|Year : 2021 | Volume
| Issue : 2 | Page : 96-100
Dealers in black gold: Knowledge attitude, and practices among fecal sludge operators in Bengaluru, Southern Karnataka
Anissa Mary Thomas Thattil1, Nancy A Gnanaselvam2, K Rajitha2, B Ramakrishna Goud2
1 Department of Community Medicine, Father Muller Medical College, Mangaluru, Karnataka, India
2 Department of Community Health, St. John's Medical College, Bengaluru, Karnataka, India
|Date of Submission||06-May-2020|
|Date of Acceptance||03-Jun-2020|
|Date of Web Publication||9-Jul-2021|
Dr. B Ramakrishna Goud
Department of Community Health, St. John's Medical College, Bangalore - 560034, Karnataka
Source of Support: None, Conflict of Interest: None
Background and Objectives: Fecal sludge management (FSM) is an unorganised sector, which is wrought with occupational health hazards for fecal sludge operators (FSOs). This study was conducted to identify the knowledge, attitude, and practices regarding FSM among FSOs. Study Setting and Design: This cross-sectional study was conducted in a rural area of Anekal Taluk, Bengaluru Urban District, Karnataka and in Hosur, Krishnagiri District, Tamil Nadu. Methods and Materials: Snowball method of sampling was employed and, 60 participants were interviewed using an interviewer administered semi-structured questionnaire. Statistical Analysis: The data has been described using measures of central tendency, frequencies, and percentages. Results: All 60 participants were males with a mean age of 33.7 ± 7.9 years. Majority practised Hindu religion (98.3%) and 95.0% belonged to the scheduled castes; only 3.3% were illiterate. According to modified SLI, 45.0% belonged to high standard of living. The common occupational hazards reported were injuries, social stigma, and alcoholism. Although 91.7% felt that personal protective equipment (PPE) would protect against health hazards, 65.0% felt that it hampered work. Most (86.7%) felt that FSM was attached to social stigma. None reported the use of the full set of required PPE. All participants reported washing their hands and feet with only water at the end of each operation. Conclusion: The knowledge and practices followed by the FSOs were found to be inadequate in this study. Health awareness generation and provision of PPE must be employed to ensure sustained behaviour change.
Keywords: Fecal sludge, knowledge, manual scavengers, occupation, practices, unorganized
|How to cite this article:|
Thattil AM, Gnanaselvam NA, Rajitha K, Goud B R. Dealers in black gold: Knowledge attitude, and practices among fecal sludge operators in Bengaluru, Southern Karnataka. Indian J Occup Environ Med 2021;25:96-100
|How to cite this URL:|
Thattil AM, Gnanaselvam NA, Rajitha K, Goud B R. Dealers in black gold: Knowledge attitude, and practices among fecal sludge operators in Bengaluru, Southern Karnataka. Indian J Occup Environ Med [serial online] 2021 [cited 2021 Jul 27];25:96-100. Available from: https://www.ijoem.com/text.asp?2021/25/2/96/321060
| Introduction|| |
The sanitation system in India is primarily serviced by onsite sanitation (OSS) systems. On site sanitation systems refer to those systems where the “storage of fecal matter occurs within the premises of the dwelling and its immediate surroundings.” OSS systems generate fecal sludge, which is “raw or partially digested, slurry or semi-solid in consistency and results from the collection of excreta and black water with or without grey water.” In systems such as septic tanks and single pit latrines, the fecal sludge needs to be evacuated and treated off-site.
Fecal sludge management (FSM) includes the storage, collection, transport, treatment, and safe end-use or disposal of fecal sludge. Fecal sludge operators (FSOs) are those individuals “engaged in the collection, de-sludging, handling, transportation, treatment and disposal of sludge and/or septage from septic tanks or sewage treatment plants.” This occupation is relegated to the vulnerable groups such as the scheduled castes, due to the caste system that is still prevalent in India. The collection of fecal sludge, although prohibited by law, still continues illegally, and is often performed under dangerous conditions. The informal nature of FSM and the vulnerability of the FSOs exacerbates the occupational hazards such as exposure to pathogenic material, slips, trips and falls, ergonomic hazards, exposure to hazardous gases, and psychosocial hazards such as stigma and substance abuse. Considering that FSO is not an organized sector, it is essential to identify the gaps that exist in the knowledge and practices regarding the occupational hazards of FSM, in order to take effective and targeted preventive action. This study was thus conducted in an attempt to identify the knowledge, attitude, and practices regarding the occupation of fecal sludge management among the FSOs in a rural area of Bangalore Urban District in Karnataka.
| Methodology|| |
This cross-sectional study was conducted over 12 months in a rural area of Anekal Taluk, Bangalore Urban District, Karnataka. The population of Anekal taluk is around 517,575 according to the 2011 Census of India. According to the National Family Health Survey of India 4 (NFHS-4), 86.6% of the households have improved sanitation facilities in this district. The town of Devanahalli, situated 40 km away, has the nearest fecal sludge Treatment Plant (FSTP).
