Healthcare waste management practices and safety indicators in Nigeria

A review towards developing a hierarchical model for sustainable hospital solid waste management in rural areas of Zimbabwe

Management of solid waste from rural hospitals is amongst problems affecting Zimbabwe due to diseases, population, and hospital increase. Solid waste from rural hospitals is receiving little attention translating to environmental health problems. Therefore, 101 secondary sources were used to write a paper aiming to proffer a hierarchical model to achieve sustainable solid waste management at rural hospitals. Rural hospitals' solid waste encompasses electronic waste, sharps, pharmaceutical, pathological, radioactive, chemical, infectious, and general waste. General solid waste from rural hospitals is between 77.35 and 79% whilst hazardous waste is between 21 and 22.65%. Solid waste increase add burden to nearly incapacitated rural hospitals. Rural hospital solid waste management processes include storage, transportation, treatment methods like autoclaving and chlorination, waste reduction alternatives, and disposal. Disposal strategies involve open pits, open burning, dumping, and incineration. Rural hospital solid waste management is guided by legislation, policies, guidelines, and conventions. Effectiveness of legal framework is limited by economic and socio-political problems. Rural hospital solid waste management remain inappropriate causing environmental health risks. Developed hierarchical model can narrow the route to attain sustainable management of rural hospitals' solid waste. Proposed hierarchical model consists of five-layered strategies and acted as a guide for identifying and ranking approaches to manage rural hospitals' solid waste. Additionally, Zimbabwean government, Environmental Management Agency and Ministry of Health is recommended to collaborate to provide sufficient resources to rural hospitals whilst enforcing legal framework. Integration of all hierarchical model's elements is essential whereas all-stakeholder involvement and solid waste minimisation approaches are significant at rural hospitals.

Smart waste bin monitoring using IoT for sustainable biomedical waste management

Suboptimal management of healthcare waste poses a significant concern that can be effectively tackled by implementing Internet of Things (IoT) solutions to enhance trash monitoring and disposal processes. The potential utilisation of the Internet of Things (IoT) in addressing the requirements associated with biomedical waste management within the Kaduna area was examined. The study included a selection of ten hospitals, chosen based on the criterion of having access to wireless Internet connectivity. The issue of biomedical waste is significant within the healthcare sector since it accounts for a considerable amount of overall waste generation, with estimates ranging from 43.62 to 52.47% across various facilities. Utilisation of (IoT) sensors resulted in the activation of alarms and messages to facilitate the prompt collection of waste. Data collected from these sensors was subjected to analysis to discover patterns and enhance the overall efficiency of waste management practices. The study revealed a positive correlation between the quantity of hospital beds and the daily garbage generated. Notably, hospitals with a higher number of beds were observed to generate a much greater amount of waste per bed. Hazardous waste generated varies by hospital, with one hospital leading in sharps waste (10.98 kgd-1) and chemical waste (21.06 kgd-1). Other hospitals generate considerable amounts of radioactive waste (0.60 kgd-1 and 0.50 kgd-1), pharmaceuticals, and genotoxic waste (16.19 kgd-1), indicating the need for specialised waste management approaches. The study sheds light on the significance of IoT in efficient waste collection and the need for tailored management of hazardous waste.

Improving the hospital waste management at the Farabi hospital in Malekan -Iran: An action research study

Hospital waste poses numerous concerns for both human health and the environment. Using an action research technique, this study attempts to improve waste management at the Farabi Hospital in Malekan city-Iran. In 2020, integrated (quantitative-qualitative) action research was done. For action research, the Simmons model was employed. First, a list of significant issues was found during the waste management process evaluation using a standard checklist and brainstorming with hospital officials and workers. The identified issues were prioritized using a prioritization matrix. Then, after consulting with hospital officials, 11 interventions were designed and implemented over six months. Finally, waste management performance was re-evaluated. Average knowledge of the participants about hospital waste management (HWM) standards was improved significantly (64 ± 13.8 before the training, 84.6 ± 20.6). General waste production was reduced by 27.7% in terms of garbage bags and 23.4% in terms of waste weight (95.5 kg-73.1 kg), respectively. Infectious waste output was reduced by 22.8% in the number of garbage bags and 32.1% in the weight of waste (57.5 kg-39 kg). The rate of compliance with HWM criteria was improved from 10 to 33 items. Although the interventions in this study improved the HWM to an acceptable level, more interventions and ongoing monitoring are required. The study's findings also show that an action research strategy might address a wide range of issues and weaknesses in hospitals and related facilities.

