Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.
References
[1]
Mol, M.P., Gonçalves, J.P., Silva, E.A., Scarponi, F.D.O., Greco, D.B., Cairncross, S. and Heller, L. (2016) Seroprevalence of Hepatitis B and C among Domestic and Healthcare Waste Handlers in Belo Horizonte, Brazil. Waste Management & Research, 34, 875-883. https://doi.org/10.1177/0734242X16649686
[2]
Ali, M., Wang, W., Chaudhry, N. and, Geng, Y. (2017) Hospital Waste Management in Developing Countries: A Mini Review. Waste Management & Research, 35, 581-592. https://doi.org/10.1177/0734242X17691344
[3]
Koolivand, A., Mahvi, A.H., Alipoor, V., Azizi, K. and Binavapour, M. (2012) Investigating Composition and Production Rate of Healthcare Waste and Associated Management Practices in Bandar Abbass, Iran. Waste Management & Research, 30, 601-606. https://doi.org/10.1177/0734242X11416037
[4]
Haylamicheal, I.D., Dalvie, M.A., Yirsaw, B.D. and Zegeye, H.A. (2011) Assessing the Management of Healthcare Waste in Hawassa City, Ethiopia. Waste Management & Research, 29, 854-862. https://doi.org/10.1177/0734242X10379496
[5]
De Titto, E., Savino, A.A. and Townend, W.K. (2012) Healthcare Waste Management: The Current Issues in Developing Countries. Waste Management & Research, 30, 559-561. https://doi.org/10.1177/0734242X12447999
[6]
Akpieyi, A., Tudor, T.L. and Dutra, C. (2015) The Utilization of Risk-Based Frame Works for Managing Healthcare Waste: A Case Study of the National Health Service in London. Safety Science, 72, 127-132. https://doi.org/10.1016/j.ssci.2014.08.014
[7]
Minoglou, M., Gerassimidou, S. and Komilis, D. (2017) Healthcare Waste Generation Worldwide and Its Dependence on Socio-Economic and Environmental Factors. Sustainability, 9, Article 220. https://doi.org/10.3390/su9020220
[8]
Ferreira, J.A., Bila, D.M., Ritter, E. and Braga, A.C.S. (2012) Chemical Healthcare waste Management in Small Brazilian Municipalities. Waste Management & Research, 30, 1306-1311. https://doi.org/10.1177/0734242X12459551
[9]
Mmanga, M., Singini, W., Di Bella, V., Flaherty, M.G. and Holm, R.H. (2019) Unpacking Healthcare Waste Management at Rural Village Health Clinics in the Ntcheu District (Malawi). Environmental Monitoring and Assessment, 191, Article No. 175. https://doi.org/10.1007/s10661-019-7306-6
[10]
Windfeld, E.S. and Brooks, M.S.L. (2015) Medical Waste Management: A Review. Journal of Environmental Management, 163, 98-108. https://doi.org/10.1016/j.jenvman.2015.08.013
[11]
Chaerul, M., Tanaka, M. and Shekdar, A.V. (2008) A System Dynamics Approach for Hospital Waste Management. Waste Management, 28, 442-449. https://doi.org/10.1016/j.wasman.2007.01.007
[12]
Elimelech, E., Ayalon, O. and Flicstein, B. (2011) Hazardous Waste Management and Weight-Based Indicators: The Case of Haifa Metropolis. Journal of Hazardous Materials, 185, 626-633. https://doi.org/10.1016/j.jhazmat.2010.09.064
[13]
Diaz, L.F., Eggerth, L.L., Enkhtsetseg, S.H. and Savage, G.M. (2008) Characteristics of Healthcare Wastes. Waste Management, 28, 1219-1226. https://doi.org/10.1016/j.wasman.2012.09.018
[14]
Maamari, O., Brandam, C., Lteif, R. and Salameh, D. (2015) Health Care Waste Generation Rates and Patterns: The Case of Lebanon. Waste Management, 43, 550-554. https://doi.org/10.1016/j.wasman.2015.05.005
[15]
Sartaj, M. and Arabgol, R. (2015) Assessment of Healthcare Waste Management Practices and Associated Problems in Isfahan Province (Iran). Journal of Material Cycles and Waste Management, 17, 99-106. https://doi.org/10.1007/s10163-014-0230-5
[16]
