Transaction on Biomedical Engineering Applications and Healthcare

Vol-3 Issue-1, April 2022, PP.1-9

Asessment of Biomedical Waste

Management Among Primary Healthcare
Workers in Gwadabawa Local Government
of Sokoto State, Nigeria
Ghazali Sabo1, Ahmad Zayyanu2, Kabiru Musa Abdullahi3, Zayyanu Malami4
Abdullahi Aliyu5, Sabi'u Muhammad6, Abdul'aziz Bello 7

1
Department of Environmental Health, Sultan Abdurrahman College of Health Technology Gwadabawa, Sokoto State,
Nigeria
2
Sultan Abdurrahman College of Health Technology Gwadabawa, Sokoto State, Nigeria
3,4,5,6
Department of Medical Laboratory Science, Sultan Abdurrahman College of Health Technology Gwadabawa, Sokoto
State, Nigeria
7
State College of Basic and Remedial Studies Sokoto, Nigeria
E-mail: [email protected]

Abstract - The aim of the study “Assessment Of Biomedical Waste Management Among Primary Healthcare
Workers In Gwadabawa Local Government Of Sokoto State” was to assess Biomedical Waste Management Among
Primary Healthcare Workers In Gwadabawa Local Government Of Sokoto State. The type of design utilized in this
study was descriptive survey type. Therein, it revealed the use of personal protection among healthcare workers in
the course of waste management in Gwadabawa local government, Sokoto state. Most of the participants (30.0%)
submitted that they wear protective glasses sometimes, then always (13.3%), very few (1.6%). 18.3% uses protective
foot wears sometimes, 13.3% frequently, and 3.3% of the respondents do not used protective foot wears. Most of
them 26.7% always wash their hands, 15.0% wash hands frequently, and 8.3% wash their hands sometimes. 28.3%
wear labsuit sometimes and 16.0% wear labsuits always. On the question “Have you ever been vaccinated against
microbes which could arise from waste?” Only 6.7 submitted that they are always vaccinated. When asked “When do
you receive training on waste management?” only 3.3 % received training always. Relating to sorting or segregation
of waste, 16.7% said they practiced it always, 10.0% practiced it sometimes. 3.3% said they never practice
sorting.10.0% have 3 boxes, and 11.7% have 4 boxes for waste segregation. 20.0% of the respondents said always
there is storage after collection, while 1.6% said there is none. The waste storage place are incineration (16.7%) open
dumping (6.7%), dig trench (1.6%), and well-equipped and maintained (3.3%). Types of waste treatment reported
are: incineration (11.7%), disinfection (11.7%), chemical (6.7%), and autoclaving (3.3%). The challenges or
constraints as experienced by respondents are: absence of plans(20.0%), lack of monitoring and evaluation (20.0%),
poor hygiene in collection, storage, transportation, and treatment (16.7%),poor/lack of waste segregation
facility(16.7%), lack of personal protective equipment (13.3%), lack of training (10.0%), lack of post-exposure drugs
(10.0%). The workers are not fully practicing personal protective measures. There is also lack of adequate training of
workers on biomedical waste in healthcare in Gwadabawa.

Keywords— biomedical waste, primary healthcare, personal protective equipment, hygiene, monitoring

I. Introduction
1.1 BACKGROUND OF THE STUDY
Biomedical waste can be dubbed as a waste generated during the diagnosis, testing, treatment research or
production of biological products for humans or animals (Longe and Wiliams, 2006; Federal Ministry of Health,
2018). It includes syringes, live vaccines, laboratory samples, body parts, bodily fluids, waste, sharp needles,
cultures and lancets. Biomedical waste can be non-hazardous or bio-hazardous (Federal Ministry of Health,
2018). Circa 75- 90% of the biomedical wastes are non-hazardous and as harmless like any other municipal
waste. The remaining 10-25% is hazardous and can be injurious to humans or animals and deleterious to
environment (Abah, 2020). Waste which is biological in nature is a potential source of infection transmission,
especially hepatitis B and C, HIV, and tetanus (Longe and Williams, 2006; International Committee of the Red
Cross, 2011).
Biomedical wastes management is of great importance due to its potential environmental hazards and health