Adherence to recommended hospital waste management practices by healthcare workers at Murtala Muhammad Specialist Hospital Kano, Nigeria

Introduction

the aim of this study was to determine what proportion of patients with confirmed esophageal cancer at the largest hospital in the country were recorded in the Zambia National Cancer Registry (ZNCR).

Methods

we reviewed esophageal cancer records at the University Teaching Hospital (UTH) and ZNCR, between 2015 and 2017. Using Stata version 15, data were summarised and the Kruskal-Wallis was used to compute comparisons, Kaplan-Meier curves for survival estimates and Cox regression for associated factors.

Results

included in the final analysis were records for 222 patients with confirmed esophageal cancer and of these 51/222 (41%) were appearing in the ZNCR. The mean age of the patients was 56.2 years (SD, 13.0) and only 2/222 (1%) were confirmed alive at the time of data analysis. The median time from endoscopic diagnosis to histological confirmation was 12.5 days (IQR 7.5 - 21.5) and arrival at the Cancer Diseases Hospital (CDH) for treatment was 20 days (IQR 10 - 34). The overall median survival time in the study was 259 days (CI 95%; 151 - 501). Age, sex, time to diagnosis, histological classification and grade of tumour did not show any evidence of predicting survival in both the univariate and multivariable cox regression model (p>0.05).

Conclusion

a significant proportion of esophageal cancer cases seen at UTH were not included in the national registry suggesting that official figures for the prevalence of esophageal cancer in Zambia are underestimated. There is an urgent need to improve the collection of data on esophageal cancer in Zambia.

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.

Macro-economic determinants, maternal and infant SDG targets in Nigeria: Correlation and predictive modeling

Objectives

Unambiguously, Nigeria is off-track in achieving the health-related SDGs. Consequentially, this study aligns with SDG 3 which calls for "good health and wellbeing for people by ensuring healthy lives and promoting wellbeing for all at all ages". This article examines the combined effect of health expenditure and other key macro-economic factors on health indices such as maternal and newborn and child mortality in Nigeria. Contrary to existing literature, we formulated a model that predicts the level of macro-economic determinants needed to achieve the SDG targets for maternal and newborn and child mortality in Nigeria by 2030.

Methodology

The study used Autoregressive Distributed Lag (ARDL), which is usually used for large T models. The study period spans from 1995 to 2020.

Results

We found a significant negative relationship between health outcomes and macro-economic determinants namely, household consumption, total health expenditure, and gross fixed capital while we determined a significant positive relationship between health outcomes and unemployment. Our findings are further supported by out-of-sample forecast results suggesting a reduction in unemployment to 1.84 percent and an increase in health expenditure, gross fixed capital, household consumption, control of corruption to 1,818.87 billon (naira), 94.46 billion (naira), 3.2 percent, and -4.2 percent respectively to achieve SDG health targets in Nigeria by 2030.

Policy implication

The outcome of this result will give the Nigerian government and stakeholders a deeper understanding of the workings of the macro-economic factors, concerning health performance and will help position Nigeria, and other SSA countries by extension, toward reducing maternal mortality to 70 per 100,000 and newborn and child mortality to 25 per 1,000 births by 2030. The African leaders should consider passing into law the need for improvement in macro-economic factors for better health in Africa. We also recommend that the Nigerian government should steadily increase health expenditure to reach and move beyond the forecast level for improvement in maternal and infant mortality, given the present low and unimpressive funding for the health sector in the country.

