Project; e Cover sources photo are as followed: Topleft, e- presentations, astheir well defending as duringtheir assertions judging. responsible accuracyjustifying for the andvalidity of all data andcalculations are that used in teams verifyallowing to contest or withinthem thei and appendices help to teams acreate proposal. dataThe provided are balance of creativity Provided andknowledge. are informative f complex anddoes not necessarily have encouraging anideal solution, thus a discerning of representation circumstances in and Ghana. , The scenario is case organizations of existing reflection individuals. or case The however,topic, is a true andAll plots characters within casedescribed the are considered andbear nofictional direct independent sources, independent may have beenadapted usefor in this and case, are clearly cited - Waste Africa Project; Top Waste right, Bottom left, Adam Minter

/smithsonianmag.com Ghana e- Waste Country Assessement, Country Waste SBC e-

r recommendations, if recommendations, r necessary. Teams are ; Bottom right, Waste CountryWaste SBC Assessement, acts within and figures the case Jon Spaull/SciDev.Net

derived from

Waste Africa Waste

2 Fall 2019 UAB Global Health Case Competition

seen a peaceful transition between administrations (Central Intelligence Agency, 2019). disembarked the bus situation at Agbogbloshie As the bus continued to roll through the city, Efie sure off what she needed to get done in the office so that she could visit Doreen and make school to help the recyclers, and make a little money to take home. played among the broken refrigerators, car tires, and electronics. Some kids would skip inside. Doreen’s house was next to the Agbogbloshie waste s leftoverfrom e- burned while playingwith friends. The boy had gotten too close to a smoldering fire Just that morning Doreen had texted to say her 8year old son project. They’d worked together sofor long slum on the other side of the city and had been akey community advocate on Efie Also on Efie should focus on if GHANA were to submit a proposal. Efie particular (UNEP) Programme request proposals for uniquea forgrant from the United Nations Environment to show that she could be a leader on something new. GHANA had just received a maternal healthinitiative boss. She’d been brought onwith the organization three years before GHANA her office at the Efie Opening Scena Introduction perfect idea theirfor next project.

still wasn’t sure what to make of this grant had a lot on her mind as she boarded the bus that would take her across Accra to Afram

for short for health health 1

: Flag of Ghana was getting medical treatment for his burns. ’s mind was atext from her friend Doreen. Doreen lived in waste recyclerswho were burning the insulation off cables to retrieve the ian HealthGhana intervention with the rema ining portion supporting advocacy efforts. ). For). one, thatwould require certaina percentage of the funds to focus ona ,

Efie in the city’sslums the in started mixingwith her assignment at work

had rio Efie

moreenergy 20minutesthan earlier

needed to propose a new advocacy focus project to her

Advocacy N in 1992. Since then, the presidency has consis reformed the government in decades of political instability, anew constitution country subfirst in Ghana gained independence from Britain in 1957, the Accra Demographics: Ghana & , but now that it had wrapped up, she needed

theycouldn’thelp but become friends.

etwork of Accra of etwork

opportunity ’s

thought -

Saharan Africa to do so. After

s or what particular issue she of young Afram young of

( to a presidential republic Afram Afram confusingly called called confusingly Efie . She had the ite where kids often . had beenbadly When she When to work on a the Old Fadama

