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Greener Journal of Environmental Management and Public Safety, vol. 8, no. 1, pp. 25-39, 2019
Greener Journal of Environmental Management and Public Safety
Vol. 8(1), pp. 25-39, 2019
ISSN: 2354-2276
Copyright ©2020, the copyright of this article is retained by the author(s)
https://gjournals.org/GJEMPS
A Study to Assess the Status and Challenges of
Medical Waste Management Practices in a
University Health Institution, Southern Nigeria
1Charity O. CHUKUMAH; 1Gabriel C. C. NDINWA;
2Solomon AKPAFUN
1Department of Industrial Safety & Environmental Management Technology
School of Environmental Studies, Delta State School of Marine Technology, Burutu
2Department of Urban & Regional Planning, School of Environmental Studies
Delta State School of Marine Technology, Burutu
ARTICLE INFO
ABSTRACT
Article No.: 01202011
Type: Research
Introduction: Medical waste includes all types of waste with potential
characteristics to spread diseases, generated from healthcare institutions.
Objective: The study was carried out to assess the status and challenges of
medical waste management practices in Delta State University Teaching Health
Institution. Methodology: A cross-sectional survey was carried out between March
and August 2019. Multistage sampling approach comprising of purposive sampling
and case study approach was employed for the study. The approach involved
estimating the quantity of medical waste generated and the evaluation of waste
management strategy used by the healthcare institution. A total of 240
respondents were sampled. Collected data were subjected to statistical analysis
using SPSS version 21. Result and discussion: Average total weight of waste
generated from the departments was estimated to be 948.366 kg/day. Medical
waste generation rate was 13.598 kg/patient/day with an average bed per day
generation rate of 1.133 kg/bed/day. Kitchen department had the highest
generation rate of (254.448 kg/day) whereas the least generation rate was from NET
(9.11 kg/day). It was observed that segregation of waste at source exist but poorly
implemented and monitored as medical waste was still being mixed and dumped
with general wastes that were collected, transported and disposed. Segregation
was not carried out in line with NHCWMP standards. Waste generated were
collected on a daily base and transported to a designated place for temporary
storage. Lidded plastic container, storage house, hand cart, waste skip and
wheeled trolley were mainly used to store and transport waste. The institution lack
sufficient waste containers to handle volumes of medical waste. The result
revealed that higher percentage of waste handlers were poorly educated and
irrespective of the availability of PPE; they were observed to be wrongly used by
waste handlers. Land fill was revealed to be the most preferred final disposal
option but occasionally incineration and open pit burning were also adopted.
Conclusion: This study has helped to establish a baseline data on medical waste
management strategy in Delta State University Teaching Health Institution.
*Corresponding Author
Gabriel C. C. Ndinwa
E-mail: gndinwa@ gmail.com
Keywords: Medical waste
generation; Disposal facilities;
Segregation; Teaching health
institution; Oghara
26 Chukumah et al / Greener Journal of Environmental Management and Public Safety
INTRODUCTION
The challenges of medical waste management
and its final disposal practices including other toxic
hazardous wastes has become a rapidly growing
global concern recently dived into my researchers in
order to proffer solution to the potential risks posed to
the general public. Advancement in health programs
has increased the challenges of medical waste
management globally, particularly in the developing
countries (DaSilva et al., 2005; Al Emad 2011).
Generally, waste from the medical sector has been
defined by several scholars to include materials that
are generated in the course of health protection,
medical diagnosis, treatment and scientific research,
immunization of humans and testing of biological
specimen (Ramokate and Basu, 2009; Mbu, 2015).
Medical wastes are classified as a potential reservoir
of pathogenic organisms that requires reliable, safe
and appropriate handling techniques (Abor and Anton,
2008). It is an environmental and public health issue
that requires immediate attention in both industrialized
and developing countries.
Poor management of medical wastes result in
adverse impacts on the health of the public as well as
deteriorating the quality of the environment with the
most common reoccurring issues on its management
to include the occupational safety of the workers
handling the waste and safe disposal of the materials
generated (Ananth et al., 2010). Persons most
exposed to the potential risk from the improper
handling and management of medical wastes include
professional and non-professional staff of the medical
centres, waste handlers, hospital patients and their
visitors (Arab et al., 2008). A reasonable number of
researchers have reported that the inappropriate
handling and disposal of medical waste poses
potential risks to health workers who may be directly
exposed to the health facilities as well as people who
reside close to the facilities, especially children and
scavengers who may become severely exposed to
infectious waste materials and life threatening
diseases such as HIV/AIDs, hepatitis B and C (WHO,
2002, 1999; Oke, 2008; Coker et al., 2009; Path, 2009;
Adegbita et al., 2010). In addition to health risk from
medical wastes, threat to the environment equally
needs to be considered; this includes contamination of
soil, water sources and poisonous emissions from
improper burning. In the long run, waste from medical
facilities does not only impair the quality of life but as
well affect the welfare of the entire people where the
facilities are sited (Bathma et al., 2012; Nwachukwu et
al., 2013 ).
The disposal of medical waste in uncontrolled
sites has been reported by scholars from other
countries to have a direct environmental impact by
contaminating the soil and ground waters (Ananth et
al., 2010). Chemical residues discharged from medical
establishments into sewerage system have been
reported to adversely affect the operations of biological
sewage treatment plants as well as the natural
ecosystem of the receiving water bodies (Omofunmi et
al., 2016). Similar challenges have equally been
acknowledged from pharmaceutical residues like
antibiotics and other drugs, phenol and derivatives,
disinfectants and antiseptics. Chemical materials
stored in torn bags and containers, directly impact
negatively on the health of workers whom comes in
direct contact with them (Mbu, 2015).
