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

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

* 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.
2. Methodology
2.1. Profile of the study area
This study was conducted in the Tamale metropolitan area (Map
presented as supplementary material - Fig. 1). The Tamale metropolitan
assembly (TaMA) forms part of the 16 urban, municipal, and district
assemblies (MMDAs) in the Northern region of Ghana. It is located at 9◦
16 and 9◦ 34 North and longitude 0◦ 36 and 0◦ 57 West (Ghana Statis­
tical Service, 2014). The metropolis has a total estimated land size of
750 km2 and a population of 223,252, with a higher proportion (80.8 %)
living in urban localities (Ghana Statistical Service, 2014). The people of
the Tamale Metropolis are youthful, with 36.4 % of this group below 15
years.
2.2. Research design
This study employed the cross-sectional research design to achieve
the study’s objectives. According to Bryman (2012), cross-sectional
design helps the researcher triangulate quantitative and qualitative
methods. Also, De (2002) also explained that cross-sectional design is
imperative, especially when the researcher is answering questions such
as ‘why’ or ‘how’, thus its use in this study.
2.3. Sample size determination
The sample frame from which the sampled respondents for this study
were drawn was 108,888. This is the urban population of the Tamale
Metropolis, considering the age group between 15 and 64 years (Ghana
Statistical Service, 2014). The Ghana Statistical Service (2014) data
were used in this study because, at the start of the study, data from GSS
(2021) were unavailable. The sample size was computed using Dill­
man’san (2000) formula. The formula is mathematically expressed as:
n=[
[(N) (p) (1 − p) ]
] plastic bins (Wb) were determined before weighing the used PPE to
( )2
(N − 1) CB + (p) (1 − p)
Where:
n = sample size needed for the desired level of precision.
N = population size (108,888).
p = proportion of the population expected to be chosen (0.5).
B = acceptable amount of sampling error, or precision which is set at
0.05 or 5%.
C = confidence level which is estimated at 1.96 that corresponds to
Weight of PPE waste generated at household
DailyPer Capita PPE waste Generation =
Total number of persons in the household × Total number of generation days
the 95% level (1.96)
[(108, 888) (0.5) (1 − 0.5)]
n= ( 0.05)2
[(108, 888 − 1) 1.96
+ (0.5) (1 − 0.5)]
27, 222
n= = 383.41 ≈ 383
71
Hence, the total sample size for the study was 383 participants.
2.4. Sampling techniques and procedure
A three-stage sampling approach was used to select respondents for
the study. Specifically, stratified-random sampling was used to first
select 6 communities from a larger sample frame of 41 communities,
2
Cleaner Waste Systems 6 (2023) 100115
followed by systematic sampling and then purposive sampling within
the sample frame. Thus, the Tamale metropolis was first stratified into
three strata based on the most popular solid waste collection/disposal
method (Alhassan et al., 2017). The collection/disposal methods iden­
tified were house-to-house (HtH) waste collection, communal container
use (CCU), and ‘strictly not HtH nor CCU’ (i.e., indiscriminate dumping,
burying, burning etc.). This was important for examining how the
various methods of waste collection/disposal practices among the
different strata played out in the management of PPE waste in the
Tamale metropolis.
Subsequently, two communities were randomly selected from each
stratum. These were: Vittin-Estate and Agric (for HtH), Lamashegu and
Gumbihini (for nor CCU) and Kukuo and Dungu (strictly not HtH).
Following this, systematic sampling was used to select 373 households
(Vittin-Estate (53), Agric (53), Lamanshegu (80), Gumbihini (80),
Wurishe-Kukuo (53) and Sagnarigu-Dungu (54)) from the communities
taking into consideration the estimated average number of households
in each community. Finally, purposive sampling was used to select six
waste collectors from the communities and four heads of key institutions
(TaMA, Savannah Waste Service, Tamae West Hospital (TWH), and
Tamale Central Hospital (TCH)) in the Tamale metropolis for interviews.
TCH and TWH were chosen based on the fact that they are both sec­
ondary hospitals which allows for fare comparisons and the willingness
of the staff of these hospitals to participate in the study.
2.5. Data collection
Data on how respondents handle PPE waste was collected using
questionnaires, interviews, and observation aided by a checklist. Also,
used PPE in the selected communities was collected morning and eve­
ning for 16 weeks (from October 2021 to January 2022) for identifica­
tion and quantification. Waste bins and plastic bags were provided to the
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
ensure that the weights of the PPE wastes were rightly calculated. The
following formula was used to calculate the weight of used PPE:
Weight of used PPE = Wt - (Wb + Wp) (1)
Where Wt = total weight of waste and containers, Wb= weight of
waste bin, Wp = weight of polythene bag.
The daily per capita generation rate of used PPE was calculated
(Miezah et al., 2015) using the formula:
(2)
For each household, semi-structured questionnaire containing both
opened-ended and closed-ended questions was administered to the
household heads or any available adult.
In the case of waste management at disposal sites, face-to-face in­
terviews were used as the first approach to obtain ‘in-house’ information
necessary for assessing how used PPE was treated at the disposal sites.
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
personal observation were used to validate the information gathered
through interviews. The quantities of used PPE generated in the
outpatient departments (OPDs) of two leading hospitals within the study
area were also estimated and compared to appreciate the level of PPE
A.B. Atta et al.
waste generation and management by the health sector over the study
period.