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problems. The waste produced in the course of primary health care activities carries a higher potential for
infection and injury than any other type of waste. The management biomedical waste in the hospital requires its
segregation and removal from the health care establishments in such a way that it will not serve as a source of
health hazards to those who are directly or indirectly related to the hospital (Federal Ministry of Health, 2018).
According to world health organization (2014), biomedical waste was classified in ten categories (10): (1)
Human Anatomical Waste, (2) Animal Waste, (3) Microbiology and Biotechnology Waste, (4) Waste sharps,
(5)Discarded Medicines and Cytotoxic drugs, (6) Soiled Waste, (7) Solid Waste, (8) Liquid Waste, (9)
Incineration Ash, (10)Chemical waste (Sambo, 2020).
The improper management of biomedical waste is a major challenge for our cities and towns which should be
managed so that it does not endanger human health, harm the environment, pose risks to air, water, soil, plants
or animals, be a nuisance through odours or noise, or adversely affect places of special interest. Nigerian
development policies have been poorly coordinated and, are highly dominated by economic objectives making
environmental protection low in ranking. Furthermore, available funding rests in the public sector hampering
medical waste management primarily by the high rate of corruption and low private sector participation.
Consequently, private sector contribution to medical waste management is low (World Health Organization and
the United Nations Children’s Fund, 2019).
All the specific procedures of biomedical waste, segregation, packaging and labelling should be explained to
the medical and ancillary staff and displayed in each department on charts located on the walls nearby the
Medical waste containers that should be specifically suited for each category of waste (Federal Ministry of
Health, 2018). Biomedical waste has to be transported to the treatment or disposal facility site in a safe manner.
The vehicle should have certain specifications it should be covered and secured against accidental opening of
door (Federal Ministry of Health, 2018). According to the different categories of waste generated from primary
health care activities, waste treatment methods are as follows: (a) Incineration, (b) Autoclave treatment, (c)
Hydroclave treatment, (d) Microwave treatment,(e) Mechanical/Chemical Disinfecting, (f) Sanitary and secured
Land filling (Federal Ministry of Health, 2018).
Primary health care (PHC) is a medical facility that delivers medical care to outpatients and on occasion may
participate in large scale immunization programs. PHCs generally produce limited quantities of waste. So,
biomedical waste management is also important for primary care physicians. According to Manar et al. (2014),
it was found that the processes of biomedical waste management were poor and unacceptable across the levels
of health facilities, and it was poorest in primary care settings as compared to secondary and tertiary care
settings (Sambo, 2020). Woefully biomedical waste is yet to received adequate attention worldover. A survey in
Brazil in 2004 found that, the overall waste management was without recycling method and collection was
through the general municipal waste management system. In Africa, the situation is more critical as reports from
various regions of the continent show poor management of biomedical waste. A study by Manyele (2003) as
reported by Longe and Wiliams (2006) described the management of biomedical waste in Tanzania as being
poor and the handlers lacks proper awareness of waste treatment. The situation of poor biomedical waste
management was also similar from South Africa, Kenya, Mozambique, and Swaziland (Longe and Wiliams,
2006). Thus, there is utmost importance in asessment of biomedical waste management among primary
healthcare workers in Gwadabawa local government of Sokoto state.
1.2 STATEMENT OF THE PROBLEM
At the global level, 18-64% of health care facilities are reported to have unsatisfactory biomedical waste
management; predictors include lack of awareness, Africa is estimated to have 67,740 health facilities and
produce approximately 282,447 tons of medical waste yearly (Nigeria Health Watch, 2021).
The management of biomedical waste is a major challenge for our primary health care facilities and present
environmental sustainability. The waste should be managed so that it does not endanger human health, harm the
environment, pose risks to air, water, soil, plants or animals, be a nuisance through odours or noise, or adversely
affect places of special interest (Federal Ministry of Health, 2018).
A major issue related to of present biomedical waste management in many primary health care facilities is
that, the implementation of biomedical waste regulation is unsatisfactory as some hospitals are disposing of
waste in a haphazard, lack of recycling, improper segregation practices, inadequate training of primary health
care staffs, insufficient resources and poor disposal (Longe and Williams, 2006). Also, biomedical waste
scattered in and around hospitals invites flies, insects, rodents, cats and dogs that are responsible for spread of
communicable diseases like cholera, plague and rabies (Federal Ministry of Health, 2018). Additionally, the
health sector in the country is still receiving low allocation of resources and funding, which in turn cause lack of
enough funding to properly manage biomedical waste in the healthcare facilities. Therefore, it is pertinent to
carry out this study to analyze the current status of biomedical waste management in Gwadabawa healthcare

