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Cleaner Waste Systems 6 (2023) 100115

Contents lists available at ScienceDirect

Cleaner Waste Systems


journal homepage: www.journals.elsevier.com/cleaner-waste-systems

The assessment of personal protective equipment waste management in a


developing neighbourhood: Examples of Tamale metropolis
Amadu Buare Atta a, Abubakari Zarouk Imoro b, *, Richard Osei Agyemang b,
Nana Aboagye Acheampong c
a
Department of Environmental Management and Sustainability Sciences, University for Development Studies, Tamale, Ghana
b
Department of Environment, Water and Waste Engineering, University for Development Studies, Tamale, Ghana
c
Department of Microbiology, University for Development Studies, Tamale, Ghana

A R T I C L E I N F O A B S T R A C T

Keywords: This study assesses the management practices and factors influencing Personal Protective Equipment (PPE) waste
PPE waste disposal in the Tamale metropolis. A three-stage sampling approach was used to select 383 respondents to
Reusable PPE participate in this study. A social experiment was conducted for the first time to determine critical factors
Single-use PPE
influencing waste bin use in the study area. 413.82 ± 2.16 kg PPE waste was generated from the six selected
Waste collection
communities from October 2021 to January 2022. Single-use PPE comprised 58.72 %, and reusable PPE was
Waste disposal
Waste management 41.28 %. It was also found that the Tamale Central Hospital generated more (156.59 ± 0.41 kg) PPE waste than
(137.63 ± 0.36 kg) the Tamale West Hospital. Waste materials were not segregated, and no standard treatment
method was used to handle PPE waste. Waste bin height above 150 cm was the most preferred by males, while
most female participants preferred a waste bin height of 125 cm. The participants chose yellow as the colour PPE
waste bins should have. Interestingly the heart shape was the most (41 %) patronised waste bin shape by females,
and the square shape was the most (38 %) preferred by males. The study concludes that inadequate provision of
waste bins, lack of enforcement of assembly by-laws, and inadequate training of waste handlers retard the
effective management of PPE waste in the Tamale metropolis.

1. Introduction collection, transport, treatment, and control of social behaviour con­


cerning PPE waste disposal. A reconnaissance survey in some parts of the
Waste management problems have compounded with the wide­ Tamale metropolis provided evidence of the littering of roads, drains,
spread use of Personal Protective Equipment (PPE), especially during and public places (hospitals, playgrounds) with used PPE (face masks
the COVID-19 pandemic. These include issues related to collecting, and surgical gloves). Earlier studies (Denteh et al., 2018; Adongo et al.,
transporting, treating, and disposing of PPE waste. Poor management of 2015; Puopiel and Owusu-Ansah, 2014) have also reported solid waste
used PPE poses health threats to humans (World Health Organziation, management in the Tamale metropolis. However, there is limited in­
2020) and the environment. Conventionally, PPE use against pathogens formation about PPE waste management in the Tamale metropolis and
was predominant in the hospital environment. However, the COVID-19 critical factors influencing waste disposal practices. Thus this study
pandemic necessitated that PPE is used in every setting of life leading to focused on assessing the management of used PPE in the Tamale
high volumes of PPE in domestic solid waste streams (Singh et al., 2020). metropolis and salient factors that shape waste disposal practices. The
The increasing use of facemasks and gloves both in hospitals and among study provides baseline data and information that can influence
the general population (Calma, 2020; Zambrano-Monserrate et al., decision-making regarding the development of sustainable strategies for
2020) increases the chances of inappropriate disposal leading to envi­ managing used PPE in a typical developing township.
ronmental (Aneesh et al., 2021; De-La-Torre et al., 2021; Saadat et al.,
2020; Iddrisu et al., 2023) and public health (Nzediegwu and Chang,
2020) risks. Besides the health and environmental concerns, the
increasing use of PPE affects the government’s decisions on the

* Corresponding author.
E-mail address: zaroukimoro@yahoo.com (A.Z. Imoro).

https://doi.org/10.1016/j.clwas.2023.100115
Received 14 April 2023; Received in revised form 7 August 2023; Accepted 8 August 2023
Available online 9 August 2023
2772-9125/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

2. Methodology followed by systematic sampling and then purposive sampling within


the sample frame. Thus, the Tamale metropolis was first stratified into
2.1. Profile of the study area three strata based on the most popular solid waste collection/disposal
method (Alhassan et al., 2017). The collection/disposal methods iden­
This study was conducted in the Tamale metropolitan area (Map tified were house-to-house (HtH) waste collection, communal container
presented as supplementary material - Fig. 1). The Tamale metropolitan use (CCU), and ‘strictly not HtH nor CCU’ (i.e., indiscriminate dumping,
assembly (TaMA) forms part of the 16 urban, municipal, and district burying, burning etc.). This was important for examining how the
assemblies (MMDAs) in the Northern region of Ghana. It is located at 9◦ various methods of waste collection/disposal practices among the
16 and 9◦ 34 North and longitude 0◦ 36 and 0◦ 57 West (Ghana Statis­ different strata played out in the management of PPE waste in the
tical Service, 2014). The metropolis has a total estimated land size of Tamale metropolis.
750 km2 and a population of 223,252, with a higher proportion (80.8 %) Subsequently, two communities were randomly selected from each
living in urban localities (Ghana Statistical Service, 2014). The people of stratum. These were: Vittin-Estate and Agric (for HtH), Lamashegu and
the Tamale Metropolis are youthful, with 36.4 % of this group below 15 Gumbihini (for nor CCU) and Kukuo and Dungu (strictly not HtH).
years. Following this, systematic sampling was used to select 373 households
(Vittin-Estate (53), Agric (53), Lamanshegu (80), Gumbihini (80),
2.2. Research design Wurishe-Kukuo (53) and Sagnarigu-Dungu (54)) from the communities
taking into consideration the estimated average number of households
This study employed the cross-sectional research design to achieve in each community. Finally, purposive sampling was used to select six
the study’s objectives. According to Bryman (2012), cross-sectional waste collectors from the communities and four heads of key institutions
design helps the researcher triangulate quantitative and qualitative (TaMA, Savannah Waste Service, Tamae West Hospital (TWH), and
methods. Also, De (2002) also explained that cross-sectional design is Tamale Central Hospital (TCH)) in the Tamale metropolis for interviews.
imperative, especially when the researcher is answering questions such TCH and TWH were chosen based on the fact that they are both sec­
as ‘why’ or ‘how’, thus its use in this study. ondary hospitals which allows for fare comparisons and the willingness
of the staff of these hospitals to participate in the study.

