EVALUATION OF HEALTH RISKS OF IMPROPER BIOMEDICAL WASTE MANAGEMENT AMONG HEALTH WORKERS IN SELECTED HOSPITALS IN DOUALA, CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Biomedical waste issues in poor nations such as Cameroon have been neglected due to limited resources that are allocated to various governmental priorities (Diaz, 2018). Consequently, governments and health institutions have disregarded the handling of biomedical waste. In addition, the general public lacks awareness regarding the potential health hazards and environmental contamination resulting from improper management of biomedical waste (Eggerth, 2018). Biomedical wastes are classified as infectious and hazardous due to their ability to include pathogens that might cause diseases when exposed to them (Kuchbanda & Mayo, 2017). Approximately 10-25% of the total waste stream is considered hazardous due to its toxic, genotoxic, reactive, radioactive, corrosive, inflammable, explosive, and shock-sensitive properties (Awodele et al., 2017; Adewoye, 2018; Oparah, 2020). Accidents, carelessness, negligence, or ignorance can result in exposure to hazardous wastes, which can have adverse health effects with varying or similar consequences. Improper management of biomedical wastes can have harmful impacts on workers, patients, waste handlers, and the community. These wastes can increase the risk of infections, hazardous effects, injuries, and environmental contamination. Hence, the act of separating biomedical wastes at the location where they are produced is crucial for effective biomedical waste management (Wahab & Adesanya, 2021).

Inadequate biomedical waste management include the mishandling, separation, storage, transportation, treatment, and disposal of waste produced by medical procedures. This waste comprises sharps, pathological waste, pharmaceutical waste, and other hazardous items that have the potential to cause infections, toxic exposure, and environmental pollution (Chalabi et al., 2017). Improper treatment of biomedical wastes can lead to many health hazards, such as gastroenteric, respiratory, and skin infections, as well as nosocomial infections (Rushbrook et al., 2019). Research conducted by Chalabi et al. (2017) has revealed that the improper handling of biomedical waste, particularly sharp objects, can lead to the transmission of harmful viruses such as Human Immunodeficiency Virus (HIV) infection, Hepatitis B, and Hepatitis C. Improperly treated and disposed of biomedical wastes often contain high concentrations of dangerous and antibiotic-resistant bacteria, which can lead to the transmission of infections to individuals and the surrounding environment. Encountering skin punctures, abrasions, and wounds from sharp objects, as well as being exposed to chemical irritants, poses health risks. Approximately 5.2 million individuals, including 4 million children, perish due to diseases caused by trash, according to estimates (Afolabi, Aluko & Fehintola, 2018). According to the World Health Organisation, there are approximately 8-16 million cases of Hepatitis B virus (HBV) infections each year, accounting for 32% of all new cases. Additionally, there are 2.3-4.7 million cases of Hepatitis C virus (HCV) infections, representing 40% of all new cases. Furthermore, there are 80,000 to 160,000 cases of HIV infections, which make up 5% of all new cases. These infections are primarily caused by the use of contaminated syringes and needles due to inadequate biomedical waste management systems (WHO, 2020; Dinesh et al., 2021).

Improper disposal of chemicals and radioactive wastes from radiotherapy might result in fatality and severe radiation burns (Chalabi et al., 2017). Improperly managed and disposed pharmaceutical wastes, including unused and expired medicines and vaccines from homes and hospitals, are linked to health concerns (Chalabi et al., 2017; Akter, 2021). Expired vaccinations containing attenuated live microorganisms have the potential to infect waste handlers instead of providing immunity. Prolonged exposure to drugs in the environment can have detrimental effects on pregnant women and children (Akter, 2021). Pharmaceutical waste has been discovered to pollute surface water and drinking water, leading to both immediate and long-term health problems, including reproductive and cellular damage (Akter, 2021; Włoszczak-Szubzda, 2021).

The discharge of harmful gases, such as dioxins and heavy metals, from disposal methods like burning and cremation of biomedical wastes is frequently linked to health concerns and environmental dangers. The vapours contain carcinogenic substances that have mutagenic properties, which can cause harmful consequences in people even at low levels of exposure (Saad et al., 2019). The significance of health hazards resulting from inadequate management cannot be overstated. Healthcare professionals (such as doctors, nurses, sanitation workers, and maintenance staff) are not the sole individuals impacted. High-risk populations include out-patients, carers, visitors, support services staff (laundry), workers in waste disposal facilities, and the general public (Włoszczak-Szubzda, 2021; Eme, 2019). Health care professionals are exposed to occupational health hazards, which lead to higher rates of illness, death, and economic burden.