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facilities.The aim of this research study is to assess the biomedical waste management in some primary health
workers in Gwadabawa Local Government, Sokoto State.

2. MATERIALS AND METHODS

2.1 STUDY DESIGN
The type of design utilized in this study was descriptive survey type. It involves collection of data at a certain
time.
2.2 STUDY AREA
Gwadabawa is a Local Government Area in Sokoto State, Nigeria. Its headquarters are in the town of
Gwadabawa on the A1 highway. It comprises Gwadabawa, Salame, Chimmola and Asara districts. It has an area
of 991 km2 and a population of 231,358 at the 2006 census. The postal code of the area is 843.
2.3 SAMPLING METHOD AND SAMPLE COLLECTION INSTRUMENT
The method of sampling was through convenience sampling using questionnaire designed from past literature
guidance. The samples in qualitative study are usually smaller than that of quantitative one. Thus, the sample
size consisted of sixty participants from different healthcare facilities in Gwadabawa local government. The
samples are drawn from Gwadabawa town, Salame, Tambagarka, and Mammande PHCs.

Figure 1: A typical Primary healthcare in Gwadabawa where data was collected; Source: Field work

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Figure 2: An open biomedical waste dumping site in Gwadabawa; Source: Field work

Figure 3: A respondent filling the questionnaire of the study, Source: Fieldwork

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2.4 DATA MANAGEMENT

The data was managed using Microsoft excel software to calculate descriptive statistics of frequency and
percentage.

3. RESULTS AND DISCUSSION

3.1 RESULTS
The results for this study of Assessment Of Biomedical Waste Management Among Primary Healthcare
Workers In Gwadabawa Local Government Of Sokoto State” were displayed in tables 1-3.

Table 1: Demographic properties of respondents

Items Frequency Parameters
1.What is your sex?
Male 50 83.3
Female 10 16.7
2. What is your religion?
Islam 60 100
3. What is your age ?
15-25 20 33.3
26-35 40 66.7
4. What is your level of education?
Secondary 10 16.7
Tertiary 50 83.3
4b. What is your occupation?
Staff 30 50.0
Student 20 33.3
Labourer 10 16.7
The table 1 shows the demographic of the respondents. They are all Muslims and age range between 15-35
years. The education is either secondary or tertiary level.
Personal protection
Table 2: Responses on use of personal protections use during Biomedical Waste Management among primary
healthcare workers in Gwadabawa local Government of Sokoto State
Question(s) Frequency(n:60) Percentage
5. When do you use goggle or
facemasks?
a. None 4 1.6
b. Sometimes 36 30.0
c. Frequently 6 5.0
d. Always 16 13.3
6. When do you use protective foot
wears?
a. None 4 3.3
b. Sometimes 22 18.3
c. Frequently 16 13.3
d. Always 16 13.3
7. When do you wash your hands?
a. None
b. Sometimes 0 0.0
c. Frequently 10 8.3
d. Always 32 15.0
57 26.7
When do you use protective labsuits?
a. None