2.3. Sample size determination


2.5. Data collection
The sample frame from which the sampled respondents for this study
were drawn was 108,888. This is the urban population of the Tamale Data on how respondents handle PPE waste was collected using
Metropolis, considering the age group between 15 and 64 years (Ghana questionnaires, interviews, and observation aided by a checklist. Also,
Statistical Service, 2014). The Ghana Statistical Service (2014) data used PPE in the selected communities was collected morning and eve­
were used in this study because, at the start of the study, data from GSS ning for 16 weeks (from October 2021 to January 2022) for identifica­
(2021) were unavailable. The sample size was computed using Dill­ tion and quantification. Waste bins and plastic bags were provided to the
man’san (2000) formula. The formula is mathematically expressed as: houses selected for used PPE quantification. The waste was sorted and
weighed in plastic bins and bags. The weight of the plastic bags (Wp) and
n=[
[(N) (p) (1 − p) ]
] plastic bins (Wb) were determined before weighing the used PPE to
( )2
(N − 1) CB + (p) (1 − p) ensure that the weights of the PPE wastes were rightly calculated. The
following formula was used to calculate the weight of used PPE:
Where: Weight of used PPE = Wt - (Wb + Wp) (1)
n = sample size needed for the desired level of precision.
N = population size (108,888). Where Wt = total weight of waste and containers, Wb= weight of
p = proportion of the population expected to be chosen (0.5). waste bin, Wp = weight of polythene bag.
B = acceptable amount of sampling error, or precision which is set at The daily per capita generation rate of used PPE was calculated
0.05 or 5%. (Miezah et al., 2015) using the formula:
C = confidence level which is estimated at 1.96 that corresponds to

Weight of PPE waste generated at household


DailyPer Capita PPE waste Generation = (2)
Total number of persons in the household × Total number of generation days

the 95% level (1.96)


For each household, semi-structured questionnaire containing both
[(108, 888) (0.5) (1 − 0.5)]
n= ( 0.05)2 opened-ended and closed-ended questions was administered to the
[(108, 888 − 1) 1.96
+ (0.5) (1 − 0.5)] household heads or any available adult.
In the case of waste management at disposal sites, face-to-face in­
27, 222 terviews were used as the first approach to obtain ‘in-house’ information
n= = 383.41 ≈ 383
71 necessary for assessing how used PPE was treated at the disposal sites.
Hence, the total sample size for the study was 383 participants. Heads of stakeholder institutions (Tamale metropolitan assembly,
Savannah waste service) and waste collectors from the selected com­
munities were interviewed. Subsequently, a standard checklist and
2.4. Sampling techniques and procedure
personal observation were used to validate the information gathered
through interviews. The quantities of used PPE generated in the
A three-stage sampling approach was used to select respondents for
outpatient departments (OPDs) of two leading hospitals within the study
the study. Specifically, stratified-random sampling was used to first
area were also estimated and compared to appreciate the level of PPE
select 6 communities from a larger sample frame of 41 communities,

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waste generation and management by the health sector over the study height, colour, and shape emerged as the first choice was counted and
period. totalled. Responses from males (50) and females (50) were counted
separately so gender user preferences could be analysed. This exercise
2.6. Social experiment (voting) was essential to determine the factors that significantly influ­
enced the waste disposal practices of inhabitants in the study area.
2.6.1. One-factor at a time study
A one-factor at a time (OFAT) social experiment was conducted to 2.8. Data analysis
determine key factors influencing positive waste disposal behaviours in
the study community. The OFAT approach was adopted because there Means of weighed PPE waste were computed and represented by bar
was the need first to establish factors that affect waste disposal before charts and trend lines. Analysis of variance (ANOVA) was performed to
looking into the interactive effects of the factors. The OFAT social compare the variation among the weekly mean quantity of PPE waste
experiment was preceded by a reconnaissance survey to sample the most generated between the selected communities at 5 % significantly
important factors concerning the objective of the experiment. Waste different using SPSS V. 23. Where applicable, participants’ perceptions
bins’ height, colour, and shape were prioritised among a list of factors. were presented in bar charts.
Thus three (3) different heights (175, 150, and 125 cm) were chosen for
the study based on the prevailing height of inhabitants in the sampled 3. Results and discussion
community. Also, from the reconnaissance survey, it was realised that
the sampled population preferred the shapes of waste bins to be square, 3.1. Quantities of PPE waste generation in the Tamale metropolis
the shape of heart, and cone shape. The colours: pink, yellow, and green
came up as among the colours they wish their waste bins were painted 3.1.1. PPE waste generated in the communities over the study period
with. Results obtained from the estimation of used PPE showed that the
One hundred (100) random people from the study community will­ total quantity of used PPE generated in the six (6) selected communities
ingly participated in this social experiment. This comprised fifty (50) from October 2021 to January 2022 ranged between 45.4 ± 1.51 kg to
males and 50 females. Each participant was given a coded nose mask to 105 ± 2.40 kg. The highest quantity of 105 ± 2.40 kg was generated in
use and dispose of in a waste bin of his or her own choice. The disposal Lamashegu and the least (45.4 ± 1.51 kg) from Kukuo (Fig. 1A).
site was set up such that there were bins made of cardboard placed at the ANOVA results showed that the weekly mean quantity of PPE waste
selected heights (125, 150, 175 cm) at one location, another set of bins generated across the selected communities was significantly different (P-
made of the colours earlier stated at another spot, and a third set made of value < 0.05) from each other. Data in Fig. 1A shows that Lamashegu
the shapes concerned at a designated spot within the experimental and Gumbihini generated higher quantities of PPE wastes than Kukuo
environment. and Vittin-Estate. This may be attributed to the differences in household
For the study about the effect of height, colour, and shape were sizes between the communities and the existing waste collection
maintained constant as required in an OFAT experiment. The colour methods. Lamashegu and Gumbihini are more populated with larger
used in this particular experiment was green because it is the prevailing household sizes than Kukuo and Vittin-Estate. Earlier studies have re­
colour of bins in the study area, while the shape used was a rectangle to ported that rapidly increasing population, economic growth, and afflu­
reflect the prevailing shape of bins in the area. In the case of the effect of ence have contributed to increments in quantities of municipal solid
colour on the waste bin preferred, height (90 cm – the prevailing height waste generated (Aguilar-Virgen et al., 2010; Al-khatib et al., 2010;
of bins in the area) and shape (rectangle) were kept constant, and for the Nabegu, 2010; Fakare et al., 2012).
effect of shape, height (90 cm) and colour (green) were kept constant. In the case of the Communal Container Use (CCU) service signed on
All experiments were replicated to have repeated measures. by Lamashegu and Gumbihini inhabitants, the assembly was responsible
for managing wastes directly from homes. Skips were provided at
2.6.2. Pairwise ranking designated places by the TaMA to collect wastes from homes. Some
The pairwise ranking method was used to rank the participants’ interesting observations about this management option included the
preferred choices of waste bins in order of priority. The pairwise ranking following; the proximity of skips played a role in the frequency of
is a research technique that ranks a set of options by comparing random disposal by residents. Also, skips were often overflowing with waste, and
pairs in a head-to-head choosing exercise (Negahban et al., 2017). It is some waste, including PPE, was often dispersed by wind. This finding is
also called pairwise comparison, paired comparison, or pairwise sur­ in consonance with that reported in the study conducted by Okyer­
veys. Using this method, the participants were asked to rank the factors e-Hayford (2016), which revealed that skips at the Kwame Nkrumah
(height, colour, and shape) influencing their PPE waste disposal prac­ University of Science and Technology (KNUST) hospital sometimes
tices. A pairwise comparison table was thus drawn, and the list of fac­ overflowed with medical waste, including used PPE. Considering the
tors, height, colour, and shape of bins, was entered in the first column total week-by-week generation of PPE in the study area (holding com­
and then across the top row (Supplementary material – Table 2). Two munity as constant), there was no significant difference (P value > 0.05)
pairs of factors were compared at a time, one from the column and the between the mean PPE waste generated across the 16 weeks. This
other from the row of the table. Each participant was asked to compare observation could be because the study communities’ weekly social and
and choose the most critical factor between factors considered at the economic activities did not vary significantly.
moment and the preferred choice recorded. This exercise was repeated However, trend analysis on the quantity of used PPE generated by
until all the 100 participants (50 male and 50 female) had made and the communities in the metropolis showed a non-uniform pattern, as
ranked their choices in order of preference. The most preferred option shown in Fig. 1B. This is similar to the observation reported in the study
was ranked first (1st), the next was ranked second (2nd), and the least by Okyere-Hayford (2016), where a non-uniform pattern in medical
was ranked third (3rd). waste generation was noticed in different wards of the KNUST hospital.
In the case of this current study, this observation can be attributed to the
2.7. Social choice theory heterogeneous nature of people in the Tamale metropolis (different
demographic characteristics). Also, the fluctuation observed in the
The social choice theory was conducted after pairwise ranking the pattern of PPE waste generation every month could be due to the
factors influencing waste disposal practices. This was done by counting president of Ghana’s periodic national updates on COVID-19 cases.
the number of times each factor emerged as the first choice for males Thus, anytime a national update might have been given in relation to
(50), and the same was done for females (50). Thus, the number of times COVID-19 case hikes or a new strain of the virus was announced, PPE

