SOLID WASTE MANAGEMENT AND ITS

IMPACT ON THE PREVALENCE OF DISEASE

CASE STUDY

NAKAWA DIVISION - KAMPALA CITY

BY

GATLUAK MIAK DENG

02/02613/122578

A RESEARCH DISSERTATION SUBMITTED TO THE

FACULTY OF SCIENCES AND TECHNOLOGY IN PARTIAL

FULFILLMENT OF THE

REQUIREMENTS OF THE AWARD OF A BACHELORS

DEGREE IN ENVIRONMENTAL HEALTH SCIENCE

OF

CAVENDISH UNIVERSITY

JULY, 2013

1

DECLARATION

I, Gatluak Miak Deng, do hereby declare that this work is my own except where

acknowledged. I do declare that this work has never been submitted for any similar

award at any University.

SIGNATURE OF CANDIDATE………………………………….

GATLUAK MIAK DENG

(CANDIDATE)

DATE………………………………………………

SIGNATURE………………………………………………………

Mr. SOLOMON KIGOZI

(SUPERVISOR)

DATE………………………………………………

2

DEDICATION

To my dearest, wives Monica Yar Kuol(Man-Gatlwakdit) and Mama-Atiek-thalyep,

sons Elijah Gatlwak D’Mike and Ezra Gatlwak D’Mike Gatlwak and daughter Mary

Atiek-thalyep and Josephine Atiek-thalyep, my dearest mother Rebecca Nyadieng

(Mayuokdit), brothers Abram Goch(Ashuetnok), Jamesburg Lual(Makualdeeu),Pe ter

Mabior John, Elijah Mabil and Elijah Manyok and sisters Rechal Amer, Mary Atiek

and uncle Daniel Deng Miak (Deng-areng) and Daniel Deng Ajang (D’Paarthi) and the

friends John Bol (Artist), Isaiah Lual(Lual-aloch),Chuol Yok(Gar-yok), John Simon

Kachuol,William Akol Nhial and the most of all who offer me his time always Mr.

Michael Kashuku whose support and prayers were quintessential to the successful

completion of this program

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Acknowledgements

I acknowledge with much gratitude the patience and help I received from the staff of

Cavendish University especially Mr. Solomon Kigozi. Thanks also goes to my big

brother Simon Akuei Deng without whose support this project would not have been

possible.

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TABLE OF CONTENTS

PAGE

Declaration………………………………………………………………………..i

Dedication………………………………………………………………………...ii

Acknowledgements………………………………………………………………iii

Table of contents………………………………………………………………….iv

List of tables………………………………………………………………………vii

List of acronyms………………………………………………………………….viii

Abstract…………………………………………………………………………....ix

CHAPTER ONE: INTRODUCTION

1.0 Introduction……………………………………………………………………1

1.1 Background to the study……………………………………………………….1

1.2 Statement of the problem………………………………………………………5

1.3 Objective of the study…………………………………………………………6

1.4 Scope of the study……………………………………………………………..6

1.5 Significance of the study………………………………………………………6

1.6 Hypothesis……………………………………………………………………..7

CHAPTER TWO: SOLID WASTE MANAGEMENT BY KCCA AND KITEEZI

LANDFILL

2.1 Kitezi Landfill…………………………………………………………..........9

CHAPTER THREE: LITERATURE REVIEW

3.0 Review of related literature……………………………………………...10

3.1.1. Waste Management Elements…………………………………………….10

3.1.2. Environment and Health………………………………………………….11

3.13. Economic………….………………………………………………….13

3.4 Planning and Management…………………………………………….14

5

CHAPTER FOUR: PRESENTATION AND DISCUSSION OF FINDINGS

4.1 Methodology…………………………………………………………………15

4.1.1 Research Design………………………………………………………….…15

4.1.2 The Model……………………………………………………………….….15

4.1.3 Discussion of variables……………………………………………………...16

4.1.4 Data Type……………………………………………………………….…..16

4.1.5 Data Source…………………………………………………………………16

4.1.6 Data analysis………………………………………………………………...17

4.2 Empirical findings………………………………………………………….….17

4.2.1 Results of the correlation analysis……………………..………………….…17

.2.2 Results of the regression analysis………………………………………….….20

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS

4.1 Summary of findings…………………………………………………………22

4.2 Recommendations…………………………………………………………….23

Reference………………………………………………………………………..27

APPENDIX A: Spearman’s correlation analysis…………………………………30

APPENDIX B: Regression analysis results………………………………………31

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LIST OF TABLES

PAGE

2.1: Waste composition in Nakawa division…………………………………11 4.1: Results of regression analysis……………………………………………17

7

Abstract

Urbanization and population growth are solely responsible for high increasing rate of

solid waste in the urban areas and its proper management is a major problem of Uganda

National Water and Sewerage Corporation. Management of solid waste all over the

world is one of the first important priorities to the protection of community health as

well as the environment. Solid waste comprises all the waste arising from human and

animal activities that are normally solid and are discarded as useless.

In recent years there has been a sharp increase in the prevalence of certain diseases like

diarrhea and malaria that are linked to poor solid waste management and disposal many

of which are communicable and yet a sound solid waste management policy has been

in place. Therefore there is a need to investigate why despite having a good waste

management policy in place there has been an increase in prevalence of diseases like

diarrhea, cholera, dysentery and malaria.

The study established that increased implementation of Solid Waste management

policies did not lead to the expected reduction in reported cases of malaria and diarrhea.

By significantly failing to impact positively on the reduction on occurrence of malaria

and diarrhea, an increment of the increased implementation of Solid Waste

management policies has failed to lead to a reduction in reported cases of malaria and

diarrhea.