2.6. Social experiment
2.6.1. One-factor at a time study
A one-factor at a time (OFAT) social experiment was conducted to
determine key factors influencing positive waste disposal behaviours in
the study community. The OFAT approach was adopted because there
was the need first to establish factors that affect waste disposal before
looking into the interactive effects of the factors. The OFAT social
experiment was preceded by a reconnaissance survey to sample the most
important factors concerning the objective of the experiment. Waste
bins’ height, colour, and shape were prioritised among a list of factors.
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
community. Also, from the reconnaissance survey, it was realised that
the sampled population preferred the shapes of waste bins to be square,
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
with.
One hundred (100) random people from the study community will­
ingly participated in this social experiment. This comprised fifty (50)
males and 50 females. Each participant was given a coded nose mask to
use and dispose of in a waste bin of his or her own choice. The disposal
site was set up such that there were bins made of cardboard placed at the
selected heights (125, 150, 175 cm) at one location, another set of bins
made of the colours earlier stated at another spot, and a third set made of
the shapes concerned at a designated spot within the experimental
environment.
For the study about the effect of height, colour, and shape were
maintained constant as required in an OFAT experiment. The colour
used in this particular experiment was green because it is the prevailing
colour of bins in the study area, while the shape used was a rectangle to
reflect the prevailing shape of bins in the area. In the case of the effect of
colour on the waste bin preferred, height (90 cm – the prevailing height
of bins in the area) and shape (rectangle) were kept constant, and for the
effect of shape, height (90 cm) and colour (green) were kept constant.
All experiments were replicated to have repeated measures.
2.6.2. Pairwise ranking
The pairwise ranking method was used to rank the participants’
preferred choices of waste bins in order of priority. The pairwise ranking
is a research technique that ranks a set of options by comparing random
pairs in a head-to-head choosing exercise (Negahban et al., 2017). It is
also called pairwise comparison, paired comparison, or pairwise sur­
veys. Using this method, the participants were asked to rank the factors
(height, colour, and shape) influencing their PPE waste disposal prac­
tices. A pairwise comparison table was thus drawn, and the list of fac­
tors, height, colour, and shape of bins, was entered in the first column
and then across the top row (Supplementary material – Table 2). Two
pairs of factors were compared at a time, one from the column and the
other from the row of the table. Each participant was asked to compare
and choose the most critical factor between factors considered at the
moment and the preferred choice recorded. This exercise was repeated
until all the 100 participants (50 male and 50 female) had made and
ranked their choices in order of preference. The most preferred option
was ranked first (1st), the next was ranked second (2nd), and the least
was ranked third (3rd).
2.7. Social choice theory
The social choice theory was conducted after pairwise ranking the
factors influencing waste disposal practices. This was done by counting
the number of times each factor emerged as the first choice for males
(50), and the same was done for females (50). Thus, the number of times
3
Cleaner Waste Systems 6 (2023) 100115
height, colour, and shape emerged as the first choice was counted and
totalled. Responses from males (50) and females (50) were counted
separately so gender user preferences could be analysed. This exercise
(voting) was essential to determine the factors that significantly influ­
enced the waste disposal practices of inhabitants in the study area.
2.8. Data analysis
Means of weighed PPE waste were computed and represented by bar
charts and trend lines. Analysis of variance (ANOVA) was performed to
compare the variation among the weekly mean quantity of PPE waste
generated between the selected communities at 5 % significantly
different using SPSS V. 23. Where applicable, participants’ perceptions
were presented in bar charts.
3. Results and discussion
3.1. Quantities of PPE waste generation in the Tamale metropolis
3.1.1. PPE waste generated in the communities over the study period
Results obtained from the estimation of used PPE showed that the
total quantity of used PPE generated in the six (6) selected communities
from October 2021 to January 2022 ranged between 45.4 ± 1.51 kg to
105 ± 2.40 kg. The highest quantity of 105 ± 2.40 kg was generated in
Lamashegu and the least (45.4 ± 1.51 kg) from Kukuo (Fig. 1A).
ANOVA results showed that the weekly mean quantity of PPE waste
generated across the selected communities was significantly different (P-
value < 0.05) from each other. Data in Fig. 1A shows that Lamashegu
and Gumbihini generated higher quantities of PPE wastes than Kukuo
and Vittin-Estate. This may be attributed to the differences in household
sizes between the communities and the existing waste collection
methods. Lamashegu and Gumbihini are more populated with larger
household sizes than Kukuo and Vittin-Estate. Earlier studies have re­
ported that rapidly increasing population, economic growth, and afflu­
ence have contributed to increments in quantities of municipal solid
waste generated (Aguilar-Virgen et al., 2010; Al-khatib et al., 2010;
Nabegu, 2010; Fakare et al., 2012).
In the case of the Communal Container Use (CCU) service signed on
by Lamashegu and Gumbihini inhabitants, the assembly was responsible
for managing wastes directly from homes. Skips were provided at
designated places by the TaMA to collect wastes from homes. Some
interesting observations about this management option included the
following; the proximity of skips played a role in the frequency of
disposal by residents. Also, skips were often overflowing with waste, and
some waste, including PPE, was often dispersed by wind. This finding is
in consonance with that reported in the study conducted by Okyer­
e-Hayford (2016), which revealed that skips at the Kwame Nkrumah
University of Science and Technology (KNUST) hospital sometimes
overflowed with medical waste, including used PPE. Considering the
total week-by-week generation of PPE in the study area (holding com­
munity as constant), there was no significant difference (P value > 0.05)
between the mean PPE waste generated across the 16 weeks. This
observation could be because the study communities’ weekly social and
economic activities did not vary significantly.