Improper management of medical waste can
create serious health threatening challenges especially
threats to the health and safety of the workers and the
environment where the facilities are sited (Ali and
Kuroiwan, 2009). In countries like Nigeria, where many
health concerns are competing for limited resources, it
is not surprising that medical waste management has
received less attention and priority it deserves from
stakeholders and government (Abah and Ohimain,
2011). Although, reliable quantitative data on the
nature and quantity of waste from medical facilities and
the appropriate management techniques to adequately
dispose of these wastes has remain a challenge in
many developing countries around the world. It is
believed that several hundreds of tons of waste from
the health sector are deposited openly in waste dumps
and surrounding environments, often alongside with
other solid waste materials (Alagoz and Kocasay,
2007; Abah and Ohimain, 2010). In Nigeria, there is
neither available database nor records on the quantity
and nature of waste generated from the health sector.
Waste from this sector which poses serious life
threatening potential risk on environmental health has
been reported to be at the ground floor on issues with
priority from the government. Available evidence
revealed that medical waste are handled and managed
in line with other solid wastes that are generated on a
daily base (Edmund, 2012). Several hospitals are
seemed to dispose their waste in dustbins, drains and
canals as well as dumping on the outskirts of the
towns. Such disregard to protecting the general health
of the public occurs as a result to lack of awareness,
low waste management skill, lack of waste treatment
facilities and systems, nonchalant attitude of the
coordinating ministries and agencies; bribery and
corruption among health inspectors. The challenge is
getting worse on a daily base with rapid spread in
numbers of health centres, government owned general
hospitals, private clinics and diagnostic laboratories
across the country (Mokuolu, 2009).
The rapid increase of healthcare institutions in
Delta State exerts a tremendous impact on human
health ecology. Estimate suggests that there are more
than 625 healthcare centres existing in the state
(Ibekwe, 2015). These facilities generate hazardous
and toxic wastes in hundreds of tons on daily
operations. Only a few have the necessary requisite
and facilities to safely manage the wastes. The current
strategy reportedly used in handling these wastes in
Delta state is a player to positively contributing to the
spread of infectious diseases. The generated liquid
and solid wastes contain toxic and infectious materials
that are simply disposed into the nearest drain and
garbage heap respectively; thereby posing risk to
waste pickers and scavengers that picks up scrap from
these garbage dumps. Very few studies have been
carried out on medical waste in Nigeria particularly in
Chukumah et al / Greener Journal of Environmental Management and Public Safety 27
Delta State and presently, considerable gap exist in
literature with regards to the assessment of medical
waste management practices in the state; hence the
need for this study. The main objective of this study is
to assess the status and challenges of medical waste
management practices in Delta State using the State
University Teaching Health Institution as case study.
RESEARCH DESIGN AND METHODOLOGY
Study Area
Delta State University Teaching Hospital,
Oghara with the acronym DELSUTH is a health
institution visited by people of different race, age
group, gender and religion when medically unfit. The
health institution is located at Oghara main town in
Ethiope West Local Government Area of Delta State. It
lies at latitude 5°35'11.99" N and longitude 6°06'0.60"
E (see Figure 1). The health institution is 17 m above
sea level and sited in a town covering an area of 1,175
km2 within the tropical rain forest belt of Nigeria
(Ibekwe, 2015). The health institution is a renowned
and National University Commission (NUC) accredited
University Teaching Hospital owned by Delta State
Government. It was built as an initial 180-bed capacity
ultra-modern specialist hospital and upgraded to 250-
bed capacity. Other important close landmarks include:
Nigerian Naval Logistics Headquarters, Mopol 51 Base
of the Nigeria Police Force, Local Government Council
headquarter, Pan Ocean Flow Station and Gas Plant,
Delta Polytechnic, Otefe and Western Delta University.
The health institution renders services to an estimated
adult population of 288,070 (Ibekwe, 2015) with over
2,064 staff strength comprising of 230 medical doctors
and 572 nurses (see Table 1).
Fig. 1: Map of Oghara showing the Health Institution
Table 1: Characteristics of the health institution
Characteristic
Strength
Number of beds
250
Approximate number of health care workers (post
registration)
532
Consultant Clinicians
94
Doctors
230
Nurses
572
Pharmacists
23
Out-patient attendance in the previous year (2018)
28,416
Source: Fieldwork, 2019
28 Chukumah et al / Greener Journal of Environmental Management and Public Safety
Research Design
The study adopted a cross sectional survey to
assess the status and challenges of medical waste
management practices in Delta State University
Teaching Health Institution, Oghara from March to
August 2019. It made use of a multistage sampling
approach. Firstly, a purposive sampling approach was
employed in selecting the respondents. Out of 240
respondents selected for the study, 50% were health
workers in different areas of specialty like doctor,
nurse; laboratory technologist and pathologist who are
the primary generators of these wastes during the
course of carrying out their professional duties (see
Table 2). The balance 50% of respondents are waste
handlers, out-patients and residents in the community.
Solid waste sampling was performed once per day
from each department within the health institution;
weighed daily for 60 days and quantity recorded
according to its classification (see Table 3) over a
period of 6-months to determine the generation rates.
The methodology applied also consisted of
questionnaire survey and in-depth interview with the
sampled respondents. The information was collected
using forms specifically developed for this purpose.
Site visits was conducted to support and supplement
information gathered in the survey. Interviews and site
visits was helpful in obtaining information about
common practices in the management of wastes.
Questionnaires were developed from studying
previous research on this area, so that they would
cover all basic requirements needed for the study. Self
administered questionnaire was adapted from WHO
recommendation assessment tool. Pre-testing of
questionnaire was made to assess the validity of the
questions out of the study area. Spot-checks and
review of the completed questionnaires were made
daily by the researchers to ensure completeness and
consistency of the information collected. Collected
data were then subjected to further statistical analysis.
