Tadesse and Kumie BMC Public Health 2014, 14:1221

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RESEARCH ARTICLE Open Access

Healthcare waste generation and management

practice in government health centers of Addis
Ababa, Ethiopia
Menelik Legesse Tadesse1* and Abera Kumie2

Abstract
Background: Healthcare wastes are hazardous organic and inorganic wastes. The waste disposal management in
Addis Ababa city is seen unscientific manner. The waste management practice in the health facilities are poor and
need improvement. This study will help different organizations, stakeholders and policy makers to correct and improve
the existing situation of healthcare waste legislation and enforcement and training of staff in the healthcare facilities in
Addis Ababa. The study aimed to assess the existing generation and management practice of healthcare waste in
selected government health centers of Addis Ababa.
Methods: The cross-sectional study was conducted to quantify waste generation rate and evaluate its management
system. The study area was Addis Ababa. The sample size was determined by simple random sampling technique, the
sampling procedure involved 10 sub-cities of Addis Ababa. Data were collected using both waste collecting and
measuring equipment and check list. The Data was entered by EPI INFO version 6.04d and analyzed by and SPSS
for WINDOW version15.
Results: The mean (±SD) healthcare waste generation rate was 9.61 ± 3.28 kg/day of which (38%) 3.64 ± 1.45 kg/day
was general or non-hazardous waste and (62%) 5.97 ± 2.31 kg/day was hazardous. The mean healthcare waste
generation rate between health centers was a significant different with Kurskal-Wallis test (χ2 = 21.83, p-value = 0.009).
All health centers used safety boxes for collection of sharp wastes and all health centers used plastic buckets without
lid for collection and transportation of healthcare waste. Pre treatment of infectious wastes was not practiced by any of
the health centers. All health centers used incinerators and had placenta pit for disposal of pathological waste however
only seven out of ten pits had proper covering material.
Conclusion: Segregation of wastes at point of generation with appropriate collection materials and pre- treatment of
infectious waste before disposal should be practiced. Training should be given to healthcare workers and waste
handlers. Incinerators must be constructed in a manner that facilitates complete combustion and the lining of
placenta pit should be constructed in water tight material.
Keywords: Healthcare wastes, Health centers, General waste, Hazardous waste, Addis Ababa, Ethiopia

Background the negative impact of improper waste disposal. Waste is

In developing countries such as Ethiopia the international generated from any where such as home, school, industry
or local policy that generator of waste is responsible for and health care facilities.
the proper management, treatment and disposal of waste Healthcare wastes (HCW) that are generated from
has remained on paper and is yet to be implemented. The healthcare establishments; hospitals, health centers, medical
notion that waste is the responsibility of the government research centers, pharmaceutical manufacturing plants,
authorities has not enable waste generators to appreciate pharmacies, blood banks, and home health care activities
are some of the generators of healthcare waste. Healthcare
* Correspondence: [email protected]
wastes generated from health facilities and diagnostic
1
Menelik II Health Science College, Addis Ababa, Ethiopia activities can be broadly categorized to general waste
Full list of author information is available at the end of the article

© 2014 Tadesse and Kumie; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
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Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this
article, unless otherwise stated.
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and hazardous waste. However, it remains true only when Objectives