mentally ticked

and the

tently ’s last last ’s

3 Fall 2019 UAB Global Health Case Competition

Statistical Service, 3013; World Population Review, 2019). count from other parts of Ghana or other parts of Africa. Consistent with the rest of the about 53% of people in the Greater Accra Region having migrated to the district ei current population of million 2.48 at 1 District opolitan Metr Accra is the capital of Ghana. The 2010 census puts the population of the Accra (W In 2016, only 27% of the population was using safely managed drinking water services rate attributed to exposure to unsafe servicesWASH was 18.8 per 100,000 population. Organization ( fine particulate matter in urban areas is about 31.1 µg/m3 – pollu health, with the age- respiratory disease was 20.8%. dying disease. Ghana. In 2016, about 15.5 million people required intervention for a neglected tropical Ghanaian life expectancy at birth is 63.4 years. Infectious diseases are common in line. (Central Intelligence Agency, 2019). for alarge portion of foreign exchange. 24.2% of the population lives below the poverty 20% of Ghana’s economy 2017,and theper GDP capita amountingto $4,700. The agriculture sector co population. The Ghanaian economy is growing quickly,with agrowth rate of 8.4% in a 3.34% annual rate of change, with urban areas already containing 56.1% of the Ghana has been experiencing aninflux of migration from rural areas t median age being 21.2 years. any religion. 18% identifying as Muslim lingua franca languages are spoken in Ghana, but English is the official language and serves as a the population; no one ethnic group comprises more than half of the populati An estimated 28.1 million people live in Ghana, with several HO tion up to 203.8 per 100,000 population in 2016. The annual mean concentration of ry between the ages of 30 and 70 , 2018). , o

Regarding noncommunicable diseases in t ver half (56%) of the population in Accra is under the age of 24 (Ghana

More than half (57%) of the population is under the age of 25, with the

for Ghanaiansfor

WHO ) standardized mor

guideline suggests no more than 10 µg/m3. Additionally, mortality .66 million .66 . Gold, oil, and cocoa exports, along with remittances, account ,

5% followingtraditional beliefs .

About 71% of the population identifies as Christian, with

Of those over the age of 15, 76.6% can read and write.

Environmental is another risk to Ghanaian . The region as awhole is a hotspot for emigration, with

people. Current estimates from the UN suggest a from cardiovascular disease, diabetes or chronic t ality rate attributed to household and ambient air

he same year the probability of , and5% not

the the ethnic groups making up World Health o urban centers – identifying with on mprises mprises . Multiple Multiple . ther

4 Fall 2019 UAB Global Health Case Competition

certain countries in Africa. nearly 80% of the e- As aresult of the high cost of proper e- Terazono et al., 2006; million tons a year to 40 million tons ayear. ( generation e ownership microwaves, etc. In just the last decade, acombination of increasing electronics to limited E access to regular trash collection created 2.01 billion tons waste of solid Japan,and country’s degree of urbanization and industrialization, with health, safety, the environment, Globally Introduction trashe to & Global Trash & E for raw material to cater to large e- investigating ’s recycling centers and their response to e- e for Zhanget al., 2012) - - waste.Because of waste is defined as - waste

there : computers, mobile telephones, keyboards, printers, cables, cords,

along with shortened lifespan of electronics has led to a dramatic increase in ; however in manycountries, the estimated globale- h s as been poor recognition of the issue of trash disposal and its effect on a 2: wasteamounts from differentregions s as well . Some countries receiving e- items in Agbogbloshie, Source: Martin Holzknecht, Arnika Holzknecht, Martin Source: Agbogbloshie, in items waste Electronic waste generated in high

, they are often overwhelmed or inac a ranking electrical and electronic equipment waste, including, but not Zhanget al., 2012) lack of e of lack

The The

low labor costs as topas trash producers. -

e waste regulations and more. Trash production is often proportionate to a

- (Simmons, 2016; The World Bank, 2019 ). waste trade . -

waste disposal at special recycling facilities, Still, more than half of the world does not have Waste

in developing countries - - Grant et al., 2013; Robinson, 2009; waste income process is process waste imports have and improper tracking countriesis exported wasteproduction ranges from 20 I n 2016, the world’s cities alone

.

Additionally, many of the fueled by the strong demand cessible. In areview article the U waste, many were unable . S .

, , Brazil, China, , (Lundgren, 2012; recycling centers

of e of to China and

- waste

5 Fall 2019 UAB Global Health Case Competition

Schluep, undergoing the processing processing in itself contributes to chemical exposures, not to mention the material materialsbuild up. The burning of car tires and known to discharge harmful chemical directly into soil. Ash and partially burned dismantling, material recovery, and final disposal processes. These processes are Das, 2015). being responsible for ground and surface water contamination (Maheshwari, Gupta, & the air, causing allergies, irritation, and even cancer and birth problems in addition to infection and disease transfer. Biogas landfill sites are harmed popularly used waste disposal method, threats on polluting natural resources like theon environmental health of The mismanagementof trash andillegal dumping practices have H deleterious effects of toxin exposure. these workers often neither use personal protective equipment nor are aware of the barely literate, face hazardous toxin exposure (Pinto, 2008) people in the recyclingcenters, commonly from populations that are e alth impacts Environmental health impacts health Environmental 2011

The majority envirof ).

by the accumulation of pollutants, injuries and lacerations,

(Amoyaw surrounding onmental pollution from e- - Osei, Agyekum, Pwamang, Mueller, Fasko, & es released from these landfill sites contaminate

and populations residing in close proximity to land, air, and water. Landfills areas. It poses adverse short and long other long .

