generalwmp10

RESEARCHARTICLEOpenAccessHealthcarewastemanagementpracticesandsafetyindicatorsinNigeriaAbayomiSamuelOyekale1*andTolulopeOlayemiOyekale2AbstractBackground:Adequatemanagementofhealthcarewaste(HCW)isaprerequisiteforefficientdeliveryofhealthcareservices.
InNigeria,thereareseveralconstraintsmilitatingagainstpropermanagementofHCW.
Thisisraisingsomeenvironmentalconcernsamongstakeholdersinthehealthsector.
Inthisstudy,weanalyzedthepracticesofHCWmanagementanddeterminantsofrisky/safeindicesofHCWdisposal.
Methods:Thestudyusedthe2013/2014ServiceDeliveryIndicator(SDI)datathatwerecollectedfrom2480healthcarefacilitiesinNigeria.
Descriptivestatistics,PrincipalComponentAnalysis(PCA)andOrdinaryLeastSquare(OLS)regressionwereusedtoanalyzethedata.
Results:Theresultsshowedthat52.
20%and38.
21%ofthesampledhealthcarefacilitiesfromCrossRiverandBauchistatespossessedguidelinesforHCWmanagement,respectively.
TrainingsonmanagementofHCWwereattendedby67.
18%and53.
19%ofthehealthcarefacilitiesfromCrossRiverandImostates,respectively.
Also,32.
32%and29.
50%ofhealthcarefacilitiesfromruralandurbanareaspreviouslysentsomeoftheirstaffmembersfortrainingsonHCWmanagement,respectively.
Sharpandnon-sharpHCWwereburntinprotectedpitsin45.
40%and45.
36%ofallthesampledhealthcarefacilities,respectively.
Incineratorswerereportedtobefunctionalinonly2.
06%ofthetotalhealthcarefacilities.
InBauchiandKebbistates,23.
58%and21.
05%ofthehealthcarefacilitiesrespectivelyburntsharpHCWwithoutanyprotection.
UsingPCA,computedriskyindicesfordisposalofsharpHCWwerehighestinBayelsastate(0.
3070)andKebbistate(0.
2172),whileindicesofriskydisposalofnon-sharpHCWwerehighestinBayelsastate(0.
2868)andOsunstate(0.
2652).
TheOLSresultsshowedthatat5%levelofsignificance,possessionofmedicalwastedisposalguidelines,stafftrainingsonHCWmanagement,travelinghoursfromthefacilitiestolocalheadquartersandbeinglocatedinruralareassignificantlyinfluencedindicesofrisky/safemedicalwastedisposal(p0.
05),implyingthatheterosce-dasticitywasnotaproblemintheestimatedmodels.
ThecomputedF-teststatisticsalsoshowstatisticalsignificance(pF0.
00750.
0000AdjR-squared0.
00650.
0163Breusch-Pagan/Cook-Weisberg1.
282.
42MeanVIF1.
33OyekaleandOyekaleBMCPublicHealth(2017)17:740Page8of13DiscussionTheneedforpropermanagementofHCWasameansofsafeguardinghealthworkers'safetyandpreventingundueoutbreakofdiseasescannotbeoveremphasized[25,26].
Thisstudyfoundthatmajorityofthesampledhealthcarefacilitiesdidnothavemedicalwastedisposalguidelines.
ThisisareflectionofpoorattitudesbyhealthcareserviceproviderstothemanagementoftheirHCW.
Severalpreviousstudieshaveindicatedunethicalconductsbyhealthcarefacilitiesintheirwastedisposalactivities[27–31].
ManyresearchershavesimilarlydecriedpoorcoordinationandpersistentdormancyofinstitutionalframeworksforthemanagementofHCWinNigeria[32–34].
However,healthcarefacilitiesareabletodismisstheirdutyofensuringstringentdiligenceinHCWmanagementandgoscot-freeasaresultofin-abilityofexistinglegalprovisionstoimposeamandatory"dutyofcare"onhealthcareserviceprovidersanden-forcesomestringentpenaltiestoserveasdeterrentfordefaulters[9].