The study established that piecemeal and rapid implementation of waste management

policies failed to impact on the betterment or reduction of disease prevalence in the

expected direction. In order for increased implementation of waste management

policies to have a meaningful impact on the quality of health services there is a need

for gradual, methodological and prioritization of selected policy implementat ion to give

all stake holders ample time to adapt.

8

Nicely designed policies also need equally efficient implementation. One of the key

performance indicators (KPIs) in solid waste management is speedy management of the

same. Furthermore, Kitezi landfill will not be adequate for long and measures need to

be in place to expand on it and possibly identify other potential landfill sites as the rate

of urbanization is quite quick.

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CHAPTER ONE

1.0 BACKGROUND OF THE STUDY

Urbanization and population growth are solely responsible for high increasing rate of

solid waste in the urban areas and its proper management is a major problem of Uganda

National Water and Sewerage Corporation. Management of solid waste all over the

world is one of the first important priorities to the protection of community health as

well as the environment. Solid waste comprises all the waste arising from human and

animal activities that are normally solid and are discarded as useless or unwanted

disposal (Tchobanoglous, et al. 1993). Wastes can be generated by natural phenomena

such as wind, erosion, precipitation, volcanic eruptions, flooding of river banks,

atmospheric fallouts, among others and by human activities including domestic;

commercial, industrial and agricultural practices (ACS, 1969, Eipper, 1970 and

Moncrief, 1970). Among the factors contributing to wastes generation in Kampala are:

rapid population growth and high concentration of the population in urban areas,

industrial development, changes in eating habits, and the widespread use of disposable

containers and packages resulting in huge amounts of waste. The magnitude of wastes

generated from human activities alone may exceed 18,000 tons per year for a

developing area (Habbit, 1989 and Onibokun, 1989). 1967).

According to http://www.ukessays.co.uk/essays/health/solid-wastes-effects-at-human-

development-and-health the management of municipal solid waste is becoming a major

public health and environmental concern in urban areas of many developing countries

(Harris, 2004). The improper management of solid wastes represents a source of

environmental pollution, and poses risks to human health (Puri et al., 2008). Munic ipa l

10

waste in most cities contain human excreta, animal excreta, hazardous chemica l

pollutants and sharps which can facilitate the spread of diseases and injury particula r ly

among children playing near waste dumpsites and employees in waste management

sector (Da Zhu et al, 2008). Poor disposal of solid waste is associated with spread of

vector borne-diseases like malaria and dengue fever (McKenzie et al., 2004; Puri et al.,

2008). Infrequently disposed refuse tend to become breeding sites for mosquitoes, as

pools of rain water collect in discarded cans, bottles and car tires (Ofomata and Eze,

2001) Mosquitoes are responsible for the transmission of malaria-a life threatening

disease through their bites (Human Protection Agency, 2009). Malaria accounts for an

estimated 300-500 million cases globally; which is an endemic disease in sub-Saharan

Africa. It accounts for about 1.5-2.5 million deaths yearly, most of them among children

under five years (WHO, 2009). Decomposing organic materials can become breeding

sites for pests, rats, flies and vermin that enhance the likelihood of disease transmiss ion

like diarrhoea and Lassa fever (Simon, 2008). Lassa fever is a haemorrhagic fever

common in four African countries: Guinea, Liberia, Nigeria and Sierra Leone. It is

transmitted to humans from contacts with food or household items contaminated with

rodent excreta (HPA, 2009; WHO, 2009).

Uncollected waste left to accumulate or dumped in the streets can block water drains

and channels which can cause flooding, posing significant environmental and public

health risks (Whiteman et al, 2008). Ground or surface water pollution can occur when

rain water combines with decomposing waste and seep through permeable soil, fina lly

contaminating surface and ground water with both lethal materials and pathogenic

organisms (Ofomata and Eze, 2001); this is extremely dangerous as ground water is the

main source of drinking water for most cities in the developing world (Oluwasola,

2007). Incineration of municipal solid waste contributes to air pollution by the release

11

of noxious materials into the air, which may cause ill-health (Ofomata and Eze, 2001).

Uncontrolled incineration of solid waste can also cause fire outbreaks in nearby homes

and farms. Other impacts of poor Municipal Solid Waste disposal include disgust ing

odour, unsightliness and general degradation of the environment .

Each household in Uganda generates approximately 1 tonne of Domestic Waste per

year! Urban Domestic Waste Management is drawing increasing attention, as citizens

observe that too much garbage is lying uncollected in the streets, dustbins, causing

inconvenience and environmental pollution, and being a risk for public health.

Although government authorities apply all the means at their disposal, the piles of

wastes only seem to grow from day to day. In Kampala city alone Domestic Waste

generation rates range between 0.5kg and 1.1kg per capita per day. The population of

Kampala City and its suburbs is estimated at 1.5 million. The estimate of waste per

capita generation per day is 0.5kg. This makes the total collection to be 1.5 million x

0.5kg = 750,000kg per day or 750 tonnes generated per day. Domestic Waste generation

is higher among high income earners populations. On average the collection is 45-50%

of this and so on a daily basis collection amounts to 375 tonnes or 37,500kg of waste

collected a day from Kampala. In composition, plastics underwhich polythene falls

account for 1.6% with the highest being 73.8% for vegetable matter with the rest being

tree cuttings, glass, metals, paper. etc. Kampala city generates 800 tons of domestic

waste per day.

On the management however, the dumping is done by the K.C.C. at Mpererwe, a

landfill made in 1996 after the former one at Lweza and Lubigi.

