Health Care Waste Segregation Behavior among Health Workers in Uganda: An Application of the Theory of Planned Behavior

Healthcare waste management practice and its predictors among health workers in private health facilities in Ilu Aba Bor Zone, Oromia region, South West Ethiopia: a community-based cross-sectional study

OBJECTIVES

A lack of safe healthcare waste management (HCWM) practice poses a risk to healthcare staff, patients and communities. In low-income countries like Ethiopia, studies on the level of safe HCWM practices in private healthcare facilities are limited. This study was designed to assess the level of good HCWM practice and associated factors among health workers in private health facilities.

METHODS

An institution-based cross-sectional study was conducted in the Ilu Aba Bor zone, South West Ethiopia. A random sample of 282 health workers from 143 private health facilities was included in the study. Data were collected using a pretested structured questionnaire that included sociodemographic characteristics, healthcare factors, knowledge assessment and an observation checklist adapted from WHO guidelines. The collected data were entered into EpiData V.3.1 and analysed with SPSS V.25.0. Multivariable logistic regression analysis was used to identify factors associated with HCWM practice. Variables with a p value of <0.05 at 95% CI were declared significant.

RESULTS

More than half (58.7%) of private-sector health workers had good HCWM practice. The presence of the HCWM committee (adjusted OR (AOR)=9.6, 95% CI 4.5 to 20.6), designated healthcare waste storage site (AOR=3.0, 95% CI 1.5 to 6.5), reading the HCWM manual (AOR=4.4, 95% CI 2.2 to 9.0) and having good knowledge of HCWM (AOR=2.6, 95% CI 1.06 to 6.15) were factors associated with good HCWM practice.

CONCLUSION

About three out of five health workers in private healthcare facilities were practising good HCWM. The presence of an HCWM committee, waste management utilities, reading HCWM guidelines and knowledge of health workers were the identified factors. Health workers should read guidelines to improve their knowledge, and the presence of committees and waste management utilities in private clinics should be followed to ensure compliance with safe HCWM practice.

Identifying the influencing factors and constructing incentive pattern of residents' waste classification behavior using PCA-logistic regression

With the acceleration of urbanization, domestic waste has become one of the most inevitable factors threatening the environment and human health. Waste classification is of great significance and value for improving urban environmental quality and promoting human well-being. Based on the theory of planned behavior, we added external and socio-economic factors to systematically examine how they affect residents' waste classification behavior (WCB). We collected 661 valid data through a questionnaire survey conducted in Jinan, a pilot city for waste classification in China. Key driving factors were identified by combining binary logistic regression and the principal component analysis. The results showed that the elderly, women, and people with higher education are more likely to participate in waste classification. Attitude, collaborative governance, and institutional pressure positively affect WCB, while subjective norm and infrastructure have a negative effect. Knowledge mastery and degree of publicity are positively and significantly related to WCB, but other perceived behavioral control sub-variables negatively affect WCB. Based on the results and status of waste classification in Jinan, we propose the multi-agent linkage governance pattern from various dimensions to explore a powerful guiding incentive that can enhance WCB and provide a reference for waste management policymakers.

Healthcare Waste-A Serious Problem for Global Health

Healthcare waste (HCW) is generated in different healthcare facilities (HCFs), such as hospitals, laboratories, veterinary clinics, research centres and nursing homes. It has been assessed that the majority of medical waste does not pose a risk to humans. It is estimated that 15% of the total amount of produced HCW is hazardous and can be infectious, toxic or radioactive. Hazardous waste is a special type of waste which, if not properly treated, can pose a risk to human health and to the environment. HCW contains potentially harmful microorganisms that can be spread among healthcare personnel, hospital patients and the general public, causing serious illnesses. Healthcare personnel are the specialists especially exposed to this risk. The most common medical procedure, which pose the highest risk, is injection (i.e, intramuscular, subcutaneous, intravenous, taking blood samples). The World Health Organization (WHO) estimates that around 16 billion injections are administered worldwide each year. However, if safety precautions are not followed, and needles and syringes are not properly disposed of, the risk of sharps injuries increases among medical staff, waste handlers and waste collectors. What is more, sharps injuries increase the risk of human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV/HCV), tuberculosis (TB), diphtheria, malaria, syphilis, brucellosis and other transmissions. Disposing of medical waste in a landfill without segregation and processing will result in the entry of harmful microorganisms, chemicals or pharmaceuticals into soil and groundwater, causing their contamination. Open burning or incinerator malfunctioning will result in the emission of toxic substances, such as dioxins and furans, into the air. In order to reduce the negative impact of medical waste, waste management principles should be formulated. To minimize health risks, it is also important to build awareness among health professionals and the general public through various communication and educational methods. The aim of this paper is to present a general overwiev of medical waste, its categories, the principles of its management and the risks to human health and the environment resulting from inappropriate waste management.