proper segregation and separation of waste is practiced [1]. General objective
World Health Organization (WHO) reported that from To assess the existing generation and management prac-
the total waste generated by health care activities, 85% is tice of healthcare wastes in selected government health
general waste and the balance is considered as hazardous, centers of Addis Ababa.
as it tends to be infectious, toxic or radioactive [2].
Study in Ethiopia showed the mean standard deviation Specific objectives
(± SD) of healthcare waste generation rate per health
center was 1.79 ± 0.57 Kilogram/day (kg/day). Of which To determine the healthcare waste generation rate at
(52.0%) 0.93 ± 0.3 kg/day and (48.0%) 0.86 ± 0.33 kg/day selected government health centers.
were general or non-hazardous waste and hazardous waste, To describe the type of healthcare waste generated
respectively [3]. Another study in the hospital of Addis from selected government health centers.
Ababa, Ethiopia showed the mean healthcare waste pro- To assess the practice of waste management at selected
duced were 0.5 kg/patient/day and 1.6 kg/bed/day [4]. government health centers.
There are different estimates regarding the share of
general and hazardous constituents of health care waste Methods
generation. This may be the segregation of healthcare Study design, area and population
waste at point of generation is weak in health facilities Institutional based cross-sectional study was conducted
and assumed these wastes are non-contaminated and to quantify healthcare waste generation rate and evaluate
pose no risk of infection. Such management of the health- its management system from 25th to 31st of January 2011
care waste is doing by traditional way and some of the in the governmental health centers of Addis Ababa. Addis
healthcare waste disposal to be in-forced by the good will Ababa is the capital city of Ethiopia, with the total popula-
of managers. Another assumption is the limitation of tion of 2,917,295 (1,389,817 males and 1,527,478 females)
existing facilities, lack of adequate institutional arrange- [6]. The city has three layers of administration; the City
ments, operation insufficiency, local authorities inefficiency Administration at the top, 10 Sub cities Administration in
in performing their task effectively are some points for the the middle and 116 Woredas at the bottom [7]. Each
poor management but few take proper care of their waste. sub city administration has the estimated population of
Now wastes threaten the public, since the health care 300,000 and each Woreda administration has the popu-
facilities are situated in the heart of the city and there- lation of 30,000. The increase in population number favors
fore healthcare waste, if not properly managed can cause the health facilities to have more healthcare wastes. The
dangerous infection and posses a potential threat to the source population was 26 government health centers in 10
surrounding environment, person handling it and to the sub cities [8]. The study population, 10 health centers, 1
public. from each sub city was selected by simple random sam-
Health and environmental effects, uncertainty regarding pling and lottery approach was employed (Figure 1).
regulations and negative perceptions by waste handlers are
some important concerns in healthcare waste management Sample size and sampling procedure
in a country [5]. An estimating a mean sample size for a very large popu-
There were limited studies in our country as focused on lation formula was used to calculate the sample size [9];
the hospital healthcare waste generation and handling prac- considering an assumption of proportion 95% level of con-
tice. At present, there is no available information that de- fidence and 7% marginal error. This was done by referring
scribes the actual practice of handling the healthcare waste from previous studies mean generation: 1.79 kg per day;
in the health centers of Addis Ababa. Effective management SD 0.57 kg per day over 80 measurements in 10 hospitals
of proper disposal of the healthcare waste is uncertain. This [3]. Seven consecutive days sample measurement was done
study focus on the health center (HC) because they are the in ten health centers. Data were collected by using pre-
primary health care unites in the city. Addis Ababa City prepared data entry sheet for the daily measurement of the
Administration Health Bureau (AACAHB) in the near fu- amount of healthcare waste rate, pre tested check list and
ture builds health centers in every Woreda also the health interview tools. Data were collected for 24 hours from each
policy of the country supports the healthcare waste man- sampling unit in different color coded polyethylene bags.
agement. So the outcome of the study can be used as base The bags color was yellow, red and black. Yellow bags were
line data for planning and implementation activities. It contained for infectious clinical wastes and yellow safety
can also help the policy makers, the researchers and other boxes for sharp wastes. Black bags were contained for
concerned bodies to develop effective healthcare waste non infectious (non risk) wastes. Red bags contained
management system to Addis Ababa and the country as for drugs and radioactive hazardous wastes. Each plastic
a whole. bag were labeled by BANNER brand sticker showed the date,
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Figure 1 Schematic representation of each Health Centers in Addis Ababa city Administration, January 2011.

