Chapter One: Introduction

1. Background

Medical wastes are of great importance due to its environmental health hazards
and public health risks. The World Health Organisation has advocated medical
wastes as special wastes and it is now commonly acknowledged that certain
categories of medical waste are among the most hazardous and potentially
dangerous of all waste arising in communities (Sawalem et al, 2009), as
exposure to the waste can cause injury or diseases. With this regard solid waste
management is anything just about every government provides for its residents
while service levels, environmental impact and costs vary dramatically.
Moreover, in a World Bank Report, 2012, it states that as the world hurtles
toward its urban future, the amount of municipal solid waste is growing even
faster that the rate of urbanisation (World Bank Report, 2012). A decade ago 2,9
billion residents generated about 96kg of solid waste per person per day yet
today its about 3 billion residents generating 1,2kg per person per day, (ibid).

Furthermore, at a global view there is a link between waste generation and the
polluter pays principle which involves allocating a cost of waste management
services, resource consumption and pollution control to consumers and
producers with the goal that all subsides for resources use production and waste
management services are eliminated, (Horning et al, 2013)

In West Africa in general and Ghana in particular, the issue of collection,

management and disposal of solid waste continues to feature prominently in
major towns and cities across region, (Grover, 2008). The contamination of
water bodies leading to spread of water borne diseases and health hazards,
(ibid). Ghana faces a challenge of waste disposal and unavailability of properly
engineered disposal sites and waste treatment plants inadequate haulage
equipment and lack of expertise and appropriate technical knowhow.

Adding on this, solid waste management is one of the priority issues affecting
the SADC region. The rising quality of life and high rates of resource
consumption patterns have a negative impact on the environment. These have
resulted in generation of waste beyond the handling capacities of the majority of
waste, (Wallace et al, 2001). However, the majority of SADC countries are now
grappling with the problems of high volumes of waste low capacity to
management and high cost involved in the management (Ibid). This was further
exacerbated by the lack of proper disposal technologies and methodologies
being coupled with poor enforcement resulting in rampant illegal dumping of
both industrial and institutional waste as a common practice, (Ruff, 2000).

According to Horning et al (2013), in Sub Saharan Africa (SSA), particularly in

South Africa, the Institute of Waste Management of South Africa is taking
action to reduce the healthy and environmental risks associated with waste
through improvements to household waste separation, collection and disposal
by 2017 (ibid). This initiative stems from South Africa’s Waste Act 59 of 2008
and related waste management strategy standards for waste collection, (Ruff,
2000).

The UNCHS (2000), reported that in Botswana and Mozambique nearly all
solid waste is disposed off in an open dump site rather than sanitary landfill.
This gives risk to unhygienic conditions where the proliferation of disease,
vectors is facilitates and risk s of surface and ground water contamination is
high.

On the other hand, in Zimbabwe most of the waste generated is discarded into
the surrounding environment causing significant health hazards. In a study done
by Pandit et al (2005), it showed that sanitary solid waste disposal constitute
one of the most pressing challenges facing urban and local authorities in
Zimbabwe currently in recent years, there has been considerable increase in
illegal waste dumping which indicates that throughout the country waste
disposal systems are inefficient and environmentally unsafe. Moreso, solid
waste management has emerged as one of the major challenges confronting
almost all local authorities in Zimbabwe. As highlighted by the Practical Action
Report (2007), Zimbabwe produces an average of 2,5 million tones of solid
waste (household and industrial) and the waste collection by local authorities
has dropped from 80% of total waste across different authorities in the 1990s to
as low as 30% by 2006.

