Background
Electronic waste (e-waste) consists of discarded cell phones, computers, appliances, and other electrical or electronic products, and electronic waste recycling involves the salvaging of these items for repair or for extraction of valuable metals and components. As of 2016, a total of 44.7 million tons of e-waste had been created globally, and that number is expected to grow to 52.2 million by 2021 [
10]. Due to the high consumer demand for the latest generation of electronics, and subsequent discarding of older electronics, the amount of e-waste being created is increasing substantially over time [
24,
30,
45]. The high e-waste recycling and disposal costs in high-income countries has led to the exportation of e-waste to low- and middle-income countries (LMICs) where labor costs are lower, but where resources to recycle and dispose of the products in a safe and sustainable manner are limited or absent [
44]. The 1989 Basel Convention was developed to prevent the inter-country movement of hazardous waste, but some high-income countries, such as the United States, have not ratified the convention and continue to export used, obsolete, and often unrepairable electronic equipment as “donations” to countries throughout Africa and Asia, where they are recycled by informal workers [
50]. This informal recycling scheme creates important economic opportunities for impoverished workers and communities in LMICs and recovers valuable raw materials from e-waste, preventing these materials from being discarded, but the processes used may result in unnecessarily high occupational risks [
3,
9]. Unfortunately, informal e-waste recycling sites are not well-regulated by local governments and many may have no occupational health and safety oversight.
Informal e-waste recycling workers collect, sort, and repair or dismantle e-waste using crude de-manufacturing methods and very basic, non-specialized hand tools. Workers often remove plastic or rubber coatings from wires and other valuable metal components for resale (the final goal of e-waste recycling activities) by burning the e-waste materials. All of these tasks are often performed without the benefit of safe working procedures, personal protective equipment (PPE), sanitation facilities, or safety training, all of which are common features in formal work settings in high-income nations [
18,
48]. This can place e-waste workers at an increased risk of injury, exposure to noise and subsequent noise-induced hearing loss, and multiple other adverse health effects associated with their work [
5,
15,
39,
54]. In addition to the adverse physical health impacts, workers may also suffer from personal and occupational stress due to factors often affecting vulnerable (and frequently migrant) e-waste workers [
15]. Regulatory attention and efforts to improve occupational health among e-waste recycling workers could result in safer working and living conditions, a living wage [
8,
11,
35,
43], and better access to PPE, but additional research is needed to better characterize occupational health needs among these workers.
The Agbogbloshie market in Accra, Ghana, offers an excellent example of informal e-waste recycling. After over 10 years of accepting and recycling electronic waste from Europe, North America, and Asia [
6], Agbogbloshie has become one of the most polluted informal e-waste recycling sites in the world [
23]. The informal e-waste site at Agbogbloshie consists of primarily workers who have traveled to the site from northern Ghana and, to a lesser extent, other West African countries in search of work. At the time of our study this site was effectively unregulated; there was no formal oversight for the e-waste recycling workers at the site, and all workers were essentially independent contractors. The payment structure used at the site was based on the amount by weight of valuable metals (primarily copper) that each worker was able to recover from the e-waste. To the best of our knowledge, the Greater Accra Scrap Dealers Association, which provided overall leadership to work operations at the site, but which did not directly employ any e-waste recycling workers, did not advocate for the workers in any formalized capacity or control employment conditions at the site.
In order to address the multiple occupational exposures among this vulnerable population of recycling workers, we examined the relationship between e-waste work activities, stress, noise exposures, and injury experience. While a number of studies have focused on the relationship between noise and injuries [
16,
17,
19,
33,
36,
37], there is a paucity of studies on injuries among e-waste recycling workers [
18], and those that have been conducted have not examined work activities in detail [
27]. Our study had two hypotheses: first, that higher perceived stress levels would be associated with higher injury risk, and second, that higher noise exposures (evaluated both objectively and subjectively) would be associated with higher injury risk. Our study evaluated exposures and injury outcomes without defining or exploring an a priori-defined injury mechanism.
Discussion
This study is one of the first to evaluate injury risk factors among e-waste recycling workers. The participants in our study had experienced a substantial number of injuries in the 6 months prior to their participation in the study, many of them involving lacerations to the hand, a finding that has also been reported by other authors [
9,
54]. Use of certain PPE, such as gloves, was found to be associated with a significantly reduced number of injuries. A number of factors, including participation in e-waste dismantling activities, higher perceived stress and more frequent perceived noise exposure, were associated with an increased number of injuries. These relationships remained strong even when controlling for other factors such as age, use of gloves, perceived health status, work activity, and measured noise levels. These findings suggest the need for increased attention to injury risks faced by e-waste recycling workers, and present possible opportunities for intervention, including increased public awareness, worker training programs, government intervention to address health and safety issues [
46,
54], promotion of regulation, and government financing to enforce higher safety measures [
52].
Although other studies have examined health-related issues among informal e-waste workers at the Agbogbloshie market site in Accra [
23], our study filled an important gap by evaluating several upstream factors related to total worker health and safety outcomes. Our results supported our first hypothesis: greater perceived stress was associated with a higher number of injuries. Cohen’s PSS measures perceived lack of control over personal stress associated with day-to-day issues [
21], and our results indicated that workers had high levels of perceived stress which could influence their injury rate related to e-waste recycling work. This finding, coupled with the significant independent relationship of self-reported health status and number of injuries, suggests that intervention efforts focused on mental and physical health among e-waste recycling workers may be warranted. Additional studies of the relationship between occupational exposures and working conditions among informal e-waste recycling workers and perceived and objectively assessed health status are needed to confirm these findings [
2,
23] and better characterize the environmental health issues associated with e-waste recycling work [
2,
7,
25].
