hypothesis of solid waste management

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solid-waste management , the collecting, treating, and disposing of solid material that is discarded because it has served its purpose or is no longer useful. Improper disposal of municipal solid waste can create unsanitary conditions, and these conditions in turn can lead to pollution of the environment and to outbreaks of vector-borne disease—that is, diseases spread by rodents and insects . The tasks of solid-waste management present complex technical challenges. They also pose a wide variety of administrative, economic, and social problems that must be managed and solved.

Historical background

In ancient cities, wastes were thrown onto unpaved streets and roadways, where they were left to accumulate. It was not until 320 bce in Athens that the first known law forbidding this practice was established. At that time a system for waste removal began to evolve in Greece and in the Greek-dominated cities of the eastern Mediterranean. In ancient Rome , property owners were responsible for cleaning the streets fronting their property. But organized waste collection was associated only with state-sponsored events such as parades. Disposal methods were very crude, involving open pits located just outside the city walls. As populations increased, efforts were made to transport waste farther out from the cities.

After the fall of Rome, waste collection and municipal sanitation began a decline that lasted throughout the Middle Ages . Near the end of the 14th century, scavengers were given the task of carting waste to dumps outside city walls. But this was not the case in smaller towns, where most people still threw waste into the streets. It was not until 1714 that every city in England was required to have an official scavenger. Toward the end of the 18th century in America, municipal collection of garbage was begun in Boston , New York City , and Philadelphia . Waste disposal methods were still very crude, however. Garbage collected in Philadelphia, for example, was simply dumped into the Delaware River downstream from the city.

A technological approach to solid-waste management began to develop in the latter part of the 19th century. Watertight garbage cans were first introduced in the United States, and sturdier vehicles were used to collect and transport wastes. A significant development in solid-waste treatment and disposal practices was marked by the construction of the first refuse incinerator in England in 1874. By the beginning of the 20th century, 15 percent of major American cities were incinerating solid waste. Even then, however, most of the largest cities were still using primitive disposal methods such as open dumping on land or in water.

Technological advances continued during the first half of the 20th century, including the development of garbage grinders, compaction trucks, and pneumatic collection systems. By mid-century, however, it had become evident that open dumping and improper incineration of solid waste were causing problems of pollution and jeopardizing public health . As a result, sanitary landfills were developed to replace the practice of open dumping and to reduce the reliance on waste incineration. In many countries waste was divided into two categories, hazardous and nonhazardous, and separate regulations were developed for their disposal. Landfills were designed and operated in a manner that minimized risks to public health and the environment. New refuse incinerators were designed to recover heat energy from the waste and were provided with extensive air pollution control devices to satisfy stringent standards of air quality. Modern solid-waste management plants in most developed countries now emphasize the practice of recycling and waste reduction at the source rather than incineration and land disposal.

Solid-waste characteristics

The sources of solid waste include residential, commercial, institutional, and industrial activities. Certain types of wastes that cause immediate danger to exposed individuals or environments are classified as hazardous; these are discussed in the article hazardous-waste management . All nonhazardous solid waste from a community that requires collection and transport to a processing or disposal site is called refuse or municipal solid waste (MSW). Refuse includes garbage and rubbish. Garbage is mostly decomposable food waste; rubbish is mostly dry material such as glass, paper, cloth, or wood. Garbage is highly putrescible or decomposable, whereas rubbish is not. Trash is rubbish that includes bulky items such as old refrigerators, couches, or large tree stumps. Trash requires special collection and handling.

Construction and demolition (C&D) waste (or debris) is a significant component of total solid waste quantities (about 20 percent in the United States), although it is not considered to be part of the MSW stream. However, because C&D waste is inert and nonhazardous, it is usually disposed of in municipal sanitary landfills.

Another type of solid waste, perhaps the fastest-growing component in many developed countries, is electronic waste , or e-waste, which includes discarded computer equipment, televisions , telephones , and a variety of other electronic devices. Concern over this type of waste is escalating. Lead , mercury , and cadmium are among the materials of concern in electronic devices, and governmental policies may be required to regulate their recycling and disposal.

Solid-waste characteristics vary considerably among communities and nations. American refuse is usually lighter, for example, than European or Japanese refuse. In the United States paper and paperboard products make up close to 40 percent of the total weight of MSW; food waste accounts for less than 10 percent. The rest is a mixture of yard trimmings, wood, glass, metal, plastic, leather, cloth, and other miscellaneous materials. In a loose or uncompacted state, MSW of this type weighs approximately 120 kg per cubic metre (200 pounds per cubic yard). These figures vary with geographic location, economic conditions, season of the year, and many other factors. Waste characteristics from each community must be studied carefully before any treatment or disposal facility is designed and built.

Rates of solid-waste generation vary widely. In the United States , for example, municipal refuse is generated at an average rate of approximately 2 kg (4.5 pounds) per person per day. Japan generates roughly half this amount, yet in Canada the rate is 2.7 kg (almost 6 pounds) per person per day. In some developing countries the average rate can be lower than 0.5 kg (1 pound) per person per day. These data include refuse from commercial, institutional, and industrial as well as residential sources. The actual rates of refuse generation must be carefully determined when a community plans a solid-waste management project.

Most communities require household refuse to be stored in durable, easily cleaned containers with tight-fitting covers in order to minimize rodent or insect infestation and offensive odours. Galvanized metal or plastic containers of about 115-litre (30-gallon) capacity are commonly used, although some communities employ larger containers that can be mechanically lifted and emptied into collection trucks. Plastic bags are frequently used as liners or as disposable containers for curbside collection. Where large quantities of refuse are generated—such as at shopping centres, hotels, or apartment buildings—dumpsters may be used for temporary storage until the waste is collected. Some office and commercial buildings use on-site compactors to reduce the waste volume.

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Waste Management and the Environment II

Evolving The Theory Of Waste Management: Defining Key Concepts

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Edited By: C.A. Brebbia, Wessex Institute of Technology, UK, S. KUNGOLOS, University of Thessaly, Greece, V. POPOV, Wessex Institute of Technology, UK and H. ITOH, University of Nagoya, Japan

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10.2495/WM040461

E. Pongrácz, P. S. Phillips & R. L. Keiski

The Theory of Waste Management represents a more in-depth account of the domain and contains conceptual analyses of waste, the activity upon waste, and a holistic view of the goals of waste management. Waste Management Theory is founded on the expectation that waste management is to prevent waste causing harm to human health and the environment. The proper definition of waste is crucial to constructing a sustainable agenda of waste management. It is largely the case that current legislation attends to existing waste. Definitions emerging from this condition may, however, conflict with the goals of waste prevention, because something that already exists cannot be prevented from arising. When material is assigned the label of ‘waste’, it will be treated as such; consequently, despite its explicit wish of waste prevention, implicitly, legislation essentially amasses waste. The inherent philosophical implication of such definitions is that they are not able to facilitate a sustainable waste management system. Therefore, new, dynamic definitions for waste and waste management must be sought, which can explain why waste is created and can offer an intrinsic solution for the problem. A radically new approach, based on an object-oriented modelling language, is presented to define the key concepts of waste management. Keywords: Theory of Waste Management, waste, non-waste, waste management, definition, theory, purpose, structure, state, performance. 1 Introduction There is a clear distinction drawn between using the word ‘theory’ in the scientific domain, as opposed to everyday life. In common usage, ‘theory’ is

Theory of Waste Management, waste, non-waste, waste management

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Testing the Role of Waste Management and Environmental Quality on Health Indicators Using Structural Equation Modeling in Pakistan

Associated data.

Data published in this study are available on request from the corresponding author. The data are not publicly available due to the policy of the research project.

Improper management of municipal waste has become a growing concern globally due to its impact on the environment, health, and overall living conditions of households in cities. Waste production has increased because households do not adopt waste management practices that ensure sustainability. Previous studies on household waste management often considered socio-economic aspects and overlooked the environmental and behavioral factors influencing the disposal practices and health status. This study adopted four constructs, defensive attitude, environmental knowledge, environmental quality, and waste disposal, by employing a structural equation modeling approach to explore research objectives. Data from 849 households of the Islamabad-Rawalpindi metropolitan was collected by using a multi-stage sampling technique. The structural model results showed that the two constructs, environmental knowledge and defensive behavior, positively affect household health status. The most significant health-related considerations are waste disposal and environmental quality, both of which negatively impact health status and do not support our hypothesis. The results provide valuable perspectives to enable households to engage actively in waste management activities. The findings indicate that understanding the intentions of household health status drivers can assist policymakers and agencies in promoting an efficient and successful community programmes related to sustainable solid waste management by allowing them to foster how the desired behavior can be achieved.

1. Introduction

Municipal solid waste (MSW) is an important economic and environmental issue around the globe. MSW management is already a critical concern for municipal authorities, especially in emerging economies, due to the exponential increase in waste generation parallel with population growth, increasing living standards, urbanization, and rapid development [ 1 , 2 ]. In parallel, MSW management authorities lack infrastructure and the capacity to safely collect and dispose of waste to meet the growing demand. Rural-to-urban migration in emerging economies has resulted in unplanned urban settlements, which put tremendous pressure on municipality authorities. As a result, coping with household solid waste has become a big stumbling block for urban growth. Nevertheless, there is a gap between the demand and supply of these services in terms of quality and efficiency [ 3 , 4 ].

The MSW problem has become an important challenge to sustainable development in developing countries [ 5 ]. The lack of resources coupled with municipalities’ weak institutional capacity to comply with existing solid waste management structure, insufficient facilities for collection, transport, treatment and disposal of waste, limited technical competence and low level of public knowledge have made solid waste management difficult for local authorities [ 3 , 6 ]. Improper waste management leads to waste spreading along the roadsides, drainage, and haphazard dumping, all of which pose a serious risk to the environment and health [ 7 ] and urban flooding and waterlogging [ 8 ].

Open dumping and waste burning have been related to major public health hazards and contamination sources, resulting in the release of harmful dioxins and other toxic substances. At very low doses, these compounds cause a surprising range of harmful effects in humans. Adaptation of defensive behavior is a cognitive process of individuals, including people’s value and belief systems, attitudes and perceptions, personalities, motivations, aspirations, and community, to reduce the negative effects of excessive waste disposal. These cognitive factors drive household decisions about the hazardous impact of waste on human health and the environment and the essence of their reaction to negative impacts have prompted environmental psychologists to pay more attention to psychological aspects of climate change adaptation [ 9 , 10 ].

Pakistan’s population has been rising at a rate of 2.4% per year since 1998, reaching a peak of 207.7 million in 2017, which corresponds to the sixth most populous country. Islamabad is the capital and tenth-largest city with a 1.019 million population and Rawalpindi is the 4th largest city with 2.09 million inhabitants [ 11 ]. The average waste generation rate varies from 1.896 kg/house/day to 4.29 kg/house/day. Although the waste collection system is inadequate, the average waste collection rate in Pakistan’s public sector is 50% [ 12 ]. Open dumping is the most common practice, and dumping sites are often set on fire to reduce the amount of waste that accumulates, which has adverse effects on health and the environment. Public health and societal life are affected by health hazards, pest proliferation, and the spread of diseases. Municipalities fail to manage solid waste due to financial constraints and the careless behavior of the inhabitants. Solid waste has negative impacts on the environment, including air, soil, water contamination, climate change, and devastating effects on the flora and fauna [ 13 , 14 ].

The contribution of this study covers three aspects. First, to the authors’ knowledge, there was no inclusive research in Pakistan on household environmental and defensive behaviors in relation to waste disposal and studies that have generally investigated household’s defensive behaviors have been limited in Pakistan [ 15 ], although there has been some work on the environmental quality and adaptation for the poor sewage system in Pakistan [ 15 , 16 , 17 , 18 , 19 ]. Second, the study is of great worth in monitoring, controlling and humanizing local peoples’ waste management behavior. Specifically, the current study analyzes the impact of different socio-psychological variables (environmental quality, environmental knowledge, and defensive behavior) on health status that has received little attention. Accordingly, this study focused on the metropolitan area of Rawalpindi-Islamabad, Pakistan in order to gain a better understanding of the social economic and environmental factors that influence health. Third, our study also provides viable policy options for mitigating the health hazards of waste pollution and poor environmental quality within the Asian region since we share a common culture, so question is therefore also relevant to other countries in the Asian region.

2. Theoretical Model

Inter-relationships between constructs.

The need for environmental conservation in society has gradually increased. Human activities and anthropogenic impacts have a substantial adverse environmental effect [ 19 , 20 ]. In this regard households have different solid waste management preferences. In general, individuals make their choices based on the assumptions of rationality and self-interest.

Several studies have examined the role of key socio-economic and demographic variables such as age [ 21 ], income, educational attainment [ 22 ] and health status. Waste is the product of human and economic activity, and it is determined by person, ecosystem, and community behavior. Solid waste is a significant environmental problem that jeopardizes long-term environmental sustainability [ 23 ]. Therefore, the following hypotheses are put forth based on theoretical framework (see Figure 1 ):

Structural model of the hypotheses

Waste disposal is positively and significantly associated with health status.

The researchers have made significant efforts to relate improper solid waste management to health issues such as respiratory disorders, vector disease, aesthetic damage, drain blockage, water and soil contamination [ 2 , 24 ]. Environmental deterioration through waste pollution, air and water quality contribute significantly to the proliferation of diseases [ 25 , 26 ]. The consumption and waste disposal habits of households have a direct effect on the environment [ 27 , 28 , 29 ].

Environmental quality is positively and significantly associated with health status.

The social and consumption behavior of households are imperative factors that contribute to waste generation and disposal. The social and consumption behavior of households depends on environmental knowledge. As a result, environmental awareness leads to defensive behavior, which is needed to avoid the harmful effects of solid waste [ 30 , 31 ]. As a result, households are encouraged to participate in hygiene waste management programs to reduce the negative impact on public health and the environment. Therefore, health and environment should be understood as two essential inseparable development aspects that cannot be sustained as though they operate in a vacuum [ 32 , 33 ].

Defensive behavior is positively and significantly associated with health status.