Bubi District one of the seven districts in Matabeleland province which faces a
great challenge on solid waste management especially institutional like
hospitals. Despite the provision waste management is a great challenge. From
the quarterly report (2003), its highlighted that solid waste separation is not
really done accordingly as there are increased numbers of staff who are taking
Post Exposure Prophylaxis as a result of needle stick injuries at the hospital pit.
The institutional waste is not disposed off to a proper landfill as the local
authority has not one landfill available and this has led to resorting to burning as
a waste management yet it ‘s not environmentally friendly. Moreso, from the
water tests that were done by the Environmental Department it shows that some
water bodies close to the institution had califorms which shows that these water
bodies were contaminated in one way or another. However, it is against this
background that this paper seeks to find out knowledge altitudes and practices
of staff on solid waste management at Inyathi District Hospital Matabeleland
North Province.
1.1 Research Objectives
 To assess the level of knowledge of staff on solid waste management at
Inyathi District Hospital
 To evaluate the practices of how staff handle solid waste at Inyathi
Hospital
 To examine risks associated with handling of solid waste at Inyathi
Hospital
 To give recommendations on programme interventions associated with
proper management of solid waste at Inyathi Hospital.
1.2 Research Questions
 What is the level of understanding of staff on solid waste management at
Inyathi Hospital?
 What are the practices of staff on solid waste management at Inyathi
Hospital?
 What is the risk perception of staff concerning solid waste management at
Inyathi Hospital?
 What are the programme interventions associated with proper
management of solid waste at Inyathi Hospital.

1.3 Significance of Study

Hazardous and potentially hazardous waste is generated in institutions like

health care establishments (Pandit et al, 2005). Institutional solid waste can
have significant negative impacts on human health and the environment.
There are no or little statistical information institutional waste generation
collection and disposal, low awareness level with regard to the existing
legislation on environmental management in particular solid waste
management is not seen as priority area in institutional organisations (ibid).
Health care workers are the backbone of the health delivery system and lack
of knowledge on solid waste management can predispose the health workers
to infection.

The anticipated results of the study may help come up with strategies that
improve knowledge levels among workers on solid waste management. The
findings will also be used by other students who may want to further
research studies on waste management in the area. If equipped with
knowledge, this will improve the effectiveness of health delivery system and
reduce health spending on conditions emanating from poor solid waste
management.

Moreover, the anticipated results of this study may help to empower, build
capacity of health care workers in risk reduction and avoidance while
enabling them to focus on personal development building careers and
improving their knowledge on life skills. However, this will consequently
provide a stimulus for further research, policy making or changes,
formulation of effective strategies which can be used by other organisations
in order to improve solid waste management in institutions.
 Chapter Two: Literature Review

2. Introduction

This chapter will be focusing on related literature of the knowledge, attitudes

and practices of hospital staff on solid waste management at a health care
institution. Casley and Lury (1987), defined literature review as an evaluative
report of information found in the literature related to the selected area of study.
Literature review is important to the researcher because no research is
absolutely new and so no research is carried out in a vacuum (Bell, 1993). Also
according to Saunders (2003), Literature review makes a case for further
investigation and research highlighting gaps in knowledge and asking questions
that need to be answered for the betterment of the discipline. Thus literature
review forms a foundation for the researcher and it works as a guide since it is a
collective body of prior work. It gives the researcher an insight into what data
gathering instruments and their inherent measures of success have been used in
similar circumstances. Moreso, literature review summarises the previous work
and offers suggestions for future research, (Casley and Lury, 1987). Thus it can
be observed that the review of literature is an essential part of research.

2.1 Knowledge of Staff on Solid Waste Management

Medical wastes are of great importance due to its potential environmental

hazards and public health risks. The World Health Organisation (WHO) has
recommended and advocated that medical waste as special waste and it is now
commonly acknowledged that certain categories of medical wastes are among
the most hazardous and potentially dangerous waste (Sawalen et al, 2009).
Handling medical waste requires knowledge as a way to reduce the spread of
disease as there has been an increase in public concern about the management
of solid waste on a global basis (Coker et al, 2008). Medical or hospital
personnel should be trained and solid waste management and this can be seen
with a study done by Silva et al (2004) which showed that 93% of the
participants did not have any training on hospital waste management. In a
similar study done by KARACHI IN 2007, it is shown that similar results
however the level of knowledge measures aggregate and they reported none of
the workers having good knowledge. This can be attributed to the sense that
health workers lack knowledge of waste management and refresher courses and
also low levels of the staff especially housekeeping staff. This is supported by
the study done by Karachi which showed that overally the sanitary workers had
poor knowledge of waste handling steps that is segregation, collection and safe
transport.