- lasting fuels for pyrolytic pyrolytic for fuels lasting wasteresults from .

The Lancet (2013) claims

serious implications urban, poor, and

are

the most - term term

6 Fall 2019 UAB Global Health Case Competition

cardiovascular, integumentary, and neurological complications after inhalation or matterproduced from open- 2014). In one of the largest e- compounds such as dioxin, and toxic such as and (Kumar & Arun, air burning of discarded electronics, cables etc. burned in informal “backyards”. Gold and other valuable metals are extracted by open- developingWhen nations process- e heavy60% ionsmetal andabout 2.7% part of the air that people breathe. E the water and soil, and toxins produced as a result of the accumulate in the soil, water, and . contains harmful elements like reservoirs used by humans for drinking, washing, cleaning, and bathing. E The toxic compounds in factorywaste and household garbage dissolve in natural water hazardous (Wildmer, Krapf, Khetriwal, Schnellmann, & Boni, 2005). Ghana. posed by trash mismanagement in affected areas like the Agbogbloshie slum in Accra, and infectious outbreaks ar Poisoning of food by hazardous chemicals, air toxicity, prevalence of disease carriers, cellular expression and function, and decrease lung function (Grant et al., 2013) studies haveconcluded Human health impacts. health Human

Figure 1 exposure to -

Prin e air burning has been linked with respiratory, digestive, ciple WEEE Recycling Activities (Amoyaw Activities Recycling WEEE ciple just just waste processing sites in Guiyu, lead, cadmium, , etc. (W some of the implications of the environmental - waste e waste alone is generally comprised of more than - waste can change thyroid function, change

The harmfulThe chemicals from e- other , some of it is dismantled, it of shredded, some , or

pollutants, making it highly toxic and —increasing public exposure to organic - Osei et al., 2011) Osei al., et burning China, particulate fine HO of e of

M , 2017), which can

- ultiple research waste waste leach into - waste become a .

7 Fall 2019 UAB Global Health Case Competition

Policy excreting them. (Heacock et al., 2016) larger equipment (The Lancet, 2013); however, their smaller body size means they receive oftenare employedat e- contaminants such as particulate matter deposits on outdoor items and toys. Children children are less able to identify and appreciate threats from environmental al. (2007) were found to be at risk for their risk of exposure. In fact, over 80% of Guiyu children sampled in a study by Huo et breastfeeding and hand- heightens theirsusceptibili increased food intake per body weight of growing children and pregnant women and behavioral impairment, and congenital malformations (Dietrich, 2010). The differentiat toxic heavy metals (Guo et al., 2010). In exposed fetuses, instrumental processes of cell placental tissue in women who live in Guiyu showed elevated levels of lead and other children repr While the aforementioned risks apply to the general populace, pregnant women and 2003). cancers affecting the lungs, liver, stomach, and kidneys ( h suc effects as low birthweight, thyroid malfunction, and genotoxicity, as well as agents from dump sites, landfills, and incinerators has been linked with physiological again contaminating the soil, crops, and marine life. Exposure to biological or chemical waste disposed of into a water source, hazards as they can accumulate in landfills and drainage systems. Effluent UNEP, and carriers of leishmaniasis and bartonellosis can breed in standingwater ( fever, zikavirus, dengue fever, and malaria (Thomson, 1995). Additionally, sandflies accumulate and provide a breeding ground for Aedes mosquitoes posed Adverse effects from particulate matter and heavy metals are not the only health risks concentrations. , nickel, lead, and cadmium that were nearly twice the maximum permissible collectedl from exposure route (Robinson, 2009). In astudy by Zheng et al. (2013) rice samples being deposited and entering the soil and crops in other locations 2011). Particulate matter from burning can also be dispersed by winds and travel before markers of inflammation, metabolic stress, and DNA damage (Yang, Jin, Xu, & Lu, expression of Interleukin 8(IL- ing estion (Guo et al., 2010). Research has also linked particulate matter with increased