Sustainability in gastroenterology and digestive endoscopy: Position Paper from the Italian Association of Hospital Gastroenterologists and Digestive Endoscopists (AIGO)

Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure-dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the 'triple bottom line' of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gastroenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital executives, single endoscopic units can structure health policies and investment to build a "green endoscopy". The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sustainability in digestive endoscopy. The "green endoscopy" can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.

Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh

Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.

Developing an effectiveness index for biomedical waste management in Indian states using a composite indicators approach

The waste from healthcare facilities (HCFs) is most devastating as they induce health hazards and pollute the environment. The effective management of biomedical waste is an essential function of the state governments, depending on state policies and facilities in HCFs. The performance assessment at the state level provides explanatory information for the decision-makers to dispose of biomedical waste. Therefore, this paper aims to establish an effectiveness index for assessing the performance of biomedical waste management for the Indian states. The designed conceptual framework, which acts as the building block for the index, interlinks the technical, managerial, and sustainability dimensions. To assess the existing waste management practices, significant sub-indicators are analyzed for India's northern and southern states. The indicators are transformed into comparable units using the proportionate normalization technique. The weight to the respective indicators follows the entropy method and additive aggregation to form the indices for various states. The developed index allows comparing management practices among the states and highlights the alarming situation. Based on the magnitude of indices values, states are categorized as red, yellow, and green zones. The robustness of the model is validated by performing sensitivity analysis and the cluster analysis tests the reliability of indicators and categorization of states with the existing methodology. The analysis will be useful to the decision-makers of state pollution boards by providing special attention to capacity building and waste prevention technologies.

Healthcare waste management in the Tamale Central Hospital, northern Ghana. An assessment before the emergence of the COVID-19 pandemic in Ghana

Healthcare waste (HCW) poses several environmental and public health challenges. However, much attention has not been given to its management. The present study sought to assess the healthcare waste management (HCWM) practices in the Tamale Central Hospital (TCH) by characterizing and measuring the quantities of waste generated and the associated implications. Observation of the value chain of healthcare waste management, waste quantification using a weighing scale (Top-pan-spring balance), and semi-structured interviews were used in the data collection. The study revealed that, except for sharps, there was no segregation of infectious and non-infectious waste, and healthcare waste was not treated before final disposal. The study showed that a daily record of 5.1 kg of sharps, 24.46 kg of infectious waste and 59.45 kg of general waste was generated. The maternity ward produced more general waste (14 kg), whereas the theatre generated the highest infectious waste (5.70 kg) and sharps (0.8 kg) daily. Generally, the maternity ward recorded the highest daily waste generation of 17.9 kg. The waste treatment method available in the hospital was incineration. However, the incinerator was found to be dysfunctional. Thus, an improvised method (dug pit) was used irrespective of the associated health and environmental implications. The study also revealed that the hospital did not quantify the amount of solid waste that was generated. Inadequate finance and lack of supervision were linked to the problem of poor healthcare waste management in the study area. Also, 82% of the workers mentioned that there was poor HCW segregation at the departments whereas 76% of the patients who received healthcare at the facility were unsatisfied with the HCWM practices. A strong linear relationship in the responses made was recorded. The healthcare waste management index showed that the HCWM practice at the facility was unsatisfactory as it was medium-ranked. The study, therefore, recommends that the hospital considers constructing an on-site waste treatment facility, segregate and quantify waste for effective allocation of resources for treating healthcare waste.

Effectiveness of a multimodal capacity building initiative for upgrading biomedical waste management practices at healthcare facilities in Bangladesh: a 21st century challenge for developing countries

INTRODUCTION

Bio-medical Waste Management (BMWM) has attracted critical attention across the world as its improper management can pose a serious threat for healthcare workers (HCWs), the general population and the environment as well. This study aims to analyse the effectiveness of a multimodal intervention (MMI) in upgrading BMWM practices at healthcare facilities across Bangladesh.

