ENVIRONMENTAL AND HEALTH IMPACT ASSESSMENT OF HOSPITAL

WASTEWATER IN SOUTH-WEST, NIGERIA

Ph.D. Proposal

By

ONAWUMI Foluso Victoria (B.Sc. Ife, PGD and M. Tech. ogbomoso)

Civil Engineering Department, Faculty of Engineering and Technology

Ladoke Akintola University of Technology, Ogbomoso Oyo State, Nigeria

 JULY 2024

1.0 INTRODUCTION

1.1 General Background

Water is the most important requirement for human life to exist. In fact, water is

essential not only for human life but also for animals, plants and all other living beings. The

importance of water for the living beings may be judged from the fact that it is part of life

itself, since the protoplasm of most living cells contains about 80 per cent water, and any

substantial reduction of this percentage of water is disastrous (Modi, 2006). However,

utilization of water is not only for drinking purpose but also for cooking, laundering, heating,

air conditioning, bathing and washing; for agriculture, stock raising (i. e. cattle breeding, pig

breeding etc.) and gardens; for industrial processes and cooling, for water power and steam

power generation, fire protection, disposal of wastes, fishing, swimming, boating and other

recreational purposes; for wild life propagation, and navigation (Modi, 2006). It is thus

evident that every activity of man involves some use of water.

Moreover, the importance of water in human life is so much that the development

of any city of the world revolves around some source of water supply (UNEP, 2019). It is

difficult to imagine any clean and sanitary environment without water. Invariably, the
progress of sanitation throughout the world has been clearly associated with water, the most

rapid and extensive has been the advance of public health.

The Hospital is a health care institution that is built, staffed and equipped to provide

patient diagnosis of diseases, treatment, both medical and surgical, of the sick and injured, it

is also used for housing during the process of diagnosis and treatment. Based on the activities

taking place within the hospitals, different units/services require a large volume of water and

each of these services generate large amount of wastewater (Billot et al., 2008).

Wastewater is any water that has been adversely affected in quality by human

activities influence. It comprises of liquid waste discharged by domestic residences,

commercial properties, industrial and/or agricultural wastes, and can encompass a wide range

of potential contaminants and concentrations (Nielsen et al., 2004). Waste water that contains

urine, faeces, kitchen and laundry waste is referred to as sewage.

The quantity as well as characteristics of hospital wastewater are determined by

the size of the hospital, the number and types of wards, and units of the hospital, and also by

management policies and the level of awareness of the institution (Kumar et al., 2007).

According to Al Aukudy et al., (2018), a hospital in a developed country generates 400-

1200L of wastewater per bed per day as compared with developing countries the value

generated is 200-400L/capital/day while generally, domestic wastewater generated is 100-

400L/capital/day.

Generally, the characteristics of wastewater generated from hospitals are similar

to those of domestic wastewater, but a proportion of hospital wastewater consists of highly

toxic, nonbiodegradable, and infectious pollutants (Al Aukidy et al., 2018). Contamination of

biota by hospital wastewater is a major environmental and human healthcare issue. Hospital
effluents has been reported to consist of tens to several hundreds of micrograms per litre

concentrations of antibiotics, cytostatic and other drugs (Zhang et al., 2020).

Hospital wastewater is also considered major contributors to emerging

contaminants. Other routes for emerging contaminants entering into hospital wastewater

include the direct disposal of unused or expired drugs, disinfectants, radionuclides, landfill

leachates and application of sewage sludge to ensure soil fertility (Celic et al., 2018). All

these contaminants combine with hospital effluents and reach the municipal sewer network

(with or without treatment) in developed countries but in developing countries the effluents

are discharged into the septic tanks, or directly to open drainage channels (mostly without

treatment). They will sometimes end up in open ground.

The existence of these pollutants in various environmental matrices, including

surface water, groundwater, soil, and sediments can threatens human health, health of aquatic

ecosystem and the environment (Rasheed et al., 2019).

1.2 Problem Statement

As an environmentalist, this study is borne out of direct observations made of

wastewater management in healthcare facilities and the possible environmental

consequences. There was direct discharge of blood samples from the laboratory into open

water drainage channels. Also observed among others was wastewater from the x-ray unit. A

continuation of wastewater from these different sources within hospital premises is directly

received by the soil in the environment.