12

Table 2.1 Waste composition in Nakawa division

Vegetable Matter 73.8%

Paper 5.4%

Sawdust 1.7%

Plastic 1.6%

Metal 3.1%

Glass 0.9%

Tree cuttings 8.0%

Street debris 5.5%

1.2 STATEMENT OF THE PROBLEM

Recent economic developments on many fronts in Uganda have seen urban settlements

grow at a very high rate. Urbanization and population growth have both grown almost

by equal proportions. This has seen Kampala city triple in size from what it was 20

years ago. Urbanization and population growth are solely responsible for high

increasing rate of solid waste in the urban areas and its proper management is a major

problem of Kampala City Council authority. In recent years there has been a sharp

increase in the prevalence of certain diseases like diarrhea and malaria that are linked

to poor solid waste management and disposal many of which are communicable and

yet a sound solid waste management policy has been in place. Therefore there is a need

to investigate why despite having a good waste management policy in place there has

been an increase in prevalence of diseases like diarrhea, cholera, dysentery and malaria.

13

1.3 PURPOSE AND OBJECTIVES OF THE STUDY

1.3.1 Purpose of the study

The purpose of this research was to carry out an evaluation of the solid waste

management system in Kampala city in general and Nakawa division in particular and

see if it is connected to the increased prevalence of diarrhea and malaria

1.3.2 Objectives of the study

To find out if there is any relationship between the current waste management

policies and practices and the increased prevalence of diarrhea and malaria in

Nakawa division.

To analyze and evaluate the solid waste management (SWM) program in Nakawa division; and

To suggest recommendations and areas for further research.

1.4 RESEARCH QUESTIONS

Is any relationship between the current waste management policies and

practices and the increased prevalence of diarrhea, cholera, dysentery and

malaria in Nakawa division?

What are the solid waste management (SWM) programs in Nakawa division?;

and What are the recommendations and areas for further research?

AREA AND SCOPE OF THE STUDY

1.5.1 Geographical Scope

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The study will be carried out in Nakawa division health center IV where first line

treatment facilities to deal with diarrhea, cholera, dysentery and malaria are located .

1.5.2 Subject scope

The study mainly covered the incidence of reported cases of diarrhea, cholera,

dysentery and malaria at health centre IV in Nakawa division of Kampala city

1.5.3 Time scope

The research covered a period of 10years, 2002-2012; this was because it was a period

when there was a huge increase in urban population in Kampala city in general and

Nakawa division in particular.

1.6 SIGNIFICANCE OF THE STUDY

In general, there is a lack of literature discussing how to implement integrated

approaches to environmental management (Margerum and Born 1995). Regarding solid

waste management in particular, there has been improvement regarding interest,

research and expertise in integrated approaches in developing countries, however, there

is a lack of information about local initiatives (Furedy 1997). There is a need for

information to be shared, projects to be evaluated, and difficulties to be discussed

(Furedy 1997).

1.7 Hypothesis

It is hypothesized that a negative relationship exists between the adoption of newer

solid management policies and the increase of malaria and diarrhea.

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CHAPTER TWO

SOLID WASTE MANAGEMENT BY KCCA AND KITEEZI LANDFILL

Working with the World Bank's International Finance Corporation (IFC), the Kampala

Capital City Authority (KCCA) in Uganda to grant a concession to a private investor

for the management of Kampala City’s solid waste treatment facility - the Kiteezi

Landfill.

More specifically, an IFC investment brief said that it is envisaged a private operator

will design and finance the extension of the current sanitary landfill, upgrade existing

facilities and operate the site.

Currently, the KCCA is responsible for the majority of waste collection and transport.

The authority services less affluent areas and collects solid waste from joint collection

points and refuse banks, as well as on a bring to truck / sound horn basis in informal

settlements.

Currently there is no charge for waste services and the costs of collection, transport

and landfill management are covered by the KCCA's own budget.

According to the IFC brief, the regulatory framework enables the KCCA to levy a

service fee to users.

In addition to the KCCA collections, there are several private operators competing

within the same geographical market and providing door to door waste collection to

16

paying customers and transporting it to the landfill. The brief noted that currently there

is no exclusivity for operators in designated collection zones.

2.1 Kiteezi Landfill

The Kiteezi landfill which will be the subject of the concession is located in the Wakiso

district, around 15km from Kampala City centre. Until recently, the KCCA has

delegated the management of the site to a private operator under a temporary permit.

The IFC brief explained that the current regulation obliges all waste collection

companies to dispose waste in the Kiteezi landfill and that there are currently no other

licensed waste disposal and treatment facilities in the City of Kampala.

The landfill is also currently in the process of extension to the south.

17

The brief added that prospective operators are encouraged to assess the potential

revenues to be derived from the capture of the landfill gas reserve in the existing

landfill.

CHAPTER THREE

3.0 Review of related literature

This chapter looked at the literature on solid waste management and disposal best

practices in place.

According to (Schubeler, Wehrle and Christen 1996). Jindal et al. (1998); the overall

aim of establishing sustainable SWM systems is to meet the needs of all citizens,

including the poor identify the need for SWM to accomplish “a more hygienic, safe and

pollution-free environment; cleaner and more comfortable living conditions, and a

higher standard of living; reduction in diseases; and optimum utilization of resources”.

3.1.1. Waste Management Elements

The functional elements of a solid waste management system typically include: waste

generation (sources, quantity, composition, storage); collection; transfer and

transportation; processing or treatment; and final disposal. Waste reduction, reuse and

recycling have been incorporated in more comprehensive waste management strategies.

In the design of an efficient and effective waste management system, each element of

the waste management process and compatibility between elements must be considered

(Jindal et al. 1998).

