AN EVALUATION OF MEDICAL WASTE MANAGEMENT AND DISPOSAL PRACTICES OF PUBLIC HEALTH FACILITIES IN CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

The primary challenges associated with health-care waste include a lack of knowledge regarding the health risks, inadequate training in proper waste management, the absence of waste management and disposal systems, limited financial and human resources, and a low level of importance placed on the issue (Idris, 2022). Several nations lack adequate regulations or fail to enforce them. Ensuring the management of health-care waste necessitates heightened focus and carefulness to prevent negative health consequences linked to inadequate procedures, such as the risk of exposure to infectious organisms and harmful substances (WHO, 2018). Waste can be defined as any material or substance that is not intended for further use or consumption (Zulfiquer 2018 & Amin Shah, 2017). Hospital trash refers to waste generated from healthcare and related activities that have the potential to cause infection, such as swabs, bandages, dressings, etc., or that may be dangerous, such as drugs. Medical waste refers to garbage that is produced as a result of healthcare activities in places such as doctor's offices, dental clinics, hospitals, and laboratories (Secure Med, 2019).

  According to Keller et al. (2021), medical waste refers to any substance that has the potential to come into contact with the body during activities such as diagnosis, research, drug administration, or therapy. Medical waste is often contagious or potentially infectious and often contains bodily fluids. However, the word can also encompass general trash from any medical practice, as well as specialised waste streams commonly seen in the medical business (Billingsley, 2020). Medical care is essential for survival and well-being, yet, the waste produced by medical operations has become a significant worry due to its composition. The presence of micro-organisms in it poses a significant risk of infection to individuals and the wider population if not disposed of correctly (Babanyara et al., 2023). Medical waste is the second most perilous waste, surpassed only by nuclear waste. Medical waste is both dangerous and contagious, and it poses significant risks to public and environmental health by potentially polluting the air and contaminating soil and water supplies. Therefore, in order to safeguard the well-being of both humans and the environment, it is necessary to subject healthcare waste to specialised treatment and management before its ultimate disposal (Akanbi et al., 2019).

 A significant amount of effort is required to create the supply of efficient and widespread healthcare, together with the safe and efficient disposal of clinical waste. Over the past decade, there has been a rise in the number of health care facilities. This increase can be attributed to both demographic changes and the support from worldwide efforts to eliminate and manage various infectious illnesses. As a result, there has been a simultaneous rise in the amount of medical waste produced (Doumtsop, 2017). Varying approaches have been observed in different nations when it comes to managing such wastes. Developing countries, in particular, have the most challenging situation, as they tend to treat these wastes in a careless and disorganised manner, without a proper framework for healthcare waste management (Chakar et al., 2019; Harhay et al., 2019; Shaw, 2021). Regulations pertaining to the proper disposal of healthcare waste are either absent or inadequately implemented in numerous developing nations. Poor management of clinical waste in these nations, particularly inadequate segregation, treatment, and disposal methods, poses a hazard to the environment, occupational and public health, and raises the risk of transmitting blood-borne viruses (Solberg 2009, Babanyara et al., 2023).

A WHO review found that in twenty-two developing countries, the percentage of healthcare facilities that fail to implement appropriate healthcare waste management ranged from 18 to 64% (WHO, 2017). Medical waste management in most African countries is inadequate. According to a recent analysis of solid medical waste management in Africa (Udofia et al., 2019), only 30% of nations fulfilled at least half of the World Health Organization's (WHO) recommendations on medical waste management (Chartier et al., 2018). The highest level of compliance was observed in the daily collection of garbage from its sources, which was achieved by 100% of the countries. Furthermore, waste management in these countries is characterised by the absence of segregation and inadequate handling. This is compounded by the prevalent practice of unregulated and substandard burning, which contributes to environmental issues such as the release of harmful air pollutants, notably dioxin, and the presence of heavy metals in both gaseous and solid waste by-products (Todd et al., 2021). Effective management of medical waste is vital to safeguard human and environmental well-being. This entails minimising the production of dangerous waste and implementing stringent measures to regulate the storage, transportation, treatment, reuse, recycling, recovery, and ultimate disposal of waste materials (UNEP, 2020). Developing countries have taken steps to enhance their waste management procedures in response to increasing concerns about medical waste. These initiatives have been documented in studies by Kumar et al. (2017), Tabash et al. (2018), and Awodele et al. (2019).

