AN EVALUATION OF HEALTHCARE WASTE MANAGEMENT PRACTICES AND THEIR IMPLICATIONS FOR ENVIRONMENTAL HEALTH IN HOSPITALS IN CAMEROON

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Healthcare is fundamentally essential to human life and well-being. However, the waste generated from healthcare activities, due to its complex chemical and biological composition, has become an increasingly critical concern. Improper disposal of medical waste poses significant threats, as it can harbour pathogenic microorganisms capable of infecting not only healthcare personnel and patients but also the surrounding communities (Babanyara et al., 2018). Medical waste is regarded as the second most hazardous type of waste after nuclear waste. Beyond its infectious nature, it has the capacity to contaminate land, air, and water resources, posing serious risks to both human and environmental health. Healthcare waste (MW) arises from a variety of sources and materials, such as sharp instruments, human tissues and organs, blood, chemical residues, pharmaceutical discards, and radioactive materials. These materials may be either hazardous or non-hazardous and originate mainly from hospitals and clinics (Das et al., 2021). However, the generation of such waste is not restricted to formal healthcare institutions. The World Health Organization (WHO) notes that diagnostic, treatment, and immunization procedures are sometimes conducted at home, thereby contributing to the growing volume of medical waste from domestic sources as well. Although only 10% to 25% of medical waste is classified as hazardous, mishandling it can have severe consequences, including disease transmission, environmental pollution, and contamination of neighbourhoods (Rai, Kothari, & Singh, 2019; Lemma et al., 2022). The outbreak of the COVID-19 pandemic significantly exacerbated the situation, leading to widespread environmental, economic, and public health disruptions across the globe (Ranjbari et al., 2022). The emergence of new COVID-19 variants and the associated increase in infections and fatalities resulted in a surge in the use of single-use medical items and protective gear. Items such as surgical masks, gloves, plastic syringes, air-purifying respirators, and high-flow nasal cannulas became more common, thereby intensifying the volume and diversity of healthcare waste (Shammi et al., 2022). This sudden and sharp increase in healthcare waste has presented significant challenges to existing medical waste management (MWM) frameworks. These challenges include changes in waste volume and composition, irregular disposal schedules, increased infection risk, and strain on waste segregation, treatment, and disposal systems (Farughi et al., 2020). When healthcare waste management practices fall short of WHO’s recommended standards, the risk of disease transmission among patients, caregivers, waste handlers, and the wider population increases drastically (Das et al., 2021). Unfortunately, in many developing countries, including those in sub-Saharan Africa, healthcare waste is often disposed of alongside municipal solid waste in open dumpsites that are easily accessible to the public and stray animals. This informal and poorly regulated waste disposal practice contributes to the uncontrolled spread of infectious agents, particularly in regions where healthcare infrastructure is underdeveloped (Yazdani, Torkayesh, & Chatterjee, 2020; Zhang et al., 2019). Additionally, in these settings, incineration is often prioritized over recycling, despite the fact that incineration releases toxic substances detrimental to environmental and human health (Ye, 2022). Moreover, many developing nations lack access to environmentally sustainable technologies for medical waste treatment such as autoclaving, microwaving, pyrolysis, and chemical disinfection (Wang et al., 2020). Due to these limitations, scholars have increasingly drawn attention to the urgency of addressing medical waste management in low- and middle-income countries (Shammi et al., 2022; Chen et al., 2021; Wang et al., 2020). Hence, in order to protect human and environmental health and promote sustainability, it is crucial to ensure that healthcare waste is treated, handled, and disposed of safely and efficiently—especially during health emergencies. Effective healthcare delivery systems require not only the establishment of robust universal health coverage but also the adoption of safe, structured, and sustainable clinical waste disposal methods. Based on this imperative, the present study aims to assess the impact of healthcare waste management practices on environmental health in hospitals across Cameroon. 