18

In developing countries, municipal solid waste contains on average around 50% organic

matter and 30% recyclable materials, meaning that potentially 80% of waste can be

recycled (Habitat 1994). Compared to industrialized countries, the waste is dense and

has a high moisture content since it is composed primarily of organic matter (Habitat

1994). Per capita waste generation rates are lower in developing countries than in

industrialized countries because of lower levels of prosperity and consumption, and

extensive recovery and reuse of materials before and during waste collection (Jindal et

al. 1998). In Indonesian cities, it is estimated that waste pickers reduce refuse quantit ies

by one third (Furedy 1990).

Tesfaye, Z (2007); in his dissertation found out that the daily waste generation in Addis

Ababa city from each individual is expected to be 0.252Kg. Current waste generation

in the city is 2,940 m3/day of which 80% is collected and disposed on dumping site

every day. This open dumping site has no liner system and other groundwater pollut ion

and public health risks control mechanism.To analyze groundwater pollution and public

health risks in the vicinity of Reppi solid waste dumping site Addis Ababa City,

Ethiopia. A cross sectional study was conducted in Reppi solid waste dumping site from

April 10 to 25/ 2007 to analyze associated risks to the groundwater and the public health

in its vicinity. For groundwater issue leachate, nearby well water and far away spring

water samples were collected based on the distance difference and for public health

issue. Based on standard sampling procedures 316 in the near by community and 316

from the controlled group were used for the study. Extreme care was taken to avoid

alteration of chemical composition of samples during sampling. The study parameters

for leachate, and groundwater quality were determined in Addis Ababa City

Environmental Protection Authority and Ethiopian Geological Survey Water

Laboratories. It includes physicochemical parameters such as PH, chloride, total

19

hardness, alkalinity, TDS, TSS, DO, BOD, COD, Nitrate, Ammonia, Phosphate and

trace metals. Standard methods were used for the analysis of the samples. The public

health parameters were collected using pre designed questionnaires. Result and

discussion: Physicochemical analysis of leachate and groundwater showed that more

than 95% of parameters in nearby well water analysis is more higher than the far away

spring water and much exceeded WHO drinking water quality standard. This may be

due to contaminants transport from dumping site to ground water. More than 95% risk

ratio Public health risks were found in the nearby residents. From this study we can

conclude that there is an increase in risk to ground water and public health that is

reported near Reppi solid waste dumping site. There fore the concerned authority

should take appropriate intervention measures to groundwater and the health of the

community.

Abul S,(2010) found out that, solid waste disposal sites are found on the outskirts of

the urban areas, turning into the child sources of contamination due to the incubation

and proliferation of flies, mosquitoes, and rodents; that, in turn, are disease transmit ters

that affect population’s health, which has its organic defenses in a formative and

creative state. What to do with solid waste has long troubled governments, industr ies,

and individuals. Therefore, this study was design to determine the effects of the

dumpsite on the surrounding human settlement in the Mangwaneni area of the Golf

Course dumpsite in Manzini city. The effects that were assessed were the possible

impacts of the dumpsite on the health and the environment and also the residents view

regarding the location of the dumpsite. Data were collected from 78 household heads,

through the use of self-administered questionnaires. Households heads were divided

into strata, with 39 nearby (<200m) and 39 far away (>200m) of the Mangwaneni area.

20

In order to achieve its objectives, a comparison between the nearby and far away

residents was done. The result shows that both residents were affected by the location

of the dumpsite closer to their settlements. It was also noted that the residents whose

houses are less then 200 meters from the dumpsite are victims of malaria, chest pains,

cholera, and diarrhea. However, residents whose houses are more than 200 meters are

also affected with the chest pain and bad smell from the dumpsite, but mainly when

wind is blowing in their direction. The study concludes that dumpsites should be located

at least 200 meters away from human settlements. Therefore, the study recommends

that dumpsites should be properly located and managed to minimize its effects on the

environment. The government and municipalities should revise laws regarding the

locations of the dumpsites.

Growing urban populations and increasing consumption levels result in increased waste

generation. As well, industrialisation and modernisation result in changes in waste

composition as products such as plastic bags replace banana leaves1. Uncontrolled

dumping is widely practiced in Asian developing countries because of rapid

urbanization and lack funding, resources and space for landfills (Jindal et al. 1998).

3.2 Environment and Health

In developing regions of Asia such as Indonesia, improper disposal of solid waste is a

major source of environmental pollution (Listyawan 1997). Wisnu (1999b) estimated

that 60% of solid waste is not collected or disposed of properly in Bali, and is instead

dumped in “informal” landfills, the ocean or along the side of roads. The need to

21

improve public cleansing and solid waste management has gained the attention of

citizens, government and industry in Indonesia (Listyawan 1997).

Morley E (2004) came to the conclusion that waste is an inevitable by-product of our

use of natural resources. The amount and make-up of waste in any given area depends

on factors such as the local population density, economic prosperity, time of year, type

of housing and whether there are local waste minimisation initiatives such as home

composting. He looked at whether the evidence showed that waste management

operations might cause health effects for people living nearby. Where the literature

review showed that there might be a link between waste management operations and

health effects, we calculated what this might mean for local populations. He studied

this in two ways. Firstly, he considered whether the results of epidemiological studies

could be used to quantify any extra health effects that might arise in populations living

close to municipal solid waste management facilities, compared to those that would

arise if the municipal solid waste facility was not there. Secondly, we estimated the

health effects caused by emissions of particular pollutants to the air, based on

information on the health effects of increasing levels of these pollutants. He could not

do a similar calculation for emissions to water or land, because it is not possible to make

similar estimates of public exposure to these pollutants. Where the information

permitted, the health effects were calculated on a “per tonne of waste processed” basis.

This enabled us to compare the health impacts of different waste management option

Increased emissions under non-standard operating conditions could be a concern for

open windrow composting, if the waste is not handled properly. Disposal of ash from

incinerators needs to be carefully managed and landfills can give rise to emissions to

water, land or air unless properly managed. For most of the municipal solid waste

facilities studied, we found that health effects in people living near waste management

22

facilities were either generally not apparent, or the evidence was not consistent or

convincing. However, a few aspects of waste management have been linked to health

effects in local people.

