ASSESSING HEALTHCARE WASTE MANAGEMENT PRACTICE AND ITS PREDICTORS AMONG HEALTH WORKERS IN PRIVATE HEALTH FACILITIES IN CAMEROON: CASE STUDY OF MBINGO BAPTIST HOSPITAL, BAINGO, CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Healthcare facilities may produce hazardous waste that poses potential risks to healthcare staff, patients, the local community, and the environment if not managed appropriately (Kumar, 2018). Healthcare waste (HCW) is a distinct sort of trash that is well recognised as one of the most hazardous and destructive pollutants found in communities (Debere et al., 2021; Kumar, 2018). The trash may consist of sharp objects, non-sharp objects, blood, body parts, chemicals, medications, medical devices, radioactive materials, and other types of biological waste (Gelaye, 2021). According to the World Health Organisation (WHO) in 2022, approximately 15% of the healthcare waste produced is classified as hazardous due to its potential to be infectious, poisonous, or radioactive. Healthcare facilities worldwide generate substantial quantities of potentially infectious and hazardous waste annually, posing a significant public health risk (WHO, 2022). Health institutions have the responsibility of ensuring that their actions related to waste processing, treatment, and disposal do not have any harmful impacts on human health or the environment (Kumar, 2018). Nevertheless, the proportion of waste produced by healthcare establishments has been relatively neglected compared to other forms of pollution, especially in low-income countries (Debere et al., 2021; Kumar, 2018).

The practice of healthcare waste management (HCWM) includes the following steps: categorising and labelling waste containers based on the type of healthcare waste (segregation), providing appropriate protective equipment and utility supply for waste transportation (collection), and allocating secure and sufficient temporary storage space for waste (storage). Additionally, it involves activities such as transportation, treatment, and disposal of the waste (WHO, 2022; Debere et al., 2021; Kumar, 2018) There is a global deficiency in the provision of safe waste management services for healthcare waste, particularly in low-income countries (Mol et al., 2022). On a global scale, around 33% of healthcare facilities fail to adequately handle healthcare waste. Managing healthcare workers (HCWs) has emerged as a highly significant issue in developing countries due to the adverse impact of mishandling medical waste on various aspects such as the environment, public health, workplace safety, water quality, and the increased likelihood of disease transmission (Marinkovic et al., 2018). The healthcare waste management (HCWM) in many low-income countries has frequently been inadequate, giving rise to worries regarding the use of inappropriate procedures in these nations (Omoleke et al., 2021).

While high income countries typically have higher levels of healthcare waste (HCW) production compared to middle income and low-income countries, a study conducted in 22 low-income nations revealed alarming concerns regarding HCW. The study found that between 18% and 64% of healthcare institutions in these countries employed inadequate waste disposal methods, highlighting potential issues (Dehghani et al., 2021). Many countries, particularly low-income nations, have inadequate practices, capacities, and policies for dealing with healthcare waste disposal, which need to be intensified given the enormity of the problem. While healthcare is gaining significance in the national health plans of numerous countries, there has been a lack of focus on healthcare workers (HCW) in low-income nations (Chisholm et al., 2021). Several African nations, such as Ethiopia, Botswana, Nigeria, Algeria, and Cameroon, lack national rules for the proper disposal of healthcare waste (HCW) (Chisholm et al., 2021). This is because health concerns often vie with other economic sectors for the scarce resources that are available. Consequently, the management of healthcare waste (HCW) does not receive the appropriate level of importance that it should. In numerous low-income nations, there is still a practice of managing and disposing of hazardous healthcare waste (HCWs) together with regular household garbage. This poses a substantial health hazard to municipal personnel, the general public, and the environment. Furthermore, the current methods of segregating, collecting, and storing HCWs in isolated locations are inadequate, as highlighted by Yazie et al. (2019).

