, vol. I, no. November. 2019.
[21] A. Desgroppes and S. Taupin, “Kibera: The Biggest Slum in Africa? no. May, 2019.
[22] D. Seal, “Penetrometer tests on 109 pit latrines in Kibera, Nairobi, Kenya,” vol. 44, no. 3, pp. 459–463, 2018.
[23] E. Muchukuri and F. R. Grenier, “Social determinants of health and health inequities in Nakuru (Kenya),” Int. J. Equity Health, vol. 8, pp. 1–8, 2009, doi: 10.1186/1475-9276-8-16.
[24] J. Corburn and C. Hildebrand, “Slum sanitation and the social determinants of women’s health in Nairobi, Kenya,” J. Environ. Public Health, vol. 2015, 2015, doi: 10.1155/2015/209505.
[25] Kenya National Bureau of Statistics, 2019 Kenya Population and Housing Census Volume 1: Population by County and Sub-County, vol. I, no. November. 2019.
[26] F. Tofail et al., “Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial,” Lancet child Adolesc. Heal., vol. 2, no. 4, pp. 255–268, 2018, doi: 10.1016/S2352-4642(18)30031-2.
[27] C. Sijbesma, “Sanitation and hygiene in south Asia: Progress and challenges,” in Waterlines, 2008, vol. 27, no. 3, pp. 184–204, doi: 10.3362/1756-3488.2008.023.
[28] M. W. Jenkins, O. Cumming, and S. Cairncross, “Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania,” pp. 2588–2611, 2015, doi: 10.3390/ijerph120302588.
[29] R. Tiwari, “Occupational health hazards in sewage and sanitary workers,” Indian J. Occup. Environ. Med., vol. 12, no. 3, pp. 112–115, 2008, doi: 10.4103/0019-5278.44691.
[30] World Health Organization, “The Sanitation challenge: Turning commitment into reality,” WHO Publ., 2004.
[31] A. Nakagiri, C. B. Niwagaba, P. M. Nyenje, R. N. Kulabako, J. B. Tumuhairwe, and F. Kansiime, “Are pit latrines in urban areas of Sub-Saharan Africa performing? A review of usage, filling, insects and odour nuisances,” BMC Public Health, vol. 16, no. 1, pp. 1–16, 2016, doi: 10.1186/s12889-016-2772-z.
[32] B. Sahiledengle, F. Alemseged, and T. Belachew, “Sanitation practice and associated factors among slum dwellers residing in urban slums of Addis Ababa, Ethiopia: A community based cross-sectional study,” vol. 10, no. October, pp. 370–377, 2018, doi: 10.5897/JPHE2018.1064.
[33] S. Diener et al., “A value proposition: Resource recovery from faecal sludge - Can it be the driver for improved sanitation?” Resour. Conserv. Recycl., vol. 88, pp. 32–38, 2014, doi: 10.1016/j.resconrec.2014.04.005.
[34] L. Waldman, P. Reed, and T. Hrynick, Accountability in health systems and the potential of mHealth, vol. 490, no. 490. 2017.
[35] Republic of K. Ministry of Health, “Kenya environmental Sanitation and Hygiene Policy,” 2016.
[1] A. Peal, B. Evans, I. Blackett, P. Hawkins, and C. Heymans, “Fecal sludge management (FSM): analytical tools for assessing FSM in cities,” J. Water, Sanit. Hyg. Dev., vol. 4, no. 3, p. 371, 2014, doi: 10.2166/washdev.2014.139.
[2] O. M. de la Salud, Guidelines on sanitation and health. 2018.
[3] F. O. Gudda, W. N. Moturi, O. S. Oduor, E. W. Muchiri, and J. Ensink, “Pit latrine fill-up rates: variation determinants and public health implications in informal settlements,” pp. 1–13, 2019.
[4] E. Marshall, “‘Slum,’” Notes Queries, vol. s4-XII, no. 308, pp. 413–413, 2018, doi: 10.1093/nq/s4-xii.308.413b.
[5] A. Peal, B. Evans, I. Blackett, P. Hawkins, and C. Heymans, “Fecal sludge management (FSM): Analytical tools for assessing FSM in cities,” J. Water Sanit. Hyg. Dev., vol. 4, no. 3, pp. 371–383, 2014, doi: 10.2166/washdev.2014.139.
