Application of Multi-Criteria Decision Approach in the Assessment of Medical Waste Management Systems in Nigeria

Abstract

Globally, the pandemic of COVID-19 has penetrated all spheres of human endeavors, and noteworthy is the tremendous increase in the volume of healthcare wastes generated in Nigeria. There has been an increase in medical waste materials produced as a result of the extensive use of both disposable personal protective equipment (PPE), such as face shields and nose and face masks, and highly infectious waste materials, such as contaminated syringes, needles, and soiled bandages from diagnosed positive cases. Despite the huge volume in waste generation, a standardized evaluation framework is currently lacking in the management of medical wastes in Nigeria. This study has developed a novel assessment framework for managing medical wastes, which is curated from the technical guidelines of the World Health Organization (WHO). The applicability of the framework was examined on seven designated public and private-owned hospitals in Ota. The fuzzy analytical hierarchy process (FAHP) and analytical hierarchy process (AHP) approaches of multi-criteria decision analysis were utilized in modelling an evaluation framework for the objective of medical waste management. Carefully designed interview questionnaires, observations, and site visits were carried out to obtain data from healthcare professionals in Ota. Results show that waste segregation was practiced more decisively in private hospitals than public hospitals. Waste segregation is established as a key determinant in implementing an effective waste management system in any healthcare facility. The success of waste segregation in healthcare institutions is highly dependent on good hospital management, organizational policies, efficient budget planning for waste management, and the operational running cost. Disposal methods investigated were mostly open burning and incessant dumping for most public health care centers. Deficient waste management practices were observed in waste disposal, waste transportation, storage, and organizational policies. While the awareness and capacity building on occupational safety practices and environmental public health is widely known by health workers and waste handlers, compliance and enforcement are critical challenges. The validation of results using fuzzy TOPSIS and a sensitivity analysis shows a high degree of the consistency, stability, and robustness of the model. Findings from the present study can aid decision making, as this will benefit policy makers and key stakeholders in developing more comprehensive and effective medical waste management guidelines in Nigeria. In addition, future decision-making studies could augment the results from the current research by assessing the impact of the pandemic preparedness and response on medical waste management.

Healthcare Waste Management in Nigeria: A Review

“…Poor segregation of the waste leads to an increased quantity of infectious components since all waste that has come in contact with infectious components is classified as infectious [16]. Waste segregation is therefore a critical determinant of effective healthcare waste management [38]. Hence diligent segregation of waste will yield more quantities of clean stream that would be easier, safer, and cost-effective to manage through recycling, landfilling, and composting [39].…”

“…However, there is a significant number of case studies on the level of training and awareness in hospitals (tertiary, secondary, and primary) at different city locations across the country [39,[45][46][47][48][51][52][53][54]. More studies have been done on government-owned hospitals than on private hospitals [38,44]. In the majority of the studies, training of healthcare workers occurs only once after employment and there is little or no subsequent training to update the knowledge of the workers [24,55].…”

Identifying and Predicting Healthcare Waste Management Costs for an Optimal Sustainable Management System: Evidence from the Greek Public Sector

“…Wassie et al [ 60 ] state that African countries, especially Ethiopia, do not perform proper healthcare waste management practices, and the average rate of HCW generation in Africa is 0.8 kg/bed/day; Ethiopia has an average of 1.1 kg/bed/day alone [ 61 , 62 ]. Moreover, in Nigeria, the HCW generation is between 0.562 and 0.670 kg/bed/day, with a peak rate of 1.68 kg/bed/day [ 63 , 64 , 65 ]. Hamoda et al [ 66 ] stated that the medical wastes produced by two public hospitals in Kuwait were 4.89–5.4 kg/day/patient and 3.65–3.97 kg/day/patient, respectively.…”

“…This situation gets even worse if we take into account that the HCW produced during the last three years of the COVID-19 pandemic has increased dramatically, along with the lack of healthcare professionals that are needed to manage HCW but do not due to the increased demand for healthcare services during the pandemic; the pandemic is considered to have a vital impact to the environment and public health [ 63 ]. According to the United Nations Environment Programme [ 74 ], the pandemic has increased the amount of hazardous healthcare waste by 3.4 kg/bed/day, which is almost ten times more than the average volume of hazardous healthcare waste, which ranges from 0.2 to 0.5 kg/bed/day [ 50 ].…”

A review of environmental and economic aspects of medical devices, illustrated with a comparative study of double-lumen tubes used for one-lung ventilation

“…Topics Singleuse vs. reuse (Esmizadeh et al, 2021) Qualitative environmental & economic considerations X (Etim et al, 2021) Medical waste reduction (Farrell & Smyth, 2021) Medical waste reduction (Feldman & Hui, 1997) Health economics (Gaberik et al, 2021) Qualitative environmental & economic considerations (Garay et al, 2017) Health economics X (Ghodrat & Samali, 2018) Economics & environment (Gobbi, 2011) Economics & waste reduction (Goel et al, 2021) Life cycle assessment (Grimmond et al, 2021) Life cycle assessment X (Hazem & Fahim, 2021) Economics & waste reduction (Hemmes, 1991) Health economics X (Ho & Copeland, 2020) Qualitative environmental & economic considerations (Hospodkova & Vochyanova, 2019) Health economics (Houngbo et al, 2008) Health economics (Hoyle, 2011) Health economics (Hsu et al, 2008) Health economics (Hughes et al, 2021) Health economics X (Hunstiger, 1988) Health economics (Hunt et al, 2011) Qualitative environmental & economic considerations (Iyer, 2018) Life cycle assessment (Jordan, 1996) Economics & waste reduction (Kane et al, 2018) Economics & environment (Keyes et al, 1993) Health economics (Khan & Ali, 2014) Medical waste reduction (Kim et al, 2018) Health economics (Koch & James, 1995) Health economics X (Korambayil et al, 2020) Economics & life cycle assessment (Kumar, 2021) Qualitative environmental & economic considerations (Kwakye et al, 2010) Economics & environment X ( Larsen et al, 2019) Health economics X (Latta et al, 2021) Life cycle assessment (Lee & Kim, 2019) Health economics X ( …”