AN ASSESSMENT OF HEALTHCARE WASTE MANAGEMENT PRACTICES IN RURAL HEALTH FACILITIES IN CAMEROON

CHAPTER ONE

INTRODUCTION

Background of the Study

Any waste generated by healthcare activities is referred to as healthcare waste. It could also be referred to as infectious waste, hospital garbage, or medical waste. Hospitals, Health Posts, emergency medical care services, healthcare centres and dispensaries, obstetric and maternity clinics, outpatient clinics, and similar establishments are among the main causes of healthcare waste, according to Askarian et al. (2020). Dental offices, mental health facilities, tattoo parlours, and illicit drug users are further sources. Nonetheless, there are two main classifications for healthcare waste: hazardous "healthcare risk waste" and non-hazardous "general waste." 

General trash makes up between 75% and 90% of the waste generated in healthcare facilities. This covers things like dust, papers, and packaging materials. If it hasn't come into contact with any hazardous material, it can be disposed of in the same manner as other non-hazardous garbage. The remaining 10–25% of trash is dangerous and may include sharp objects like lancets, needles, and other items, syringes, bodily fluids or blood, infected surgical equipment, delivery bowls, gloves and gauze, plasters, and other items. It might also include other chemicals, lab reagents, and outdated medications. Here, handling hazardous materials safely is the primary priority. Non-hazardous wastes, however, shouldn't be disregarded because improper management and segregation can cause them to become contaminated with hazardous elements. 

Hazardous healthcare waste is divided by Asomugha et al. (2022) into: garbage that could be infectious: garbage that has pathogens in it. Used bandages, swabs, and other items that have come into contact with excrement or diseased patients fall under this category. It also contains bodily fluids including blood, urine, and faeces, among other liquid wastes. Furthermore, there are many different kinds of healthcare waste, and the quantity generated rises annually. Moreover, it is inevitable that the general waste component will get polluted and need to be classified as hazardous if there is little to no segregation of hazardous and non-hazardous trash (Awodele et al., 2019). Exposure to medical waste poses a risk to all members of the community, including those working in healthcare facilities and those who may come into contact with it due to inadequate waste management practices. 

Numerous harmful microorganisms can be found in infectious wastes. Microorganisms can enter the body through a cut, puncture, or abrasion on the skin, which may have been brought on by sharp objects infected with pathogens. Entry can also occur by ingestion, inhalation, or through mucous membranes in the mouth, nose, or eyes. Additionally, healthcare waste poses a significant risk of infection with the human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Injuries caused by needle sticks that are tainted with human blood are the main way that these viruses spread. Prick wounds, commonly from the point of a needle but also from other sharp objects, are known as needle stick injuries. It is advised that all employees handling medical waste receive vaccinations to reduce the risk of HBV. 

Furthermore, reducing threats to public health and keeping infectious waste under control are the goals of healthcare waste management. The term "healthcare waste management" (HCWM) refers to the full range of tasks involved in gathering, moving, treating, and getting rid of garbage produced in medical facilities and research labs. Hospital maintenance and cleanliness procedures also include healthcare waste management. Waste minimisation, identification and segregation, recycling, suitable packaging, handling and storage, and appropriate treatment and disposal are the measures needed to accomplish this goal, though. The three most frequently mentioned concerns in appropriate HCWM are illegal scavenging, occupational health and safety for healthcare personnel, and safe waste disposal. Segregation, collection and storage, treatment, transport, and safe disposal are the four main phases of HCW disposal that require adherence to national laws (WHO, 2018). Hazardous waste, general garbage, infectious non-sharps waste, and sharps are the four main kinds of HCW that should be arranged for segregation and separate storage, collection, and disposal. The trouble spots are the same for all healthcare units and at all management stages, even though present healthcare waste management procedures differ from hospital to hospital. Therefore, a survey will be conducted in order to  assess the awareness and attitudes of healthcare workers towards healthcare waste management in Cameroon.

