Knowledge, Attitudes, and Practices Regarding Hepatitis B and C Infection among Informal Waste Pickers in Aden, Yemen: A Cross- Sectional Study

In many cities around the world, a quiet but essential workforce keeps the streets clear. These are the informal waste pickers, individuals who manually sort through trash, landfills, and street corners to salvage recyclable materials like plastic, metal, and glass. They work without the protection of formal employment contracts or safety regulations, often handling waste that has been discarded by hospitals, homes, and businesses. Among the dangers they face are invisible threats carried in blood: viruses that cause hepatitis B and hepatitis C. These are serious infections that attack the liver, sometimes leading to permanent damage or cancer. They spread when infected blood enters the body, often through tiny cuts or punctures from sharp objects hidden in the garbage. While vaccines and treatments exist, they are not always accessible to the most vulnerable workers. Understanding what these workers know about these diseases, how they feel about the risks, and what they actually do to protect themselves is crucial for designing health programs that can save lives.

A team of researchers in Aden, Yemen, decided to look closely at this hidden population to see where the gaps in protection lie. They traveled across the city's eight districts to find and speak with 177 informal waste pickers. These workers, mostly men with an average age of thirty, had been sorting trash for varying lengths of time, from less than five years to over a decade. The researchers asked them detailed questions about their daily work, their living situations, and their understanding of hepatitis. They wanted to know if the workers could identify the causes of the disease, recognize its symptoms, or understand how it spreads. They also asked about the workers' attitudes toward the disease and whether they felt their job put them at risk. Finally, they checked what safety gear the workers actually used and whether they had ever been tested for the virus or received a vaccine.

The results painted a stark picture of vulnerability. The study found that knowledge about hepatitis was extremely low. Only a tiny fraction of the workers, about one in ten, could correctly explain what causes hepatitis or how it is transmitted. Most did not know that the disease affects the liver or that it can lead to cancer. Even more concerning, only about one in six workers knew that a vaccine existed to prevent hepatitis B. This lack of knowledge was matched by a lack of protection. The workers reported that their job was filled with sharp dangers, yet almost none of them wore safety gear. Just one or two people out of the entire group said they regularly wore protective gloves, and even fewer used eye protection, face masks, or safety boots. The most common safety item was safety boots, worn by only four percent of the participants.

The physical risks these workers face are immediate and frequent. The study revealed that nearly nine out of ten workers had been pricked by a needle or sharp object while working. Similarly, almost all of them had been exposed to broken glass or other sharp materials. Despite this constant danger, very few had ever been screened for hepatitis. Only four percent had been tested for the virus, and a mere one and a half percent had received the hepatitis B vaccine. The researchers also looked at how the workers' knowledge related to their feelings and actions. They found that those who knew more about the disease tended to have more positive attitudes toward protecting themselves. However, knowing more did not necessarily mean they were using safety gear; the link between what they knew and what they actually did was weak and inconsistent.

The study concludes that informal waste pickers in Aden are operating in a high-risk environment with almost no safety net. They face frequent exposure to blood-borne viruses but lack the basic knowledge, equipment, and medical care needed to stay safe. The researchers suggest that fixing this problem requires more than just handing out pamphlets. It demands a coordinated effort to bring health education, free vaccines, and proper safety gear directly to these workers. Because these individuals operate outside the formal system, they are often overlooked by standard health and safety programs. The findings serve as a clear call to action, highlighting that without targeted intervention, this marginalized group will continue to face preventable health threats every day they work.