Ferronato, N. and Torretta, V. (2019) Waste Mismanagement in Developing Countries: A Review of Global Issues. International Journal of Environmental Research and Public Health, 16, Article 1060. https://doi.org/10.3390/ijerph16061060
[17]
Barbosa, F.C.L. and Mol, M.P.G. (2018) Proposal of Indicators for Health Care Waste Management: Case of a Brazilian Public Institution. Waste Management & Research, 36, 934-941. https://doi.org/10.1177/0734242X18777797
[18]
Ananth, A.P., Prashanthini, V. and Visvanathan, C. (2010) Healthcare Waste Management in Asia. Waste Management, 30, 154-161. https://doi.org/10.1016/j.wasman.2009.07.018
[19]
Tesfahun, E., Kumie, A. and Beyene, A. (2016) Developing Models for the Prediction of Hospital Healthcare Waste Generation Rate. Waste Management & Research, 34, 75-80. https://doi.org/10.1177/0734242X15607422
[20]
Moreira, A.M.M. and Günther, W.M.R. (2013) Assessment of Medical Waste Management at a Primary Health-Care Center in São Paulo, Brazil. Waste Management, 33, 162-167. https://doi.org/10.1016/j.wasman.2012.09.018
[21]
Caniato, M., Tudor, T. and Vaccari, M. (2015) International Governance Structures for Health-Care Waste Management: A Systematic Review of Scientific Literature. Journal of Environmental Management, 153, 93-107. https://doi.org/10.1016/j.jenvman.2015.01.039
[22]
Lee, S., Vaccari, M. and Tudor, T. (2016) Considerations for Choosing Appropriate Healthcare Waste Management Treatment Technologies: A Case Study from an East Midlands NHS Trust, in England. Journal of Cleaner Production, 135, 139-147. https://doi.org/10.1016/j.jclepro.2016.05.166
[23]
Geng, Y., Ren, W.X., Xue, B., Fujita, T., Xi, F., Liu, Y. and Wang, M. (2013) Regional Medical Waste Management in China: A Case Study of Shenyang. Journal of Material Cycles and Waste Management, 15, 310-320. https://doi.org/10.1007/s10163-013-0118-9
[24]
Thakur, V. and Ramesh, A. (2015) Healthcare Waste Management Research: A Structured Analysis and Review (2005-2014). Waste Management & Research, 33, 855-870. https://doi.org/10.1177/0734242X15594248
[25]
World Health Organization (2014) Safe Management of Wastes from Health-Care Activities. http://www.searo.who.int/srilanka/documents/safe_management_of_wastes_from_healthcare_activities. pdf?ua=1
[26]
Caniato, M., Tudor, T.L. and Vaccari, M. (2016) Assessment of Health-Care Waste Management in a Humanitarian Crisis: A Case Study of the Gaza Strip. Waste Management, 58, 386-396. https://doi.org/10.1016/j.wasman.2016.09.017
[27]
El-Salam, M.M.A. (2010) Hospital Waste Management in El-Beheira Governorate, Egypt. Journal of Environmental Management, 91, 618-629. https://doi.org/10.1016/j.jenvman.2009.08.012
[28]
Yazie, T.D., Tebeje, M.G. and Chufa, K.A. (2019) Healthcare Waste Management Current Status and Potential Challenges in Ethiopia: A Systematic Review. BMC Research Notes, 12, Article No. 285. https://doi.org/10.1186/s13104-019-4316-y
[29]
Hasan, M.M. and Rahman, M.H. (2018) Assessment of Healthcare Waste Management Paradigms and Its Suitable Treatment Alternative: A Case Study. Journal of Environmental and Public Health, 2018, Article ID: 6879751. https://doi.org/10.1155/2018/6879751
[30]
Dehghani, M.H., Ahrami, H.D., Nabizadeh, R., Heidarinejad, Z. and Zarei, A. (2019) Medical Waste Generation and Management in Medical Clinics in South of Iran. MethodsX, 6, 727-733. https://doi.org/10.1016/j.mex.2019.03.029
[31]
Taslimi, M., Batta, R. and Kwon, C. (2020) Medical Waste Collection Considering Transportation and Storage Risk. Computers & Operations Research, 120, Article 104966. https://doi.org/10.1016/j.cor.2020.104966
[32]
Chartier, Y. and World Health Organization (2014) Safe Management of Wastes from Health-Care Activities. World Health Organization, Geneva.
