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FACTORS AFFECTING MEDICAL WASTE MANAGEMENT AMONG HEALTH

WORKERS AT MSAMBWENI COUNTY REFFERAL HOSPITAL, KWALE COUNTY.

BY

KIBET FAITH JEPCHIRCHIR

D/UPHRIFT/20011/626

THE RESEARCH DISSERTATION SUBMITTED TO KENYA MEDICAL TRAINING

COLLEGE IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF THE AWARD
OF DIPLOMA INHEALTH RECORDS AND INFORMATION TECHNOLOGY.

FEBRUARY 2022

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DECLARATION
This dissertation is my original work and has never been presented for award of diploma in any
other institution.

Signature……………………

Date…………………………

Kibet Faith Jepchirchir

D/UPHRIFT/20011/626

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SUPERVISOR’S APPROVAL
This dissertation has been submitted for review with approval from college supervisors.

INTERNAL SUPERVISOR

SIGNATURE…………………………….

DATE………………….

NAME: MS BEVERLYN OKIRU BSc.-HRIM

Department of health records –KMTC, Msambweni campus.

EXTERNAL SUPERVISOR

SIGNATURE……………………

DATE………………………….

NAME: MS GLADYS JEPKORIR. BSc-CM

Pediatrics department Lungalunga sub-county hospital.

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DEDICATION
This study is dedicated to my beloved parents, my sibling Rose and my fiancé Emmanuel for
their support, love and encouragement during this study. May God bless you all?

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ACKNOWLEDGEMENT
My sincere gratitude goes to Almighty God who sustained me in good health and enabled me to
accomplish this research study. My appreciation goes to my subject lecturer Mr. Kenneth murik
and my supervisor Madam Beverlyn Okiru for their endless advice and encouragement during
preparation of this proposal. Am very grateful to our lecturers Msambweni K.M.T.C for their
administrative support. I remain solely grateful to all the above and others who supported me and
contributed to my writing in completion of my research study, I thank you so much.

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TABLE OF CONTENTS
DECLARATION ........................................................................................................................................ ii
SUPERVISOR’S APPROVAL...................................................................................................................iii
DEDICATION ............................................................................................................................................iv
ACKNOWLEDGEMENT .......................................................................................................................... v
LIST OF TABLES ...................................................................................................................................... ix
LIST OF FIGURES .....................................................................................................................................x
ABBREVIATION AND ACRONYMS ...................................................................................................... xi
DEFINITION OF TERMS ........................................................................................................................ xii
ABSTRACT ............................................................................................................................................. xiii
CHAPTER ONE: BACKGROUND OF THE STUDY .............................................................................. 1
1.1: INTRODUCTION ......................................................................................................................... 1
1.2 PROBLEM STATEMENT ............................................................................................................ 3
1.3 JUSTIFICATION ........................................................................................................................... 4
1.4 RESEARCH QUESTION .............................................................................................................. 5
1.5 OBJECTIVES ................................................................................................................................. 5
1.5.1 BROAD OBJECTIVES ........................................................................................................... 5
1.5.2 SPECIFIC OBJECTIVES ....................................................................................................... 5
1.6 SCOPE AND LIMITATION.......................................................................................................... 5
2.0 INTRODUCTION........................................................................................................................... 6
2.1. KNOWLEDGE .............................................................................................................................. 6
2.1.1 Awareness ................................................................................................................................. 6
2.1.2practices ..................................................................................................................................... 7
2.2. ENVIRONMENTAL FACTORS ................................................................................................. 7
2.2.1. Disposal methods of medical waste. ....................................................................................... 8
2.2.2 Transportation of medical waste ............................................................................................. 9
3.3. HOSPITAL FACTORS ................................................................................................................. 9
3.3.1 Policy ......................................................................................................................................... 9
3.3.2 Waste Resources ..................................................................................................................... 10
CHAPTER THREE: RESEARCH METHODOLOGY ............................................................................ 11
3.0: INTRODUCTION ....................................................................................................................... 11
3.1 STUDY DESIGN ........................................................................................................................... 11

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3.2 STUDY AREA............................................................................................................................... 11

3.3 STUDY POPULATION................................................................................................................ 11
3.3.1 INCLUSION CRITERIA ...................................................................................................... 11
3.3.2 EXCLUSION CRITERIA ..................................................................................................... 11
3.4 VARIABLES ................................................................................................................................. 12
3.4.1 DEPENDENT VARIABLE ................................................................................................... 12
3.4.2 INDEPENDENT VARIABLES ............................................................................................. 12
3.5 SAMPLING TECHNIQUE .......................................................................................................... 12
3.6 SAMPLE SIZE DETERMINATION .......................................................................................... 12
3.7 DEVELOPMENT OF DATA COLLECTION TOOL/INSTRUMENTS ................................. 13
3.8 DATA COLLECTION PROCESS .............................................................................................. 13
3.9 PRE-TESTING ............................................................................................................................. 13
3.10 VALIDITY .................................................................................................................................. 14
3.11 RELIABILITY ............................................................................................................................ 14
3.12 DATA MANAGEMENT AND ANALYSIS .............................................................................. 14
3.13 ETHICAL CONSIDERATION ................................................................................................. 14
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS............................................................................. 15
4.0 INTRODUCTION......................................................................................................................... 15
4.1SECTION A: SOCIAL DEMOGRAPHIC FACTORS............................................................... 15
4.2 LEVEL OF KNOWLEDGE ON MEDICAL WASTE MANAGEMENT. ............................... 17
4.2.1 Respondents’ response on color coding for medical waste segregation. .................................. 17
4.2.2 Respondents’ response on different categories of medical waste ............................................. 18
4.2.3 Respondents’ response on use of personal protective gear ....................................................... 18
4.2.4 Respondents’ response on attending training on medical waste management .......................... 19
4.3 ENVIRONMENTAL FACTORS ................................................................................................ 20
4.3.1 Respondents’ response on methods disposal ............................................................................ 20
4.3.2 Respondents’ response on location of incinerator .................................................................... 20
4.3.3 Respondents’ response on means of transport of medical waste .............................................. 21
4.3.4 Respondents’ responses on cost of transporting ....................................................................... 22
4.4 HOSPITAL FACTOR ........................................................................................................................ 23
4.4.1 Respondents’ response on budget on medical waste management. .......................................... 23
4.4.2 Respondents’ response on segregation bins ............................................................................. 24