Ogunrinola,I. Oluranti (2003) came to the conclusion that refuse dumpsites are found

both within and on the outskirts of cities in Nigeria and due to poor and

ineffectivemanagement, the dumpsites turn to sources of health hazards to people living

in the vicinity of such dumps. Thisstudy is therefore designed to examine, in

quantitative terms, the health and economic implications of solid wastedisposal among

sampled residents of two major refuse disposal dumps in Lagos, Nigeria. The data used

for thestudy was generated from the primary source, while the SPSS software was used

in the data analyses. In addition tothe descriptive analysis which forms the bedrock for

the conclusion drawn in this paper, both the linear probabilityand ordinary least squares

regression models were also used in the analyses. The models examined

thedeterminants of health status as well as the labour supply of the sampled respondents

respectively. The results showthat pollution variables are statistically significant in the

determination of health status as well as the labour supply performance of respondents.

Based on these findings, policy measures that would enhance the health status

and improved labour market performance of residents were put forward

Waste is unsightly and malodourous, polluting land, air and water, clogging drainage

systems, posing serious public health risks, and restricting potential land use (Pernia

1992; Haan, Coad and Lardinois 1998). Spontaneous ignition of gases and deliberate

burning are common at dumpsites (Thomas-Hope 1998). The burning of garbage

23

releases smoke and hazardous substances. Leachate from the waste can contaminate

soil, surface water and groundwater. Mosquitoes that can carry dengue fever and yellow

fever breed in fresh water from accumulated rainfall in cans and bottles (Pinnock 1998).

Disease vectors such as mosquitoes, flies, cockroaches and rodents thrive on solid waste

(Pinnock 1998). The pathways of direct and indirect contact identified include insects,

rodents, pigs, birds, air and water pollution, and food contamination (Pinnock 1998).

Similarly, Fedorak and Rogers identified three mechanisms by which micro-organisms

could be disseminated from a waste disposal site (1991). The first mechanism was

leachates into groundwater, the second was airborne particles, and the third was life

forms that consume or pick up microbes. Waste such as facial tissues, pet feces, soiled

diapers and putrescible food may contain large numbers of micro-organisms (Fedorak

and Rogers 1991).

In developing countries, amenities for workers’ welfare are normally absent (Jindal et

al. 1998). People working in the waste management sector can encounter a number of

work related health concerns such as pain, illness, stress, injuries, accidents and

emergencies. Waste pickers at dump sites report numerous negative health effects, such

as eye irritations, respiratory diseases, asthma, leg cramps, backache, pain in arms,

dental problems, parasitism, intestinal disorders, diarrhoea, skin diseases, severe

headache, lacerations, puncture injuries, minor accidents and mental health problems

(Lohani and Baldisimo 1991; Pinnock 1998). Factors that contribute to these ailments

include unsanitary conditions (smoke, dust, faecal matter, rats, insects), unhealthy

practices (food contamination), heavy loads, handling operation, mechanised

equipment, nature of the materials handled, extent to which safeguards are employed

24

(gloves, boots, etc.) and availability of cleaning facilities (Lohani and Baldisimo 1991;

Lardinois and van de Klundert 1995; Pinnock 1998).

Workers often do not use safety equipment such as facemasks, ear plugs, gloves and

proper footwear, and there is a need for education about health and safety issue s

(Thomas-Hope 1998). The lack of precautions, unsafe practices, noise, high

temperatures, polluted atmosphere (dust, hazardous chemicals), contaminated waste,

and long working hours in many working areas present serious health hazards

(Lardinois and van de Klundert 1995; Habitat 1994). There is a need to improve

standards and strengthen labour and health regulations, however, even when regulat ions

exist, many informal recycling activities do not comply with them (Lardinois and van

de Klundert 1995). Lack of enforcement of legislation is a common problem in Asian

developing countries (Jindal et al. 1998).

Porta D et tal (2009) concluded in their publication that management of solid waste

(mainly landfills and incineration releases a number of toxic substances, most in small

quantities and at extremely low levels. Because of the wide range of pollutants, the

different pathways of exposure, long-term low-level exposure, and the potential for

synergism among the pollutants, concerns remain about potential health effects but

there are many uncertainties involved in the assessment. Their aim was to

systematically review the available epidemiological literature on the health effects in

the vicinity of landfills and incinerators and among workers at waste processing plants

to derive usable excess risk estimates for health impact assessment. They examined the

published, peer-reviewed literature addressing health effects of waste management

between 1983 and 2008. For each paper, they examined the study design and assessed

potential biases in the effect estimates. They evaluated the overall evidence and graded

25

the associated uncertainties. In most cases the overall evidence was inadequate to

establish a relationship between a specific waste process and health effects; the

evidence from occupational studies was not sufficient to make an overall assessment.

For community studies, at least for some processes, there was limited evidence of a

causal relationship and a few studies were selected for a quantitative evaluation. In

particular, for populations living within two kilometres of landfills there was limited

evidence of congenital anomalies and low birth weight with excess risk of 2 percent

and 6 percent, respectively. The excess risk tended to be higher when sites dealing with

toxic wastes were considered. For populations living within three kilometres of old

incinerators, there was limited evidence of an increased risk of cancer, with an

estimated excess risk of 3.5 percent. The confidence in the evaluation and in the

estimated excess risk tended to be higher for specific cancer forms such as non-

Hodgkin's lymphoma and soft tissue sarcoma than for other cancers. The studies they

have reviewed suffer from many limitations due to poor exposure assessment,

ecological level of analysis, and lack of information on relevant confounders. With a

moderate level confidence, however, theye have derived some effect estimates that

could be used for health impact assessment of old landfill and incineration plants. The

uncertainties surrounding these numbers should be considered carefully when health

effects are estimated. It is clear that future research into the health risks of waste

management needs to overcome current limitations.