However, trend analysis on the quantity of used PPE generated by
the communities in the metropolis showed a non-uniform pattern, as
shown in Fig. 1B. This is similar to the observation reported in the study
by Okyere-Hayford (2016), where a non-uniform pattern in medical
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
heterogeneous nature of people in the Tamale metropolis (different
demographic characteristics). Also, the fluctuation observed in the
pattern of PPE waste generation every month could be due to the
president of Ghana’s periodic national updates on COVID-19 cases.
Thus, anytime a national update might have been given in relation to
COVID-19 case hikes or a new strain of the virus was announced, PPE
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

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

4
A.B. Atta et al.
usage was triggered, resulting in the generation of more waste, and
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
in the study area, single-use PPE was 242.98 ± 0.83 kg (58.72 %),
representing the majority of the wastes generated, while reusable PPE
was 170.84 ± 0.61 kg (41.28 %) representing the least of the waste
generated (Table 1). This finding is similar to that reported by De-la-­
Torre et al. (2021) in Peru, revealing that 67 % of used masks were
single-use. They argued that single-use masks are generally cheaper and
more accessible than fabric masks, hence the higher quantities of
single-use PPE in the solid waste stream. An observation made in this
current study was that because fabric masks are reusable, they were
washed and reused many times before disposal. Thus, this could be why
these masks were comparatively lower in quantity than the single-used
type.
There was no significant difference (P value > 0.05) between the
mean PPE waste generated across the four months. However, the total
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
able PPE. These were relatively higher than those generated in
November and December 2021 and January 2022 (Fig. 1C). This
observation could be due to the stricter enforcement and adherence to
the COVID-19 protocols when active cases were still on the rise. Klemes
et al. (2020) also observed a significant surge in the volume of plastic
waste during the COVID-19 pandemic. They reported that potential
short-term and long-term changes in plastic waste management prac­
tices are necessary to reduce the eminent adverse environmental effect
of this waste category. Generally, PPE use generates approximately 20
tons of waste per day in a relatively small area like the Silesian region
(Vanapalli et al., 2019).
The prevention and minimisation of waste through practices such as
materials reuse, recycling, and waste recovery is the most cost-effective
and preferred solid waste management activity (ISWA, 2013; World
Health Organisation, 2014). The high generation of waste materials,
such as face masks or gloves, presents opportunities for recycling or
energy recovery (Piotr et al., 2020).
Both surgical gloves and leather gloves waste were generated in all
the communities. The total quantity of hand gloves generated was 61.44
± 0.61 kg consisting of 31.65 ± 0.29 kg of surgical gloves and 29.79
± 0.31 kg of leather gloves. The highest quantity of 8.98 ± 0.37 kg of
gloves was generated at Dungu while the least (1.75 ± 0.11 kg) was
generated at Vittin-Estates (Table 1). The higher quantity of gloves
recorded in Dungu could be attributed to the high number of hair­
dressing salons in the Dungu enclave that use surgical gloves in their
beautician businesses, and this is probably facilitated by patronage by
the students at University for Development Studies (UDS) Dungu
campus.
Waste sanitiser bottles were also found in all the communities during
the study period (October 2021 to January 2022). The total quantity of
waste sanitiser bottles generated ranged from 11.45 ± 0.71 kg to 3.21
± 0.52 (Table 1). Vittin-Estate generated the highest quantity of 11.45
± 0.71 kg, while Agric generated the least quantity of 3.21 ± 0.52 kg
(Table 1). The more significant amounts recorded at Vittin-Estate could
result from the economic activities (Cluster of schools and shops/points
of sale of retail goods), which bring many people around and the
attended larger volumes of waste generated. Also, Vittin-Estate is closer
to the Tamale teaching hospital, where the use of sanitisers is expected
to be high.
The total PPE waste generation rate in the study area was 0.204 kg/
person/day. The rate at which single-use PPE was generated was
0.13 kg/person/day, and reusable PPE was 0.074 kg/person/day (Sup­
plementary material – Table 2). Lamashegu electoral area recorded the
highest PPE waste generation rate of 0.052 kg/person/day, while Kukuo
electoral area had the lowest generation rate of 0.022 kg/person/day.
The higher rate of PPE waste generation recorded at Lamashegu could be
due to the high economic activities within these communities.
5
Cleaner Waste Systems 6 (2023) 100115
Lamashegu has a cluster of schools, a market, clinics, and lorry parks.
3.1.2. PPE waste generated in selected hospitals
Results obtained from the PPE waste estimation at OPDs of the
Tamale Central Hospital (TCH) and Tamale West Hospital (TWH)
showed that TCH had the highest (156.59 ± 0.41 kg) total PPE waste
generation compared to TWH (137.53 ± 0.36 kg) during the period of
the study (Fig. 1D). The ANOVA of the mean quantity of PPE waste
generated on month-by-month basis between the two health institutions
was not significantly different (P value > 0.05) from each other. An
earlier study by Ahmed et al. (2014) on two hospitals (Al Ribat uni­
versity hospital and Al Saudi Hospital, Khartoum State, Sudan) showed
varied quantities of waste generation over the study period they
considered. According to Ahmed et al. (2014), this was due to the
population difference between the areas where the two hospitals were
located. A similar conclusion could be attributed to the observation
made in this study.
3.2. Assessment of PPE waste management measures in the Tamale
metropolis
According to World Health Organziation (2020) guidelines, PPE
waste, including used masks and hand gloves, should be managed like
infectious waste. To ensure the safety of humans and the environment,
sustainable management of used PPE should include practices such as
waste minimisation, segregation, storage, transportation, treatment, and
responsible disposal (Acter, 2000; Al-Habash and Al-Zu’bi, 2012). Below
are the waste management practices observed in the study area.