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4.4.3 Respondents’ response on policies and procedures adopted. .................................................... 25

4.4.4 Respondents’ response on review or update of policies ........................................................... 26
CHAPTER FIVE: DISCUSSION AND CONCLUSION ......................................................................... 27
5.0 INTRODUCTION .............................................................................................................................. 27
5.1 DISCUSSION ................................................................................................................................ 27
5.2CONCLUSION .............................................................................................................................. 28
5.3RECOMMENDATION ................................................................................................................. 28
5.4FURTHER RESEARCH ............................................................................................................... 29
REFERENCES ......................................................................................................................................... 30
APPENDIX I: WORK PLAN ................................................................................................................... 32
APPENDIX II. BUDGET ......................................................................................................................... 34
APPENDIX III: letter from NACOSTI ..................................................................................................... 35
APPENDIX IV: Authorization letter ........................................................................................................ 36
APPENDIX V: MAP ................................................................................................................................ 37
APPENDIX VI: QUESTIONNAIRE........................................................................................................ 38

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LIST OF TABLES
Table 4.2 socio demographic data ............................................................................................................ 15
Table 4.3 respondents’ response on use of personal protective gear ......................................................... 18
Table 4.4 respondents’ response on location of incinerators ..................................................................... 20
Table 4.5 respondents response on policies and procedures adopted ........................................................ 25
Table 6 work plan...................................................................................................................................... 32
Table 7 Budget .......................................................................................................................................... 34

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LIST OF FIGURES
Figure 4.1 respondents’ response on color coding for medical waste management ................................ 17
Figure 4.2 respondents’ response awareness of different categories of medical waste .......................... 18
Figure 4.3 respondents’ response on training on medical waste management........................................ 19
Figure 4.4 respondents’ response on methods of disposal of medical waste ........................................... 20
Figure 4.5 respondents’ response on means of transport ........................................................................ 21
Figure 4.6 respondents’ response on cost of transporting medical waste................................................ 22
Figure 4.7 respondents’ response on budget on medical waste management......................................... 23
Figure 4.8 respondents’ response on adequacy on bins ........................................................................... 24
Figure 4.9 respondents’ response on review or updates of policies yearly .............................................. 26
Figure 10 map ........................................................................................................................................... 37

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ABBREVIATION AND ACRONYMS

1. HCW - Health care waste management
2. HCF - Health care facility
3. MWM -Medical waste management
4. WHO – World health organization
5. MOH - Ministry of health
6. HCWM -Health care waste management
7. UNICEF–united Nation International Children’s
8. UNEP – United Nations Environment Programme
9. GOK -Government of Kenya
10. POPs – Persistent organic pollutant
11. SDGs – sustainable development goal
12. HIV - human Immunodeficiency Virus

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DEFINITION OF TERMS
MEDICAL WASTE: This is total waste generated from hospital during service delivery.it can be
produced in Liquid or solid from.

HEALTH WORKERS: This are who delivers care and services to the sick and ailing either
directly as doctors and nurses or indirectly as aides,helpers,laboratory technicians or even medical
waste handlers.

MANAGEMENT: Refers to the generation, minimizing, segregation, collection, transportation,

disposal and monitoring of waste materials.

WASTE: Refers to a substance which the owner want at a given time which has no current
perceived market value.

KNOWLEDGE: is a familiarity, awareness and understanding someone or something as fact,

information description and skill which is acquired through experience through education by
perceiving, discovery and learning.

ENVIRONMENTAL FACTORS: This are external influences that can affect an individual
health and well-being they include exposure to pollution.

HOSPITAL FACTORS: This is health care system which refers to the amount and distribution
of health service facilities or availability of service delivery that support the individual patient.

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ABSTRACT
Medical waste is seen as amounting problem in recent times, there have been press statement of
medical waste being managed in an incorrect manner. Medical waste is poorly managed and has
led to 30% of health workers suffer from needle prick and injuries and other hospital acquired
infections resulting from mismanagement of medical waste, medical waste is considered to be the
second most dangerous waste that health workers need to get knowledge about it and to the hospital
it helps promote high standards of medical waste management. This aims to assess the level of
knowledge among health workers, to identify environmental factors as well as to determine
hospital factors. Using a descriptive cross-sectional study design to carry out the research. The
participant was sampled by use of stratified and simple random sampling technique to get 49 health
workers in which 47 respondents participated in the study. The tool used was questionnaire and
information was obtained by use of Self-administered questionnaires and pretesting was done in
kilifi county referral hospital. Data was cleaned, coded, edited and was presented inform of tables,
charts and graphs and analyze by use of Microsoft excel permission was obtained from the
participant, discussion states that majority 86% of the respondents’ were aware of the medical
waste management, 43% of the respondents’ disagreed that policies are reviewed and updated at
least once a year. This study concluded that majority of health workers were not aware of the
different categories of medical waste segregation, the environment within the facility was not in
good condition, and policies were not adopted by majority of the health workers. This recommends
that, there is need for frequent update and refresher training on medical waste management to all
health workers, the county government of kwale to provide budget to health care facilities so as to
procure enough healthcare waste commodities and the ministry of health need to adopt safe
technologies for treatment and disposal of medical waste to protect the environment.

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CHAPTER ONE: BACKGROUND OF THE STUDY

1.1: INTRODUCTION
Medical waste management or waste disposal is all the activities and action required to manage
waste from the start to its final disposal (WHO, 2017)).This includes among other thing collection,
segregation, treatment, storage, transportation and disposal of waste together with monitoring and
regulation. Poor management of health-care waste exposes health care workers, waste handlers
and the community to infections, toxic effects and injuries. There is also a potential for spreading
drug resistant microorganisms from health care facilities into the environment through poor
HCWM (WHO, 2015).

Globally, every year an estimated 16million infections are administered worldwide but not all of
the needles and syringes are properly disposed afterward. About 85% of the waste produced by
health care providers are non-hazardous and the remaining 15% is considered hazardous
materials is infectious, toxic or radioactive(WHO).assessment found that just over half 58%
sampled facilities from 24 countries had adequate system for safe disposal of HCW
(WHO/UNICEF, 2015). In Asia countries have been using poor incineration technique for a long
period of time (Mastafapoor, 2011). In Kathmandu Nepal, medical waste management is found to
be insufficient because of various factors that result to mixing medical waste with municipalities
waste using low standard incineration leading to persistent organic pollutants(POPs)into the field,
soil and water sources(Menju Karki,2021).