category of waste, room for waste collected and time started. Variables
Total wastes per day were measured at each study unit by re- The amount of healthcare waste generated and waste man-
moving the plastic bags every morning and its weight was agement practice were the outcome variables where as the
measured every day at 9:00 A.M using weighing scale. material used for healthcare waste collection, transporta-
The site visit was conducted by using check list to review tion, presence or absence of healthcare waste management
of segregation, handling, collection and storage practice at policies and segregation of healthcare waste at the source
the various case teams of the health centers. Interview was were independent variables.
conducted about the management issues with the health
center managers. Care was taken during waste collection;
Statistical methods
data collectors use gloves, masks, gown and antiseptics to
Data were entered to Statistical Software for Epidemiology
prevent infection. At least 11 case teams were chosen;
(EPI INFO) version 6.04d and analyzed by Statistical Pack-
Delivery, Emergency Injection and Dressing room, Labora-
age for Social Science (SPSS) for Window Version 15 to
tory, Human immunodeficiency Virus (HIV) Counseling
enable the estimation of healthcare waste generation rate
and Testing and Anti Retroviral Treatment (ART), Phar-
in each health center. Comparison of visitors, healthcare
macy, Focus Antenatal Care (FANC), Expanded Program
waste generation rate and its types among health centers
for Immunization (EPI), Family Planning (FP), Tubercu-
were compared using Kurskal-Wallis test and relation of
losis (TB) and Leprosy, Out Patient Department (OPD),
visitors and amount of healthcare waste in study health
and Integrated Management of Neonatal and Child Illness
centers were computed by Spearman’s rank correlation.
(IMNCI) and growth monitoring. Incinerator and deep
The results on evaluation of the average quantity of
burial and placenta pits were seen.
healthcare wastes and waste management system were re-
Measurement was done by using Weighing Scale which
ported using different descriptive statistics.
is analog and digital is used at the study units and re-
corded. Data quality was assured by the measurement of
waste by using spring balance capacity range from 20gm Ethical consideration
to 400 gm, Electronic infant Scale model ACS-20A-YE, Ethical clearance was obtained from Addis Continental
Electronic balance model Sartorius Basic Type BA6100, Institute of Public Health (ACIPH); Permission was
Electronic compact balance model EPB-10001 L digital obtained from Addis Ababa city Administration Health
scale and XY Electronic balance model XY-JC/JB”. The Bureau and from the Managers/Directors of the health
measuring instruments were calibrated by using known centers. Consent was obtained from each health centers.
weight, a standard of 20 g, 100 g, 500 g and 1000 g The participants were free either to participate or not. The
weighting objects every morning before the actual mea- study wasn’t cause any harm to neither the study subjects
surement started. The standard value was recorded for nor to the data collector. Data collectors were trained to
comparison to the daily activities. For the purpose of data use protective materials when handling healthcare wastes.
collection 10 enumerators and 3 supervisors were take Supervisors were alert if there were any injuries during
one day training by the principal investigator. collection period.
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Results waste was from delivery case team where as less amount
Service, case team and patient flow in the study health (0.97%) 0.915 ± 0.97 kg/day of healthcare waste was gen-
centers erated at IMNCI case team. The mean health care waste
A total of 22,045 patients visited in all case teams, of generation rate in different case teams in the study health
which 4,647(21.08%) patients visited OPDs in all health centers was statistically significant (χ2 = 19.62, p-value <
centers in 7 days. The mean (±SD) patient flow per day 0.033) (see Table 3).
in all sections and the mean patient flow at OPD were
316.6 ± 104 and 66.9 ± 23.97, respectively. More patients Annual HCW generation rate estimation
were seen to Site E and Site G health centers, 3864 and The annual healthcare waste generation rate can be calcu-
3041, respectively. On the other hand less number of lated and the estimation per health center was 3501.86 ±
patients was seen to Site J and Site H health centers, 1204.29 kg/year. The annual flow of patients and mean
1396 and 1641, respectively. healthcare waste generation rate per patient per day (the
assumption was each patient who visited the health center
Waste Generation rate may generate the same amount of HCW throughout the
Daily HCW generation in health centers year).
The mean (±SD) healthcare waste generation rate was
9.61 ± 3.28 kg/day, of which 3.64 ± 1.45 kg/day (38%) was Visitors and HCW generation comparison
general waste and 5.97 ± 2.31 kg/day (62%) was hazardous Patient flow, healthcare waste generation rate and its types
waste. High amount of healthcare waste per day was gen- such as general and hazardous waste (sharps, infectious,
erated at Site G and Site E health centers, 14.49 kg/day and pathological waste) among different health centers
and12.55 kg/day, respectively. Small amount of healthcare were compared using Kruskal-Wallis test to check for
waste was recorded at Site J and Site D health centers, the presence of significant difference among their values.
3.95 kg/day and 5.5 kg/day, respectively (see Table 1). There was a significant difference to mean of healthcare
The types of hazardous waste generated from study waste (χ2 = 21.83, p-value = 0.009) and the mean hazard-
health centers were sharps, infectious and pathological ous waste (χ2 = 26.75, p-value = 0.002) among study health
which were placenta and blood. The mean (±SD) generation centers. There was no significant difference for the mean
rate of sharps, infectious and pathological waste in each patient flow (χ2 = 14.504, p-value = 0.106) and the mean
health center was 0.87 ± 0.28 (14.57%), 2.2 ± 0.84 (38.36%) general waste (χ2 = 13.41, p-value = 0.145) (see Table 4).
and 2.8 ± 1.4 (47.24%) kg/day, respectively (see Table 2). The extent or strength of linear relationship between
numbers of patients and amount of healthcare waste gen-
Daily HCW generation rate in different case teams eration rate were checked using Spearman’s rank correl-
In different case teams the amount of healthcare waste gener- ation coefficient (rs) in all health centers. Spearman’s rank
ation rate was different. The mean (±SD) healthcare waste correlation coefficient showed that there was a positive
generation rate in all section was 8.66 ± 10.95 kg/day. Great linear relationship as number of patients increased health-
amount about (40.79%) 38.60 ± 2.0 kg/day of healthcare care wastes also increased in all study health centers. A