[33]
Olaifa, A., Govender, R.D. and Ross, A.J. (2018) Knowledge, Attitudes and Practices of Healthcare Workers about Healthcare Waste Management at a District Hospital in Kwazulu-Natal. South African Family Practice, 60, 137-145. https://doi.org/10.1080/20786190.2018.1432137
[34]
Meleko, A., Tesfaye, T. and Henok, A. (2018) Assessment of Healthcare Waste Generation Rate and Its Management System in Health Centers of Bench Maji Zone. Ethiopian Journal of Health Sciences, 28, 125-134. https://doi.org/10.4314/ejhs.v28i2.4
[35]
Khan, B.A., Cheng, L., Khan, A.A. and Ahmed, H. (2019) Healthcare Waste Management in Asian Developing Countries: A Mini Review. Waste Management & Research, 37, 863-875. https://doi.org/10.1177/0734242X19857470
[36]
Ciplak, N. and Kaskun, S. (2015) Healthcare Waste Management Practice in the West Black Sea Region, Turkey: A Comparative Analysis with the Developed and Developing Countries. Journal of the Air & Waste Management Association, 65, 1387-1394. https://doi.org/10.1080/10962247.2015.1076539
[37]
Kwikiriza, S., Stewart, A.G., Mutahunga, B., Dobson, A.E. and Wilkinson, E. (2019) A Whole Systems Approach to Hospital Waste Management in Rural Uganda. Frontiers in Public Health, 7, Article 136. https://doi.org/10.3389/fpubh.2019.00136
[38]
Santos, E.D.S., Gonçalves, K.M.D.S. and Mol, M.P.G. (2018) Healthcare Waste Management in a Brazilian University Public Hospital. Waste Management & Research, 37, 278-286. https://doi.org/10.1177/0734242X18815949
[39]
Kalogiannidou, K., Nikolakopoulou, E. and Komilis, D. (2018) Generation and Composition of Waste from Medical Histopathology Laboratories. Waste Management, 79, 435-442. https://doi.org/10.1016/j.wasman.2018.08.012
[40]
Xin, Y. (2015) Comparison of Hospital Medical Waste Generation Rate Based on Diagnosis-Related Groups. Journal of Cleaner Production, 100, 202-207. https://doi.org/10.1016/j.jclepro.2015.03.056
[41]
Arab, M., Baghbani, R.A., Tajvar, M., Pourreza, A., Omrani, G. and Mahmoudi, M. (2008) Report: The Assessment of Hospital Waste Management: A Case Study in Tehran. Waste Management & Research, 26, 304-308. https://doi.org/10.1177/0734242X08093598
[42]
Wafula, S.T., Musiime, J. and Oporia, F. (2019) Health Care Waste Management among Health Workers and Associated Factors in Primary Health Care Facilities in Kampala City, Uganda: A Cross-Sectional Study. BMC Public Health, 19, Article No. 203. https://doi.org/10.1186/s12889-019-6528-4
[43]
Sahiledengle, B. (2019) Self-Reported Healthcare Waste Segregation Practice and Its Correlate among Healthcare Workers in Hospitals of Southeast Ethiopia. BMC Health Services Research, 19, Article No. 591. https://doi.org/10.1186/s12913-019-4439-9