Sub-Sahara Africa, is estimated to have 67,740 health-facilities and produce approximately

282,447 tons of MW every year ( (Udofia et al, 2013)however, the composition of the waste stream
may be higher than the expected 10% to 25% because of poor waste handling practices ( Fadipe
et al., 2011). .medical waste management in Nigeria reports that health-care waste disposal was
carried out by open burning at the facility site without treatment( (Abahand, 2011).

Waste facilities are becoming greater than ever to address the basic health needs of the
community and to achieve the sustainable development goal (SDG), Studies have revealed that
there was no waste segregation in most facilities. But they were treated, stored, transported and
dispose wrongly (Haylamicheal et al, 2011). In Uganda, health workers had poor waste
management methods. 3.4% had acceptable waste disposal methods. Despite the strong national

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legislation and regulation policies which focus on proper HCWM, the practices by many health
workers are still described as unsafe and poor (Mukama et al.,2016).

Kenya there is poor segregation practices taking place up to 50%waste in some medical facilities
are found to be infectious (GOK, 2015)Due to poor segregation of MW in HCFs it has been
mentioned as a major reason for the higher proportion of hazardous waste to non-hazardous waste
(Nkonge et al, 2014)Great challenges are experienced in health care waste management system
that there are grave dangers to health workers on daily basis caused by indiscriminate disposal of
health care waste (GOK, 2015). In Kericho county referral hospital there is a wide scope of people
severed by the facilities leading to generation of different types of medical waste which complicate
the medical waste management chain (Achieng et al, 2019). At Msambweni county referral
hospital experience the problem of health care waste management due to poor segregation of
medical waste and disposal practices thus increasing the risk associated with such poor practices
to the health workers.Therefore,need to determine factors affecting medical waste management
among health workers at Msambweni county referral hospital, Kwale county.

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1.2 PROBLEM STATEMENT

Medical waste management is the activity that requires to be properly managed from its start to
the final disposal (WHO, 2017)Unfortunately, in Kenya medical waste is seen as amounting
problem in recent times, there have been press statement of medical waste being disposed of in an
incorrect manner (Daily nation, 2015). HAIs have been a major contributor to the burden of
morbidity and mortality in Kenya and the actual burden of HAIs has not been accurately
quantified, but it is projected to account for about 10% to 25% of hospital admission in government
HFs and 2.5% of HIV infections in health care workers.32% of hepatitis B cases and 40%of
Hepatitis C cases and multi drug resistance TB pose a great threat to health workers (WHO,
2010)Therefore ,to fulfill this crucial gap this study will determine factors affecting medical waste
management among health workers.

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1.3 JUSTIFICATION
Health care waste is considered second dangerous waste in the world, that needs to be properly
managed (Kumar, 2013). Due to low adherence of health workers on medical waste management
at Msambweni county referral hospital, establishment of policies and regulations on how to handle
medical waste management helped the health workers to get knowledge on medical waste
management and to the hospital it helped promote high standards of health care waste management
in order to reduce the risks of exposure to infections, environmental pollution and improve safety
of health workers. The study therefore, acted a useful material for reference to other researcher
and to serve as a partial fulfillment of the requirements for the award of the Diploma in health
records and information technology.

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1.4 RESEARCH QUESTION

1. What is the level of knowledge of health workers on medical waste management at msambweni
county referral hospital?

2. How is environmental factors affecting medical waste management among health workers at
msambweni county referral hospital?

3. Which are the hospital factors affecting medical waste management among health workers at
msambweni county referral hospital?

1.5 OBJECTIVES
1.5.1 BROAD OBJECTIVES
To determine factors affecting medical waste management among health workers at msambweni
county referral hospital

1.5.2 SPECIFIC OBJECTIVES

1. To assess the knowledge of health workers on medical waste management at msambweni county
referral hospital

2. To identify the environmental factors affecting medical waste management among health
workers at msambweni county referral hospital

3. To determine the hospital factors affecting medical waste management among health workers
at msambweni county referral hospital

1.6 SCOPE AND LIMITATION

This study was focusing on generation, segregation, treatment, storage, transportation and disposal
of medical waste at Msambweni county referral hospital for a period of one month, Because of the
busy nature of health workers in health care facility some questions were not answered.

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CHAPTER TWO: LITERATURE REVIEW

2.0 INTRODUCTION
This chapter reviews the reports and views of different researchers about factors affecting medical
waste management.

2.1. KNOWLEDGE
Knowledge about the segregation of medical waste has been reported poor among the health
workers ( (Kumar, 2013)and thus poor knowledge among health workers regarding the waste
management has been associated risk and is known to be highly contributing reasons to poor
(Gulis.G. et al,, 2010)Inadequate knowledge of handling of HCW can have serious health
consequences and a significance impact on the environment (Vishal,et al.,2012)

2.1.1 Awareness
Factors associated with improper segregation includes inadequate awareness, poor healthcare
waste practice and inadequate management by facility leadership (Kumar et al, 2013). Proper
training is therefore, needed for to improve the knowledge of the health workers who are handling
the waste in routine ( (Shaikh BT et al, 2013)Training aims at highlighting the role and
responsibilities of health workers in the overall management, programme especially the waste
handlers ,therefore training needs of health workers were established( (S.V. Manyele et al,,
2012)Training of health workers on implementing the policy is thus critical if a waste management
programme to be successful. The overall aim of training is to develop awareness of the health
safety and environmental issue relating to health care waste and those can affect health workers in
their daily work ( (Shaikh BT et al, 2013)Minimal training for MWM operators should include
information on the risk associated with the handling of medical waste, procedures for dealing with
spillage and other accident and instructions on the use of PPEs, training needs will depend on the
type of operation and technology involved (Visha B. et al,, 2015).In hospitals that stated that there
waste handlers were trained ,it has been found that training did not impact on their knowledge
although the quality of this training is unclear( (Hakim et al, 2014).WHO reports indicates that the
level of infectious waste generated is higher in developing countries this can be attributed to a lack
of awareness by HCWs concerning correct definition for infectious medical waste, as well as a
poor understand of waste regulation standards, especially concerning proper segregation
(M.Askarian et al,2010).

