BACKGROUND

A health risk assessment is the process to estimate the nature and probability of adverse health effects in humans who may be exposed to hazards in a contaminated environmental media now or in the future. The original concept of human health risk assessment (appraisal) is generally credited to Dr. Lewis C. Robbins, whose works on cervical cancer and heart disease prevention during the late 1940s led him to the idea that a physician might record a patients’ health hazards as a guide to preventive efforts and then to the creation of a simple health hazard chart could give the medical examination a more perspective orientation (Schoenbach, 1987)

         The activity of human health risk assessment is carried out inclusively worldwide including Cameroon This is clearly seen in articles like “Air Quality and Human Health Risk Assessment in the Residential Areas and the Proximity of the Nkolfoulou Landfill in Yaoundé Metropolis, Cameroon” (Feuyit 2019), “Health Impact Assessment of a Clinical Waste Management Policy for Cameroon” (Grulis and Mochungong, 2013)

         Health risk assessment is a straightforward and structured method and important as it ensures the risks to health, safety and wellbeing of employees are suitably eliminated, reduced or controlled. One of the harmful health effects on humans often is as a result of exposure to waste mostly in the waste management process. Wastes are substances or objects, which are disposed of or are intended to be disposed of or are required to be disposed of by the provisions of national law. The threat of endemic, emerging and reemerging infectious diseases from waste at health care facilities demands effective infection control practices among health care workers and other caregivers. Waste management is a process of collecting, segregating, disposing or recycling and monitoring of waste materials. Health care waste management is a significant public health and environmental problem (Ruoyan et al., 2010) particularly in developing countries where it is hampered by technological, economic, social difficulties and inadequate training of staff responsible for the handling and processing of wastes (Alagöz and Kocasoy, 2008). In the majority of developed countries, there is an established regulatory policy framework in relation to health care waste management (Blenkharn, 2007) with drivers such as public health protection and European Directives transposed into national legislation (e.g. the Hazardous Waste Regulations 2006 in the UK). Though waste from healthcare facilities comprises a small fraction of infectious and hazardous waste, the potential environmental and health hazard could be deleterious if not properly handled, the worst-case scenario being in developing countries (Pruss et al., 1999) where health care waste management systems can be inexistent or ineffective in delivering sustainable waste management solutions.

             Healthcare waste contains infectious pathogens, toxic chemicals, heavy metals, and may contain substances that are genotoxic or radioactive (Alagöz and Kocasoy, 2008; Patwary et al., 2009). These substances have potential to cause adverse health effects to humans and the environment if not handled properly. Of particular concern is the risk of infection to those who handle the waste and the general public (Mbongwe et al., 2008), particularly in the vicinity of the authorized or unauthorized disposal and landfill sites. A study on the management of biomedical waste conducted by, the World Health Organization (WHO) estimated that in 2000, contaminated syringes from health care facilities generated 21 million hepatitis B (HBV) infections (32% of all new infections), 2 million of hepatitis C (HCV) infections (40% of all new infections), and 2,600,000 HIV infections (5% of all new infections).  Safe and secure management of medical and health care waste can be ensured by the adoption of management practices which are based on clear plans and policies that provide for continuous improvement. These practices need to be integrated into routine employee training, continuing education, and management evaluation processes for systems and personnel (Da Silva et al., 2005). Guidance and training on managing hazardous waste in developing countries has been developed by United Nations Environment Programme and the International Solid Waste Association (UNEP and ISWA, 2002). Several studies in Africa point out that medical waste management is still in its infancy; characterized by the lack of awareness on the impacts of healthcare waste, the total absence of medical waste regulations and a high incidence of non-compliance in cases where they are existing (Bendjoudi et al., 2009; Longe and Williams, 2006; Soliman and Ahmed, 2007).

              The Cameroon healthcare delivery system is characterized by multiple healthcare providers including both the public sector and private sector including religious establishments and private enterprises such as the large Agro-industries. In 1999, of the 1689 health centers and 339 hospitals, the Ministry of Public Health (MINSANTE) operated a total of 1362 (67%) hospitals and health centers with the rest managed by the private sector (MINSANTE, 2001). Public and private sectors play complementary roles in the provision of health care in order to improve the supply of health care to the population in terms of quality and access (Ntembe, 2009) and contributing towards public health improvement.