Predicting the Intention to Sort Waste at Home in Rural Communities in Lebanon: An Application of the Theory of Planned Behaviour

Low- and middle-income countries (LMICs) such as Lebanon have limited technical, economic, and social infrastructures to manage municipal solid waste properly. Understanding what motivates citizens to sort waste at home is paramount to designing effective, efficient, and equitable waste management interventions. Within the solid waste management project “RES-Q” in Southern Lebanon, we investigated the socio-cognitive predictors of waste sorting in a sample of 767 households from the targeted area using the Theory of Planned Behaviour (TPB). Perceived behavioural control (β = 0.96, p < 0.001), perceived norms (β = −0.30, p < 0.001), and current behaviour (β = 0.06, p < 0.001) were the strongest predictors of intention; attitude toward separating waste was not a significant predictor (β = 0.04, p = 0.3881). Consequently, future behavioural interventions should build capability and opportunity to perform the behaviour before normalising it. For example, citizens should receive bins and bags to separate waste and be shown how to perform the behaviour and how easy and convenient it is to increase their behavioural control. In parallel, waste collection and treatment infrastructures must be in place so that citizens can see that sorting waste is a social norm. These actions will ensure the success of future behavioural interventions within the RES-Q project and beyond.

Application of the Theory of Planned Behavior in Autonomous Vehicle-Pedestrian Interaction

Automobile manufacturers, alongside technology providers, researchers, and public agencies, are conducting extensive testing to design autonomous vehicles (AVs) algorithms that will provide a complete understanding of road users, specifically pedestrians. Pedestrian behavior and actions determination are highly unpredictable depending on behavioral beliefs, context, and socio-demographic variables. Context includes everything that potentially affects one’s behavior; in AVs–pedestrian interaction, context may consist of weather conditions, road structure, social factors norms, and traffic volume. These influencing elements, therefore, need to be focused on during the development of pedestrian interaction algorithms. For this purpose, the pedestrian behavior questionnaire for FAVs (PBQF) is designed based on the theory of planned behavior (TPB). A total of almost 1000 voluntary participants completed this multilingual survey. As socio-demographic values and physiological perception varies with local norms, regions, and ethnicity, participants from 27 countries were therefore chosen to account for this variation. One of the key findings of this study is the influence of pedestrian attributes and the context on pedestrian behavior. Pedestrian action cannot be understood without visual observation of the pedestrian themselves and their context. The findings showed that pedestrians build communication with vehicles based on their driving styles. The vehicle’s driving style leads pedestrians to think that the vehicle is human-driven or autonomous. The results also revealed that pedestrians use several cues to show their intention. The general perception of AVs was also analyzed, and the communication between AVs and pedestrians with different displaying options was investigated.

Nurses' intention to report child abuse in Saudi Arabia: A cross-sectional study

BACKGROUND

Child abuse is a prevalent problem with short and long-term consequences. While most countries have enacted child abuse reporting laws, the Saudi healthcare system has not paid sufficient attention to nurses' role in the reporting of child abuse.

OBJECTIVE

This study aimed to 1) identify the factors associated with nurses' intention to report child abuse by testing a hypothetical model; 2) examine the patterns underlying their intention to report child abuse; and 3) investigate the differences in reporting based on clinical practice areas.

PARTICIPANTS AND SETTING

A convenience sample of 248 nurses recruited from emergency and pediatric inpatient units and primary healthcare centers in Riyadh, Saudi Arabia was used.

METHODS

In this cross-sectional study, data were collected using the Child Abuse Report Intention Scale and another self-report measure in February 2019.

RESULTS

Most nurses had not reported even one case of child abuse during their clinical practice. Knowledge about child abuse (β = .210, P = 0.000), subjective norms (β = .218, P = 0.001), and organizational support in guideline implementation (β = .138 P = 0.038) were significantly associated with the intention to report child abuse. Nurses reported a stronger intention to report child sexual abuse than other types of abuse. Clinical practice areas were significantly associated with nurses' intention to report child abuse.

CONCLUSIONS

Nurses' professional preparation for child abuse reporting is inadequate. The findings underscore the importance of enhancing their knowledge about child abuse and reporting laws, promoting social support, and creating an empowering clinical environment.

Self-reported healthcare waste segregation practice and its correlate among healthcare workers in hospitals of Southeast Ethiopia

BACKGROUND

The key to the effective management of healthcare wastes is segregation of the waste at the point of generation; no matter what final strategy for treatment and disposal of wastes is selected, it is critical that waste streams are separated. In Ethiopia, healthcare waste segregation practice among healthcare workers is overlooked and scarcely addressed in the scientific literature. This hospital-based cross-sectional study was, therefore, conducted to assess healthcare waste segregation practice and its correlate among healthcare workers in Bale zone, southeast Ethiopia.