According to the National Healthcare Waste Management Plan Report

(NHWMP, 2003), Nigeria and its citizens are exposed to unnecessary health and
environmental risk factors from unsafe healthcare waste and wastewater practices which has

a higher risk of the periodical outbreak of cholera, it has been established that hospital

wastewater is toxic and contains non-biodegradable pollutants such as pharmaceutically

active compounds (PhACs), X-ray, contrast media, surfactants, and disinfectants, which are

highly persistent compounds and termed emerging contaminants (ECs) can be toxic to

human beings and other aquatic organisms at low concentrations (μg/L to ng/L).

Managing Hospital wastewater is a crucial environmental concern, as it can

significantly impact the surrounding ecosystem and human health if not properly treated and

disposed of. The management of healthcare wastewater in Nigeria is well below minimum

hygiene standards, hence, healthcare workers, patients, and surrounding communities are

exposed to nosocomial infections. It also have negative impacts on Nigeria’s natural

resources (air, soil, and water).

There exists a considerable gap with regards to the assessment of healthcare waste

management practices in Nigeria, the nature and quantity of healthcare wastewater

managements including waste segregation. They are often poorly examined and documented

in several countries of the world despite their health risk (Oke, 2005). Iweriebor et al., 2014

report that Hospital wastewater systems contribute to the spread of antibiotic-resistant

bacteria into the environment.

Mobilization and return of the contaminants to the food chain or in drinking

water

increases the possibility of exposure of living organisms to hazardous substances originating

from healthcare waste thereby imparting greater risks to the environment on the long run.

Hence, the need to assess the environmental impact of hospital wastewater disposal in a
 developing country like Nigeria. This assessment will address the extents of the pollutants
in

environmental matrices, and the hospital wastewater. It will also look into environmental
health

impact and management practices, knowledge gap and future research directions, and also

provide relevant information that can guide decision-makers and environmental scientist in

their future policies and research endeavours.

1.2.2. Research Questions

1. How does the usage of the hospital affect its immediate environment?

2. Why is it necessary for hospital wastewater to be treated before releasing it to the

environment?

3. What is the proper procedure for the discharge of hospital wastewater to its immediate

environments

4. Is this procedure of discharge of hospital wastewater followed in our healthcare

services providers?

1.2.3. Significance of the study

The study will estimate the population of patients in the teaching hospital and give an

estimated quantity of water use and its equivalent wastewater per capital per person, the

hospital wastewater will also be characterized This will help environmental authorities and

physical planners to know the

1.3 Aim and Objective

1.3.1 Aim

The aims of this study is to carry out an environmental impact assessment of

wastewater management and disposal of hospital waste in a developing country.

1.3.2 Objectives

The specific objectives are to:

(i) General survey and characterization of health care facilities within the study area.

(ii) Determine the physico- chemical and microbial characteristics of the environmental

matrices (air, soil and water) of the study area.

(iii) Evaluation of the heavy metal’s characteristics of the environmental matrices of the

study area.

(iv) Investigate the characteristic of the hospital treatment plant wastewater constituent.

(v) Carry out biodegradation on the wastewater samples

(vi) Determine level of toxicity of the samples using laboratory animals

(vii) Establish the environmental impact of the hospital wastewater in the environmental

matrices.
2.0 METHODOLOGY

2.1 General survey

2.1.1 The study area

The survey would often base on a series of interviews with key informants and interrogation

with the personnel in charge of administration and works departments. Included in the

investigation is to know the area occupied by the facility, the size of the hospital, the types of

clinics with the number of units in the hospitals, the types of wards, and the number of staff
working

in the facilities (both skilled and non-skilled), estimate water use per capita per day by

patients, visitors, and caregivers, and also an estimate of wastewater for treatment and
hospital

management policies

.2.1.2 Estimate of water use per capita per day by patients, visitors and care giver.

This study would utilize a quantitative approach with the use of a questionnaire survey.

The questionnaire would be written in English language, it would be administered based

on a one-to-one approach as many of the patients might not be able to express themselves

in English because the southwest speaks predominately Yoruba. This will include an
estimate

of the water pump per day, using a measure of the 10-liter bucket used by the
correspondent/what number used per day for bathing, toileting, laundry, cooking (if allowed),
and drinking. The visitors and caregiver would also be subjected to the same questioning.

2.1.3 Estimate of wastewater for treatment.

The conversion factor of water to wastewater would be estimated with

some criteria such

as the number of occupied beds, personnel, and wards.