Household defensive behavior is motivated by awareness of potentially harmful effects, as well as time and resources. Previous research [ 34 , 35 , 36 ] looked at several incidents in various parts of the world. According to these reports, households that have been exposed to certain catastrophe circumstances are more risk-averse. Individuals who are aware of then issue are more likely to respond and engage in risk-reduction practices. Based on the above literature, we develop the following hypotheses.

Environmental knowledge is positively and significantly associated with health status.

3. Research Methods

3.1. data collection.

To achieve the study’s objectives, data on household waste management practices environmental quality, environmental knowledge, defensive behavior and health status were gathered from 849 respondents. For selecting the sample size and study area, several factors have been taken into consideration such as the socio-economic and demographic characteristics of selected households for survey. A “multi-stage systematic technique” was used to choose the study area and household sample size.

So far, Pakistan does not have an institutional review board or national ethical guidelines for social science studies. Therefore, the study adhered to existing research ethics principles such as obtaining verbal consent to participate in research, safeguarding personal data, informal privacy, and allowing participants to withdraw their consent if they so wished at any point. In addition, no personal information was used in this analysis. Participants, who provided information related to solid waste generation and related information, were used in this research.

A questionnaire has been finalized after conducting pre-testing in the field. Pre-testing helped us to construct a better contextualize and revised questionnaire. A five-point Likert scale 1 = strongly disagree; 2 = disagree; 3 = neutrality; 4 = agree; 5 = strongly agree, was used to evaluate each question in the questionnaire. We have designed six questions to measure households’ waste disposal behavior, five questions for environmental quality, six questions on environmental knowledge, six questions on defensive behavior. Finally, we have designed four questions related to household health. Precise questions are shown in Table 1 . Primarily data was input into the Statistical Package for the Social Sciences (SPSS) software (IBM, Armank, NY, USA) to generate descriptive statistics and their frequency and correlation test. Finally, we conducted a structural equation analysis through Analysis of Moment Structures (AMOS 20). Social-economic information of respondents is given in Appendix A (see Table A1 ).

Statements and scales used for the four constructs.

3.2. Measurement Model (MM)

In this analysis, the structural equation modeling (SEM) method is used to evaluate the data using latent constructs in this study. To test our model, we used the Anderson and Gerbing’s [ 35 ] two-step approach. The first step was to establish a satisfactory measurement model (MM) using confirmatory factor analysis (CFA). The MM included latent constructs for environmental awareness, environmental quality, waste disposal, safety, and health status. Confirmatory factor analysis was used to determine the reliability of constructs. In additional, convergent and discriminant validity is used to evaluate construct validity. The magnitude, direction, and statistical significance of each latent construct’s standardized factor loadings were checked for convergent validity. Additionally, using the average variance extracted (AVE) and the building reliability, convergent validity was investigated. A MM is valid when a minimum AVE level is higher than 0.5, and when the minimum value of CR is higher than 0.7 [ 36 ].

Maximum likelihood estimation in structural equation modeling assumes multivariate normality. We looked at the univariate distributions for each component because assessing all aspects of multivariate normality is difficult. This method can be used to determine multivariate normality [ 37 ]. Multivariate collinearity was calculated by running multiple regressions, each with a different item as the dependent variable and the rest of the items as the independent variables, and then analyzing the tolerance and variance inflation factor (VIF) for each regression [ 37 ]. We measured each statement’s communality extraction to check the reliability and validity of each construct scores above 0.5., which showed that each factor is independent [ 37 , 38 ].

After we attained a rational measurement model, the structure model was calculated to test the health status hypotheses. Structural modeling is used to predict relationships between households’ cognitions constructs (environmental knowledge, environmental quality, waste disposal, defensive behavior) and their health status. The SM is shown in Figure 2 .

Structural equations modeling and path coefficients between variables.

The first step is to test the reliability test of survey data. There are two generic measures for reliability: Cronbach’s α and composite reliability [ 39 ]. The Cronbach’s α value is used to check the reliability of the data. Data is consistent when Cronbach’s α lies between 0.60 and 0.70; the data set used in analysis is highly reliable when the value is between 0.70 and 0.80 and cut off scores for composite reliability is between 0.6 and 0.7 [ 40 ]. SPSS 23.0 was used to check the internal reliability of five constructs (environmental knowledge, environmental quality, waste disposal, defensive behavior and health status). The results of Cronbach’s α values for five latent variables; waste disposal, defensive behavior environmental knowledge, environmental quality, and health status is 0.92, 0.92, 0.89, 0.93, and 0.85 respectively revealed good internal consistency.

A confirmatory factor analysis was applied to check the properties of the measurement scale [ 41 ]. The conventional rules of thumb [ 37 ] are followed for goodness-of-fit indices of the confirmatory factor analysis. Reliability tests try to find the stability and consistency of measuring instruments. Confirmatory factor analysis shows goodness-of-fit and specific indices for the empirical data such as chi-square standardized by degrees of freedom (λ/df) is shown in Table 2 . It should be less than five [ 42 ], in our study it is 3.71. The NFI, and CFI should exceed 0.9 and RMSEA should be less than 0.10 [ 43 ]. Here, goodness of fits was as follows; NFI = 0.931, CFI = 0.948, and RMSEA = 0.057. Thus, results showed that the model could be accepted for empirical analysis with good convergent indices and goodness of fit [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Results of correlation test are given in Appendix A (please see Table A2 ).

Reliability and validity test.

χ 2 test statistics/df; CFI (comparative fit index); NFI (normed fit index); RMSEA (root mean square error of approximation).

5. Discussion

Results show that SEM is an appropriate methodology for explaining the behavior of the metropolitan Islamabad-Rawalpindi area towards waste management. The configuration of the MM and SM was appropriate. In four-specified MM, the latent constructs waste disposal, environmental quality, environmental knowledge, defensive behavior was reliably described by the measurable items. All the standard coefficients of estimated SEM revealed that path analysis ( Figure 2 ) specified the relationships’ strength among all variables. Standard coefficients depict that all the observed indicators have values around 0.5 and are strongly related to their associated constructs [ 38 ]. Regarding direct and indirect effects, subsequent explanations are made.

The SM results showed that two constructs—environmental knowledge and defensive behavior—positively affect the household health status. Environmental knowledge positively influences the health status (0.30) and defensive behavior (0.01) of households at 0.5 [ 37 ]. Low-carbon consumption and environmental behavior is linked with environmental knowledge [ 45 , 46 ]. Individuals with a dearth of knowledge are more likely to harm the environment. Household’s defensive behavior has a direct positive effect on health status (0.14) and our hypothesis is confirmed. Hence, the findings show that households who are well aware of health and environmental risks are more involved in defensive practices.

The standardized coefficient of environmental quality on defensive behavior and household health status is statistically significant and has a negative impact. Environmental quality has a direct impact on health status [ 46 ] and an indirect impact on the defensive practices of households. This implies that the households who are putting efforts to adopt a green environment are less intent on adopting defensive behavior and vice versa. The most important factor related to health risk is waste disposal, which negatively affected health status and does not support our hypothesis. The findings indicate that inadequate waste management has serious effects on household health and results are consistent with the existing literature [ 14 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Moreover, waste disposal has a positive indirect impact on household defensive behavior, indicating an increase in improper waste disposal, leading to improved household defensive practices.

Estimated results are shown in Table 3 . The standardized path coefficients of the households’ environmental knowledge and defensive behavior are 0.202 ( p < 0.01) and 0.094 ( p < 0.01) respectively. The impact of environmental knowledge and defensive practices on health is statistically significant at 1% confidence level. Results shows that direct effects of environmental knowledge and defensive practices on health are supported to our hypothesis. Our results are consistent with existing studies. Moreover, the environmental knowledge has largest effect (0.202) on household’s health status accompanied by defensive behavior.

Results of the structural model (SM).

Note: ***, **, significant at, 1%, and 5%.

While the impact of environmental quality is statistically significant −0.049 ( p < 0.01), results shows that environmental quality has detrimental effects on household health status. The standardized path coefficients of waste disposal is statistically significant −0.273 ( p < 0.01). Water, air, food and rats dwelling pollution through flies’ sources of several diseases in humans as plague, salmonellosis, trichinosis, endemic typhus dysentery, diarrhea and amoebic dysentery [ 46 , 47 , 48 , 49 , 50 ].

6. Conclusions and Policy Implications

We estimated an SM to test the hypotheses after we obtained a valid MM. Table 3 presents the results for the SM. The regression coefficient of waste disposal and environmental quality on health was negative and significant, suggesting the rejection of hypotheses H1, and H2. Waste disposal has a positive indirect effect on the defensive behavior of households, suggesting that a rise in excessive waste disposal leads to shift in defensive behavior, and environmental quality has a direct effect on health and an indirect impact on household standard precautions. The positive and significant regression coefficient of defensive behavior and environmental knowledge on health supports hypotheses H3 and H4.

The results of this study offer useful perspectives for policymakers. In the present case study, this could be related to the government’s solid waste management strategy. Government agencies and non-governmental organizations (NGOs) could participate to encourage households to segregate of waste at first source and propagate the benefits of a healthy environment. While environmental knowledge is an important factor regarding waste segregation and disposal it is recommended that government agencies and other associations tackle solid waste management by providing detailed information regarding different scenarios of waste disposal and segregation, and different households recycling forecasts at local and national levels. They should also provide details about the dangerous effects of illegal solid waste disposal on safety and the environment. In other words, the focus should be on shaping a proper system for collecting and disposing of waste. Accuracy and timelines of information are therefore important.

Acknowledgments

We are humbly grateful to Muhammad Haseeb Raza for his assistance in conceptual framework, data analysis of this research and for their comments on an earlier versions of the manuscript.

The data distribution of households for each socio-economic and demographic characteristic are presented in Table A1 . Demographic statements that were incorporated in the survey included gender, age, education and income. A majority of (64.8%) of respondents in the sample are males and 35.2% are females. A substantial portion (37%) of households belongs to the early middle age group (21–30). The education level of households was low as follows: 23.9% of households were illiterate, 6.7% of households attended secondary school, 25.7% went to high school and just 21.7% of households had entered university. Regarding income, 21% of households claimed their monthly family income was less than 30.000 thousand rupees and 24% of respondents reported to being in the high income group.

Social-economic information of respondents.

Source: [ 14 ].

Correlations of the constructs.

Note: *, **, significant at 1% and 5% and squared correlations in parentheses.

Author Contributions

Conceptualization, T.A.; Data curation, T.A.; Formal analysis, T.A.; Methodology, T.A.; Project administration, F.J.; Resources, F.J.; Supervision, F.J. All authors have read and agreed to the published version of the manuscript.

This research does not receive any funding.

Institutional Review Board Statement

So far, Pakistan does not have an institutional review board or national ethical guidelines for Economics studies. The study therefore adhered to existing research ethics principles such as obtaining verbal consent to participate in research, retaining personal informal privacy, and allowing participants to withdraw their consent if they so wished at any point. In addition, no personal information was used in this analysis.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Youth and sustainable waste management: a SEM approach and extended theory of planned behavior

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• Volume 20 , pages 2041–2053, ( 2018 )

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• Ava Heidari 1 ,
• Mahdi Kolahi 1 ,
• Narges Behravesh 1 ,
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• Fatemeh Ehsanmansh 1 ,
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• Fahimeh Zanganeh 1  

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The present study aims to develop the Theory of Planned Behavior (TPB) to explain comprehensively the establishment of intention and behavior toward source separation of waste. The extended TPB involves the significant structures affecting the behavior along with the original variables of TPB model. Data were gathered from 420 students in Ferdowsi University, Iran, using questionnaires, and analyzed by cluster analysis, discriminant analysis and structural equation modelling techniques (SEM). The cluster analysis identified three distinct grouping according to TPB constructs, and it was validated by discriminant analysis. SEM results displays that motivation had the most important impact on intention, followed by moral obligation, perceived behavior control, subjective norm, situational factor and attitude. Fit statistic of the extended TPB model was good and had better explanatory power compared to the original TPB. It describes 81 and 57% of the variance for intention and behavior toward source separation waste, respectively.

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Authors would like to enthusiastically appreciate all FUM students who kindly joined this survey and filled out the questionnaire.

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Heidari, A., Kolahi, M., Behravesh, N. et al. Youth and sustainable waste management: a SEM approach and extended theory of planned behavior. J Mater Cycles Waste Manag 20 , 2041–2053 (2018). https://doi.org/10.1007/s10163-018-0754-1

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DOI : https://doi.org/10.1007/s10163-018-0754-1

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Optimization of the Solid Waste Management System in Saint-Petersburg Based on the Morphological Composition Study

• A. Chusov , E. Neguliaeva , M. Romanov
• Published 2018
• Environmental Science

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Design of an optimal waste utilization system: a case study in st. petersburg, russia.

1. Introduction

Generation of municipal solid wastes (MSWs) is closely linked to the population growth process, the urbanization rate, change of lifestyle, and an increase in household income [ 1 ]. MSW contains various types of organic materials that produce a variety of gaseous products, including GHGs, when dumped, compacted, and covered in landfills. However, storing MSW in landfills is the oldest and still the primary waste management strategy in many countries. Landfills generate methane (CH 4 ) in combination with other landfill gases (LFGs) through the natural process of bacterial decomposition of organic waste under anaerobic conditions. Given that CH 4 is about 21 times a more powerful greenhouse gas (GHG) than carbon dioxide (CO 2 ), emissions of LFGs are an important source of GHGs. Worldwide CH 4 emitted from landfilling of MSW accounted for nearly 750 million tons of carbon dioxide equivalent (CO 2 -eq.)in 2006, and represented over 12% of total CH 4 emissions [ 1 , 2 ].

Russia is the world's top emitter of CH 4 from the waste sector, followed by USA and China, representing 37.4 million tons of CO 2 -eq. or 5% of total global CH 4 emissions in 2006 [ 3 ]. The generation of MSW in Russia tripled during the period 1980 to 2007, and has continued to rise due to high economical growth. In 2007, the annual production of MSW per capita in Russia was 440 kg, which is approximately half that in Western countries [ 4 ]. Currently, landfills are the primary means for disposal of MSW in Russia ( Table 1 ).

