A Review of Medical Waste Management in South Africa

Medicines Wastage and Its Contributing Factors in Public Health Facilities of South Gondar Zone, Amhara Regional State, Ethiopia

Background

In developing countries like Ethiopia, medicines wastage becomes a major healthcare system challenge. However, data that displayed the type, extent, and contributing factors of medicines wastage were limited.

Methods

A health facility-based explanatory sequential mixed study was conducted from December 2021 to February 2022. One drug and therapeutics committee (DTC) and one store man per health facility, working during the study period were included for their perception of medicines wastage and possible causes. As key informants, 1 Chief Executive Officer (CEO) and 1pharmacy head were also included per facility. In total, 80 participants were included in this study. The quantitative data to determine the magnitude of medicine wastage were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 25.

Results

The overall medicines wastage in the three consecutive years was 6.3%. The trend over the three years indicated that medicines wastage is 6.5%, 5.9%, and 6.5% in 2011, 2012, and 2013 Ethiopian Fiscal Year (EFY), respectively. The medicine wastage rate has been increasing nearly by 3% between 2011/2012 and 2012/2013. The main sources of wastage of medicines were expiry (99.3%). The perceived reasons for such medicine's wastage were near-expiry medicines (<6 months) being delivered to the health facilities by suppliers, poor communication and coordination with key stakeholders, and the presence of overstocked medicines due to improper forecasting of need in the facilities.

Conclusion

There is an excessive rate of medicines wastage which needs immediate mitigation by exchanging nearly expired medicines with other health facilities, communicating with suppliers and even prescribers, using auditable pharmaceutical transactions and services (APTS), providing continuous training, pursuing quality and safety medicines reuse scheme, implementation of pharmacist waste-reducing activities in all stages of the pharmaceutical supply chain, reducing medication amounts in stock, and through the use of electronic stock management tools.

Chemical characteristics of bottom ash from biomedical waste incinerators in Ghana

Biomedical waste (BMW) incineration is the most used alternative disposal method in developing countries, such as Ghana. The improper disposal of incinerator-generated bottom ash (BA) is a significant concern due to the hazardous nature of waste. A study was conducted at Tema Hospital (TGH) and Asuogyaman Hospital (VRAH) incinerator sites. The BA samples were sent to the Council for Scientific and Industrial Research, Institute of Industrial Research, Ghana. The BA samples were weighed with fisher analytical balance, ground, and sieved with standard grade meshes of 120, 100, and 80 to determine the BA particle size distribution. The chemical composition and heavy metals were analysed using X-ray fluorescence spectrometry (XRF) and atomic absorption spectroscopy (AAS) techniques. The results indicated the chemical composition of the analysed BA samples was CaCO₃ (49.90%), CaO (27.96%) and MgCO₃ (6.02%) for TGH and CaCO₃ (48.30%), CaO (27.07%), and SiO₂ (6.10%) for VRAH, respectively. The mean concentration (M) (kg m^-3) and standard deviation (SD) for TGH in the BA were 7.082 ± 0.478 (Ti), 4.657 ± 0.127 (Zn) and 4.271 ± 1.263 (Fe), while that of VRAH consisted of 10.469 ± 1.588 (Ti), 7.896 ± 2.154 (Fe) and 4.389 ± 0.371 (Zn). Therefore, the heavy metals' mean concentration at the BA is above the WHO permissible limits of soil, i.e., 0.056 kg m^-3 (Ti), 0.085 kg m^-3 (Pb), 0.100 kg m^-3 (Cr) and 0.036 kg m^-3 (Cu). Furthermore, the heavy metal mean concentrations of TGH and VRAH present in the BA analysed samples were ranked in descending order: Ti > Zn > Fe and Ti > Fe > Zn, respectively. It is therefore recommended that BA must be properly disposed of because of the hazardous nature of heavy metals present in the analysed samples, which are able to cause environmental and public health issues.

