Factors associated with health care waste management practices among healthcare workers in Kaabong District, Uganda

Abstract

Background: Health care waste management (HCWM) is a key part of the health care delivery system. Most studies on HCWM have focused on the state of HCWM in health facilities with few having explored the practices of healthcare workers on HCWM and associated factors. Study Objectives: This study aimed at assessing the HCWM practices and associated factors among healthcare workers in Kaabong District, Uganda. Methods: A cross-sectional study of 135 healthcare workers involving both quantitative and qualitative methods (14 Health Facility In-charges/HCWM Focal Person as Key Informants) was conducted in 17 health facilities. State of HCWM practice was assessed by converting four HCWM indicators (minimization, segregation, waste storage in colour-coded bins and use of protective gear while handling waste) into composite percentage scores. Quantitative data was analysed in Stata SE 14. Prevalence ratios (PR) obtained using a multivariate Poisson regression model were used as a measure of association between state of HCWM practice and associated factors. Qualitative data was thematically analysed. Results: Total solid HCW generation rates (kg/day) were 23 and 97.15 for non-hazardous waste and hazardous waste respectively. Majority (95.6%) of healthcare workers satisfactorily practiced HCWM. At 66.7% and 99.3%, minimization and use of personal protective equipment were the least and most performed practices respectively. Close to two-thirds (65.2%) of the respondents segregated waste at the source. More than half (58.5%) of the respondents were not aware of the national HCWM guidelines. More than half (51.9%) of the healthcare workers were knowledgeable in the principles of HCWM. Sex and education level were marginally and significantly associated with satisfactory HCWM practice. Male healthcare workers were 0.92 times less likely to have satisfactory HCWM practices compared to their female counterparts (APR=0.92, 95% CI: 0.85 – 0.99). Healthcare workers with an education level of a diploma and above were 1.25 times more likely to have satisfactory HCWM practices compared to those with lower levels of education after controlling for other factors (APR=1.25, 95% CI: 1.01 – 1.55). Qualitative interviews corroborated the fact that most healthcare workers satisfactorily practiced HCWM, segregated waste and used protective gear while handling waste. Conclusion: Health facilities in Kaabong generate mostly hazardous waste. State of HCWM practices of healthcare workers was satisfactory. Lower proportions of satisfactory HCWM practice were observed among male healthcare workers. Slightly higher proportions of satisfactory HCWM practice were observed among healthcare workers with an education level of a diploma and above. Refresher trainings on HCWM should be organized for all healthcare workers with emphasis on segregation and minimization.