Table 1 The amount of daily Healthcare waste generation rate in health centers, Addis Ababa City Admin., January 2011
Name of Healthcare waste, Kg/day
health center
Total HCW in 7 days Mean of HCW mean (+ SD) Mean of general waste (%) Mean of hazardous waste (%)
Site A 77.41 11.06 ± 4.49 5.50(49.76) 5.56(50.24)
Site B 70.92 10.13 ± 5.17 2.33(22.98) 7.80(77.02)
Site C 44.55 6.36 ± 3.83 2.93(46.02) 3.44(53.98)
Site D 39.18 5.597 ± 3.75 1.81(32.39) 3.78(67.61)
Site E 87.83 12.55 ± 6.63 3.79(30.23) 8.75(69.77)
Site F 74.81 10.69 ± 5.52 3.196(29.9) 7.49(70.1)
Site G 101.40 14.49 ± 5.28 5.81(40.09) 8.68(59.91)
Site H 76.40 10.91 ± 5.49 4.35(39.86) 6.56(60.14)
Site I 72.50 10.36 ± 5.40 4.78(46.15) 5.58(53.85)
Site J 27.62 3.95 ± 2.48 1.89(47.99) 2.052(52.01)
Overall mean 67.26 9.61 3.64 5.97
SD 22.97 3.28 1.45 2.31
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Table 2 Distribution of types and amount of daily Table 4 Comparison of visitors, HCW generation rate and
hazardous and non-hazardous waste generation rate in its types among health centers, Addis Ababa City Admin.,
health centers, Addis Ababa City Admin., January 2011 January 2011
Name of Sharps Infectious Pathological Total hazardous Name of Mean rank
health center Kg/day Kg/day Kg/day waste Kg/day health center
Patient flow Total HCW General Hazardous
Site A 0.441 2.043 3.072 5.556 waste waste
Site B 1.086 2.462 4.256 7.804 Site A 36.79 42.57 46 38
Site C 0.584 1.343 1.508 3.435 Site B 31.21 38.14 27 42.71
Site D 0.745 1.385 1.654 3.784 Site C 36.57 25 31.57 20.29
Site E 1.148 3.587 4.019 8.754 Site D 33.43 20.14 21.71 22.14
Site F 1.120 3.088 3.283 7.491 Site E 53.71 44.43 38.86 48.86
Site G 1.213 2.423 5.043 8.679 Site F 38.36 41 33.86 44
Site H 0.940 2.817 2.807 6.565 Site G 46.86 51.86 47.14 51.86
Site I 0.861 2.756 1.961 5.577 Site H 27.43 40.43 42.14 42.43
Site J 0.530 0.971 0.551 2.052 Site I 32.07 37.86 43.43 32.43
Average 0.867 2.287 2.815 5.969 Site J 18.57 13.57 23.29 12.29
SD 0.2802 0.8419 1.4018 2.3095 Chi-Square 14.504 21.825 13.414 26.751
Asymp. Sig. 0.106 0.009 0.145 0.002
strong linear relationship was observed at Site D, Site C Degree of freedom = 9.