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Awareness regarding medical waste management has been reported in several studies as being a
major contributor to poor handling practices (Aksakal et al., 2011).Health workers awareness
about proper infectious waste disposal in Cameroon as also been reported to be below standards
al., (Gulis.G. et al,, 2010)Growing awareness of health and environmental hazards has greatly
increased public demand for information and guidance on these issues. Health workers awareness
on the disease that can be transmitted through handling medical waste is a critical factor in
minimizing infection transmission. Demand has intensified as the prevalence of HIV/AIDS and
viral hepatitis B has risen among health workers ( (ozdarA., 2013)).The awareness of medical
waste management among health care workers is often limited with inadequate sensitization and
lack of improper implementation of the existing national guidelines ( (Z.letho, 2021)

2.1.2practices
Poor handling practices during waste generation, treatment, separation, storage, transportation and
disposal can bring about environmental and increase the risk of contracting infectious diseases.
Many individual in the management level in health care facilities abdicate the role of management
of health care waste to the poorly educated and lowest category of workers who are either not
trained (WHO, 2010)Studies also suggested that the practices of health workers are not up to the
standards which lead to major threats of environmental pollution segregation is the main step by
workers one possible reason is lack of training (R. paudel et al,, 2010)Medical waste management
has been entrusted with waste segregation at the source off generation into labelled color coded
container bins that have been assigned for the different categories of waste. All health workers
need to have exemplary professional practices I n this regard(OSHA,2012).Hazardous and non-
hazardous medical waste increases costs substantially if mixed and not segregated prior to disposal
grading MWM worldwide issue .A study conducted in UK revealed that all of the health workers
that were careless in the practice of segregation were either in the group of 16-20 or 20-30(
(pudussery, 2011)recycling is also problematic ,first safety recycling workers remain a challenge
since they must be fully protect during their worker as waste may be contaminated with
virus(Brunell,2020).

2.2. ENVIRONMENTAL FACTORS

This are factors that can affect health through physical exposures such as air pollution, this factors
make up the physical and natural environment which are external to the individual and can have

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a positive or negative influence on a person’s participation on performance of activities or on a

person’s body function.

2.2.1. Disposal methods of medical waste.

Incinerators has been reported as the most common treatment technology available for medical
waste ( (caniato et al,, 2015). However incinerators are increasingly becoming an unpopular option
for both treatment and disposal of waste due to environmental concern( wilburn,2012) studies in
Africa indicates the continent is not positioned to tackle the quantity of hazardous waste it
produces, much of the waste is dumped without treatment in open and poorly functioning
incinerators (fobil et al,, 2015).Over the years, the environment has become a public concern due
to pollution related illnesses many health workers have suffered chronic illnesses related to long
term low concentrations of harmful substances. Others have suffered from illness related to short-
term high concentration of harmful chemicals or substances and personnel in the presence of waste
that causes harmful by-product will always be at risk (Giusti, 2014)although proper disposal of
health care waste reduces risks, indirect health risks may occur through the release of toxic
pollutants into the environment through treatment or disposal. For instant, landfills can
contaminate drinking water if they are not properly constructed, occupational risk exist at disposal
facilities that are not well designed run or maintained. Regular disposal of pharmaceutical waste
into “general waste” has allowed stream of different medicines to enter landfill and aquatic
environment. This has affected the quality of the surrounding land and water accessed by the
resident (lexchin et al, 2018)medical waste can be infectious to both people and the environment
causing high contamination and cross contamination risks based on the references of WHO and
other guidelines medical waste must be treated near to its source of its generation. This needs
responsibility from every employee working in the hospital who is involved in the segregation
process. Suitable location and equipped waste disposal facilities can reduces the necessary
transportation of hazardous materials. There is high risk considering of medical waste such as
inappropriate disposal ( (Vilvalert et al, 2015)In developing countries, HCWM has not gained
much momentum and healthcare waste is frequently disposed along with domestic waste (Moreira
AMM et al,, 2013)when health care waste is placed in landfills or buried contamination of ground
water may occur, which may result in the spread pathogen, presence in waste and can also enter
and remain in the air for long period (Cheng YW et al,, 2011)).

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2.2.2 Transportation of medical waste

Collection and transportation of medical waste to treatment centers is a critical operational problem
that local authorities face in all cities (WHO,2015).medical waste collection problem can be
viewed as a routing problem which determines minimum cost routes on a network, medical waste
risk that is a function of the load of hazardous waste being carried by the vehicle along with storage
risk for hazardous waste at hospital( nulz et al,2014)medical waste management system should
ensure a safe and environmentally sound collection and transportation of medical waste. Waste
collection includes proper segregation, methods of collection, temporary storage condition and the
condition of internal transportation is very important art of the collection stage is to preserve the
waste hierarchy in particular to prevent waste generation (Emmanuel et al., 2014).data on the cost
associated with managing HCW are limited, primarily owing to commercial sensitivity however
(windfield et al, 2015) reported a rate of $US741 in USA also (kocasoy et al,2010) note that the
collection and transportation of the waste can constitute around 80%-95% of expenditure. The
legislation explicitly includes the safeguarding of the environment and the reduction of
wastefulness as essential recommendation that operates should follow. Indeed there is a focus on
ensuring that the most efficient and cost-effective waste treatment should be chosen (Testa et al,
2012).

3.3. HOSPITAL FACTORS

3.3.1 Policy
Healthcare facility should have a waste management policy and a waste plan, it is the responsibility
of health information management and public health professionals to plan health information
system, develop health policies, and identify current and future information needs (stacy, 2012)
.Despite the policy guidelines on injection and health care waste management developed by MOH
there is sufficient evidence that HCWs in Kenya facilities is not properly handled (MOH, 2010).
It is reported that lack of comprehensive guidelines and legislation of healthcare waste
management adversely affect knowledge and awareness among health workers regarding health
hazards of infectious waste and their impact on the environments where guideline exists such as
south Africa studies indicate that they may not be fully adhered to (DEA, 2012)developed
countries have developed formulated policies which are easily enforced as a result of access to
sufficient resources( (Todor, 2016)and in developing countries on the other hand, lack greatly in
the ability to implement such policies owing to resources constrains (Kerdsuwan et al,

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2015)challenges of covid -19 pandemic and solutions waste management compliance in health
care facilities are the hospital level showed that the level of waste management compliance among
health workers was 43% (powell-jackson et al,, 2020).Many countries still do not have the proper
rules on medical waste management and if they have they do not actually put them into practices
(YY Babanyara, 2013)

