Discussion
septic
COMMUNICABLE DISEASES, EVENTS, COVID-19 INFECTION
We conducted the study to understand the effect of an occupational health safety intervention on the waste and sanitation workers in Bangladesh. We found that the intervention improved workers' knowledge of communicable diseases, including the key COVID-19 transmission and prevention components, their understanding of the importance of using and maintaining PPEs, and workers' attitudes toward using and washing PPEs and work equipment. The intervention also improved workers' practice of regularly changing/cleaning masks and equipment, maintaining hygiene after returning home from work, handwashing before-during-after work, maintaining coughing etiquette and social distancing at the workplace, and disposing of waste in designated areas. The intervention also ensured the availability of necessary PPEs to the workers and successfully impacted the use of those diverse PPEs. On the other hand, the intervention was less effective in improving workers' understanding of social distancing, quarantine, and isolation, their attitude towards handwashing before and after using toilets and having meals, and their practice of disposing of PPEs, handwashing before taking food and after using the toilet, using the mask, and disinfecting equipment.The intervention made the occupational health and safety guidelines available to the workers in the intervention areas. It ensured that the workers understood what the guideline contained, which may have impacted the improved adherence to guidelines in intervention areas more than in control areas. It may have impacted the workers' knowledge, attitude, and practices.To improve the worker's occupational health and safety, context-specific and appropriate intervention, especially training, has been recommended in different LMIC settings, including Bangladesh (The intervention from ITN-BUET was designed so that the workers receive training from the people they know or work with, as it might have a better chance of meeting the workers' contextual demands. This initiative also reduced the chance of potentially spreading misinformation, which was largely a concern during COVID-19 (Workers from the intervention areas could also easily perceive the benefit of the training compared to workers in control areas indicating the appropriate reach of the intervention to the workers. The learnings from the training events might have improved their attitude (in intervention areas) towards the importance of using and washing PPEs, cleaning waste management tools regularly, and injury management. On the other hand, the workers' attitude towards handwashing before critical handwashing time, such as before meals and after using the toilet, did not show any association with the intervention. Different development agencies and the government of Bangladesh have been working on improving people's handwashing, including waste and sanitation workers, for many years, and previous large-scale trials observed low improvement in handwashing with soap practices (During COVID-19, the family members of the waste and sanitation workers were particularly in danger of getting infected (Fear arousal was one of the primary incentives for people to maintain protective conduct among threat perception indicators during CVOID-19 (Ensuring the availability of appropriate PPEs (including consideration of gender appropriateness) to the waste and sanitation workers was recommended as a crucial measure to reduce occupational health risks, including COVID-19 infection and transmission (Changing behaviour is a complex process and it is normal to experience many lapses and relapses when trying to change behavior because it can be an inherently unstable and unsteady process (The study had a few limitations. We conducted the study just one month after the intervention provision to see the immediate effect. However, the impact of the intervention might be different after six months or a year, which can be explored in the future to realize the long-term impact of the intervention. Also, we selected the study sites (both intervention and control areas) purposively; thus, it does not fully represent the situation of the sanitation workers in the country. Nonetheless, we selected the sites from all eight divisions, considered the cultural and geographical diversities, and ensured representation from large cities (city corporations) and small towns (municipalities). Moreover, during observation of the workers' practices at the workplace, the workers did not perform all activities at all times, resulting in a few observations in certain aspects. Also, many sanitation workers (especially drain cleaners and septic tank/pit emptiers) were working late at night, making it harder for the researchers to reach the workers at the workplace because of security concerns and the unavailability of safe transportation. These affected the number of observed practices.