3.3 Economic

Modebe A et tal ,(2009) in their study in eastern Nigeria found out that solid waste

management remains one of the major challenges of urbanization faced by developing

countries. The sanitary state of an area is largely influenced by the waste handling

26

practices of the residents and the measures in place for safe waste evacuation and

disposal. This study was aimed at examining the waste handling practices among

households in Awka, an urban area in south eastern Nigeria. Methodology: they

conducted a cross-sectional, descriptive study. A total of 200 households were selected

using a multi-staged random sampling technique and information was obtained from

them using an interview-administered questionnaire. The data obtained was analyzed

and relevant proportions calculated. The results were that the bulk of the solid waste

generated consisted of putrescible matter and cellophane bags. 170 (85%) of the

households stored their waste in a closed container outside the house. 73% of the

respondents disposed their waste through the inefficient government waste

management agency, 27% dumped theirs in unauthorized areas and the remainder

patronized private mobile cart pushers. Majority of the respondents (87.5%) did not sort

their waste prior to disposal. Despite very good knowledge of waste recycling (95%),

only 35 households (17.5%) practiced it. More than half of the respondents expressed

dissatisfaction with the level of government involvement in waste management and

wished it could do more. Conclusion was that there is a need for greater government

involvement, community participation and orientation with private sector involvement

in waste management in Awka with a view to building capacity for effective delivery

of waste management services and ultimately improve the sanitary state of the city

thereby reducing preventable disease burden on the populace.

Waste recycling can reduce waste disposal costs for local authorities by extending the

life of landfills, reducing the need to invest in transport vehicles and equipment,

reducing vehicle operation and maintenance costs, and reducing fuel consumption for

transporting waste (Habitat 1994). Businesses are provided with cheap raw materials.

27

In several countries, steel, paper and glass industries are dependent on recycled

materials (Jindal et al. 1998). The use of recycled materials reduces the need to import

raw materials, meaning that less money is spent on foreign currency. Banning the

import of foreign waste helps prevent the destruction of local markets for recycled

materials, and the health and environmental problems associated with contaminated

waste (Habitat 1994).

Recycling is a labour-intensive activity with relatively low start-up costs, providing

opportunities for employment and income generation for a great number of people as

waste pickers, itinerant waste buyers, waste dealers, workers in recycling businesses,

business managers and entrepreneurs (Lardinois and van de Klundert, 1995). Waste

recycling often serves as an entry point into the urban economy, providing participants

with economic benefits, higher social status, on-the-job training and business

opportunities (Marti 1991; Panwalkar 1991).

3.4 Planning and Management

Planning and management of solid waste in developing countries is a complex

undertaking because of the need to balance environmental goals (such as waste

reduction), social goals (related to waste pickers), contextual factors (such as income

disparity) and stakeholder interests (such as health, safety and aesthetics) (Furedy 1997;

Fernandez 1997a). Compromises are necessary because of the potential tension

between different goals and conflict between stakeholders (Furedy 1997). The

environmental approach to SWM based on the principles of “reduce, reuse, recycle and

recover” provides a basis for partnerships to improve SWM in developing countries

(Furedy 1997).

28

Thayyil J et tal (2013)The present study aimed to assess the occupational health

problems of municipal solid waste management workers. Cross-sectional descriptive

study was conducted among solid waste management workers of Kerala, India. All

workers (408) were included the study of which 313 (77%) participated. Data were

collected by direct interview and clinical examination using a structured questionna ire.

The observed morbidity like respiratory diseases, eye diseases, dermatologica l

problems and nail infections were elicited by clinical examination. The point

prevalence of other occupational related health events present either during the study

time or during 1 month recall period and that occurred ever after entry in present

occupation was collected by self-reported complaints and doctors diagnoses. The mean

age was 42.5 ± 7.2 years. The observed morbidity like respiratory diseases, eye

diseases, dermatological problems, nail infections were high ranged from 21% to 47%.

The reported prevalence of occupation related morbidities like falls (63.6%), accidents

(22%), injuries (73.2%), and water-vector borne disease (7.1%) were high. The current

prevalence of musculoskeletal morbidities showing that all major joints are involved

(17-39%).The work related health-problems were reported to be high. The prevalence

of Respiratory, dermatological, eye problems and injury, musculoskeletal problems

were reported to be high among municipal solid work handlers. Measures are needed

to improve the work environment of waste handlers by ensuring availability protective

gears based on ergonomic principles, clean drinking water and washing and sanitation

facilities during working hours.

Woodson,P(2007) concluded that,solid waste results from various sources, such as

animal wastes, hazardous wastes, industrial and medical wastes, food wastes, minera l

29

waste, and nonhazardous wastes. In addition to recognizing the numerous sources of

waste, the management of solid waste requires understanding treatment and disposal

options; legal aspects, such as policy development, enforcement, regulation, and

reporting; and the transportation of wastes. Boards of health around the nation have

varying levels of authority for implementing, improving, or investigating solid waste

management. The growing volume of solid waste generated by communities is a

concern for public health officials. Some of the concerns include aesthetics (e.g., the

visual appearance of many collection sites and odors associated with solid waste), the

potential for groundwater contamination, an increase in vectors rodents, insects, etc.)

that may spread diseases, and other issues regarding sanitation. To handle these matters,

boards of health and local health agencies must determine the appropriate means of

collecting, storing, and transferring wastes; the location of landfills; and the practice of

recycling, when possible, to reduce costs and improve environmental conditions. In

addition, boards of health may be responsible for overseeing the regulation and

licensure of the conditions and facilities of solid waste disposal.