METHODS

This quasi-experimental study, with a pre- and post-test design, was carried out at nine healthcare facilities (five public, three private and one autonomous) over three phases and concluded in 2019. The MMI included various strategies including: i) system change; ii) education and training, iii) visual reminders, iv) monitoring and feedback; v) ensuring sustainability at the study hospitals. The data collected from 2726 HCWs and waste handlers through direct observation was statistically analysed using SPSS 24.

RESULT

Significant improvements were observed in waste segregation practices (rising from 1% to 79%) using colour-coded bins. Use of PPEs during transportation and final management/disposal was also enhanced from 3% to 55%. Compliance to use of standardized methods for collecting and transporting biomedical waste (BMW) increased substantially from 0% to 78% while compliance to standard final management/disposal of BMW practices improved by 39%.

CONCLUSION

Compliance to BMWM practices is very poor in Bangladesh due to a lack of knowledge, manpower and resources. Nevertheless, MMI can be used as a tool to significantly upgrade BMWM practices across healthcare facilities. Such initiatives will assist the government of Bangladesh to achieve sustainable development goal (SDG) 3.3 and universal health coverage by 2030.

Medical waste management at the primary healthcare centres in a north western Nigerian State: Findings from a low-resource setting

Objectives

This study aims to examine medical waste management (MWM) practices and identify the challenges of optimal MWM at the primary healthcare (PHC) level in Kebbi State, Nigeria.

Study design

This study was a cross-sectional survey of 265 primary healthcare workers (PHCWs) and health facilities (HFs) in Kebbi State.

Methods

The study tool used was a questionnaire adapted from the WHO rapid assessment tool on MWM and water sanitation. Descriptive and inferential statistical analyses were conducted using SPSS version 20 software.

Results

Data generated from 257 HWs were used in this study. Amidst other findings, only 65 (25%) HFs had MWM guideline or policy document; out of these 65HFs, only 19 (7%) of them had problem with its implementation. Only 42 (16%) HFs had a compensation package or a health insurance policy to take care of their health workers in case of MWM-associated hazards while 22 (9%) HFs had specific budgetary allocation for MWM. Only 105 (41%) HFs had trained staffers on MWM. Sharps, blood/body fluids and domestic wastes were the top three (3) wastes generated among the surveyed HFs. Medical waste treatment was on-site in 124 (48%) HFs and burn-and-bury method was the adopted method of medical waste disposal in 198 (77%) HFs. However, the majority (76%) of the surveyed HWs expressed dissatisfaction about the waste treatment practices adopted in their HFs.

Conclusion

Our study revealed a poor level of MWM practices in Kebbi State, Nigeria. The state government and partners need to urgently address the identified operational and policy gaps in MWM in Kebbi State, Nigeria. Furthermore, our study revealed the negative implication of fragmented governance and leadership structure at the PHC level on policy, practice and administration of medical waste management in the Kebbi State, Northwestern Nigeria. Addressing the gaps found in this study would contribute to the attainment of the United Nations Sustainable Development Goals in health and well-being, sustainable cities and communities and contribute to poverty eradication.

Temporal assessment of municipal solid waste management in Nigeria: prospects for circular economy adoption

This work reviewed the past and current status of municipal solid waste (MSW) management in Nigeria towards offering a direction for the future. The past status shows that poor policy regimes, inadequate financing mechanisms, absence of waste data, and abysmal institutional arrangement negatively impacted the MSW management outcomes in the country. At present, few improvements recorded like an increase in the number of landfills, and public-private partnerships have been largely undermined by the continuous upsurge in the urban population and lack of corresponding growth in critical capacities in terms of economic resources, technological advancement, and state-of-the-art urban infrastructures. The current waste generated in cities in Nigeria is calculated as 66,828 tonnes per day (TPD) at the total urban population of 106 million, while the projected value for 2040 will be 125,473 TPD at the urban population of 199 million. The current work further discusses prospects and implications for circular economy adoption in solid waste valorization in Nigeria.

