Health issues of sanitation workers in a town in Karnataka: Findings from a lay health-monitoring study.

BACKGROUND:Official estimates are not available for mortality or morbidity among sanitation workers (including manual scavengers) in India. Little is known about their health issues and health-seeking behaviour in the context of their occupational hazards (work practices and exposures). We attempted to understand the nature of health problems of sanitation workers using a lay epidemiological process. METHODS:A community-based organization working in Chitradurga town in Karnataka for the development of sanitation workers recorded the health problems of workers and their treatment-seeking practices every month using a health-monitoring tool. We used a lay epidemiological approach to identify occupational health problems and deficiencies in healthcare access through the narrative of workers' perceptions of their illness. Descriptive analysis was done to map the occupational health status, healthcareseeking practices and the social support mechanisms in place. RESULTS:Injuries and chest pain were the most commonly reported illnesses. Most workers continued to work without appropriate treatment as they ignored their illness, and did not want to miss their wages or lose their job. Self-medication was common. Intake of alcohol was prevalent to cope with the inhuman task of cleaning filthy sewage, and as a modality to forget their health problems. The pattern of illnesses reported during monthly monitoring was also reported as long-standing illnesses. Health and safety mechanisms at workplace did not exist and were not mandated by regulatory bodies. CONCLUSION:Health and safety of sanitation workers has been inadequately addressed in public health research. Sanitation work lacks specific protective regulatory guidelines to address health hazards unlike other hazardous occupations.