Researchers in low-income nations have examined the current practices of healthcare waste management (HCWM) in specific healthcare facilities within their countries. A case study conducted in Nigeria discovered that the amount of healthcare waste management (HCWM) practice was determined to be nonexistent, indicating that it was unsustainable.34 The percentage of healthcare waste (HCW) produced in healthcare facilities in Ethiopia varied between 21% and 70%.Sixteen Poor healthcare waste management (HCWM) practices in the country, such as open dumping and uncontrolled burning, increase the likelihood of transmitting infectious diseases like the hepatitis B virus (HBV), causing environmental contamination, offensive odours, and the proliferation of insects, rats, and worms. These risks can be mitigated by implementing appropriate HCWM practices (Ezeudu et al., 2022). The main issues related to inadequate healthcare waste management (HCWM) practice include a lack of knowledge regarding the health risks of HCW, insufficient training in proper waste management techniques, the absence of effective waste management and disposal systems, limited financial and human resources, and a low level of importance given to the topic. The ability of a healthcare facility to efficiently handle healthcare workers (HCWs) is impacted by several factors, including the dedication and professional background of the staff, their level of knowledge and training, the availability of waste management facilities, the presence of a dedicated waste management team, and adherence to a national regulatory framework (Muluken et al., 2019).

In order to address the challenges posed by healthcare waste (HCW), the World Health Organisation (WHO) has created a comprehensive worldwide guideline document. This document covers various aspects like the regulatory framework, planning considerations, waste reduction and recycling, proper handling, storage, and transportation, treatment and disposal alternatives, as well as training (Mol et al., 2022). Furthermore, the WHO/UNICEF Joint Monitoring Program has initiated a global campaign to guarantee that all healthcare facilities possess sufficient water, sanitation, and hygiene services. This initiative aims to address healthcare waste (HCW) and regularly report on the proper management of HCW, as part of broader monitoring endeavours focused on water and sanitation in healthcare facilities (WHO, 2022). Despite advancements in the past decade in the management of healthcare waste (HCW) following the World Health Organization's distribution of guidelines on national HCW management plans in sub-Saharan countries, healthcare institutions still face significant challenges in handling HCW and mitigating potential risks. Lessons learnt from India's experience have been valuable for low-income nations. However, the effective management of HCW and the prevention of potential hazards remain crucial concerns. Several low-income nations lack adequate rules or fail to enforce them, highlighting the necessity for government dedication and assistance in achieving universal and sustainable progress. Additionally, certain healthcare facilities do not comply with their country's Healthcare Waste Management (HCWM) strategy (WHO, 2022).

The management of healthcare waste in Cameroon poses substantial difficulties, especially in private health facilities where there may be lower resources and less strict regulatory scrutiny compared to public institutions. The problem is worsened by the absence of standardised waste management protocols, inadequate infrastructure, insufficient training for healthcare staff, and restricted availability of suitable waste disposal technology (Fongang & Achu, 2021). Consequently, numerous healthcare establishments in Cameroon, particularly those in the private sector, face challenges in efficiently handling their waste. The Mbingo Baptist Hospital, a prominent private healthcare facility in Baingo, Cameroon, serves as a crucial case study for comprehending the present condition of healthcare waste management in the private sector. Mbingo Baptist Hospital, a prominent healthcare provider in the region, manages a significant amount of medical waste on a daily basis. The actions and attitudes of healthcare professionals about waste management in this institution can offer useful insights into the efficacy of current policies and pinpoint opportunities for enhancement. Healthcare workers' compliance with appropriate waste management practices can be influenced by various factors, such as their level of training, awareness of the hazards linked to improper waste disposal, resource availability, and the existence of explicit guidelines and enforcement measures (Sambo et al., 2017). Comprehending these factors is essential for creating focused interventions that can improve waste management practices in healthcare environments. Therefore, the necessity for this investigation arises.

1.2 Statement of the problem

The management of healthcare waste in Cameroon is still a major issue, especially in private health facilities where there may be less supervision and allocation of resources compared to public institutions. Inadequate handling of healthcare waste presents significant hazards to public health, the environment, and the well-being of healthcare personnel. The dangers encompass the transmission of infectious diseases, pollution of soil and water resources, and contact with dangerous substances, all of which can have extensive implications for both the local community and the wider ecosystem.