It is worth noting that due both to the lack of accurate statistics, and also to the existence of thousands of unofficial landfill areas, the exact number of landfills in Russia is unknown [ 5 ]. A rough estimate shows that the area occupied by landfills in Russia is equivalent to eight cities of the size of Moscow, or more than 0.8 million hectares; although it does not cover too much space on a geographical scale [ 5 - 7 ]. Current waste disposal in Russia is causes many environmental problems in Russia and also affects neighboring countries. As an example, the huge amount of solid waste generated in the North-Western part of Russia, in St. Petersburg and Leningrad Oblast (region), has been identified as the most extensive source of pollution around the Baltic Sea [ 6 ].

Due to international collaboration and the development of federal and regional MSW management programs, there is now a visible trend towards improvement of current waste management practices in Russia [ 6 , 7 ]. Development of such projects has increased since Russia's ratification of the Kyoto Protocol in 2005. The shift from waste landfill disposal to alternative treatment methods within Russian waste management is expected to have positive impacts on global warming, not only directly by decreasing GHG emissions, but also indirectly by saving energy and materials from non-renewable resources. However, due to the lack of studies on municipal solid waste management system (MSWMS) in Russia, such aspects have not yet been considered. A few evaluating studies addressing waste management in Russia have been presented recently [ 5 , 8 - 10 ]. However, all of these studies considered only evaluation of GHG emissions resulting from waste landfilling as an independent operation, and have not considered assessment of other waste treatment options. These options are very closely interlinked and can influence the central components of the MSWMS, such as waste generation, separation, collection, and transportation.

This study is an effort to design an optimal waste management/utilization system and to assess the current waste management practices as one system. This study reports the main outcome of the evaluation analysis conducted for St. Petersburg city. As an analysis tool a linear programming (LP) model has been formulated to design and to evaluate MSWMS considering various waste treatment options. The comparison between the different scenarios has been performed taking into account energy, and the economic and environmental aspects, representing the sustainability of the proposed MSW utilization system.

2. Sustainable Waste Management and Waste Management Models

According to Tchobanoglous and Kreith [ 13 ], MSWMS is a complex process because it involves many technologies, associated with controlling generation, handling and storage, transportation, processing and final disposal of MSW under legal and economically acceptable social guidelines that protect the public health, and the environment. The main function of any MSWMS is the treatment of waste generated; where in addition, energy and recyclable materials can be recovered as by-products. Currently, MSW generated by households and economic activities is seldom used as a renewable energy resource. However, utilizing MSW in waste-to-energy (WTE) processes helps to mitigate GHG emissions generated from waste treatment by reducing CH 4 emissions. It also reduces the impact of GHGs as they replace fossil fuels in energy production activities.

Waste generation and disposal is generally considered as a major indicator of an unsustainable society. Based on waste hierarchy, the concept of sustainable waste management handles MSW in an environmentally effective, economically reasonable and socially acceptable way [ 14 ]. The waste hierarchy represents the order of preference for main options of municipal solid waste management (MSWM) and has become a key waste management concept in many European countries [ 15 ]. Based on environmental merits the waste hierarchy indicates that some strategies/technologies for waste handling are more appropriate than others, and could have very different impacts on climate change, not only directly by a decrease in (GHG) emissions, but also indirectly by saving energy and materials from non-renewable resources [ 16 , 17 ].

The complexity of a MSWMS can be described by the number of relationships between the components in the system. Due to the complexity of MSWMS, computer models should be built as supporting tools to explain, control or predict the behavior of these systems, as well as to plan and assess waste management [ 18 ]. Over the past decades, various evaluation techniques have been used to analyze MSWMS. These techniques include numerical solving methods, life cycle assessment (LCA), life cycle inventory (LCI), material flow analysis (MFA), input-output (IO) tables, and several optimization approaches, such as linear programming (LP), mixed integer programming (MIP), and dynamic programming (DP) [ 19 - 23 ]. The first MSW models, from the period between the 1960s to the 1970s, were optimization models and mainly dealt with specific aspects of waste management, that included the routing of waste vehicle collection and the location of waste transfer stations [ 24 ]. Such models were limited to analyzing only one time period, one processing option, and a single waste generation source; making them unsuitable for long term planning [ 22 , 25 ]. Later, several computer models were developed for strategic planning to calculate recovery rates, costs and environmental impacts of MSWMS. In addition, there are studies involving technical, economic and environmental analysis in order to evaluate the potential energy production from MSW [ 26 - 28 ]. In the past ten years, the assessment of integration of WTE applications into existing energy systems has also been included in several studies [ 21 , 29 ].

MSW model applications highlight how waste can be used as an alternative way to landfilling and for reducing GHG emissions. The double role of MSW as a fuel and as a material that can be recycled, leads to a broader range of technologies for their treatment. This has given rise to a lot of different structures and solutions for MSW treatment systems.

In order to design the optimal MSWMS, several characteristics of the target area are required along with the aspects relating to MSW and its management, such as the annual amount of generated waste, waste composition and density, and an existence of treatment technologies. The following aspects may also be included: urbanization rate, waste composition, climatic condition, etc. [ 30 ]. It needs to be mentioned that the presence of a market for by-products, such as recycled materials, compost, and/or energy carriers produced from waste is another necessary aspect of the designed MSWMS. To be sustainable waste management needs to be appropriate to the local conditions of the target area with respect to economic, environmental and social perspectives. Social issues considered within waste management may include a variety of factors, such as household size, occupation, income, consumption patterns, willingness to separate at source, willingness and ability to pay and public acceptance of waste management plans, etc. [ 31 , 32 ]. However, the literature reviewed showed that the third aspect of sustainability has received less attention than the economic and environmental issues. Given that waste represents an important and easily accessible source of sustainable energy, assessment of energy generated from waste could be considered as an additional aspect of sustainable waste management. This study considered the sustainability of MSWMS through energy, economic and environment components, namely the 3E's [ 33 , 34 ]. Such an approach can bring an important contribution to the improvement of MSWMS resulting in balances of environmental, economic and energy aspects.

3. Methodology

3.1. the proposed msw management system.

This study presents a MSW utilization system considering a set of representative waste treatment technologies widely applied in many countries. The performance of the proposed waste management system is evaluated taking into account the 3E's aspects. These parameters were chosen as a set of criteria characterizing the sustainable MSWMS. A general representation of the proposed system is shown in Figure 1 . The system considers thermal and non-thermal waste treatment technologies and several demand sectors for by-products generated due to waste processing.

3.2. Description of the Optimization Model

This section describes the mathematical formulation of the LP optimization model used in the study. In order to determine the lowest cost structure of MSWMS, the model formulated in this study used a common LP technique often applied to solve waste management problems. As a specific point, incorporation of economic, environmental and energy (3E's) aspects, as well as the introduction of several constraints which emphasize the utilization of waste for energy and recycling purposes are used to evaluate the sustainability of the designed system. Objective functions and model constraints are derived taking into consideration economic (total cost, revenue, unit treatment cost, etc. ), environmental (CO 2 -eq. emissions), and energy parameters (energy produced from waste).

The model formulated in this paper has been developed and implemented in GAMS (General Algebraic Modeling System), a tool, developed for solving mathematical programming and optimization problems [ 35 ]. The LP formulation of the optimization model, represented in Figure 2 is described below.

3.2.1. Objective Function

The objective function of the model includes minimization of the net cost of the proposed MSW utilization system defined as the difference between total cost and revenue, as described in Equations (1) and (2) . The total cost of the MSW utilization system is calculated from the summation of the costs for collection / transportation, and treatment / landfill disposal. Revenue is derived from the selling of by-products, such as recyclable materials, compost, and energy generated by WTE facilities.

3.2.2. Features Evaluated by the Model

The developed model evaluates several aspects of the proposed MSW utilization system. These aspects, such as net cost, emissions and energy generated by the system represent the main sustainability features of the proposed MSWMS ( Equations (3) – (5) ).

System net cost

n c j = t c j - b k j ⋅ p k (3)

Environmental impact of the system

In order to assess emissions (CO 2 , CH 4 , and N 2 O) from waste incineration, as well as emissions from other waste treatment technologies, IPCC methodology has been used in the present research [ 36 ]. According to this methodology, if incineration of waste is used for energy purposes, both fossil and biogenetic emissions should be estimated.

C O 2 = ( ∑ j ∑ i q i j ⋅ e m f j + ∑ j ∑ i q i j ⋅ ( d j + f r j ⋅ d r j ) ⋅ cap - 1 tr ⋅ em tr ) (4)

Energy generated by the system

E n = ∑ i ∑ j q i j ( LHV i + LHV RDF + ⋅ LFG g r ⋅ eff coll ⋅ LVH LFG + gas g r ⋅ eff coll ⋅ LVH gas ) ⋅ η e , h (5)

3.2.3. Constraints

Mass balance constraints

All wastes generated in the study area should be transported to treatment plants or disposal site.

∑ i q i = ∑ j ∑ i q i j (6)

Maximum capacity constraints

These constraints consider that planned capacity at each facility should be less than or equal to the maximum allowable capacity of the facility.

∑ i q i j ≤ T c a p j (7)

Waste availability constraint

The waste flow used in the model is subject to the components of each waste material. Because of the different characteristics of waste materials, each type of waste should be processed in the suitable treatment facilities as shown in Table 2 .

q i j ≤ a i j ⋅ ∑ i q i (8)

Waste utilization constraints

These constraints represent a relation between total amount of waste generated in the target area and amount of waste materials allocated for recycling, composting, and energy production purposes.

∑ e ∑ j ∑ i q ije = r f WTE ⋅ ∑ i q i (9) ∑ m , c ∑ j ∑ i q ijm , c = f r WTR ⋅ ∑ j q i (10)

Landfill disposal constraint

This constraint defines the amount of waste allocated directly to landfill and untreated residues coming from other treatment facilities, which are to be transported to a final disposal site.

∑ i q i , landfill + ∑ j ∑ i q i j ⋅ f r j = f r LFD ⋅ ∑ i q i (11)

Non-negativity constraints

This constraint assures that only positive amounts of waste materials are considered in the solution.

q i j ≥ 0 (12)

3.3. Scenario Settings

In order to evaluate the impacts of different waste management options on the MSW utilization system, several scenarios were constructed in this study: A baseline or business as usual (BAU) scenario and four alternative scenarios are explained below. All scenarios are based on the same input data given for the generated amount of waste in the target area.

3.3.1. BAU Scenario (BAU)

The BAU scenario represents the existing MSWMS in the target area, and is the baseline upon which the results from other scenarios are compared.

3.3.2. Low cost Scenario (Low cost)

To achieve the optimal mix of treatment technologies with the minimal net cost of the proposed MSW utilization system, this scenario has been designed without considering regulation constraints, such as the desired amount of waste for recycling and/or for energy generation.

3.3.3. Max Energy Recovery Scenario (WTE)

In this scenario, the amount of waste allocated to energy production is maximized. In order to maximize the preference of energy produced from waste, the constraint on promoting the use of MSW for energy production is included in the model formulation.

3.3.4. Recycling Scenario (WTR)

The MSW utilization system presented in this scenario considers the maximum recycling capability of the proposed system. The constraint on the use of MSW for recycling purposes looking forward to increasing output of material recycled is considered in the model.

3.3.5. WTE&WTR

In this scenario high priority has been given to the energy generated from waste and the recycling of waste materials. Regulation constraints used in the model formulation have been defined as a combination of the average maximal value for the amount of waste used for energy production (50%), and the average material recycling rates (30%).

3.4. Study Area and Input Data

3.4.1. study area.

A case study was conducted in the city of St. Petersburg, the third largest city in Europe after Moscow and London, and the second largest city in Russia. Also it is known as a major industrial center with a population of approximately 4.6 million. St. Petersburg is located on the Neva River at the head of the Gulf of Finland on the Baltic Sea and it is often recognized as the most western city in Russia ( Figure 3 ).

In recent years the population of St. Petersburg has decreased, however, due to economic growth the amount of MSW increased by 20% from 1994 to 2008 [ 8 , 37 ]. Annually, over 1 million tons of MSW is generated in St. Petersburg, from which over 70% is directly disposed in five disposal landfill sites located around the city [ 10 ]. In 2008 the annually collected amount of MSW was about 1.06 million tons, of which 25% was generated by commercial, and 75% by residential sectors ( Table 3 ). Only a small amount went to the two waste treatment plants near the city. Insufficient waste treatment has been recognized as a problem by city authorities and several Russian environmental agencies and NGO's. The major challenges within waste management in St. Petersburg are long transportation distances and improper treatment and storage of waste. Furthermore, the lack of a suitable waste utilization system in St. Petersburg causes many problems, such as a huge loss of useful materials, and emissions of many dangerous pollutants which have a significant influence on the environment inside and outside the city. St. Petersburg is responsible for 20% of the pollution in the Baltic Sea, where the MSW generated in the city is one of the main sources of this pollution [ 6 ].

In order to solve the problems of ineffective waste management in St. Petersburg, the administration of the city has developed several environmental measures, such as increasing the capacity of the present composting and recycling plants and building several new facilities, such as modern landfills and WTE facilities to process all waste generated in the city. Increasing waste separation at source is also one of such measures [ 42 ]. Given that St. Petersburg has a wide DHS network and an electrical grid; energy produced from MSW could be used as an energy source in the existing energy system located in the city.

3.4.2. Input Data

(1) waste data.

Generally, any MSW is composed of three groups of materials, such as organic waste (kitchen waste, garden waste, etc. ), non-recyclable inorganic waste (dust, cinder, ash, etc. ), and recyclable waste (paper, plastics, glass, metal, etc. ). Typical composition of MSW in St. Petersburg and other Russian cities is shown in Table 1 . It should be noted that organic waste is the main component of MSW in St. Petersburg representing more than 30% of the total waste. This study considers the nine largest fractions, totaling 98%, of the MSW currently generated in St. Petersburg, which are paper, glass, metal, plastic, textile, wood, organic waste, rubber, leather, and others. Current waste statistics data in Russia is based on volume measurements. For this reason the total annual amount of waste generated in the target area has been estimated according to the average density of the MSW 232 kg/m 3 . Since the data of the composition of the waste material and the heating values for each type of MSW generated in the target area was not available, it was estimated using the average data from several existing literature sources ( Table 4 ).

