Prevalence, predictors and economic burden of morbidities among waste-pickers of Mumbai, India: a cross-sectional study

BACKGROUND The occupation of waste-picking characterised as 3Ds - dangerous, drudgery and demanding. In this context, the study aimed to assess occupational morbidities among the waste-pickers and attempts to identify potential individual level risk factors enhancing health risks. Additionally, economic burden of morbidities has been assessed. METHODS The burden of the morbidities was assessed and compared with a comparison group through a cross-sectional survey. Waste-pickers (n = 200) and a comparison group (n = 103) working for at least a year were randomly selected from the communities living on the edge of the Deonar dumping site. The difference in the prevalence of morbidities was tested using the chi-square test. The effect of waste picking resulting the development of morbidities was assessed using the propensity score matching (PSM) method. A multivariate logistic regression model was employed to identify the individual risk factors. T-test has been employed in order to analyse the difference in health care expenditure between waste pickers and non-waste pickers. RESULTS The prevalence of morbidities was significantly higher among the waste-pickers, particularly for injuries (75%), respiratory illness (28%), eye infection (29%), and stomach problems (32%), compared to the comparison group (17%, 15%, 18%, and 19% respectively). The results of the PSM method highlighted that waste-picking raised the risk of morbidity for injuries (62%) and respiratory illness (13%). Results of logistic regression suggest that low level of hygiene practices [household cleanliness (OR = 3.23, p < 0.00), non-use of soap before meals (OR = 2.65, p < 0.05)] and use of recyclable items as a cooking fuel (OR = 2.12, p < 0.03) enhanced health risks among the waste pickers when adjusted for the age, duration of work, duration of stay in community and substance use. Additionally, the high prevalence of morbidities among waste pickers resulted into higher healthcare expenditure. Findings of the study suggest that not only healthcare expenditure but persistence of illness and work days lost due to injury/illness is significantly higher among waste pickers compared to non-waste pickers. CONCLUSIONS The study concluded that waste-picking raised the risk of morbidities as also expenditure on healthcare. Results from the study recommend several measures to lessen the morbidities and thereby incurred healthcare expenditure.