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b. Sometimes 6 5.0
c. Frequently 34 28.3
d. Always 4 3.3
20 16.7
8. Have you ever been vaccinated
against microbes which could arise from
waste?
a. None 14 4.2
b. Sometimes 6 5.0
c. Frequently 2 1.6
d. Always 8 6.7
9. When do you receive training on
waste management?
a. None 10 8.3
b. Sometimes 10 8.3
c. Frequently 4 3.3
d. Always 4 3.3

Biomedical waste management

Table 3: Biomedical Waste Management Among Primary Healthcare Workers In Gwadabawa Local
Government Of Sokoto State
Items Frequency Percentage
10. Is there sorting/segregation of waste into its types
in different containers?
None 4 3.3
sometimes 12 10.0
frequently 20 16.7
Always 0 0.0
11. How many segregation boxes are there?
3 10.0
4 12 11.7
14
12. Name the purposes of the boxes
To prevent widespread of germs 14 11.7
Safety box 16 15.0
General waste disposal 2 1.6

13. Is there an arrangement for storage in the facility

apart from the initial collection place?
None
sometimes 2 1.6
frequently 8 6.7
Always 24 20.0
0 0.0
14. Describe the nature of the storage place
Incineration
Open dumping 20 16.7
Well-equipped and maintained 8 6.7
Dig-trench 4 3.3
2 1.6
15. Name the type of treatment of waste
Incineration 14 11.7
Chemical 8 6.7
disinfection 14 11.7
Autoclaving 4 1.6

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16. Select the biomedical waste constraint in your

facility
Absence of plans 24 20.0
Poor/ lack of waste segregation facility 20 16.7
Lack of personal protective equipment 16 13.3
Absence of post exposure drugs 12 10.0
Absence of pre-exposure drugs 20 16.7
Indiscriminate dumping of waste 12 10.0
Poor hygiene in collection, storage, transportation, and
treatment 20 16.7
Lack of monitoring and evaluation 12 10.0
Lack of training ` 12 10.0
12 10.0
12 10.0

3.2 DISCUSSION
Health facility is a source of hazardous waste. 80% of the waste in healthcare facilities is general waste,
whereas the remaining 20% is hazardous. This necessitates proper design and policies to curtail spread of
infection or hazardous to the public (Ngwuluka et al., 2009). Large and small healthcare facilities like, rural
health posts, immunization posts, clinics, provides useful services to the individuals and communities. They are
front line of defense against epidemics such as malaria, HIV, cholera etc. In Africa, there is little or management
of healthcare waste. Commonly, it is dispose off along with general waste (with little or no treatment), in dug
pits or buried .In some places it is incinerated (sometimes improperly), some are dumped in sanitary outlets such
as sewage system, latrine or septic tank. Thus, the waste from the facilities can pose great harm to the public.
Biomedical wastes are generated during the diagnosis, treatment, or immunization of humans or in research
activities pertaining to testing of biological sample. Although all individuals exposed to hazardous health care
waste are potentially at risk, the principal group at risk includes health care providers, waste handlers, patients,
visitors to healthcare facilities, workers in support service including laundry, and scavengers. Hazards from
infectious waste and sharps may spread Human immunodeficiency virus (HIV), hepatitis B and C virus, and
other blood-borne pathogens. WHO estimated that each year there are about 8 to 16 million new cases of
hepatitis B Virus(HBV), 2.3 to 4.7 million cases of hepatitis C Virus(HCV) and 80,000 to 160,000 cases of HIV
due to unsafe injection and mostly due to poor healthcare waste management system. Lassa fever and Ebola
virus, endemic in West Africa, have also joined the league of blood borne pathogens. Health facilities in Nigeria
have become source of dissemination of disease-causing materials, through the enormous quantities of
improperly managed health care wastes being generated in the course of providing health services. A study
carried out in Jos, Nigeria showed that waste handling practice fell below waste management practices
prescribed by WHO and other regulatory authorities as wastes were not segregated and were in appropriately
disposed. Proper waste handling helps to ensure appropriate hospital hygiene and safety of healthcare waste
handlers, healthcare providers and communities at large. The best practice is to segregate at source into color
coded containers for proper disposal as the waste poses high risk to the group. All categories of health workers
are exposed to the hazards of biomedical waste however, the level of exposure varies from one category of
health workers to another and from one health facility to another within the same country. Of these categories,
the waste handlers are the least educated as such their knowledge and risk perception of biomedical waste
varies and such may affect their ability to use personal protective equipment as at when necessary (Kaoje et
al., 2018). Table 2 displays the use of personal protection among healthcare workers in the course of waste
management in Gwadabawa local government, Sokoto state. Most of the participants (30.0%) submitted that
they wear protective glasses sometimes, then always (13.3%), very few (1.6%). 18.3% uses protective foot
wears sometimes, 13.3% frequently, and 3.3% of the respondents do not used protective foot wears. Most of
them 26.7 always wash their hands, 15.0 wash hands frequently, and 8.3 wash their hands sometimes. 28.3%
wear labsuit sometimes and 16.0% wear labsuits always. (Kaoje et al., 2018) reports the use of Personal
Protective equipment by all respondents in a study in the Sokoto Hospital. This is in contrary to the findings in
this study. On the question “Have you ever been vaccinated against microbes which could arise from waste?”
Only 6.7 submitted that they are always vaccinated. When asked “When do you receive training on waste
management?” only 3.3 % received training always.
Biomedical waste management among primary healthcare workers in Gwadabawa local government of

