الفهرس 
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Abstract
Solid waste management has emerged as an important human and environmental health issue. Current global Municipal Solid Waste generation levels are approximately 1.3 billion tonnes per year. Municipal solid waste workers (MSWWs) around the world are exposed to several health hazards which occur throughout the waste management chain, from collection to final disposal and so they are at risk for work-related disorders and injuries. The magnitude of work related health problems may be influenced by an individua’s level of protection and exposure.
The potential health effects of both waste itself and the consequences of managing have been the subject of a vast body of research.
Workers must be provided with the suitable of personal protective equipment and training them on the proper use. The availability, training, and use of PPE are taken in the present study as indicators of exposure and biochemical changes as indicators of effect.
We conducted a cross-sectional study at a solid waste sorting and recycling plant at the main municipality company in Alexandria. The study comprised all current workers employed by the municipality at the selected waste sorting and recycling plant. The aim was to evaluate the availability and use of personal protective equipment and some biochemical changes among solid waste sorting and recycling workers in Alexandria.
All workers were interviewed using a pre-designed structured questionnaire tool to collect socio-demographic, occupational and medical data. The workers were also checked for the availability and use of personal protective equipment and their appropriateness using a pre-designed checklist. Blood samples were collected and analyzed to investigate the potential deleterious effects of the complex mixture of chemicals in solid wastes on biomarkers indicative of adverse health effect, with a special regard to hepatic and renal functions among workers included in solid waste sorting activities. extended our analysis to explore whether the availability, training, and proper use of personal protective equipment will make concerns.
The main results of the present study were as follows:
1. All the workers were males (100.0%) and the majority (92.1%) were rural residents, married (90.1%), of low literacy (80.2%) and having low income (63.4%), and employed for a period less than 10 years (72.3%).
2. More than half (53.5%) of the workers were smokers and a similar percentage reported the presence of chronic morbidities.
3. The occurrence of work-related injuries and accidents during the last year prior the study was 2% and 3% respectively whereas work-related sick leaves represented 5.0% compared with 6.9% for non-occupational causes.
4. On examination, the majority (74.3%) were found normotensive, equal percentages (12.9%) had low and high blood pressure measurement respectively, about 8.9% were tachypneic, 50.5% were overweight, and about 16.8% were obese.
5. The most frequent clinical complaints were related to the respiratory systems in the last 3 months, mainly difficult breathing (26.9%), cough (24.9%), and wheezy chest (14.9%).
6. Joint pain was reported by about one-third of the workers (33.7%). The most common affected joints were the knee (49.0%), lower back (30.0%), shoulder (13.6%).
7. About 5.0% and 3.0% were seropositive for HCV and HBV.
8. Most of the workers had normal liver function and kidney function tests. Elevated ALT, AST, urea or creatinine were experienced by 5.0%, 3.0%, 9.9% and 1.0% of the workers respectively.
9. The level of hsCRP as a biomarker of inflammation was within the normal range among the majority of the workers 87.1% and was elevated in about 12.9%.
10. The total serum IgE was obviously high among the majority of the workers (79.2%).
11. The overall or the apron was provided for and used by most of the workers (81.2%). Other PPE including safety shoes or boots, thick gloves, caps, face mask were provided and used by less than one-third of the workers.
12. The majority of the workers were using the overall, safety shoes, safety goggles, ear plugs or muffs and the safety reflective vest for periods longer than the recommended period of use. On the contrary, most of those using the hats, protective gloves and face masks were using them within the recommended period of use.
13. The adequacy of PPE availability, use and effectiveness was guaranteed for 10.9%, 12.9% and 5.0% of the workers and about 55.4% of them claimed that the eating area was not free from exposures or health hazards.
14. There is no significant difference between the adequacy PPE availability or use and the socio-demographic characteristics of the workers. however, workers using effective PPE were more likely to be above 40 years of age and married [p<0.05].
15. Workers using inadequately effective PPE were more likely to have history of hospitalization for occupational cause in last six months prior the study, occupational Injury last year [p<0.05] and occupational accident last year [p<0.005].
16. The adequately available/used PPEs were more encountered among workers reported having chronic diseases, clinical complaints, musculoskeletal pain, HCV and HBV seropositive status although the difference was statistically insignificant.
17. The mean level of serum SGPT (ALT) and serum SGOT (AST) were within normal range and did not differ significantly among workers in relation to the adequacy of PPE availability, use or effectiveness.
18. The elevated SGPT (ALT) or SGOT (AST), elevated blood urea and creatinine, hsCRP and total serum IgE were more frequent among workers with inadequate availability or use of PPE and except for hsCRP, these did not differ significantly among workers in relation to the availability, use or effectiveness of PPE.
19. Interestingly, the mean level of serum urea was significantly higher among workers with adequately available and adequately effective PPE, although the levels were still within the normal range [p<0.05].
20. The mean total serum IgE was obviously high among workers with inadequately available or used PPE [p<0.05].
21. It was obvious that mean health index was significantly higher among workers if PPE was not adequately available, used or effective.
In conclusion
Despite the initiatives to further improve the working conditions, it is unlikely that all health risks can be eliminated. Specific occupational demands remain present in the job of refuse management.
The study concludes that waste sorting workers faced tremendous health challenge and experienced a disease burden which is not merely a consequence of their occupation. They are undoubtedly exposed to increased risks of occupational accidents, musculoskeletal complaints, respiratory, gastrointestinal and skin infections as the basic principles of occupational health and safety are disregarded. The health index that amalgamate biomarkers indicative of adverse health effect was higher among workers if PPE was not adequately available, used or effective. Although these workers do not have overt clinical disease, these changes in their biochemical profile alarm a preclinical condition.
8. RECOMMENDATIONS
Based on the present study, the following recommendations are made:
1. A job specific periodic health surveillance for refuse collectors should be made as a policy in order to monitor their health status to detect early signs of work related disease and to monitor the work ability of the refuse collector.
2. Vaccinations should be monitored routinely. Required vaccinations of workers in the waste management industry include vaccines against tetanus, hepatitis A and B.
3. There is a need for use of improved waste handling equipment and correct ergonomic postures to workers involved in solid waste sorting.
4. Wearing of masks should be mandatory for worker in spaces with increased loads of microorganisms.
5. Adequate protective wears, such as nose masks, hand gloves, protective clothing and safety boots should be provided to MSWWs, to ensure their safety and that of the public in general.
6. In addition to PPE, workers at solid waste sorting plant would need also water and soap for the promotion of personal hygiene at the work place.
7. For the workers to develop sense of stringency, seriousness and commitment to be careful and keen and develop attitude of risk defense a minimum 5-6 units or preferably all PPE should be available and used
8. To get full benefit of PPE use, workers are advised to drink enough amount of water.
9. There is a need to draw the attention of local governments and commercial waste handling companies employing waste handlers to their responsibility to provide and educate their workers/employees on the correct and appropriate use of PPE to effectively protect their health.
10. There is a need for proper handling, containment or destruction of dangerous waste [disposable needles, syringes, blades, IV lines, bandages and blood bags found in the general waste stream] by users prior to disposal. Campaign must be organized to educate citizens about the importance of sorting waste before disposal.
11. Action must focus on improving and intensifying preventive measures to minimize bioaerosol levels at work stations by installing vacuum cleaning system and enclosing conveyers.
12. Further longer term perspective studies of solid waste sorting workers help to get a more comprehensive picture of long term effects of solid waste exposure in order to guide the design and implementation of health promotion measures to protect the health and safety of waste handlers.