[6] D. Kone and S. Peter, “Sandec Training Tool 1.0 - Module 5: Faecal Sludge Management,” p. 35, 2014, doi: 10.1017/CBO9781107415324.004.
[7] Y. Roquelaure, “Promoting a Shared Representation of Workers’ Activities to Improve Integrated Prevention of Work-Related Musculoskeletal Disorders q,” Saf. Health Work, vol. 7, no. 2, pp. 171–174, 2016, doi: 10.1016/j.shaw.2016.02.001.
[8] G. Mansour, C. Oyaya, and M. Owor, “Situation analysis of the urban sanitation sector in Kenya,” Urban Sanit. Res. Initiat. Ghana, no. July, p. 27, 2017.
[9] S. Africa and K. Eales, “Sanitation Partnerships Series: Bringing pit emptying out of the darkness: A comparison of approaches in Durban,” no. April, 2005.
[10] “Review of Manual Pit Emptying Equipment Currently in Use and Available in Freetown and Globally,” no. April, 2016.
[11] S. Chowdry and D. D. Kone, “Business Analysis of Fecal Sludge Management: Emptying and Transportation Services in Africa and Asia,” Bill Melinda Gates Found., no. September, 2012.
[12] Z. Burt, R. Sklar, and A. Murray, “Costs and willingness to pay for pit latrine emptying services in Kigali, Rwanda,” Int. J. Environ. Res. Public Health, vol. 16, no. 23, 2019, doi: 10.3390/ijerph16234738.
[13] N. Kamau and H. Njiru, “Water, sanitation and hygiene situation in Kenya’s urban slums,” J. Health Care Poor Underserved, vol. 29, no. 1, pp. 321–336, 2018, doi: 10.1353/hpu.2018.0022.
[14] K. Eales, “Sanitation Partnerships Series: Bringing pit emptying out of the darkness: A comparison of approaches in Durban, South Africa, and Kibera, Kenya,” no. April, p. 9, 2005.
[15] C. Murungi and M. P. van Dijk, “Emptying, Transportation and Disposal of feacal sludge in informal settlements of Kampala Uganda: The economics of sanitation,” Habitat Int., vol. 42, pp. 69–75, 2014, doi: 10.1016/j.habitatint.2013.10.011.
[16] J. Emina et al., “Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence from the Nairobi Urban Health and Demographic Surveillance System,” vol. 88, pp. 200–218, 2011, doi: 10.1007/s11524-011-9594-1.
[17] D. Beguy et al., “HDSS Profile HDSS Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS),” pp. 1–10, 2015, doi: 10.1093/ije/dyu251.
[18] B. U. Mberu, T. N. Haregu, C. Kyobutungi, and A. C. Ezeh, “Health and health-related indicators in slum, rural, and urban communities: A comparative analysis,” Glob. Health Action, vol. 9, no. 1, pp. 1–13, 2016, doi: 10.3402/GHA.V9.33163.
[19] J. Corburn and I. Karanja, “Informal settlements and a relational view of health in Nairobi, Kenya: sanitation, gender and dignity.,” Health Promot. Int., no. November 2014, pp. 258–269, 2014, doi: 10.1093/heapro/dau100.
[20] KNBS, 2019 Kenya Population and Housing Census Volume 1: Population by County and Sub-County, vol. I, no. November. 2019.
[21] A. Desgroppes and S. Taupin, “Kibera: The Biggest Slum in Africa? no. May, 2019.
[22] D. Seal, “Penetrometer tests on 109 pit latrines in Kibera, Nairobi, Kenya,” vol. 44, no. 3, pp. 459–463, 2018.
[23] E. Muchukuri and F. R. Grenier, “Social determinants of health and health inequities in Nakuru (Kenya),” Int. J. Equity Health, vol. 8, pp. 1–8, 2009, doi: 10.1186/1475-9276-8-16.
[24] J. Corburn and C. Hildebrand, “Slum sanitation and the social determinants of women’s health in Nairobi, Kenya,” J. Environ. Public Health, vol. 2015, 2015, doi: 10.1155/2015/209505.