Research has indicated that health personnel employed at private facilities may receive inadequate training in the implementation of appropriate waste management protocols, in contrast to their counterparts working in public hospitals. The absence of sufficient training can result in incorrect trash segregation and handling (Nguetnkam & Tsafack, 2019). Achu (2021) claims that private health facilities frequently have limited access to suitable waste management infrastructure, including storage and treatment facilities. These circumstances can result in inefficient waste management methods and heightened health hazards (World Health Organisation, 2020). Furthermore, adherence to healthcare waste management standards is vital to guarantee the secure and efficient handling of waste. Nevertheless, private institutions such as Mbingo Baptist Hospital may encounter difficulties in complying with these laws as a result of insufficient regulatory supervision and assistance (Sambo et al., 2017).

Although proper waste management is crucial, there is data indicating that numerous private health facilities in Cameroon, notably Mbingo Baptist Hospital, face difficulties in implementing standardised waste management methods. This issue is frequently exacerbated by reasons such as insufficient training for healthcare personnel, inadequate infrastructure, restricted availability of waste disposal technology, and a lack of explicit instructions and enforcement procedures (Fongang & Achu, 2021). Mbingo Baptist Hospital, a prominent private healthcare provider in Baingo, faces distinctive issues due to the considerable volume and intricate nature of the healthcare waste it generates. Healthcare professionals at this establishment have a vital responsibility in guaranteeing the safe and efficient management of waste. Nonetheless, the extent to which they follow waste management protocols and practices may be affected by several factors, such as their degree of expertise, access to resources, institutional backing, and understanding of the health and environmental hazards linked to inappropriate waste disposal Nguetnkam & Tsafack, 2019).

The absence of extensive data on the management of healthcare waste in private health institutions in Cameroon, specifically at a well-known institution such as Mbingo Baptist Hospital, underscores a significant deficiency in the current body of literature. In order to develop effective interventions that can enhance waste management and guarantee the safety of healthcare workers and the community, it is essential to have a comprehensive awareness of the existing practices and the factors that influence them. This study aims to fill this void by evaluating the healthcare waste management practices among healthcare professionals at Mbingo Baptist Hospital and identifying the primary factors that influence these practices.

Objectives of the study

The primary objective of this study is to critically assess healthcare waste management practice and its predictors among health workers in private health facilities in Cameroon: case study of Mbingo Baptist Hospital, Baingo, Cameroon. Specific objectives of this study are to:

To evaluate the current healthcare waste management practices among health workers at Mbingo Baptist Hospital

To identify the predictors of effective healthcare waste management practices among health workers

To analyze the extent of training and awareness regarding healthcare waste management among health workers at Mbingo Baptist Hospital.

To assess the role of hospital management and policies in shaping healthcare waste management practices.

To propose strategies for improving healthcare waste management practices at Mbingo Baptist Hospital

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What are the current healthcare waste management practices among health workers at Mbingo Baptist Hospital?

What are the key predictors of effective healthcare waste management practices among health workers?

How aware are health workers of the health and environmental risks associated with improper waste management?

How do hospital management and institutional policies influence healthcare waste management practices?

What strategies can be implemented to improve healthcare waste management practices at Mbingo Baptist Hospital?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The current healthcare waste management practices among health workers at Mbingo Baptist Hospital is inadequate.

Ha: The current healthcare waste management practices among health workers at Mbingo Baptist Hospital is adequate.

1.6 Significance of the study

The importance of this study, which evaluates the practices of healthcare waste management and the factors that influence them among health professionals at private health facilities in Cameroon, particularly at Mbingo Baptist Hospital in Baingo, is multifaceted. The subject matter deals with crucial matters that have extensive consequences for the well-being of the general population, the sustainability of the environment, the practices of regulations, and the management of healthcare facilities.

