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A STATISTICAL ANALYSIS OF MEDICAL WASTE GENERATION, MANAGEMENT AND THE HEALTH IMPLICATIONS: A CASE STUDY OF ENUGU METROPOLIS, ENUGU STATE, NIGERIA - Ohakwe Johnson

A STATISTICAL ANALYSIS OF MEDICAL WASTE GENERATION, MANAGEMENT AND THE HEALTH IMPLICATIONS: A CASE STUDY OF ENUGU METROPOLIS, ENUGU STATE, NIGERIA - Ohakwe Johnson

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Published by Francis Abulude
The aims of this study are; (i) to assess the medical waste management practices (ii) to obtain
information on the most common health problems associated with medical waste handling and (iii) to
determine the average volume of medical waste generated in a hospital per day as well as the total
volume generated in all the hospitals per day / month. For this purpose, well structured questionnaires
were distributed to the health care managers and waste handlers in each of the 12 randomly selected
hospitals (7 publics and 5 privates) in Enugu Metropolis. Data for the management practices were
obtained through the health care managers while those on health implications were gotten from the
waste handlers and finally those on waste generation were obtained through site visits. Based on the
data obtained, it was discovered that the management practices in all the hospitals surveyed are still
below the stipulated standards. The wastes are not appropriately treated before final disposal. Open
burning and burial is an uncommon but usual practice in all the hospitals. Using chi-square test, it was
found that significant difference exist between the most common health problems associated to waste
handling as regards the waste carriers and the final disposers. 85.3% of the waste carriers (cleaners)
indicated of having tiredness or headache or pains while 78.7% of the final disposers indicated of
having catarrh or cough or tiredness. Using a t-test for difference of two means, no significant
difference was found between private and public hospitals as regards waste generation. On average,
between 185.3kg and 299.7kg of medical waste is generated in each of the hospitals per day while a
total of 3367.3kg to 7302.3kg is generated in all the 22 identified hospitals in Enugu Metropolis per day
resulting in a total generation of 101031.9kg to 219068.1kg per month.
The aims of this study are; (i) to assess the medical waste management practices (ii) to obtain
information on the most common health problems associated with medical waste handling and (iii) to
determine the average volume of medical waste generated in a hospital per day as well as the total
volume generated in all the hospitals per day / month. For this purpose, well structured questionnaires
were distributed to the health care managers and waste handlers in each of the 12 randomly selected
hospitals (7 publics and 5 privates) in Enugu Metropolis. Data for the management practices were
obtained through the health care managers while those on health implications were gotten from the
waste handlers and finally those on waste generation were obtained through site visits. Based on the
data obtained, it was discovered that the management practices in all the hospitals surveyed are still
below the stipulated standards. The wastes are not appropriately treated before final disposal. Open
burning and burial is an uncommon but usual practice in all the hospitals. Using chi-square test, it was
found that significant difference exist between the most common health problems associated to waste
handling as regards the waste carriers and the final disposers. 85.3% of the waste carriers (cleaners)
indicated of having tiredness or headache or pains while 78.7% of the final disposers indicated of
having catarrh or cough or tiredness. Using a t-test for difference of two means, no significant
difference was found between private and public hospitals as regards waste generation. On average,
between 185.3kg and 299.7kg of medical waste is generated in each of the hospitals per day while a
total of 3367.3kg to 7302.3kg is generated in all the 22 identified hospitals in Enugu Metropolis per day
resulting in a total generation of 101031.9kg to 219068.1kg per month.