Health-care waste management practices: The case of Ho Teaching Hospital in Ghana

Approximately 15% of wastes generated in hospitals is hazardous. Improper handling of this waste renders the remaining fraction infectious which is perilous to the health of hospital workers, patients, visitors and even communities. Sufficient data on medical waste management practices particularly in low-income countries such as Ghana is required for effective monitoring and policy making. This study sought to assess the waste generation rates, waste management practices, frequency of sharp injuries and the knowledge of health-care workers on waste management guidelines in Ho Teaching Hospital in Ghana. Data was collected through observations and questionnaire administration from 100 health-care workers. The results revealed that the total amount of wastes generated was 1.70kg/patient/day (490.62 kg/day) comprising of 57.48%, 33.98% and 8.54% of general, infectious and hazardous wastes respectively. Further investigations showed that 52% of the health-care workers knew about the existence of a hospital waste management policy and 89% attested that they had received training on medical waste management. The existing waste management committee was however, non-functional. Waste segregation at source and the use of color-coded waste receptacles were not strictly followed. Contaminated general wastes were landfilled whiles hazardous wastes were either incinerated or buried. Only 11% of the waste handlers were always completely dressed in personal protective equipment and about 77% of the waste handlers always sustained sharp injuries. Incentivizing the waste management team to ensure strict adherence to a waste management plan would improve waste management at the hospital.

A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment

Health-Care Risk Waste (HCRW) treatment protects the environment and lives. HCRW is waste from patient diagnostics, immunization, surgery, and therapy. HCRW must be treated before disposal since it pollutes, spreads illnesses, and causes harm. However, waste treatment increases the healthcare sector's carbon footprint, making the healthcare sector a major contributor to anthropogenic climate change. This is because treating HCRW pollutes the environment and requires a lot of energy. Treating HCRW is crucial, but its risks are not well-studied. Unintentionally, treating HCRW leads to climate change. Due to frequent climate-related disasters, present climate-change mitigation strategies are insufficient. All sectors, including healthcare, must act to mitigate and prevent future harms. Healthcare can reduce its carbon footprint to help the environment. All contributing elements must be investigated because healthcare facilities contribute to climate change. We start by evaluating the environmental impact of different HCRW treatment technologies and suggesting strategies to make treatments more sustainable, cost-effective, and reliable to lower the carbon footprint.

Comparing Environmental Policies to Reduce Pharmaceutical Pollution and Address Disparities

Pharmaceutical products, including active pharmaceutical ingredients and inactive ingredients such as packaging materials, have raised significant concerns due to their persistent input and potential threats to human and environmental health. Discourse on reducing pharmaceutical waste and subsequent pollution is often limited, as information about the toxicity of pharmaceuticals in humans is yet to be fully established. Nevertheless, there is growing awareness about ecotoxicity, and efforts to curb pharmaceutical pollution in the European Union (EU), United States (US), and Canada have emerged along with waste disposal and treatment procedures, as well as growing concerns about impacts on human and animal health, such as through antimicrobial resistance. Yet, the outcomes of such endeavors are often disparate and involve multiple agencies, organizations, and departments with little evidence of cooperation, collaboration, or oversight. Environmental health disparities occur when communities exposed to a combination of poor environmental quality and social inequities experience more sickness and disease than wealthier, less polluted communities. In this paper, we discuss pharmaceutical environmental pollution in the context of health disparities and examine policies across the US, EU, and Canada in minimizing environmental pollution.

Medical laboratory waste generation rate, management practices and associated factors in Addis Ababa, Ethiopia

Background

Biomedical wastes (BMWs) generated from medical laboratories are hazardous and can endanger both humans and the environment. Highly infectious biomedical wastes are produced at an unacceptably high rate from health laboratories in developing countries with poor management systems, such as Ethiopia. The purpose of this study was to assess the rate of biomedical waste generation, management practices, and associated factors in public healthcare medical laboratories in Addis Ababa, Ethiopia.

Materials and methods

From July 13 to September 25, 2020, a health institution-based cross-sectional study was conducted in 6 hospital laboratories and 20 health centres laboratories in Addis Ababa, Ethiopia. Data on socio-demographic characteristics, knowledge and practice of biomedical waste management and generation rate were collected d in health facilities using pre tested data collection tools. SPSS version 20 was used to manage the data. To identify independent predictors of the dependent variable, descriptive statistics, Pearson correlation, linear, and logistic regression analysis were used. The strength of the association was determined using an odds ratio with a 95% confidence interval.