 Cameroon encounters multiple difficulties in managing and disposing of medical waste in its public health institutions. These issues are frequently exacerbated by a scarcity of resources, poor infrastructure, insufficient training, and a lack of stringent regulatory enforcement (Gilbert, 2021). Public health facilities in Cameroon face challenges in effectively managing the segregation, collection, transportation, treatment, and disposal of medical waste, which might pose potential risks to public health (Malase, 2022). The significance of efficient medical waste management cannot be exaggerated, since poor practices might result in severe consequences. For instance, if syringes that have been illegally discarded are reused, it can lead to the spread of blood borne illnesses like HIV and hepatitis. Likewise, the unregulated disposal of medications can result in environmental pollution, impacting the quality of water supplies and soil (Kwan, 2019). Although efficient medical waste management is of utmost significance, there is a scarcity of factual evidence regarding the practices of public health facilities in Cameroon. Gaining insight into the present condition of medical waste management and pinpointing the deficiencies in these procedures are crucial measures in enhancing the safety and efficiency of waste disposal methods within the nation. The objective of this study is to assess the methods and procedures used by public health facilities in Cameroon for managing and disposing of medical waste.

1.2 Statement of the problem

Effective management of medical waste is a crucial concern that has significant implications for public health, environmental well-being, and adherence to regulatory requirements. Public health facilities in Cameroon produce substantial quantities of medical waste, which includes dangerous substances including contaminated sharps, medications, and biological waste. Efficient handling and proper disposal of this material are crucial to minimise potential hazards and ensure adherence to optimal procedures.

Inadequate handling of medical waste poses a significant threat to both public health and the environment (Lam, 2023). Public healthcare institutions generate several types of waste, including infectious, dangerous, and general refuse. Every type of waste requires specific protocols for its management, treatment, and disposal. Inadequate management of medical waste can lead to the spread of diseases, pollution of the environment, and harmful consequences for both healthcare workers and the general public (Pius & Nwankwo, 2023). The efficacy of biomedical waste management in Public health facilities in Cameroon is significantly impacted by the knowledge, attitudes, and practices (KAP) of healthcare professionals regarding the segregation, storage, handling, and disposal of medical waste in public health facilities throughout Cameroon. While there are set standards and procedures, variations in understanding and implementation among staff members might compromise the safety and efficiency of waste management protocols.

According to Mane (2019), pollution caused by medical waste can have significant adverse impacts on ecosystems, wildlife, and natural resources. Inadequate management of medical waste can be a source of environmental pollution. As an illustration, the process of medicines seeping into water bodies can cause disturbance to aquatic ecosystems by impacting the well-being and reproductive functions of fish and other wildlife (Kolpin et al., 2020). Moreover, the process of burning medical waste might result in the release of harmful substances such as dioxins and furans, which have the potential to build up in the food chain (Yamazaki et al., 2019). Exposure to medical waste can have a direct impact on wildlife. Animals can consume or get caught in waste products, resulting in harm or fatalities. Marine creatures have been documented to experience adverse effects from consuming plastic and other waste items (Jambeck et al., 2017). In addition, contaminants originating from medical waste can negatively impact the natural environments where wildlife resides, leading to a decrease in the variety of species and causing disturbances in the functioning of ecosystems (Harrison et al., 2020).

Poor handling of medical waste presents substantial health hazards. Improper disposal can result in the transmission of contagious diseases, physical harm, and persistent health issues for individuals and communities alike. Medical waste, such as discarded needles, contaminated dressings, and other objects containing biological hazards, might include disease-causing microorganisms that can cause illnesses. Untreated sharps waste has the potential danger of needle-stick injuries, which can result in the transmission of illnesses such as HIV and hepatitis (Kumar et al., 2021). Improper methods of disposing waste, such as burning it openly or burying it in landfills, might worsen these hazards by releasing disease-causing microorganisms into the environment (Garg et al., 2020). Improper handling of medical waste can result in wider public health concerns. Contaminated trash can cause water and soil pollution, which in turn can have a negative impact on agricultural output and supplies of drinking water (Murray et al., 2019). Prolonged exposure to toxic waste can lead to the development of persistent health issues, such as respiratory and dermatological ailments (Baker et al., 2018).

The problem lies in the lack of factual knowledge regarding the current state of medical waste management and disposal techniques in public health facilities in Cameroon. Without this data, it is difficult to identify specific areas for improvement or develop targeted programs to enhance waste management systems in the country. This study seeks to address this problem by assessing the medical waste management and disposal methods employed by public health facilities in Cameroon.

Objectives of the study

The primary objective of this study is to critically evaluate medical waste management and disposal practices of public health facilities in Cameroon. Specific objectives of this study are to:

To analyze the existing practices related to the management and disposal of medical waste in public health facilities across Cameroon

To assess the level of knowledge among healthcare workers regarding medical waste management guidelines, procedures, and regulatory requirements.