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Published by: Francis Abulude on Mar 18, 2011
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25
Continental J. Applied Sciences 6 (1): 25 - 30, 2011 ISSN: 1597 - 9928©Wilolud Journals, 2011 http://www.wiloludjournal.comA STATISTICAL ANALYSIS OF MEDICAL WASTE GENERATION, MANAGEMENT AND THEHEALTH IMPLICATIONS: A CASE STUDY OF ENUGU METROPOLIS, ENUGU STATE, NIGERIAOhakwe JohnsonDepartment of Mathematics and Statistics, Faculty of Sciences, Anambra State University, P.M.B. 02, Uli,Anambra State, NigeriaE-mail:ohakwe.johnson@yahoo.com ABSTRACTThe aims of this study are; (i) to assess the medical waste management practices (ii) to obtaininformation on the most common health problems associated with medical waste handling and (iii) todetermine the average volume of medical waste generated in a hospital per day as well as the totalvolume generated in all the hospitals per day / month. For this purpose, well structured questionnaireswere distributed to the health care managers and waste handlers in each of the 12 randomly selectedhospitals (7 publics and 5 privates) in Enugu Metropolis. Data for the management practices wereobtained through the health care managers while those on health implications were gotten from thewaste handlers and finally those on waste generation were obtained through site visits. Based on thedata obtained, it was discovered that the management practices in all the hospitals surveyed are stillbelow the stipulated standards. The wastes are not appropriately treated before final disposal. Openburning and burial is an uncommon but usual practice in all the hospitals. Using chi-square test, it wasfound that significant difference exist between the most common health problems associated to wastehandling as regards the waste carriers and the final disposers. 85.3% of the waste carriers (cleaners)indicated of having tiredness or headache or pains while 78.7% of the final disposers indicated of having catarrh or cough or tiredness. Using a t-test for difference of two means, no significantdifference was found between private and public hospitals as regards waste generation. On average,between 185.3kg and 299.7kg of medical waste is generated in each of the hospitals per day while atotal of 3367.3kg to 7302.3kg is generated in all the 22 identified hospitals in Enugu Metropolis per dayresulting in a total generation of 101031.9kg to 219068.1kg per month.KEYWORDS: Medical waste, management, disposal, Enugu MetropolisINTRODUCTIONMedical waste (MW) is a very hazardous waste, second to radioactive waste. The improper management anddisposal of MW causes serious health and environmental problems in terms of air, water and land pollution(Manyele, 2004a). Though MW constitutes a small fraction of the municipal solid waste (MSW), the potentialenvironmental and health hazards could be extremely dangerous if not properly handled. The worst casescenario of MW management is in developing countries (WHO, 1999). Among the developing countries wheremedical waste management (MWM) are far from being satisfactory, the situation appears to be more critical inAfrica as reports from around the continents indicate poor MWM practices (Leonard, 2003; Manyele, 2004a).Longe and Williams (2006) assessed MWM practices in Lagos Metropolis in Nigeria and discovered that in allthe hospitals surveyed, there were indication of absence of full compliance with the protocols for handling MWas stipulated in the relevant sections of the guidelines and standards for environmental pollution control inNigeria. They discovered that burning and burial of MW is an unusual but common practice in the hospitals andalso that most of the hospitals surveyed do not appropriately treat their waste before final disposal. Furthermore,they estimated the total MW volume generated in the hospitals to be 611.5Kg/per day and 18345Kg / per monthby all the surveyed hospitals in Lagos Metropolis.According to Manyele (2004b), MW generation is high and is increasing in Tanzania reaching up 0.75Kg/bedper day on average. Given the large number of beds in the country, it is obvious that MW requires immediateattention.Hospital waste handling is a hazardous waste activity which requires a high standard. It calls for specifictraining that depends on the nature of the work in the hospitals, the hazards and possibility of worker and theresponsibilities of the individual workers (U.S. – DOE, 1996; Blackman, 1996).Considering the increasing MW generation in the country and mindful of the low-class management practicesand the health risks associated with MW handling, this study is therefore aimed at studying the MWM practices
 
26
Ohakwe Johnson: Continental J. Applied Sciences 6 (1): 25 - 30, 2011and the total volume of MW being generated by the hospitals in the Enugu Metropolis per day/month as well asthe most common health problems associated with MW handling.Here MW handlers would be classified into two namely; carriers and final disposers. Carriers are those thatclean the hospitals, collect the waste with plastic buckets/waste bins/bags and dump them at a collection pointbefore treatment and final disposal while the final disposers are those that treat/burn/bury the waste.Study AreaThe study area, Enugu urban area, is the capital of Enugu State and was once the capital of the former Easternregion. The area lies approximately within Latitude 6
0
20”N and 6
0
30”N and Longitude 7
0
20”E and 7
0
20”Eand is bounded by several other states; in the North by both Benue and Kogi States, in the South by Abia andImo States while in the West and East by Anambra and Ebonyi States respectively. The official populationFigure of Enugu Urban area, from the 2006 population census stands at 722, 664 (NPC, 2006).Data, Survey Instrument and ResultsOut of the 22 identified hospitals in the Enugu Metropolis comprising government and private owned hospitals,12 were randomly selected. Within the 12 selected hospitals 7 were government owned while 5 were privateowned. Government owned hospitals are called public hospitals while private owned ones are called privatehospitals. Data for the study were collected from the 12 selected hospitals through the distribution of a simpleand objective questionnaire as follows;Data on waste generation were collected through site visits. Each of the selected hospitals were visited once forthis purpose and all the collected waste in plastic containers, dust bins and plastic buckets and so on, were eachput on a measuring device and the weights carefully taken. The overall results are presented in Table 1.Data on the prevalent health problems associated with MW handling were distributed to the waste handlers(carriers and final disposers) in each of the hospitals and the results are presented in Table 2.Finally, data on waste management practices were obtained by distributing questionnaires designed based on theguidelines of the safe management of waste for health care facilities (WHO (1999) to the health care managersin each of the hospitals [Table 3].A preliminary analysis was carried out on the volume of waste generated per day on the selected hospitals. Herea t-test for difference of two means was used to determine if there exist significant difference between thevolume of MW generated by government and private owned hospitals so as to deal with them differently. Fromthe test in Table 1, using minitab 14, it was discovered that there is no significant difference between thevolumes of MW generated in both categories of hospitals and as a result, the data from both categories of hospitals were handled together.Considering that the sample selection of the surveyed hospitals was done using a simple random samplingmethod without replacement, a 95% confidence interval was constructed for average daily volume of MWgenerated per hospital and the total volume generated in all the hospitals in Enugu Metropolis per day using
__
__2
y
Sy n
α 
±
 (1)and
^
__2
y
SN y n
α 
±
 (2)respectively (Okafor (2002)), with
 