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Fig. 1. Quantity of PPE waste generated in the metropolis.

Table 1
Total PPE waste (kg) generated across the study communities.
Community Single-use PPE (kg) Reusable PPE (kg) Total waste generated (kg)

Surgical mask Respirators Surgical gloves Fabric masks Leather gloves Sanitiser bottles

Vittin-Estate 20.45 ± 1.28 7.21 ± 0.45 1.75 ± 0.11 11.86 ± 0.74 2.94 ± 0.18 11.45 ± 0.71 55.66 ± 1.71
Agric 21.36 ± 1.33 3.88 ± 0.24 7.51 ± 0.46 14.01 ± 0.87 1.81 ± 0.11 3.21 ± 0.52 51.78 ± 2.24
Gumbihini 40.52 ± 2.53 1.45 ± 0.09 4.18 ± 0.26 21.95 ± 1.06 6.88 ± 0.43 9.11 ± 0.56 84.09 ± 2.51
Lamashegu 49.73 ± 3.1 6.41 ± 0.40 5.55 ± 0.34 28.64 ± 1.48 5.69 ± 0.35 8.98 ± 0.56 105 ± 2.40
Dungu 37.18 ± 2.32 5.15 ± 0.32 8.98 ± 0.37 9.11 ± 0.94 7.02 ± 0.43 4.45 ± 0.27 71.89 ± 2.57
Kukuo 16.71 ± 1.04 4.28 ± 0.26 3.68 ± 0.23 10.16 ± 0.63 5.45 ± 0.34 5.12 ± 0.57 45.4 ± 1.51
Overall Total 185.95 ± 1.92 28.38 ± 0.29 31.65 ± 0.29 95.73 ± 0.95 29.79 ± 0.31 42.32 ± 0.57 413.82 ± 2.16
Percent (%) 44.93 6.86 7.65 23.13 7.20 10.23 100