[44]
Awodele, O., Adewoye, A.A. and Oparah, A.C. (2016) Assessment of Medical Waste Management in Seven Hospitals in Lagos, Nigeria. BMC Public Health, 16, Article 269. https://doi.org/10.1186/s12889-016-2916-1
[45]
Parida, A., Capoor, M.R. and Bhowmik, K.T. (2019) Knowledge, Attitude, and Practices of Bio-Medical Waste Management Rules, 2016; Bio-Medical Waste Management (Amendment) Rules, 2018; and Solid Waste Rules, 2016, among Health-Care Workers in a Tertiary Care Setup. Journal of Laboratory Physicians, 11, 292-299. https://doi.org/10.4103/JLP.JLP_88_19
[46]
Datta, P., Mohi, G.K. and Chander, J. (2018) Biomedical Waste Management in India: Critical Appraisal. Journal of Laboratory Physicians, 10, 6-14. https://doi.org/10.4103/JLP.JLP_89_17
[47]
Hadipour, M., Saffarian, S., Shafiee, M. and Tahmasebi, S. (2014) Measurement and Management of Hospital Waste in Southern Iran: A Case Study. Journal of Material Cycles and Waste Management, 16, 747-752. https://doi.org/10.1007/s10163-013-0214-x
[48]
Cesaro, A. and Belgiorno, V. (2017) Sustainability of Medical Waste Management in Different Sized Health Care Facilities. Waste and Biomass Valorization, 8, 1819-1827. https://doi.org/10.1007/s12649-016-9730-y
[49]
Manga, V.E., Forton, O.T., Mofor, L.A. and Woodard, R. (2011) Health Care Waste Management in Cameroon: A Case Study from the South-Western Region. Resources, Conservation and Recycling, 57, 108-116. https://doi.org/10.1016/j.resconrec.2011.10.002
[50]
Farzadkia, M., Moradi, A., Mohammadi, M.S. and Jorfi, S. (2009) Hospital Waste Management Status in Iran: A Case Study in the Teaching Hospitals of Iran University of Medical Sciences. Waste Management & Research, 27, 384-389. https://doi.org/10.1177/0734242X09335703
[51]
Sasu, S., Kümmerer, K. and Kranert, M. (2012) Assessment of Pharmaceutical Waste Management at Selected Hospitals and Homes in Ghana. Waste Management & Research, 30, 625-630. https://doi.org/10.1177/0734242X11423286
[52]
Khammaneechan, P., Okanurak, K., Sithisarankul, P., Tantrakarnapa, K. and Norramit, P. (2011) Effects of an Incinerator Project on a Healthcare-Waste Management System. Waste Management & Research, 29, S91-S96. https://doi.org/10.1177/0734242X11411013
[53]
World Health Organization (2017) Safe Management of Wastes from Health-Care Activities: A Summary. World Health Organization, Geneva.
[54]
Singh, H., Rehman, R. and Bumb, S. (2014) Management of Biomedical Waste: A Review. International Journal of Dental and Medical Research, 1, 14-20.