Statement of the Problem

The issues arising from healthcare facilities due to waste include radiation burns, injuries caused by sharp objects, and poisoning/pollution during waste incineration (WHO/UNICEF, 2018). Gajurval (2018) identified several disorders that can be harmful to human health when they are linked to waste materials. The examples of pathogens are viruses such as HIV/AIDS, bacteria like Streptococcus Typhoid, and parasites such as wucheraria bancrofti. According to Thornton et al. (2019), healthcare waste can lead to environmental pollution, unpleasant odours, and the rapid proliferation of disease-carrying organisms such as rodents and worms. These organisms can transmit diseases like typhoid, cholera, plague, rabies, and AIDS when contaminated syringe-needle injuries come into contact with human blood or fluids. Awodele et al. (2019) stated that inadequate management of healthcare waste can lead to more severe harm than the original disorders. Leonard et al. (2022) emphasised that inadequate management of healthcare waste poses a significant risk to the health of hospital personnel, patients, and the wider community. 

Despite these circumstances, there is a lack of awareness among many people in Cameroon regarding the possible hazards that medical waste poses to their health, environment, and socio-cultural well-being. This is caused by a lack of understanding and a specialised policy for handling healthcare waste, which is important for dealing with the problems associated with it, some of which are known to be dangerous (Akinwale et al., 2019; Awodele et al., 2019). According to Thakur et al. (2022), having a strong understanding of the risks associated with healthcare waste is crucial for implementing effective healthcare waste management practices, especially in poor countries. This lack of information is highly detrimental, as it has been demonstrated that insufficiently managed healthcare waste might potentially expose individuals to various health issues (Adedigba et al., 2020; Manyele & Mujuni, 2020). 

Few studies have been done, but those that have indicate that healthcare waste management is a problem in both primary and tertiary care facilities in Cameroon, despite the shortage of information on the country's health care waste management system (Doumtsop, 2019). The under allocation of resources in the healthcare sector has resulted in a lack of focus and urgency on health care waste management.The incinerator is absent from the majority of healthcare facilities, and in those that are, it may be malfunctioning.  Hence, it is in the light of these that the study seeks to assess the awareness and attitudes of healthcare workers towards healthcare waste management in Cameroon.

 1.3  Objectives of the Study

The main purpose of this study is to assess the awareness and attitudes of healthcare workers towards healthcare waste management in Cameroon. Specifically, the study will;

Identify the healthcare waste management practices in rural health facilities across Cameroon.

Assess the adequacy of waste management infrastructure and resources in these rural facilities.

Evaluate the  impact of healthcare waste management practices on the health and safety of rural communities.

Evaluate the challenges  faced by rural health facilities in managing healthcare waste.

1.4  Research Questions

The following questions have been prepared for the study:

What are the healthcare waste management practices in rural health facilities across Cameroon?

How adequate are the waste management infrastructure and resources in these rural health facilities?

What is the impact of healthcare waste management practices on the health and safety of rural communities in Cameroon?

What challenges do rural health facilities face in managing healthcare waste in Cameroon?

1.5 Research Hypotheses

H0: There is no significant relationship between the awareness of healthcare waste management and the attitudes of healthcare workers towards it in Cameroon.

Ha: There is a significant relationship between the awareness of healthcare waste management and the attitudes of healthcare workers towards it in Cameroon.

1.6 Significance of the Study

The study findings will help in designing more effective waste management policies and procedures, ensuring that they are aligned with the needs and realities of healthcare workers. Additionally, the study will contribute to better healthcare waste management practices, reducing environmental and health risks associated with improper waste disposal, and promoting a safer and more sustainable healthcare environment in Cameroon.

Furthermore, the study will contribute to the improvement of current theoretical frameworks on the incorporation of environmental health practices into healthcare systems and the attitudes of healthcare professionals in supporting efficient waste management.

1.7 Scope of the study   

The scope of this study is boarded on the awareness and attitudes of healthcare workers towards healthcare waste management in Cameroon. Empirically, this study will evaluate the level of awareness among healthcare workers on the importance of healthcare waste management, assess the attitude of healthcare workers towards healthcare waste management practices and regulations, and the factors influencing healthcare workers' awareness and attitudes regarding healthcare waste management.

Geographically, the study will be delimited to some selected health centers in Cameroon.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Healthcare waste: Any waste material generated from healthcare activities, including the diagnosis, treatment, and immunization of humans or animals, research activities, and the production or testing of biologicals.

Healthcare Waste Management: process of handling healthcare waste, from its generation to its final disposal.

Pathogen: often present in healthcare waste, particularly in infectious waste, and pose significant risks if not managed and disposed of properly.

Management practices: Management practices are the strategies, methods, and techniques used by an organization or individual to plan, organize, lead, and control resources effectively to achieve specific goals and objectives. These practices can include decision-making, communication, problem-solving, and employee management

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