and Site J health centers, the spearman’s correlation coeffi-

cient was 0.964, 0.955 and 0.929, respectively. Site B, centers had no formal or informal separation of the health-
Site E and Site H health centers were far from a perfect care waste guidelines (Table 6). Moreover the labeling of
linear relationship 0.071, 0.697, and 0.500 respectively the waste containers didn’t see by seven of the study health
(see Table 5). centers. Three out of ten health centers, the waste handlers
didn’t wear heavy duty gloves and wear sturdy shoes while
Waste management working. All health centers used open bucket for the trans-
All health centers used different color plastic buckets for portation of healthcare wastes (Table 6).
the collection healthcare waste. Half of the health cen- Pathological wastes were seen to all studied health cen-
ters didn’t have separate containers for the collection of ters. Cytotoxic to three of the health centers and reagent
hazardous and non hazardous wastes. These practices were wastes to four health centers were found. The out dated
adjacent to the study area that half of the study health pharmaceuticals found by four of the health centers were
waiting decision for disposal.
Table 3 Distribution and daily amount of healthcare The majority, nine of the health centers, had interim
waste generation rate by point source in Health centers, waste storage and easy for the staffs to access but six of
Addis Ababa City Admin., January 2011
Case teams HCW (Kg/day) Mean ± (SD) Percent Mean Rank Table 5 Relation of visitors and amount of healthcare
OPD 3.029 ± 0.15 3.20 8.67 waste in study health centers, Addis Ababa City Admin.,
Pharmacy 12.40 ± 0.65 13.10 31.00
January 2011
Name of health center Spearman’s rank correlation coefficient
Laboratory 11.586 ± 0.5 13.11 24.25
Site A 0.857
Emergency 12.406 ± 0.5 13.11 25.33
Site B 0.071
FNAC 2.759 ± 0.16 1.37 11.67
Site C 0.955
Delivery 38.600 ± 2.03 40.79 25.00
Site D 0.964
TB 1.973 ± 0.14 2.09 8.67
Site E 0.697
EPI 3.055 ± 0.16 3.23 11.67
Site F 0.875
FP 4.950 ± 0.2 5.23 16.33
Site G 0.847
VCT & ART 3.597 ± 0.25 3.80 13.67
Site H 0.500
IMNCI 0.915 ± .097 0.97 6.00
Site I 0.857
Mean 8.66
Site J 0.929
SD 10.95
Total 0.685
X2 = 19.62, p-value < 0.033 degree of freedom = 10.
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Table 6 Healthcare waste management practice and risks it was also confirmed by seven of health centers haven’t
of healthcare waste in study health centers Addis Ababa had any applicable national, regional and local guideline
city Administration, January 2011 for health care wastes management moreover seven of
Description Yes No the health centers didn’t organize healthcare waste man-
n = 10 n = 10 agement committee (Table 6).
Separate containers for hazardous and non 5 5
hazardous waste Healthcare workers related to HCWs risk
Formal or informal HCW separation guideline 5 5 Six out of ten health centers management had no concern
Labeling of the container 3 7 about the healthcare waste management as their routine
Personal protective equipment usage by HCW 7 3
work while seven health centers managers agreed that
handlers healthcare wastes pose any risk to their waste collectors,
HCW transportation container with lid 0 10 handlers and healthcare workers. In this study there were
at least 48 waste handlers worked to ten health centers
Presence of interim HCW storage container 9 1
among these eight managers knew the waste handlers
Treatment of infectious waste before disposing off 0 9
were encounter needle stick injury in the past 12 months
Ash remain disposal within close damping 8 2 (Table 6). All injuries were occurred in the work hours,
Fencing the incinerator 7 3 the types of injuries sustained were deep injury, slight skin,
Placental pit constructed with concrete 7 3 superficial and splash answered by of the health center
Focal person for HCW in Health center 10 0 managers. Four of the health centers had no registration
book for any injury or healthcare waste contamination to
Presence of SOP FOR HCW 6 4
their staffs (Table 6).
Presence of HCW management committee 3 7
Registration book for any HCW injury or 6 4 Discussion
contamination
The mean (±SD) healthcare waste generation rate per
Managers concern on HCW 6 4 health centers was 9.61 ± 3.28 kg/day, of which (38%)
Needle stick injury in the past 12 months 8 2 3.64 ± 1.45 kg/day was general or non-hazardous waste
Any risk to HCW handlers 7 3 and (62%) 5.97 ± 2.31 kg/day was hazardous. There was
a significant difference (χ2 = 21.83, p-value = 0.009) in
the total healthcare waste generation rate between health
the health centers interim waste storage containers had centers (see Table 4). This may be due to higher visitors’
no lid and the storage time was over 48 hours (Table 6). number flow in season of the year and resource allocation
Treatments of wastes by all health centers were un- to the health centers. Mean while there was no signifi-
thinkable. All health centers used incinerators for onsite cance different (χ2 = 14.504, p-value = 0.106) in patient
destruction of health care wastes except placenta which flow between study health centers.
was disposed to placenta damping pits. The incinerators There was statistically significant of healthcare waste
were built from local bricks but four health centers have generation rate in different case teams of the health cen-
no adequate air inlets for facilitating combustion of ter (χ2 = 19.62, p-value <0.033). The highest generation
wastes. The ash remains for eight health centers had rate 40.79% of healthcare waste was in delivery case team
