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Occupational health outcomes among sanitation workers: A systematic review and meta-analysis
BACKGROUND: Sanitation workers are essential to global public health and societal wellbeing. However, the health risks and outcomes associated with exposure to occupational risk factors among sanitation workers are neither well understood nor well quantified. We undertook a systematic review to (1)...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Urban & Fischer
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837624/ https://www.ncbi.nlm.nih.gov/pubmed/34942466 http://dx.doi.org/10.1016/j.ijheh.2021.113907 |
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author | Oza, Hemali Harish Lee, Madison Gabriella Boisson, Sophie Pega, Frank Medlicott, Kate Clasen, Thomas |
author_facet | Oza, Hemali Harish Lee, Madison Gabriella Boisson, Sophie Pega, Frank Medlicott, Kate Clasen, Thomas |
author_sort | Oza, Hemali Harish |
collection | PubMed |
description | BACKGROUND: Sanitation workers are essential to global public health and societal wellbeing. However, the health risks and outcomes associated with exposure to occupational risk factors among sanitation workers are neither well understood nor well quantified. We undertook a systematic review to (1) identify occupational risk factors among sanitation workers and (2) assess the effect of occupational exposure to human fecal sludge and wastewater on selected health outcomes among these workers. METHODS: We searched four databases (i.e., PubMED, MEDLINE, EMBASE, and LILACS) for eligible studies from inception through to January 01, 2020. The included population was workers ≥15 years engaged, formally or informally, in installing, operating, servicing, cleaning or emptying a sanitation technology at any step of the sanitation chain. The included comparator was workers in other occupations or the general population. Eligible outcomes were: mortality (any or all causes), gastroenteritis, occupational injuries, respiratory diseases, musculoskeletal disorders, and mental and social health conditions. Risk of bias was assessed separately on exposure assessment and health outcome using a modified Liverpool Quality Assessment Tool (LQAT). We pooled sufficiently homogenous studies using inverse variance meta-analysis with random effects. RESULTS: A total of 65 studies (9 cohort studies, 56 cross-sectional studies) met the inclusion criteria. One quarter of studies (n = 15) were from middle-income countries. Few studies assessed occupational risk factor exposures directly; most assigned exposure via proxy of occupation of sanitation worker. We judged nearly all studies to have “high risk of bias” in exposure and outcome assessment. Despite these limitations, the consistency of the overall evidence suggests that sanitation workers are at increased risk of gastroenteritis and respiratory conditions, and may be at increased risk of musculoskeletal disorders and mental/social health conditions. The pooled odds ratio for hepatitis A--the only outcome deemed suitable for meta-analysis--was 2.09 (95% Predicted Interval: 1.39–3.00, 12 studies). There was conflicting evidence from studies of increased risk of mortality; only one study reported on injuries. CONCLUSION: Despite a large number of studies, there is limited evidence to date of the health risks faced by sanitation workers, particularly among groups that may be at particular risk-- women, informal workers and those living in low-income countries. Nevertheless, the research to date provides suggestive evidence of elevated occupational risk among sanitation workers across a range of health condition. More research is needed to improve the current bodies of evidence for all included health outcomes to be able to quantify disease burden among this occupational group. |
format | Online Article Text |
id | pubmed-8837624 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Urban & Fischer |
record_format | MEDLINE/PubMed |
spelling | pubmed-88376242022-03-01 Occupational health outcomes among sanitation workers: A systematic review and meta-analysis Oza, Hemali Harish Lee, Madison Gabriella Boisson, Sophie Pega, Frank Medlicott, Kate Clasen, Thomas Int J Hyg Environ Health Article BACKGROUND: Sanitation workers are essential to global public health and societal wellbeing. However, the health risks and outcomes associated with exposure to occupational risk factors among sanitation workers are neither well understood nor well quantified. We undertook a systematic review to (1) identify occupational risk factors among sanitation workers and (2) assess the effect of occupational exposure to human fecal sludge and wastewater on selected health outcomes among these workers. METHODS: We searched four databases (i.e., PubMED, MEDLINE, EMBASE, and LILACS) for eligible studies from inception through to January 01, 2020. The included population was workers ≥15 years engaged, formally or informally, in installing, operating, servicing, cleaning or emptying a sanitation technology at any step of the sanitation chain. The included comparator was workers in other occupations or the general population. Eligible outcomes were: mortality (any or all causes), gastroenteritis, occupational injuries, respiratory diseases, musculoskeletal disorders, and mental and social health conditions. Risk of bias was assessed separately on exposure assessment and health outcome using a modified Liverpool Quality Assessment Tool (LQAT). We pooled sufficiently homogenous studies using inverse variance meta-analysis with random effects. RESULTS: A total of 65 studies (9 cohort studies, 56 cross-sectional studies) met the inclusion criteria. One quarter of studies (n = 15) were from middle-income countries. Few studies assessed occupational risk factor exposures directly; most assigned exposure via proxy of occupation of sanitation worker. We judged nearly all studies to have “high risk of bias” in exposure and outcome assessment. Despite these limitations, the consistency of the overall evidence suggests that sanitation workers are at increased risk of gastroenteritis and respiratory conditions, and may be at increased risk of musculoskeletal disorders and mental/social health conditions. The pooled odds ratio for hepatitis A--the only outcome deemed suitable for meta-analysis--was 2.09 (95% Predicted Interval: 1.39–3.00, 12 studies). There was conflicting evidence from studies of increased risk of mortality; only one study reported on injuries. CONCLUSION: Despite a large number of studies, there is limited evidence to date of the health risks faced by sanitation workers, particularly among groups that may be at particular risk-- women, informal workers and those living in low-income countries. Nevertheless, the research to date provides suggestive evidence of elevated occupational risk among sanitation workers across a range of health condition. More research is needed to improve the current bodies of evidence for all included health outcomes to be able to quantify disease burden among this occupational group. Urban & Fischer 2022-03 /pmc/articles/PMC8837624/ /pubmed/34942466 http://dx.doi.org/10.1016/j.ijheh.2021.113907 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Article Oza, Hemali Harish Lee, Madison Gabriella Boisson, Sophie Pega, Frank Medlicott, Kate Clasen, Thomas Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title | Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title_full | Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title_fullStr | Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title_full_unstemmed | Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title_short | Occupational health outcomes among sanitation workers: A systematic review and meta-analysis |
title_sort | occupational health outcomes among sanitation workers: a systematic review and meta-analysis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837624/ https://www.ncbi.nlm.nih.gov/pubmed/34942466 http://dx.doi.org/10.1016/j.ijheh.2021.113907 |
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