Our second hypothesis (that increased noise exposure would be associated with a significantly increased number of injuries) was also supported by our results. Greater perceived noise exposure was associated with a significant increase in number of injuries after controlling for other co-exposures. However, in our sensitivity analysis, higher objectively measured noise levels (quantified via personal noise dosimetry) showed the opposite effect, where increase noised levels were associated with a significant reduction in the number of injuries. It is possible that this is a spurious finding, given the very small sample size of 26 participants for the sensitivity analysis. One important issue that may help explain these divergent results is that our evaluation of noise exposures was not temporally aligned with our injury evaluation, which may have introduced additional bias. Our noise measurements covered a single 24-h period (the maximum duration we deemed possible while still being able to reliably recover our dosimeters), while our perceived noise items addressed frequency of high noise exposure but did not specify a time period, and our injury questions related to injuries experienced in the past 6 months. Given this situation, the perceived noise exposure frequency variable may be considered a more valid measure of long-term noise exposure, since participant reporting may have involved consideration of exposures over a period of weeks or months. Our results, combined with those of others [
16,
19,
33,
36,
37], support a relationship between occupational noise exposure and injuries, and suggest a potential route for interventions intended to reduce noise exposure and, perhaps, risk of injury.
The total number of injuries sustained by the e-waste workers in this study exceeded 400 over a 6-month period, including one worker who reported 40 injuries. Work activities, and particularly dismantling, were significantly associated with injuries even after controlling for other co-variates. Most of the injuries reported were lacerations from sharp objects and occurred during dismantling activities. While approximately one-quarter of the participating workers reported using gloves during e-waste recycling work, use of PPE was quite low overall. This likely reflects at least two factors: first, a lack of sufficient individual-level financial resources to individually purchase PPE (necessary, given the absence of a formal employer); and second, a likely lack of access to commercially-available supplies of PPE. However, we did not survey workers with regards to where they obtained gloves and other PPE, so there is substantial uncertainty regarding both PPE origin and pricing. Our results did, however, indicate that glove use was not significantly associated with age, income, or seniority. It is possible that the practice of handwashing before prayer (Wudo) in the Muslim tradition influences the decision to seek out protection for the hands. If worker’s hands are not defiled prior to prayer, they do not have to practice Wudo, which can be challenging given the lack of sanitation on the site. Therefore, it is possible that glove use may have more to do with religious practice than with occupational safety for at least some workers, in an effort to avoid having to purchase bottled or sachet water for Wudo.
In addition to injury hazards, participants reported long hours of work. Other studies have documented dangerous physical working conditions [
3,
26,
39] and identified a relationship between mental health factors and occupational injury in other work settings [
14,
28,
32]. Unfortunately, e-waste recycling workers at Agbogbloshie have previously reported insufficient income to afford the Ghanaian health insurance scheme, and as a result many of their injuries were left untreated [
43,
54]. This is an important environmental justice issue; the informal e-waste recycling industry in Ghana has been reported to generate millions of dollars in revenue for the country annually [
20], but the benefits to e-waste recycling workers have been limited. The economic opportunities e-waste recycling work presents for unskilled and often undocumented labor has likely hindered formalization of the work processes and, as a result, possibly slowed adoption of improved health and safety practices [
29‐
31,
35,
40,
51,
53].
Limitations
This study has a number of limitations. First is the small sample size and cross-sectional nature of the study. While most participants had worked at the site for several years, and anecdotal reports indicated that conditions and work practices do not appear to have changed substantially over that period, it is nevertheless possible that injury risks could have changed in meaningful ways over our 6-month injury reporting window. This could introduce positive or negative bias into our estimates of injury frequency. Also, because exposures and injury experiences were evaluated simultaneously, we were unable to assess causality; we cannot determine, for example, whether workers who reported poor health status have more injuries as a result of that health status, or vice versa. Second, our assessment of injury risk may have been influenced by the healthy worker effect, and our injury estimates may have been biased negatively by the exclusion of less healthy workers who are no longer doing e-waste recycling work due to illness or injury. Third, our assessment of work activities conducted by the workers was completed using activities reported to us by participants, that we then collapsed into smaller post hoc categories. We used this approach to try to reduce the large number of specific work activities reported by individual workers into a manageable number of broader job categories. However, in doing so, we may have introduced misclassification of work activities, which could bias our understanding of injury risks associated with our defined work activities. Fourth, our participants came from Northern Ghana and other West African countries and spoke a number of languages; it is possible that errors or miscommunication by our translators, differences in the context and interpretation of some questions, or social response biases introduced by perceived or actual social class differences between our participants and translators, may have introduced additional misclassification. This possibility is reflected in the significant univariate Poisson regression results for interview language and interviewer. The cultural appropriateness of the PSS and OSS instruments we used has not been validated in this population. Fifth, the temporal misalignment between our objective and subjective measures of noise exposure may at least partially explain the poor correlation between objective or subjective noise exposures, as well as the inconsistencies in our injury risk models that included a noise exposure variable. Finally, although we emphasized to participants that their responses would be confidential and would never be shared with others, some workers may have purposely misrepresented the number of injuries experienced or health status to avoid perceived adverse impacts on their employment.
Acknowledgements
The authors are indebted to the participants, without whom this research would not have been possible. The authors also wish to acknowledge Professors Julius Fobil and Emmanuel Assampong, Judith Stephens, Krystin Carlson, Rachel Long, Mozhgon Rajaee, Kwaku Badu-Dwuma, and Rollin Kofi for their assistance with data collection.