The geographically contiguous area of the city of Hosur, belonging to the Krishnagiri district of Tamil Nadu, was also included in this study. The population of Hosur stands at 539,663 and only 29.9% have an improved sanitation facility in this district.,
For the purpose of this study, an FSO was defined as any individual who was engaged in the collection, de-sludging, handling, transportation, and/or disposal of fecal sludge from septic tanks or pits for a period of at least 7 days in a month.
The sample size was calculated with the assumption that the prevalence of occupational health hazards among FSOs would be of 50% and a precision of 15%, thus obtaining a sample size of 43 participants. In this study, we interviewed a total of 60 participants.
Ethical approval was obtained from the Institutional Ethics Committee. Written informed consent was obtained from all the participants.
The sampling method employed was that of snowball sampling. This method was chosen due to the stigmatized and unorganized nature of the occupation and due to the difficulty in procuring an official list of those employed in faecal sludge management.
An interviewer administered questionnaire was constructed to capture the sociodemographic details, knowledge about the health hazards of FSM, the attitude of the FSOs toward the occupation of FSM, and practices followed by the FSOs.
The sociodemographic details have been described using mean with standard deviation, median with inter-quartile ranges, frequencies, and percentages. The knowledge, attitude, and practices have been described using frequencies and percentages.
| Results|| |
The mean age of the 60 study participants was 33.7 ± 7.9 years. The baseline characteristics of the participants are described in [Table 1].
The median average monthly income of the participants was reported to be INR 8,000 (IQR: 12,000-5,000) and that the mean days of work in a month in the occupation of fecal sludge management was 13.8 ± 3.8 days. Almost half the participants (43.3%) reported having a secondary source of income, most of whom performed unskilled labor (21.7%) such as tree-cutting, digging pits, grave-digging, and load-lifting, while 15% reported performing semi- skilled work such as that of painters, masons, auto-rickshaw drivers, as well as drivers of light vehicles and 6.7% reported doing skilled work such as heavy vehicle driving as an alternate source of income. Three participants also reported that they had taken loans from the bank ranging from 2 to 15 lakhs for the purpose of purchasing mechanical trucks for fecal sludge collection.
Knowledge regarding the occupation of faecal sludge management
Majority of the participants (91.7%) reported that they were aware that FSM had occupational hazards. [Table 2] describes the knowledge of the participants regarding the health hazards related to FSM.
None of the participants were aware about any vaccinations that would protect them from diseases they were exposed to during FSM and neither had they been immunized against any. Majority of the participants (90.0%) reported that they were aware about the presence of pathogenic micro-organisms in the fecal sludge. The most common routes of exposure through which infection could be acquired were reported to be oral, nasal, and dermal routes together (38.3%), followed by the nasal route (23.3%) and oral route only (15.0%), while 15.0% reported that they did not know about the routes of infection. When asked regarding the most common vectors seen at the site of work, the most common response was cockroaches (95.0%), followed by mosquitoes (58.3%), house flies (41.7%), and rats (13.3%).
Attitude toward the occupation of FSM
Majority of the participants (93.3%) reported that they felt FSM was an important occupation, although 86.7% reported that they faced social stigma due to it. Almost half of the study participants (45.0%) reported that they felt repulsed on seeing or coming in contact with fecal sludge. The other questions identifying the attitude of the participants are as given in [Table 3]. All participants felt that it was important to wash hands thoroughly with soap and water before eating and 98.3% felt that it was important to bathe and change clothes after every operation.
Practices followed during FSM
When asked about personal hygiene practices, all participants reported that they washed their hands with only water immediately after each operation and 96.7% washed hands with soap after returning from a FSO. Most of the participants (91.7%) reported that they took a bath after daily and all participants reported that they washed their hands with soap and water before consumption of food. However, 93.3% of the participants reported that they did not use a face mask, 95.0% did not use goggles, 88.3% did not use gloves, and 91.7% did not use rubber boots during their work. The main reason cited for the low rate of usage was that PPE was not provided to them.
