الفهرس 
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Abstract
In Egypt, with the growing population and development pressures, the problem of the solid waste has worsened considerably in both urban and rural areas. Its negative manifestations on public health, environment and national economy are becoming quite apparent and acute.
This study aimed to assess and analyze the quality of air and the work- related risks/disorders associated with handling and management of solid waste in Alexandria. In addition; to identify, analyze and assess the occupational hazards associated within the different selected work locations, and to evaluate the work-related risks/disorders and their possible impacts on workers’ health. And finally, to propose suitable engineering measures to minimize work-related risks and disorders, and administrative and medical measures to minimize impacts on health.
The study was conducted in the main municipality company in Alexandria (Egypt).Air samples were collected (as total and respirable particulates (TSP and PM10), total volatile organic compounds (TVOCs), ammonia (NH3), methane (CH4), and the air pollutants emittedfrom landfill flare.Moreover, physical environments were evaluated including noise and thermal exposures in the work environment. All the workers (n=379) of the involved operations and locations, viz the temporary collection locations, the storage stations, the composting plants and the landfill, in the main municipality company in Alexandria (Egypt) were interviewed. The managers of the studied locations were also interviewed concerning; work operations, work related health problems and ailments, control measures at workplace, individual means of protection, and risk of accident at workplace, as well as a control group of 177 male workers of the Security Company who accepted to participate in the study, were the target population of the study.
Data were collected using a pre-designed structured interview questionnaire including personal and socio-demographic data (age, marital status, ethnic origin, stability at work, social relations, and socio-economic level),nutritional status including anthropometric measurements (height, weight, BMI and food sufficiency); occupational health and safety culture (including evaluation of personal hygiene,personal protective equipment (PPE), vaccination, and smoking); professional data classified as: professions and occupational history (actual exposure time calculated in shifts), duration of the current work (approximated to a year) , the number of working days /week, and the number of working hours /day;occupational hygiene (including degree of exposure, lifting of the weights at work and training);accident likelihood at work,occupationalaccidents during the past year, body organs injured and types of injuries);the complaints of workers about the respiratory, cardiovascular, gastro-intestinal system, dermal, musculoskeletal system and the degree of disability of musculoskeletal system were all recorded.The collected data were further revised, coded, fed to computer and analyzed using IBM SPSS software package version 20.0. Many relations were estimated between the different studied parameters.
Although the cases within the different selected locations were of moderate to good personal hygiene, bad personal hygiene’ behaviors were observed among the subjects during the course of the study such as eating during work and also without washing hands. It has also been noticed that the subjects who keep praying always keep their clothes clean. Within the different studied groups, it was noticed that 56.7% (n= 34) and 23% (n= 38) of the cases within the temporary collection locations and the landfill were always lifting weights at work. Otherwise, only 15.6% (n=24) of the workers within the compositing plants were sometimes doing such activity.
The majority of the cases had one accident, or more than three accidents in the selected locations, and plus three accidents for the landfill also. Extremities considering hand or finger, leg, knee, and foot or toe had the highest percentages regarding the body organs injured among the temporary collection locations, compositing plants, and landfill’ workers, the highest percents of injuries within the hand or finger were 74.1% (n= 83), 78.6% (n= 66), and 38.1% (n= 8), respectively. The wounds was the highest types of injuries within the temporary collection locations, the compositing plants, and the landfill’ workers with percents of 71.4% (n= 80), 50 %( n= 42) and 33.3 % (n= 7), respectively.
The highest percent of productive cough complaint was 46.7% (n= 28) within the landfill’ workers. Concerning the dyspnea as a respiratory system complaint was about two thirds (n= 102, 66.2%) as a highest percent within compost plants’ workers. The wheezy chest complaints represented the highest percent within the landfill’ workers as 38.3% (n= 23). The highest percent of rhinitis ≥3 months was 36.8% (n= 21) within the landfill’ workers.
The highest percent ofpremature beat complaint was 26.7% (n= 16) within landfill’ workers. The highest percent of tachycardia complaint 40.0% (n= 24) was among the landfill’ workers. One half (n= 30, 50%) as the highest percent was among the landfill’ workers had chest pain complaint.
Nausea and vomiting represented the highest percent within the landfill’ workers (44.6%, n= 25). About two thirds (n= 37, 61.7%) of landfill’ workers had heartburn complaints. Less than two thirds as (n= 35, 58.3%) among the landfill’ workers had the flatulence complaints
The percentages of dermal diseases appearance were as 11.7% (n=7), 9.1 %( n= 14) and 4.2 % (n= 7), respectively, among the landfill’ workers followed by compositing plants’ workers then temporary collection locations’ workers. The warts represented among the temporary collection locations’ workers and those of landfill with equal percent 28.6% (n= 2). The fungal infection within the landfill locations was twice of the compositing plants location as 28.6% (n= 2) and 14.3% (n= 2), respectively. Considering skin allergy, it appeared within the temporary collection locations, landfill and compositing plants’ workers with percents 71.4% (n= 5),42.9 % (n= 3) and 28.6 % (n= 4), respectively. Regarding the appearance of more than one disease, was within the compositing plants’ workers only with percent 57.1% (n= 8).