doses of toxicant relative to their body size andhave difficulty processing and

by e by 1991). Even when sterile, uncollected trash and e- ion and maturation may beaffected—leading to premature birth, cognitive - waste and trash. Improper disposal or storage allows standing water to esent avulnerable subpopulation, as research has revealed that even ocations around e-

wast to - ty to environmental toxicants ("Electronic waste," n.d), while mouth behavior among veryyoung children exacerbates e sites because their small hands are ideal for dismantling 8) and Reactive Oxygen Species (ROS) waste processing sites showed concentrations of

can leach into ground and open water sources —highlighting their vulnerability as Lundgren, 2012; wastedeposits pose fire and — — a major human vectors of yellow -

biological biological Rushton, Rushton, WHO & & WHO , or or , —

8 Fall 2019 UAB Global Health Case Competition

sound” ( “environmentally sound” manner, yet the Convention fails to define “environmentally countries thatcomebilateral to a agree ment to manage the e- out the ambiguous language of the agreements; prohibited trade is exempt between not implemented or enforced it (www.basel.int). Criticism of the Basel Convention points to less developed countries. Though ( hazardouswaste from Organisation for Economic Cooperation and Development Amendment” has been added to the treaty, which outright bans the movement of legally bound to any aspects of the convention. Since its inception the “Basel Ban to ratify this treaty are Haiti and the United States of America, meaning that they are not throughoutthe 1980’s countries, largely spurred on by public outcry as awareness of the e- to curb the movement of hazardous waste from high signed onMarch 22, 1989 and went into effect in 1992. Wastes and their Disposal (Basel Convention) is the The Basel Convention on the Control of Transboundary Movements of Hazardous International Policy ) OECD

Oteng member states, the European Union, and Liechtenstein (or “Annex VII” nations) - Ababio, M. 2012). .

With 187 countries party to the convention, the only nations yet

havingratified theBan Amendment, Ghana has - United Nations treaty that was income The BaselThe Conventionis meant countries- to low wastean in waste issue grew income

9 Fall 2019 UAB Global Health Case Competition

al, 2012) used. These practices place, so outdated protocols like opening burning and mechanical shredding still are recycling, especially in terms of environmental and human health concerns, were e accepted from industrialized countries, A the past ten years, as the use of electronic devices increased in Africa and imports were Ghana’s capital city of Accra. The site originated as ascrap metal recycling site, but in Agbogbloshie, one of the most widely known e- History of Agbogbloshie public health (S support actors at every level Environmentally Sound E Management(Act Act 917), passedin 2016, andtheTechnical Guidelines on sustai Ghana was the first country in Africa to adopt official guidelines and policies to Policy Domestic recent years, the infrastructure original purpose finds its way to the carts and sheds of recyclers in Agbogbloshie. Until enforcement of this policy ( of second- health. A regulatory bill passed in 2010 prohibiting the importation, saandle, distribution itself commit the government to protecting both the natural environment and public including the 1991 These concerns have a historical precedent, as previous institutions and policies, waste” (Quaye, Akon- resources from Government, and lack of innovation in the effective management of E influence, poor attitudes o indicate literature shedding light on these policies’ effectiveness. 2018). theseWith regulations just coming into effect recently, there is little to no disbursement of the money according to provisions contained in the Act” (WEEELogic, this tariff goes directly to Ghana’s E fee between $.15and $15 on October 1, 2018, requiring importers of electronics and electronic equipment to pay a - waste recycling (Srigboh et al, 2016). Electronic waste that cannot be reused for its nably manage e- d . There is heightened concern for exposure to toxic elements like , lead,

that there have beengaps in e- hand air conditioners, freezers, and refrigerators, but there was little to no ustainable Recycling I Agbogbloshie onal EnvironmentalNati Action Plan and Yamga, Asante, & Daniels, 2019). put recycli waste. These policies include the Electronic Waste Control and - f Ghanaiansf in waste handling and management, lack of Waste Management,Waste passed in 2018. These guidelines p Amoyaw er item er

of theof e

and regulations necessary to safely manage e- ng workers risk at for many health problems , depending onthe product. The money gained from - - waste Fund, which will “coordinate the Osei, - waste recycling sector in Ghana in protecting ndustries gbogbloshie became an important location for waste law enforcement “partly dueto political

et2011). al, .