[55]
Njagi, N.A., Oloo, M.A., Kithinji, J. and Kithinji M.J. (2012) Health-Care Waste Incineration and Related Dangers to Public Health: Case Study of the Two Teaching and Referral Hospitals in Kenya. Journal of Community Health, 37, 1168-1171. https://doi.org/10.1007/s10900-012-9578-4
[56]
Padmanabhan, K.K. and Barik, D. (2019) Health Hazards of Medical Waste and Its Disposal. In: Barik, D., Ed., Energy from Toxic Organic Waste for Heat and Power Generation, Woodhead Publishing, Cambridge, 99-118. https://doi.org/10.1016/B978-0-08-102528-4.00008-0
[57]
De Titto, E. and Savino, A. (2019) Environmental and Health Risks Related to Waste Incineration. Waste Management & Research, 37, 976-986. https://doi.org/10.1177/0734242X19859700
[58]
Santoro, M., Minichilli, F., Linzalone, N., Coi, A., Maurello, M.T., Sallese, D. and Bianchi, F. (2016) Adverse Reproductive Outcomes Associated with Exposure to a Municipal Solid Waste Incinerator. Annali dell’Istituto Superiore di Sanita, 52, 576-581.
[59]
Domingo, J.L., Marquès, M., Mari, M. and Schuhmacher, M. (2020) Adverse Health Effects for Populations Living Near Waste Incinerators with Special Attention to Hazardous Waste Incinerators. A Review of the Scientific Literature. Environmental Research, 187, Article 109631. https://doi.org/10.1016/j.envres.2020.109631
[60]
Saria, J.A. (2016) Levels of Heavy Metals in Bottom Ash from Medical Waste Incinerators in Dares Salaam. Journal of Multidisciplinary Engineering Science Studies, 2, 599-605.
[61]
Udofia, E.A., Gulis, G. and Fobil, J. (2017) Solid Medical Waste: A Cross Sectional Study of Household Disposal Practices and Reported Harm in Southern Ghana. BMC Public Health, 17, Article No. 464. https://doi.org/10.1186/s12889-017-4366-9
[62]
Dash, A., Kumar, S. and Singh, R.K. (2015) Thermolysis of Medical Waste (Waste Syringe) to Liquid Fuel Using Semi Batch Reactor. Waste and Biomass Valorization, 6, 507-514. https://doi.org/10.1007/s12649-015-9382-3
[63]
Fang, S., Jiang, L., Li, P., Bai, J. and Chang, C. (2020) Study on Pyrolysis Products Characteristics of Medical Waste and Fractional Condensation of the Pyrolysis Oil. Energy, 195, Article 116969. https://doi.org/10.1016/j.energy.2020.116969
[64]
Hossain, M.S., Santhanam, A., Norulaini, N.N. and Omar, A.K.M. (2011) Clinical Solid Waste Management Practices and Its Impact on Human Health and Environment: A Review. Waste Management, 31, 754-766. https://doi.org/10.1016/j.wasman.2010.11.008
[65]
Borowy, I. (2020) Medical Waste: The Dark Side of Healthcare. História, Ciências, Saúde-Manguinhos, 27, 231-251. https://doi.org/10.1590/s0104-59702020000300012
[66]
Aung, T.S., Luan, S. and Xu, Q. (2019) Application of Multi-Criteria-Decision Approach for the Analysis of Medical Waste Management Systems in Myanmar. Journal of Cleaner Production, 222, 733-745. https://doi.org/10.1016/j.jclepro.2019.03.049
[67]
Woolridge, A. and Hoboy, S. (2019) Chapter 27—Medical Waste. In: Letcher, T.M. and Vallero, D.A., Eds., Waste, 2nd Edition, Academic Press, Cambridge, 517-530. https://doi.org/10.1016/B978-0-12-815060-3.00027-X
[68]
Babanyara, Y.Y., Aliyu, A., Gana, B.A. and Musa, M. (2020) A Review of the Knowledge, Attitude, and Practices of Healthcare Wastes Workers (HCWS) on Medical Waste in Developing Countries. In: Marfe, G. and Di Stefano, C., Eds., Risks and Challenges of Hazardous Waste Management: Reviews and Case Studies, Bentham Science Publishers, Karachi, 25-45. https://doi.org/10.2174/97898114724661200101
[69]
Janik-Karpinska, E., Brancaleoni, R., Niemcewicz, M., Wojtas, W., Foco, M., Podogrocki, M. and Bijak, M. (2023) Healthcare Waste—A Serious Problem for Global Health. Healthcare, 11, Article 242. https://doi.org/10.3390/healthcare11020242
[70]
Doylo, T., Alemayehu, T. and Baraki, N. (2019) Knowledge and Practice of Health Workers about Healthcare Waste Management in Public Health Facilities in Eastern Ethiopia. Journal of Community Health, 44, 284-291. https://doi.org/10.1007/s10900-018-0584-z
[71]
Wilson, D.C., Rodic, L., Cowing, M.J., Velis, C.A., Whiteman, A.D., Scheinberg, A., Vilches, R., Masterson, D., Stretz J. and Oelz, B. (2015) ‘Wasteaware’ Benchmark Indicators for Integrated Sustainable Waste Management in Cities. Waste Management, 35, 329-342. https://doi.org/10.1016/j.wasman.2014.10.006
[72]
Bichmann, W., Rifkin, S.B. and Shrestha, M. (1989) Towards the Measurement of Community Participation. World Health Forum,10, 467-472.