Table 2: Breakdown of respondents for the study
S/N
Profession
No of questionnaire administered
Percentage
1
Doctor
30
12.5
2
Nurse
30
12.5
3
Laboratory Technologist
30
12.5
4
Pathologist
30
12.5
5
Waste Handler
40
16.7
6
Out Patients
40
16.7
7
Residents
40
16.7
Total
240
100
Source: Fieldwork, 2019
Ethical approval
Ethical approval was obtained from the ethical
approval committee of the Delta State University,
Abraka. A formal letter of introduction collected from
the Department of Industrial Safety and Environmental
Management, School of Marine Technology, Burutu,
Delta State was given to the University and permission
secured. To clear any misconceptions about the
intention of the study, participants were informed on
the purpose of the study, benefits and harms of
participation. After verbal consent was obtained from
each participant, questionnaires were distributed to
participants and filled in the presence of the data
collectors. Codes were given to participants instead of
names to keep their responses confidential.
Statistical Analysis
The questionnaires were cleaned, coded and
data were entered into Statistical Package for the
Social Sciences (SPSS) version 21 software and
analyzed. Frequency count and percentage table was
used in analyzing the demographic and socioeconomic
characteristics of the respondents.
RESULTS AND DISCUSSION
This study was designed to assess the status
and challenges of medical waste management
practices in Delta State University Teaching Hospital in
order to ascertain if the waste management procedure
applied meets WHO standard for healthcare waste
management. To achieve these set out objectives;
respondents of varying categories were engaged with
typeset questionnaires and personal interview. Data
collected were subjected to descriptive and statistical
analysis. Presented in Table 3 is the categories of
medical waste as outlined by WHO (2004). Table 4
contains summary details of generated waste in the
study area from March to August 2019. The
demographic and socio-economic representation of
the sampled respondents are presented in Table 5,
whereas Figure 2 displays working experience
between health workers and waste handlers.
Perceived facilities for the collection and segregation
of medical waste are shown in Table 6. Table 7
displays facilities for storage and transportation of
medical waste; so also is Table 8 which revealed with
details on the perceived facilities for the treatment and
disposal of waste. Table 9 revealed the conditions of
facilities for waste handler and Table 10 deals with
details on the condition of waste storage facilities.
Respondents perceived categories of medical waste
Chukumah et al / Greener Journal of Environmental Management and Public Safety 29
generated in the study area are displayed in Table 11;
and Table 12 shows the perceived impact of medical
waste on the respondents. Analysis on respondents’
perceived preventive measures for medical waste
management and health workers satisfaction are
shown in Tables 13 and 14.
Table 3: Categories of medical waste
Waste category
Examples
Infectious waste
Waste that may contain pathogens. This includes
used dressings, swabs and other materials or
equipment that has been in contact with infected
patients or excreta. It also includes liquid waste
such as blood specimen, faeces, urine and other
body secretions.
Pathological waste
Waste from human tissues like placentas, blood,
body parts and fetuses. Anatomical waste is a sub-
group of pathological waste and consists of
recognizable body parts.
Waste Sharps
Needles, scalpels, infusion sets, blades and broken
glass
Pharmaceutical waste
This includes expired pharmaceuticals and items
contaminated by pharmaceuticals (bottles, boxes)
which are no longer needed.
Genotoxic waste
Include substances with genotoxic properties that
has the capacity to cause genetic damage such as
certain drugs and genotoxic chemicals.
Chemical waste
Waste containing chemical substances like film
developer, laboratory reagents, solvents and
disinfectants that have expired and no longer
needed.
Waste with high content of heavy metals
This category of waste includes broken
thermometers, gauges, batteries and blood-
pressure.
Pressurized containers
This includes gas cartridges, cylinders and aerosol
cans.
Radioactive waste
Waste containing radioactive substances from
radiotherapy and laboratory research.
General waste
Papers, packaging materials, kitchen-waste,
cardboard, debris, x-rays sheets, garden waste,
tins, food-leftovers, and plastic bags
Source: WHO (2004)
A. Generation of medical waste per department for
the period
The assessment of medical waste is very
important because it helps in organizing the flow chart
of waste, stage by stage; all through from the point of
generation to collection, treatment and final disposal
(Uddin et al., 2014). The quantity of waste generated
by any health institution can only be established
through an assessment process carried out specifically
for that particular healthcare organization. This is
because the quantity of waste generated during a
particular timeframe depends on several factors and
can as well help to provide detailed holistic
30 Chukumah et al / Greener Journal of Environmental Management and Public Safety
management plan. It is therefore imperative to
measure medical waste in order to identify the
categories, nature and types of waste generated as
well as to map out effective management plan to
combat the likely negative impacts on human health
and the general environment (Kelly, 2012).
Average total weight generated medical waste
per kg/day in the departments studied was 948.366
kg/day. This consisted of infectious and non-infectious
waste. Within the study period, the health institution
with a 250-bed capacity recorded an average number
of 174 patients. Medical waste generation rate was
13.598 kg/patient/day with an average bed per day
generation rate of 1.133 kg/bed/day. Kitchen
department had the highest generation rate of 254.448
kg/day followed by internal department (151.31
kg/day), emergency (133.65 kg/day); outpatient clinics
(131.37 kg/day); general surgery (94.22 kg/day) and
least generation coming from NET (9.11 kg/day). The
recorded average generation rate for kitchen
department could probably be due to the number of
patients’ visitors patronizing the kitchen and staff
whose shifts necessitate that they stay late at the
hospital. The overall waste generated at the internal
department (151.31 kg/day) was slightly higher than
the generation rate from emergency unit (133.65
kg/day) even with the emergency ward recording
higher average number of patients. Laboratory
department had a generation rate (18.508 kg/day)
close to the rate from X-ray department (19.25 kg/day).
