Dissertation for Dr. Mike D'Gatlwakdit

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………………………………………………

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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),Peter
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

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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

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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 implementation to give
all stake holders ample time to adapt.

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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). Municipal

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waste in most cities contain human excreta, animal excreta, hazardous chemical
pollutants and sharps which can facilitate the spread of diseases and injury particularly
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 transmission
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, finally
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

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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 disgusting
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.

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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.

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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

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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.

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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).

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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 quantities
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 pollution
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

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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 transmitters
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, industries,
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.

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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 issues
(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 regulations
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 questionnaire.
The observed morbidity like respiratory diseases, eye diseases, dermatological
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, mineral

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 comprehensive
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 implementation
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 implementation
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
SelectedDisease 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 efficient
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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