1.2 Statement of the Problem Over the past decade, there has been a notable increase in the number of healthcare facilities, largely driven by international support aimed at combating infectious diseases and population growth. This expansion has, in turn, led to a significant rise in the volume of healthcare waste generated (Doumtsop, 2019). However, the management of this growing volume of waste differs widely between countries. Developing nations are particularly vulnerable, as they often lack structured systems for the safe handling and disposal of healthcare waste (Pruthvish et al., 2019; Harhay et al., 2019; Walkinshaw, 2021). In many of these countries, the regulatory frameworks for managing clinical waste are either absent or poorly enforced. This leads to unsafe practices, including inadequate segregation, treatment, and disposal, which pose serious risks to public health, occupational safety, and the environment. Improper management of medical waste significantly increases the likelihood of transmitting blood-borne pathogens and other infectious diseases (Solberg, 2019; Babanyara et al., 2018). A WHO (2010) evaluation revealed that in 22 developing countries, between 18% and 64% of healthcare facilities failed to implement proper medical waste handling protocols. Specifically, in Africa, the majority of countries do not manage healthcare waste effectively. A study by Chartier et al. (2018) found that only 30% of African countries complied with half of WHO’s medical waste management recommendations. While some countries achieved high compliance in terms of daily waste collection (up to 100%), overall adherence to safe handling practices remained poor (Udofia et al., 2018). Compounding the issue, many healthcare facilities in developing regions routinely engage in unregulated burning of medical waste. This method results in the release of hazardous pollutants such as dioxins and heavy metals, which can severely degrade air quality and cause long-term health and environmental damage (Pruss et al., 2019). A responsible and comprehensive approach to medical waste management is essential to mitigate these dangers. Such an approach involves reducing the generation of hazardous materials, enforcing stringent guidelines for their storage, transportation, treatment, and ensuring environmentally sound final disposal (UNEP, 2020). In recent years, growing awareness of the adverse effects of poor waste management has led to new initiatives in some developing countries aimed at improving clinical waste handling practices (Tabash et al., 2018; Awodele et al., 2019). Despite this progress, there remains a pressing need for further investigation and improvement, particularly in the context of Cameroon. Thus, this study seeks to assess the impact of healthcare waste management on the environmental health conditions within Cameroonian hospitals.  1.3  Objectives of the Study The main purpose of this study is Evaluation of Healthcare Waste Management Practices and Their Implications for Environmental Health in Hospitals in Cameroon.  Specifically, the study will; i.Assess the healthcare waste management practices adopted by Cameroonian hospitals. ii.Assess the impact of healthcare waste management practices on environmental health within hospital settings. iii.Assess the environmental health issues associated with inadequate healthcare waste management. iv.Proffer strategies for improving healthcare waste management practices to mitigate environmental health risks in hospitals. 1.4  Research Questions The following questions have been prepared for the study: i.What healthcare waste management practices are adopted by hospitals in Cameroon? ii.How do healthcare waste management practices impact environmental health within hospital settings in Cameroon? iii.What environmental health issues are associated with inadequate healthcare waste management in Cameroonian hospitals? iv.What strategies can be proposed to improve healthcare waste management practices and mitigate environmental health risks in hospitals? 1.5 Research Hypotheses H0: Healthcare waste management practices in Cameroonian hospitals do not have a significant impact on the environmental health of surrounding areas. Ha: Healthcare waste management practices in Cameroonian hospitals have a significant impact on the environmental health of surrounding areas. 1.6 Significance of the Study The results of the study will help improve healthcare waste management procedures, lower the dangers to the environment and public health that come with inappropriate waste disposal, and support the development of a safer and more sustainable healthcare environment in Cameroon.  Moreover, the research will enhance existing theoretical frameworks about the integration of environmental health practices into healthcare systems and the perspectives of healthcare practitioners regarding effective waste management. Nevertheless, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. 1.7 Scope of the study    The scope of this study is boarded on Evaluation of Healthcare Waste Management Practices and Their Implications for Environmental Health in Hospitals in Cameroon. Empirically, this study will assess the impact of healthcare waste management practices on environmental health within hospital settings, the environmental health issues associated with inadequate healthcare waste management and proffer strategies for improving healthcare waste management practices to mitigate environmental health risks in hospitals. Geographically, the study will be delimited to some selected hospital in Cameroon. 1.8 Limitation of the study In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.  1.9 Definition of Terms Healthcare waste: Any waste material generated from healthcare activities, including the diagnosis, treatment, and immunization of humans or animals, research activities, and the production or testing of biologicals. Healthcare Waste Management: process of handling healthcare waste, from its generation to its final disposal.