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usage was triggered, resulting in the generation of more waste, and Lamashegu has a cluster of schools, a market, clinics, and lorry parks.
when the number of cases reported was low, then PPE usage dropped.
Out of the total quantity of 413.82 ± 2.16 kg of used PPE generated 3.1.2. PPE waste generated in selected hospitals
in the study area, single-use PPE was 242.98 ± 0.83 kg (58.72 %), Results obtained from the PPE waste estimation at OPDs of the
representing the majority of the wastes generated, while reusable PPE Tamale Central Hospital (TCH) and Tamale West Hospital (TWH)
was 170.84 ± 0.61 kg (41.28 %) representing the least of the waste showed that TCH had the highest (156.59 ± 0.41 kg) total PPE waste
generated (Table 1). This finding is similar to that reported by De-la-­ generation compared to TWH (137.53 ± 0.36 kg) during the period of
Torre et al. (2021) in Peru, revealing that 67 % of used masks were the study (Fig. 1D). The ANOVA of the mean quantity of PPE waste
single-use. They argued that single-use masks are generally cheaper and generated on month-by-month basis between the two health institutions
more accessible than fabric masks, hence the higher quantities of was not significantly different (P value > 0.05) from each other. An
single-use PPE in the solid waste stream. An observation made in this earlier study by Ahmed et al. (2014) on two hospitals (Al Ribat uni­
current study was that because fabric masks are reusable, they were versity hospital and Al Saudi Hospital, Khartoum State, Sudan) showed
washed and reused many times before disposal. Thus, this could be why varied quantities of waste generation over the study period they
these masks were comparatively lower in quantity than the single-used considered. According to Ahmed et al. (2014), this was due to the
type. population difference between the areas where the two hospitals were
There was no significant difference (P value > 0.05) between the located. A similar conclusion could be attributed to the observation
mean PPE waste generated across the four months. However, the total made in this study.
PPE waste generated by the communities in October (125.16 ± 2.40 kg)
consisted of 73.56 ± 1.41 kg of single-use and 51.6 ± 0.99 kg of reus­ 3.2. Assessment of PPE waste management measures in the Tamale
able PPE. These were relatively higher than those generated in metropolis
November and December 2021 and January 2022 (Fig. 1C). This
observation could be due to the stricter enforcement and adherence to According to World Health Organziation (2020) guidelines, PPE
the COVID-19 protocols when active cases were still on the rise. Klemes waste, including used masks and hand gloves, should be managed like
et al. (2020) also observed a significant surge in the volume of plastic infectious waste. To ensure the safety of humans and the environment,
waste during the COVID-19 pandemic. They reported that potential sustainable management of used PPE should include practices such as
short-term and long-term changes in plastic waste management prac­ waste minimisation, segregation, storage, transportation, treatment, and
tices are necessary to reduce the eminent adverse environmental effect responsible disposal (Acter, 2000; Al-Habash and Al-Zu’bi, 2012). Below
of this waste category. Generally, PPE use generates approximately 20 are the waste management practices observed in the study area.
tons of waste per day in a relatively small area like the Silesian region
(Vanapalli et al., 2019). 3.2.1. Segregation, collection, storage, and transportation of PPE waste
The prevention and minimisation of waste through practices such as The majority (65.83 %) of the respondents in the six (6) communities
materials reuse, recycling, and waste recovery is the most cost-effective studied indicated that segregation of waste was not practised as rec­
and preferred solid waste management activity (ISWA, 2013; World ommended by US EPA (2002) and World Health Organziation (2020). It
Health Organisation, 2014). The high generation of waste materials, was also found that Lamashegu had the highest record of no segregation
such as face masks or gloves, presents opportunities for recycling or (80 %) of waste, with Vittin-Estate recording the least of 53% (Fig. 2A).
energy recovery (Piotr et al., 2020). Moreover, no colour-coded or labelled bins were found in the commu­
Both surgical gloves and leather gloves waste were generated in all nities. Earlier works including that of Mensah (2012), Asante et al.
the communities. The total quantity of hand gloves generated was 61.44 (2014), and Yawson (2014) also reported on the poor segregation, no
± 0.61 kg consisting of 31.65 ± 0.29 kg of surgical gloves and 29.79 colour-coded bins, and no labelling of medical waste bins in Ghana.
± 0.31 kg of leather gloves. The highest quantity of 8.98 ± 0.37 kg of Also, a similar study by Shomar & Abed (2013) reported that only
gloves was generated at Dungu while the least (1.75 ± 0.11 kg) was 18.8% of respondents separated hazardous waste from non-hazardous
generated at Vittin-Estates (Table 1). The higher quantity of gloves wastes in healthcare facilities. These earlier findings show that poor
recorded in Dungu could be attributed to the high number of hair­ waste segregation is not a peculiar problem of the study area but tran­
dressing salons in the Dungu enclave that use surgical gloves in their scends other jurisdictions.
beautician businesses, and this is probably facilitated by patronage by An observation made by some households’ representatives and
the students at University for Development Studies (UDS) Dungu confirmed by observations in this study was that even when they
campus. segregated used PPE, the used PPE was still mixed up with other solid
Waste sanitiser bottles were also found in all the communities during waste materials by waste collectors during collection. This is consistent
the study period (October 2021 to January 2022). The total quantity of with reports by Coker et al. (2009), Sawalem et al. (2009), and Udofia
waste sanitiser bottles generated ranged from 11.45 ± 0.71 kg to 3.21 et al. (2015) that collectors mix segregated waste materials during
± 0.52 (Table 1). Vittin-Estate generated the highest quantity of 11.45 collection. Mixing hazardous and non-hazardous waste is against the
± 0.71 kg, while Agric generated the least quantity of 3.21 ± 0.52 kg World Health Organisation (2014) guidelines. Results from the question
(Table 1). The more significant amounts recorded at Vittin-Estate could items on PPE waste collection and storage containers used at homes
result from the economic activities (Cluster of schools and shops/points showed that most (51.74 %) of the respondents collected and stored PPE
of sale of retail goods), which bring many people around and the wastes in immobile waste bins. Only a few (1.87 %) used trollies
attended larger volumes of waste generated. Also, Vittin-Estate is closer (Table 2).
to the Tamale teaching hospital, where the use of sanitisers is expected Data in Table 2 further shows that Vittin-estate had the highest re­
to be high. cord of 44 (83%) waste bins usage, and Lamashegu had the most minor
The total PPE waste generation rate in the study area was 0.204 kg/ record of 25 (31.25 %) waste bin usage. This result was expected
person/day. The rate at which single-use PPE was generated was because communities like Vittin-Estate subscribed to the house-to-house
0.13 kg/person/day, and reusable PPE was 0.074 kg/person/day (Sup­ (HtH) waste collection method, where waste bins are provided by pri­
plementary material – Table 2). Lamashegu electoral area recorded the vate waste management companies like Savannah waste service for the
highest PPE waste generation rate of 0.052 kg/person/day, while Kukuo temporary storage of waste. In contrast, the Lamashegu community
electoral area had the lowest generation rate of 0.022 kg/person/day. primarily relied on communal container services.
The higher rate of PPE waste generation recorded at Lamashegu could be It was also observed that some waste containers had no covers and
due to the high economic activities within these communities. were kept in open areas in compounds. This was rampant in Lamashegu

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Fig. 2. Used PPE segregation, collection, and handling.

Table 2
Containers for collection and temporary storage of solid waste.
Frequencies Total %

Vitin-Estate Agric Gumbihini Lamashegu Dungu Kukuo


Waste bins 44 32 30 25 26 36 193 51.74
Cardboard boxes 5 9 12 17 10 6 59 15.82
Plastic bags 3 5 6 8 2 4 28 7.51
Trollies 1 1 1 2 1 1 7 1.88
Others 0 6 30 29 14 7 86 23.05
Total 53 53 80 80 53 54 373 100