, 2018). Enforcement of Act 917 began waste sites in the world, is located in

However, the Ghanaian Constitution a

recent focusgroup

(Asante et waste not in -

10 Fall 2019 UAB Global Health Case Competition

Nations Environment Programme. par electronic waste (2016) describes how comes from is often misunderstood. In an article thefor Smithsonian Magazine, i serious issue in Agbogbloshie, few agree on the numbers. For example, Agbogbloshie While there is general agreement that trash management, and specifically e - Osei, solving pollution issues toxic threats in 2013 by , an international non- most well known as a dumps Agbo and zoning regulations in the area, and rural markets, gentrificatio The population of Agbogbloshie continues to rise due to the growth of the nearby immigrated to Ghana from nearby countries of Togo, Benin, or Burkina Faso. Korle Agbogbloshie borders the Old Fadama slum, which stretches along Present remaining heavily polluted. inability of government officials to collaborate with slum residents led to the lagoon high hopes for the project, the issues of political commitment, lack of resour community members to have an active role in creating their own futures. Despite the about the importance of sanitation and environmental hygiene. This allowed the of the project included educating community members, starting with sc construction of asewage treatment plant, and a network of drains. Another component the lagoon of silted material, improving flood control measures, the surrounding communities. The restoration project, which began in 2000, included (Boadi and Kuitunen, 2002). Routine periods of flooding were also hazardous to the of fish ceased to exist, whichwas detrimental to both commercial use and recreation surface drains, pollutedwater runoff filledthe lagoon, and over time the abundant stock environment through education programs. Due to the extended release of waste into bodies of water on earth, as well as to involve the community in managing their the Korle Lagoon to its natural ecology after it had become one of the most polluted EcologicalRestoration Project Efforts to contain waste effects have been made in the past, including the Korle Lagoon collected from the Agbogbloshie site (Srigboh et al, 2016). , and copper, which have been found in the soil, water, ash, sediment and dust E s currently the world’s second largest e- - waste Africa Programme that say ts of AfricaWest is produced in Ghana and Africa”West according to the United gb etal, 2011 ). Lagoon. Around 80,000 people reside in Old Fadama, some of whom have loshie - itself day s day even though “

encompassesindustrial, commercial, andresidential areas n and displacement from other areas of Accra, a lack of planning Agbogbloshie became the symbol of a growing crisis exporting of

in low in ituation

ite -

85 percent (KLERP) and middle-

and scrap-

Feldt

Ghana imports about 215,000 .

, which began in 1999. KLERP aimed to restore waste dumpsite; however, where that waste et al.

of the e- metal yard. income countries - to

(2013) - urban migration within Ghana. waste dumped

reported 2011 numbers from the It was named one of the top ten profit organization dedicated to

(Pure Earth, n.d. in Ghanaand other tons

the Odaw River and hool children, of used ces, and waste, is a ; , butis Amoyaw Minter Minter -

11 Fall 2019 UAB Global Health Case Competition

to In environmental studies conducted around the area, lead levels ranged134 from ppm every year. consumer electronic 400 ppm, estimated estimated background soil ( in Agbogloshie soils have been found to be over one hundred times the levels in typical discharge direc recycling activities in Agbobloshie typically take place allows hazardous chemicals to soil as highas 18,125 ppm amongsampled soil (Caravanos, Clark, Fuller, & Lambertson, 2011). the U number of people at risk for lead exposure is at 40,000 people. tly into the soil. Levels of antimony, cadmium, tin, zinc, copper, and lead n ited Sates Amoyaw s from Western Europe and generates 129,000 3: Onion mark - Osei,

Environmental Protection Agency’s standard leadlevel for et in Agbogbloshie area of Accra, Source: Adam Minter

et al, 2011).