When asked about the measures that could prevent or reduce their exposure to occupational health hazards, the use of gloves (65.0%) and the use of aprons (5.0%) were reported to prevent fecal sludge from coming in contact with skin while the use of masks (78.3%) and alcohol consumption (18.3%) were reported as helpful in dealing with malodour. The various practices used to reduce malodour, as reported by 24 participants were:
- Pouring kerosene into the pit/tank at the start of the operation (20%)
- Unsealing the pit and keeping it open for 15–20 min to allow it to “breathe” (8.3%)
- Application of bleaching powder (5.0%)
- Application of phenol (5.0%)
| Discussion|| |
Growing urbanization will result in an increasing demand for sustainable onsite sanitation solutions in the near future. However, in the presence of limited financial investments, scarcity of land and personnel as well the lack of awareness about the occupational hazards, the adverse health impacts of unsafe fecal sludge management will increase. Fecal sludge management is an occupation that has a high degree of occupational health hazards with minimal control and preventive measures currently in place and must be recognized as such.
In this study, all the participants were males with a mean age of 33.7 ± 7.9 years. The predominance of males in the productive age group might be due to the demands of the occupation such as working at night, skill of driving heavy vehicles, travelling long distances, and the physically intense nature of work which includes removal of the containment structure lid and descent into the pit for manual removal of fecal sludge. Majority (95.0%) of the participants belonged to the scheduled castes which is similar to a study that found 90% of their participants belonged to the scheduled caste. The scheduled castes are traditionally considered to belong to the lowest social strata in society and thus, “offensive” or “polluting” occupations are commonly assigned to them., The study participants were found to have received formal education up to middle school (26.7%) and high school (26.7%). This incomplete formal education could be due to the reason that children of manual scavengers often drop of school on account of discrimination and because adolescent boys in India are expected to contribute to the family purse, especially those who belong to the lower socio-economic classes.
In this study, 45.0% were found to have a high standard of living. This finding can be explained by the schemes present in the states of Tamil Nadu and Karnataka (from where most of the participants hailed) such as “Free Color Television Scheme for the People of Tamil Nadu,” free distribution of electric fans and mixer grinders and the Pradhan Mantri Ujjwala Yojana (PMUY) which provides liquid petroleum gas connections to below poverty line households. These schemes explain the possession of consumables reported by the participants—color TV (83.3%), LPG (58.3%), scooter or moped (40.0%).
The occupation of FSM has constant exposure to faecal matter which can result in the transmission of fecal-borne infections. Hand hygiene is an important barrier against these infections and has found to reduce diarrhoea related deaths by 50% and respiratory infections by 16%. All our study participants reported that they washed their hands and feet with water immediately after each occupation. Soap was not used, primarily because it was not available at the site of operation, although they reported washing their hands with soap and water before consumption of food. This figure is much higher than a study conducted in Kathmandu, Nepal where on 65% of the manual scavengers reported washing their hands and feet with soap and water. The awareness about the importance of hand washing seems to be high in this study, which can perhaps be attributed to the educational status of the participants.
Although awareness was high, majority of the study participants did not use PPE such as gloves, goggles, or boots. Although 91.7% of the participants reported that they felt that PPE protected against health hazards, 65.0% felt that PPE hampered their work. Some participants reported that PPE led to increased risk of occupational accidents such as slips, trips, and falls as the fecal sludge seeped into boots and gloves while working and provided less traction. The participants reported that they found it difficult to screw pipes together while wearing gloves and that they were unable to assess whether a surface was slippery or not when they wore boots. This might be due to the fact that none of the participants were formally trained in the proper use of PPE and that the commercially available PPE might not appropriately fit every individual.
In this study, 88.3% of the participants felt stigmatized due to their occupation. This finding is similar to other studies that report that local communities often did not recognize the importance of FSM and stigmatized the workers., A study conducted in Gulbarga among manual scavengers found that 54.5% reported that the society viewed their occupation as “bad.” This stigma leaves individuals with very few alternate options for livelihood, effectively hindering social mobility. Alcohol consumption (86.7%) was also reported as an occupational hazard. This is in line with the previous studies where manual scavengers reported that they consumed alcohol in order to dull their senses while cleaning out the fecal sludge, to block out the malodour and, also to gain “courage” before entering the pit.,,
All the participants in this study were aware about the law prohibiting manual scavenging. However, three-fourths of the participants (75.0%) felt that the occupational hazards must not be reported to the higher authorities. This could be due to the fear of unemployment if the relevant authorities realized that manual scavenging still persisted in spite of the law against it.