2.2 Physiochemical and microbial analysis of the environmental matrices

2.2.1 Evaluation of the level of air microbial contamination in the hospital environment

It would be evaluated using Standard Microbial technique. Passive air sampling would be

performed using sterile plates in accordance with Ndimele et al., 2015.

2.2.2 Soil Analyses.

Soil sample would be collected from the facility and taken to the laboratory for the

following parameters: -

2.2.2.1 Soil physical Analyses

Soil samples would be taken from the study area to the laboratory for test using the

recommended chemical soil test procedures. The following physical parameters are to be

determined, they are; pH, Electrical conductivity, and soil classification

2.2.2.2 Soil Chemical Analyses

The following chemical test parameters would be carried out in the laboratory; Soil

Nitrogen (N), Organic Carbon (OC), Phosphorus (P), Potassium (K), Calcium (Ca),

Magnesium (Mg), Sulphur (S), and Soil micronutrients (Zn, Fe, Ni, Pb)

2.2.3 Physico-chemical analyses of groundwater/surface water

Water samples would be collected from hand-dug wells/surface water surrounding

the hospital and subjecting it to various physical, chemical, and biological investigations
using

standard methods for laboratory analyses. The following parameter investigations will be

carried out.

2.2.3.1 Water Physical Analyses

The pH, Temperature, Turbidity, Colour, electrical conductivity, and total

suspended solids are the physical parameters to be investigated.

2.2.3.2 Water Chemical Analyses

The following chemical parameters are to be considered namely, Dissolved oxygen,

BOD, COD, TCC, Nitrite, Nitrate, Phosphate, Chloride and Ammonia using
standard

methods of measurements.

2.2.3.3 Water Biological Analyses.

The following biological parameters will be investigated namely, colony counts

and

faecal coliform tests using standard methods

2.3. Investigation of Hospital Treatment Plant Wastewater Constituent

Physical, chemical, and biological investigations of the hospital treatment plant

wastewater will be carried out. Samples of the wastewater from the treatment plant would be

collected and taken to the laboratory for analysis.

2.4 Determination of Heavy metals present in all samples (wastewater, soil and

groundwater).

The Heavy metals to be considered are Cadmium, Chromium, Copper, Iron, Lead,

Nickel, Mercury, and Zinc. The investigation would be carried out with the use of Induced

Coupled Plasma-mass Spectroscopy.

2.5 Biodegradation on the samples

Biodegradation refers to the degradation of organic contaminants in soil and/or

groundwater by indigenous or transplanted/acclimated microorganisms, primarily bacteria

and fungi. Organic contaminants are converted into carbon dioxide, water, and microbial cell

mass under aerobic conditions (in the presence of oxygen). Under anaerobic conditions (in

the absence of oxygen), methane, small quantities of carbon dioxide and hydrogen, and
occasionally intermediate species, which may be less, equally, or more hazardous that the

metabolized compound produced.

2.6 Determination of level of toxicity of the samples using laboratory animals

Toxicity test uses bio-organisms instead of testing components and compounds to detect

toxicity in water samples. The main advantage of toxicity test is the fact that it is not
necessary

to deploy this test on many available pollutants. Base of deploying toxicity test is when
special

biological species are exposed to toxic compounds in a sample of water; there would be a

measurable biological response for each of them. To measure potential effect of polluted
water

on organisms, there should be a standard to measure biological response. Samples of these

standards consist of luminescence of algae, metabolic performance, and respiratory rate.

2.7 Statistical Analysis

The data obtained from this research work would be subjected descriptive and inferential

Statistical analyses. The descriptive statistical analysis was in form of tables, percentages
while

the inferential statistical analysis involved using analysis of variance (ANOVA).

2.7.1 Quality Assessment

Quality assessment checks the effectiveness of quality control practices used in the

laboratory, and is used to determine if an analytical process is meeting quality assurance

guidelines. Quality assessment is achieved through systematic documentation of accuracy

and

precision. The descriptive statistics used to quantify a laboratory quality assessment program
can be presented in a variety of ways. Precision is presented in terms of standard deviation

(SD) or relative standard deviation (RSD) from the mean of repeated measurements on the
same sample.

2.7.2 Graphical presentation

Quality assessment statistics can be presented graphically through control charts for

ease of interpretation. X-charts can be used to present both accuracy and precision data,

example of x-chart is shown in figure 3.1.