According to Pure Earth (n.d.), the . Over half of the sampled soil exceeded The unfortified ground on which

tons

of e of

-

waste

12 Fall 2019 UAB Global Health Case Competition

questions: following the judges to answer able should be yourviewing presentation, After November 2 Proposal presentations will beviewed and scored by apanel of judges onSaturday, the approved this initiative, and your team has until Saturday morning to crafta proposal to waste United Nations Environment Programme ( Efie Team Assignment

5. 4. 3. 2. 1. • • • UNEP. The parameters of this grant include: went into the GHANA office that morning and proposed that the team apply for

& its health impacts in Agbogbloshie. The Executive Director of GHANA has minutes of Q&A Explain your strategies in aconcise Funding: $ Timeline: 5year Across your interventions, what are your specific plans to address: What is your budget and how is it split across progra ms? What policy advocacystrategy or plan will have the most impact and why? What health intervention will have the most impact and why? Why should UNEP fund a proposal on this topic? o o o e. d. c. b. a.

nd intervention(s). A higher portion may beallocated, but no less than 50% At least 50% of the funding must 50% of the funding may contribute to advocacy efforts Some measure of funding must go into policy advocacy, but no more than UNEP funding UNEP Your presentation should include a clearly delineated budget for use of the Enforcement of recent le recent of Enforcement Lack of recycling infrastructure and waste management Health impacts of e- e of Issues E . The top 3presentations will advance to the final round. - wast 2,000,000 e supply

- maximum - waste contamination of water and air

waste contamination gislation like Act 917

UNEP 15- minute presentation,

be used

)

grant, focusing on the issue of e-

for (a) direct public health

followed by 5

the the

13 Fall 2019 UAB Global Health Case Competition

your to development: support intervention Resources Important    • • • • • • • • • • • provisions for education, product, or service delivery? current health systems, training/education required to implement plan, what levels economic improvement, and productivity at the personal, family, and community choose to target them? from recommen The Policy Advocacy 30 October Wednesday, “Managing and ProtectingWaste Health” Tuesday,October 29 new products/services proposed? particularly innovative or creative; novel application of existi Innovation with recommendation(s) and how those will addressed be Identification Risk program improvements and demonstrate impact and after proposed intervention(s) and how this information will beused to inform Monitoring and Evaluation: Comparison of baseline data, to data collected during Sustainability extensive coverage beyond Agbogbloshie, provided there is evidence of success Scalability applicable Legal and Ethical Issues extent to which they have taken in local cultural context and technologies Acceptability Cultural transportation and/or opportunity costs to stakeholders Impact Economic Feasibility Social Benefit/Social Return on Investment Choice of Target Population: is theWho target population and why did the team

areas of consideration e Ghana 2011.

: Howwell the do proposed strategies utilize and/or improve capacity of : Application of recommendation to other communities or more : Are there aspects of the proposal which could be considered ded resource with the caveat that you keep in mind the assessment is

- : Plans for how the program will Waste CountryWaste Assessment

Workshop withWorkshop Sean McMahon : Direct costs associated with prop

& Mitigation Strategies

: Cultural perceptions of the proposed strategies and the th th | 11am th :

Strategies for how these will beaddressed, if | 5pm 5pm | for yourfor proposal: –

12pm | The Edge of Chaos of Edge | The 12pm –

7pm | The Edge of Chaos : Potential challenges/risks associated Seminar with Dr. Lisa McCormick Lisa withDr. Seminar

by by : Impact on health outcomes,

proceed once funding ends Amoyaw

osed strategies; - Osei

ng technologies or

et al. is a

14 Fall 2019 UAB Global Health Case Competition

Figures A ttachments 2

& 3 : Maps of Source:Ghana,

World Atlas World

15 Fall 2019 UAB Global Health Case Competition

Figure Figure 4 - 5 : Maps of Agbogbloshie and areas surrounding , Source:, Amoyaw - Osei