There has been an alarming increase in the amount of waste from health care with increase in the number of hospitals and dispensaries that the local government might be unable to deal with or clear. With the exception of a few large hospitals, many health care institutions are facing the problem of disposal of waste generated. The health risks associated with waste include:

• Improper disposal and lack of properly designed landfills results in contamination of water and exposure to toxic wastes
• Inadequate incineration can result in toxic air pollution; the failure to use proper filters adds to the release of such pollutants into the air. Incineration of chlorine containing waste produces dioxins that are carcinogenic
• Lack of segregation of the biomedical wastes can risk an exposure to sharps among the workers of waste disposal and treatment. Even on needle stick injury from an infected source patient can result in 30% risk of hepatitis B, 1.8% risk of hepatitis C and 0.3% risk of human immune deficiency virus.
• Pouring of antibiotics into the drain results in the killing of required microbes and altering the environment that helps in the breakdown of biological matter in septic tanks

Management of waste requires diligent knowledge and practices but most often, these management practices do fail and some concerns that require to be addressed are;

• Lack of awareness of health hazards related to health care waste
• Lack of training on proper waste disposal practices
• Absence of available constructed waste disposal systems
• A low priority level even after knowing the harmful effects of improper waste disposal
• A lack of funds and resources towards constructing waste disposal systems
• Occupational risks to health care waste exists but have not been efficiently addressed.

With the above mentioned, proper management of health care waste is important as infectious materials present in the waste can infect the health care workers, patients and hospital staff

Healthcare waste management within the Nkwen Baptist Health Center Bamenda-Cameroon and the Regional Hospital Bamenda Cameroon follows all the activities and actions required to manage health care waste from its interception to its final disposal. Importantly, the concept of “waste-management hierarchy” is core to the entire process of managing these wastes. Although to a large extend, waste management is based on the concept of 3R’s which are Reduce, Reuse and Recycle, the Bamenda Regional Hospital and the Nkwen Baptist Health Center’s waste is generally not reused or recycled to ensure infection prevention control.

           Basic steps in waste management here include minimization, waste segregation, waste collection/storage, waste transportation, treatment and waste disposal. In relation to the guiding principles of health care waste management, the “duty-of-care” principle stipulates that any person that generates waste has a duty to dispose of the waste safely. According to the United Nations Educational Scientific and Cultural Organization (UNESCO) and the Commission on the Ethics of Scientific Knowledge and Technology, another principle important to health care waste management is the “precaution” principle which requires that as a health worker, one must always assume that waste is hazardous until shown to be safe. Taking necessary precautions in the course of generating and handling waste could reduce the risks associated with hazardous waste as well as their spread to other health workers, patients and the environment (UNESCO-COMEST, 2005)

Health care waste handlers are at the risk of infections. Therefore, this study on assessment of risks associated with healthcare waste management in Bamenda Cameroon precisely in the Bamenda Regional Hospital and the Nkwen Baptist Health Center seeks to find out if there are possible health risks associated with the practice of healthcare waste management, and to assess these risks and recommend better ways that could limit or eliminate these risks if they are associated.

PROBLEM STATEMENT

Healthcare waste management in the North West Region of Cameroon especially at the level of treatment and disposal has serious effects on human health and the environment at large if not properly done. Hazardous waste has enormous impacts on the environment most of which are short term and others long term: short term effects include water pollution which result from waste mismanagement leading to chemicals which run into our waterways making streams, rivers, lakes and aquifers unsafe to use for drinking or agricultural purposes. Also, human health in areas downstream may be affected. However, it is the long-term results that are terrifying. Long-term effects include signs of mutation in animals, cancer and other diseases in humans, trash in our waterways and green spaces, and the destruction of many natural resources. Body fluids are another kind of hazardous waste that is often disposed improperly; we now have to worry about the spread of human disease as well. There is no published information on the management of medical waste in the North West Region and the potential risks it poses to those involved in its management. The Nkwen Baptist Health Center and the Bamenda Regional Hospital in Cameroon generates and manages its healthcare waste via various methods which if not well handled will result to great environmental issues of concern along site health complications on the workers, clients and inhabitants around this area. This research is aimed at identifying whether these methods of healthcare waste management are environmentally friendly, if they expose employees and clients to a health risk or not and to what degree.

RESEACH QUESTIONS

• What are the various kinds of waste generated by the Nkwen Baptist Health Center and the Bamenda Regional Hospital Cameroon?
• What are the various methods applied by Nkwen Baptist Health Center and the Bamenda Regional Hospital in managing their health care waste?
• Are there chances of poor health care waste management in these two institutions? If yes, what degree of effects does it have on the environment, on its employees and clients?

MAIN OBJECTIVE

To assess the various health risks associated with healthcare waste management within the Nkwen Baptist Health Center and the Bamenda Regional Hospital Cameroon and to recommend better ways of managing healthcare waste in these institutions to minimize environmental pollution, health risks on employees and clients through the use of environmentally friendly healthcare waste management systems.

SPECIFIC OBJECTIVES

Below are various objectives to be attained in order to accomplish the main objective

• To identify the various kinds of waste generated by the Nkwen Baptist Health Center and the Regional Hospital in Bamenda-Cameroon.
• To identify the various methods applied by Nkwen Baptist Health Center and the Bamenda Regional Hospital in managing their healthcare waste.
• To find out if there are chances of poor waste management in Nkwen Baptist Health Center and the Bamenda Regional Hospital. If yes, find out the degree of its effects on the environment and on its employees and clients