Inappropriate medical waste (MW) management practices have become one of the major concerns in developing countries.
The objectives of this study are to appraise the procedures and techniques available in collection and segregation of MW, treatment and recycling processes, disposal practices and compliances with rules and regulations in the Health-care Facilities (HCFs) in Ota, South West Nigeria. The HCFs visited includes general hospital, private hospitals, clinics, and primary health-care centers.
The survey involved the use of structured questionnaires, in-depth interviews and on-site observations. Statistical Package for Social Sciences (SPSS) software application was employed for analysis. Responses were coded using a linkert scaling procedure. Hypotheses were tested using Bivariate regression technique involving inferential statistics.
In addition, the study utilized chi-square non-parametric test for normal distributional effect of the variables. Results showed that MW management practices in most facilities are not totally in line with prescribed standards as expected.
It is recommended that a sustained cooperation should be developed among all key actors (government, HCF’s responsible and waste managers) so as to implement a safe and reliable medical waste management strategy. This should not only be limited to legislation and policy formulation but also in its monitoring and enforcement.
Generation of waste is indispensible with respect to its hazards and good disposable practices has been very poor. Medical waste has continued to generate increasing public interest due to the health problems associated with exposure of human beings to potentially hazardous wastes arising from health-care facilities.
Medical wastes are from hospitals, primary health-care centers (PHCs), dispensaries, dialysis centers, first-aid posts and sick bays, medical and biomedical laboratories, biotechnology laboratories, medical research centers, mortuary and autopsy centers, blood banks and blood collecting centers, nursing homes for elderly, maternity homes, pharmaceutical, chemical and chemist store.
Studies have highlighted that ineffective management of infectious hospital waste in developing countries can compromise the quality of patient care and create significant occupational public and environmental health risks.
Although, treatment and disposal of health-care waste aims at reducing risks, indirect health risks may occur through the release of toxic pollutants into the environment during treatment or disposal. Improper handling of medical waste can create harmful effects and reduce the overall benefits of health-care.
Studies conducted in developing countries regarding Medical waste management (MWM) has described it as being poor and that the general awareness on related issues is lacking among generators and handlers.
Despite the fact that health-care waste is labeled as hazardous because of the serious direct threat it poses to human health, the situation of poor MWM is still common in developing countries like South Africa, Nigeria, Swaziland, Mozambique, Kenya and Tanzania. An assessment conducted in 22 developingcountries in 2002 showed that 18 to 64% of HCFs do not use proper waste disposal methods.
Generally, lack of awareness about health hazards, poor management practice, insufficient financial and human resources and poor control of waste disposal are the most common problems connected with MWM in developing countries like Nigeria.
No doubt some studies have been conducted on waste generation, segregation and disposal, but little attention has been given to awareness of potential risks associated with medical waste and the need of personnel protection in rural and semi- urban settings.
Presently, a gap exists in knowledge and practice among health personnel which requires being bridged not only for the study area but also in the entire nation. Manyele et al. (2003) expressed that developed nations recognized poverty as a basic factor that inhibited the success of African efforts in the area of environmentally sound management of hazardous waste.
In Nigeria, medical waste falls under the category of infectious waste according to Federal Environmental Protection Agency (FEPA) now National Environmental Standards and Regulations Enforcement Agency (NESREA). This class of waste requires a particular type of management rather than being dumped with the rest of other waste.
Speculations from various bodies have pointed out that in Nigeria; medical waste disposal has received no attention in contrary to what it deserves. Health hazards due to improper MWM affect not only HCF’s occupants but also spread into the vicinity.
The survey involved the use of structured questionnaires administered to health-care workers, in-depth interviews and on-site observations which lasted for five months, January to May, 2013. The main items of the questionnaire were focused on medical waste segregation, collection, treatment, recycling process, waste disposal and waste management practices.
The study also captures health workers understanding on the current MWM. The research instrument was divided into two parts. First part dealt with personal information of the respondent and the type of health-care facility that is currently being considered.