Hence, it is crucial to determine the health hazards linked to inadequate management of biological waste in order to raise awareness about occupational health risks and develop regulations for occupational health safety and waste management. Thus, it is crucial to provide adequate hygiene and sanitation in healthcare facilities, as well as the safety of workers and the surrounding environment (Eggerth, 2018). Appropriate management is necessary for the treatment of biomedical wastes in order to reduce the risk of direct contact and damage to both persons and the environment (Denloye, 2018). Biomedical waste should be segregated at its source into bags or containers with colour-coded labelling. Both medical staff and the institution creating the garbage should prioritise the proper collection and disposal of this rubbish (Sarker, 2019). Insufficient handling of medical waste can lead to accidents caused by sharp instruments, environmental pollution owing to hazardous chemicals, and the transmission of diseases through infectious organisms (Ahami, 2017). Presently, the management of biomedical waste in healthcare facilities has emerged as a burgeoning issue. Recent evidence suggests that the management of biomedical waste in health institutions in Africa is still insufficient (Sarker, 2019).

According to the World Health Organisation (WHO), the person responsible for creating each waste item should classify it based on its potential for causing harm, the required treatment methods, and the suitable mode of disposal (WHO, 2018). It is advisable for every medical facility to possess separate bins that are colour-coded for various categories of healthcare waste. More precisely, infectious garbage must be discarded in yellow bins, chemical and pharmaceutical waste in brown bins, and general refuse in black dumpsters. According to the World Health Organisation (WHO, 2019), waste bags and sharp containers should not be packed above 75% of their capacity. The pickup period should be decided based on the amount of rubbish and should not exceed one day. Every healthcare waste management system requires access to land for the final disposal of any remaining healthcare waste materials once they have been reduced or treated. Landfills should possess specific desirable characteristics, such restricted accessibility to discourage scavenging, daily application of soil coverings to avoid noxious odours, frequent compaction of waste, and proper isolation of the garbage (Annette et al., 2020). Common waste management technologies encompass combustion, landfilling, autoclaving, and chemical treatment. India has pioneered an innovative solar treatment process (Majid, 2019).

In Cameroon, the swift growth of healthcare institutions has not consistently been accompanied by sufficient mechanisms for waste disposal. The difference between these two factors has raised concerns about the efficiency of biological waste management methods (Mambou et al., 2019). Urban centres like as Douala, where healthcare facilities are concentrated, face a significant risk of inadequate management of biomedical waste (Kouadio et al., 2021). Healthcare personnel are in the forefront of being exposed to the risks related with biological waste. The potential hazards encompass needle-stick injuries, exposure to infectious agents, and contact with hazardous substances (Afolabi et al., 2022). These dangers are worsened by the absence of sufficient training, insufficient protective equipment, and the lack of strict waste management practices. The challenges in many hospitals in Douala are exacerbated by a scarcity of resources and a lack of understanding of the risks associated with incorrect waste disposal (Kouadio et al., 2021). The objective of this study is to assess the potential health hazards that arise from inadequate handling of biomedical waste among healthcare professionals at certain hospitals in Douala.

1.2 Statement of the problem

Effective management of biomedical waste is a crucial concern in healthcare environments, as mishandling of this material can result in substantial health hazards for healthcare professionals and the wider population. The expansion of healthcare facilities in Douala, Cameroon has not been followed by sufficient enhancements in waste management methods. The discrepancy has sparked worries regarding the potential health hazards linked to inadequate handling of biomedical waste in the city's hospitals.

Research has indicated that healthcare professionals who come into contact with inadequately handled biomedical waste are more likely to be at a higher risk of infection (Olubunmi et al., 2020). Improper segregation, processing, and disposal of biological waste in Douala put healthcare personnel at risk of exposure to dangerous microorganisms. Inadequate handling of waste containing pathogenic microorganisms can lead to the transmission of diseases such as Hepatitis B, Hepatitis C, and HIV, which can have severe health implications for healthcare workers (Osei-Asibey et al., 2020; Nguendo et al., 2021). The inclusion of perilous substances and sharp objects in biomedical waste heightens the likelihood of chemical burns, respiratory ailments, and physical harm. Despite the existence of rules, numerous facilities do not possess the necessary infrastructure and practices to properly manage these risks. As a consequence, workers may have potentially severe health consequences (Afolabi et al., 2022; Kone et al., 2020).