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and Gumbihini. This practice falls short of WHO (2005) regulations, PPE waste, the following were noted: limited knowledge on managing
which list waste bins lined with polythene bags and with covers as PPE waste and using preventive measures such as hand washing and
appropriate for waste collection. The rules of Ghana’s MLGRD and EPA sanitisers. Others included inadequate storage containers, delays in the
(2002) state that containers or bins for used PPE storage must be in lifting of waste by the waste management companies and the long dis­
roofed areas where the waste is protected from rainfall, wind, and tances inhabitant had to cover to reach communal skips (Supplementary
scavenging animals. This was, however, observed only in Vittin-Estate material – Table 3).
and the Agric areas. An assessment of the PPE waste management practices based on
Also, respondents were asked about suggestions for improving PPE personal observations and aided by a standard checklist (UNEP, 2013;
waste collection and storage. Results from this enquiry showed that the MLGRD, 2002) showed that the institutions (TCH and TWH) had a
majority (53.38%) of the respondents supported the novel design of higher level of compliance (71.43 %) with regards to their existing waste
automated devices with the option to collect used PPE automatically. In management practices as compared to what (28.57 %) was observed at
comparison, a minority (7.84%) endorsed the use of mobile phone ap­ the household levels (Table 3).
plications to facilitate the timely collection of used PPE (Fig. 2B). This Households did not treat PPE waste before disposal. This is contrary
finding is similar to the results from an earlier study in Poland by Piotr to the recommendation of the World Health Organisation (2014) that
et al. (2020) in which 37% of respondents were found to support the use infectious medical waste, such as PPE waste, should be treated before
of automated devices for PPE waste collection. disposal. From all information sources, the hospitals studied treated only
Waste management companies, including Savanna waste services, waste medical sharps, and this was by incineration. The incinerator­
used motorised tricycles and refuse trucks to transport waste from s/combustion facilities used by the hospitals did not have air pollution
households to communal collection containers or the Gbalahi landfill on control devices, and this is contrary to the recommendations of the
behalf of the Tamale metropolitan assembly. Unfortunately, it was UNEP (2013), which states that incinerators for medical waste should be
observed that waste collectors used their bare hands to empty waste fitted with air pollution control devices to filter pollutants emanating
from tricycles into communal containers and disposal trucks. Similarly, from the combustion process.
a report by Udofia et al. (2015) indicated that hazardous waste,
including used PPE, was manually lifted into vehicles in communities 3.2.3. Assessment of the treatment of used PPE at Gbalahi landfill site
they studied, as observed in this study. The treatment and final disposal site for solid waste, including used
PPE, is the landfill site at Gbalahi. Gbalahi is a suburb of Tamale located
3.2.2. Treatment and disposal methods used to handle PPE waste in the about 13 kilometres from the central business district. An assessment of
communities the functional elements of the landfill through personal observation
There was no standard treatment method for PPE waste in the aided by a standard checklist showed the presence of a weighbridge,
communities. While burying and burning was common practice in the wastewater treatment facility, gas recovery, and leachate collection
communities, some (23.33%) respondents did not know the treatment systems. However, no internal access (a well-designed route within the
methods for disinfecting PPE waste (supplementary material - Fig. 2). site for vehicular movement) was provided. This notwithstanding, the
In response to receiving any training on the treatment and disposal of Gbalahi landfill is also closer (∼ 1 km) to the Wovuguma community
PPE wastes since the outbreak of the COVID-19 pandemic, 73.73 % of and thus pose a nuisance to this community.
the respondents indicated that they did not receive such training and The functional elements at the landfill site were considered a priority
26.27 % stated they received training on the management of PPE wastes. by the manager of the site, and the representative of the waste man­
Vittin-Estate had a comparatively higher score (28.57 %) for those who agement department (TaMA) was the waste treatment plant. It was
received training, and Kukuo recorded the lowest (9.2 %) for those who graded a score of 40 % followed by internal access within the landfill (30
had received training (supplementary material - Fig. 3). A further %). Weighbridge and proximity to human settlement scored 10% each,
enquiry showed that the majority (80 %) of those who received training and the leachate collection and gas recovery system scored 5 % (sup­
were people employed in the formal sector (office workers, nurses, plementary material, Fig. 4). It wasn’t very pleasant to know that the
teachers etc.) and that these people had received the training from their wastewater treatment plant and the gas recovery facility at the landfill
workplaces. site were not functioning well when the study was being conducted. This
This study’s findings on the low coverage of training on handling PPE is a deviation from the recommendation of UNEP (2013) which em­
waste resonate well with the study by Zheng et al. (2021), where it was phasises the presence and full functionality of such components of a
reported that the training on the management of used PPE and pre­ landfill. Another unfortunate observation was that most of the cells at
ventive measures was still limited. This situation can put the general the landfill were filled, and the waste materials dumped in the cells were
public and waste handlers at high risk of infection. not levelled and compacted.
On the subject matter of the problems affecting the safe handling of Regarding the waste handling and treatment procedures at the

Table 3
Level of compliance of PPE waste management practices in communities and health institutions.
Waste management practices In Compliance Not in Compliance N/A Overall Rating
for this Assessment

1 Personal protective equipment (PPE) is reused IC I ¼ 71.43%


2 Appropriate waste disposal time I C C ¼ 28.57%
3 Compliance with source segregation I C
4 Covered waste bins I C
5 Record on waste-PPE generated IC
6 Does incinerators have pollution control devices I C
7 PPE waste treatment methods Incineration I
Microwave disinfection
Autoclave
None
Burying in pits C

I = Institutions, C = Communities and IC = both institutions and communities


Grading adopted from UNEP (2013) & MLGRD (2002)

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A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

landfill site, respondents (The officer in charge of the landfill and the release dioxins and other carcinogens into the atmosphere. Burning of
representative of waste management departments) contacted during the PPE waste contravenes the guidelines of EPA (2002) and World Health
interviews indicated that there were procedures in place for the Organisation (2014), which state that solid medical waste should be
handling and treatment of wastes at the landfill. They noted that trained decontaminated and disposed of through incineration. Also, incinerators
personnel visually inspected waste loads to recognise wastes that should be fitted with air pollution control devices to control the emission
required special handling. This practice aligns with the recommendation of pollutants from the incineration process (EPA, 2002; World Health
of the UNEP (2013), which stipulates that waste load entering the Organisation, 2014).
landfill should be visually inspected by trained personnel to identify According to the head of the waste management division of
waste that requires special handling. The waste handling procedures Savannah waste service, waste segregation was not practised at the
most practiced at the landfill site are presented in Fig. 2C. source (homes and institutions) in the study area. Segregation allows
Moreover, an interview with the representative of the waste man­ reusable materials to be diverted from the landfill and, thus, reduces the
agement department indicated that used PPE treatment/disposal volumes of waste that reach landfills. It was also observed that no
methods at the landfill site were mainly through burning (60% of waste decontamination activities/procedures were practised at primary
received) (supplementary material, Fig. 5). Used PPE were burnt (communal skips) disposal sites. This contradicts the recommendation
together with plastics, leather, and other combustible materials. Ac­ that potentially infectious waste should be decontaminated before
cording to Abor (2013), several countries around the world use haz­ disposal (Alhumoud and Alhumoud (2007)).
ardous waste treatment technologies such as incineration, autoclaving, According to Abor and Bouwer (2008), waste segregation and
and microwave disinfection, but this was not the case at the Gbalahi decontamination reduce the volume and any risk of the spread of in­
landfill site in Tamale, Ghana. fections from waste materials. Another finding was that waste handlers
Unlike incineration, burning is uncontrolled combustion that can from the waste management departments used one or two of the

Fig. 3. Effect of waste bin characteristics on waste disposal practices.