Another graphical display is the R-chart or range chart.R-chart data consist solely of

replicate ranges and can only be used to document precision. Figure 3.2 shows typical R-
chart

used for quality assessments

2.8 Establish the environmental impact of the hospital wastewater on the soil and

groundwater in the area.

The following steps would be taken in determining the environmental impact of the

hospital wastewater;

(i)

2.10 Reviewed papers

Astha et al., 2020 “Hospital wastewater treatment scenario around the globe”,

considered the review of present state of hospitals from developing countries to developed

countries and comes up with a conclusion that though WHO and task force agency of few counties

have a fare set of laws and guidelines regarding management of hospital wastewater but there is no

definite ways of separation and segregation of hospital wastewater and the impacts of direct and

indirect discharge to the environment. Hospital sewage sludge of high concentration of helminthes
and other pathogens should be properly treated using aerobic and or anaerobic digestion or

insemination before its disposal. Also, toilet discharge of patients treated with radioactive

procedures must be segregated and collected separately to avoid future dander due to radioactivity

decay that may arise from sewage. It also concludes that collection of urine at source is a better

option and carried the effluent to pre-treatment unit where important nutrients can be trapped. The

application of Membrane Bio Reactor (MBR) in combination with activated sludge process is widely

accepted for treatment of hospital wastewater due to its high rate of removal of bacteria and

antibiotics although, the installation, operation, and maintenance cost of MBR process is higher

compared to other conventional wastewater treatment. It suggests that research should be focused

on developing risk-based approach treatment technologies as this is recognized as best technology

of treatment of hospital wastewater.

Jafari Mosavi, (1993), “The Environmental impact Assessment of hospital waste

incinerator”, the report makes a study of the environmental impact of incineration of hospital

waste. It explores the different methods used in the disposal of waste, the nature of waste was

reviewed in relation to quantities, composition and classification. The study also focused on

methods of waste disposal including the characteristics and nature of incineration, the activities

involved in the combustion process of waste and the nature of incineration stack emissions and the

biological material released to the environment. The study also analyses the link between hospital

waste incineration and Environmental Impact Assessment, considering the positive and negative

impacts of the incineration and covers the direct and indirect impact, temporary, permanent and

cumulative impacts, short- and long-term impacts were also evaluated taking into account relevant

information.

Muhammed et al., (2021), “Hospital wastewater as a source of environmental

contamination: An overview of management practises, environmental risk and treatment process”

. This paper provides extensive contaminants pathways to the environment, management practises,

and operative treatments alternatives for removing emerging contaminants from the hospital

wastewater. From the study, it was concluded that in most cases healthcare facilities discharge

contaminants into biotic system without any prior treatment thereby threatening the health and

survival of the environment. With the high rate of toxicity and pollutant load of hospital wastewater,

appropriate treatment methods should be designed based on the type of effluent from the health

facility and the catchment area. These contaminants are detected downstream of wastewater

treatment plants, this is because the plants are not designed to remove all types of contaminants.

Normally, hospital wastewater undergo pre-treatment, biological treatment, advanced treatment,

and post-treatment processes in the plant considered. It was also concluded that advanced

treatment stages such as ozonation, activated carbon, AOPs, are sometimes required to effectively

eliminate these emerging contaminants.

KNOWLEDGE GAP; In the midst of COVID-19 pandemic, the wastewater discharged from hospitals

and quarantine centres have introduced additional environmental challenges. There should be a

proper management and surveillance of this wastewater as a contribution to the overall

management of the pandemic and to advanced planning for another possible wave of infections

Okereke et al., 2016: “Environmental and Health impact of industrial wastewater effluents

in Nigeria”. This paper reviewed the environmental and health impacts of untreated and

inadequately treated wastewater effluents in Nigeria. it reports the industrial wastewater effluents

and the appropriate test analysis that gives extents of pollutants and toxicity of the effluent

wastewater before discharge. The impacts of the wastewater were considered as its

environmental impact degradation which results in decreased level of dissolved oxygen, release of

toxic substances, and accumulation of biological pollutants. It concludes that industrial wastewater

effluents are a major contributor to a variable number of water pollution problems which include
enrichment of water by nutrient salts that cause structural challenges to the ecosystem such as

increased growth of algae, interferences with the recreational growth of algae, interference with the

recreational value of water health risk to both aquatic and biotic factors. It includes the need to

remedy and reduce the overall impacts of these effluents in receiving water bodies.