3.2.1. Segregation, collection, storage, and transportation of PPE waste
The majority (65.83 %) of the respondents in the six (6) communities
studied indicated that segregation of waste was not practised as rec­
ommended by US EPA (2002) and World Health Organziation (2020). It
was also found that Lamashegu had the highest record of no segregation
(80 %) of waste, with Vittin-Estate recording the least of 53% (Fig. 2A).
Moreover, no colour-coded or labelled bins were found in the commu­
nities. Earlier works including that of Mensah (2012), Asante et al.
(2014), and Yawson (2014) also reported on the poor segregation, no
colour-coded bins, and no labelling of medical waste bins in Ghana.
Also, a similar study by Shomar & Abed (2013) reported that only
18.8% of respondents separated hazardous waste from non-hazardous
wastes in healthcare facilities. These earlier findings show that poor
waste segregation is not a peculiar problem of the study area but tran­
scends other jurisdictions.
An observation made by some households’ representatives and
confirmed by observations in this study was that even when they
segregated used PPE, the used PPE was still mixed up with other solid
waste materials by waste collectors during collection. This is consistent
with reports by Coker et al. (2009), Sawalem et al. (2009), and Udofia
et al. (2015) that collectors mix segregated waste materials during
collection. Mixing hazardous and non-hazardous waste is against the
World Health Organisation (2014) guidelines. Results from the question
items on PPE waste collection and storage containers used at homes
showed that most (51.74 %) of the respondents collected and stored PPE
wastes in immobile waste bins. Only a few (1.87 %) used trollies
(Table 2).
Data in Table 2 further shows that Vittin-estate had the highest re­
cord of 44 (83%) waste bins usage, and Lamashegu had the most minor
record of 25 (31.25 %) waste bin usage. This result was expected
because communities like Vittin-Estate subscribed to the house-to-house
(HtH) waste collection method, where waste bins are provided by pri­
vate waste management companies like Savannah waste service for the
temporary storage of waste. In contrast, the Lamashegu community
primarily relied on communal container services.
It was also observed that some waste containers had no covers and
were kept in open areas in compounds. This was rampant in Lamashegu
A.B. Atta et al. Cleaner Waste Systems 6 (2023) 100115

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

6
A.B. Atta et al.
and Gumbihini. This practice falls short of WHO (2005) regulations,
which list waste bins lined with polythene bags and with covers as
appropriate for waste collection. The rules of Ghana’s MLGRD and EPA
(2002) state that containers or bins for used PPE storage must be in
roofed areas where the waste is protected from rainfall, wind, and
scavenging animals. This was, however, observed only in Vittin-Estate
and the Agric areas.
Also, respondents were asked about suggestions for improving PPE
waste collection and storage. Results from this enquiry showed that the
majority (53.38%) of the respondents supported the novel design of
automated devices with the option to collect used PPE automatically. In
comparison, a minority (7.84%) endorsed the use of mobile phone ap­
plications to facilitate the timely collection of used PPE (Fig. 2B). This
finding is similar to the results from an earlier study in Poland by Piotr
et al. (2020) in which 37% of respondents were found to support the use
of automated devices for PPE waste collection.
Waste management companies, including Savanna waste services,
used motorised tricycles and refuse trucks to transport waste from
households to communal collection containers or the Gbalahi landfill on
behalf of the Tamale metropolitan assembly. Unfortunately, it was
observed that waste collectors used their bare hands to empty waste
from tricycles into communal containers and disposal trucks. Similarly,
a report by Udofia et al. (2015) indicated that hazardous waste,
including used PPE, was manually lifted into vehicles in communities
they studied, as observed in this study.
3.2.2. Treatment and disposal methods used to handle PPE waste in the
communities
There was no standard treatment method for PPE waste in the
communities. While burying and burning was common practice in the
communities, some (23.33%) respondents did not know the treatment
methods for disinfecting PPE waste (supplementary material - Fig. 2).
In response to receiving any training on the treatment and disposal of
PPE wastes since the outbreak of the COVID-19 pandemic, 73.73 % of
the respondents indicated that they did not receive such training and
26.27 % stated they received training on the management of PPE wastes.
Vittin-Estate had a comparatively higher score (28.57 %) for those who
received training, and Kukuo recorded the lowest (9.2 %) for those who
had received training (supplementary material - Fig. 3). A further
enquiry showed that the majority (80 %) of those who received training
were people employed in the formal sector (office workers, nurses,
teachers etc.) and that these people had received the training from their
workplaces.
This study’s findings on the low coverage of training on handling PPE
waste resonate well with the study by Zheng et al. (2021), where it was
reported that the training on the management of used PPE and pre­
ventive measures was still limited. This situation can put the general
public and waste handlers at high risk of infection.
On the subject matter of the problems affecting the safe handling of
Table 3
Level of compliance of PPE waste management practices in communities and health institutions.
Waste management practices
1 Personal protective equipment (PPE) is reused
2 Appropriate waste disposal time
3 Compliance with source segregation
4 Covered waste bins
5 Record on waste-PPE generated
6 Does incinerators have pollution control devices
7 PPE waste treatment methods Incineration
Microwave disinfection
Autoclave
None
Burying in pits
I = Institutions, C = Communities and IC = both institutions and communities
Grading adopted from UNEP (2013) & MLGRD (2002)
Cleaner Waste Systems 6 (2023) 100115
PPE waste, the following were noted: limited knowledge on managing
PPE waste and using preventive measures such as hand washing and
sanitisers. Others included inadequate storage containers, delays in the
lifting of waste by the waste management companies and the long dis­
tances inhabitant had to cover to reach communal skips (Supplementary
material – Table 3).
