The effect of improving solid waste collection on waste disposal behaviour and exposure to environmental risk factors in urban low‐income communities in Pakistan

OBJECTIVE: To estimate the effect of improving waste collection services on waste disposal behaviour and exposure to environmental risk factors in urban, low‐income communities in Pakistan. METHODS: We enrolled six low‐income communities in Islamabad (Pakistan), four of which received an intervention consisting of a door‐to‐door low‐cost waste collection service with centralised waste processing and recycling sites. Intervention communities underwent community‐level and household‐level mobilisation. The effect of the intervention on waste disposal behaviour, exposure to waste and synanthropic fly counts was measured using two cross‐sectional surveys in 180 households per community. RESULTS: Intervention communities had less favourable socio‐economic indicators and poorer access to waste disposal services at baseline than control communities. Use of any waste collection service increased from 5% to 49% in the intervention communities (difference 44%, 95% CI 41%, 48%), but the increase was largely confined to two communities where post‐intervention coverage exceeded 80% and 90%, respectively. An increase in the use of waste collection services was also found in the two control communities (from 21% to 67%, difference 47%, 95% CI 41%, 53%). Fly counts decreased by about 60% in the intervention communities (rate ratio 0.4, 95% CI 0.3, 0.4) but not in the control communities (rate ratio 1.52, 95% CI 1.1, 2.2). The decrease in fly counts was largely confined to the two high‐coverage intervention communities. CONCLUSION: Introduction of a low‐cost waste collection service has the potential for high uptake in low‐income communities and for decreasing the exposure to waste and synanthropic flies at household level. Intervention success was constrained by low uptake in half of the intervention communities.