The interaction and cooperation of stakeholders is necessary for implementation of an

integrated approach to solid waste management. Interaction is identified by Margerum

and Born as the key operational element for integrated environmental management

(1995). The participation of stakeholders enables the needs of people to be targeted

more effectively and ownership to be enhanced (Shubeler 1996). Stakeholders whose

capacities should be employed and developed during the planning and management of

solid waste include governments, businesses, the informal sector, civil society and the

general public (Schubeler, Wehrle and Christen 1996).

30

CHAPTER FOUR

PRESENTATION AND DISCUSSION OF FINDINGS

This chapter presents the methodology used and the empirical findings of the study.

The methodology section includes the research design, data type and sources,

discussion of the variables, data collection procedures and the data analysis techniques.

The section on empirical analysis presents the results of the regression and correlation

analysis.

4.1 Methodology

4.1.1 Research Design

This is a case study of Nakawa division of Kampala City Authority (KCCA) health

centres. The division was chosen because it is the biggest in land area. Furthermore,

Nakawa division is one of the fastest growing areas in the country with a comprehens ive

master plan for rapid improvement and expansion. The study assesses solid waste

management policies and their impact on the prevalence of diseases like diarrhea, and

malaria.

31

4.1.2 The Model

The study estimates a simple linear regression model. In the study, prevalence of

disease is hypothesized to depend on the solid waste management policies

Thus,

PVd = f (SWMPs)………………………………………… (1)

Where;

PVd = Prevalence of disease

SWMPs = Solid Waste management policies

However, there are several components of Solid Waste management policies. These

are: daily doorstep collection of “wet” (food) wastes for composting, improvement of

existing landfill sites, setting up of waste-processing and disposal facilities, provision

of a buffer zone around such sites, waste segregation (by not mixing “wet” food wastes

with “dry” recyclables like paper, plastics, glass, metal etc.), and prohibition of

Littering and throwing of garbage on roads . Substituting for the various diseases into

(1) results in equations (2) to (3) as given below;

DIOS = f (SWMPs)…………………………………………………. (2)

MAL = f (SWMPs)…………………………………………………. (3)

Where:

DIOS = Diarrhea

MAL = Malaria

32

From equation (1), it is hypothesized that the prevalence of disease depends on the rate

of implementation of the Solid Waste management policies. As such, it is expected that

the coefficients in equations (2) and (3) are negative.

4.1.3 Discussion of variables

The study has basically two variables: Solid Waste management policies and

prevalence of disease. Solid Waste management policies are well recognized as a key

factor in the success of high health care levels in many African countries

4.1.4 Data Type

The study was based on the prevalence of selected disease 2003 – 2013. The diseases

selected for use in the study are diarrhea, and malaria reported cases.

4.1.5 Data Source

Various data sources were utilized during the data collection process. Data on malaria

and diarrhea was collected from Records Office for Kiswa Health Centre. Data on Solid

Waste management policies were obtained from the Resource Centre of Kampala City

Council Authority (KCCA).

4.1.6 Data analysis

The study used the statistical package for social sciences (SPSS) to analyse the data. To

test the hypothesis, correlation analysis was used. The purpose of this method of data

analysis was to establish whether or not there was any relationship between the

prevalence of disease and the implementation of Solid Waste management policies.

Spearman’s correlation coefficients were computed so as to establish the nature of

relationship (positive or negative?). For deeper analysis, ordinary least squares (OLS)

33

regression analysis of the implementation of Solid Waste management policies and the

prevalence of diarrhea and malaria was carried out.

4.2 Empirical findings

This sub-section presents the results of empirical analysis that was carried out by the

study. Specifically, it presents the results of the correlation analysis as well as the

regression analysis.

4.2.1 Results of the correlation analysis

To establish the relationship between the prevalence of disease and the implementa t ion

of Solid Waste management policies, correlation analysis to compute Spearman’s

correlation coefficients between the prevalence of disease and the implementation of

Solid Waste management policies was carried out. Results of correlation analysis are

presented in Appendix B:

Where:

DIOS = Diarrhea

MAL = Malaria

From the results presented in Appendix B, the relationship between prevalence of

disease and the implementation of Solid Waste management policies has been

established. The results reveal that the implementations of solid waste management

policies have had the unexpected impact on the prevalence of disease. The study

established the existence of a positive correlation between the prevalence of disease and

34

the implementation of Solid Waste management policies. This relationship is

statistically significant at the 10 percent test level, implying that the positive

relationship is statistically different from zero. This means that as the as the number of

Solid Waste management policies are implemented, reported cases of malaria and

diarrhea goes up. A coefficient of 500 implies that at a 10 percent increase in the number

of policies implemented by Kampala City Council Authority increases diarrhea rate by

5.0 percent since an increase in reported malaria cases denotes a worsening in quality

of health services, it can be concluded that the increased implementation of Solid Waste

management policies has had a negative impact on the quality of health services (with

regard to reported diarrhea cases) in Naguru division of Kampala. Thus the stated

hypothesis that there is a negative relationship between the prevalence of disease and

the implementation of Solid Waste management policies is rejected with regard to

reported cases of malaria.

A positive relationship was discovered to exist between the implementation of Solid

Waste management and reported cases of malaria at the hospital. It is noted that an

improvement in the quality of health services might increase demand for the service by

attracting new users. This would increase among other things reported cases of malaria.

Thus the finding that a positive relationship exists between the reported cases of malaria

and implementation of Solid Waste management policies is not particularly surprising.