An assessment of the PPE waste management practices based on
personal observations and aided by a standard checklist (UNEP, 2013;
MLGRD, 2002) showed that the institutions (TCH and TWH) had a
higher level of compliance (71.43 %) with regards to their existing waste
management practices as compared to what (28.57 %) was observed at
the household levels (Table 3).
Households did not treat PPE waste before disposal. This is contrary
to the recommendation of the World Health Organisation (2014) that
infectious medical waste, such as PPE waste, should be treated before
disposal. From all information sources, the hospitals studied treated only
waste medical sharps, and this was by incineration. The incinerator­
s/combustion facilities used by the hospitals did not have air pollution
control devices, and this is contrary to the recommendations of the
UNEP (2013), which states that incinerators for medical waste should be
fitted with air pollution control devices to filter pollutants emanating
from the combustion process.
3.2.3. Assessment of the treatment of used PPE at Gbalahi landfill site
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
about 13 kilometres from the central business district. An assessment of
the functional elements of the landfill through personal observation
aided by a standard checklist showed the presence of a weighbridge,
wastewater treatment facility, gas recovery, and leachate collection
systems. However, no internal access (a well-designed route within the
site for vehicular movement) was provided. This notwithstanding, the
Gbalahi landfill is also closer (∼ 1 km) to the Wovuguma community
and thus pose a nuisance to this community.
The functional elements at the landfill site were considered a priority
by the manager of the site, and the representative of the waste man­
agement department (TaMA) was the waste treatment plant. It was
graded a score of 40 % followed by internal access within the landfill (30
%). Weighbridge and proximity to human settlement scored 10% each,
and the leachate collection and gas recovery system scored 5 % (sup­
plementary material, Fig. 4). It wasn’t very pleasant to know that the
wastewater treatment plant and the gas recovery facility at the landfill
site were not functioning well when the study was being conducted. This
is a deviation from the recommendation of UNEP (2013) which em­
phasises the presence and full functionality of such components of a
landfill. Another unfortunate observation was that most of the cells at
the landfill were filled, and the waste materials dumped in the cells were
not levelled and compacted.
Regarding the waste handling and treatment procedures at the
In Compliance Not in Compliance N/A Overall Rating
for this Assessment
IC I ¼ 71.43%
I C C ¼ 28.57%
I C
I C
IC
I C
I
C
7
A.B. Atta et al.
landfill site, respondents (The officer in charge of the landfill and the
representative of waste management departments) contacted during the
interviews indicated that there were procedures in place for the
handling and treatment of wastes at the landfill. They noted that trained
personnel visually inspected waste loads to recognise wastes that
required special handling. This practice aligns with the recommendation
of the UNEP (2013), which stipulates that waste load entering the
landfill should be visually inspected by trained personnel to identify
waste that requires special handling. The waste handling procedures
most practiced at the landfill site are presented in Fig. 2C.
Moreover, an interview with the representative of the waste man­
agement department indicated that used PPE treatment/disposal
methods at the landfill site were mainly through burning (60% of waste
received) (supplementary material, Fig. 5). Used PPE were burnt
together with plastics, leather, and other combustible materials. Ac­
cording to Abor (2013), several countries around the world use haz­
ardous waste treatment technologies such as incineration, autoclaving,
and microwave disinfection, but this was not the case at the Gbalahi
landfill site in Tamale, Ghana.
Unlike incineration, burning is uncontrolled combustion that can
Fig. 3. Effect of waste bin characteristics on waste disposal practices.
8
Cleaner Waste Systems 6 (2023) 100115
release dioxins and other carcinogens into the atmosphere. Burning of
PPE waste contravenes the guidelines of EPA (2002) and World Health
Organisation (2014), which state that solid medical waste should be
decontaminated and disposed of through incineration. Also, incinerators
should be fitted with air pollution control devices to control the emission
of pollutants from the incineration process (EPA, 2002; World Health
Organisation, 2014).
According to the head of the waste management division of
Savannah waste service, waste segregation was not practised at the
source (homes and institutions) in the study area. Segregation allows
reusable materials to be diverted from the landfill and, thus, reduces the
volumes of waste that reach landfills. It was also observed that no
decontamination activities/procedures were practised at primary
(communal skips) disposal sites. This contradicts the recommendation
that potentially infectious waste should be decontaminated before
disposal (Alhumoud and Alhumoud (2007)).
According to Abor and Bouwer (2008), waste segregation and
decontamination reduce the volume and any risk of the spread of in­
fections from waste materials. Another finding was that waste handlers
from the waste management departments used one or two of the
A.B. Atta et al.
following PPE: face masks, hand gloves, boots and overalls (Fig. 2D).
Meanwhile, the vast majority (79%) wore inappropriate/insufficient
sets of PPE (supplementary material - Fig. 6). The primary reason for this
observation was that PPE was difficult to use. However, the refusal or
inappropriate use of PPE violates the MLGRD & EPA (2002) and World
Health Organisation (2014) regulations. These regulations require
appropriate PPE to protect against infectious diseases such as COVID-19.