Results

In this study, the mean ± SD daily generation rate of biomedical wastes was 4.9 ± 3.13 kg/day per medical laboratory. Nineteen medical laboratories (74.3%) had proper biomedical waste management practice, which is significantly associated with professionals’ knowledge of biomedical waste management policies and guidelines, the availability of separate financial sources for biomedical waste management, and the level of training of professionals.

Conclusion

The study found that medical laboratories in Addis Ababa’s public healthcare facilities generate a significant amount of biomedical waste. Nearly two-thirds of hospitals performed proper waste segregation, collection, storage, and treatment procedures for biomedical waste generated in their laboratories. However, there was a poor transportation and disposal method. As a result, paying special attention and implementing the current national guidelines for biomedical waste management is recommended.

Sustainable waste management of medical waste in African developing countries: A narrative review

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method - if not applying the right technologies - potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

The use of photovoice to transform health science students into critical thinkers

BACKGROUND

Students are often inadequately prepared for higher education, particularly concerning independent learning and critical thinking. These attributes are essential, especially in health science students as health care needs are complex. Innovative methods of teaching that promote these attributes are thus required. One such method, which has been included previously in other disciplines is photovoice, a participatory method, in which students become co-creators of knowledge. The aim of the study was to determine whether photovoice would promote critical thinking in students enrolled for a module in Public Health. The study also aimed to analyze the experiences of students using this methodology, as part of their learning.

METHODS

Photovoice was introduced to a class of 56 chiropractic and homeopathy students registered for a module on Epidemiology: Public Health in 2019. Students working in self-selected groups were required to take photographs of environmental factors, involved in causing disease. After engaging in a group dialogue, one photograph was selected for presentation in class, with a discussion of how environmental factors visible in the photograph affect the health of individuals. Presentations were assessed based on the picture, presentation quality and ability to answer questions. Focus group discussions were subsequently held to understand the experience of students with this new teaching method. Data was analyzed using thematic analysis.

RESULTS

Students established that it was a positive experience. They recognized the lived realities, within the community, that cause disease. The assignment demonstrated how learning can occur beyond the lecture room and extend into communities. Students offered realistic solutions to health problems that were confronted by communities. In addition, students participated in unintended community engagement.

CONCLUSIONS

The incorporation of photovoice into undergraduate teaching in the health science module promoted higher order learning such as problem solving and critical-thinking. Students transformed from rote learners to critical thinkers who reflected upon what they were taught and how this related to the lived realities of the community. Student communication improved as they disseminated knowledge to others. Teaching using this alternative pedagogy has the potential to produce graduates who are responsive to the local needs of the community.

Assessment of Knowledge about Healthcare Risk Waste Management at a Tertiary Hospital in the Northern Cape Province, South Africa

This study aimed at assessing the knowledge about healthcare risk waste (HCRW) management among doctors, professional nurses, pharmacists and laboratory technicians, in accordance with National Environmental Management, Waste Act 59 of 2008, Constitution of South Africa and sustainable development goals (SDG). The quantitative cross-sectional study was conducted, using self-administered questionnaires and stratified random sampling was used. Data was analyzed using the descriptive and inferential statistics. One hundred and forty-four participants were included in the study. The majority 90.28% of the participants were aged 19–50 years, females (71%), professional nurses (36%), and they had 1–10 years of experience (71%). The health professionals were knowledgeable of sharps waste (89%), slightly over (52%) knew anatomical waste, whereas (27%) and (17%) knew radioactive and cytotoxic waste, respectively. Health professionals (92%) agreed that the sharps-waste container should be disposed of in a yellow bin container, at least (63%) and (27%) agreed that red liner and box should be used for both infectious non anatomical waste and for cytotoxic waste. The null hypothesis was tested on knowledge versus age, profession and gender, and evidence against it was found on waste storage period in all three variables where chi-square and Fisher exact p-values were less than the 5% significant level. More attention should be directed towards similar HCRW management training at the hospital for all health professionals and behavior modification. The hospital management must ensure that HCRW-trained health professionals and HCRW management officials put into practice what they have learnt.