(2) Treatment methods

The waste treatment technologies considered include landfilling of all types of waste with LFG extraction, incineration of all waste fractions with energy recovery, recycling of all types of waste except organic, anaerobic digestion and large scale composting of organic and paper waste ( Table 5 ). The anaerobic digestion is assumed to be combined with composting facilities to increase the quality of composting product by including the digestate [ 43 ]. Each technology is characterized by several specific parameters, such as costs (capital investments, operation and maintenance), emissions coefficients, and types of generated by-products. The energy produced from incineration, and the biogas produced from landfilling and anaerobic digestion, is assumed to be used either for heating and/or for electricity generation. Electricity or heat produced from waste treatment processes is assumed to be supplied to the existing electrical grid or to the district heating system (DHS). DHS is widely expanding in Russia and is currently used to heat most buildings in urban areas and also partially in rural areas. St. Petersburg has the oldest and largest DHS network in the world which covers about 6,000 km [ 44 , 45 ].

(3) Economic aspects

By using a combination of data collected for St. Petersburg and data for waste treatment technologies adapted from several sources, transportation costs and treatment costs for each treatment facility have been calculated. The calculated costs of treatment facilities include the country location cost factor that represents the relative cost difference between two geographic locations. No personnel costs were considered in the analysis due to lack of available data. The revenue of the system is based on the sale of by-products, such as sorted materials, compost and generated energy. The selling prices of the by-products are the same as current values in the recycling and energy markets ( Table 6 ). Transportation cost and selling prices of by-products were obtained for year 2008.

(4) Environmental aspects

This study focuses on emissions directly related to the waste treatment, transportation and energy production processes within MSWMS in the target area. The Global Warming Potential (GWP) concept that assesses the possible warming effects in relation to CO 2 equivalent on the atmosphere from the emission of each gas generated has been applied in this analysis. Based on IPCC methodology [ 36 ] and Tchobanoglous and Kreigh [ 13 ], the main GHG pollutants such as CO 2 , CH 4 , and N 2 O have been evaluated.

3.4.3. System Boundaries and Major Assumptions

In order to obtain the optimal solution, the following assumptions were made in the model.

The geographical boundary of St. Petersburg set the limits for the included type of waste streams, but there are no limits to location of the processing facilities.

Current analysis is limited to the treatment of waste generated during a one year period. Constant residue rates have been set for all types of treatment technologies used in the present analysis.

The waste source separation rate of 100% has been set for all types of waste materials. In addition, the average value for the recovery factors used for material recovery facilities is assumed to be 90% [ 13 ]. It needs to be noted, that the value set for recovery factor represents the maximum available rate which can be used in this technology. However, decreasing this rate may cause an increase of energy produced from MSW or/and increase in final disposal rate.

The model assumes the average round trip transportation distance of 40 km and average cost of transportation of 2.1 USD/t/km associated with all waste treatment facilities. Waste materials accumulated in the collecting places are moved to the treatment and disposal sites using 11 tons trucks.

Another important assumption of this model is the omission of the scale effect for the waste treatment facilities.

3.5. Sensitivity Analysis

Currently, the long distance of MSW transportation is pointed out among other things as one of the major problem within waste management in Russia [ 52 , 53 ]. In order to study the performance of the proposed MSW utilization system, the changes in the distance for waste transportation have been conducted as a sensitivity analysis.

4. Results and Discussion

4.1. optimal solution for each scenario.

This section presents the results obtained from the calculation using a LP model, as well as an assessment of the 3E's aspects of the system in each scenario. For each modeling scenario the optimal solution representing designed MSWMS is calculated. The calculated results for the value of the objective function for the five different scenarios and evaluated aspects of the system are presented in Table 7 . Figure 4 shows the changes in configuration of the proposed MSWMS. Results can be interpreted as follows.

In the BAU scenario, it is assumed that there is no introduction of alternative waste treatment technologies, except existing low capacity treatment plants and landfills without LFG collection and recovery systems. Under this scenario, there is no energy production from waste and GHG emissions achieve the maximum value compared to other scenarios considered. Over 70% of waste materials generated in the target area are directly allocated to landfill site and the rest is processed in the composting and material recovery facilities ( Figure 5 ). However, more than half of the composted material finally goes to landfill, due to low quality of the produced compost [ 8 ]. The low quality of the produced compost results because of the low efficiency of the separation and sorting process and the existence of glass, plastics and heavy metal in the final product. The final disposal rate in this scenario represents almost 90% of the total MSW generated.

In order to achieve the optimal solution of the MSWMS under Low cost scenario, the majority of the waste flow (98%) is allocated between material recovery, composting and landfilling composed with LFG recovery systems. These technologies represent a central part of the designed waste management system.

The optimal system representing the best technology mix for the WTE scenario is mainly based on incineration and waste landfilling with LFG recovery. This scenario shows the complete utilization of waste for energy purposes without material recovery, except metal fractions collected from the ash.

As an alternative to waste landfilling, maximal recycling capability was introduced in the MSWMS designed under the WTR scenario. Waste flow allocated in material recovery and composting facilities represents more than 85% of total waste generated in the target area.

The design of MSWMS, with high priority given to energy produced from waste and material recycling is considered in the WTE&WTR scenario. Complete recovery of plastic, glass and metal waste, and low capacity composting facilities are introduced in this scenario. In contrast to the other designed scenarios, landfill facilities constructed with LFG recovery, represent the main WTE option.

In addition, the introduction of RDF production facilities in all designed scenarios was found to be the most economically feasible choice for treatment of waste materials, such as wood, rubber and leather.

4.2. Performance of the Designed System

In order to evaluate the sustainability of the designed MSWMS, the 3E's aspects, represented by net cost, energy and emissions generated by the system were evaluated. The BAU scenario representing the current MSWMS was used as a baseline for comparison. This scenario presents the minimal system cost (111.31 M USD/year) and a low level of revenue (2.12 M USD/year) generated from the system due to low recycling ability. As a result, the net cost of the system is high compared to the other designed scenarios. Unit treatment cost is equal to 104.45 USD/t. This scenario had the highest values of GHG emissions due to the large quota of waste landfilling without LFG recovery systems and represents 1.32 M tons of CO 2 -eq. t/year or 1.23 tons of CO 2 -eq./t. The cost of the waste management system mainly consists of transportation and treatment costs. Transportation cost is equal to 88.5 M USD/year or 80% of the total cost for waste management.

The optimal MSWMS which considers a mix of alternative waste treatment methods is represented by the Low cost scenario. This scenario with no limitation on the amount of waste for recycling and for energy generation represents the best solution or best scenario in comparison with other designed scenarios. The objective function of the best solution has a total value of 77.80 M USD/year or 72.9 USD/t. The introduction of alternative waste treatment technologies has an effect on the system cost and emissions Thus, the system cost and the unit treatment cost increase more than 15% compared to the BAU scenario and reaches values equal to 129.76 M USD/year or 121.75 USD/t. Moreover, CO 2 emissions decreased by 70% in this scenario, resulting from the improvement of recycling activities.

From an energy point of view, the best strategy is the WTE scenario, representing maximal amount of energy (1,188.25 GWh/year) produced from waste. Although the WTE scenario considers maximal utilization of waste for energy production; it does not show a significant reduction of system emissions (1.16 M tons of CO 2 -eq./year or 1.08 tons of CO 2 -eq./t). This scenario shows the highest system cost (165.78 M USD/year) and unit treatment cost (155.56 USD/t) with little environmental benefits in comparison to the BAU scenario. The energy generated from MSW may substitute fossil fuels and reduce GHG emissions resulting from energy activities. Currently, natural gas (with share of 97%) represents the main fossil fuel resource used for energy generation in the target area. The energy produced under the WTE scenario represents 2.5% of the total annually consumed energy (44,812 GWh/year) in St. Petersburg. Moreover, replacing the energy generated from fossil fuels results in a 3% decrease in GHG emissions resulting from the energy sector.

A common treatment technology used by all designed scenarios is material recovery, representing the major source of income of the proposed system. The WTR scenario with a high level of materials recovery shows the highest amount of revenues from the sale of recycled materials equal to 53.29 M USD/year. In terms of CO 2 emissions, results obtained from this scenario showed that the introduction of a high recycling rate ultimately reduces GHG emissions up to 0.15 M tons CO 2 -eq./year. This result was obtained by considering several assumptions related to the waste collection and separation, and represents an unrealistic scenario compared with the present situation in St. Petersburg. Currently, the selective collection of MSW is not well organized in the target area, however there are several programs coordinated by the municipality, and improvement of the source separation of waste is expected. In addition, changes in policy, the improvement of the recycling efficiency of treatment facilities, and the improvement of households with regard to recycling processes could achieve feasible goals. Due to the lack of suitable data associated with the types and composition of waste materials generated in St. Petersburg, compensative effects, such as substitution of raw materials, resulting from the recovery of waste materials has not been considered in the present analysis.

The targets set for the WTE&WTR scenario are close to the real targets which can be set in St. Petersburg in order to solve the current waste management problem. Figure 6 illustrates waste material flow and energy flow of the optimal MSWMS, designed for the WTE&WTR scenario while considering the introduction of regulation constraints for waste utilization. More than 60% of total waste generated in the target area is allocated to landfilling with a LFG recovery system. The rest of the waste materials are allocated between recycling, RDF and composting facilities. The results of this scenario show that due to low market price, recycling of waste paper is not an economically favorable option. In this scenario, the landfill site plays a significant negative role as a main contributor of GHG emissions generated by the designed MSWMS. Based on the assumption that only 45% of LFG produced is effectively recovered, the remaining 55% is released into the atmosphere. CO 2 emissions generated by landfill sites represent over 90% of total emissions (0.83 M tons of CO 2 -eq./year) produced by the system. Compared to other designed scenarios, this scenario represents the minimal system costs (127.92 M USD/year) and unit treatment cost (120.02 USD/t).

According to the calculation results, transportation costs consume the largest portions of the total cost of the proposed MSW utilization system. From the sensitivity analysis of the best scenario (Low cost), it can be seen that changes in waste transportation distance have a significant effect on the cost of the proposed MSW system ( Figure 7 ). Moreover, it can be concluded from the results that the increase of the waste transportation distance will result in a decrease of the system revenue and growth of the final disposal rate due to reduction of recycling activity. For example, if the waste transportation distance increases by 10 km, the final disposal rate grows sharply by more than double. On the other hand, smaller distances for waste transportation, resulted in the growth of the waste recycling rate, and a decrease in waste to energy and final disposal rates ( Figure 8 ).

Introduction of new waste treatment technologies would reduce the total system emissions. All developed scenarios give a significant reduction of GHG compared to the BAU scenario. The best way to achieve maximum GHG reductions (more than 50%) from the system is to apply the WTR scenario based on the assumption that the maximum amount of waste is recycled, with a high recycling rate at more than 80%. This effect is due to the reduced emissions of LFG from landfills. From an economic point of view, the WTR and Low cost scenarios allow the highest revenue from the sale of the by-products generated from the waste treatment process. Finally, the optimal balance between the amount of waste allocated to energy production and recycling can be achieved in the WTE&WTR scenario. The achieved results demonstrate that the presence of an LFG recovery system, as a WTE treatment option, has a significant influence on the modeling results. As an alternative to landfill, anaerobic digestion systems and incineration were not included in the technology mix calculated in the model. One of the possible reasons is the high cost compared to other waste treatment technologies. In order to introduce such a technology, additional financial instruments or policies have to be implemented, such as landfill tax, or carbon tax. Due to the low price of electricity generated from fossil fuels, the results of the study show that the energy recovery from waste in the form of electricity is not involved in the optimal solution for the designed MSWMS.

5. Conclusions

In this research, the municipal solid waste management system in St. Petersburg has been modeled while considering the introduction of alternative waste treatment facilities. The model has been solved using the GAMS software.

This study indicates that an increase of alternative MSW treatment options gives positive energy, and economical and environmental benefits compared with the present MSWMS.

Recycling of the MSW was the main waste processing option in the model results. Introduction of recycling is an appropriate solution to manage the increasing amount of waste generated by society. Theoretically the consumers may be motivated to increase the source separation rate of MSW if forced to pay for each kg of waste. However, because of a lack of equipped collection places for separated waste materials this does not currently seem realistic in St. Petersburg or other Russian regions [ 54 ]. Another way to involve the population in the waste separation process is the introduction of customer benefits, such as introducing low collection and transportation fees for completely separated waste. Incentives, such as the introduction of financial support to stimulate the development of markets for recovered materials with more stable market prices, could also increase recycling rates.

Heat generated from waste treatment processes was the most optimal energy carrier according to the results of the calculation as it was assumed in this study, the heat generated from waste is supplied to DHS because of the existing heat transfer network. However, in Russia however, typical district heating distribution for space heating is operational for only part of the year from October to April [ 55 ]. During the summer period, the heat generated from MSW could be used for water heating. This would then bring an additional benefit due to reduction of GHG emissions generated from the consumption of fossil fuels.

The main limitation of this paper is the quality of input data. The actual optimal solution can be reached only with highly detailed data for the target area. The results of the presented model are based on some assumptions in the absence of the available data, such as waste composition, heating values, and waste transportation distance. This could change with more accurate data. In addition, consideration of compensative effects related to material recycling and energy production from waste may have a strong influence on the output results of the model.

For further research on MSW management in other regions of Russia, the model can be easily modified to meet local conditions; however the model accuracy is directly proportional to the set of detailed input data. Regional differences, such as climatic conditions, location, urbanization rate, waste compositions, transportation distance, and existence of markets for by-products, are an important feature of the designed system. In order to design an optimal MSW utilization system in other regions of Russia, regional differences must be considered as a major feature of the system.

Click here to enlarge figure

Sources: (a) [ 11 ]; (b) [ 12 ]; (c) [ 8 ].

Sources: [ 37 - 41 ].

Sources: (a) [ 13 ]; (b) [ 36 ]; (c) [ 25 ].

CRF = [i (1 + i) n]/[(1 + i) n − 1]; Operation life = 25 years, Discount rate = 11%; Thermal efficiency = 70%; Electrical efficiency = 20%; Heat losses = 15%; Electricity distribution losses = 10%; HVRDF = 12 MJ/kg; HVbiogas = 21 MJ/m3; HVLFG = 17.7 MJ/m3; Biogas collection efficiency =100%; LFG collection efficiency = 45%; Cost location factor = 1.47 (2007 year); Sources: [ 13 , 25 , 41 , 46 ].