To identify the barriers faced by public health facilities in managing medical waste effectively across Cameroon.

To propose recommendations for improving medical waste management practices in public health facilities across Cameroon.

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 practices for managing and disposing of medical waste in public health facilities in Cameroon?

What is the level of knowledge among healthcare workers regarding medical waste management?

What are the barriers faced by public health facilities in managing medical waste in Cameroon?

What recommendations can be made to enhance medical waste management practices in public health facilities?

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: There are no current practices for managing and disposing of medical waste in public health facilities in Cameroon.

Ha: There are current practices for managing and disposing of medical waste in public health facilities in Cameroon.

1.6 Significance of the study

The assessment of medical waste management and disposal procedures in public health facilities in Cameroon is of great importance in various areas. The objective of the study is to improve the efficiency of medical waste management procedures in public health institutions, safeguard public health and the environment, ensure adherence to regulations, and promote better healthcare and community results.

Efficient management of medical waste is essential in order to mitigate health risks. Adhering to appropriate disposal methods decreases the likelihood of coming into contact with infectious agents, hazardous materials, and toxic compounds. This measure aids in mitigating the transmission of illnesses and reducing health hazards for patients, healthcare personnel, and the general public. Appropriate management and elimination of medical waste, including sharp objects and other substances that may pose a risk, aid in the prevention of injuries and infections that may occur due to unintentional needle pricks and exposure to contaminated waste. Implementing efficient waste management protocols fosters public confidence in healthcare organisations by showcasing a dedication to both safety and environmental conservation. Enhancing the management of medical waste improves the reputation of healthcare facilities, resulting in stronger community relations and higher trust in healthcare services.

Furthermore, effective administration of medical waste ensures the prevention of environmental pollution, encompassing the avoidance of water sources, soil, and air contamination. This action aids in the conservation of natural resources and mitigates the ecological consequences of medical waste. Implementing efficient waste management procedures promotes environmental sustainability by minimising the volume of garbage that is deposited in landfills and incinerators. This reduces the environmental impact of healthcare operations and promotes ecological equilibrium.

Furthermore, the process of detecting deficiencies in knowledge and training among healthcare professionals contributes to the enhancement of training programs and guarantees that the staff is adequately informed about optimal procedures and regulatory obligations. Gaining insight into existing methodologies and obstacles empowers healthcare establishments to enhance their waste management protocols, resulting in streamlined and impactful operations.

Furthermore, the analysis highlights deficiencies in resources and infrastructure, providing guidance for allocating investments towards essential equipment and facilities to enhance waste management. This can result in enhanced waste management systems and more secure means of disposal. The study's recommendations can enhance the utilisation of existing resources, hence enhancing the overall efficiency and effectiveness of waste management systems.

Moreover, this study provides significant data to the current body of research on the management of medical waste, specifically in public health facilities in Cameroon. The findings can provide guidance for future research and help solve developing difficulties with the management of medical waste in similar contexts, hence enabling continuous advancements in healthcare waste management.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate medical waste management and disposal practices of public health facilities in Cameroon. Specifically, this study seeks to analyze the existing practices related to the management and disposal of medical waste in public health facilities across Cameroon and assess the level of knowledge among healthcare workers regarding medical waste management guidelines, procedures, and regulatory requirements. 

Further, this study will focus on identifying the barriers faced by public health facilities in managing medical waste effectively across Cameroon and it also seeks to propose recommendations for improving medical waste management practices in public health facilities across Cameroon.

 The study is carried out in Cameroon. 

1.8 Limitations of the study

During the examination, the researchers observed numerous minor limitations, which are typical in any human attempt. The primary constraint was the paucity of comprehensive literature on the subject, stemming from the dearth of data on an evaluation of medical waste management and disposal practices of public health facilities in Cameroon. Consequently, a substantial investment of time and effort was required to ascertain the suitable materials, books, or information and collect data. 

Moreover, this study is limited by its limited sample size and restricted geographic coverage, concentrating exclusively on Cameroon. Hence, the ability to generalise the results of this study to a wider scope is limited, emphasising the necessity for more research. 

Furthermore, the researcher's shortcomings were predominantly attributed to financial restraints, as they are a student who lacks the necessary financial resources to support themselves. The excessively high transportation fees at the study site presented a difficulty in fulfilling the financial responsibilities associated with transportation costs.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while concurrently meeting the responsibilities of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Waste management: Waste management refers to the process of managing, treating, and disposing of waste in a safe and environmentally responsible manner. The goal of waste treatment is to reduce the harm caused by waste to human health and the environment.

Biomedical waste: Biomedical 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.

Biomedical waste management: Biomedical 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.