[73]
Muriithi, J.G. (2003) Community Participation in Health Development in Nyandarua District, Kenya. Master’s Thesis, Kenyatta University, Nairobi. http://irlibrary.ku.ac.ke/handle/123456789/12948
[74]
Ferronato, N., Ragazzi, M., Elias, M.S. T., Portillo, M.A.G., Lizarazu, E.G.G. and Torretta, V. (2020) Application of Healthcare Waste Indicators for Assessing Infectious Waste Management in Bolivia. Waste Management & Research, 38, 4-18. https://doi.org/10.1177/0734242X19883690
[75]
Nkonge, A.N., Magambo, J.K., Kithinji, J.M., Mayabi, A.O. and Ndwiga, T. (2014) Management of Healthcare Waste in National Teaching and Referral Hospitals in Kenya. International Journal of Environment and Waste Management, 14, 199-209. https://doi.org/10.1504/IJEWM.2014.064087
[76]
Wilson, D.C., Rodic, L., Scheinberg, A., Velis, C.A. and Alabaster, G. (2012) Comparative Analysis of Solid Waste Management in 20 Cities. Waste Management & Research, 30, 237-254. https://doi.org/10.1177/0734242X12437569
[77]
Niyongabo, E., Jang, Y.C., Kang, D. and Sung, K. (2019) Generation, Management Practices and Rapid Risk Assessment of Solid Medical Wastes: A Case Study in Burundi. Journal of Material Cycles and Waste Management, 21, 950-961. https://doi.org/10.1007/s10163-019-00854-0
[78]
Kenny, C. and Priyadarshini, A. (2021) Review of Current Healthcare Waste Management Methods and Their Effect on Global Health. Healthcare, 9, Article 284. https://doi.org/10.3390/healthcare9030284
[79]
Government of Kenya (1999) Environmental Management and Coordination Act.
[80]
Government of Kenya (2006) Legal Notice No. 121: Environmental Management and Coordination (Waste Management) Regulations.
[81]
Ministry of Health, Kenya (2015) Health Care Waste Management Strategic Plan 2015-2020. Nairobi.
[82]
Ministry of Health, Kenya (2016) National HCWM Implementation Plan, 2016-2021. Nairobi.
[83]
Ministry of Medical Services and Ministry of Public Health and Sanitation, Kenya (2011) National Guideline for Safe Management of Health Care Waste. Nairobi.