8
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

following PPE: face masks, hand gloves, boots and overalls (Fig. 2D). Table 4
Meanwhile, the vast majority (79%) wore inappropriate/insufficient Participants’ prioritisation of waste bin characteristics.
sets of PPE (supplementary material - Fig. 6). The primary reason for this Factor Male vote Per cent (%) Female vote Per cent Total
observation was that PPE was difficult to use. However, the refusal or (%)
inappropriate use of PPE violates the MLGRD & EPA (2002) and World Height 27 54 13 26 40
Health Organisation (2014) regulations. These regulations require Shape 17 34 15 30 32
appropriate PPE to protect against infectious diseases such as COVID-19. Colour 6 12 22 44 28
Using a self-developed operations and maintenance checklist to 50 100 50 100 100

assess the Gbalahi landfill site, it was concluded that the Gbalahi landfill
is a partly functional waste treatment facility with poor routes/internal respectively). This notwithstanding, it was found that colour had no
access within it, and it is located about 1 kilometre away from the significant impact on waste collection (Leeabai et al., 2021). Thus,
nearest human settlement. Based on the problems above and informa­ though colour may influence waste disposal practices, it may not matter
tion gathered from managers of the landfill site and other stakeholders when it comes to waste collection.
(waste management companies), the landfill’s performance was rated
50 % out of 100 %. The undesirable state of the landfill could be 3.3.3. Effect of the shape of waste bin on PPE waste disposal
attributed to factors including low revenue generation and a limited In the case of the most patronised waste bin shape, females disposed
number of skilled manpower. of their used-nose masks more 20.5 (41 %) in the heart-shaped waste bin
(Fig. 3C). The higher usage of the heart shape waste bin by females was
3.3. One-factor at a time study attributed to two reasons; society’s perception that the female gender
likes to be loved (love symbolised by the heart shape) and also, empathy
3.3.1. Effect of height of waste bin on PPE waste disposal practice towards COVID-19 victims. The male participants, on the other hand,
Results from the social experiment showed that 44% of the male patronised 19 (38 %) of the square shape more than the heart and cone-
participants in the experiment disposed of their used-nose masks in the shaped waste bins (Fig. 3C). The high patronage of the square shape
bin placed at a height of 175 cm (Fig. 3A). This was not unexpected as waste bin by the males could be attributed to the fact that the square
the average height of male participants in the experiment was 169 shape looks more like the common rectangular shaped waste bins that
± 5 cm. Meanwhile, the bin that received the least (26 %) patronage are mostly used and that the males probably just wanted to stick to what
from the males was placed at a height of 125 cm (Fig. 3A). The reason is known. This finding is similar to that reported by Leeabai et al. (2022)
associated with the low patronage of the bin placed at 125 cm was that who found that square shape bins were one of the most preferred bins for
they (males) had to bend over to drop their used masks into this bin and waste disposal.
found this situation inconvenient. In an earlier study by Leeabai et al.
(2022), the top position (higher height) was one of the preferred posi­
tions for waste bin slots and thus this current study’s findings are in line 3.4. Social choice theory
with that of Leeabai et al. (2022). It is therefore suggested that, to illicit
good PPE waste disposal practices among males in this community, it is Results from the voting exercise conducted after the pairwise ranking
important to give some consideration to waste bin heights, especially showed that the majority (54 %) of the male participants chose height as
heights above 150 cm. the factor influencing their waste disposal practice the most (Table 4). A
In the case of the females, the waste bin placed at a height of 125 cm study by Leeabai et al. (2019) reported that aside from height, the dis­
received the highest 19 (38 %) patronage (Fig. 3A). This observation was tance at which waste bins are placed affects waste disposal behaviours in
not expected because the average height of female participants in the Thailand. Thus, increased distance between trash bins and waste gen­
experiment was 150 ± 6 cm. Thus, the bin placed at 150 cm was ex­ eration points decreased waste collection and disposal practices and vice
pected to receive more used-nose masks. According to the majority, 19 versa.
(38 %) of the female participants chose to dispose of the used-nose mask In the case of the female gender, the majority (44 %) chose colour as
in the bin placed at 125 cm because they were used to bending over to a factor that influenced their waste disposal practices, whiles a few (26
dispose of waste. Expectedly, the waste bin which received the most %) choose height as a factor that influenced their waste disposal prac­
minor 12 (24 %) patronage was the one placed at a height of 175 cm tices (Table 4).
(Fig. 3A). It is generally not comforting for one to stretch to higher An earlier study by Leeabai et al. (2021) found that trash bin colour
heights to dispose of waste, thus the low patronage of the waste bin preference had a non-negligible impact on human behaviour towards
placed at 175 cm. waste separation, treatment, and disposal. Colour improves waste bin
recognition and noticeability and helps waste handlers sort waste for
3.3.2. Effect of colour of waste bin on PPE waste disposal disposal (Clarke et al., 2018; Liu et al., 2018). Moreover, colour
The preferred colour for PPE waste bins for both males 19 (38 %) and perception influences human memory and decision-making (Elliot and
females 22.5 (45 %) was yellow (Fig. 3B). Coincidentally, yellow is the Maier, 2014). Both male and female gender practically sided with each
colour code for waste bins meant for receiving infectious waste (Pandey other (34 % and 30 % respectively) in terms of their preference for the
et al., 2016). It was possibly the case that the participants who chose to shape of waste bins as a factor that influenced their waste disposal
dispose of their used-nose mask in the yellow bin had some prior practices (Table 4). In other words, both male and female gender had
knowledge of the colour code for waste bins designated for infectious similar considerations with regard to the shape of waste bin containers
waste. For the males, the pink waste bin recorded the least 14 (28 %) (Table 4).
patronage while the green waste bin was the least 11.5 (23 %) patron­
ised by the females. These observations were associated with the colour 4. Conclusion and recommendation
these genders identify with. The general statement from the participants
was that pink is associated with the female gender while green is a dull This study reports that the quantity of used PPE generated in the
colour which males might like. study area within the study period was 413.82 kg. Single-use PPE was
In an earlier work by Leeabai et al. (2021), it was found that colour the most commonly generated PPE waste in the metropolis. Tamale
preferences had statistically significant correlations with bin-colour Central Hospital produced more PPE waste than Tamale West Hospital.
usage rates (p = 0.009 for combustible waste bins, p = 0.032 for The waste handling practices of inhabitants and the hospitals studied did
incombustible waste bins, and p = 0.012 for PET bottle bin, not meet the requirement of WHO, EPA and the Ministry of Local