Sources: (a) [ 40 ]; (b) [ 47 ]; (c) [ 48 ]; (d) [ 49 ]; (e) [ 50 ]; (f) [ 51 ]

Acknowledgments

The authors are thankful to the anonymous reviewers for the valuable comments and time allocated for revising this paper. Mikhail Rodionov is grateful to the Japanese Ministry of Education, Culture, Sports, Science and Technology for the financial support provided through his scholarship program.

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© 2011 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).

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Rodionov, M.; Nakata, T. Design of an Optimal Waste Utilization System: A Case Study in St. Petersburg, Russia. Sustainability 2011 , 3 , 1486-1509. https://doi.org/10.3390/su3091486

Rodionov M, Nakata T. Design of an Optimal Waste Utilization System: A Case Study in St. Petersburg, Russia. Sustainability . 2011; 3(9):1486-1509. https://doi.org/10.3390/su3091486

Rodionov, Mikhail, and Toshihiko Nakata. 2011. "Design of an Optimal Waste Utilization System: A Case Study in St. Petersburg, Russia" Sustainability 3, no. 9: 1486-1509. https://doi.org/10.3390/su3091486

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• Published: 26 August 2024

Solid health care waste management practice in Ethiopia, a convergent mixed method study

• Yeshanew Ayele Tiruneh 1 ,
• L. M. Modiba 2 &
• S. M. Zuma 2  

BMC Health Services Research volume  24 , Article number:  985 ( 2024 ) Cite this article

31 Accesses

Metrics details

Introduction

Healthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods.

This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town.

A mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town.

Seventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ‘‘ the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market’’ . The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus.

Hand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.

Peer Review reports

Healthcare waste (HCW) encompasses all types of waste generated while providing health-related services, spanning activities such as diagnosis, immunization, treatment, and research. It constitutes a diverse array of materials, each presenting potential hazards to health and the environment. Within the realm of HCW, one finds secretions and excretions from humans, cultures, and waste containing a stock of infectious agents. Discarded plastic materials contaminated with blood or other bodily fluids, pathological wastes, and discarded medical equipment are classified as healthcare waste. Sharps, including needles, scalpels, and other waste materials generated during any healthcare service provision, are also considered potentially hazardous to health [ 1 ].

Healthcare waste in solid form (HCW) is commonly divided into two primary groups: infectious and non-infectious. The existence of pathogens in concentrations identifies infectious waste or amounts significant enough to induce diseases in vulnerable hosts [ 1 ] If healthcare facility waste is free from any combination with infectious agents, nearly 85% is categorized as non-hazardous waste, exhibiting characteristics similar to conventional solid waste found in households [ 2 ]. World Health Organization (WHO) recommends that appropriate colour-coded waste receptacles be available in all medical and other waste-producing areas [ 3 ].

Solid waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Improper disposal of sharps waste increases the risk of disease transmission among health facility workers and general populations [ 1 ]. Inadequate and inappropriate handling of healthcare waste may have serious public health consequences and a significant environmental impact. The World Health Organization (2014) guidelines also include the following guidance for hand washing and the use of alcohol-based hand rubs: Wash hands before starting work, before entering an operating theatre, before eating, after touching contaminated objects, after using a toilet, and in all cases where hands are visibly soiled [ 4 ].

Among the infectious waste category, sharps waste is the most hazardous waste because of its ability to puncture the skin and cause infection [ 3 ]. Accidents or occurrences, such as near misses, spills, container damage, improper waste segregation, and incidents involving sharps, must be reported promptly to the waste management officer or an assigned representative [ 5 ].

Africa is facing a growing waste management crisis. While the volumes of waste generated in Africa are relatively small compared to developed regions, the mismanagement of waste in Africa already impacts human and environmental health. Infectious waste management has always remained a neglected public health problem in developing countries, resulting in a high burden of environmental pollution affecting the general masses. In Ethiopia, there is no updated separate regulation specific to healthcare waste management in the country to enforce the proper management of solid HCW [ 6 ].

In Ethiopia, like other developing countries, healthcare waste segregation practice was not given attention and did not meet the minimum HCWM standards, and it is still not jumped from paper. Previous study reveals that healthcare waste generation rates are significantly higher than the World Health Organization threshold, which ranges from 29.5–53.12% [ 7 , 8 ]. In Meneilk II Hospital, the proportion of infectious waste was 53.73%, and in the southern and northern parts of Ethiopia, it was 34.3 and 53%, respectively. Generally, this figure shows a value 3 to 4 times greater than the threshold value recommended by the World Health Organization [ 7 ].

Except for sharp wastes, segregation practice was poor, and all solid wastes were collected without respecting the colour-coded waste disposal system [ 9 ]. The median waste generation rate was found to vary from 0.361- 0.669 kg/patient/day, comprising 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated increased as the number of patients flow increased. Public hospitals generated a high proportion of total healthcare waste (59.22%) in comparison with private hospitals (40.48) [ 10 ]. The primary SHCW treatment and disposal mechanism was incineration, open burning, burring into unprotected pits and open dumping on municipal dumping sites as well as in the hospital backyard. Carelessness, negligence of the health workers, patients and cleaners, and poor commitment of the facility leaders were among the major causes of poor HCWM practice in Ethiopia [ 9 ]. This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia.

The setting for this study was all health facilities found in Hossaena town, which is situated 232 kms from the capital city of Ethiopia, Addis Ababa, and 165 kms from the regional municipality of Hawasa. The health facilities found in the town were one university hospital, one private surgical centre, three government health centres, 17 medium clinics, and 19 small clinics were available in the city and; health facility workers who have direct contact with generating and disposal of HCW and those who are responsible as a manager of health facilities found in Hossaena town are the study settings. All health facilities except drug stores and health facility workers who have direct contact with healthcare waste generation participated in this study.

A mixed-method study design was used. For the quantitative part of this study, all healthcare workers who have direct contact with healthcare waste management practice participated in this study, and one focus group discussion from each health facility was used. Both of the study participants were taken from the same population. All health facility workers who have a role in healthcare waste management practice were included in the quantitative part of this study. The qualitative data collection phase used open-ended interviews, focus group discussions, and visual material analysis like posters and written materials. All FGDs were conducted by the principal investigator, one moderator, and one note-taker, and it took 50 to 75 min. 4–6 participants participated in each FGD.

According to Elizabeth (2018: 5), cited by Creswell and Plano (2007: 147), the mixed method is one of the research designs with philosophical assumptions as well as methods of inquiry. As a method, it focuses on collecting, analyzing, and mixing both quantitative and qualitative data in a single study. As a methodology, it involves philosophical assumptions guiding the direction of the collection and analysis and combining qualitative and quantitative approaches in many phases of the research project. The central premise is that using qualitative and quantitative approaches together provides a better understanding of the research problems than either approach alone.

The critical assumption of the concurrent mixed methods approach in this study is that quantitative and qualitative data provide different types of information, often detailed views of participants’ solid waste management practice qualitatively and scores on instruments quantitatively, and together, they yield results that should be the same. In this approach, the researcher collected quantitative and qualitative data almost simultaneously and analyzed them separately to cross-validate or compare whether the findings were similar or different between the qualitative and quantitative information. Concurrent approaches to the data collection process are less time-consuming than other types of mixed methods studies because both data collection processes are conducted on time and at the same visit to the field [ 11 ].

Data collection

The data collection involves collecting both quantitative and qualitative data simultaneously. The quantitative phase of this study assessed three components. Health care waste segregation practice, the availability of waste segregation equipment for HCW segregation, temporary storage facilities, transportation for final disposal, and disposal facilities data were collected using a structured questionnaire and observation of HCW generation. Recycling or re-using practice, waste treatment, the availability of the HCWM committee, and training data were collected.

Qualitative data collection

The qualitative phase of the data collection for this study was employed by using focus group discussions and semi-structured interviews about SHCWMP. Two focus group discussions (FGD) from each health facility were conducted in the government health facilities, one at the administrative level and one at the technical worker level, and one FGD was conducted for all private health facilities because of the number of available health facility workers. Each focus group has 4–6 individuals.

In this study, the qualitative and the quantitative data provide different information, and it is suitable for this study to compare and contrast the findings of the two results to obtain the best understanding of this research problem.

Quantitative data collection

The quantitative data were entered into Epi data version 3.1 to minimize the data entry mistakes and exported to the statistical package for social science SPSS window version 27.0 for analysis. A numeric value was assigned to each response in a database, cleaning the data, recoding, establishing a codebook, and visually inspecting the trends to check whether the data were typically distributed.

Data analysis

Data were analyzed quantitatively by using relevant statistical tools, such as SPSS. Descriptive statistics and the Pearson correlation test were used for the bivariate associations and analysis of variance (ANOVA) to compare the HCW generation rate between private and government health facilities and between clinics, health centres and hospitals in the town. Normality tests were performed to determine whether the sample data were drawn from a normally distributed population.

The Shapiro–Wilk normality tests were used to calculate a test statistic based on the sample data and compare it to critical values. The Shapiro–Wilk test is a statistical test used to assess whether a given sample comes from a normally distributed population. The P value greater than the significance level of 0.05 fails to reject the null hypothesis. It concludes that there is not enough evidence to suggest that the data does not follow the normal distribution. Visual inspection of a histogram, Q-Q plot, and P-P plot (probability-probability plot) was assessed.

Bivariate (correlation) analysis assessed the relationships between independent and dependent variables. Then, multiple linear regression analysis was used to establish the simple correlation matrices between different variables for investigating the strength relationships of the study variables in the analysis. In most variables, percentages and means were used to report the findings with a 95% confidence interval. Open-ended responses and focused group findings were undertaken by quantifying and coding the data to provide a thematic narrative explanation.

Appropriate and scientific care was taken to maintain the data quality before, during, and after data collection by preparing the proper data collection tools, pretesting the data collection tools, providing training for data collectors, and proper data entry practice. Data were cleaned on a daily basis during data collection practice, during data entry, and before analysis of its completeness and consistency.

Data analysis in a concurrent design consists of three phases. First, analyze the quantitative database in terms of statistical results. Second, analyze the qualitative database by coding the data and collapsing the codes into broad themes. Third comes the mixed-method data analysis. This is the analysis that consists of integrating the two databases. This integration consists of merging the results from both the qualitative and the quantitative findings.

Descriptive analysis was conducted to describe and summarise the data obtained from the samples used for this study. Reliability statistics for constructs, means and modes of each item, frequencies and percentage distributions, chi-square test of association, and correlations (Spearman rho) were used to portray the respondents’ responses.

All patient care-providing health facilities were included in this study, and the generation rate of healthcare waste and composition assessed the practice of segregation, collection, transportation, and disposal system was observed quantitatively using adopted and adapted structured questionnaires. To ensure representativeness, various levels of health facilities like hospitals, health centres, medium clinics, small clinics and surgical centres were considered from the town. All levels of health facilities are diagnosing, providing first aid services and treating patients accordingly.

The hospital and surgical centre found in the town provide advanced surgical service, inpatient service and food for the patients that other health facilities do not. The HCW generation rate was proportional to the number of patients who visited the health facilities and the type of service provided. The highest number of patients who visited the health facilities was in NEMMCSH; the service provided was diverse, and the waste generation rate was higher than that of other health facilities. About 272, 18, 15, 17, and 20 average patients visited the health facilities daily in NEMMCSH: government health centres, medium clinics, small clinics, and surgical centres. Paper and cardboard (141.65 kg), leftover food (81.71 kg), and contaminated gloves (42.96 kg) are the leading HCWs generated per day.

A total of 556 individual respondents from sampled health facilities were interviewed to complete the questionnaire. The total number of filled questionnaires was 540 (97.1) from individuals representing these 41 health facilities.

The principal investigator observed the availability of handwashing facilities near SHCW generation sites. 17(3.1%) of health facility workers had hand washing facilities near the health care waste generation and disposal site. Furthermore,10 (3.87%), 2 (2.1%), 2 (2.53%), 2 (2.1%), 1 (6.6%) of health facility workers had the facility of hand washing near the health care waste generation site in Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH), government health centres, medium clinics, small clinics, and surgical centre respectively. This finding was nearly the same as the study findings conducted in Myanmar; the availability of hand washing facilities near the solid health care waste generation was absent in all service areas [ 12 ]. The observational result was convergent with the response of facility workers’ response regarding the availabilities of hand washing facilities near to the solid health care waste generation sites.

The observational result was concurrent with the response of facility workers regarding the availability of hand-washing facilities near the solid health care waste generation sites.

The availability of personal protective equipment (PPE) was checked in this study. Three hundred ninety-two (72.6%) of the respondents agree on the facility’s availability of one or more personal protective equipment (PPE). The availability of PPEs in different levels of health facilities shows 392 (72.6%), 212 (82.2%), 56 (58.9%), 52 (65.8%), 60 (65.2%), 12 (75%) health facility workers in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively agree to the presence of personal protective equipment in their department. The analysis further shows that the availability of masks for healthcare workers was above the mean in NEMMCSH and surgical centres.

Focus group participants indicated that health facilities did not volunteer to supply Personal protective equipment (PPEs) for the cleaning staff.

“We cannot purchase PPE by ourselves because of the salary paid for the cleaning staff.”

Cost inflation and the high cost of purchasing PPEs like gloves and boots are complained about by all (41) health facility owners.

“the reason for the absence of some of the PPEs like boots, goggles, and shortage of disposable gloves are owing to cost inflation from time to time and sometimes absent from the market is the reason why we do not supply PPE to our workers.”

Using essential personal protective equipment (PPEs) based on the risk (if the risk is a splash of blood or body fluid, use a mask and goggles; if the risk is on foot, use appropriate shoes) is recommended by the World Health Organization [ 13 ]. The mean availability of gloves in health facilities was 343 (63.5% (95% CI: 59.3–67.4). Private health institutions are better at providing gloves for their workers, 67.1%, 72.8%, and 62.5% in medium clinics, small clinics, and surgical centres, respectively, which is above the mean.

Research participants agree that.

‘‘ there is a shortage of gloves to give service in Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital (NEMMCSH) and government health centres .’’