Besides this, although there is increased global awareness among health care
professionals about hazards and also appropriate management techniques the
level of awareness in India has been found to be unsatisfactory. The problem of
solid waste also affects the knowledge of staff, as in a , the results showed that
there was a poor level of knowledge and awareness of biomedical waste
generation, hazards, legislation and management among health care personnel,
(Sawalem et al, 2009) Moreso, Boadi (2001), stated that 36% of nurses had poor
knowledge of solid waste generation and legislation and just 15%of hospital
hands had an excellent awareness of biomedical waste management practices.

However, in a study conducted in New Delhi, India it was reported that the
majority of the respondents were not aware of the proper clinical waste
management regulations. Similar results were found in a study of hospital
medical staff in Agra by (Saunders, 2003) which showed that lack of knowledge
and awareness towards legislation of biomedical waste because one third of
staff were not were not aware of where the waste from the hospital was
ultimately treated and disposed of. Also in another study presently done in India
by (De Roors, 1974), it compared the solid waste on knowledge, attitude and
practice (KAP) among health care personnel, showed that nurses, doctors and
laboratory technicians have a better knowledge than the sanitary staff regarding
biomedical waste management. In contrast, in another study, it suggested that
many dentists had knowledge about waste management but they lacked
appropriate attitude to engage in the practices for the problem.

2.2 Practices of Staff on Solid Waste Management

Mostly there is great link between the knowledge and practices of handling
solid waste. The practice of reporting injuries resulting from improperly
disposed biomedical waste was found to be miserably low among staff. In a
study done by Stein et al (2004), it was reported that only 37% of participants
reported that they had ever suffered needle stick injuries and this could have
been attributed by the fact that most of the staff were unaware about the formal
systems of injury reporting which should ne established within all health
facilities.

In support of this, annual injuries with potentially contaminated material

reported in hospitals also shows that the contaminated material and the injuries
associated with medical waste and all resulted from punctures and these occur
during patient care before its considered as waste. The group more exposed to
medical waste injuries is housekeepers since they are responsible for waste
collection.

The house keepers are the group with more medical waste injuries while doctors
and nurses usually suffer needlestick injuries as this is related to their daily
tasks, and of each medical staff group who provide patient care and the
housekeepers collect and transport the medical waste.

Moreover, the hospital waste management practices adopted in a study by Ruff

(2000) showed that adequate knowledge about the health hazard of hospital
waste, proper technique and methods of handling the waste and practices of
safety measures can go a long way toward the safe disposal of hazardous
hospital waste and protect the community from various adverse effects of
hazardous waste.

2.3 The Risks Associated with Handling Solid Waste

The mismanagement of health care waste poses health risks to people and the
environment by contaminating the air soil and water resources. According to the
World Health Report (2007) health care units are supposed to safeguard the
health of the community, however, health care wastes if not properly managed
can pose an even greater threat than the original diseases themselves. Moreso,
infections may occur by direct contact with biological pathogens such as
hepatitis B or through exposure to biological contamination resulting in
respiratory ailments, (Ibid). This can be viewed with regards to the study done
by Rao (2008) which revealed that at its main dump site 974 children were
examined 27% of which had clinic cough, 25% wheezing and 19% shortness of
breath. At the same dumpsite 10 years earlier 70% of the informal recycles had
upper respiratory ailments including tuberculosis, bronchitis and asthma. (Ibid).

According to other studies, it indicated that the clinical solid waste management
at health care facilities is inadequate in developing countries where the waste is
handled and disposed together with non clinical waste which is creating a vital
and even fatal health risk to health care workers and the general public
(UNAIDS, 2005). Also surveys reveal that the incidences of contracting
diseases are most prevalent among waste handlers compared to other staff,
(ibid). The waste handlers’ general exposure due to their occupational job
functions could result in an infection during waste handling through punctures.
Moreover, the evidence available states that poor management practices and
improper precautions taken by clinical waste workers during waste collection
segregation and disposal might be the main reasons for the spread of infectious
diseases among clinical waste handlers (Stein et al, 2006).

According to Silva et al 2005, among the various types of clinical

waste, the handling of and disposal of sharps clinical waste is of great
concern in developing and transitional countries of the world. Sharps
such as the hypodermic needles is considered a highly hazardous
waste resulting from the common contamination from the patients’
blood and infects wounds with the pathogens in the contaminated
waste. Therefore, clinical sharp waste is considered as a waste with
double or higher risk to health care workers due to its potential of
infection by injury. Also there are potential health effects of both
waste itself and the consequences of managing it have health risks.

