ABSTRACT

Infectious diseases are also increasing globally adding to the generation of more. Presently, around 1.47 billion tonnes of solid waste are produced each year globally and this figure has increased year on year. Of these 1.47 billion tonnes, 5.9 million tonnes are estimated to be a result of healthcare waste (HCW). A cross-sectional research design using quantitative methods was employed in this study. A sample size of 110 participants was adopted for the study. A convenient sampling technique will be used to select the study population. It relies on data collection from participants who were conveniently available and ready to participate in the study. A well-structured questionnaire (parted in three sections in accordance with the specific objectives) administered through face to face interview alongside a pen that they used in answering the questionnaire. Out of the 110 respondents, 98(89.09%) were female, 75(68.18%) were of age 18 to 29 years, 82(74.55%) were single. A greater proportion of the participants 72(64.45%) were nurses, majority 83(75.45%) had work experience ranging from 0 to 5 years. Most of the participants; (83.64%) had adequate knowledge on hospital waste management. A greater proportion 93(84.55%) agree that waste is stored in open dumps in the vicinity of the hospital, 74(67.27%) agree they lack properly labeled waste containers and safe storage rooms in the hospital. Majority 61(55.45%) said lack of personal protective equipment increases the risk of contracting infection by health workers. Based on the study it showed that majority of the health workers had adequate knowledge on proper hospital waste management. Most of the participants were of age 18 to 29 years mostly being female and had work for 0 to 5 years with majority of the respondent being nurses. In addition, most of the health workers faced a lot of challenges towards hospital waste management which was mentioned as lack of personal protective equipment’s, lack in properly well labeled waste containers, dumping of waste in the vicinity of the hospital, poor operational strategies and no documented waste management and disposal policies.

CHAPTER ONE

INTRODUCTION

1.1 Background

Infectious diseases are also increasing globally adding to the generation of more waste (Lafferty et al., 2016). Presently, around 1.47 billion tonnes of solid waste are produced each year globally and this figure has increased year on year (Zaman et al., 2016). Of these 1.47 billion tonnes, 5.9 million tonnes are estimated to be a result of healthcare waste (HCW) (Voudrias et al., 2018). Yet, owing to the sensitive nature and rigorous legislative requirements, only limited studies have explored the Health Care Waste streams in detail to put forward optimum methods for their treatment (Valchokosta et al., 2020). The magnitude of infectious risk associated with waste is high in low-income countries. Each year, Africa, Asia, and South America are the most affected by the infectious risk for professionals and populations, estimated between 15 and 20% due to hospital waste or infectious healthcare waste (Ismail et al., 2020). Healthcare has become one of the fastest growing global industries in recent years (Yeoh, et al., 2012). Worldwide health spending is higher than ever and continues to rise every year. In 2017, global health spending was estimated at USD 7.8 trillion worldwide and was around 10% of the world gross domestic product (GDP) (Global spending on health, 2020). This increase in spending is due to expanding population numbers and a greater need for healthcare interventions. The global population is increasing and is expected to continue to do so, with it estimated to be around 8.6 billion by 2030 and 9.8 billion by 2050 (Wilson et al., 2020). Consequently, there would be a need for more healthcare interventions and treatments as the population both expands and lives longer resulting in generation of more healthcare waste (HCW) than ever before. With aging population, while chronic disease spending is continuing to grow, so too is the cost of having multiple morbid conditions (MMCs). MMCs lead to elevated use of use of primary care and specialist care services as well as increased medication use and elevated hospital admissions (Mchails et al., 2016).