placed at the bottom of the incinerators to be stored where as fewer amounts 0.97% of healthcare waste was in
and two of the health centers had kept to the open field. IMNCI and growth monitoring case team (Table 3). This
The incinerators were fenced by seven of health centers. variation may be due to the difference of number of at-
Five of the health centers incinerator, ash disposal parts tendance, the kinds of healthcare service, the type and the
and placenta pits were away from any of the water source. nature of waste generated at each case team.
Three out of ten health centers the placenta pits were not The annual mean (±SD) healthcare waste generation
fulfilled the standard of WHO where their slabs made rate per health center was 3501.86 ± 1204.29 kg/year. The
from stone and wood and the coverage of the pits were assumption was the preferable method to estimate annual
fenced by plastics with no cautioned signs to protect the health care waste generation rate because the mean of
workers and other clients (Table 6). annual healthcare waste was determined by annual patient
The responsibility of healthcare wastes showed that flow within the health center.
eight of the health centers had different health profes- The mean healthcare waste generation rate in gram per
sionals and administrator staffs to run the management, patient per day per health center in this study was 57.37. It
two health centers had used sanitarians. was higher than the study done in Ethiopia 35 g/patient/
Six of the health centers had no current standard op- day in health center and 500 g/patient/day in hospital [3].
erational procedures for healthcare waste management, It was also different from another study done in Sylhet city,
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Bangladesh in diagnosis center and higher clinics, the mean In this study all the health centers used incinerators,
healthcare waste generation rate was 0.041 kg/patient/day no open burning was occurred for disposing used needles
[10]. This variation may be due to geographical location, and other sharps, different studies had done in most
season of the year, availability of different facilities, social African countries, waste disposal was reported to be prob-
status of the patients (i.e. income, living standard, aware- lematic. Cameroon (1998), Chad (1997), Coted’Ivoire (1997),
ness about disease), healthcare waste management and Guinea-Bissau (1997), and Uganda (1998) showed that
legislation of system of the country. no health centers had the facilities for safe disposal of
The proportion of general (38%) and hazardous (62%) used needles and other sharps. In Ethiopia (1997-98),
of healthcare wastes in this study was different in WHO Kenya, Rwanda and Zambia, incineration of used syringes
report in hospital setting, general was 85% and hazardous and needles was reported to the common practice [15].
was 15% [2]. Another study conducted by Yoseph in similar setting re-
It was also different with the study done in Sylhet city, vealed that 42.5%( 17 out of 40) of the health institutions
Bangladesh in diagnosis center and higher clinics general incinerators were used for disposing used needles and
waste accounted 63.97% and hazardous waste accounted other sharps and the rest 57.5% of the institution used
36.03% [11]. The difference could be due to seasonal vari- open burning and other methods to dispose used needles
ation, availability of different facilities, resource allocation and other sharps [16].
and the variation of denominators between hospitals and In this study all health centers used sewer lines for li-
health centers. quid waste from laboratory and delivery room. It was
All health centers used safety boxes for collection of simply dispose without any treatment in the premises of
sharp wastes. It was better than the study done in Ethiopia the health centers. This was similar with the study done
on injection safety, safety box was observed only in 2(4%) by MoH in Ethiopia in 1989 in 16 health centers and 48
of the 52 health facilities assessed [12]. This variation may clinics. It was reported that most of them had no proper
be due to the risk of used needles and sharps related with liquid waste and solid waste disposal facilities [17].
improper collection might be given better attention by Three out of ten studied health centers the placenta
governmental health system, getting training by waste pits had not been found constructed by concrete founda-
handlers and managers. tion (Figure 2a and b). They were not convenient to waste
Waste segregation and treatment are the most import- handlers, the public and the environment by releasing
ant option in the management of hazardous wastes. Waste bad odor to the atmosphere and accessible for vector
management system in this study revealed that segrega- breeding.
tion of waste at source was practiced by half of health Segregation of wastes at source was not practiced at all
centers. This finding was most likely consistent with the health centers in this study and also in West Gojjam zone,
survey conducted on four federal hospitals by Ministry of Ethiopia [3].
Health (MoH); all but one hospital was segregate infec- Eight out of ten health centers in the study area showed
tious waste at source [13]. This was similar with other that there were needle stick injury, different studies
study conducted on four hospitals in Nigeria segregation showed in developing countries the data available are very
of waste was not practice by any of the study health insti- few and are mere gross under estimation of the real risks
tutions [14]. [2]. This needle stick injury may be related with improper