On the spot observation, revealed that majority of the
waste generated from the laboratory and X-ray
departments are infectious and of high risk; therefore
requiring all necessary measures to keep infectious
waste from non-infectious wastes. This finding agrees
with the assertion made by Yashpal and Poonam
(2000), that there is an urgent need to ensure that
infectious waste are separated from non-infectious
waste. Reason is because infectious waste, which
constitutes about 10-15% when mixed with non-
infectious waste, can render the entire waste
infectious. Also, the observed quantity of generated
wastes at the laboratory unit depended on two major
factors: number of tests per day and nature of these
tests. It was established in this study that the quantity
of generated wastes is proportional to the number of
tests per day. This finding conform the assertion by
Bdour et al. (2007). The total average weight
generated waste per kg/day in the departments
studied were lower than the rate reported by Farzadika
et al. (2009) in Iran University of Medical Sciences
teaching hospital; Tesfahun et al. (2014) in some
selected Ethiopian public and private hospitals but
higher than the rate reported by Madhukumar and
Ramesh (2012) in medical college hospital, Bangalore.
Table 4: Summary of generated waste at DELSUTH (March – August 2019)
Department
Average total
weight generated
(kg/d)
Average
number of
patients
Generation rate
(kg/patient/day)
Percentage by
total weight
General surgery
94.22
62
1.519
9.93
Emergency
133.65
375
0.356
14.093
Internal department
151.31
58
2.608
15.955
Neurology
13.42
9
1.491
1.41
Orthopedic
18.64
17
1.096
1.96
NET
9.11
11
0.828
0.961
Outpatient clinics
131.37
826
0.159
13.852
Operating theatre
78.01
23
3.391
8.23
X-ray unit
19.25
367
0.052
2.03
Pharmacy and Disinfection
11.09
-
-
1.17
Laboratory
18.508
139a
0.133b
0.019
Blood bank
15.34
31
0.494
1.62
Kitchen
254.448
173
1.471
26.830
Total
948.366
174
13.598
100
Total average weight generated = 948.366 kg/day; average number of patients = 174; total number of beds
= 250 beds; generation rate = 13.598 kg/patient/day; generation rate 1.133 kg/bed/day.
a Number of tests per day
b Kg/test/day
B. Demographic and socio-economic
representation of respondents
A total of 240 respondents participated in the
study. Half of these respondents (50%) were health
workers in this order: medical doctors (12.5%), nurses
(12.5%), pathologists (12.5%) and laboratory
technologists (12.5%). This was followed by waste
handlers (16.7%), out patients (16.7%) and residents
(16.7%) (see Table 2). Further analysis revealed that
50% were female respondents whereas the other 50%
were their male counterparts. However, majority of
these female respondents were from the health
workers and waste handler cadre. Also, the analysis
Chukumah et al / Greener Journal of Environmental Management and Public Safety 31
for the male respondents revealed that male from
health workers and out patients constituted over 75%
of the total male respondents. Out of the 240
respondents, the result revealed that a higher
percentage is within the age range of 31-40 years;
followed by age range of 41-50 years and below 30
years. Those above 61 years of age constituted only
3.3% from the total respondents. Uniquely revealed
from the study is that 42.5% from the 120 health
workers’ respondents sampled were predominantly
within the age range of 41-50 years; followed by age
range of 31-40 years which constituted 31.7% and age
range of 51-60 years with a percentage ratio of 22.5%.
Table 5: Demographic and socio-economic characteristics of the respondents
Categories of Respondents
Variables
Health
workers
Waste
handlers
Out patients
Residents
Total
Gender
F
%
F
%
F
%
F
%
F
%
Male
72
60
13
32.5
18
45
17
42.5
120
50
Female
48
20
27
67.5
22
55
23
57.5
120
50
Sub-Total
120
100
40
100
40
100
40
100
240
100
Age group
F
%
F
%
F
%
F
%
F
%
below 30 yrs
4
3.3
10
25
3
7.5
7
17.5
24
10
31 - 40 yrs
38
31.7
21
52.5
9
22.5
14
35
82
34.2
41 - 50 yrs
51
42.5
7
17.5
11
27.5
12
30
81
33.7
51 - 60 yrs
27
22.5
2
5
11
27.5
5
12.5
45
18.8
61 & above
0
0
0
0
6
15
2
5
3.3
Sub-Total
120
100
40
100
40
100
40
100
240
100
Level of education
F
%
F
%
F
%
F
%
F
%
No formal education
0
0
0
0
2
5
0
0
2
0.8
Primary school
0
0
7
17.5
8
20
10
25
25
10.4
Secondary school
0
0
29
72.5
17
42.5
14
35
60
25
Tertiary institution
120
100
4
10
13
32.5
16
40
153
63.8
Sub-Total
120
100
40
100
40
100
40
100
240
100
Level of income
F
%
F
%
F
%
F
%
F
%
below 25,000
0
0
0
0
5
12.5
8
20
13
32.5
26,000 - 55,000
0
0
36
90
15
37.5
12
30
63
26.3
56,000 - 105,000
56
46.7
4
10
14
35
16
40
90
37.5
105,000 & above
64
53.3
0
0
6
15
4
10
74
30.8
Sub-Total
120
100
40
100
40
100
40
100
240
100
32 Chukumah et al / Greener Journal of Environmental Management and Public Safety
Figure 2: Chart showing working experience between health workers and waste handlers
Information as regard the level of education
attained by the respondents revealed that 0.8% had no
formal education; 10.4% had primary school
certificates, 25% were secondary school certificate
holders and 63.8% had one form of degree or the
other from a tertiary institution. Overall average,
revealed that majority of the respondents are
educated. This finding corroborated the submissions
by Mokuolu (2009); Olubukola (2009) and Awodele
(2016). Further finding revealed that 100% of the 120
respondents of health workers sampled had one
university degree or the other conforming that a
university degree is the minimum educational
prerequisite to practice any major medical profession
in Nigeria. This results also supported the earlier
assertion made by Adegbita (2010) and Oli et al.