One half (n= 30, 50%) of the landfill’ workersfelt continuous pain or discomfort of upper back during the last year. Considering the feelingof continuous pain or discomfort, of arm or hand diseases or disorders during the last year appeared as 46.7% (n= 28) among the landfill workers, and 23.3% (n= 14) of them felt continuous pain or discomfort from either buttock or thigh during the same period.
The percentages of 26% (n=40 ), 23.3% (n=14 ) and 15.2 % (n=25), respectively, among the compositing plants, the landfill and the temporary collection locations’ workers were feeling of continuous pain, discomfort ,disorders of knee during the last year. Also 25% (n=15) of the landfill’ workers had the highest percent of continuous pain or discomfort at the lower leg during the last year.
The maximum prevalence of the upper limp percents of degree of disability of<25% was among the landfill’ workers as 5% (n= 3) percent of disability. The majority of the cases namely the temporary collection locations, the compositing plants and the landfill’ workers, as well as the control subjects, (n= 149, 90.3%), (n= 134, 87.0%) (n= 45, 75.0%) and (n= 168, 94.9%), respectively, were within the category of ≥75% degree of disability.
The distribution of the workers according to the lower limp percents degree of disabilityof <25% was among landfill’ workers as 6.7% (n= 4). The majority of the cases, namely the temporary collection locations, the compositing plants and the landfill’ workers {(n=127, 77%), (n= 114, 74) and (n= 44, 73.3%) respectively} were within the category of ≥75% degree of disability.
The majority of the cases, namely the temporary collection locations, the compositing plants and the landfill’ workers were within the category of <25% degree of back disability (n=145, 87.9%), (n= 130, 84.4) and (n= 46, 76.7%) respectively, while those within the category ≥75% were (n=1, 0.6%) , (n=2, 1.3%) and (n= 2, 3.3%) among the same groups, respectively.
According to the managers’ point of view, psychological stress due to misconduct and wounds due to medical waste had the highest prevalence at temporary collection locations {n= 7, 58.3%} and {n= 5, 41.7%}, respectively. Within the compositing plants, sharp objects exposure had the highest prevalence(n= 5, 62.5%), versus those of landfill; who stated that all the workers had exposed to each of dust, thermal exposure for long periods, vapors and bad odour and to tankers transporting open garbage, equally, with a percent of 100% (n=3) for each of them. Considering occupational health and safety management (OHS) team, the managers’ point of view was that; there was no work related disorders (n=3).
The highest percents of critical conditions at workplace which were sharp objects and hazardous substances in waste and handling heavy loads at the temporary collection locations with the percents of 75% (n= 9) and 66.7% (n= 8), respectively. Concerning the compositing plants, critical conditions at workplace were inhalation of harmful vaporsand infectious factors in wastewith percents (n= 8,100%), and (n= 7, 87.5%), respectively.The point of view of occupational health and safety management team (OHS) was that critical conditions at workplace was the weather, (n= 2, 66.7%). The point of view among the landfill managers was that only the handling of heavy loads was considered a critical condition at workplace, (n= 1,33.3%).
The common injuries included torsion, fraction, scratch(bruise), rapture, burn, suffocation, and wound. All types of common injuries were present in the temporary collection locations with different percents; 66.7% (n=8), 33.3% (n=4),58.3% (n=7), 41.7% (n=5), 16.7% (n=2), 16.7% (n=2) and 33.3% (n=4), respectively.Regarding the versus of to the OHS team, the only registered type of injuries in the temporary collection locations is the scratch (n= 3,100%); followed by the compositing plants which had the highest percent of scratch among as the common injuries (n= 7, 87.5 %). Within the landfill, the only stated type of injuries is the suffocation (n=3,100 %).
The dermal disorder (rash), the respiratory complaints (pneumonia), the upper and the lower motor system disorders,and cartilage as the occupational diseases were the highest percentages within the temporary collection locations (n= 8, 66.7%), (n=6, 50%), (n= 5, 41.7%) , (n= 7,58.3%) and (n= 5,41.7% ), respectively. The highest occupational diseases among the cases of compositing plants, due to their work, weregastroenterology (diarrhea) followed by respiratory diseases (pneumonia) with percents of 50% (n= 4) and 37.5% (n= 3), while; the landfill cases had the highest percent 100 % (n=3) for each of dermatology (rash), respiratory diseases (pneumonia), allergy and gastroenterology (diarrhea).