Efficient management of healthcare waste is crucial in order to minimise the health hazards that can arise from inappropriate disposal of waste. This study seeks to improve the safety of patients and healthcare workers at Mbingo Baptist Hospital by assessing current procedures and finding areas for improvement. Enhanced waste management practices can mitigate the likelihood of infections, injuries caused by sharp objects, and exposure to dangerous substances, therefore promoting improved public health outcomes.

Furthermore, inadequate management of healthcare waste might result in substantial environmental contamination. The study's primary objective is to evaluate and enhance waste management techniques, which is in line with endeavours to reduce environmental pollution. Appropriate disposal and treatment of trash can avert soil and water contamination, thereby promoting a more robust ecosystem. Environmental sustainability is of growing importance in Cameroon, given its current setting.

Furthermore, this study offers significant insights into the compliance of private health institutions with both national and international standards for the management of healthcare waste. The research can assist identify areas where compliance is lacking, which can then be used to make modifications to policies and strengthen regulatory enforcement. This will guarantee that private facilities adhere to set standards and practices.

Furthermore, private health institutions like Mbingo Baptist Hospital might enhance their operational procedures by comprehending and enhancing waste management techniques. This include the enhancement of resource utilisation, the refinement of waste segregation and disposal techniques, and the allocation of funds towards suitable infrastructure. Improved waste management can also result in cost savings by decreasing the necessity for remedial measures and emergencies associated with garbage mishandling. The study aims to provide insight into the present state of training and knowledge among healthcare professionals about waste management. This information is vital for the development of focused training programs and capacity-building activities that can enhance waste management procedures in private health facilities in Cameroon. Staff members that receive superior training are more inclined to follow established guidelines, leading to enhanced efficiency in waste management.

Furthermore, the project will provide useful data to the current body of research on healthcare waste management practices and factors that influence them among healthcare workers, specifically in private healthcare institutions in Cameroon and similar environments. The findings may identify certain areas that want more examination, providing direction for future research endeavours in the realm of biomedical waste management and healthcare waste practices.

1.7 Scope of the study

Broadly, this study focus is to critically assess healthcare waste management practices and its predictors among health workers in private health facilities in Cameroon. Specifically, this study seeks to evaluate the current healthcare waste management practices among health workers across Cameroon, identify the predictors of effective healthcare waste management practices among health workers in Cameroon and analyze the extent of training and awareness regarding healthcare waste management among health workers in Cameroon. 

Further, this study will focus on assessing the role of hospital management and policies in shaping healthcare waste management practices in Cameroon and it also seeks to propose strategies for improving healthcare waste management practices in Cameroon.

 The study is carried out in Mbingo Baptist Hospital, Baingo Cameroon. 

1.8 Limitations of the study

During the assessment, the researchers noted certain minor constraints, which are customary in any human endeavour. The main limitation was the lack of extensive literature on the subject, resulting from the scarcity of data on assessing healthcare waste management practice and its predictors among health workers in private health facilities in Cameroon: case study of Mbingo Baptist Hospital, Baingo, Cameroon. Therefore, a significant allocation of time and exertion was necessary to determine the appropriate materials, books, or information and gather data. 

Furthermore, this study is constrained by its small sample size and narrow geographic scope, focusing just on Mbingo Baptist Hospital, Baingo, Cameroon. Therefore, the capacity to extrapolate the findings of this study to a broader context is restricted, underscoring the need for more investigation. 

Moreover, the researcher's limitations were primarily ascribed to financial constraints, as they are a student who lacks the requisite financial means to sustain themselves. The exorbitant transportation rates at the research site posed a challenge in meeting the financial obligations related to transportation expenses.

Furthermore, the researcher faced a time constraint due to the need to do this research while simultaneously fulfilling the obligations of attending lectures and participating in other educational pursuits.

1.9 Definition of terms

Medical waste: Medical waste is any waste containing infectious or potentially infectious materials. These wastes are generated during the diagnosis, treatment, and immunization of humans and animals. Biomedical wastes can be in both solid and liquid forms.

Medical waste management: Medical waste management plays a crucial role in safeguarding the safety and well-being of individuals and the environment. It encompasses the proper handling, treatment, and disposal of waste generated by healthcare facilities.

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