Exploring Phytochemicals for Combating Antibiotic Resistance in Microbial Pathogens

Antibiotic resistance or microbial drug resistance is emerging as a serious threat to human healthcare globally, and the multidrug-resistant (MDR) strains are imposing major hurdles to the progression of drug discovery programs. Newer antibiotic-resistance mechanisms in microbes contribute to the inefficacy of the existing drugs along with the prolonged illness and escalating expenditures. The injudicious usage of the conventional and commonly available antibiotics in human health, hygiene, veterinary and agricultural practices is proving to be a major driver for evolution, persistence and spread of antibiotic-resistance at a frightening rate. The drying pipeline of new and potent antibiotics is adding to the severity. Therefore, novel and effective new drugs and innovative therapies to treat MDR infections are urgently needed. Apart from the different natural and synthetic drugs being tested, plant secondary metabolites or phytochemicals are proving efficient in combating the drug-resistant strains. Various phytochemicals from classes including alkaloids, phenols, coumarins, terpenes have been successfully demonstrated their inhibitory potential against the drug-resistant pathogens. Several phytochemicals have proved effective against the molecular determinants responsible for attaining the drug resistance in pathogens like membrane proteins, biofilms, efflux pumps and bacterial cell communications. However, translational success rate needs to be improved, but the trends are encouraging. This review highlights current knowledge and developments associated challenges and future prospects for the successful application of phytochemicals in combating antibiotic resistance and the resistant microbial pathogens.

Drivers of anthropogenic air emissions in Nigeria - A review

This study presents a review of sources and atmospheric levels of anthropogenic air emissions in Nigeria with a view to reviewing the existence or otherwise of national coordination aimed at mitigating the continued increase. According to individual researcher's reports, the atmospheric loading of anthropogenic air pollutants is currently on an alarming increase in Nigeria. Greater concerns are premised on the inadequacy existing emission inventories, continuous assessment, political will and development of policy plans for effective mitigation of these pollutants. The identified key drivers of these emissions include gas flaring, petroleum product refining, thermal plants for electricity generation, transportation, manufacturing sector, land use changes, proliferation of small and medium enterprises, medical wastes incineration, municipal waste disposal, domestic cooking, bush burning and agricultural activities such as land cultivation and animal rearing. Having identified the key sources of anthropogenic air emissions and established the rise in their atmospheric levels through aggregation of literature reports, this study calls for a review of energy policy, adoption of best practices in the management air emissions and solid wastes as well as agriculture and land use pattern which appear to be the rallying points of all identified sources of emission. The study concluded that the adoption of cleaner energy policies and initiatives in energy generation and usage as against pursuit of thermal plants and heavy dependence on fossil fuels will assist to ameliorate the atmospheric loadings of these pollutants.

Potential for improving routine immunisation waste management using measles vaccination campaign 2017 in Kebbi State, Nigeria

BACKGROUND

Immunisation activities generate sharps and infectious non-sharp waste that have harmful impact on the community and health care workers if disposed of improperly, leading to carbon mono oxide (CO) emissions which contribute to global warming. Health care waste is not effectively managed, especially in some developing countries. However, measles supplemental immunisation activities (SIAs) are used to strengthen routine immunisation system, including waste management. The waste management planning provides an opportunity to build capacity, mobilize resources and strengthen structures to ensure continual disposal of routine immunisation waste.

METHODS

We reviewed the Kebbi State and LGA routine immunisation waste management situation and identified existing gaps; developed and implemented the plan for waste management, including strengthening routine immunisation waste management. The process included, reactivation of measles technical coordination committee, mobilizing resources for funding, and sustenance of immunisation waste management. The health care workforce was trained in safe immunisation waste disposal practices.

RESULTS

Immunisation waste management committee and the structure was established and strengthened at the state and LGA levels and a total cost of 11,710.70 USD was expended on injection waste management, with an average cost per injection of 0.01 USD. A total of 11,829 safety boxes were incinerated in the state, including those generated from routine immunisation sessions. Twenty-one Local Immunisation Officers, 1097 and 2192 team supervisors and healthcare worker vaccinators respectively were trained on immunisation waste disposal.