Although most of the participants were aware about the occupational hazards of FSM, awareness programmes must be conducted in order to give the FSOs a complete understanding about the health hazards of FSM and the preventive measures they can take to protect themselves from disease. Majority of the participants (88.3%) felt stigmatized due to their occupation and only 3.3% felt that the occupational hazards must be reported to the authorities.
In conclusion, the knowledge and practices followed by the FSOs were found to be inadequate in this study. The informal institution of FSM must be converted in a formal institution and integrated into the organized occupational sector. Information, education, and communication activities must be conducted among the communities, stakeholders of residential construction and sanitation workers about the importance of FSM and about the adequate construction of onsite sanitation systems which will aid in de-stigmatizing this occupation. In order to address the exposure and subsequent development of diseases, occupational health services must be provided to the FSOs in the form of regular medical check-ups, vaccinations, and health education sessions along with the provision of PPE.
Limitations of the study
The small sample size of the study might limit the generalizability of the study findings to the fecal sludge operators in other parts of the country. It is also possible that a social desirability bias may have arisen while participants were responding to the questionnaires.
The authors would like to sincerely thank the study participants for their cooperation and time. They would also like to extend their gratitude to Dr Sobin Sunny and Dr Sakthi Arasu for their invaluable assistance.
Declaration of patient consent
The authors certify that they have obtained consent from all the study subjects. The subjects have been assured that their identities will not be revealed given the sensitive nature of their occupation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Government of India. Census of India availability and type of latrine facility: 2001-2011. 2011.
Klingel F, Montanegro A, Kone D, Strauss M. Fecal sludge management in developing countries. EAWAG, SANDEC, Swiss Federal Institute for Environmental Science and Technology; 2002.
WHO. On-Site Sanitation. In: The Health and Environment Lexicon. 2009.
AECOM International Development, Swiss Federal Institute of Aquatic Science and Technology, (EAWAG). A Rapid Assessment of Septage Management in Asia: Policies and Practices in India, Indonesia, Malaysia, the Philippines, Sri Lanka, Thailand, and Vietnam [Internet]. 2010. Available from: http://pdf.usaid.gov/pdf_docs/PNADS118.pdf
WASH. Fecal sludge management-landscape study of practices, challenges and opportunities. Kodaikanal; 2009.
ILO. Informal economy. In: Encyclopaedia of consumer culture. 2011.
International Institute for Population Sciences (IIPS). National family health survey (Nfhs-4) 2015-16; 2017. p. 1-666.
Ministry of Health and Family Welfare G of I. National family health survey-4 District Fact Sheet Krishnagiri. 2015.
Human Rights Watch. Cleaning human waste: Manual scavenging, Caste, and Discrimination in India. 2014. 104 p.
Sathish K. A study on occupational hazards faced by manual scavengers: With special reference to social work intervention. Natl J Multidisc Res Dev 2018;3:41-4.
Khurana I, Ojha T. Burden of inheritance can we stop manual scavenging? Yes, but first we need to accept it exists. New Delhi, IndiaWaterAid; 2009.
Tara PA. Health problems of scavengers: The case of Kathmandu. Third Pole 2010;8:57-61.
Nkansah A, Fisher J, Khan MS. Manual pit emptying as a sustainable livelihood in Ghana. Proc Inst Civ Eng-Eng Sustain 2012;165:215-21.
Itoo RA, Naik AA. Socio-economic conditions of manual scavengers with special reference to Gulbarga district of Karnataka state. Indian Streams Res J 2013;III: 1-3.
Service EN. About 90,000 manual scavengers in Hyderabad; alcoholism, domestic violence rampant. The New Indian Express; 2017.
Foundation MG. Landscape and business analysis for FSM emptying and transportation in Africa and Asia landscape and business analysis for FSM emptying and transportation in Africa and Asia. 2016.
Rangamani S, Obalesha KB, Gaitonde R. Health issues of sanitation workers in a town in Karnataka: Findings from a lay health-monitoring study. Natl Med J India 2015;28:70-3.
[Table 1], [Table 2], [Table 3]