Using a self-developed operations and maintenance checklist to
assess the Gbalahi landfill site, it was concluded that the Gbalahi landfill
is a partly functional waste treatment facility with poor routes/internal
access within it, and it is located about 1 kilometre away from the
nearest human settlement. Based on the problems above and informa­
tion gathered from managers of the landfill site and other stakeholders
(waste management companies), the landfill’s performance was rated
50 % out of 100 %. The undesirable state of the landfill could be
attributed to factors including low revenue generation and a limited
number of skilled manpower.
3.3. One-factor at a time study
3.3.1. Effect of height of waste bin on PPE waste disposal practice
Results from the social experiment showed that 44% of the male
participants in the experiment disposed of their used-nose masks in the
bin placed at a height of 175 cm (Fig. 3A). This was not unexpected as
the average height of male participants in the experiment was 169
± 5 cm. Meanwhile, the bin that received the least (26 %) patronage
from the males was placed at a height of 125 cm (Fig. 3A). The reason
associated with the low patronage of the bin placed at 125 cm was that
they (males) had to bend over to drop their used masks into this bin and
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
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
important to give some consideration to waste bin heights, especially
heights above 150 cm.
In the case of the females, the waste bin placed at a height of 125 cm
received the highest 19 (38 %) patronage (Fig. 3A). This observation was
not expected because the average height of female participants in the
experiment was 150 ± 6 cm. Thus, the bin placed at 150 cm was ex­
pected to receive more used-nose masks. According to the majority, 19
(38 %) of the female participants chose to dispose of the used-nose mask
in the bin placed at 125 cm because they were used to bending over to
dispose of waste. Expectedly, the waste bin which received the most
minor 12 (24 %) patronage was the one placed at a height of 175 cm
(Fig. 3A). It is generally not comforting for one to stretch to higher
heights to dispose of waste, thus the low patronage of the waste bin
placed at 175 cm.
3.3.2. Effect of colour of waste bin on PPE waste disposal
The preferred colour for PPE waste bins for both males 19 (38 %) and
females 22.5 (45 %) was yellow (Fig. 3B). Coincidentally, yellow is the
colour code for waste bins meant for receiving infectious waste (Pandey
et al., 2016). It was possibly the case that the participants who chose to
dispose of their used-nose mask in the yellow bin had some prior
knowledge of the colour code for waste bins designated for infectious
waste. For the males, the pink waste bin recorded the least 14 (28 %)
patronage while the green waste bin was the least 11.5 (23 %) patron­
ised by the females. These observations were associated with the colour
these genders identify with. The general statement from the participants
was that pink is associated with the female gender while green is a dull
colour which males might like.
In an earlier work by Leeabai et al. (2021), it was found that colour
preferences had statistically significant correlations with bin-colour
usage rates (p = 0.009 for combustible waste bins, p = 0.032 for
incombustible waste bins, and p = 0.012 for PET bottle bin,
9
Cleaner Waste Systems 6 (2023) 100115
Table 4
Participants’ prioritisation of waste bin characteristics.
Factor Male vote Per cent (%) Female vote Per cent Total
(%)
Height 27 54 13 26 40
Shape 17 34 15 30 32
Colour 6 12 22 44 28
50 100 50 100 100
respectively). This notwithstanding, it was found that colour had no
significant impact on waste collection (Leeabai et al., 2021). Thus,
though colour may influence waste disposal practices, it may not matter
when it comes to waste collection.
3.3.3. Effect of the shape of waste bin on PPE waste disposal
In the case of the most patronised waste bin shape, females disposed
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
attributed to two reasons; society’s perception that the female gender
likes to be loved (love symbolised by the heart shape) and also, empathy
towards COVID-19 victims. The male participants, on the other hand,
patronised 19 (38 %) of the square shape more than the heart and cone-
shaped waste bins (Fig. 3C). The high patronage of the square shape
waste bin by the males could be attributed to the fact that the square
shape looks more like the common rectangular shaped waste bins that
are mostly used and that the males probably just wanted to stick to what
is known. This finding is similar to that reported by Leeabai et al. (2022)
who found that square shape bins were one of the most preferred bins for
waste disposal.
3.4. Social choice theory
Results from the voting exercise conducted after the pairwise ranking
showed that the majority (54 %) of the male participants chose height as
the factor influencing their waste disposal practice the most (Table 4). A
study by Leeabai et al. (2019) reported that aside from height, the dis­
tance at which waste bins are placed affects waste disposal behaviours in
Thailand. Thus, increased distance between trash bins and waste gen­
eration points decreased waste collection and disposal practices and vice
versa.
In the case of the female gender, the majority (44 %) chose colour as
a factor that influenced their waste disposal practices, whiles a few (26
%) choose height as a factor that influenced their waste disposal prac­
tices (Table 4).
An earlier study by Leeabai et al. (2021) found that trash bin colour
preference had a non-negligible impact on human behaviour towards
waste separation, treatment, and disposal. Colour improves waste bin
recognition and noticeability and helps waste handlers sort waste for
disposal (Clarke et al., 2018; Liu et al., 2018). Moreover, colour
perception influences human memory and decision-making (Elliot and
Maier, 2014). Both male and female gender practically sided with each
other (34 % and 30 % respectively) in terms of their preference for the
shape of waste bins as a factor that influenced their waste disposal
practices (Table 4). In other words, both male and female gender had
similar considerations with regard to the shape of waste bin containers
(Table 4).
4. Conclusion and recommendation
This study reports that the quantity of used PPE generated in the
study area within the study period was 413.82 kg. Single-use PPE was
the most commonly generated PPE waste in the metropolis. Tamale
Central Hospital produced more PPE waste than Tamale West Hospital.