[25] Kenya National Bureau of Statistics, 2019 Kenya Population and Housing Census Volume 1: Population by County and Sub-County, vol. I, no. November. 2019.
[26] F. Tofail et al., “Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial,” Lancet child Adolesc. Heal., vol. 2, no. 4, pp. 255–268, 2018, doi: 10.1016/S2352-4642(18)30031-2.
[27] C. Sijbesma, “Sanitation and hygiene in south Asia: Progress and challenges,” in Waterlines, 2008, vol. 27, no. 3, pp. 184–204, doi: 10.3362/1756-3488.2008.023.
[28] M. W. Jenkins, O. Cumming, and S. Cairncross, “Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania,” pp. 2588–2611, 2015, doi: 10.3390/ijerph120302588.
[29] R. Tiwari, “Occupational health hazards in sewage and sanitary workers,” Indian J. Occup. Environ. Med., vol. 12, no. 3, pp. 112–115, 2008, doi: 10.4103/0019-5278.44691.
[30] World Health Organization, “The Sanitation challenge: Turning commitment into reality,” WHO Publ., 2004.
[31] A. Nakagiri, C. B. Niwagaba, P. M. Nyenje, R. N. Kulabako, J. B. Tumuhairwe, and F. Kansiime, “Are pit latrines in urban areas of Sub-Saharan Africa performing? A review of usage, filling, insects and odour nuisances,” BMC Public Health, vol. 16, no. 1, pp. 1–16, 2016, doi: 10.1186/s12889-016-2772-z.
[32] B. Sahiledengle, F. Alemseged, and T. Belachew, “Sanitation practice and associated factors among slum dwellers residing in urban slums of Addis Ababa, Ethiopia: A community based cross-sectional study,” vol. 10, no. October, pp. 370–377, 2018, doi: 10.5897/JPHE2018.1064.
[33] S. Diener et al., “A value proposition: Resource recovery from faecal sludge - Can it be the driver for improved sanitation?” Resour. Conserv. Recycl., vol. 88, pp. 32–38, 2014, doi: 10.1016/j.resconrec.2014.04.005.
[34] L. Waldman, P. Reed, and T. Hrynick, Accountability in health systems and the potential of mHealth, vol. 490, no. 490. 2017.
[35] Republic of K. Ministry of Health, “Kenya environmental Sanitation and Hygiene Policy,” 2016.
@article{"International Journal of Medical, Medicine and Health Sciences:80370", author = "Ivy Chumo and Sheillah Simiyu and Hellen Gitau and Isaac Kisiangani and Caroline Kabaria Kanyiva Muindi and Blessing Mberu", title = "Manual Pit Emptiers and Their Heath: Profiles, Determinants and Interventions", abstract = "The global sanitation workforce bridges the gap between sanitation infrastructure and the provision of sanitation services through essential public service work. Manual pit emptiers often perform the work at the cost of their dignity, safety, and health as their work requires repeated heavy physical activities such as lifting, carrying, pulling, and pushing. This exposes them to occupational and environmental health hazards and risking illness, injury, and death. The study will extend the studies by presenting occupational health risks and suggestions for improvement in informal settlements of Nairobi, Kenya. This is a qualitative study conducted among sanitation stakeholders in Korogocho, Mukuru and Kibera informal settlements in Nairobi. Data were captured using digital voice recorders, transcribed and thematically analysed. The discussion notes were further supported by observational notes made during the interviews. These formed the basis for a robust picture of occupational health of manual pit emptiers; a lack or inappropriate use of protective clothing, and prolonged duration of working hours were described to contribute to the occupational health hazard. To continue working, manual pit emptiers had devised coping strategies which include working in groups, improvised protective clothing, sharing the available protective clothing, working at night and consuming alcohol drinks while at work. Many of these strategies are detrimental to their health. Occupational health hazards among pit emptiers are key for effective working and is as a result of a lack of collaboration amongst stakeholders linked to health, safety and lack of PPE of pit emptiers. Collaborations amongst sanitation stakeholders is paramount for health, safety, and in ensuring the provision and use of personal protective devices.
", keywords = "Sanitation, occupational health, manual emptiers, informal settlements. ", volume = "15", number = "6", pages = "142-7", }