Furthermore in a study done by (DC2010), the unsanitary methods adopted

for disposal of solid waste is a serious health concern with significant
environmental, social and health costs associated with it. Open dumping of
waste facilitates the breeding of diseases vectors like flies, cockroaches, rats
and other pets. Cooker et al (2006) stated that improper management of solid
waste represents a source of environmental pollution and poses risks to
human health particularly among children who play near waste dump sites
and the employees in the waste management sector.
However, from the study by the Environmental agency (2002) infected
hospital waste can transmit diseases, especially if it finds portals of entry. As
the main concern of infections hospital waste is the transmission of
HIV/AIDS virus and more often hepatitis B or C through injuries which are
contaminated by human blood. This is usually more peculiar because of the
fact that there is a risk of lack of priority on basis of worker safety when
dealing with waste within health care facilities.

Adding on to this, in a study done in Ethiopia, shows that in any health care
establishment nurses and housekeeping personnel are the main groups at risk
of injuries where annual rates of injuries are 10-20 per 1000 workers and
also the annual rate for USA is 186 per 1000 (WHO, 1999). Moreover, in a
study done in Nigeria, it showed that antibiotic resistant Escherichia coli has
been shown to survive in an activated sludge plant at the plasmids from
laboratory strains contained in health care waste were transferred to
indigenous bacteria via the waste disposal system (Ruff, 2000). The solid
waste from hospitals produce occupational risks such as direct exposure to
blood and needlestick pollution of ground water (ibid). Moreso, concern
regarding solid waste is mainly due to the presence of pathogenic organisms
and organic substances in hospital solid waste in significantly high
concentrations. Therefore, improper handling of solid waste in hospitals may
increase the airborne pathogenic bacteria which could adversely affect the
hospital environment and the community at large and have a considerable
impact on human health due to the aesthetic effects (Sawalem et al, 2009).

Moreover, the waste produced in the course of health care activities carries a
higher potential for infection and injury than any other type of waste. In
adequate and inappropriate knowledge of handling of health care waste may
have serious health consequences and a significant impact on the
environment as well. Furthermore, hospital waste refers to all waste
 biological or non biological that is discarded and is not intended for further
use on hospitals. Also according to WHO report around 85% of hospital
waste is actually hazardous, 10% are infective and 5% are non infectious but
hazardous.

2.4 Recommendations on Programme Interventions Associated with

proper Management of Solid Waste

Although there is increased global awareness among health care professionals

about hazards and also appropriate management techniques the level of
awareness remains unsatisfactorily on solid waste management. In India, the
Ministry of Environment and Forests has promulgated the Biomedical Waste
rules 1998 of proper management of biomedical waste. These rules were met to
improve the overall waste management of health care facilities, (De Roors,
1974). However the introduction of laws is not sufficient for proper disposal of
solid waste.

Moreover, health care waste in most worldwide countries is disposed of using

incineration which is also viable to inactive heat resistant pathogenic bacteria
are released into the environment through stack gas and bottom ash and
sterilisation of sharps waste before final disposal of the waste will be
recommended to treat nosocomial infections. Waste management is now also
tightly regulated in developed countries and it includes generation, collection
transportation and the final disposal of waste. Moreover the structural
adjustment programmes in an attempt to raise additional fund has encouraged
the privatisation of solid waste collection through the provision of legislation
requiring Environmental Impact Assessments prior to the development as
another recent feature in most Southern African countries. Some of the SADC
countries including Zimbabwe have all put in place local environmental plans
and implemented them to some extent.
Most of the waste generated is discarded into surrounding environment causing
significant health hazards. In Zimbabwe, Epworth community based group uses
locally available equipment to collect and manage reusable material from the
waste, (Tsakona et al, 2007). Moreso, the Bin it Zimbabwe programme, a
partnership of government, private sector, Non Governmental Organisations and
Community Based Organisations was also launched to promote efforts to
separate waste at source and the antilittering campaign across the country. This
programme has promoted the age of colour coded bin liners for different kinds
of garbage.. It helps to improve the regarding awareness among Zimbabweans
(ibid). In contrast with South Africa, which has highly developed recycling
various garbage separation and recycling countries.