3.3.2 Waste Resources

Waste segregation in some observed facilities in the country which has embraced segregation
practices using color-coded bins, use of color coded waste containers is lower in the facilities, the
packaging involved putting waste color code waste bags, with most waste being kept at waste
holding storage area without being sealed the practice in Kenya is that most waste loaded onto
waste transportation facilities without being tied or covered. Labelling of waste bags is a
recommended practice to ensure each waste category is easily identified and waste load can be
traced back to their point of generation the current practice. In Kenya health facilities is that
labelling is rarely done (WHO,2016).It was reported that insufficient adequacy of waste handling
(TJ.Lyasenga, 2010) the budgetary constraints in the developing countries may negatively
influence the availability of resources for medical waste management (atringer, 2011). Obtaining
resources to purchase bins, bin-liner founds for personnel deployment and maintenance of
treatment equipment has been difficult to obtain most facilities (HCWM plan, 2020).

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CHAPTER THREE: RESEARCH METHODOLOGY

3.0: INTRODUCTION
This chapter seeks to explain how the research was conducted and the procedures and the process
that was used to achieve the purpose of the study. It was to outline the study design, study area,
study population,variables,sampling technique, sample size determination, data collection
procedures, data analysis,reliability,validity,pre-testing and ethical consideration.

3.1 STUDY DESIGN

The study adopted descriptive cross-sectional study design. This design was to determine factors
affecting medical waste management among health workers at msambweni county referral
hospital.it is considered to be appropriate since it measures or estimate the variables attribute of
the target population at a particular point in time.

3.2 STUDY AREA

The study was conducted at Msambweni county referral hospital. . It is located at Kwale county,
Msambweni sub-county county, vingujini location and mwaembe sub-location. It’s at Ukunda-
Ramisi 2km off road and 300m from the Indian Ocean .It is a level 5 government health facility
that offers 24hrs medical care services. It has a bed capacity of 155 with 214 health workers and
serves a population coverage of 800000 people.

3.3 STUDY POPULATION

The study was targeting 214 health workers working at Msambweni county referral hospital.

3.3.1 INCLUSION CRITERIA

The study included all the health workers at Msambweni county referral hospital who must have
worked for more than six months at the facility.

3.3.2 EXCLUSION CRITERIA

The study excluded health workers at Msambweni county referral hospital who were busy during
the study hours, those who were working during night hours at the time of the study and those who
were not be willing to participate in the study.

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3.4 VARIABLES
3.4.1 DEPENDENT VARIABLE
This is used to measure or describe the problem under the study and it is the Medical waste
management.

3.4.2 INDEPENDENT VARIABLES

This is used to measure the factors that are assumed to influence the study; Knowledge,
Environmental factors, Hospital factors.

3.5 SAMPLING TECHNIQUE

The study was to adopt stratified sampling technique and simple random sampling technique,
where stratified sampling technique is where health workers are divided into stratas according to
their department i.e. pharmacy department, Nursing department and in every stratum the study
will use simple random sampling to select the respondent from the target population.

3.6 SAMPLE SIZE DETERMINATION

The sample size was calculated using Mugenda and Mugenda 2003. The formula was used because
it explains a simplified way of calculating sample size for a population less than 10,000.

nf =n /(1+n/N)

Where

Where;

nf=desired sample size when the population is less than 10,000

n=working sample size 30% of target population 214

30/100*214=64

1 = constant

N=target population

nf= n/(1+n/N)

nf= 64/ (1+64/214)

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nf= 49 respondents

=sample size*strata size/population size

Table 3.1 stratas

DEPARMENTS STRATA SIZE POPULATION SIZE

Nursing 115 26
Medical officer 17 4
Lab technician 12 3
Pharmacy 10 2
Clinical medicine 44 10
Health record 7 2
Radiology 4 1
physiotherapy 5 1
totals 214 49

3.7 DEVELOPMENT OF DATA COLLECTION TOOL/INSTRUMENTS

This study used questionnaire which included open and closed ended questions. The open ended
questions allows the respondent to answer in own words on the other hand, closed ended questions
initiates specific responses to facilitate easy analysis of the data.

3.8 DATA COLLECTION PROCESS

This is a way of gathering information for research purpose. Data was collected using self –
administered questionnaires, as it was to serve as the most appropriate tool since the respondents
are literate. The researcher seek consent from the respondent and carry out the data collection.

3.9 PRE-TESTING
The questionnaires was administered at kilifi county referral hospital to health workers which was
10% of the sample size. The respondents was selected to check for validity and to ensure
reliability of the questionnaire.

13
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3.10 VALIDITY
The validation of instrument was done by research supervisor to ensure content and the format of
the questionnaire is consistence to the objectives of the study.

3.11 RELIABILITY
The researcher ensured reliability by asking the same questions twice in different format to clarify
previous answers given by the respondent and if the information given is true.

3.12 DATA MANAGEMENT AND ANALYSIS

Data was cleaned, coded, checks on accuracy and completeness. The analysis was done using
Microsoft Excel because it organizes data in a summarized way that can easily be understood and
presented in form of charts, tables and graphs.

3.13 ETHICAL CONSIDERATION

The research permit was obtained from National Commission for Sciences, Technology and
Innovation (NACOSTI) Ethical clearance was granted by KMTC Msambweni campus from the
Principal through the HOD of HRI department. Researcher also seek permission from the hospital
management of Msambweni county referral hospital. The researcher obtained consent from the
respondent before administering the questionnaire and assure them information was confidential
and only for academic purpose.

14
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CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.0 INTRODUCTION
This contains data analysis and presentation of the data collected and presented by use of tables and charts
with brief explanation. A total of 47 respondent participated in the study there response were collected and
presented as seen below.

4.1SECTION A: SOCIAL DEMOGRAPHIC FACTORS.

The table below shows that majority of the respondents were female 28(57%) while male were 19(39%).
majority of the respondents 16(33%) were of age 36-45, 15(31%) were of age 46above, while 11(22%)
were of age 25-35 and the least 5(10%) were of age 18-25. According to their occupation majority 24(49%)
were nurses, nearly a quarter of the respondents were 10(21%) were clinical officers,4(8%) medical
officers, pharmacist and lab technician were both 2(4%),lastly ,health records officers2(4%),radiologist
1(2%),physiotherapist1(2%),.respondents response cording to working experience majority 23(47%) had
5years above, nearly 20(41%) had 1-5 years, minority 4(8%) Had experience between 6months -1 year.
About working hours about 28(57%) were working for 6-8 hours, 13(27%) working for 8-12 hours, the
least 6(12%) working for 4-6hours.