The waste handling practices of inhabitants and the hospitals studied did
not meet the requirement of WHO, EPA and the Ministry of Local
A.B. Atta et al.
Government and Rural Development guidelines. Gbalahi landfill is the
final disposal site for used PPE in the Tamale metropolis. Used PPE at the
landfill was not disinfected before disposal. It was also found that the
male participants in the social experiment chose height as the essential
characteristic of a waste bin that can influence the rate of patronage of a
waste bin. In contrast, the female participants chose colour as the most
important factor to consider when designing higher-use waste bins. A lot
of advocacy and training are needed to change the present narrative
about how used PPE are managed in the metropolis. Radio and televi­
sion programmes and social media can be good starting points. Future
research studies may want to look into behavioural change communi­
cation strategies needed to convince societies to dispose of used PPE
responsibly. Also, life cycle assessment of locally produced (cloth mask)
face mask will be an interesting subject to research. The effect of
ambient temperature on PPE usage is also an important area to
investigate.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Data availability
Data will be made available on request.
Appendix A. Supporting information
Supplementary data associated with this article can be found in the
online version at doi:10.1016/j.clwas.2023.100115.
References
Abor, P.A., Bouwer, A., 2008. Medical waste management practices in a Southern African
hospital. Int. J. Health Care Qual. Assur. 21, 356–364. https://doi.org/10.1108/
09526860810880153.
Adongo, R., Kuuder, C., Amoako, E., Asare, W., Duwiejuah, A.B., Arthur, V., 2015.
Stakeholder views on waste and its management in Tamale Metropolis, Ghana. J. Sci.
Res. Rep. 6, 340–349. https://doi.org/10.9734/jsrr/2015/15283.
Aguilar-Virgen, Q., Armijo de Vega, C., González, P., Ojeda-Benítez, S., 2010. Municipal.
Solid Waste Generation and Characterization in Ensenada, Mexico. The Open Waste
Management Journal 3, 140–145. https://doi.org/10.2174/
1875934301003010140.
Ahmed, N.O., Gasmelseed, G.A., Musa, A.E., 2014. Assessment of hospital solid waste
management in Khartoum State hospitals. J. Appl. Ind. Sci. 〈https://www.research
gate.net/publication/271202564〉.
Al-Habash, M., Al-Zu’bi, A., 2012. Efficiency and effectiveness of medical waste
management performance, health sector and its impact on environment in Jordan
applied study. World Appl. Sci. J. 19, 880–893. https://doi.org/10.5829/idosi.
wasj.2012.19.06.2775. 〈http://doi〉.
Alhassan, et al., 2017. Do socio-psychological factors influence households’ willingness-
to-pay for improved solid waste management services? Evidence from Ghana. Int. J.
Green Econ. 11 (3/4), 183. https://doi.org/10.1504/ijge.2017.089854.
Alhumoud, J.M., Alhumoud, H.M., 2007. An analysis of trends related to hospital solid
wastes management in Kuwait. Manag. Environ. Qual.: Int. J. 18, 502–513. https://
doi.org/10.18502/kss.v4i14.7912.
Al-Khatib, I.A, Monou, M., Zahra, A.F.A, Shaheen, H.Q., Kassinos, D., 2010. Solid waste
characterization, quantification and management practices in developing countries.
A case study: Nablus district–Palestine. Journal of environmental management 91
(5), 1131–1138.
Aneesh, et al., 2021. Morphological description and molecular characteristics of a new
species of Anilocra Leach, 1818(crustacea: Isopoda: Cymothoidae) from India. Int. J.
Parasitol.: Parasites Wildl. https://doi.org/10.1016/j.ijppaw.2021.03.007.
Asante, et al., 2014. Healthcare Waste Management; Its Impact: A Case Study Of The
Greater Accra Region, Ghana. Internationa. Journal of Science and Technology
Research 3 (3).
Bryman, A., 2012. Social Research Methods, edition 4. Oxford University Press,, UK
http://doi: 10.4236/oalib.1108523.
10
Cleaner Waste Systems 6 (2023) 100115
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.
com/2020/3/26/21194647/.
Clarke, et al., 2018. Thai norms for name, image, and category agreement, object
familiarity, visual complexity, manipulability, and age of acquisition for 480 color
photographic objects. J. Psycholinguist. Res. https://doi.org/10.1007/s10936-017-
9544-5.
Coker, A., Sangodoyin, A., Sridhar, M., Booth, C., Olomolaiye, P., Hammond, F., 2009.
Medical waste management in Ibadan, Nigeria: obstacles and prospects. Waste
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/
97814462663495.
De-la-Torre, et al., 2021. Investigating the current status of COVID-19 related plastics
and their potential impact on human health. Curr. Opin. Toxicol. 47–53. https://doi.
org/10.1016/j.cotox.2021.08.002.
Denteh, S.N., Cobinna, S.J., Adam, W., Aboka, E.Y., 2018. Household solid waste
management: compositional analysis, storage, and collection in the Vittin Target
Areas, Tamale Ghana. UDS Int. J. Dev. 5 (1) https://doi.org/10.47740/237.
UDSIJD6i.
Elliot, A.J., Maier, M.A., 2014. Color psychology: effects of perceiving color on
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,
andIntegrity of Information Disseminated by the Environmental Protection Agency.
U.S. Environmental Protection Agency, Office of Environmental Information (2810)
1200 Pennsylvania Avenue, NW Washington, DC 20460.
Fakere, A.A., Fadairo, G., Olusegun, O., 2012. Domestic Waste Management and Urban
Residential Environment: Focus on Akure, Nigeria. International Journal of
Engineering and Technology 2 (5), 878–887.