2.5 Summary

This chapter dealt with the review of related literature and the following chapter
deals with research methodology.
 Chapter Three: Research Methodology

3 Introduction

In this chapter, the strategies used to carry out the study were outlined and
described. The study population, research design, data collection tools, data
analysis and the ethical considerations will be highlighted.

3.1 Research Design

In this research, descriptive survey will be used as a data collection tool as it can
be done in a variety of ways like questionnaires. Creswell (2003),research
design is the determination and statement of the general research approach or
strategy adopted for the particular project and it adheres to the research
objectives. Research design is a plan of study providing overall framework for
collection of data. To obtain the data, descriptive survey will be used for this
study. A descriptive research is an innovative tool for the researchers as it
presents an opportunity to use both quantitative and qualitative data as a means
to reconstruct the ‘what is ‘ of a topic, (Leeydens et al, 2004). The method is
considered to be appropriate because it gives the general idea about the present
problem. Leedy (1993), stated that surveys are conducted to establish the nature
of an existing condition provide an insight into the situation and have a higher
degree of representatives.

Surveys are objective, specific, practical, accurate and factual, (ibid). Moreso,
Oppenheim (1996), states that descriptive surveys tell us how many members of
a population have a certain characteristic. The descriptive survey method allows
data to be collected through the use of research instruments such as
questionnaires.
 3.1.2 Advantages of Descriptive Survey

Descriptive survey is a convenient data collection tool which can be

administered to the participants through a variety of ways like through
questionnaires. Leedy (1993), also states that descriptive survey has the ability
to accommodate large sample size’s generalisability of results, ability to
distinguish small differences between diverse sample and increased capabilities
of using advanced statistical analysis and ease of administering and recording
questions and answers.

3.1.3 Disadvantages of Descriptive Survey

According to Popper (1981), the principle of confidentiality is the primary

weakness of descriptive research, often the respondents are not truthful as they
feel need to tell the researcher what they think the researcher wants to hear.
Also, Leedyen et all (2004), said the method has difficulty in developing
accurate survey instrument and an increased potential low response rate.

3.2 Data Collecting Tools

As a way to gather information from the sample, various methods can be used
and in this research questionnaires and observations were used to collect data.
The instrument used in this study is a questionnaire which consists of close and
open ended questions and the observations by the researcher as instruments are
discussed below.

3.2.1 Questionnaire

Bell (1993), defined a questionnaire as a document that asks the same questions
to individuals in the sample. In this study self administered questionnaires were
used to solicit information from health workers as a way to find out their
knowledge, attitudes and practices in relation to solid waste management. It
shall also be noted however that questionnaires require questions that are
straight forward enough to be comprehended soley on the basis of printed
instructions and definitions (Casley et al, 1987).

3.2.2 Advantages of Questionnaires

A questionnaire was chosen because it provides some privacy and

confidentiality leading to valid and reliable findings. The questionnaire
addresses a larger population that is dispersed geographically at a minimum cost
(Christensen, 1994). As highlighted by Ackroyd et al (1981), a large amount of
information can be collected from a number of people in short period of time
and in a relatively cost effective way. The researcher also chose questionnaires
since the results of the study can be quickly and easily quantified by either the
researcher or through the use of software packages. Popper (1959), stated that
positivists believe that quantitative data can be used to create new theories and
or test existing hypothesis. In this study, the researcher will personally collect
filled questionnaires so as to avoid participants influencing each other.
Questionnaires use both qualitative and quantitative data and can be associated
with positivistic methodologies ( Burns et al, 2003)

3.2.3 Disadvantages of Questionnaires

Questionnaires have been known to suffer from misinterpretation by the

respondents, (Abrason et al, 1999). Moreso, phenomelogists states that
quantitative research I simply artificial creation by the researcher as it is asking
only limited amount of information without explanation, (ibid). There is also a
level of researcher imposition meaning that when developing the questionnaire,
the researcher makes their own decisions and assumptions as to what is and is
not important, therefore they may be missing something that is important,
(Pooper, 1959). According to Cohen et al (1985), the respondents can lie since
they can remain anonymous and athe questionnaires have low rate of return
especially if they are postal questionnaires.