AbahandOhimain[35]reportedthatinasurveyofatertiaryhealthfacilityinNigeria,itwasfoundthatthehospitaldidnothavewastemanagementmanuals.
PossessionofguidelinesonHCWmanagementwasfoundtoenhancesafeindicesofHCWdisposal.
ThisisexpectedsincepossessionofHCWmanagementguidelinewillassistdesignatedstaffmemberstounder-standtheproceduresfortreatingdifferentcomponentsofwasteproductsthatareemanatingfromhealthcarecenters.
Theresultsalsoindicatedlowtrainingofstaffonmed-icalwastemanagement.
ThisisapointertoinadequateattentionbeinggiventomanagementofHCWbymanyhealthcarefacilitiesinNigeria.
ThissituationmaybeaperfectreflectionofinadequacyofavailablefundswhichisamajorproblemconfrontingmanyhealthcarefacilitiesinNigeria[36].
Precisely,inasituationwheredoctorsareunabletoprocurebasicmedicalequipment,fundingmaynotbeavailablefortrainingthosewhomanageHCW.
Althoughtheessentialityoftrainingscannotbeoveremphasizedinhealthcarewastemanage-ment,somepreviousstudieshavehighlightednon-complianceonthepartofdesignatedinstitutionsandotherstakeholders[37].
Awodeleetal.
[8]foundthatinsomeselectedhealth-carefacilitiesinLagos,abilityofhospitalstaffwithsubstantialleveloftrainingtoproperlyhandleHCWwasquitebetterthanthosewithlittleornotraining.
AbahandOhimain[35]alsoreportedthatinatertiaryhospitalinNigeria,only11.
5%oftherespondentsre-ceivedsometrainingsthatwererelatedtomanagementTable6HeteroscedasticityCorrectedParametersofDeterminantsofSafeWasteManagementIndicesinNigeriaSafeSharpDisposalIndexSafeNon-SharpWasteDisposalIndexToleranceVariablesCoefficientsRobustStd.
Error.
t-statCoefficientsRobustStd.
Error.
t-stat1/VIFStaffreceivedtrainingonwastemanagement0.
08700.
05781.
510.
11590.
05762.
0185.
06Southernstates0.
14080.
05822.
420.
32510.
06095.
3480.
39Ruralhealthcarefacilities0.
22640.
05604.
040.
08450.
05631.
5080.
45Publichealthcarefacilities0.
15100.
08601.
760.
15810.
09481.
6785.
84Dispensaries/healthcenter0.
20950.
06583.
180.
27060.
06893.
9374.
19Travelinghourstoheadquarters0.
07060.
03242.
180.
01040.
03340.
3185.
45Electricity0.
08330.
05631.
480.
05950.
05381.
1160.
47Generators0.
13570.
07231.
880.
15770.
07282.
1764.
17Batteriesassecondpowersource0.
32930.
30321.
090.
19910.
30660.
6597.
30Solarpanelassecondpower0.
38850.
26011.
490.
64200.
30062.
1494.
11Othersourceofpower0.
01220.
15000.
080.
01160.
17190.
0793.
97Improvedsourceofwater0.
02830.
04740.
600.
03520.
04660.
7688.
90Numberofoutpatienthoursperday0.
00150.
00360.
410.
00240.
00350.
6777.
30Wastemanagementguidelines0.
32810.
06614.
960.
38440.
06815.
6587.
39Constant0.
20950.
13951.
500.
16150.
14691.
10F(14,2465)8.
018.
28Prob>F0.
00000.
0000AdjR-squared0.
04880.
0686Breusch-Pagan/Cook-Weisberg187.
35***553.
06***MeanVIF1.
33***-statisticallysignificantat1%levelOyekaleandOyekaleBMCPublicHealth(2017)17:740Page9of13ofHCW,while46%understoodtheimportanceofhavinginplaceefficientwastemanagementguidelines.
Ogbonnaetal.
[38]foundthatinsomehealthcarefacil-itiesinPortHarcourt,inadequatetrainingofdesignatedstaffwasidentifiedasamajorconstrainttopropermanagementofHCW.