(2016) in their research work were they observed that
health workers are among the most educated
workforce in developing countries. Outpatients with
secondary school certificate outnumbered other
outpatient respondents with a percentage ratio of
42.5%; followed by those who attended tertiary
institutions (32.5%) and primary school certificate
holders (25%). Investigation on income of respondents
revealed that respondents with an income range of
56,000 – 105,000 had the highest percentage;
followed by those in the range of above 105,000 and
below 25,000. Specifically, it was revealed that a larger
percentage of health workers constituted income wage
of 56,000 – 105,000 and above 105,000. This was so
because Nigeria is a country where the level of
education determines the monthly income of
government workers. Also revealed in the study was
that all the respondents earned a monthly income
above the National Minimum wage which was pegged
at 18,000 during this study.
Figure 2 revealed details on working experience
between health workers and waste handlers since they
are full time workers with the healthcare institution.
37.5% of the sampled waste handlers have worked for
5-7 years, followed by 30% who have worked for 2-4
years; 22.5% have worked for 7-9 years, whereas only
10% have worked for less than 2 years. Among health
workers, 44.2% were recorded for those who have
worked for 5-7 years; 29.2% for those with 7-9 years;
20% for 2-4 years and only 6.6% have worked for less
than 2 years. Respondents in the category of
outpatients were asked the number of days stayed in
the hospital whereas respondents that were residents
were asked to state the number of years they have
lived in the community where the healthcare institution
operates. All these criteria were read out to the
respondents in order to ascertain how knowledgeable
the respondents were about the issue under study.
Residents that have lived between 1-2years and more
than 2years recorded percentage ratio of 14.2% and
15.4% respectively. Among those that have resided in
the study area for a period of 1-10 years has a
percentage score of 42.3%, whereas those that have
resided more than 10 years had 18.5% and less than a
year had 9.6%. Among the respondents that were
outpatient, those that have been visiting the healthcare
institution for one medical challenge or another for the
past one year had a higher percentage of 48.1%.
B. Inventory of Medical Waste Management
Facilities
Handling and storage of special medical waste
consist of strategies for packaging at source and
packaging for transportation. For packaging at source,
all categories of medical waste are placed in leak-proof
and disposable containers. Furthermore, Bdour et al.
(2007) noted in their study that the containers
designed for sharp wastes should be puncture proof.
Glass containers generally are unsuitable based on
specific environmental protection reasons. Also, WHO
(2004) recommended that containers for pathological
waste should be colour-coded to indicate the level of
risk. To ascertain and authenticate inventory of the
facilities used by the healthcare institution studied to
segregate and collect waste; the view of waste
handlers and health workers were used as their
perception will provide a better reliable data to guide
0
5
10
15
20
25
30
35
40
45
Less than
2 Yrs
2 - 4 Yrs 5 - 7 Yrs 7 - 9 Yrs
Percentage (%)
Health workers
Waste handlers
Chukumah et al / Greener Journal of Environmental Management and Public Safety 33
the researchers rather than the perception of patients
and residents, because they are more familiar as well
as major users of these facilities. Critical analysis as
shown in Table 6, detailing the perception of waste
handlers and health workers revealed punctured proof
containers to have the highest Waste Collection Index
of 3.54 with a deviation of 0.28 from the mean. This
was followed by colour waste container having a WCI
of 3.43 and deviation of 0.17 from the mean. It was
also revealed that plastic bag and colour coded bins
had WCI that were slightly below the mean with
deviation of -0.03 and -0.04 respectively. Conveyor
had Waste Collection Index value of 2.87 which was
far below the mean and a deviation of -0.39.
Table 6: Facilities for the collection and segregation of medical waste
Facilities
Rating
F
SWV
WCI
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Puncture proof
containers
315
221
26
4
0
160
566
3.54
3.26
0.28
0.0784
Colour waste container
340
125
53
31
0
160
549
3.43
0.17
0.0289
Plastic bag
200
229
77
4
6
160
516
3.23
-0.03
0.0009
Colour coded bins
240
157
95
23
0
160
515
3.22
-0.04
0.0016
Conveyor
145
137
155
4
18
160
459
2.87
-0.39
0.1521
Total
16.29
0.2619
Lack of specific and affordable transportation
facilities in the management of healthcare institution’s
waste as well as lack of monitoring capacities have
been reported by several scholars in other parts of the
world to hamper smooth medical waste treatment and
disposal options (Abor and Anton, 2008; Ali and
Kuroiwa, 2009; Path, 2009). Oke (2008) asserted that
to avoid waste accumulation, collection must be on a
regular basis. Alagoz and Kocasoy (2007) noted in
their study that medical waste must be transported to a
central storage area within the healthcare institution
before being treated and removed. According to
Yawson (2014), medical waste collection must follow
specific routes through the healthcare facilities to
reduce the passage of loaded carts from the wards
and other clean areas. The carts should be easy to
load and unload as well have no sharp edges that can
damage waste bags or containers. Ananth et al. (2010)
reported that transportation of medical waste has not
been given the attention needed. Results in Table 7
shows the analysed rating difference on waste storage
and transportation facilities; which are mandatory for
the smooth movement of medical waste from on-site to
off-site. The result revealed that lidded container has
the highest Waste Storing Index of 3.61 with deviation
of 1.18 from the mean; followed by storage house
(WSI 3.41, deviation 0.98); hand cart (SWI 3.14,
deviation 0.71) and waste skip (SWI 2.99, deviation
0.56). It was also observed that the mean was higher
than the values of other facilities in descending order:
wheeled trolley (SWI 2.16, deviation -0.27); wheeled
bin (SWI 1.84, deviation -0.59); bin lorry (SWI 1.28,
deviation -1.15) and wheelbarrow (SWI 1.01, deviation
-1.42). This has also been reported by Ramokate and
Basu (2009); Adegbita et al. (2010) and Ananth et al.