Table 4.1 socio demographic data

INDICATOR FREQUENCY PERCENTAGE

GENDER;
Male 19 39%
Female 28 57%
Total 47 96%
AGE;
18-25 5 10%
25-35 11 22%
36-45 16 33%
46 and above 15 31%
Totals 47 96%
OCCUPATION;
Pharmacist 2 4%
Nurses 24 49%
Clinical officers 10 21%
Medical officers 4 8%
Laboratory 3 6%
technicians 2 4%
Health records 1 2%
officers 1 2%
Radiologist
Physiotherapist

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-

Totals 47 96%
WORKING
EXPERIENCE;
6 Months to 1 year 4 8%
1-5 years 20 41%
5 years and above 23 47%

Totals 47 96%

WORKING
HOURS; 6 12%
4-6 hours 28 57%
6-8 hours 13 27%
8-12 hours
Totals 47 96%

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-

4.2 LEVEL OF KNOWLEDGE ON MEDICAL WASTE MANAGEMENT.

4.2.1 Respondents’ response on color coding for medical waste segregation.
The researcher intension was to find out how color coding for medical waste management affect
knowledge of health workers on medical waste management. The table below shows that
majority of the respondents’42(86%) knew the color coding for medical waste segregation while
5 (10%) responded that they don’t know of color coding for medical waste segregation.

n =47

colour coding for medical waste

10%

86%

yes no

Figure 4.1 respondents’ response on color coding for medical waste management

17
-

4.2.2 Respondents’ response on different categories of medical waste

The researcher intended to know how awareness of the different categories if medical waste
generated at the facility affect medical waste management among health workers. Majority
26(53%) of the respondents were aware of the different categories of medical waste while 21(43%)
were not aware of different categories of medical waste.

n = 47

awareness of different categories of MW

60%
53%
50%
43%
40%

30%

20%

10%

0%
YES NO

Figure 4.2 respondents’ response awareness of different categories of medical waste

4.2.3 Respondents’ response on use of personal protective gear

The researcher intension was to know how knowledge on the use of personal protective gears when
handling medical waste affects medical waste management. The table below shows that majority
25(51%) used gloves, nearly 15(31%) used wore overall while the least 7(14%) used bear hands
to hand medical waste.

n =47

Table 4.2 respondents’ response on use of personal protective gear

Personal protective gear frequency percentage

Gloves 25 51%
Overall 15 31%
Bear hand 7 14%
total 47 96%

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-

4.2.4 Respondents’ response on attending training on medical waste management

Researcher intension was to know how training affects knowledge of health on factors affecting
medical waste management. The figure below shows that 28(57%) of the respondents have ever
attended training on medical waste management whereas 19(39%) of the respondents have never
attended any training.

n=47

training on medical waste management

39%

57%

YES NO

Figure 4.3 respondents’ response on training on medical waste management.

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-

4.3 ENVIRONMENTAL FACTORS

4.3.1 Respondents’ response on methods disposal
The researcher intension was to know how methods used to dispose medical waste affects the
environment at the facility. The figure below shows Majority 23(47%) of the respondents’ said
that incinerators, 16(33%) said they use autoclaving and the least 8(16%) said they use chemicals.

n =47

methods for disposal of medical waste

50% 47%
45%
40%
35% 33%
30%
25%
20% 16%
15%
10%
5%
0%
incinerators autoclaving chemicals

Figure 4.4 respondents’ response on methods of disposal of medical waste

4.3.2 Respondents’ response on location of incinerator

The researchers’ intension was on location of incinerator on how it affects the environment. The
figure below shows that majority 28(69%) of the respondents’ said that it’s located far from the
facility compound whereas11 (27%) of the respondents said that incinerator is within the facility.

n=39

Table 4.3 respondents’ response on location of incinerators

Location of incinerator frequency percentage

Far from the hospital 11 27%
Within the hospital 28 69%
totals 39 96%

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-

4.3.3 Respondents’ response on means of transport of medical waste

The researcher wanted to know how transportation of medical waste affects the environment.
Majority 26(53%) said they use trolleys while 11(23%) use vehicle and the least 10(20%) use
wheelbarrow to transport medical waste.

n= 47

means of transport

20%

trolleys
vehicle
53% wheelbarrows
23%

Figure 4.5 respondents’ response on means of transport

21
-

4.3.4 Respondents’ responses on cost of transporting

This research intended to know how transportation of medical waste management affects cost.
.majority of the respondents’ 26(54%) disagree where 21(42%) agree that cost of transport affects
medical waste management.

n =47

cost of transporting medical waste

60%
54%

50%
42%
40%

30%

20%

10%

0%
disagree agree

Figure 4.6 respondents’ response on cost of transporting medical waste

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4.4 HOSPITAL FACTOR

4.4.1 Respondents’ response on budget on medical waste management.
The researcher intended to know how hospital budget affects medical waste management. Majority
24(49%) agree, nearly 14(29%) disagreed and the least 9(18%) strongly agree that there is budget
for healthcare waste management.

n =47

budget on medical waste management

60%

49%
50%

40%

29%
30%

20% 18%

10%

0%
agree disagree strongly agree

Figure 4.7 respondents’ response on budget on medical waste management

23
-

4.4.2 Respondents’ response on segregation bins

Researchers’ intension was to know how waste resources affects medical waste management. Half
of the respondents’ 25(51%) disagree that segregation bins were adequate, whereas 21(43%)
agreed that bins are adequate and lastly 1(2%) strongly agree that segregation bins were adequate.

n=47

adequacy on bins

2%

43%
51%

disagree agree strongly agree

Figure 4.8 respondents’ response on adequacy on bins

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-

4.4.3 Respondents’ response on policies and procedures adopted.

The intention was to know if there is medical waste policies and procedures adopted. The figure
table below shows majority 23(47%) agree, nearly 21(43%) disagreed, minority 3(6%) strongly
agree that there is medical waste policies and procedures adopted.