Masks are the most available personal protective equipment for health facility workers compared to others. 65.4%, 55.6%, and 38% of the staff are available with gloves, plastic aprons and boots, respectively.

The mean availability of masks, heavy-duty gloves, boots, and aprons was 71.1%, 65.4%, 38%, and 44.4% in the study health facilities. Health facility workers were asked about the availability of different personal protective equipment, and 38% of the respondents agreed with the presence of boots in the facility. Still, the qualitative observational findings of this study show that all health facility workers have no shoes or footwear during solid health care waste management practice.

SHCW segregation practice was checked by observing the availability of SHCW collection bins in each patient care room. Only 4 (1.7%) of the room’s SHCW bins are collected segregated (non-infectious wastes segregated in black bins and infectious wastes segregated in yellow bins) based on the World Health Organization standard. Colour-coded waste bins, black for non-infectious and yellow for infectious wastes, were available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. Only 6.7% of the waste bins were pedal operated and adequately covered, and the rest were fully opened, or a tiny hole was prepared on the container’s cover. All of the healthcare waste disposal bins in each health facility and at all service areas were away from the arm’s reach distance of the waste generation places, and this is contrary to World Health Organization SHCWM guidelines [ 13 ]. The observation result reveals that the reason for the above result was that medication trolleys were not used during medication or while healthcare providers provided any health services to patients.

Most medical wastes are incinerated. Burning solid and regulated medical waste generated by health care creates many problems. Medical waste incinerators emit toxic air pollutants and ash residues that are the primary source of environmental dioxins. Public concerns about incinerator emissions and the creation of federal regulations for medical waste incinerators are causing many healthcare facilities to rethink their choices in medical waste treatment. Health Care Without Harm [ 14 ], states that non-incineration treatment technologies are a growing and developing field. The U.S. National Academy of Science 2000 argued that the emission of pollutants during incineration is a potential risk to human health, and living or working near an incineration facility can have social, economic, and psychological effects [ 15 ].

The incineration of solid healthcare waste technology has been accepted and adopted as an effective method in Ethiopia. Incineration of healthcare waste can produce secondary waste and pollutants if the treatment facilities are not appropriately constructed, designed, and operated. It can be one of the significant sources of toxic substances, such as polychlorinated dibenzo-dioxins/dibenzofurans (PCDD/ PCDF), polyvinyl chloride (PVC), hexachlorobenzenes and polychlorinated biphenyls, and dioxins and furans that are known as hazardous pollutants. These pollutants may have undesirable environmental impacts on human and animal health, such as liver failure and cancer [ 15 , 16 ].

All government health facilities (4 in number) used incineration to dispose of solid waste. 88.4% and 100% of the wastes are incinerated in WUNEMMCSH and government health centres. This finding contradicts the study findings in the United States of America and Malaysia, in which 49–60% and 59–60 were incinerated, respectively, and the rest were treated using other technologies [ 15 , 16 ].

World Health Organization (2014:45) highlighted those critical elements of the appropriate operation of incinerators include effective waste reduction and waste segregation, placing incinerators away from populated areas, satisfactory engineered design, construction following appropriate dimensional plans, proper operation, periodic maintenance, and staff training and management are mandatory.

Solid waste collection times should be fixed and appropriate to the quantity of waste produced in each area of the health care facility. General waste should not be collected simultaneously or in the same trolley as infectious or hazardous wastes. The collection should be done daily for most wastes, with collection timed to match the pattern of waste generation during the day [ 13 ].

SHCW segregation practices were observed for 240 rooms in 41 health facilities that provide health services in the town. In government health centres, medium clinics, small clinics, and surgical centres, SHCW segregation practice was not based on the World Health Organization standard. All types of solid waste were collected in a single container near the generation area, and there were no colour-coded SHCW storage dust bins. Still, in NEMMCSH, in most of the service areas, colour-coded waste bins are available, and the segregation practice was not based on the standard. Only 3 (10%) of the dust bins collected the appropriate wastes according to the World Health Organization standard, and the rest were mixed with infectious and non-infectious SHCW.

Table 1 below shows health facility managers were asked about healthcare waste segregation practices, and 9 (22%) of the facility leaders responded that there is an appropriate solid healthcare waste segregation practice in their health facilities. Still, during observation, only 4 (1.7%) of the rooms in two (4.87%) of the facilities, SHCW bins collected the segregated wastes (non-infectious wastes segregated at the black bin and infectious wastes segregated at yellow bin) based on the world health organization standard. The findings of this study show there is a poor segregation practice, and all kinds of solid wastes are collected together.

In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. During observation in one of the study health facilities, infectious wastes were not collected daily and left for days. Utility gloves, boots, and aprons are not available for cleaning staff to collect and transport solid healthcare wastes in all study health facilities. 29.26% of the facilities’ cleaning staff have a face mask, and 36.5% of the facilities remove waste bins from the service area when 3/4 full, and the rest were not removed or replaced with new ones. There is a separate container only in 2 health facilities for infectious and non-infectious waste segregation practice, and the rest were segregated and collected using single and non-colour coded containers.

At all of the facilities in the study area, SHCW was transported from the service areas to the disposal site were transported manually by carrying the collection container and there is no trolley for transportation. This finding was contrary to the study findings conducted in India, which show segregated waste from the generation site was being transported through the chute to the carts placed at various points on the hospital premises by skilled sanitary workers [ 17 ].

Only 2 out of 41 health facilities have temporary solid waste storage points at the facility. One of the temporary storage places was clean, and the other needed to be properly cleaned and unsightly. Two (100%) of the temporary storage areas are not fenced and have no restriction to an authorized person. Temporary storage areas are available only in two health facilities that are away from the service provision areas.

Observational findings revealed that pre-treatment of SHCW before disposal was not practised at all study health facilities. 95% of the facilities have no water supply for hand washing during and after solid healthcare waste generation, collection, and disposal.

The United States Agency estimated sharp injuries from medical wastes to health professionals and sanitary service personnel for toxic substances and disease registry. Most of the injuries are caused during the recapping of hypodermic needles before disposal into sharps containers [ 13 ]. Nearly half of the respondents, 245 (51.5%), are recapping needles after providing an injection to the patient. Recapping was more practised in NEMMCSH and surgical centres, which is 57.5% and 57.5%, respectively. In government health centres, medium clinics, and surgical centres, the recapping of used needles was practised below the mean, which is 47.9%, 48, and 43.8%, respectively. This finding was reasonable compared to the study findings of Doylo et al. [ 18 ] in western Ethiopia, where 91% of the health workers are recapping needles after injection [ 18 ]. The research finding shows that there is no significant association P-value of 0.82 between the training and recapping of needles after injection.

Focus group participants ’ response for appropriate SHCWMP regarding patients ’ and visitors ’ lack of knowledge on SHCW segregation practice

“The personal responsibilities of patients and visitors on solid HCW disposal should be explained to help appropriate safe waste management practice and maintain good hygiene .” “Providing waste management training and creating awareness are the two aspects of improving SHCW segregation practice.” “Training upgrades and creates awareness on hygiene for all workers.”

Sharp waste collection practices were observed in 240 rooms in the study health facilities, and 9.2% of the rooms used disposable sharp containers.

Sixty per cent (60%), 13.3%, 8.24%, and 15.71% of the sharps containers in NEMMCSH, government health centres, medium clinics, and small clinics, respectively, were using disposable sharps containers; sharps were disposed together with the sharps container, and surgical centre was using reusable sharp collection container. All disposable sharps containers in medium and small clinics used non-puncture-resistant or simple packaging carton boxes. 60% and 13.3% of the disposable sharps containers in NEMMCSH and the government health centre use purposefully manufactured disposable safety boxes.

Needle sticks injury reporting and occurrence

A total of 70 injuries were reported to the health facility manager in the last one year, and 44 of the injuries were reported by health professionals. The rest of the injuries were reported by supportive staff. These injuries were reported from 35 health facilities, and the remaining six health facilities did not report any cases of injury related to work; see Tables 2 and 3 below.

Accidents or incidents, including near misses, spillages, damaged containers, inappropriate segregation, and any incidents involving sharps, should be reported to the waste-management officer. Accidental contamination must be notified using a standard-format document. The cause of the accident or incident should be investigated by the waste-management officer (in case of waste) or another responsible officer, who should also take action to prevent a recurrence [ 13 ]. Two hundred seventy-one (50.2% (CI: 45.7–54.6) of the respondents agree that satisfactory procedures are available in case of an accident, while the remaining 269 (49.8%( CI: 45.4–54.3) of respondents do not agree on the availability of satisfactory procedures in case of an accident, see Table  4 below. The availability of satisfactory procedures in case of an accident is above the mean in medium clinics, which is 60.8%. 132(24.4%) of the staff are pricked by needle stick injury while providing health services. Nearly half of the respondents, 269 (49.8%), who have been exposed to needle stick injury do not get satisfactory procedures after being pricked by a needle, and those who have not been stung by a needle stick injury for the last year. 204 (37.8%) disagree with the presence of satisfactory procedures in the case of a needle stick injury. In NEMMCSH, 30.2% of the research participants were pricked by needle stick injury within one year of period, and 48.8% of those who were stung by needle stick injuries did not agree upon the presence of satisfactory procedures in case of needle stick injuries in the study hospital. 17.9% and 49.5%, 24.1% and 60.8%, 7.6% and 50% of the respondents are pricked by needle sticks, and they disagree on the availability of satisfactory procedures in case of accidents, respectively, in government health centres, medium clinics, small clinics, and surgical centre respectively.

One hundred seventy-seven (32.7% (CI:29.1–37) respondents were exposed to needle stick injury while working in the current health facilities. One hundred three (58.1%) and 26 (32.9%) needle stick injuries were reported from WUNEMMCSH and medium clinics, which is above the mean. One hundred thirty-two(24.7% (95%CI:20.7–28.1) of the respondents are exposed to needle stick injury within one year of the period. Seventy-eight(30.2%), 17 (17.9%), 19 (24.1%), 15 (16.3%), 3 (18.8%) of the staff are injured by needle sticks from NEMMCSH, government health centres, medium clinics, small clinics, and surgical centre staffs respectively within one year of service.

The mean availabilities of satisfactory procedures in case of accidents were 321 (59.4% (CI:55.4–63.7). Out of this, 13.7% of the staff is injured by needle sticks within one year before the survey. Except in NEMMCSH, the mean availabilities of satisfactory procedures were above the mean, which is 50%, 60%, 77.2%, 66.3%, and 81.3% in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively.

Table 5 below shows that Hepatitis B, COVID-19, and tetanus toxoid vaccinations are the responses of the research participants to an open-ended question on which vaccine they took. The finding shows that 220 (40.8%) of the respondents were vaccinated to prevent themselves from health facility-acquired infection. One hundred fifty-six (70.9%) of the respondents are vaccinated to avoid themselves from Hep B infection. Fifty-nine (26%0.8) of the respondents were vaccinated to protect themselves from two diseases that are Hep B and COVID-19.

Appropriate health care waste management practice was assessed by using 12 questions: availability of colour-coded waste bins, foot-operated dust bins, elbow or foot-operated hand washing basin, personal protective equipment, training, role and responsibility of the worker, the presence of satisfactory procedures in case of an accident, incinerator, vaccination, guideline, onsite treatment, and the availability of poster. The mean of appropriate healthcare waste management practice was 55.58%. The mean of solid health care waste management practice based on the level of health facilities was summed and divided into 12 variables to get each health facility’s level of waste management practice. 64.9%, 45.58%, 49%, 46.9%, and 51.8% are the mean appropriate health care waste management practices in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres, respectively. In NEMMCSH, the practice of solid healthcare waste management shows above the mean, and the rest was below the mean of solid healthcare waste management practice.

Healthcare waste treatment and disposal practice

Solid waste treatment before disposal was not practised at all study health facilities. There is an incineration practice at all of the study health facilities, and the World Health Organization 2014 recommended three types of incineration practice for solid health care waste management: dual-chamber starved-air incinerators, multiple chamber incinerators, and rotary kilns incinerators. Single-chamber, drum, and brick incinerators do not meet the best available technique requirements of the Stockholm Convention guidelines [ 13 ]. The findings of this study show that none of the incinerators found in the study health facilities meet the minimum standards of solid healthcare waste incineration practice, and they need an air inlet to facilitate combustion. Eleven (26.82%) of the health facilities have an ash pit to dispose of burned SHCW; the majority, 30 (73.17%), dispose of the incinerated ash and burned needles in the municipal waste disposal site. In one out of 11 health facilities with an ash pit, one of the incinerators was built on the ash pit, and the incinerated ashes were disposed of in the ash pit directly. Pre-treatment of SHCW before disposal was not practised at all health facilities; see Table  6 below.

All government health facilities use incineration to dispose of solid waste. 88.4% and 100% of the solid wastes are incinerated in WUNEMMCS Hospital and government health centres, respectively. This finding was not similar to the other studies because other technologies like autoclave microwave and incineration were used for 59–60% of the waste [ 15 ]. Forty-one (100%) of the study facilities were using incinerators, and only 5 (12.19%) of the incinerators were constructed by using brick and more or less promising than others for incinerating the generated solid wastes without considering the emitting gases into the atmosphere and the residue chemicals and minerals in the ashes.

Research participants’ understanding of the environmental friendliness of health care waste management practice was assessed, and the result shows that more than half, 312(57%) of the research participants do not agree on the environmental friendliness of the waste disposal practices in the health facilities. The most disagreement regarding environmental friendliness was observed in NEMMCSH; 100 (38.8%) of the participants only agreed the practice was environmentally friendly of the service. Forty-four (46.3%), 37 (46.8%), 40 (43.5%), and 7 (43.8%) of the participants agree on the environmental friendliness of healthcare waste management practice in government health centres, medium clinics, small clinics, and surgical centres, respectively.

One hundred twenty-five (48.4%) and 39(42.4%) staff are trained in solid health care waste management practice in NEMMCSH and small clinic staff, respectively; this result shows above the mean. Twenty-seven (28.4%), 30 (38%), and 4 (25%) of the staff are trained in health care waste management practice in Government health centres, medium clinics, and surgical centres, respectively. The training has been significantly associated with needle stick injury, and the more trained staff are, the less exposed to needle stick injury. One hundred ninety-six (36.4%) of the participants answered yes to the question about the availability of trainers in the institution. 43.8% of the NEMMCSH staff agreed on the availability of trainers on solid health care waste management, which is above the mean, and 26.3%, 31.6%, 31.5%, and 25% for the government health centres, medium clinics, small clinics, and surgical centre respectively, which is below the mean.