The proportion for hazardous waste varied from country to country: Pakistan about 20%, Nigeria 26.5%, Cameroon 16.0% and in Sub-Saharan African countries about 2–10%. In Bangladesh, 36.03% in diagnostic centers and higher clinics; and about 50% in urban health centers of Tanzania constituted hazardous waste (Azage and Akumie, 2010). In Cameroon, the waste stream is complex and heterogeneous with an average waste generation rate estimated at 44.9kg/day equivalent to over 16tonnes/annum comprising 49%, 16% and 14% of general, infectious and sharps respectively (Manga et al, 2011). Effective and efficient management of HCW remains a major problem throughout the world, and has been identified as a particular problem in developing countries. A study carried out in Ethiopian hospitals in 2011 revealed that there was inadequate separation of HCW at source and poor treatment practices (Debere et al., 2013). A study in Kenya in 2012 highlighted a lack of formal training in the management of HCW among hospital staff, and little interest from the hospital administration with regard to the appropriate disposal of HCW (Njagi et al., 2012). A South African study in 2016 highlighted poor knowledge among healthcare professionals (HCPs), and the need for all staff working in health care to receive regular training to improve their knowledge and practice regarding medical waste disposal to minimize the risks associated with improper waste management (Makhura et al., 2016). While treatment and disposal methods in the developed world are varied and governed by national and international legislation, in the developing world there is a notable lack of appropriate and enforceable law surround HCW treatment and disposal (Khan et al., 2019). Developing countries often have to deal with environmental and social problems such as over-crowding and densely packed populations which leads to more waste and by extension more potential for public exposure to HCW. Despite this, developing countries are expanding on the number of healthcare facilities such as laboratories, clinics and hospitals (Mohamed et al., 2009). This increase in healthcare infrastructure has led to an increase in HCW and in most healthcare establishments staff lack the necessary education and training to properly deal with HCW. Similarly, there is a notable lack of facilities, funding and storage for sufficient systems (Deneke et al., 2011). Of the hospitals that do have facilities and equipment for incineration on site, many are not operational (Sawalem et al., 2009). In 2015 it was found that just over half of healthcare facilities from countries sampled had the necessary systems and equipment for the safe disposal of HCW (Christina and Anushree, 2021). Healthcare waste management (HWM) problems are growing with an ever-increasing number of hospitals, clinics, diagnostic laboratories in Ethiopia. Health workers are one of the key personnel who are responsible for the proper management of healthcare wastes at any health facilities. However, this performance will depend the level of knowledge and practice regarding waste management (Doylo et al., 2019). In developing countries especially in Africa, healthcare waste has not received the much needed attention that it deserves (Harhay et al., 2009). This is because of the inadequate resources in these countries resulting into low priority for HCW management (Diaz et al., 2008). In many countries, there is limited segregation of hazardous and medical wastes and usually mixed with non-infectious waste (Hassan et al., 2008). Inadequate knowledge and unsatisfactory management practices among the health care workers are major challenges in the management of HCWs (Patil and Parokhrel, 2005). Previous research indicate that HCW management may be affected by lack of formal training, lack of knowledge on HCW management, limited interest from hospital administration (Nkonge et al., 2012). In Uganda, the HCW generated is averaged at 92 Kilograms (Kg) per day in hospital while primary health care facilities (Level IV health centers, level III health Centre and level II Health Centre) generate about 42Kg, 25 kg and 20 kg respectively on daily basis (AIDSTAR, 2000). Moreover, most of these primary health care facilities lack proper HCW management facilities (Victoria et al., 2014). Despite the policy guidelines on injection and HCW management developed by the Ministry of Health, Uganda, there is sufficient evidence that HCWs including in Kampala health facilities is not properly handled (Mugambe et al., 2012). In developing countries, the quantity of healthcare waste has sharply risen in recent years as a result of rapid population growth, thus increasing the demand for health services (Tesfahun et al., 2014).The clinical staff in developing countries lacks knowledge about the transmission of hospital acquired infections caused by poor handling of healthcare waste, poor attitude of staff towards hospital discipline, and improper training of staff on HCWM (Healthcare waste management) ( Kumar et al., 2010). In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of healthcare facilities that do not use proper waste disposal methods ranges from 18% to 64% (Mohammed et al., 2014).

 In Cameroon, the health and legislative development programs deal superficially with the question of biomedical waste management. Gaps in the legislative framework prevent the sound management of such waste (Ntirenganya et al., 2010). A study in Cameroon, found that health care waste collection and handling systems, including containers and bins for segregated wastes, are generally in a poor state (Manga et al., 2011).  A proportion of the waste stream is disposed of in open dumps in combination with municipal solid wastes while some are disposed of in incinerators which are often poorly designed. The waste stream is complex and heterogeneous with an average waste generation rate estimated at 44.9kg/day equivalent to over 16tonnes/annum comprising 49%, 16% and 14% of general, infectious and sharps respectively for a typical Health Care Facility in Buea which is a medium densely populated town (Manga et al., 2011). There is the potential to recover materials from this waste stream, if adequate waste management systems are developed and implemented. Separately recovering the uncontaminated

1.2   Problem Statement

Presently, every method of HCW disposal comes with disadvantages that not only pose a threat to the environment but also a threat to human health and wellbeing often via the environment (Christina and Anushree, 2021). Every year an estimated 16 billion injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards (WHO, 2018). Current methods of HCW disposal are limited in managing the global HCW problem, it is therefore critical for this problem to be better understood in order for global change to occur. Healthcare wastes pose a serious public health problem and as such, it is essential for it to be properly managed (Hassan et al., 2008). The generation of hazardous and nonhazardous waste is a concern of an environmental risk to healthcare workers, the public and the environment at large (Azage and Akumie, 2010). Safe disposal of hospital waste is an important part of Healthcare management but most of the healthcare establishments are not following proper disposal systems. Thus the need for this study to assess the knowledge of health workers on proper hospital waste management.

1.3 Study Justification

It has been noticed that most of the health care establishments are not following proper disposal systems of hospital waste such as openly burning of biomedical waste which releases harmful emissions which pollutes the environment. This poor management of hospital waste exposes not only the health workers infections but the environment (the community) as well. So it is of great importance to know what is actually the reason for the inadequate treatment of hospital waste.

1.4   Research Questions

1) What knowledge do health workers have on proper hospital waste management at the Buea Regional Hospital and Muea Integrated Health Center?

2) What challenges do health workers have towards hospital waste management at the Buea Regional Hospital and Muea Integrated Health Center?

1.5   Research Objectives

1.5.1 General objective

  To assess the knowledge of health workers on proper hospital waste management

1.5.2   Specific Objectives

1)  To assess the knowledge of health workers on proper hospital waste management at the Buea Regional Hospital and Muea Integrated Health Center

2)  To determine the challenges of health workers towards hospital waste management at the Buea Regional Hospital and Muea Integrated Health Center.