OthersimilarstudiesincludeBabatola[39],whocon-ductedastudytoanalyzewastemanagementpracticesofhealthcarefacilitiesinAkurecityofOndostate,Nigeria.
Usingasampleoftwentyhealthcarecenters,itwasfoundthatonly2%ofthestaffthatwerehandlingHCWhadundergonesomeformoftrainingsinHCWmanagement.
Olietal.
[40]alsoanalyzedHCWmanagementpracticesofhealthcarefacilitiesinSoutheastNigeria.
Theresultsshowedthattherewasnosignificantdifferenceinprivateandpublichealthcareparticipants'knowledgeabouttherisksposedbyHCW.
Inaddition,7.
0%and16.
2%ofstafffromprivateandpublichealthcarefacilitiesrespectivelyhadpreviouslyattendedsometrainingsonHCWdisposal,whileonly22.
12%and41.
82%indicatedthatrequisitelo-gisticsandmaterialsforensuringsafetyinHCWdisposalwerealwaysavailable.
TheresultsshowthatopenburningofsharpHCWandothernon-sharpHCWwasreportedbysomehealthcarefacilities.
ItwasalsoindicatedthatsomehealthcarefacilitieswereburningsharpandHCWinprotectedpits.
Generally,burningofHCWcanconsti-tutesomeformofairpollutionasaresultofreleaseofsometoxicsubstancesintotheatmosphere.
Giventhis,drasticreductioninhumanexposurewouldstillconsti-tutesomehealthhazardsevenatextremelylowdoses[41].
Similarly,HPCSA[6]notedthatsubjectingHCWtoburninginsteadofincineratedwillreleasesomepollutantsintotheatmosphere,asaresultofdioxinsfor-mation.
Inabsenceofburning,somehealthcentersweredisposingtheirwastesinopengeneralplacesofdumpingdomesticwastes,whileothersdumptheminsidepits.
AlthoughlandfillingofHCWmaybeconsideredsafeifproperlydone,contaminationofgroundwaterisequallypossibleinsomeexceptionalcases[42].
Incineratorswereusedbyfewhealthcarefacilities,al-thoughthestandardforprotectingtheenvironmentfrompollutionthereofshouldbeensured.
Thisisasaresultofthelikelihoodofashesfromincineratingcontainingsomepollutantbecausetheycouldcontainmercuryandcadmium[43].
Insomepreviousstudies,itwasreportedthatonly30%ofthehealthcarefacilitiesinAkurewereinvolvedinwastesegregationandmajoritywerenotsteril-izinginfectiouswastesorusingincineratorsorautoclaves[39].
Similarly,Yelebeetal.
[44]analyzedwastedisposalbehaviourofsomehealthcarefacilitiesinBayelsastateofNigeria.
Itwasfoundthatmajorityofthehealthcarefaci-litiesweregrosslylackinginadoptionofstandardHCWmanagementwithabsenceofincineratorsandanytreatmentofwastesbeforedisposal.
Itwasfurthernotedthatsomehealthcarefacilitiesandmunicipalwastemanagementauthoritieswereburningwasteinopenpits,therebycompromisinghumansafetyasaresultofassoci-atedenvironmentalpollution.
Inarecentstudy,itwasfoundthat1.
98%ofthehealthcarefacilitiessampledinEbonyistatefollowedstandardproceduresinmedicalwastemanagement[45].
HealthcarefacilitiesinBayelsastatehadhighindicesofriskydisposalofsharpsandono-sharpHCW.
Simi-larly,EkitiandOsunstates,bothfromsouthwesternpartofNigeriahadlowestindicesforsafedisposalofsharpsandnon-sharpHCWdisposal.
TheresultsforBayelsastateareinlinewiththefindingsofYelebeetal.
[44].
PoormanagementofsharpHCWposessignificanthealthriskstohealthcareworkersandthoseinchargeofwastedisposal.
Precisely,WorldHealthOrganization[3,46]indicatedthatifapersonisinjuredbyaninjectionneedleinthecourseofdisposingHCW,thelikelihoodofbeinginfectedwithHepatitisBvirus,HepatitisCvirusandHIVare30%,1.
8%and0.
3%respectively.
