Access to safe sanitation services and factors associated with personal protective equipment utilisation among sanitation workers in Ethiopia: a mixed-methods study.

OBJECTIVE: Sanitation workers experience elevated occupational health risks due to hazardous exposures and social marginalisation. This study assessed access to safe sanitation services and examined Health Belief Model-based factors associated with personal protective equipment (PPE) use among sanitation workers in Ethiopia. DESIGN: A concurrent mixed-methods cross-sectional study was conducted from November 2021 to June 2022. Quantitative data were collected through face-to-face interviews using a structured interviewer-administered questionnaire via multistage simple random sampling. Concurrently, qualitative data were collected through key informant interviews and focus group discussions guided by semistructured interview guides. The quantitative data were analysed using Stata V.14, and associations between variables were examined using multivariable logistic regression. The results were presented as adjusted ORs with 95% CIs, and statistical significance was set at p<0.05. Qualitative data were analysed thematically using OpenCode V.4.03. SETTING: The study was conducted in Addis Ababa, Ethiopia. PARTICIPANTS: The quantitative survey included 821 sanitation workers, while the qualitative component comprised 12 key informants and 65 focus group participants. OUTCOME MEASURES: The primary outcomes were access to safe sanitation services and PPE use. RESULTS: Overall, 38.2% (95% CI 34.9% to 41.6%) of sanitation workers had adequate access to safe sanitation services and 54.3% (95% CI 50.8% to 57.8%) reported PPE use. PPE use was positively associated with larger household size, workplace PPE availability, supervision, higher cues to action and greater self-efficacy, whereas perceived barriers were associated with lower odds of PPE use. Qualitative findings complemented these results by showing that inconsistent PPE provision, inadequate occupational health training, weak enforcement of safety regulations, precarious employment conditions and persistent social stigma contributed to poor occupational safety practices. CONCLUSION: Sanitation workers in Addis Ababa have limited access to safe sanitation services and suboptimal PPE use. Improving organisational support, consistent PPE provision, effective supervision and occupational health training may enhance PPE use and strengthen the health, safety and resilience of this essential workforce.