Abstract: Background: Waste management refuse handlers are routinely exposed to pathogens responsible for hepatitis, tuberculosis, and gastrointestinal infections, and non-pharmaceutical safety devices (gloves, masks, protective clothing) are a primary barrier against this exposure. Evidence from Ghana, South Africa, and elsewhere in sub-Saharan Africa indicates that availability of such devices does not reliably translate into consistent use, and comparable data from Rwanda, particularly at district level, are limited [1,4,5,6]. This study assessed the uptake of non-pharmaceutical safety devices among waste management refuse handlers in Kicukiro District, Rwanda, and the factors associated with that uptake.
Methods: A concurrent mixed-methods cross-sectional study was conducted among refuse handlers employed by a waste management company operating in Kicukiro District. From a workforce of 892 staff, a sample of 276 was determined using the sample-size formula popularized by Slovin and mathematically equivalent to Yamane's approach for an unknown population variance, with a 5% margin of error, and selected by stratified random sampling. Structured questionnaires were administered to the 276 refuse handlers, and semi-structured key-informant interviews were conducted with 10 waste-management company leaders. Quantitative data were analyzed descriptively and using chi-square tests and multivariable binary logistic regression in SPSS version 28.0; qualitative data were analyzed thematically.
Results: Overall, 64.0% (177/276) of refuse handlers reported using non-pharmaceutical safety devices, with gloves (65.2%) and masks (54.3%) most commonly used; only 44.2% reported consistent use across all tasks. In multivariable logistic regression, independent positive predictors of uptake were participation in awareness/training programmes (adjusted odds ratio [AOR] 5.42, 95% confidence interval [CI] 2.90–10.14, p<0.001), acceptance of modern safety practices (AOR 6.88, 95% CI 3.54–13.36, p<0.001), permanent employment relative to casual work (AOR 3.85, 95% CI 2.10–7.05, p<0.001), and university-level education relative to secondary education (AOR 1.89, 95% CI 1.05–3.95, p=0.033). Female sex (AOR 0.45, 95% CI 0.25–0.78, p=0.004), age 46 years or older (AOR 0.40, 95% CI 0.19–0.81, p=0.012), and no formal education (AOR 0.48, 95% CI 0.24–0.97, p=0.041) were independently associated with lower uptake. Qualitative findings identified traditional beliefs, peer influence, fatalistic religious attitudes, and discomfort as recurring barriers to consistent use, even where awareness of safety devices' importance was high.
Conclusion: Uptake of non-pharmaceutical safety devices among refuse handlers among the study participants is suboptimal and inconsistent, shaped by a combination of structural employment conditions, training exposure, and socio-cultural beliefs. Training participation and acceptance of modern safety practices were the strongest modifiable predictors identified, but persistent associations with gender, age, education, and employment status indicate that behaviour-change interventions alone are unlikely to be sufficient without complementary policy and employment-formalization measures.
Keywords: personal protective equipment; occupational health; waste management; refuse handlers; Rwanda; disease prevention; mixed-methods.
Title: Uptake of non-pharmaceutical safety devices among waste management refuse handlers in Kicukiro District to prevent and control disease
Author: Denise Umuhoza, Emile Sebera, Donatien Mbonyintwari, Emile Twagirumukiza, Maurice Silari
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 1, April 2026 - September 2026
Page No: 398-411
Research Publish Journals
Website: www.researchpublish.com
Published Date: 30-June-2026