n=47

Table 4.4 respondents response on policies and procedures adopted

Policies and procedures adopted frequency percentage

Agree 23 47%
Strongly agree 3 6%
Disagree 21 43%
totals 47 96%

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-

4.4.4 Respondents’ response on review or update of policies

The study sought to find out how review or updates of policies affects medical waste management.
Majority of the respondents’ 15(31%) agree that medical waste management policies are reviewed
or updated at least once a year about 21(43%) disagree that policies are reviewed or updated, lastly
11(22%) strongly disagree medical waste policies were reviewed at least once a year.

n =47

review or update of policies yearly

50%

45%

40%

35%

30%

25%

20%

15%

10%

5%

0%
agree disagree strongly disagree

Figure 4.9 respondents’ response on review or updates of policies yearly

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CHAPTER FIVE: DISCUSSION AND CONCLUSION

5.0 INTRODUCTION
This chapter discusses the results and the interpretation of the study in comparison to previous
study findings as discussed by the research scholars. Discussion brings out clarity on the issues as
the objectives of the study and question. Besides the conclusion allows the researcher to make a
final say on the study outcomes based on the evidence of the study.

5.1 DISCUSSION
Knowledge of health workers on medical waste management helps improve on factors affecting
medical waste within the facility. The study investigated that awareness on segregation of medical
waste has been among other factors affecting medical waste management. The study results show
that 40(82%) of the respondents were aware of the different categories of medical waste while
7(14%) of the respondents were not aware of the different categories of medical waste. This
findings correlate with a study done by (R.Kumar, 2017), reports that factors associated with
improper segregation include inadequate awareness, poor medical waste management, practices
and inadequate management by facility leadership. This also agree with the study done by
(M.Askarian et al,2010), reveal that lack of awareness by health workers concerning correct
definition for infectious medical waste, as well as a poor understanding of waste regulation
standards especially concerning proper segregation. Majority 25(51%) of the respondents’
practiced segregation of medical waste using gloves while the least 7(14%) used bear hands. This
agrees with study done by (Al-Emad ,2011) states that 82% of respondents put on gloves when
disposing the medical waste meanwhile 18% reported do use bear hand while disposing medical
waste.

Hospital environment needs to be kept safe from external factors, therefore, a suitable method of
disposal for medical waste should be chosen to protect environment. The study findings indicates
that 35(71%) of the respondents said that incinerators is used while 12(25%) said open pit burning
is used. Therefore, this findings correlate with that of (wilburn,2012), which stated that
incineration has been reported as the most common treatment technology available for medical
waste, However, incinerators are increasingly becoming an unpopular option due to environmental
concerns. Transportation of medical waste has been costing and majority 26(54%) agreed that cost
affects transportation of medical waste while 21(42%) disagree that cost of transporting medical

27
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waste was a factor affecting medical waste management. This disagree with study done by
(kocasoy et al, 2010) noted that the collection and transportation of the waste can constitute around
80%-95% of expenditure.

Policies should be taken into consideration by the hospital managers at msambweni county referral
hospital as the study findings showed that 21 (43%) disagree that there is regular review or updated
policies and procedures adopted while 23(47%) agree that there is regular review or updated
policies and procedures adopted. This agree with the study of (Stacy, 2012) which states that
healthcare facilities should have waste management policy and a waste management plan. It is the
responsibility of health information management and public health professional to plan health
information system, develop health policies and identify current and future information needs.

5.2CONCLUSION
The study concluded that health workers knowledge on awareness on medical waste management
and practice was not sufficient since majority were not aware of the different categories of medical
waste and through all this it showed most have never attended any training concerning medical
waste management. The study also concluded that the environment within the facility was not in
good condition due to pollution caused by the method of medical waste disposal which was not
in good condition as well as means used for transporting medical waste has been contributing
factors affecting medical waste management. Lastly the study conclude that hospital factor was a
major concern since hospital managers had implemented policies which was not adopted at the
same time was not updated and reviewed regularly as it should be at the facility.

5.3RECOMMENDATION
The hospital managers should increase health workers knowledge by ensuring that there is
awareness on medical waste management through frequent refresher training of health workers on
the updates concerning medical waste management and be thought on risk associated with poor
practices and handling of medical waste.

The ministry of health need to ensure that the environment is kept clean by adopting safe
technologies for treatment and disposal of medical waste management thus to keep the hospital
surrounding free from pollution related to medical waste management.

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-

The county government of kwale need to provide budget to healthcare facilities so that they can
procure enough health care waste management commodities.

5.4FURTHER RESEARCH
Further research should be carried out to determine the factors that affects practice on segregation
of medical waste among health workers.

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REFERENCES
(K), M. (2008-2011). health care waste management plan.

Abahand, s. E. (2011). Health care waste management. public health and epidemiology.

Achieng et al. (2019). Medical solid waste disposal and sanitation. Afican interdisplinary studies.

caniato et al,. (2015). medcal waste transportation .

Cheng YW et al,. (2011). Medical waste production at the hospital and associated factors. waste manag.

DEA. (2012). climate protection . south africa: department of environmental affairs.

Elliott steen windfeld and Marrianne su-ling Brooks. (2015). medical waste management. environment
management, 98-108.

FC. Oloniyi and Js Ogola. (2021). challenges of effective management of medical waste in low-resource
setting. perception of health care workers in Vhembe district healthcare facilities.

fobil et al,. (2015). health care waste managemnt.

Giusti. (2014). a review of waste management practices and their impact on human health. faculty of
health and life sciences.

GOK. (2015). Health care waste management action plan. Nairobi: ministry of health.

GOK. (2015). health care waste management action plan. nairobi: ministry of health.

Gulis.G. et al,. (2010). awareness of health and environmental of poor clinician waste disposal.
occupational and environmental health, 53-59.

Hakim et al. (2014). knowledge attitude and practices of health-care personnel towards waste disposal
management. cairo: Ain sham university hospital.

Haylamicheal et al. (2011). Assesing the management of health cvare waste. waste management.

Kerdsuwan et al. (2015). efficiency improvement of medical waste management. new jersey, john wiley
and sons,ltd.

Kumar, R. S. (2013). knowlege ,attitude,and practices of health staff regarding infectious waste handling
of tertiary care health facilities. pakistan: med coll abbuttabady.

lexchin et al. (2018). pharmaceutical company spending on research and development and promotion.
pharmaceutical policy and practice.

Manga veronica E, L. A. (2011). health care waste management. cameroon.

Mastafapoor, B. a. (2011). Medical waste characterization.