27
Ohakwe Johnson: Continental J. Applied Sciences 6 (1): 25 - 30, 2011
__
2__212
;1
niiy
y yN n sS sN n n
=
= =
and
^
2 2
( )( 1)
N N n sSN n
=
 (3)Substituting the results for the overall in Table 1 into (1), (2) and (3), we obtain the following confidenceintervals
242.5 57.19
Kg
±
 (4)and
5335 1967.27
Kg
±
 (5)for the average daily MW generated per hospital and the total generated in all the hospitals per day respectively.The implication is that between 185.3kg and 299.69kg of MW is generated in each of the hospitals per day onthe average while a total of 3367.73kg to 7302.27kg is generated in all the twenty two identified hospitals inEnugu Metropolis per day. This amounts to the generation of between 101031.9kg to 219068.1kg of MW permonth.By the Chi-square test of independence in Table 2, it is clear that there is a significant dependence of commonhealth problems on the categories of waste handling. It is seen that greater percentages (14.7%, 53.4% and17.2%) of the cleaners indicated of having headache, pains and tiredness respectively while that of finaldisposers (17.3%, 22.7% and 38.7%) respectively indicated of having tiredness, catarrh and cough. This couldbe explained by the fact that the Waste Carriers (Cleaners) manually lifts the MW collected inbags/buckets/waste bins to the collection points before final disposal and as a result are prone to be tired, havepains and headache as a result of stress. That was why majority (85.3%) of them indicated tiredness or headacheor pains as their most common health problems. On the other hand, the final disposers are prone to have coughand catarrh resulting from the inhalation of toxic gaseous substances released through the open burning of thewaste materials. This would explain why majority (61.4%) indicated having cough or catarrh as the mostcommon health problems.DISCUSSIONThe adequacy or inadequacy of the waste management practices of the surveyed hospitals were measuredagainst the principal criteria as stipulated in the National guidelines for the management of medical waste. Theseinclude the presence of a tracking programme and monitoring and the existence of any medical wastemanagement plan in place. Results of this study revealed absence of tracking and monitoring programmes in allthe surveyed hospitals except two that use Supervisors (Table 3). As a result there is an absolute absence of asound tracking and monitoring programmes in all the surveyed hospitals. This finding is in agreement with thestudy of Longe and Williams (2006).On the storage/disposal of regulated, infectious, sharps and chemical wastes, the practice is low-class and isalmost the same in all the hospitals. Sharps, regulated and infectious wastes are stored in either plastics bucketsor disposable bags or waste bins or rubber buckets without a clear distinction of “what is what”. With regard tochemicals, the practice is very crude and dangerous. Chemicals are either disposed through a sink which goes toan underground pit or disposed into an open pit (Table 3) and this poses a potential environmental hazardthrough the contamination of surface and groundwater resources.As regards waste treatment, open burning is an unusual but common practice in all the hospitals except two thatincinerates using local incinerators made from bricks. The practice of open burning is tantamount to soil and airpollution as a result the release of toxic material/gases into the air and underground and this poses a potentialhealth risks. No wonder while majority of the final disposers have cough and catarrh as their most commonhealth problems [See Table 2]. The management practices / disposal methods – open pit burning, burying andincineration is similar to the practice in Tanzania (Manyele
et al.
, (2006). When MW is treated by open burningor incineration, various compounds are usually emitted. These include harmful gases such as (oxides of sulphur,

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