Trained health professionals are more compliant with SHCWM standards, and the self-reported study findings of this study show that 41.7% (95%CI:37.7–46) of the research participants are trained in health care waste management practice. This finding was higher compared to the study findings of Sahiledengle in 2019 in the southeast of Ethiopia, shows 13.0% of healthcare workers received training related to HCWM in the past one year preceding the study period and significantly lower when compared to the study findings in Egypt which is 71% of the study participants were trained on SHCWM [ 8 , 19 , 20 ].

Three out of four government health facility leaders, 17 (45.94%) of private health facility leaders/owners of the clinic and 141 FGD participants complain about the absence of some PPEs like boots and aprons to protect themselves from infectious agents.

‘ ‘Masks, disposable gloves, and changing gowns are a critical shortage at all health facilities.’’

Cleaners in private health facilities are more exposed to infectious agents because of the absence of personal protective equipment. Except for the cleaning staff working in the private surgical centre, all cleaning staff 40 (97.56) of the health facilities complain about the absence of changing gowns and the fact that there are no boots in the facilities.

Cost inflation and the high cost of purchasing PPEs like gloves and boots are complained by all of (41) the health facility owners and the reason for the absence of some of the PPEs like boots, goggles, and shortage of disposable gloves. Sometimes, absence from the market is the reason why we do not supply PPE to our workers.

Thirty-four (82.92%) of the facility leaders are forwarded, and there is a high expense and even unavailability of some of the PPEs, which are the reasons for not providing PPEs for the workers.

‘‘Medical equipment and consumables importers and whole sellers are selective for importing health supplies, and because of a small number of importers in the country and specifically, in the locality, we can’t get materials used for health care waste management practice even disposable gloves. ’’

One of the facility leaders from a private clinic forwarded that before the advent of COVID-19 -19) personal protective equipment was more or less chip-and-get without difficulty. Still, after the advent of the first Japanese COVID-19 patient in Ethiopia, people outside the health facilities collect PPEs like gloves and masks and storing privately in their homes.

‘‘PPEs were getting expensive and unavailable in the market. Incinerator construction materials cost inflation, and the ownership of the facility building are other problems for private health facilities to construct standard incinerators.’’

For all of the focus group discussion participants except in NEMMCSH and two private health facilities, covered and foot-operated dust bins were absent or in a critical shortage compared to the needed ones.

‘‘ Waste bins are open and not colour-coded. The practice attracts flies and other insects. Empty waste bins are replaced without cleaning and disinfecting by using chlorine solution.’’ “HCW containers are not colour-coded, but we are trying to label infectious and non-infectious in Amharic languages.”

Another issue raised during focus group discussions is incineration is not the final disposal method. It needs additional disposal sites, lacks technology, is costly to construct a brick incinerator, lacks knowledge for health facility workers, shortage of man powers /cleaners, absence of environmental health professionals in health centres and all private clinics, and continues exposure to the staff for needle stick injury, foully smell, human scavengers, unsightly, fire hazard, and lack of water supply in the town are the major teams that FGD participants raise and forwarded the above issue as a problem to improve SHCWMP.

Focus group participants, during the discussion, raised issues that could be more comfortable managing SHCWs properly in their institution. Two of the 37 private health facilities are working in their own compound, and the remaining 35 are rented; because of this, they have difficulty constructing incinerators and ash removal pits and are not confident about investing in SHCWM systems. Staff negligence and involuntary abiding by the rules of the facilities were raised by four of the government health facilities, and it was difficult to punish those who violated the healthcare waste management rules because the health facility leaders were not giving appropriate attention to the problem.

Focus group participants forwarded recommendations on which interventions can improve the management of SHCW, and recommendations are summarised as follows:

“PPE should be available in quality and quantity for all health facility workers who have direct contact with SHCW.” “Scientific-based waste management technologies should be availed for health facilities.” “Continuous induction HCW management training should be provided to the workers. Law enforcement should be strengthened.” “Communal HCW management sites should be availed, especially for private health facilities.” “HCWM committee should be strengthened.” “Non-infectious wastes should be collected communally and transported to the municipal SHCW disposal places.” “Leaders should be knowledgeable on the SHCWM system and supervise the practice continuously.” “Patient and client should be oriented daily about HCW segregation practice.” “Regulatory bodies should supervise the health facilities before commencing and periodically between services .”

The above are the themes that FGD participants discussed and forwarded for the future improvements of SHAWMP in the study areas.

Lack of water supply in the town

Other issues raised during FGDs were health facilities’ lack of water supply. World Health Organization (2014: 89) highlights that water supply for the appropriate waste management system should be mandatory at any time in all health service delivery points.

Thirty-nine (95.12%) of the health facilities complain about the absence of water supply to improve HCW management practices and infection prevention and control practices in the facilities.

“We get water once per week, and most of the time, the water is available at night, and if we are not fetching as scheduled, we can’t get water the whole week”.

In this research, only those who have direct contact have participated in this study, and 434 (80.4%) of the respondents agree they have roles and responsibilities for appropriate solid health care waste management practice. The rest, 19.6%, do not agree with their commitment to manage health care wastes properly, even though they are responsible. Health facility workers in NEMMCSH and medium clinics know their responsibilities better than others, and their results show above the mean. 84.5%, 74.5%, 81%, 73.9% and 75% in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centres, respectively.

Establishing a policy and a legal framework, training personnel, and raising public awareness are essential elements of successful healthcare waste management. A policy can be viewed as a blueprint that drives decision-making at a political level and should mobilize government effort and resources to create the conditions to make changes in healthcare facilities. Three hundred and seventy-four (69.3%) of the respondents agree with the presence of any solid healthcare waste management policy in Ethiopia. The more knowledge above the mean (72.9%) on the presence of the policy is reported from NEMMCSH.

Self-reported level of knowledge on what to do in case of an accident revealed that 438 (81.1% CI: 77.6–84.3%) of the respondents knew what to do in case of an accident. Government health centre staff and medium clinic staff’s knowledge about what to do in case of an accident was above the mean (88.4% and 82.3%), respectively, and the rest were below the mean. The action performed after an occupational accident revealed that 56 (35.7%) of the respondents did nothing after any exposure to an accident. Out of 56 respondents who have done nothing after exposure, 47 (83.92%) of the respondents answered yes to their knowledge about what to do in case of an accident. Out of 157 respondents who have been exposed to occupational accidents, only 59 (37.6%) of the respondents performed the appropriate measures, 18 (11.5%), 9 (5.7%), 26 (16.6%), 6 (3.8%) of the respondents are taking prophylaxis, linked to the incident officer, consult the available doctors near to the department, and test the status of the patient (source of infection) respectively and the rest were not performing the scientific measures, that is only practising one of the following practices washing the affected part, squeezing the affected part to remove blood, cleaning the affected part with alcohol.

Health facility workers’ understanding of solid health care waste management practices was assessed by asking whether the current SHCWM practice needs improvement. Four hundred forty-nine (83.1%) health facility workers are unsatisfied with the current solid waste management practice at the different health facility levels, and they recommend changing it to a scientific one. 82.6%, 87.4%, 89.9%, 75%, and 81.3% of the respondents are uncomfortable or need to improve solid health care waste management practices in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres, respectively.

Lack of safety box, lack of colour-coded waste bins, lack of training, and no problems are the responses to the question problems encountered in managing SHCWMP. Two Hundred and Fifty (46.92%) and 232 (42.96%) of the respondents recommend the availability of safety boxes and training, respectively.

Four or 9.8% of the facilities have infection prevention and control (IPC) teams in the study health facilities. This finding differed from the study in Pakistan, where thirty per cent (30%) of the study hospitals had HCWM or infection control teams [ 21 ]. This study’s findings were similar to those conducted in Pakistan by Khan et al. [ 21 ], which confirmed that the teams were almost absent at the secondary and primary healthcare levels [ 20 ].

The availability of health care waste management policy report reveals that 69.3% (95% CI: 65.4–73) of the staff are aware of the presence of solid health care waste management policy in the institution. Availability of health care waste management policy was 188 (72.9%), 66 (69.5%), 53 (677.1%), 57 (62%), 10 (62.5%) in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centre respectively. Healthcare waste management policy availability was above the mean in NEMMCSH and government health centres; see Table  6 below.

Open-ended responses on the SHCWM practice of health facility workers were collected using the prepared interview guide, and the responses were analyzed using thematic analysis. All the answered questions were tallied on the paper and exported to Excel software for thematic analysis.

The study participants recommend.

“appropriate segregation practice at the point of generation” "health facility must avail all the necessary supplies that used for SHCWMP, punishment for those violating the rule of SHCWMP",

“waste management technologies should be included in solid waste management guidelines, and enforcement should be strengthened.”

The availability of written national or adopted/adapted SHCWM policies was observed at all study health facilities. Twenty eight (11.66%) of the rooms have either a poster or a written document of the national policy document. However, all staff working in the observed rooms have yet to see the inside content of the policy. The presence of the policy alone cannot bring change to SHCWMP. This finding shows that the presence of policy in the institution was reasonable compared to the study findings in Menelik II hospital in Addis Ababa, showing that HCWM regulations and any applicable facility-based policy and strategy were not found [ 22 ]. The findings of this study were less compared to the study findings in Pakistan; 41% of the health facilities had the policy document or internal rules for the HCWM [ 21 ].

Focus group participants have forwarded recommendations on which interventions can improve the management of SHCW, and recommendations are summarised as follows.

‘‘Supplies should be available in quality and quantity for all health facility workers with direct contact with SHCW. Scientific-based waste management technologies should be available for health facilities. Continues and induction health care waste management training should be provided to the workers. Law enforcement should be strengthened. Community healthcare waste management sites should be available, especially for private health facilities. HCWM committee should be strengthened. Non-infectious wastes should be collected communally and transported to the municipal SHCW disposal places. Leaders should be knowledgeable about the SHCWM system and supervise the practice continuously. Patients and clients should be oriented daily about health care waste segregation practices. Regulatory bodies should supervise the health facilities before commencing and periodically in between the service are the themes those FGD participants discussed and forward for the future improvements of SHCWMP in the study areas.’’

The availability of PPEs in different levels of health facilities shows 392 (72.6%), 212 (82.2%), 56 (58.9%), 52 (65.8%), 60 (65.2%), 12 (75%) health facility workers in NEMMCSH, government health centres, medium clinics, small clinics, and surgical centres respectively agree to the presence of personal protective equipment in their department. The availability of PPEs in this study was nearly two-fold when compared to the study findings in Myanmar, where 37.6% of the staff have PPEs [ 12 ].

The mean availability of masks, heavy-duty gloves, boots, and aprons was 71.1%, 65.4%, 38%, and 44.4% in the study health facilities. This finding shows masks are less available in the study health facilities compared to other studies. The availability of utility gloves, boots, and plastic aprons is good in this study compared to the study conducted by Banstola, D in Pokhara Sub-Metropolitan City [ 23 ].

The findings of this study show there is a poor segregation practice, and all kinds of solid wastes were collected together. This finding was similar to the study findings conducted in Addis Ababa, Ethiopia, by Debere et al. [ 24 ] and contrary to the study findings conducted in Nepal and India, which shows 50% and 65–75% of the surveyed health facilities were practising proper waste segregation systems at the point of generation without mixing general wastes with hazardous wastes respectively [ 9 , 17 ].

Ninety percent of private health facilities collect and transport SHCW generated in every service area and transport it to the disposal place by the collection container (no separate container to collect and transport the waste to the final disposal site). This finding was similar to the study findings of Debre Markos’s town [ 25 ]. At all of the facilities in the study area, SHCW was transported from the service areas to the disposal site manually by carrying the collection container, and there was no trolley for transportation. This finding was contrary to the study findings conducted in India, which show segregated waste from the generation site was being transported through the chute to the carts placed at various points on the hospital premises by skilled sanitary workers [ 17 ].

Observational findings revealed that pre-treatment of SHCW before disposal was not practised at all study health facilities. This study was contrary to the findings of Pullishery et al. [ 26 ], conducted in Mangalore, India, which depicted pre-treatment of the waste in 46% of the hospitals [ 26 ]. 95% of the facilities have no water supply for handwashing during and after solid healthcare waste generation, collection, and disposal. This finding was contrary to the study findings in Pakistan hospitals, which show all health facilities have an adequate water supply near the health care waste management sites [ 27 ].

Questionnaire data collection tools show that 129 (23.8%) of the staff needle stick injuries have occurred on health facility workers within one year of the period before the data collection. This finding was slightly smaller than the study findings of Deress et al. [ 25 ] in Debre Markos town, North East Ethiopia, where 30.9% of the workers had been exposed to needle stick injury one year prior to the study [ 25 ]. Reported and registered needle stick injuries in health facilities are less reported, and only 70 (54.2%) of the injuries are reported to the health facilities. This finding shows an underestimation of the risk and the problem, which was supported by the study conducted in Menilik II hospitals in Addis Ababa [ 22 ]. 50%, 33.4%, 48%, 52%, and 62.5% of needle stick injuries were not reported in NEMMCSH, Government health centres, medium clinics, small clinics, and surgical centres, respectively, to the health facility manager.

Nearly 1/3 (177 or 32.7%) of the staff are exposed to needle stick injuries. Needle stick injuries in health facilities are less reported, and only 73 (41.24%) of the injuries are reported to the health facilities within 12 months of the data collection. This finding is slightly higher than the study finding of Deress et al. [ 25 ] in Debere Markos, Ethiopia, in which 23.3% of the study participants had encountered needle stick/sharps injuries preceding 12 months of the data collection period [ 25 ].

Seventy-three injuries were reported to the health facility manager in the last one year, 44 of the injuries were reported by health professionals, and the rest were reported by supportive staff. These injuries were reported from 35(85.3%) health facilities; the remaining six have no report. These study findings were better than the findings of Khan et al. [ 21 ], in which one-third of the facilities had a reporting system for an incident, and almost the same percentage of the facilities had post-exposure procedures in both public and private sectors [ 21 ].