The variable has a coefficient of 1.000 and is statistically significant at the one (1)

percent test level. Thus the impact of increased Solid Waste management policies has

led to increased service demand. The coefficient of 1.000 that a 10 percent increase in

the numbers of reported malaria cases by 10 percent. The study, therefore rejects the

hypothesis that there is a negative relationship between the recruitment of medical

35

personnel by between the implementation of Solid Waste management and reported

cases of malaria.

In concluding this section, it is important to note that, using correlation analysis, the

study has found that overall, a positive relationship exists between the implementa t ion

of Solid Waste management and reported cases of malaria.

4.2.2 Results of the regression analysis

In order to establish the impact of Solid Waste management policies on the prevalence

of disease, the study carried out regression analysis. Using the R-squared from each of

the regressions in equations (2) to (3), the study established how much the

implementation of Solid Waste management policies influenced the prevalence of

disease. Table 4.1 presents a summary of results of the regression analysis.

Table 4.1: Results of regression analysis

Independent variable: MEDSTAFF

Selected Disease R-Square F-Statistic Significance

DIOS 0.439 0.874 0.539

MAL 0.956 21.967 0.134

36

Where:

Where:

DIOS = Diarrhea

MAL = Malaria

Given the R-Squared of 0.439 for DIOS and the positive sign of the correlation

coefficient, it is concluded that the implementation of Solid Waste management policies

accounts for 43.9 percent in the increase of diarrhea cases reported. The regression F-

statistic is significant at the 10 percent test level, implying that the Solid Waste

management policies play a significant role in increasing the diarrhea cases reported.

The study found that the implementation of Solid Waste management policies play a

statistically significant role in influencing the prevalence in reported malaria cases. The

regression analysis came up with an R-Squared of 0.956, meaning that the

implementations of Solid Waste management policies account for 95.6 percent of the

reported cases of malaria. The F-Statistic strongly significant at one (1) percent test

level, implying that there exists a statistically significant linear relationship between the

recruitment implementation of Solid Waste management policies and reported cases of

malaria. Thus the implementation of Solid Waste management policies has a significant

positive impact on the reported malaria cases.

Invariably, one has to note that the increased implementation of Solid Waste

management policies has failed to reduce the prevalence of disease as expected.

Overall, it is concluded that increased implementation of Solid Waste management

policies has not had a positive impact on the quality of health services offered.

37

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter presents a summary of findings, and recommendations of the study. A few

suggestions for further research are also made in this chapter.

5.1 Summary of findings

This study was conducted to establish the relationship between the prevalence of

disease and the implementation of Solid Waste management policies.

By computing Spearman’s correlation coefficients, it was found that; overall, a positive

relationship exists between the implementation of Solid Waste management policies

and prevalence of diseases selected. Specifically, the study established that increased

implementation of Solid Waste management policies did not lead to the expected

reduction in reported cases of malaria and diarrhea. By significantly failing to impact

positively on the reduction on occurrence of malaria and diarrhea, an increment of the

increased implementation of Solid Waste management policies has failed to lead to a

reduction in reported cases of malaria and diarrhea.

38

5.2 Recommendations

5.2.1 Gradual implementation of solid waste management policies

The study established that piecemeal and rapid implementation of waste management

policies failed to impact on the betterment or reduction of disease prevalence in the

expected direction. In order for increased implementation of waste management

policies to have a meaningful impact on the quality of health services there is a need

for gradual, methodological and prioritization of selected policy implementation to give

all stake holders in general and the ultimate beneficiaries of these same policies time

to absorb, internalize, comprehend and appreciate their utility and eventual usefulness .

This administrative course of action may require hiring more specialized and

experienced personnel who are experts at carrying out regular and scientific needs

assessments and writing reports that can be used as a basis to determine which areas

need to be given priority when they next implementation cycle come around.

5.2.2 Increase in existing infrastructure

The study found that as implementation of waste management policies increases so

does consumption of health services. As seen above, the mass implementation of waste

management policies had the immediate impact of making Kiswa health centre

attractive to prospective users who poured in. however the increment in numbers of

patients is not matched by a proportional expansion of infrastructure like wards and

39

beds. This is reflected in indicators like increment in reported cases of malaria and

diarrhea.. Administratively, the way forward would be to urgently plan and organize

for the erection of new structures or expand the existing ones to try to deal with the

escalating demand for health services provided by Kampala City Council Authority

through Kiswa health centre.

5.2.3 Increased rubbish collecting equipment and landfills

Nicely designed policies also need equally efficient implementation. One of the key

performance indicators (KPIs) in solid waste management is speedy management of the

same. When collecting centers are provided the public tends to start using them. Now

that solid waste is collected on an average of 7 days, this can present a problem

especially in the wet season. Furthermore, Kitezi landfill will not be adequate for long

and measures need to be in place to expand on it and possibly identify other potential

landfill sites as the rate of urbanization is quite quick.

5.3 Suggestions for further research

The study recommends, among other things, selective implementation of solid waste

management policies to meet pressing needs in priority areass. In order to have effic ient

prioritization in the recruitment process to meet relevant departmental demand, there is

need to know the overall contribution each policy to the overall quality of health

services to be carried out. In addition the study, recommends increased funding from

both the donor community and government, as well as increasing the revenue generated

internally to expand on the existing equipment and personnel. However, the issue of

40

increased funding of the health sector especially by the donors, has been an issue of

contention between Ministry of Health and that of Finance, Planning and Economic

Development. The contention is over the potential macro economic impact of increased

funding. However, the impact of improved health on economic development cannot be

over emphasized. This study suggests that a study to harmonize the country’s health

policy and macro-economic policy so as to achieve growth in both sectors be carried

out. There is also a need to conduct a study aimed at identifying the most feasible ways

of generating internal revenue for the solid waste management.

41

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