(2010), where in their various studies they observed
lidded containers, storage house and hand cart to be
among the majority of facilities needed for the storage
and transportation of special healthcare waste.
Table 7: Facilities for storage and transportation of medical waste
Reasons
Rating
F
SWV
WSI
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Lidded plastic container
350
189
29
10
0
160
578
3.61
2.43
1.18
1.3924
Storage house
290
165
83
3
5
160
546
3.41
0.98
0.9604
Hand cart
300
45
104
53
0
160
502
3.14
0.71
0.5041
Waste skip
215
145
98
0
21
160
479
2.99
0.56
0.3136
Wheeled trolley
0
165
113
51
16
160
345
2.16
-0.27
0.0729
Wheeled bin
0
85
122
51
36
160
294
1.84
-0.59
0.3481
Bin lorry
0
0
77
89
39
160
205
1.28
-1.15
1.3225
Wheelbarrow
45
0
0
31
86
160
162
1.01
-1.42
2.0164
Total
19.44
6.9304
34 Chukumah et al / Greener Journal of Environmental Management and Public Safety
Proper selection of disposal sites is a
prerequisite for efficient and effective disposal of waste
Bathma et al. (2012). Sites for treatment technology
options must be located far away from built
environment and the disposal technology designed in
such a way that it meets standard to safeguard the
environment. Results of facilities for the treatment and
disposal of medical waste as presented in Table 8
revealed landfill and incineration to have the highest
values of WTI (waste treatment index) of 3.63 and 3.61
respectively with 1.18 and 1.16 deviations from the
mean. Open pit dumping and composting also had
positive WTI of 3.58 and 3.14. Other facilities
according to the table hierarchy had values that were
less than the mean. The fact as represented in Table 8
revealed that landfill and incineration are the most
widely used means of disposing the generated waste
from the healthcare institution studied. This however
disagree with Madhukumar and Ramesh (2012), who
reported burial pit and landfill as the most commonly
used measures to dispose medical waste in medical
college hospital, Bangalore.
Table 8: Facilities for the treatment and disposal of medical waste
Reasons
Rating
F
SWV
WTI
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Land fill
239
165
120
53
4
160
581
3.63
2.45
1.18
1.3924
Incineration
265
145
105
63
0
160
578
3.61
1.16
1.3456
Open pit burning
231
167
125
51
0
160
574
3.58
1.13
1.2769
Composting
190
143
105
62
3
160
503
3.14
0.69
0.4761
Steam sterilization
45
122
68
53
24
160
312
1.95
-0.50
0.2500
Gas disinfection
0
88
90
83
50
160
311
1.94
-0.51
0.2601
High-level disinfection
0
0
113
79
56
160
248
1.55
-0.90
0.8100
Burial pits
0
0
0
145
73
160
218
1.36
-1.09
1.1881
Recycling
60
42
0
0
98
160
200
1.25
-1.20
1.4400
Total
22.01
8.4392
Considering the type of waste segregation in
view with the responses of waste handlers and health
workers sampled which accounted for 66.7% out of
240 respondents; 91.2% of them revealed that there
exist devisable means of segregating waste at source
from the point of generation in the study area; 48.6%
of the respondents consented that leak proof container
is the major segregation facilities mainly used. The
observed finding in this study was consistent with the
report by Mokuolu (2009) in another study in Nigeria.
Furthermore, 27.4% of the sampled respondents
affirmed coloured coded bins as the facility used for
segregating medical waste; whereas 9.6% attested to
coloured waste container as the major segregation
facilities used in the study area. Moreover,
respondents who affirmed plastic bag as the
segregation devise accounted for 15.9%. Further
findings revealed that respondents who consented that
waste handlers went through the routine of waste
management training in order to equip them with detail
background knowledge on risk associated with
improper medical waste handling were 75.2%.
Table 9: Conditions of facilities for waste handler
Facilities for
Handler
Rating
F
SWV
FCI
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Heavy duty gloves
390
129
102
23
0
160
644
4.03
2.39
1.64
2.6896
Protective clothes
227
163
154
24
2
160
570
3.56
1.17
1.3689
Safety shoes
215
165
120
16
0
160
516
3.23
0.84
0.7056
Goggles
128
65
115
35
0
160
343
2.14
-0.25
0.0625
Apron
48
72
66
29
13
160
228
1.43
-0.96
0.9216
Mask
55
0
135
11
7
160
208
1.30
-1.09
1.1881
Head cap
0
0
98
45
22
160
165
1.03
-1.36
1.8496
Total
16.72
8.7859
Chukumah et al / Greener Journal of Environmental Management and Public Safety 35
Table 9 shows the result on the assessment of
health workers’ perceived condition of equipment used
by waste handlers in the study area for protection
against possible health risk associated with medical
waste management. Result from the calculated facility
condition index (FCI) revealed heavy duty gloves
which have the highest value (FCI 4.03; deviation
1.64) top the equipment used by waste handlers. This
was followed by protective clothing (FCI 3.56;
deviation 1.17) and safety shoes (FCI 3.23; deviation
0.84). Other equipment in descending order goggle
(2.14); apron (1.43); mask (1.30) and head cap (1.03)
were observed to have recorded values that was
below the mean with deviations indicating negative
sign.