a b
Figure 2 Placenta pits (a. slab made from concrete; b. made from local wood).
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handling of healthcare wastes particularly sharps because generation rate and management at different seasons is
unsafe sharps waste collection due to improper segrega- strongly recommended.
tion of wastes at the source. Sharps and needle stick injur-
ies are the commonest form of HIV, Hepatitis B Virus and Competing interest
Hepatitis Virus C exposure in health institutions especially The authors declare that they have no competing interests.

for healthcare workers and waste handlers.

Authors’ contributions
Ministry of Health of Ethiopia has prepared healthcare ML Drafted the proposal, organized the research team and data collection,
waste management guidelines in 2007 for the safe hand- performed statistical analysis and drafted the manuscript. AK participated in
ling and disposal of health care wastes also the promotion the design of the study and helped to edit the manuscript. Both authors
read and approved the final manuscript.
of occupational health and the protection of the environ-
ment from healthcare waste [18]. But six out of ten stud-
Acknowledgment
ied health centers, Standard Operational Procedures, as First I would like to express my deepest gratitude to Dr. Abera Kumie for his
well as any applicable local or regional guidelines about unreserved support throughout the study period. I sincerely thank Addis
healthcare waste management were not found. Seven out Ababa City Government Health Bureau, head of the study health centers and
case teams in the health centers for their unreserved cooperation during
of ten health centers didn’t organize safety committee to data collection time. My deepest gratitude also goes to all data collectors
follow the disposal of HCWs. It was similar with a review and supervisor for their commitment during data collection. I would like to
done by Solomon, on healthcare waste management in thank my beloved daughters Bezawit Menelik and Hermela Menelik for their
patience during the study period.
Ethiopia, it was reported that there was no guidelines
specifically deals with hazardous waste and waste from Author details
1
healthcare activities at micro level even though there is Menelik II Health Science College, Addis Ababa, Ethiopia. 2Department of
preventive medicine, School of Public Health, Addis Ababa University, Addis
at federal level prepared by the Environmental policy of Ababa, Ethiopia.
Ethiopia, the Public Health Proclamation No.200/2000
Federal Democratic Republic of Ethiopia and the Envi- Received: 6 June 2014 Accepted: 18 November 2014
Published: 25 November 2014
ronmental Pollution Proclamation No.300/2002 [12].
The existing of gap among the study groups may be
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doi:10.1186/1471-2458-14-1221
Cite this article as: Tadesse and Kumie: Healthcare waste generation and
management practice in government health centers of Addis Ababa,
Ethiopia. BMC Public Health 2014 14:1221.

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