The temporary collection locations had the highest mean value of TSP followed by the landfill with mean values of 0.01± 0.03 and 0.001±0.001 mg/m3 respectively. The compositing plants had the highest mean value of PM10 followed by the temporary collection locations, with mean values of 0.003±0.007 and 0.002±0.005mg/m3 respectively. The higher mean values of (TVOCs) were at the landfill followed by the temporary collection locations then the compositing plants with the mean values of 13.79±18.05, 3.17±6.13 and 3.05±8.33mg/m3, respectively. The highest mean value of NH3 were at the landfill followed by the temporary collection locations then compositing plants with the mean values of 4.31±8.82, 0.52±0.89 and 0.30±0.08 ppm, respectively. The highest mean values of CH4 were at the landfill followed by the temporary collection locations then compositing plants with the mean values of 1345.45±4338.8, 5.78 ± 6.72 and 2.53±2.05 ppm respectively.
The air pollutants emitted from the landfill’ flare which contain Sox, Nox, Cox , methane and % O2 with the mean values of 45.25 ± 43.62, 70.27 ± 20.23, 234.45±219.46, 4.71 ± 0.96, 22.84 ± 19.79 mg/m3 and 22.84 ± 19.79 % respectively, while the mean value of combustion efficiency of the flare was 99.74 ± 0.37%.
The highest mean value of the noise was at the temporary collection locations followed by the compositing plants, the measured results of the temporary collection locations exceeded the TLVs; otherwise, those of the compositing plants were within the TLVs. The temporary collection locations had the highest mean value of in-door wet-bulb globe temperature measured in degrees centigrade (WBGT), 24.95º C.Regarding the out-door WBGT, the landfill had the highest mean value of the WBGT 24.80 º C.The measured levels of the both WBGT in-door and out-door of the landfill and of the temporary collection locations exceeded the TLVs of 29.4ºc, while; those of the compositing plants were within the limit.
There was statistically significant relation between lifting weights with upper backcomplaintsamong the temporary collection locations’ workers (36.4%, n= 24), knee complaintsamong the compositing plants’ workers (12.5%, n= 6), and the percent of musculoskeletal disability due to lifting weights within the landfill’ workers, at ≥75% ability where the highest significant association was 74.4% (n= 29) between lifting weights and having risk of lower limb disability.
There were significant relations between the professions within the temporary collection locations’ workers and the complaints of the respiratory system, namely wheezing chest and rhinitis for ≥ months, the cardiovascular system, namely the premature beat and the chest pain, the gastrointestinal system, namely the heart burn and the flatulence, and the musculoskeletal system complaints namely the lower leg complaints.
There were significant relations within the compositing plants’ workers between the professions and complaints of the respiratory system, namely the wheezing chest, and the dermal complaints as a currently skin disease (skin allergy and more than two diseases).
There were significant relations between the professions within the landfill’ workers and the complaints of the respiratory system, namely dyspnea, wheezing chest,and rhinitis for ≥ 3 months, the cardiovascular system, namely tachycardia and chest pain, the musculoskeletal system, namely the upper back and hand/arm, and the dermal complaints within the landfill’ workers, namely the currently skin disease as (warts, fungal infection and skin allergy).
There were significant relations within the temporary collection locations’ workers between the actual exposure times calculated as work shift and the respiratory systemcomplaints,namely the productive cough and the cardiovascular systemcomplaintsdefinitely the premature heart.
There were significant relations within the compositing plants’ workersbetween the actual exposure times calculated as work shift and the cardiovascular systemcomplaintsdefinitely the premature heart and the tachycardia, and the musculoskeletal systemcomplaints,definitely the upper back and the hand/ arm, finally andthe respiratory systemcomplaintsdefinitely the rhinitis for ≥ 3 months.
There was a significant relation between the dust concentration (TSP)and respiratory system complaints within all the interviewed subjects, namely the productive cough and the rhinitis for ≥3 months. Otherwise, there was a significant relation between the dust concentration (PM10)and respiratory system complaints within all the interviewed subjects, namely the productive cough.
There was a significant relation between the total volatile organic compounds concentration (TVOCs)and the respiratory system complaints within all the interviewed subjects particularly the productive cough and the rhinitis for ≥3 months.
There were significant relations between the measured physical hazards (heat stress and noise) and the cardiovascular system complaints within all the interviewed subjects namely the premature beat, tachycardia, and chest pain.
Finally, the present study concludes that solid waste management workersshould follow safety control measures, support sufficient equipment, manage shifting (job rotating) of the workers between different work locations and didn’t keep them in one location for a long time, monitor their health status by the medical administration, supply them with the appropriate PPE in quantity and quality, follow safety instructions and provide its tools, raise awareness, and goodly train them, as presented in more details in the next section(recommendations).