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/
10.1007/s13762-023-05093-3.
ISWA, 2013. Guidelines for Design and Operation of Municipal Solid Waste Landfills
inTropical Climates. International Solid Waste Association.
Klemes, et al., 2020. Minimising the present and future plastic waste, energy and
environmental footprints related to COVID-19. Renew. Sustain. Energy Rev. 127,
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,
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.
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
SettingConditions of Trash Bins on Waste Collection Performance and Waste
Separation Behaviors; distance from walking path, separated setting, and
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?
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.
Kwame Nkrumah University of Science and Technology, Kumasi. https://ir.knust.
edu.gh/handle/123456789/5745.
Miezah, K., Obiri-Danso, K., Kádár, Z., Fei-Baffoe, B., Mensah, M.Y., 2015. Municipal
solid waste characterization and quantification as a measure towards effective waste
management in Ghana. Waste Manag. 46, 2–15. https://doi.org/10.1016/j.
wasman.2015.09.009.
MLGRD & EPA, 2002. Guidelines for the management of health care and veterinary
waste in Ghana. Accra.
Nabegu, A.B, 2010. An analysis of municipal solid waste in Kano metropolis, Nigeria.
Journal of Human Ecology 31 (2), 111–119. https://doi.org/10.1080/
09709274.2010.11906301.
Negahban, S., Oh, S., Shah, D., 2017. Rank Centrality: Ranking from Pairwise
Comparisons. Operations Research 65 (1), 266–287. https://doi.org/10.1287/
opre.2016.1534.
Nzediegwu, C., Chang, S.X., 2020. Improper solid waste management increases potential
for COVID-19 spread in developing countries. Resour., Conserv. Recycl. 161, 104947
https://doi.org/10.1016/j.resconrec.2020.104947.
Okyere-Hayford, 2016. Solid waste management practices at the university hospital,
KNUST, Kumasi, M.Phil. Thesis.
Pandey, A., Ahuja, S., Madan, M., Asthana, A.K., 2016. Bio-medical waste management
in a tertiary care hospital: A review. J. Clin. Diagn. Res. 10 (11), DC01–DC03.
https://doi.org/10.7860/JCDR/2016/22595.8822.
Piotr, et al., 2020. The use of face masks during the COVID-19 pandemic in Poland: A
SurveyStudy of 2315 young adults. Dermatologic Therapy 33, e13909. https://doi.
org/10.1111/dth.13909.
Puopiel, F., Owusu-Ansah, J., 2014. Solid waste management in Ghana: the case of
Tamale metropolitan area. J. Environ. Earth Sci. 4 (17) https://doi.org/10.4236/
ijg.2017.84026.
Saadat, et al., 2020. Environmental perspective of COVID-19. Sci. Total Environ. 728,
138870 https://doi.org/10.1016/j.scitotenv.2020.138870.
Sawalem, M., Selic, E., Herbell, J.D, 2009. Hospital waste management in Libya: A case
study. Waste. Management 29, 1370–1375. https://doi.org/10.1016/j.
wasman.2008.08.028.
A.B. Atta et al.
Shomar, R., Abed, Y., 2013. Laboratory employees’ perception about their workload and
working environment in governmental primary health care hospital laboratories-
Gaza Strip (Palestine). Int. J. Med. Sci. Public Health 2, 862–869.
Singh, N., Tang, Y., Ogunseitan, O.A., 2020. Environmentally sustainable management of
used personal protective equipment. Environ. Sci. Technol. https://doi.org/
10.1021/ acs.est.0c03022.
Udofia, E.A., Fobil, J.N., Gulis, G., 2015. Solid medical waste management in Africa. Afr.
J. Environ. Sci. Technol. 9, 244–254. 〈https://geohealthwestafrica.ug.edu.gh/files/
journals/118218-327112-1-SM.pdf〉.
UNEP, 2013. Municipal solid waste comparative analysis study in Jubah, South Sudan,
United Nations Environmental Programme. Retrieved 28th March, 2021 at <http://
unep.org/SouthSudan/>.
Vanapalli, et al., 2019. Emissions and environmental burdens associated with plastic
solid waste management. In: Al Salem, S.M. (Ed.), Plastics to Energy; Plastics Design
Library. William Andrew Publishing, Norwich, NY, USA, pp. 313–342. ISBN 978-0-
12-813140-4.
11
Cleaner Waste Systems 6 (2023) 100115
World Health Organisation, 2014. Safe Management of Wastes from Health-Care
Activities, 2nd Edition. World Health Organization.
World Health Organziation, 2020. Rational Use of Personal Protective Equipment for
Coronavirus Disease 2019 (COVID-19). World Health Organization,, Geneva on 21
April 2021. 〈https://apps.who.int/iris/rest/bitstreams/1274340/retrieved〉.
Yawson, P., 2014. Assessment of Solid Waste Management In Healthcare Facilities In The
Offinso Municipality. Master of Science in Environmental Science. Kwame Nkrumah
University of Science and Technology.
Zambrano-Monserrate, et al., 2020. Indirect effects of Covid-19 on the environment. Sci.
Total Environ. https://doi.org/10.1016/j.scitotenv.2020.138813.
Zheng, 2021. Personal Protective Equipment in COVID-19: Impacts on Health
Performance, Work-Related Injuries, and Measures for Prevention. J Occup Environ
Med. 1;63 (3), 221–225. https://doi.org/10.1097/JOM.0000000000002123. PMID:
33394877; PMCID: PMC7934332.