et al.et , 2011

16 Fall 2019 UAB Global Health Case Competition

Figure Figure 7 6 : Select causes of in2017mortality Ghana, Source:, IMHE : Agbogbloshie scarp yard –

detail map , Source:, Amoyaw - Osei

et al. , 2011 ,

17 Fall 2019 UAB Global Health Case Competition

Source: AmoyawSource: Boadi, K. O., & Kuitunen, M. (2002). Urban Waste Pollution in the Korle Lagoon, Accra, Biello, D. (2014, January 01). E Basel Convention. (n.d.) www.basel.int Amoyaw Asante, K. A., Agusa, T., Biney, C. A., Agyekum, A., Bello,W. M., M., Otsuka, … References Figure 8 Ghana.Enviro The nmentalist,22301 , - waste Retrieved June 26, 2019, from wasteAssessmentGhana.pdf http://www.basel.int/Portals/4/Basel%20Convention/docs/eWaste/E (2011).M. Ghana e- Total Environment,424 , 63- e Tanabe, S. (2012). Multi : - - applications & electronics (in tons) (in Compositionelectronics breakdown of & applications waste recyclingworkers from Agbogbloshie, Accra in Ghana. Science of The Osei, Y., A - - dump - Osei - among gyekum, O. O., Pwamang, J. Mueller, A., E., Fasko, R., Schluep,&

et al.

, 2011 Waste CountryWaste Assessment. Retrieved from top - - 10- -

traceelement levels andarsenicspeciation urine in of Waste DumpWaste among Top 10 Most Polluted Sites. most 73. doi:10.1016/j.scitotenv.2012.02.072

https://www.scientificamerican.com/article/e-

- polluted-

309. doi:10.1023/A:1020706728569 sites/

,

-

18 Fall 2019 UAB Global Health Case Competition

Minter, A. (2016, January 13). The Burning Truth Behind an E Maheshwari, R., Gupta, S., & Das, K. (2015). Impact of Landfill onWaste Health: Lundgren, K. (2012). The global impact of e- Kumar, S., & Arun, K. (2014). E Huo, X., Peng, L., Xu, X., Zheng, L., Qiu, B., Qi, Z., . . Piao, Z. (2007). Elevated blood Heacock, M., Kelly C.B., Asante, K.A., Birnbaum, L.S., Bergman, A.L., Brune, M., et al. Y.,Guo, Huo, X., Li, Y., K., L Wu, Grant, Goldizen,K., F. C., Sly, D., P. Brune, M., Neira, M., Van den Berg, M., & Ghana Statistical Service. (2013). 2010 Population & Housing Census Report: Migrati Feldt, T., Fobil, J. N., Wittsiepe, J., Wilhelm, M., Till, H., Zoufaly, A., . Göen, T. Caravanos, Jack, Edith Clark, Richard Fuller, & Calah Lambertson. (2011). Assessing Central Intelligence Agency. (2019). The World Factbook: Ghana. Retrieved from Electronic waste. (n.d). Retrieved from https://www.who.int/ceh/risks/ewaste/en/ Dietrich, K. (2010). Environmental toxicants (2nd ed.). New York: Guilford Press. nature/burning Retrieved June 21, 2019, from Technology Overview. International Labour Organization. Journal. Environmental Health Perspectives, 15, 1113 lead levels of children in Guiyu, an electronic waste recycling town China. in . Environmental Health Perspectives, 124(5), 550- (2016) E China. Science of the Total Environment, 408, 3113- cadmium, chromium and nickel in placenta from an e- A systematic review. The Lancet: Global Health, 350 1(6), Norman, R. E. (2013, December). Health consequences of exposure to e- 20Ghana.pdf http://www.statsghana.gov.gh/gssmain/fileUpload/pressrelease/Migration%20in% in Ghana. Retrieved from doi:10.1016/j.scitotenv.2013.06.097 Agbogbloshie, Ghana. Science of The TotalEnvironment,466 - (2014). High level and Disposal Site in Accra, Ghana. Journal of Health and Pollution, Workerand EnvironmentalChemical ExposureRisks at ane- https://www.cia.gov/library/publications/the-

- waste and harm to vulnerable populations: A growingglobal problem.

Journal of Environmental Science, Toxicology and Food ,

1(4).

