Healthcare Waste in Ethiopia a Study of Waste Generation, Composition and Management in the Amhara National Regional State, Ethiopia

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Addis Abeba Universty


Background: Hospitals are among the complex institutions which generate a broad range of hazardous waste materials in the course of healthcare activities. The hazardous and toxic parts of wastes from healthcare establishments consists of infectious, bio-medical, chemical, sharps and radioactive material pose serious environmental and public health risks, if they are not properly treated and disposed. Despite the great potential for environmental hazards and public health risks of healthcare waste, its proper handling and management is substantially undermined in many developing countries. The hazardous waste has a small portion of healthcare waste, but the absence of appropriate waste segregation practices leads mixing hazardous waste with general (non-hazardous) waste results the entire bulk of waste becoming potentially hazardous. In Ethiopia, there is a continued growth in the number of hospitals and other health facilities to meet the healthcare demand of the alarming population growth. Increasing the number of health institution and development of technology combined with an increase in the use of disposable medical products has contributed to the large amount and diversity in composition of healthcare waste being generated. The high generation rate compounded by poor handling and disposal practices has been increasing the risk of environmental contamination and disease transmission. To establish proper healthcare waste management system, it is crucial to know the current practice, healthcare waste composition and predicting the generation rate. The actual amount of healthcare waste generated and its composition in Ethiopia is not well defined; consequently, estimating different figures in healthcare waste management is becoming very problematic. Therefore, a comprehensive research is required for the development of effective healthcare waste management system that can minimize the health and environmental risks. Objectives: This study aimed to determine the composition and generation rate of healthcare wastes with a predictive model and assess the current practices of healthcare waste management system. Methods: The study was conducted using random selection method. Accordingly, the hospitals were selected using lottery method from private and government hospitals that are found in Amhara National Regional State, Ethiopia. Nine hospitals were selected for the study. A longitudinal study design was conducted to investigate the healthcare waste composition, and generation rate. Based on the seasonal variability data, generation rate predictive models were selected. A cross-sectional study design was used to assess the current practice of healthcare waste management system using interviews and observation. Comparative cross-sectional study xiii design was used to evaluate the effect of segregation practice on hazardous healthcare waste generation rate before and after intervention. The quantity of waste generated was estimated by collecting and weighting healthcare waste from all departments of the sampled hospitals using a calibrated sensitive weight scale every day at 6:00 PM for seven consecutive days (Monday to Sunday) for two seasons. The data were entered, compiled and analysed using EPI info version 7 and Statistical Package for Social Science (SPSS) version 16 statistical software packages. The important variables that affect the quantity of waste generated from the hospitals were identified using regression analysis. Simple and multiple linear regression models were applied to estimate or predict the hospitals healthcare waste generation rate. The analysis were done first separately for each of the 9 hospitals and then grouped by ownership and level of hospitals as well as by the categories of healthcare waste. Data description was made using mean, Standard Deviation (SD), frequency, and percentage. Data from key informant interviews and observation were analysed by theme. Results: The mean healthcare waste generation rate of hospitals was for inpatients 1.5 kg/ bed/day and outpatients 2.5 kg/outpatient/day. The average generation rate estimated in kg/bed/day and kg/outpatient/day has a statistical significance difference (P < 0.03). The generation rate of general healthcare waste in private hospitals was 1.85kg/bed/day and a public hospital was 0.78 kg/bed/day. The generation rate kg/bed/day in private and public hospitals also has a statistical significance difference (P < 0.02). The compositions of healthcare waste in public hospitals were 46.4%, 34.3%, 3.8%, 9.1%, 6.2% and 0.2% for general, infectious, sharps, pharmaceutical, pathological and radioactive wastes respectively. The compositions of healthcare waste in private hospitals were 45.3%, 29.7%, 6.7%, 17.3%, 0.5% and 0.5% for general, infectious, sharps, pharmaceutical, pathological and radioactive wastes respectively. The compositions of healthcare waste in public and private hospitals were almost similar except for pathological and pharmaceutical wastes. There were no clear local guidelines to facilitate segregation of healthcare waste in both public and private hospitals; segregation was not practiced in all hospitals. The common waste treatment method used by hospitals was incineration; all the incinerators were found to be inefficient because of faulty design, construction and operation. All public hospitals had open pits in their backyards that were used for the final disposal as burial or open incineration, while private hospitals were mixing their healthcare waste with the municipal solid waste. xiv The healthcare waste generation rate has a strong positively correlation with the number of inpatients R2= 0.935, 0.908 and 0.936 for public referral, public district and private general hospitals respectively. Similarly, the waste generation rate has positively correlated with the number of outpatients R2= 0.57, 0.868 and 0.456 for public referral, public district and private general hospitals respectively. The implementation of segregation practice was able to reduce the generation rate from 61.04 % to 42.2 % of hazardous healthcare waste. Nevertheless, with this reduction rate, the total percentage of hazardous waste (44%) was higher than that of the range (10-25%) reported by World Health Organization (WHO). Conclusions: The effect of number of inpatients and outpatients treated in the hospitals on healthcare waste generation rate varied from hospital to hospital (private general, public district and public referral hospitals). The rate also varied by ownership where private hospitals were produced significantly higher (kg/bed/day) total and hazardous waste than government-run hospitals. It was observed that as the number of inpatients and outpatients increase, the healthcare waste generation rate will also increase. The results indicated that both measurement units (kg/bed/day and kg/outpatient/day) should be used in order to precisely quantify the waste generation rates for different types of wastes at each hospital. With the current malpractices of healthcare waste management the percentage of hazardous waste was estimated to be very high (61.04%) and considering the segregation practice alone can reduce the percentage of hazardous waste by 17%. Overall, proper waste management system was almost not yet instituted in all sampled hospitals. Recommendations: A number of gaps exist regarding proper hospital healthcare waste management in the Region. Therefore, there is an urgent need for raising awareness among healthcare workers and supporting staff on healthcare waste management issues (segregation, storage, collection, transport, treatment and disposal) and their relevance in addressing public health and environmental risks. Keywords Hazardous, hospital, healthcare waste, generation rate, waste composition, waste management, private, public, Ethiopia



Hazardous, hospital, healthcare waste, generation rate, waste composition, waste management, private, public, Ethiopia