How-ever,theimplicationofsuchinjurybecomesmorealarm-inggiventhatmostofthehealthcarefacilitiesdonothaveinsurancecoveragefortheirstaff,whilefunctioningmech-anismsforcompensatingvictimsofoccupationalhealthhazardsmaybecompletelyabsent[45].
TheresultsindicatedthathealthcarefacilitiesinnorthernNigeriawereperformingbetterinHCWmanagementthantheircounterpartsinthesouthernpartsofthecountry.
OnefundamentalissueisthatforefficientmanagementofHCW,sufficientlandspace,equipmentandwelltrainedpersonnelcannotbecompromised.
Thespateofurbanization,especiallyinsouthernNigeriamayconstitutesignificantlandconstraintfortreatingHCW.
Moreimport-antly,itshouldalsobenotedthatmajorityofthesampledhealthcarefacilitiesinnorthernNigeriawereinruralareas.
Thevolumeofwastesthatwouldbegeneratedfrommanyofsuchruralhealthcarefacilitieswouldbelow,therebyfacilitatingtheirsafemanagement.
Inaddition,regularsupplyofelectricityisrequiredforprocessingHCWwhereincineratorsareusedforhighlyinfectiouswastes.
Theproblemofpowerout-ageisamajorissueinhealthcareservicedeliveryinNigeria[47,48].
Availabilityofalternativesourcesofelectricitythroughgeneratororbatteriescanfacilitatehealthcareservicedelivery.
Wastedisposalcouldaswellbecomesaferbecausehealthcarefacilitieswithsuchpowersourcesmayaswellbeabletoprocurenecessaryfacilitiesforsafeandeffectivehandlingofwastes.
Theresultsalsoindicatedthataccesstosafedrinkingwaterreducedriskysharpdisposalindices.
ThismayalsoemphasizetheroleofregularsupplyofwaterinthewholeprocessofHCWdisposal.
Simi-larly,thelongerthetimethathealthcarefacilitiesareOyekaleandOyekaleBMCPublicHealth(2017)17:740Page10of13openedforpublicuse,thelowertheirindicesofriskysharpandnon-sharpHCWdisposal.
Thismaybedir-ectlylinkedtothesizeofthehospitalsintermsofstaffandavailablefacilitiesforensuringefficienthealthcareservicedelivery.
TheneedforstafftrainingonhandlingofHCWwasreemphasizedbythere-sults.
Thishadbeenpreviouslyemphasizedinseveralpublichealthliterature[6,49].
ConclusionThisstudyhasprovidedsomeempiricalanalysesoffac-torsexplainingriskyandsafedisposalofHCWinNigeria.
ThestudyhasbenefitedfromrobustdatasetthatcutsacrossthesixgeopoliticalzonesinNigeria.
OnemajorlimitationofthestudyisinabilitytoprobeintodifferentcompositionofHCWthatweregeneratedandtheirrespectivequantitiesduetodatalimitations.
Itcanhoweverbeconcludedthathealthcarewastesareimportantcomponentofhealthcareservicedelivery.
Withoutproperdisposal,thehealthcaresystemmaybe-comeasourceofenvironmentalpollution,whichcoulddegenerateintodiseaseoutbreaks.
Inthelightofthefindingsfromthisstudy,somerecommendationsareherebymade.
First,thereistheneedforproperen-forcementofmedicalguidelinesinrelationtosafetyandefficientservicedelivery.
Thecurrentsituationpor-tendsaperplexingneglectofresponsibilitiesandfailureofinstitutionalmechanismsthatareinplacetoensureadequacyofmedicalservicedeliveryandsafetyofhealthcareworkers.
OneofthefundamentalrequisitesformanagingHCWistrainingofstaffmembersthataredirectlyconnectedtothewholeprocessesofwastesortinganddisposal.
ThisisalsoemphasizingtheneedforadequatebudgetinginrelationtotrainingofstaffonappropriatemanagementofHCW.
ThereshouldalsobeappropriatechannelsforeducatinghospitalstaffontheacceptablewaysofhandlinganddisposingHCW.
Thesemayincludetheuseofpostersandotheraudiovisualmaterials.