- truth

s of PAH s - behind- - Waste: Health Impacts in Developing Countries. EHS - iu, J., Huang, J., . . Xu, X. (2010). Monitoring of lead, metabolites in urine of e- e - waste https://www.smithsonianmag.com/science

- dumpafrica waste: Addressing the challenge. world – 1117. - 180957597/ - 555. factbook/geos/gh.html waste recycling workers from 3117.

waste recycling town in

- Waste Dump in Africa. -

361.

Waste Recycling Recycling Waste 467, 369-

16- 25.

376. -

waste:

An An on

19 Fall 2019 UAB Global Health Case Competition

The Lancet (2013). Electronic waste – Terazono, A., Murakami, S., Inanc, N., Moriguchi, Y., Sakai, S., Kojima, M., et al. Sustainable RecyclingIndustries. (2018, March 05). Ghana’s way towards sustainable Srigboh, R. K., Basu, N., Stephens, J., Asampong, E., Perkins, M., Neitzel, R. & L., Simmons, A. M. (2016, April 22). The world's trash crisis, and why many Americans are Rushton, L. (2003). Health hazards and waste management. British Medical Bulletin, Rottier, R., & Ince, M. (2003). Controlling and Preventing Disease (pp. 99- Robinson, B. H. (2009, December 20). E AkonQuaye,- W., Pure Earth. (n.d.). Agbogbloshie, Ghana. Retrieved June 26, 2019, from Pinto, V.N. (2008). E Oteng - Leicestershire (UK): Water, Engineering and Development Centre Publications. Occupational & Environmental Medicine, 12(2), 65- Material Cycles and Waste Management, (2006).Current status research and onE sound- recycling https://www.sustainable- e 74. doi:10.1016/j.chemosphere.2016.08.089 Agbogbloshie electronic waste (e- Fobil, J. (2016). Multiple elemental exposures amongst workers at the 20160421 https://www.latimes.com/world/global oblivious. T 68, 183- and environmentalimpacts. system Lens.Retrieved from management system in Ghana through the Transformative Innovation Policy https://www.worstpolluted.org/projects_reports/display/107#_ftn3 https://doi.org/10.5772/45884 Leading Edge Content for Environmental Management (pp. 150– Practices. In S. Curkovic (ed.), Sustainable Development environmentally sound e- 381(9885), 2223. Ababio, M. (2012). Electronic ManagementWaste in Ghana – - waste recycling – e - in - 197. - waste first - - ghana- snap Yamga, G., Asante, A., & Daniels, C. (2019, May). The E he Los Angeleshe Los Times.Retrieved June 27,2019, from

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20 Fall 2019 UAB Global Health Case Competition

Zhang, K., Schnoor, J., Zeng, E.Y. (2 Zheng, J., Chen, K., Yan, X., Chen, Hu,S., G Yang, F., Jin, S., Xu, Y., & World Population Review. (2019). Accra Population 2019. Retrieved from World Health Organization. (2018). World Health Statistics. Retrieved from World Health Organization. (2017, August 15). Electronic waste. Retrieved June 27, World Health Organization & Widmer R, Krapf HO, Khetriwal DS, Schnellmann M, Boni H. (2005). Global WEEELogic. (2018). Africa news: Ghana's E Thomson, M. C. (1995). Disease Prevention through Vector Control: Guidelines for The World Bank. (2019, April 1). 458. management from here? 205 96, Safety, China and the potential risk to human health. Ecotoxicology andEnvironmental metals in food, house dust, and water from an e- e in human lung epithelial cells exposed to two extracts of PM2.5 collected from an http://worldpopulationreview.com/world- eng.pdf?ua=1 https://apps.who.int/iris/bitstream/handle/10665/272596/9789241565585- 2019, https://www.who.int/ceh/risks/ewaste/en/ from https://apps programme. HealthWorld Organization. Retrieved from: and rodent control through environmental management : acommunity action perspectives on e- https://news.weeelogic.com/africa- Relief Organizations: Oxfam, UK. - waste recycling area, China. Environmental Research Letters, 6(2).

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21 Fall 2019 UAB Global Health Case Competition