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Sokoto state was shown in table 3. In terms of sorting or segregation of waste, 16.7% said they practiced it
always, 10.0% practiced it sometimes. 3.3% said they never practice sorting.10.0% have 3 boxes, and 11.7%
have 4 boxes for waste segregation. 20.0% of the respondents said always there is storage after collection, while
1.6% said there is none. The waste storage place are incineration (16.7%) open dumping (6.7%), dig trench
(1.6%), and well-equipped and maintained (3.3%). Types of waste treatment reported are: incineration (11.7%),
disinfection (11.7%), chemical (6.7%), and autoclaving (3.3%). The challenges or constraints as experienced by
respondents are: absence of plans(20.0%), lack of monitoring and evaluation (20.0%), poor hygiene in
collection, storage, transportation, and treatment (16.7%),poor/lack of waste segregation facility(16.7%), lack of
personal protective equipment (13.3%), lack of training (10.0%), lack of post-exposure drugs (10.0%).
This study explored the practices of personal protection use during waste management in Gwadabawa. It
reveals that respondents uses labcoat, glasses, protective footwear in some proportions. The practice responses
are not up to 50%, hence much need to be done. The finding is similar to that of Abah and Ohimain, 2011) and
Oyekale and Oyekale (2017). A similar study from Sudan reported inefficient management of healthcare waste
(Hassan et al., 2018). The trend of responses might be due to poor understanding of biomedical waste treatment
in healthcare by the staff, which is attributed to poor training. Proper training will eventually lead to positive
attitudes and practices (Abah and Ohimain, 2011). Hand washing reduces the incidence of diarrheal diseases by
more than 40% .Water contaminated with stool can pose greater risk to health and spread diseases like ,acute
water diarrhea, cholera, typhoid, bacillary and amoebic dysentery ,poliomyelitis, and so on. It then must be
treated and protected against sources of contamination. Environmental hygiene is also required (Ngwuluka et
al., 2009).
In the table 2, the respondents have revealed that, only few of them received training always. Lack of training
of staff on healthcare waste management is widespread phenomenon in the resources-limited countries like
Nigeria as reported by studies such as Oyekale and Oyekale (2017). Government ministries in health, and
environment agencies and relations should provide more training to healthcare staff that are directly involved in
medical waste management and should disseminate information, which helps the workers to understand the
issue and carry their work properly in accordance with laws and regulations (Abdullahi et al., 2017; Akkajit et
al., 2020).
Table 3 shows management of biomedical waste in the study area. There are segregation and sorting of waste
in some cases, but the proportions are not much. 3 or 4 boxes are used for safety box, general waste or to
prevent the spread of microbes. Similarly, in few facilities there is storage of waste after collection. These
portray an inappropriate or inefficient waste handling in most of the cases in the area of the study. This finding
is similar to past studies Abdullahi et al., (2017); Oyekale, A.S., and Oyekale, T.O. (2017); Abah(2020). The
treatments of methods in order of decreasing frequency are incineration, chemical, disinfection, and autoclaving.
Incineration/burning of plastics or waste lead to release of hazardous substances. Hazardous air pollutants are
pollutants suspected to cause cancer, reproductive and birth defects, or other serious adverse human and