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MOH. (2008-2011). Health care waste management plan. kenya: ministry of health.

Moreira AMM et al,. (2013). Assessment of medical waste management. sao paulo,Brazil: waste manag.

Nkonge et al. (2014). knowledge, attitude and practice of health care waste management and associated
health risk. community health, 1172-7.

ozdarA., B. a. (2013). medical waste training for healthcare managers. environmental health science and
engineering.

Plan, H. (2008-2011). health care waste management plan. kenya: minisry of health.

powell-jackson et al,. (2020). health care waste management .

pudussery, K. (2011). A study on the medical waste management . norfolk and Norwich.

R. paudel et al,. (2010). health care waste management. nepal health research council.

S.V. Manyele et al,. (2012). analysis of medical waste incinerators performance based on fuel
consumption and cycle time.

Shaikh BT et al. (2013). knowledge,attitude,and practice of health staff regarding infectious waste
handling of tertiary care facilities. pakistan: j ayub med coll abbuttabady.

TJ.Lyasenga, S. M. (2010). factors affecting medical waste management in lowlevel health facility.
tanzania: environmental science.

Todor, T. N. (2016). health care waste management. cornwall,united kingdom: national health service.

Udofia et al. (2013). health care waste. Africa: a silent crises.

Vilvalert et al. (2015). Two decades of environmental surveillance in the vicinity of a waste incinerator.
human health risk asssociated with metals and PCDD/FC.

Visha B. et al,. (2015). total quality management approach to healthcare waste .

WHO. (2010).

WHO. (2010). management of waste from healthcare activities. world health organisation.

WHO. (2015). Health-care waste. article.

WHO. (2015). WASTE SOLID MANAGEMENT. TANZANIA.

WHO. (2017). safe management of waste from health care activities. Geneva: world health organisation.

WHO. (2017). safe management of waste from health care activities. Geneva: world health organisation.

WHO. (2017). Safe management of waste from health-care activities. Geneva: world health organization.

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WHO/UNICEF. (2015). Water,sanitation and hygiene in health care facilities:status in low-and middle -
income countries . Geneva: world health organisation.

YY Babanyara, D. I. (2013). poor medical waste management practices and its risks to human health and
the environment. environ ealth.

Z.letho, T. .. (2021). Awareness and practice of medical waste management among healthcare providers.
National referral hospital.

APPENDIX I: WORK PLAN

Table 5 work plan

TASKS FE MAR APR MA JU JUL AU SE OC NO DE JA FE

B
B CH IL Y NE Y G P T V C N

20 20
21 22

Presenta
tion and
approval
of
research
topic

Proposal
writing

Preparat
ion of
data
collectio
n tool

32
-

Data
collectio
n

Data
analysis
and
presenta
tion

dissertat
ion

33
-

APPENDIX II. BUDGET

Table 6 Budget

ITEM QUANTITY PRICE PER TOTAL PRICE

ITEM

Plain papers 2 ream 1000 1000

Biro pens 5 pens 25 125

Ruler 1 30 30

Book 1 80 80

Flash disk 1 1000 1000

Internet session 20 sessions 50 1000

Typing and
190 pages 10 1900
printing

Binding 2 copies 50 100

Travelling To and from 500 500

Accommodation Single room 2500 2500

Miscellaneous 3500 3500

Total 12250

34
-

APPENDIX III: letter from NACOSTI

35
-

APPENDIX IV: Authorization letter

36
-

APPENDIX V: MAP

Figure 10 map

37
-

APPENDIX VI: QUESTIONNAIRE.

INSTRUCTION TO THE RESPONDENTS

I’m faith kibet from Kenya medical training college msambweni campus taking Diploma in health
records and information technology. This questionnaire seeks to determine factors affecting
medical waste management among health workers at msambweni county referral hospital. This is
for academic purpose and the information obtained through this questionnaire will be treated
confidentially. Please attend to all the questions in this questionnaire and mark where appropriate
or fill in the required information on the space provided.

CONSENT FORM

I have been informed of the purpose of the study and that my participation is voluntarily pure. I
hereby agree to participate.

Date…………………………………….. sign…………………………………………………….

SECTION A: DEMOGRAPHIC DATA

1. Gender?

a) Male [ ]
b) Female [ ]

2. Age?

a) 18-25 [ ]
b) 25-35 [ ]
c) 36-45[ ]
d) 46 and above[ ]

3. Your occupation?

a) Pharmacist [ ]
b) Nurse [ ]
c) Clinical officer [ ]
d) Medical officer[ ]

38
-

e) Dentist [ ]
f) Laboratory technician [ ]

4. Working experience?

a) 6 months to 1 year [ ]
b) 1-5 years [ ]
c) 5 years and above[ ]

5. Working hours?

a) 4-6 hours[ ]
b) 6-8 hours[ ]
c) 8-12 hours[ ]

SECTION B: KNOWLEDGE

6. Do you know of the color coding for medical waste segregation?

a) Yes [ ]

b) No [ ]

7. Are you aware of different categories of medical waste generated at the facility?

a)Yes

b) No

8. Do you usually use any of these protective gear for medical waste handling during disposal?

a) Gloves[ ]
b) Bear hand [ ]

9. Have you ever attended any training on medical waste management?

a) Yes [ ]
b) No [ ]

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-

SECTION C. ENVIRONMENTAL FACTORS

10. Which method do you use to dispose medical waste?

a) incinerators [ ]
b) autoclaving[ ]
c) use of chemicals[ ]

11. Where is the disposal methods located from the hospital compound?

a) Far from the hospital compound [ ]

b) Within the compound [ ]

12. What means is used for transporting medical waste to disposal?

a) Wheelbarrow [ ]
b) vehicle [ ]
c) Use of trolleys [ ]

13. How does it cost to transport medical waste?

a) Agree [ ]
b) disagree [ ]

SECTION D: HOSPITAL FACTORS

14. Statement on role of health managers

No statements Agree Strongly agree Disagree

1 There is budget for healthcare
waste management
2. The healthcare waste
segregation bins are adequate

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-

3 There is HCWM policies and

procedures adopted

15. Statement of Policies on medical waste management.

No statements Agree Strongly Agree Disagree

1 The healthcare waste management
policies are reviewed or updated at
least once a year
2 The healthcare facility policy
explicitly mention a commitment to
protect environment

Thank you

41