9
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

Government and Rural Development guidelines. Gbalahi landfill is the Calma, J. (2020) The COVID-19 pandemic is generating tons of medical waste: Sanitation
workers need Personal Protective Equipment too, the verge. https://www.theverge.
final disposal site for used PPE in the Tamale metropolis. Used PPE at the
com/2020/3/26/21194647/.
landfill was not disinfected before disposal. It was also found that the Clarke, et al., 2018. Thai norms for name, image, and category agreement, object
male participants in the social experiment chose height as the essential familiarity, visual complexity, manipulability, and age of acquisition for 480 color
characteristic of a waste bin that can influence the rate of patronage of a photographic objects. J. Psycholinguist. Res. https://doi.org/10.1007/s10936-017-
9544-5.
waste bin. In contrast, the female participants chose colour as the most Coker, A., Sangodoyin, A., Sridhar, M., Booth, C., Olomolaiye, P., Hammond, F., 2009.
important factor to consider when designing higher-use waste bins. A lot Medical waste management in Ibadan, Nigeria: obstacles and prospects. Waste
of advocacy and training are needed to change the present narrative Manag. 29, 804–811. https://doi.org/10.1016/j.wasman.2008.06.040.
De, Vaus, 2002. Survey in Social Research, fifth ed. Routloudge,. Doi:10.4135/
about how used PPE are managed in the metropolis. Radio and televi­ 97814462663495.
sion programmes and social media can be good starting points. Future De-la-Torre, et al., 2021. Investigating the current status of COVID-19 related plastics
research studies may want to look into behavioural change communi­ and their potential impact on human health. Curr. Opin. Toxicol. 47–53. https://doi.
org/10.1016/j.cotox.2021.08.002.
cation strategies needed to convince societies to dispose of used PPE Denteh, S.N., Cobinna, S.J., Adam, W., Aboka, E.Y., 2018. Household solid waste
responsibly. Also, life cycle assessment of locally produced (cloth mask) management: compositional analysis, storage, and collection in the Vittin Target
face mask will be an interesting subject to research. The effect of Areas, Tamale Ghana. UDS Int. J. Dev. 5 (1) https://doi.org/10.47740/237.
UDSIJD6i.
ambient temperature on PPE usage is also an important area to Elliot, A.J., Maier, M.A., 2014. Color psychology: effects of perceiving color on
investigate. psychological functioning in humans. Annu. Rev. Psychol. 65 (95), 120. https://doi.
org/10.1146/annurev-psych-010213-115035.
EPA, 2002. Guidelines for Ensuring and Maximizing the Quality, Objectivity, Utility,
Funding andIntegrity of Information Disseminated by the Environmental Protection Agency.
U.S. Environmental Protection Agency, Office of Environmental Information (2810)
This research did not receive any specific grant from funding 1200 Pennsylvania Avenue, NW Washington, DC 20460.
Fakere, A.A., Fadairo, G., Olusegun, O., 2012. Domestic Waste Management and Urban
agencies in the public, commercial, or not-for-profit sectors.
Residential Environment: Focus on Akure, Nigeria. International Journal of
Engineering and Technology 2 (5), 878–887.
Declaration of Competing Interest Ghana Statistical Service, 2014. PHS report. Page 8.
Iddrisu, et al., 2023. Review on the effects and management of personal protective
equipment waste on ocean resources. Int. J. Environ. Sci. Technol. https://doi.org/
The authors declare that they have no known competing financial 10.1007/s13762-023-05093-3.
interests or personal relationships that could have appeared to influence ISWA, 2013. Guidelines for Design and Operation of Municipal Solid Waste Landfills
inTropical Climates. International Solid Waste Association.
the work reported in this paper. Klemes, et al., 2020. Minimising the present and future plastic waste, energy and
environmental footprints related to COVID-19. Renew. Sustain. Energy Rev. 127,
Data availability 109883 https://doi.org/10.1016/j.rser.2020.109883.
Leeabai, et al., 2021. The effects of color preference and noticeability of trash bins on
waste collection performance and waste-sorting behaviors. Waste Manag. 121,
Data will be made available on request. 153–163. https://doi.org/10.1016/j.wasman.2020.12.010.
Leeabai, et al., 2022. The effects of compost bin design on design preference, waste
collection performance, and waste segregation behaviors for public participation.
Appendix A. Supporting information Waste Manag. 143, 35–45. https://doi.org/10.1016/j.wasman.2022.02.018.
Leeabai N., Suzuki S., Jiang O., Dilixiati D. Takahashi F., 2019. The Effects of
Supplementary data associated with this article can be found in the SettingConditions of Trash Bins on Waste Collection Performance and Waste
Separation Behaviors; distance from walking path, separated setting, and
online version at doi:10.1016/j.clwas.2023.100115. arrangements Vol 9, 58-67 https://doi.org/10.1016/j.wasman.2019.05.039.
Liu et al., 2018. Evaluating colour quality of lighting: Why meta-analysis is needed?
References http://doi:10.1109/ifws.2018.8587325corpus id: 57191215.
Mensah, A.A., 2012. Solid Medical Waste Management Practices: A Case Study at the
Sefwi-Wiawso Government Hospital. Master of Science in Environmental Science.
Abor, P.A., Bouwer, A., 2008. Medical waste management practices in a Southern African
Kwame Nkrumah University of Science and Technology, Kumasi. https://ir.knust.
hospital. Int. J. Health Care Qual. Assur. 21, 356–364. https://doi.org/10.1108/
edu.gh/handle/123456789/5745.
09526860810880153.
Miezah, K., Obiri-Danso, K., Kádár, Z., Fei-Baffoe, B., Mensah, M.Y., 2015. Municipal
Adongo, R., Kuuder, C., Amoako, E., Asare, W., Duwiejuah, A.B., Arthur, V., 2015.
solid waste characterization and quantification as a measure towards effective waste
Stakeholder views on waste and its management in Tamale Metropolis, Ghana. J. Sci.
management in Ghana. Waste Manag. 46, 2–15. https://doi.org/10.1016/j.
Res. Rep. 6, 340–349. https://doi.org/10.9734/jsrr/2015/15283.
wasman.2015.09.009.
Aguilar-Virgen, Q., Armijo de Vega, C., González, P., Ojeda-Benítez, S., 2010. Municipal.
MLGRD & EPA, 2002. Guidelines for the management of health care and veterinary
Solid Waste Generation and Characterization in Ensenada, Mexico. The Open Waste
waste in Ghana. Accra.
Management Journal 3, 140–145. https://doi.org/10.2174/
Nabegu, A.B, 2010. An analysis of municipal solid waste in Kano metropolis, Nigeria.
1875934301003010140.
Journal of Human Ecology 31 (2), 111–119. https://doi.org/10.1080/
Ahmed, N.O., Gasmelseed, G.A., Musa, A.E., 2014. Assessment of hospital solid waste
09709274.2010.11906301.
management in Khartoum State hospitals. J. Appl. Ind. Sci. 〈https://www.research
Negahban, S., Oh, S., Shah, D., 2017. Rank Centrality: Ranking from Pairwise
gate.net/publication/271202564〉.
Comparisons. Operations Research 65 (1), 266–287. https://doi.org/10.1287/
Al-Habash, M., Al-Zu’bi, A., 2012. Efficiency and effectiveness of medical waste
opre.2016.1534.
management performance, health sector and its impact on environment in Jordan
Nzediegwu, C., Chang, S.X., 2020. Improper solid waste management increases potential
applied study. World Appl. Sci. J. 19, 880–893. https://doi.org/10.5829/idosi.
for COVID-19 spread in developing countries. Resour., Conserv. Recycl. 161, 104947
wasj.2012.19.06.2775. 〈http://doi〉.
https://doi.org/10.1016/j.resconrec.2020.104947.
Alhassan, et al., 2017. Do socio-psychological factors influence households’ willingness-
Okyere-Hayford, 2016. Solid waste management practices at the university hospital,
to-pay for improved solid waste management services? Evidence from Ghana. Int. J.
KNUST, Kumasi, M.Phil. Thesis.
Green Econ. 11 (3/4), 183. https://doi.org/10.1504/ijge.2017.089854.
Pandey, A., Ahuja, S., Madan, M., Asthana, A.K., 2016. Bio-medical waste management
Alhumoud, J.M., Alhumoud, H.M., 2007. An analysis of trends related to hospital solid
in a tertiary care hospital: A review. J. Clin. Diagn. Res. 10 (11), DC01–DC03.
wastes management in Kuwait. Manag. Environ. Qual.: Int. J. 18, 502–513. https://
https://doi.org/10.7860/JCDR/2016/22595.8822.
doi.org/10.18502/kss.v4i14.7912.
Piotr, et al., 2020. The use of face masks during the COVID-19 pandemic in Poland: A
Al-Khatib, I.A, Monou, M., Zahra, A.F.A, Shaheen, H.Q., Kassinos, D., 2010. Solid waste
SurveyStudy of 2315 young adults. Dermatologic Therapy 33, e13909. https://doi.
characterization, quantification and management practices in developing countries.
org/10.1111/dth.13909.
A case study: Nablus district–Palestine. Journal of environmental management 91
Puopiel, F., Owusu-Ansah, J., 2014. Solid waste management in Ghana: the case of
(5), 1131–1138.
Tamale metropolitan area. J. Environ. Earth Sci. 4 (17) https://doi.org/10.4236/
Aneesh, et al., 2021. Morphological description and molecular characteristics of a new
ijg.2017.84026.
species of Anilocra Leach, 1818(crustacea: Isopoda: Cymothoidae) from India. Int. J.
Saadat, et al., 2020. Environmental perspective of COVID-19. Sci. Total Environ. 728,
Parasitol.: Parasites Wildl. https://doi.org/10.1016/j.ijppaw.2021.03.007.
138870 https://doi.org/10.1016/j.scitotenv.2020.138870.
Asante, et al., 2014. Healthcare Waste Management; Its Impact: A Case Study Of The
Sawalem, M., Selic, E., Herbell, J.D, 2009. Hospital waste management in Libya: A case
Greater Accra Region, Ghana. Internationa. Journal of Science and Technology
study. Waste. Management 29, 1370–1375. https://doi.org/10.1016/j.
Research 3 (3).
wasman.2008.08.028.
Bryman, A., 2012. Social Research Methods, edition 4. Oxford University Press,, UK
http://doi: 10.4236/oalib.1108523.