environmental effects. Plastic production results in the release of many of those substances. 60 % of all plastic
ever produced had been discarded. Of that waste, 60 % entered the environment, 12 % was incinerated, and only
9 % was recovered for recycling. The incineration/burning of waste turn one form of waste into other forms of
waste, including toxic emissions and toxic ash. Emissions from waste incineration include metals (mercury,
lead, and cadmium, etc), organic compounds (dioxins like polychlorinated dibenzo-p-dioxins, PCDD) and
furans, PAHs, VOCs, and other POPs, including polychlorinated dibenzofurans (PCDF), PCBs, and
hexachlorobenzene (HCB), acid gases (such as SO2 and HCl), particulates (dust and grit), nitrogen oxides,
carbon monoxide, and carbon dioxide (CO2). Smoke and particulates emitted can spur respiratory health
problems, particularly among children, the elderly, people with asthma, and those with chronic heart or lung
disease, while PCDF and PCBs are known carcinogens and emitted metals are known neurotoxics. The toxins
from emissions, fly ash, and bottom ash travel long distances and deposit in the environment, ultimately entering
human bodies after being accumulated in the tissues of plants and animals. The air around us contains
microplastics. Exposure to low levels of airborne microplastics is usual outdoors and higher levels are found
indoors due to more immediate sources of microplastics, such as carpets and furniture textiles, and the lack of
wind and other dispersal mechanisms. Indoor air exposure is more significant because people spend
predominant of their time indoors. The airborne plastic particles accumulate on the skin, food, resulting in
dermal and gastrointestinal exposure. Studies postulate that a person’s lungs could be exposed to 26–130
airborne microplastics per day. Other sources of airborne plastic include plastic and films used in agricultural
processes that have degraded, fibers released from clothing dryers, plastics from wears of tires, and sea salt
aerosol. Airborne plastic can also be dispersed on global air currents. Once inhaled, most fibers are likely to get
trapped by the lung lining fluid. Particles >1μm passing through the upper airway, where the lung lining is thick,
can bypass the lung lining allowing for uptake across the bronchial epithelium. The thinner plastics may

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penetrate the thinner lung lining fluid and contact the epithelium, then translocate throughout the body
(Sarkingobir et al., 2021). In table 3, the biomedical waste constraint in health facilities are: Absence of plan,
Poor/ lack of waste segregation facility, Poor hygiene in collection, storage, transportation, and treatment,
Absence of pre-exposure drugs, Lack of personal protective equipment, Lack of monitoring and evaluation,
Indiscriminate dumping of waste, Absence of post exposure drugs.

CONCLUSION
The workers are not fully practicing personal protective measures. There is also lack of adequate training of
workers on biomedical waste in healthcare in Gwadabawa.

RECOMMENDATIONS
Based on the findings of this study the following recommendations can be stated:
 The government and related agencies should provide all the necessary tools, equipments, and
personal protective equipments required for effective biomedical waste treatment in various
healthcare agencies in the state.
 There should be proper, routine training and mobilization/ sensitization of healthcare workers on
effective and efficient biomedical waste treatment in various healthcare agencies in the state.

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