In second part, respondents stated their experiences on the waste management practice in their various health-care facilities. Respondents were Doctors, Nurses, Pharmacists, Attendants and other medical experts. Names of health-care facilities assessed are not mentioned in this report for the purpose of confidentiality.
However, consents were taken from each HCF’s administrator before each survey was carried out.
The survey involved the use of structured questionnaires administered to health-care workers, in-depth interviews and on-site observations which lasted for five months, January to May, 2013. The main items of the questionnaire were focused on medical waste segregation, collection, treatment, recycling process, waste disposal and waste management practices.
The study also captures health workers understanding on the current MWM. The research instrument was divided into two parts. First part dealt with personal information of the respondent and the type of health-care facility that is currently being considered.
In second part, respondents stated their experiences on the waste management practice in their various health-care facilities. Respondents were Doctors, Nurses, Pharmacists, Attendants and other medical experts. Names of health-care facilities assessed are not mentioned in this report for the purpose of confidentiality.
However, consents were taken from each HCF’s administrator before each survey was carried out.
Qualitative and quantitative data collected through questionnaire and observation were compiled and analyzed by using percentages and proportions as well as Statistical Package for Social Sciences (SPSS). Findings were then combined and presented as a whole assessment. Responses were coded using a linkert scaling procedure.
Procedure combines descriptive analysis and bivariate regression estimation in arriving at the results obtained. The asymmetric distribution of the responses and the asymptotic significance of the hypotheses were verified for statistical significance and distributional effect using chi-square normal distribution test.
The variables of analysis were first subjected to descriptive analysis involving frequency distribution and percentages. The regression estimates were utilized to determine nature and direction of the relationship among the dependent and independent variables. Three hypotheses were made prior to conduct the study.
The first one was that majority of the HCFs in Ota lack proper arrangement for handling and treatment of medical waste. The second was that, there is inadequate awareness of waste recycling process among medical workers in Ota and the third being that, there exist low adoption of MWM practices in most of the local health-care facilities in the study area.
The HCFs in Ota metropolis, in comparison to the developed nations have minimal appropriate practices when it comes to handling and disposal of these wastes, starting from the personnel responsible for collection and storage through to the final disposal of the wastes.
Though regulation exists, but there is no implementation and enforcement. This has made many health-care facility operators to relax.
The study has demonstrated that medical waste management in Ota faces many challenges because there had been lack of data on the quantities and nature of the waste generated in previous times which this study has been able to come up with a significant information that could serve as baseline data for other researchers.
Such important data are of utmost importance for meaningful planning of waste management procedures. Also, there is no formal policy or directive put in place by stakeholders or government. Currently, the management of infectious waste is normally governed by activities of largely untrained and uneducated waste handlers from poor backgrounds.
Collectively, this study indicates important implications for the health of handlers, other health care staff, patients, their families and indeed entire residents of the community. To this end, the recommendations to improving the management of medical waste in Ota are listed below:
- A sustained cooperation must be formed among all key actors (government and waste managers) with the purpose of implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also in its monitoring and enforcement;
- All staff and waste handlers in each HCF should be regularly updated with specialized training, which provides updated knowledge about the process of waste management and associated health risks;
- The mass media should also sensitize the general public and raise their awareness level on environmental risks associated with improper management of medical waste;
- There is a need for further studies to be conducted on other aspects of medical waste, not covered by this study, so as to generate a comprehensive pool of much- needed baseline data in other local government and Nigeria.
The authors are grateful to Messrs Ifeoluwa Ogundeji, David Odey and Kingsley Chinagorom (Class of 2012/2013) of the Department of Civil Engineering, Covenant University, Ota, Nigeria who assisted in administering questionnaire for this study.
The authors express profound appreciation to all health personnel of the health care facilities that participated in the exercise for their cooperation and the management of Covenant University for providing enabling environment.