METHODS

All five hospitals found in Bale zone were included and the study participants were selected using a systematic sampling technique from each hospital. Data were collected through interview using structured questionnaires. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were employed to identify factors that correlate with healthcare waste segregation practice.

RESULTS

A total of four hundred and nine healthcare workers participated in the study, for a response rate of 97.4%. Of these, 220(53.8%) (95% CI: 49.1-58.9) of healthcare workers were found to have reported good healthcare waste segregation practice. Being male gender (AOR = 1.70, 95%CI: 1.04-2.78), less than 30 years of age (AOR = 2.02, 95%CI: 1.06-3.84), less than 2 years work experience (AOR = 2.95, 95%CI: 1.39-6.26), having good self-reported standard precaution practice (AOR = 8.47,95%CI:4.98-14.42), and working in a department with an on-site healthcare waste segregation container (AOR = 2.10, 95%CI:1.24-3.55) were factors that correlated with self-reported healthcare waste segregation practice.

CONCLUSION

Overall, only half of the healthcare workers had good healthcare waste segregation practice, which is low and unsatisfactory. Less service year, having good standard precaution practice, and the presence of onsite waste segregation container were the most important variables that correlate with self-reported healthcare waste segregation practice. Therefore, to improve healthcare waste segregation practice health authorities should focus on sufficient allocation of onsite waste receptacles. In addition, periodic training on standard precaution will improve compliance with segregation practice.

A Whole Systems Approach to Hospital Waste Management in Rural Uganda

Introduction: Safe waste management protects hospital staff, the public, and the local environment. The handling of hospital waste in Bwindi Community Hospital did not appear to conform to the hospital waste management plan, exhibiting poor waste segregation, transportation, storage, and disposal which could lead to environmental and occupational risks.

Methods: We undertook a mixed-methods study. We used semi-structured interviews to assess the awareness of clinical and non-clinical staff of waste types, risks, good practice, and concerns about hospital waste management. We quantified waste production by five departments for 1 month. We assessed the standard of practice in segregation, onsite transportation, use of personal protective equipment, onsite storage of solid waste, and disposal of compostable waste and chemicals.

Results: Clinical staff had good awareness of waste (types, risk) overall, but the knowledge of non-clinical staff was much poorer. There was a general lack of insight into correct personal or departmental practice, resulting in incorrect segregation of clinical and compostable waste at source (>93% of time), and incorrect onsite transportation (94% of time). In 1 month the five departments produced 5,398 kg of hazardous and non-hazardous waste (12; 88%, respectively). Good practice included the correct use of sharps and vial boxes and keeping the clinical area clear of litter (90% of the time); placentae buried immediately (>80% of the time); gloves were worn everyday by waste handlers, but correct heavy-duty gloves <33% of the time, reflecting the variable use of other personal protective equipment. Chemical waste drained to underground soakaways, but tracking further disposal was not possible. Correct segregation of clinical and compostable waste at source, and correct onsite transportation, only occurred 6% of the time.

Conclusion: Waste management was generally below the required WHO standards. This exposes people and the wider environment, including the nearby world heritage site, home to the endangered mountain gorilla, to unnecessary risks. It is likely that the same is true in similar situations elsewhere. Precautions, protection, and dynamic policy making should be prioritized in these hospital settings and developing countries.

Effectiveness of a theory-based mobile phone text message intervention for improving protective behaviors of pregnant women against air pollution: a randomized controlled trial

Health impact of exposure to air pollution is a public health concern. The aim of this study was to investigate an extended parallel process model (EPPM)-based mobile phone text message intervention for improving protective behaviors against air pollution among pregnant women. In this randomized controlled trial (IRCT2016102810804N8), 130 pregnant women were randomly assigned into either experimental or control groups. A valid and reliable questionnaire was used to collect data. Experimental group received mobile phone intervention on a daily basis for 2 months. Control group received usual care, only. Data were analyzed using SPSS 15 applying t test, chi-square, and Wilcoxon and Mann-Whitney U test. Although before intervention, there were no significant differences between different structures of EPPM (P > 0.05), after intervention, there were statistically significant differences between perceived severity, response efficacy, self-efficacy, and protective behaviors between two groups (P < 0.05). Implementing EPPM based-mobile phone intervention could promote protective behaviors against air pollution among pregnant women. The present study might be used as a framework for evidence-based health promotion regarding air pollution risk communication and self-care behaviors.

TRIAL REGISTRATION

IRCT2016102810804N8.