Within one year of the study period, 129 (23.88%) needle stick injuries occurred. However, needle stick injuries in health facilities are less reported, and only 70 (39.5%) of the injuries are reported to the health facilities. These findings were reasonable compared to the study findings of the southwest region of Cameroon, in which 50.9% (110/216) of all participants had at least one occupational exposure [ 28 , 29 ]. This result report shows a very high exposure to needle stick injury compared to the study findings in Brazil, which shows 6.1% of the research participants were injured [ 27 ].

The finding shows that 220 (40.8%) of the respondents were vaccinated to prevent themselves from health facility-acquired infection. One Hundred Fifty-six (70.9%) of the respondents are vaccinated in order to avoid themselves from Hep B infection. Fifty-nine (26%0.8) of the respondents were vaccinated to protect themselves from two diseases that are Hep B and COVID-19. This finding was nearly the same as the study findings of Deress et al. [ 7 ],in Ethiopia, 30.7% were vaccinated, and very low compared to the study findings of Qadir et al. [ 30 ] in Pakistan and Saha & Bhattacharjya India which is 66.67% and 66.17% respectively [ 25 , 30 , 31 ].

The incineration of solid healthcare waste technology has been accepted and adopted as an effective method in Ethiopia. These pollutants may have undesirable environmental impacts on human and animal health, such as liver failure and cancer [ 15 , 16 ]. All government health facilities use incineration to dispose of solid waste. 88.4% and 100% of the wastes are incinerated in WUNEMMCSH and government health centres, respectively. This finding contradicts the study findings in the United States of America and Malaysia, which are 49–60% and 59–60 are incinerated, respectively, and the rest are treated using other technologies [ 15 , 16 ].

All study health facilities used a brick or barrel type of incinerator. The incinerators found in the study health facilities need to meet the minimum standards of solid health care waste incineration practice. These findings were similar to the study findings of Nepal and Pakistan [ 32 ]. The health care waste treatment system in health facilities was found to be very unsystematic and unscientific, which cannot guarantee that there is no risk to the environment and public health, as well as safety for personnel involved in health care waste treatment. Most incinerators are not properly operated and maintained, resulting in poor performance.

All government health facilities use incineration to dispose of solid waste. All the generated sharp wastes are incinerated using brick or barrel incinerators, as shown in Fig.  1 above. This finding was consistent with the findings of Veilla and Samwel [ 33 ], who depicted that sharp waste generation is the same as sharps waste incinerated [ 33 ]. All brick incinerators were constructed without appropriate air inlets to facilitate combustion except in NEMMCSH, which is built at a 4-m height. These findings were similar to the findings of Tadese and Kumie at Addis Ababa [ 34 ].

Barrel and brick incinerators used in private clinic

Strengths and limitations

This is a mixed-method study; both qualitative and quantitative study design, data collection and analysis techniques were used to understand the problem better. The setting for this study was one town, which is found in the southern part of the country. It only represents some of the country’s health facilities, and it is difficult to generalize the findings to other hospitals and health centres. Another limitation of this study was that private drug stores and private pharmacies were not incorporated.

Conclusions

In the study, health facilities’ foot-operated solid waste dust bins are not available for healthcare workers and patients to dispose of the generated wastes. Health facility managers in government and private health institutions should pay more attention to the availability of colour-coded dust bins. Most containers are opened, and insects and rodents can access them anytime. Some of them are even closed (not foot-operated), leading to contamination of hands when trying to open them.

Healthcare waste management training is mandatory for appropriate healthcare waste disposal. Healthcare-associated exposure should be appropriately managed, and infection prevention and control training should be provided to all staff working in the health facilities.

Availability of data and materials

The authors declare that data for this work are available upon request to the first author.

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Acknowledgements

The authors are grateful to the health facility leaders and ethical committees of the hospitals for their permission. The authors acknowledge the cooperation of the health facility workers who participated in this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Yeshanew Ayele Tiruneh

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Dr. Yeshanew Ayele Tiruneh is a researcher of this study; the principal investigator does all the proposal preparation, methodology, data collection, result and discussion, and manuscript writing. Professor LM Modiba and Dr. SM Zuma are supervisors for this study. They participated in the topic selection and modification to the final manuscript preparation by commenting on and correcting the study. Finally, the three authors read and approved the final version of the manuscript and agreed to submit the manuscript for publication.

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Tiruneh, Y.A., Modiba, L.M. & Zuma, S.M. Solid health care waste management practice in Ethiopia, a convergent mixed method study. BMC Health Serv Res 24 , 985 (2024). https://doi.org/10.1186/s12913-024-11444-8

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Data on the Effects of Covid-19 Pandemic on the Quantity, Quality and Management of Solid Waste in Babol Hospitals

9 Pages Posted: 28 Aug 2024

Yousef Dadban Shahamat

Golestan University of Medical Sciences

Khadije Bakhshi

Gonabad University of Medical Sciences

Mostafa Javanian

Babol University of Medical Sciences

Mohammad Hadi Mehdinejada

Ahmad salehi, hosein ali asgharnia, hasan reza rokni, hosein faraji.

affiliation not provided to SSRN

Medical waste is about 1-2 % of urban waste, which is very important in terms of health. The aim this study is analyse the Effects of Covid-19 Pandemic on the Quantity, Quality and Management of Solid Waste in Babol Hospitals. In this regard, all 6 government hospitals were selected and investigated. Data were collected by the researcher using the standard checklist of the Environmental and Labor Health Center of the Ministry of Health. Finally, the obtained data were analyzed using Excel. The total solid waste produced by the studied hospitals before Covid-19 pandemic was 3019.9 kg/day, of which 51.7 % was ordinary waste, 43.25 % was infectious waste, 3.11 % was chemical waste, and 1.93 % was sharp pointed waste. The total solid waste produced in 2021 was 3053.2 kg/day, of which 35 % was ordinary waste, 59.31 % was infectious waste, 3.35 % was dangerous chemical medical waste and 2.3 % was sharp pointed waste. Given the large amount and the danger of infectious waste in the hospital, careful and continuous monitoring of the management of such waste will be necessary to ensure, maintain and increase the level of health of the personnel, patients and all referring to hospitals.

Keywords: Medical waste, Covid-19, Hospital, Babol

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Golestan University of Medical Sciences ( email )

Gorgan Iran

Gonabad University of Medical Sciences ( email )

Gonabad Iran

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Amritsar MC passes resolution to review solid waste management firm’s working

Charanjit Singh Teja

Tribune News Service

Amritsar, August 27

Finally, the Amritsar Municipal Corporation has passed a resolution to review the working of the solid waste management firm, Averda, which will include its services like collection, transportation, processing and disposal of solid waste. The decision has been taken on the instructions of the Chief Secretary, Punjab, in the wake of an ongoing hearing in the National Green Tribunal (NGT).

A meeting was held in the office of the Deputy Commissioner, Amritsar, on August 23 in which political representatives, officials of the district administration, MC Commissioner and the Medical Officer from Health Department were present. It was decided in the meeting that a final notice will be issued to Averda company regarding the deficiencies as per the agreement. It was also decided to prepare a new detailed project report (DPR) and float a new tender for collection, transportation, processing and disposal of fresh waste. Till the time a new contract is awarded, the present firm (Averda) will continue to work and improve its operations to showcase at the time of final opportunity. A separate proposal may be floated for bio-remediation of legacy waste. MC Commissioner Harpreet Singh said as per the decision taken in the meeting, the Amritsar Municipal Corporation has passed a resolution and forwarded it to the Local Government Department for approval.

“Until the time the new work order is not issued, the MC or Punjab Municipal Infrastructure Development Company may also explore the possibility of procuring a new fleet of vehicles which will be handed over to the firm for operations purposes only. In lieu of this, the tipping fees of the firm could be reduced accordingly as per the terms and conditions of the agreement. In case, a new vendor comes after the fresh tender process, the same may be used by the new vendor,” mentioned the resolution passed by the MC.

It is worth mentioning here that the NGT had imposed heavy penalties on the civic body for poor sanitation conditions and legacy waste recently.

Sullivan County releases first waste management plan in 30 years

Hear more about the plan at a public meeting on september 19.

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MONTICELLO, NY — What will the next ten years of waste management in Sullivan County look like?

A newly published, 470-page shelf-bender presents a picture—or, rather, a range of possibilities. Residents will get to hear more about it at a public meeting scheduled for noon on Thursday, September 19, at the county government center in Monticello (see sidebar).

The final draft of the Sullivan County Local Solid Waste Management Plan covers a lot of ground, from the practical to the technical to the whimsical. You’ll find cheerful suggestions for reducing food waste in families with children (Give fruits and vegetables cool names like “Xray Vision Carrots” and “Super Strength Spinach”), along with technical formulae like “GHG reduction = ~ 1,747.2 MTCO2e” in a discussion of how the solar and wind energy sources powering county buildings have reduced greenhouse gases (by 1,747.2 metric tons in 13 years).

It’s been 30 years since the county last drew up a waste management plan. A lot has changed since then. There are more categories of waste now—solid waste, recyclables, biosolids (the byproduct of sewage treatment), compost, electronics, household hazardous waste, paint, scrap metal, tires, textiles, and non-hazardous industrial waste. All are represented.

Every transfer station, scrapyard, and landfill is accounted for, as is the business end of waste management—from the revenue earned from disposal fees and the sale of recyclables, to the recent loss of property tax support. “Typically, long-term debt to fund facility projects is acquired through issuance of municipal bonds,” the draft plan states. “In prior years some of the program funding came through a local property tax levy. However, as of 2023, this tax will no longer be collected.”

The Local Environmental Justice section requires “the fair treatment and meaningful involvement of all people regardless of race, color, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies.”

The county’s sustainability initiatives include maximizing the efficiency of its fleet, renewable energy projects, an EV infrastructure reimbursement program, a climate action plan, and a composting program that started in 2023.

Burning waste, counting recyclables

The draft plan extensively covers thermal waste treatments, one of which is currently under serious consideration by the county manager and legislature. These processes typically use very high heat to reduce carbon-rich waste either to bricks that can be buried in a landfill, or to gases that can be used for fuel (gasification). Pyrolysis converts plastic into synthetic crude oil “using heat, motion, and careful reactions,” which, the final draft states, “has the potential to divert plastics destined for the landfill [and] displace virgin fossil fuel production.”

Recyclables are identified as one of the county’s biggest challenges, stemming from the difficulty in compacting loads, double handling, fluctuating market prices, and not understanding how much of it ends up in other counties.

Textiles—clothing, carpet, towels, sheets, and draperies—make up about 5 percent of Sullivan County’s waste stream. The draft plan calls textile manufacturers “among the top contributors to CO2 emissions” and says the NYS Department of Conservation found that 1.4 billion pounds of textiles are disposed of in the state each year. The plan includes suggestions for donating and otherwise recycling clothing. Some transfer stations, like Highland in Eldred and Western Sullivan in Cochecton, transport textiles to Textile Recovery Services in East Bohemia, NY.

Sullivan County has retained Cornerstone Engineering and Geology to develop the plan, which lawmakers will use to evaluate waste-handling practices. 

As to why the county hasn’t created a solid waste management plan since 1991? The plan blames “various changes in management strategies, staff turnover within the county, a major shift in waste and recycling paradigms, and evolution of solid waste management regulations over the last 30 plus year, there was no consistent follow through with the previous plan to meet timeframes in the implementation schedule.”

Breakdown of Sullivan’s waste

Paper—31 percent

Organics—18 percent

Plastics—14 percent

Miscellaneous—14 percent

Metal—9 percent

Textiles—5 percent

Wood—5 percent

Glass—4 percent

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NGT fines Punjab Government ₹1,000 crore for poor waste management

Posted 28 Aug 2024

The National Green Tribunal (NGT) ordered fine to be deposited with the Central Pollution Control Board (CPCB) for failing to manage legacy waste (solid waste kept for years) and untreated sewage.

Present framework for Municipal Solid Waste (MSW) management

• The Environment (Protection) Act, 1986  empowers the Central Government to establish authorities charged with the mandate of preventing environmental pollution in all its forms.
• The management of MSW is the function of Urban Local Bodies (ULBs).
• Solid Waste Management (SWM) Rules, 2016  requires ULBs to set up waste collection, transportation, processing, and disposal systems.

Challenges in waste management

• Public attitudes to waste and Poor segregation of waste at source.
• There is a lack of strategic MSW plan s and  availability of qualified waste management professionals is limited.
• Lack of budget with the Municipal authorities
• Data on waste generation in terms of composition and quantities is still lacking with cities. 

Way forward

• Circular economy by using wastes as resources with increased value extraction, recycling, recovery and reuse.
• A strong and independent authority is needed t o regulate waste management.
• Long-term waste management planning by  considering the private sector and NGOs as stakeholders.

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Talisay City presented a 10-year solid waste management plan

Mayor Neil Lizares alongside Talisay City Environment and Natural Resources Office head Engr. Warren Paduano and City Administrator. Atty. Jonathan Ealdama, officially unveiled the city’s approved 10-Year Solid Waste Management Plan on August 22 at Roy's Hotel, Barangay Pahanocoy, Bacolod City.

This landmark plan, developed through rigorous deliberations, marks a significant milestone in Talisay City's commitment to environmental stewardship.

The comprehensive strategy is designed to transform waste management practices in the city, directly aligning with the 'E' for Environmental Protection in Talisay City's Asenso tenets of governance.

With this plan, we aim to drastically reduce waste, promote recycling, and ensure the sustainable use of resources. These measures will not only protect the environment but also improve the quality of life for all Talisaynons.

Mayor Neil emphasized the importance of community involvement in the success of this initiative, urging all residents to strictly adhere to the solid waste management laws.

He firmly believes that this plan is not just a government mandate but a collective responsibility that by working together and following the guidelines, we can protect our environment and ensure a healthier, more sustainable future for our city.

The Solid Waste Management Plan is expected to bring long-term benefits to Talisay City, including cleaner public spaces, enhanced environmental protection, and the conservation of natural resources, all of which contribute to the city’s vision of a progressive, sustainable, greener, and smart City of Talisay starting today and in the coming years.

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