Precisely,adequateawarenessshouldbecreatedonassociatedhealthhazardstopeopleasaresultofunsafedisposalofHCW.
TheoneroustaskofhandlingHCWrequiresadequatelogis-ticsupportsandprovisionofsomeessentialequipment.
Inthelightofdecliningfundingtohealthcarefacilitiesinthepublicsector,theordealofinadequatedisposalofHCWwouldfurthercomplicatethewholeprocessesofeconomicdevelopment.
Theresultsalsohighlightsomesignificantdifferencesbetweenrural/urbanandnorthern/southernstates'healthcarefacilitiesinhandlingofHCW.
ThereisthereforetheneedforcreationofmoreawarenessanddevotionofmoreresourcestothemanagementofHCWamonghealthcarefacilitiesinsouthernNigeria.
DuetohighvolumeofHCWthataredailygenerated,urbanhealthcarefacilitiesandpublichealthcarefacil-itiesmusthaveworkableandsustainablemeansofmanagingtheirlargespectrumofwastesinawaythatensuresutmostenvironmentalandhumansafety.
Fi-nally,ensuringadequatesupplyofpowerandwateriscriticalforHCWmanagementinNigeria.
Specifically,incineratorscannotbefunctionallyutilizedifelectricitysupplyiserratic.
Similarly,severalprocessesthatareas-sociatedwithwastedisposalwouldrequireregularsup-plyofwater.
AbbreviationsHCW:HealthcareWaste;HDI:HumanDevelopmentIndicator;HIV:HumanImmuno-DeficiencyVirus;HPCSA:HealthProfessionalCouncilofSouthAfrica;IHSN:InternationalHouseholdSurveyNetwork;LAWMA:LagosStateWasteManagementAuthority;MDGs:MillenniumDevelopmentGoals;OLS:OrdinaryLeastSquare;PCA:PrincipalComponentAnalysis;SDG:SustainableDevelopmentGoal;SDI:ServiceDeliveryIndicator;UNDP:UnitedNationsDevelopmentProgramme;VIF:VarianceinflationfactorAcknowledgementsNotapplicable.
FundingHavingreceivedfundingfromtheWorldBankandAfricanDevelopmentBank,thisstudywascommissionedandfullysponsoredbytheAfricanEconomicResearchConsortium(AERC),Nairobi,Kenya.
AvailabilityofdataandmaterialsThedataforthisstudywereobtainedfromtheAfricanEconomicResearchConsortium(AERC),Nairobi,Kenya.
However,somerestrictionsapplytoitspublicavailability.
DataarehoweveravailablefromtheauthorsuponreasonablerequestandwithpermissionofAERCortheWorldBank'sofficeinAbuja,Nigeria.
Authors'contributionsBothauthorsconceptualizedthestudy.
ASOyekaleanalyzedthedataandwrotetheresultsanddiscussionssection,whileTOOyekalewasinvolvedintheconceptualizationandreviewofnecessaryliteratureforthestudy.
Bothauthorshavereadandapprovedthefinalversionofthemanuscript.
EthicalapprovalandconsenttoparticipateTheAbujaofficeoftheWorldBankcommissionedthestudy.
AlltherequiredethicalclearancesandapprovalsweregrantedbytheFederalMinistryofHealthinAbuja.
Also,noneoftheparticipantswascoercedtoparticipate.
SomeaspectsofthedatahadbeenmadeavailablebytheWorldBankforpublicusebypermissionandauthorization.
ThedataweremadeavailableforusebyAfricanEconomicResearchConsortium(AERC),Nairobi,KenyaattheinstanceofthepermissionthatwasgrantedtothembytheWorldBankOfficeinAbuja,Nigeria.
ConsentforpublicationNotapplicable.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
Publisher'sNoteSpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.
Authordetails1DepartmentofAgriculturalEconomicsandExtension,North-WestUniversityMafikengCampus,Mmabatho2735,SouthAfrica.
2InstituteofFoodSecurity,EnvironmentalResourcesandAgriculturalResearch(IFSERAR),FederalUniversityofAgriculture,Abeokuta,Nigeria.
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