Moreover, insufficient waste management techniques not only endanger the health of workers but also have wider environmental consequences. Improper disposal of biomedical waste can lead to pollution, which can contaminate land, water, and air. This pollution poses health concerns to the population and contributes to environmental deterioration (Tchounwou et al., 2017; Manga et al., 2020). Furthermore, there are notable deficiencies in the implementation of regulations and the training of personnel in Douala with regards to the management of biomedical waste. A significant number of healthcare professionals do not receive adequate training on waste management protocols, and the enforcement of existing standards is frequently inadequate, hence worsening the health hazards linked to incorrect waste treatment (Mambou et al., 2019; Abang et al., 2021). The inadequate handling of biomedical waste at hospitals in Douala presents substantial health hazards to healthcare professionals and the local population. The objective of this study is to assess the health hazards associated with insufficient management of biomedical waste and determine the elements that contribute to this problem. It is imperative to tackle these concerns in order to enhance health and safety standards in healthcare environments.

Objectives of the study

The primary objective of this study is to critically evaluate of Health Risks of Improper Biomedical Waste Management Among Health Workers in Selected Hospitals in Douala, Cameroon. Specific objectives of this study are to:

To assess the level of training and awareness among healthcare workers regarding biomedical waste management in selected hospitals in Douala

To identify the specific health risks faced by healthcare workers due to improper biomedical waste management in selected hospitals in Douala

To examine the impacts of inadequate biomedical waste management on the environment and community health in Douala.

To offer recommendations to improve biomedical waste management practices and enhance health and safety standards in the hospitals studied.

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 is the level of training and awareness among healthcare workers regarding biomedical waste management in selected hospitals in Douala?

What are the specific health risks faced by healthcare workers due to improper biomedical waste management in selected hospitals in Douala?

How does improper biomedical waste management impact the environment and community health in Douala?

What improvements can be recommended to enhance biomedical waste management practices and reduce health risks in these hospitals?

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: Healthcare workers face no significant health risk due to improper biomedical waste management in selected hospitals in Douala.

Ha: Healthcare workers face significant health risk due to improper biomedical waste management in selected hospitals in Douala.

1.6 Significance of the study

The study's importance lies in its capacity to promote the safety of health workers, optimise waste management methods, safeguard environmental and community health, provide insights for policy formulation, improve training, and contribute to public health research. Resolving the identified problems will have a significant and extensive effect on both the healthcare system and the wider population.

The study aims to analyse and comprehend the precise health threats associated with inadequate management of biological waste. This will enable the development of focused measures to safeguard healthcare workers against viral, chemical, and physical dangers. Enhancing safety rules and practices will immediately enhance the welfare of healthcare providers. The report offers a comprehensive evaluation of existing methods in the management of biomedical waste, emphasising specific areas that might be enhanced. This can result in the implementation of more efficient waste segregation, treatment, and disposal techniques, in accordance with industry standards and regulatory requirements.

Improper waste management can result in environmental contamination, which can have a detrimental impact on the quality of air, water, and soil. The study will assess the environmental impact in order to develop solutions that mitigate pollution and its detrimental impacts on community health.

Moreover, the results of this study can provide valuable insights to policymakers and regulatory organizations regarding the shortcomings and inadequacies in the methods of managing biological waste. This may result in the establishment and implementation of stricter rules and policies to guarantee the safe and lawful handling of trash.

Moreover, through evaluating the extent of training and awareness among healthcare professionals, the study can pinpoint deficiencies in knowledge and offer suggestions for improved training initiatives. This will aid in guaranteeing that all personnel have the requisite expertise and understanding to effectively handle biomedical waste in a secure manner. The study's recommendations can assist hospital administrators and managers in Douala in implementing efficient waste management practices, thereby providing a safer work environment and improving overall operational efficiency.

Furthermore, this project will provide significant data and insights to the existing research on the management of biomedical waste, specifically in the context of Cameroon and similar environments. This can facilitate future study and comparative studies in different geographical areas. 

1.7 Scope of the study

Broadly, this study focus is to critically evaluate of Health Risks of Improper Biomedical Waste Management Among Health Workers in Selected Hospitals in Cameroon. Specifically, this study seeks to assess the level of training and awareness among healthcare workers regarding biomedical waste management in selected hospitals in Cameroon and identify the specific health risks faced by healthcare workers due to improper biomedical waste management in selected hospitals in Cameroon. 

Further, this study will focus on examining the impacts of inadequate biomedical waste management on the environment and community health in Cameroon and it also seeks to offer recommendations to improve biomedical waste management practices and enhance health and safety standards in hospitals in Cameroon.

 The study is carried out in Cameroon. 

1.8 Limitations of the study

During the analysis, the researchers noted certain minor constraints, which are common in any human endeavour. The main limitation was the lack of extensive literature on the topic, which resulted from the scarcity of data on the evaluation of health risks associated with improper biomedical waste management among health workers in selected hospitals in Douala, 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 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 conduct this study while simultaneously fulfilling the obligations of attending lectures and participating in other educational pursuits.

1.9 Definition of terms

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.

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