10
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

Shomar, R., Abed, Y., 2013. Laboratory employees’ perception about their workload and World Health Organisation, 2014. Safe Management of Wastes from Health-Care
working environment in governmental primary health care hospital laboratories- Activities, 2nd Edition. World Health Organization.
Gaza Strip (Palestine). Int. J. Med. Sci. Public Health 2, 862–869. World Health Organziation, 2020. Rational Use of Personal Protective Equipment for
Singh, N., Tang, Y., Ogunseitan, O.A., 2020. Environmentally sustainable management of Coronavirus Disease 2019 (COVID-19). World Health Organization,, Geneva on 21
used personal protective equipment. Environ. Sci. Technol. https://doi.org/ April 2021. 〈https://apps.who.int/iris/rest/bitstreams/1274340/retrieved〉.
10.1021/ acs.est.0c03022. Yawson, P., 2014. Assessment of Solid Waste Management In Healthcare Facilities In The
Udofia, E.A., Fobil, J.N., Gulis, G., 2015. Solid medical waste management in Africa. Afr. Offinso Municipality. Master of Science in Environmental Science. Kwame Nkrumah
J. Environ. Sci. Technol. 9, 244–254. 〈https://geohealthwestafrica.ug.edu.gh/files/ University of Science and Technology.
journals/118218-327112-1-SM.pdf〉. Zambrano-Monserrate, et al., 2020. Indirect effects of Covid-19 on the environment. Sci.
UNEP, 2013. Municipal solid waste comparative analysis study in Jubah, South Sudan, Total Environ. https://doi.org/10.1016/j.scitotenv.2020.138813.
United Nations Environmental Programme. Retrieved 28th March, 2021 at <http:// Zheng, 2021. Personal Protective Equipment in COVID-19: Impacts on Health
unep.org/SouthSudan/>. Performance, Work-Related Injuries, and Measures for Prevention. J Occup Environ
Vanapalli, et al., 2019. Emissions and environmental burdens associated with plastic Med. 1;63 (3), 221–225. https://doi.org/10.1097/JOM.0000000000002123. PMID:
solid waste management. In: Al Salem, S.M. (Ed.), Plastics to Energy; Plastics Design 33394877; PMCID: PMC7934332.
Library. William Andrew Publishing, Norwich, NY, USA, pp. 313–342. ISBN 978-0-
12-813140-4.

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