CONCLUSION

Immunisation waste management strategies protect healthcare workers and reduce the adverse impact on the environment. Improving key areas such as human and financial resources ensures accountability towards sustainable healthcare waste management.

Antimicrobial use and resistance in food-producing animals and the environment: an African perspective

BACKGROUND

The overuse of antimicrobials in food animals and the subsequent contamination of the environment have been associated with development and spread of antimicrobial resistance. This review presents information on antimicrobial use, resistance and status of surveillance systems in food animals and the environment in Africa.

METHODS

Information was searched through PubMed, Google Scholar, Web of Science, and African Journal Online databases. Full-length original research and review articles on antimicrobial use, prevalence of AMR from Africa covering a period from 2005 to 2018 were examined. The articles were scrutinized to extract information on the antimicrobial use, resistance and surveillance systems.

RESULTS

A total of 200 articles were recovered. Of these, 176 studies were included in the review while 24 articles were excluded because they were not relevant to antimicrobial use and/or resistance in food animals and the environment. The percentage of farms using antimicrobials in animal production ranged from 77.6% in Nigeria to 100% in Tanzania, Cameroon, Zambia, Ghana and Egypt. The most antibiotics used were tetracycline, aminoglycoside and penicillin groups. The percentage of multi drug resistant isolates ranged from 20% in Nigeria to 100% in South Africa, Zimbabwe and Tunisia. In the environment, percentage of multi drug resistant isolates ranged from 33.3% in South Africa to 100% in Algeria. None of the countries documented national antimicrobial use and resistance surveillance system in animals.

CONCLUSION

There is high level of antimicrobial use, especially tetracycline, aminoglycoside and penicillin in animal production systems in Africa. This is likely to escalate the already high prevalence of antimicrobial resistance and multi drug resistance in the continent. This, coupled with weak antimicrobial resistance surveillance systems in the region is a great concern to the animals, environment and humans as well.

Healthcare waste management in a Brazilian university public hospital

Some healthcare waste presents hazardousness characteristics and requires specific procedures to ensure the safety management. Waste segregation is an important action to control the risks of each type of waste. Healthcare waste indicators also may improve the waste management system. The aim of this article was to evaluate the healthcare waste management in a Brazilian university hospital, as well as the waste indicators, quantifying and qualifying the waste generation. Weighing of wastes occurred by sampling occurred sampling of seven consecutive days or daily, between 2011 and 2017. General wastes represent more than 55.6% of the total generated, followed by infectious, sharps and chemicals wastes, respectively, 39.1%, 2.9% and 2.4%. The generation rate in 2017 was 4.09 kg bed^-1 day^-1, including all types of wastes. Non-dangerous wastes represented around 93.3%, including infectious wastes with low potential risks, while dangerous was represented by high infectious risk (1.4%), chemicals (2.4%) and sharps (2.9%). Healthcare waste indicators may favour the risk identification and improve the waste management system, in particular when involving hazardous wastes. Failures in healthcare waste segregation could represent, in addition to the health risks, unnecessary expenses.

Unpacking healthcare waste management at rural village health clinics in the Ntcheu District (Malawi)

Management of healthcare waste in low- and middle-income countries lacks a straightforward solution, especially where rural health services are provided. The purpose of our case study was to explore the knowledge and practices of health surveillance assistants operating at rural village health clinics in Ntcheu District, Malawi, with regard to the collection, segregation, transportion, treatment, and disposal of healthcare waste. Data were collected from 81 clinics. The results indicated that while general gaps in both knowledge and practice were observed, sharps (e.g., needles) management was generally being done well. An opportunity for scale-up was found in one clinic, in which local materials had been used to construct a low-cost innovative sharps disposal receptacle that had been modified from a pit latrine design. This study recommends waste management training suitable for rural settings, the promotion of low-cost sharps disposal receptacles using local materials, further opportunities for low-cost incinerators, central waste collection, and encouraging grassroots innovation in healthcare waste management.