Table 10: Condition of waste storage facilities
Criteria for waste storage
plant
Rating
F
SWV
SFI
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Good accessibility
375
229
57
16
0
160
667
4.17
3.13
1.04
1.0816
Far from the hospital room
320
286
0
41
5
160
652
4.08
0.95
0.9025
Hygiene and sanitation
240
130
180
43
0
160
593
3.71
0.58
0.3364
Exclusively sited
82
282
81
25
0
160
470
2.94
-0.19
0.0361
Adequate security
115
77
125
88
13
160
418
2.61
-0.52
0.2704
Close to site door
0
0
77
70
58
160
205
1.28
-1.85
3.4225
Total
18.79
6.0495
The condition of waste storage facilities were
analysed in the study, employing National Healthcare
Waste Management standard guidelines for citing
waste storage plants. The opinion of respondents were
sought in order to ascertain if the criteria as stipulated
in the National Healthcare Waste Management Policy
and National Healthcare Waste Management Plan
(NHCWMP) were met in citing the storage plants.
From the results, good accessibility of storage plant
recorded the highest Storage Factor Index value (SFI)
of 4.17. Next indicator with a higher SFI value above
the mean was far from the hospital room (4.08);
followed by hygiene and sanitation (3.71). Indicators
like exclusively sited (SFI 2.94), adequate security (SFI
2.61) and close to site door (SFI 1.28) had SFI values
that were below the mean. Also observed from Table
10 is that indicators in descending order from
exclusively sited had negative deviations (-0.19, -0.52
and -1.85) from the mean.
C. Respondents’ Perceived Medical Waste
Generated
To determine the appropriate waste disposal
technology for medical waste, it is necessary to
estimate the quantities and compositions of waste
generated per annual and classify the waste based on
their characteristics (Longe, 2012). Only after then can
the different appropriate technologies be selected,
adopted and applied at different stages of medical
waste management. To ascertain the perceived view
of respondents on the quantity of waste generated in
the study, the perception of all the entire categories of
respondents used were analysed in this section.
Waste generated from the study was categorized into
eleven different types. This categorization was in
accordance with medical waste classification by WHO
(2014) and NHCWMP (2018). From the perceived view
of respondents sampled during the study period from
March to August 2019; infectious waste was recorded
as the most generated waste in the study; having the
highest Medical Waste Index (MWI) value of 4.55 with
deviation of 1.76 from the mean. Isolation waste was
observed to have the second highest MWI value of
4.53 and deviation of 1.74 (see Table 11). Other types
of medical waste with recorded positive values from
the mean were waste sharps (3.58); pathological
waste (3.30); chemotherapeutic waste (3.18) and
radioactive waste (2.94) respectively. Medical wastes
like general and pharmaceutical wastes; pressurized
containers, chemical and genotoxic wastes had MWI
values that were below the mean. This lower MWI
values recorded for these categories of medical waste
reflects low generation rate in the study.
36 Chukumah et al / Greener Journal of Environmental Management and Public Safety
Table 11: Respondents perceived categories of medical waste generated
Categories of medical
waste
MWI for the study area
MWI
MWI - *MWI
(MWI - *MWI)2
Health
worker
Patients
Residents
Infectious waste
4.54
4.68
4.43
4.55
1.76
3.09
Isolation waste
4.57
4.34
4.69
4.53
1.74
3.03
Waste sharps
3.91
3.72
3.11
3.58
0.79
0.62
Pathological waste
3.30
3.49
3.12
3.30
0.51
0.26
Chemotherapeutic waste
3.28
3.22
3.05
3.18
0.39
0.15
Radioactive waste
3.14
3.01
2.68
2.94
0.15
0.02
General waste
2.62
2.36
2.27
2.42
-0.37
0.14
Pharmaceutical waste
2.03
2.45
2.00
2.16
-0.63
0.39
Pressurized container
1.18
1.62
1.84
1.55
-1.24
1.54
Chemical waste
1.06
1.37
1.16
1.19
-1.60
2.56
Genotoxic waste
1.01
1.22
1.58
1.27
-1.52
2.31
Total
30.64
31.48
29.93
30.67
*MWI
2.78
2.86
2.72
2.79
D. Effect of Medical Waste to the Environment
Respondents’ perceived impact of medical waste
on the environment was analysed and represented in
Table 12. It is a known fact that the effects of medical
waste on human population and the environment
varies in general. The major impact of waste
generated from the healthcare institution studied on
the environment was categorized and respondents’
opinion sought to ascertain the most prevalent effect in
the study area. The result revealed a recorded mean
Waste Effect Index (WEI) value of 3.49 in the study.
Furthermore, it was revealed that major effects such
as offensive odour had the highest WEI value of 4.72
and deviation of 1.23 from the mean. This was
followed by other effects like exposure to fugal and
bacterial infection (4.28) and airborne diseases (3.72)
respectively. Two other effects (contaminated
groundwater -2.99 and radioactive diseases -1.76) had
values that were lesser than the mean in the study.
Table 12: Perceived impact of medical waste on the respondents
Effects
WEI for the study area
WEI
WEI - *WEI
(WEI - *WEI)2
Health
worker
Patients
Residents
Offensive odour
4.97
4.52
4.69
4.72
1.23
1.51
Exposure to fugal,
bacterial and viral
infection
4.43
4.06
4.36
4.28
0.79
0.62
Airborne diseases
3.85
3.53
3.78
3.72
0.23
0.05
Contaminated
groundwater
3.32
2.66
3.01
2.99
-0.5
0.25
Radioactive disease
1.87
1.89
1.52
1.76
-1.73
2.99
Total
18.44
16.66
17.36
17.47
*WEI
3.69
3.33
3.47
3.49
E. Preventive Measure for Proper Medical Waste
Management
Revealed in table 13 are respondents’ perceived
preventive measures for medical waste management
in the study area. From the analysis, it was revealed
that enforcement of regulation had the highest Waste
Preventive Index (WPI) value of 4.84 and deviation of
1.15 from the mean. Respondents’ opinion as revealed
in the result further affirmed the finding that enforcing
rules and regulations serve as check and balance to
stakeholders for strict adherence to standards in
properly managing medical waste. Other preventive
measures as perceived by the respondents are
environmental management system (4.48); proper
transportation from on-site to off-site (3.94) and
Chukumah et al / Greener Journal of Environmental Management and Public Safety 37
identification of each hazardous waste (3.32)
respectively with deviations of 0.79; 0.25 and -0.37.