3.2.4 Observations

The researcher used observations as a method of data collection tool.

Observations were defined by Casley et al (1987), as the systematic description
of events, behaviours and artifacts in the social setting chosen for study. These
enable the researcher to describe existing situations doing the five senses, (ibid).
The researcher used participant observation as it is a process enabling
researchers to learn about the activities of the people under study in a natural
setting through observing and participating in these activities.

3.2.5 Advantages of Observations

Observations provide the researcher with ways to check for non verbal
expression of feelings determine who interacts with whom. Moreso,
observations provides direct access to the social phenomena under
consideration. Observations are flexible as can take forms from informal to
formal procedures yielding results and the results can be applicable in a wide
range of contexts. It also complementary with other approaches and it can
effectively complement other approaches and thus enhance es the quality of
evidence available to the researcher.

3.2.6 Disadvantages of Observations

The main disadvantage is that its time consuming and resource intensive. The
method is prone to researcher bias thus undermining reliability and hence the
validity of the data gathered. Observer effect is one of the elements as this is the
way in which the presence of an observer influences the behaviour of those
being observed.
3.3 Sampling Procedure

In this research the researcher used 20 participants who were all health
workers and the sample size was chosen using systematic sampling
method. According to Casley et al (1987), a sample refers to part of a
whole or a subset of the target population or an aggregate of the target
population with some characteristics and attributes. However, a
population refer to the entire set of objects or subjects of interest in a
statistical survey or study or can be the entire collection of observations
corresponding to the subjects under study, (ibid). The sample shall be
representative of the target population, therefore shall have the same
characteristics and attributes of the population so as to allow for the
generalisation of the results back to the population from which they are
chosen. The researcher uses probability sampling that is systematic
sampling method. This is when samples are chosen in a systematic or
regular way and every 5th person from the whole population was chosen.

3.3.1 Advantages of Systematic Sampling

According to Casley et al (1987), systematic sampling has a good coverage of

the study area as this can be easily achieved. Also, its more straight forward
compared to random sampling since it’s simply as it allows the researcher to
add a systematic element into random selection of subjects, (ibid). Moreover,
the advantage of systematic sampling is that the research is guaranteed that the
population will be evenly sampled.

3.3.2 Disadvantages of Systematic Sampling

According to Ackroyd et al (1981), the main disadvantage of systematic

sampling is that the process of selecting the sample can interact with a hidden
periodic trait within the population. To add on to its Babbie (2001) states the
disadvantages of systematic sampling can be biased as not all members have an
equal chance of being selected and can also lead to over or under representation
of a particular pattern.

3.4 Study Population

Casley et al (1987), defined a population as the entire set of objects or subjects

of interest in a statistical survey or study. The target population is the collection
of elements or objects that possess the information sought by the researcher
about which inferences are to be made. In this study, the target population is the
health care workers aged 18 and above at Inyathi District Hospital. A sample of
20 participants will be obtained for the purpose of this study.

3.5 Data Collection Procedure

The researcher sought permission to carry out the study at Inyathi District
Hospital from the District Medical Officer. Self designed questionnaires were
issued out by the researcher to the participants. The participants were not
allowed to discuss the questionnaires so as to avoid participants influencing
each other’s responses and filled questionnaires were collected personally by
the researcher for data analysis. A pilot study was conducted at Inyathi District
Hospital as a way to check on the reliability and validity of the research
instrument.

3.5.1 Reliability

Creswell (2003), defines reliability as how consistent the results are when the
experiment is repeated a number of times under same methodological
conditions. Barke (1994), also defines reliability as the ability of a measure to
produce and yield a constant result and the reliability of an instrument looks at
the extent to which the instrument produces yields some results on repeated
trials. It is also the reproducibility or repeatability or consistency of information
and the extent to which similar information is obtained when a measurement is
performed more than once, (Abramson et al, 1999).

3.5.2 Validity

According to Burns et al (2003), validity is the extent to which an instrument

measures what it is supposed to measure. It is the degree to which the evidence
supports that the manner in which interpretations used are appropriate. Thus
validity seeks to discover whether an instrument to be used is appropriate one
for what it needs to measure, (ibid). However, reliability is directly related to
validity of the measure. In this study a pilot study was conducted since it gives
warnings about the main research project could fail where the main research
project could be followed or whether the proposed methods or instrument is in
appropriate or to complicated, (Barker, 1994).