[84]
Raila, E.M. and Anderson, D.O. (2017) Healthcare Waste Management during Disasters and Its Effects on Climate Change: Lessons from 2010 Earthquake and Cholera Tragedies in Haiti. Waste Management & Research, 35, 236-245. https://doi.org/10.1177/0734242X16682312
[85]
Askarian, M., Heidarpoor, P. and Assadian, O. (2010) A Total Quality Management Approach to Healthcare Waste Management in Namazi Hospital, Iran. Waste Management, 30, 2321-2326. https://doi.org/10.1016/j.wasman.2010.06.020
[86]
Ghali, H., Cheikh, A.B., Bhiri, S., Bouzgarrou, L., Rejeb, M.B., Gargouri, I. and Latiri, H.S. (2023) Health and Environmental Impact of Hospital Wastes: Systematic Review. Dubai Medical Journal, 6, 67-80. https://doi.org/10.1159/000529432
[87]
Anozie, O.B., Lawani, L.O., Eze, J.N., Mamah, E.J., Onoh, R.C., Ogah, E.O., Umezurike, D.A. and Anozie, R.O. (2017) Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast, Nigeria. Journal of Clinical and Diagnostic Research, 11, IC011-IC04. https://doi.org/10.7860/JCDR/2017/24230.9527
[88]
Ministry of Public Health and Sanitation and Ministry of Medical Services, Kenya (2010) National Infection Prevention and Control Policy for Health Care Services in Kenya. Nairobi.
[89]
Uzochukwu, B.S.C., Ughasoro, M.D., Etiaba, E., Okwuosa, C., Anvuladu, E. and Onwujekwe, O.E. (2015) Healthcare Financing in Nigeria: Implications for Achieving Universal Health Coverage. Nigerian Journal of Clinical Practice, 18, 437-444. https://doi.org/10.4103/1119-3077.154196
[90]
Baaki, T.K., Baharum, M.R. and Akashah, F.W. (2017) Critical Success Factors of Medical Waste Management in Health Care Facilities in Nigeria: A Case Study. Journal of Design and Built Environment, 17, 18-35. https://doi.org/10.22452/jdbe.vol17no1.2
[91]
Hamadan, N., Sapri, M., Mohammed, A.H., Awang, M., Rahman, M.S.A., Rosli, N.W. and Lah, N.M. (2012) The Implementation of Clinical Waste Handling in Hospital Sultanah Aminah Johor Bahru (HSAJB). Procedia:Social and Behavioral Sciences, 65, 802-807. https://doi.org/10.1016/j.sbspro.2012.11.202
[92]
Adedigba, M.A., Nwhator, S.O., Afon, A., Abegunde, A.A. and Bamise, C.T. (2010) Assessment of Dental Waste Management in a Nigerian Tertiary Hospital. Waste Management & Research,28, 769-777. https://doi.org/10.1177/0734242X09356017
[93]
Sagoe, C., Pearson, R.D., Perry, J. and Jagger, J. (2001) Risks to Health Care Workers in Developing Countries. New England Journal of Medicine, 345, 538-540. https://doi.org/10.1056/NEJM200108163450711
[94]
Alvim-Ferraz, M.C.M. and Afonso, S.A.V. (2005) Incineration of Healthcare Wastes: Management of Atmospheric Emissions through Waste Segregation. Waste Management, 25, 638-648. https://doi.org/10.1016/j.wasman.2004.07.017
[95]
Mbongwe, B., Mmereki, B.T. and Magashula, A. (2008) Healthcare Waste Management: Current Practices in Selected Healthcare Facilities, Botswana. Waste Management, 28, 226-233. https://doi.org/10.1016/j.wasman.2006.12.019
[96]
Eckelman, M.J. and Sherman, J. (2016) Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLOS ONE, 11, e0157014. https://doi.org/10.1371/journal.pone.0157014
[97]
Honest, A., Manyele, S., Saria, J. and Mbuna, J. (2020) Assessment of Air Pollutant Emissions from Healthcare Waste Incinerators of Different Design Features. African Journal of Environmental Science and Technology, 14, 311-328.
[98]
Manisalidis, I., Stavropoulou, E., Stavropoulou, A. and Bezirtzoglou, E. (2020) Environmental and Health Impacts of Air Pollution: A Review. Frontiers in Public Health, 8, Article 14. https://doi.org/10.3389/fpubh.2020.00014