Counting of total weight of hazardous materials and
recycling had the least WPI values of 3.15 and 2.39
respectively. This reveled that respondents do not
consider these measures as the best preventive
measures from the effects of medical waste.
Table 13: Respondents’ perceived preventive measures for medical waste management
Preventive Measures
WPI for the study area
WPI
WPI - *WPI
(WPI - *WPI)2
Health
worker
Patients
Residents
Enforcement of
regulation
4.97
4.59
4.97
4.84
1.15
1.32
Environmental
management system
(EMS)
4.56
4.11
4.78
4.48
0.79
0.62
Proper transportation
from on-site to off-site
4.00
3.62
4.21
3.94
0.25
0.06
Identify each hazardous
waste
3.42
3.04
3.49
3.32
-0.37
0.14
Count the total weight of
hazardous materials
3.12
3.03
3.30
3.15
-0.54
0.29
Recycling
1.88
2.96
2.34
2.39
-1.30
1.69
Total
21.95
21.35
23.09
22.12
*WPI
3.66
3.56
3.85
3.69
F. Health Workers Satisfaction
The perception of health workers was used in
this section to measure the criteria for staff welfare that
enhances their motivation to the job. Statistical
analysis as represented in Table 14, revealed workers’
welfare with Health Workers Satisfaction Index (HIS)
value of 3.14 as the most preferred option among the
listed criteria. This was followed by provision of
equipment (HSI 3.13) with deviation of 0.20 from the
mean. Values of other criteria for staff welfare
analysed were lower than the mean and had negative
deviation values from the mean. These are arranged in
descending order in Table 14. This finding did not
necessarily reflect that those criteria with negative
deviation values from the mean are not among the
preferred options rather they might not work effectively
for health workers welfare in the study area.
Table 14: Health workers satisfaction
Criteria for Welfare
Rating
F
SWV
HIS
̅
(x-
̅)
(x-
̅)2
5
4
3
2
1
Workers welfare
222
105
128
36
11
160
502
3.14
2.93
0.21
0.0441
Provision of equipment
215
173
59
38
16
160
501
3.13
0.20
0.0400
Training for the handlers
220
109
59
58
21
160
467
2.92
-0.01
0.0001
Adequate funding
205
117
71
52
19
160
464
2.90
-0.03
0.0009
Government intervention
170
121
104
44
20
160
459
2.87
-0.06
0.0036
Adherence to medical waste
management procedure
135
97
125
24
36
160
417
2.61
-0.32
0.1024
Total
17.57
0.1911
CONCLUSION
Proper management of medical waste generated
is an integral aspect of public health and when
improperly managed can create conditions that may
adversely impact on public health and the
environment. This study assessed the status and
challenges of medical waste management practices in
Delta State University Teaching Health Institution for a
period of six months spanning from March to August
2019 in order to ascertain the efficiencies of the
managerial strategy adopted. The study was
sectionalized into two aspects; with the first covering
analysis on quantity of waste generated and the
second, covering analysis on administered
questionnaires to the respondents. Average total
38 Chukumah et al / Greener Journal of Environmental Management and Public Safety
weight generated waste from all the departments
studied was estimated to be 948.366 kg/day. This
consisted of infectious and non-infectious waste.
Within the study period, the health institution with 250-
bed capacity recorded an average number of 174
patients. Medical waste generation rate was 13.598
kg/patient/day with an average bed per day generation
rate of 1.133 kg/bed/day. Kitchen department had the
highest generation rate of 254.448 kg/day followed by
internal department (151.31 kg/day), emergency
(133.65 kg/day); outpatient clinics (131.37 kg/day);
general surgery (94.22 kg/day) and least generation
rate coming from NET (9.11 kg/day). The waste
generation rate calculated in this study excluded
seasonal variation. It was observed that segregation of
waste at source exist within the health institution but
poorly implemented and monitored as medical waste
was still being mixed and dumped with general wastes
that are collected, transported and disposed in a
similar manner. Punctured proof containers, colour
waste containers and plastic bags were the most
commonly used waste collection and segregation
equipment. It was observed that segregation was not
conducted according to NHCWMP standards. Waste
generated within the institution were collected on a
daily basis and transported to a designated place for
temporary storage. Two waste handlers were assigned
to each department to do collection at different
collection units. Lidded plastic container, storage
house, hand cart, waste skip and wheeled trolley were
mainly used to store and transport waste. A
fundamental issue from the finding was insufficient
waste containers to handle volumes of medical waste.
Analysis from the questionnaire revealed that higher
percentage of waste handlers were poorly educated.
Irrespective of the availability of personal protective
equipments; they were observed to be wrongly used
by waste handlers. Land fill was revealed to be the
most preferred final disposal option used in the study
area. However, in some situation incineration and
open pit burning were also adopted. This study has
helped to establish a baseline data and statistics on
medical waste management strategy in Delta State
University Teaching Health Institution.
ACKNOWLEDGEMENTS
The authors gratefully appreciate the permission
granted by Delta State University Teaching Hospital to
carry out this research. The authors are highly
indebted to research assistants used in data collection.
Staffs of Delta State Waste Management Board are
also not left out for their support.
Funding: No funding sources
Conflict of interest: None declared
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Cite this Article: Chukumah CO; Ndinwa GCC; Akpafun S (2019). A Study to Assess the Status and
Challenges of Medical Waste Management Practices in a University Health Institution, Southern Nigeria.
Greener Journal of Environmental Management and Public Safety, 8(1):25-39.