3.6 Data Analysis

Mauntain (1996), states that data can be analysed using either descriptive
statistics is concerned with organising and summarising the data at hand and
render it comprehensible. Descriptive statistics include the use of percentages to
answers for each question so as to compute items of this study and they are used
to describe the basic features of the data in a study. This provides simple
summaries about the sample and the measures. However, the weakness of
descriptive statistics are limited in so much that they only allow one to make
summations about the people or objects that one has actually measured. One
cannot use the data collected to generalise to other people or objects. For the
purpose of this study, data will be presented in the form of graphs , tables and
pie charts.

3.7 Ethical Considerations

Research ethics involves the application of fundamental ethical principles to a
variety of topics involving scientific research, (Bell, 1993). The researcher
adhered to ethical and legal principles which are the principle of voluntary
participation which requires people not to be coerced into participating in
research. The research will also base on the requirement of informed consent
where participants shall be fully informed about the procedures and risks
involved in research and must give their consent to participate. Also it is duty of
the researcher to guarantee participants on confidentiality as they are assured
that identifying information will not be made available to anyone who is not
directly involved in the study and also the researcher shall not put participants
in situations where they might be at risk of harm as a result of their participation
either physical or psychological harm. Moreso,the principle of privacy which
essentially means that the participants will remain anonymous throughout the
study and also respecting the cultural, political and religious beliefs of the
participants.

3.8 Chapter Summary

This chapter dealt with, research design data collecting tools, sampling
procedure, data collection procedure, reliability, validity and how data will be
analysed. The chapter also highlighted how the instruments will be administered
in order to collect the data used in the study. Also, all the questionnaires used in
the study will be personally handed to the respondents and collected by the
researcher. The next chapter deals with data presentation, data interpretation and
its analysis.

Chapter Five: Conclusions and Recommendations

5.0 Conclusion
5.1 From the study it can be concluded that the knowledge of staff of SWM is
good enough it was good for the health professionals rather than the sanitary
workers, the study also highlighted that the respondents were familiar with
SWM methods and could differentiate the types of SWM.

5.1.2 The practices of study on SWM was generally based on the available
measures or methods of SWM. The available methods were being used through
separation of SW was not really done as a result of lack of resources like the
colour coded bins for different forms of waste. The respondents separate
harmful waste only from other forms of waste yet they do not give much
emphasis on separation of waste which can be used to recycling or not.

5.1.3 The risk perceptions of health workers pertaining SW was good in this
study, though the other members could not tell whether it puts them at risk to
getting this. The awareness of individuals on hazards they are likely to get from
poor SWM helps in them deducing the practices which puts them more at risk.

5.1.4 In conclusion, the study highlighted that the are programme interventions
which are available and help in managing SW and the available programs seems
to be effective. It can also be concluded that enforcement of policies pertaining
SW should be done and use of SOP to reduce injuries.

5.2 Recommendations

5.2.1 All health services establishment employees have a role to play in the
process of waste minimisation and should:- be trained in waste management and
the management of hazardous materials. Therefore regular training projects
sufficient provision of protective measures to urgently needed to improve OS
for cleaning personnel. In institutions its also important to improve knowledge
through in cooperating SWM in the curriculum for health professionals and
having induction for the sanitary waste/hospital workers on proper handling and
disposal of solid waste.
5.2.2 Handling solid waste should be one of the priorities among staff in
institutions like hospitals as there waste are considered harmful. The institutions
should also introduce the colour coded bins or bin liners so that waste can be
segregated.

5.2.3 Giving trainings to individuals helps in improving their knowledge on

solid waste management and this will increase their risk perceptions. The
researcher also recommends that use of posters and policies in departments will
also help to increase the risk perceptions of staff on SWM.

5.2.4 The researcher recommends that enforcing the policies on SWM should
be done and use of standard operating procedures should be implemented at all
levels. Of one is found not doing the stipulated procedure should be charged a
fine and also recommends sterilisation of health care wastes prior to its disposal
to eliminate nosocomial infections.