UNIVERSITY OF NAIROBI

DEPARTMENT OF GEOGRAPHY AND

ENVIRONMENTAL STUDIES

HOSPITAL WASTE MANAGEMENT IN NAIROBI

CITY

BY

ADEPO PETER OUMA

C/50/7425/03

UNIVEF - y 0F N A | R 0 | |
t A d i AFrtUANA C01 LECTI 0 M

A PROJECT PAPER SUBMITTED IN PARTIAL

FULFILLMENT OF A MASTER OF ARTS DEGREE
IN ENVIRONMENTAL PLANNING AND
MANAGEMENT
UNIVERSITY OF NAIROBI LIBRARY

0271924 3

NOVEMBER, 2005

jn n > n !.'I~ N Y A 1 T ^ MEMORIAL

d e c l a r a t io n

m s is my original work and has not been presented for a degree anywhere.

This report has been presented for examination by our approval as University

supervisors.

P a Date {^ )
Sign.

Prof. E.H.O Ayiemba

(Supervisor)

Date //> '\ {L v ia a A J ^ £ 0 0 6

A. B. REGO

(Supervisor)
DEDICATION

This work is dedicated to my late Mom, Wilkister, who planted the seed but

did not wait to see it sprout.

u
ACKNOWLEDGEMENT
I thank the Almighty God for the gift o f life, and for seeing me through this involving research. I

have achieved all this because He cares.

Secondly, 1 would like to send my gratitude to the University o f Nairobi, from which I got the
scholarship to undertake my Masters Degree course. I thank the Chairman o f the Department o f
Geography and Environmental Studies, Prof. E. H.O. Ayiemba who is also my senior supervisor.
His leadership as the head o f the Department, corrections and guidelines, have really facilitated this
research. I am also indebted to Miss Rego whose concern and strict supervision has made this study

to be a success.

Thirdly, I wish to thank Mr. Isaiah Nyandega who voluntarily assisted me in Data Analysis. T o the
other lecturers o f the Department and members o f the technical staff who assisted me in one w ay or
the other, I “say thank you”. In particular, I must thank the former chairman o f ihe department, Dr. E
Irandu.

I also send my appreciation to my family members; dad Bishop Adipo, brother Morris, sisters Mary
and Wilfrida, and to all my friends and classmates such as Everline Mwamburi, Caroline Mulinya,
Joseph Kuria, Esther Magambo, Godana Ramat, Petit, Ogari, Muturi, Woche, Righa, Mutua, Jane
and Catherine. I cannot forget to thank Florence Dibondo, a medical staff at Ralac Medical Clinic
and Maternity who freely accorded me with the relevant information on general operations o f health
institutions.

Lastly, I must thank my fiancee, Dorice who has Deen an added strength to my side. She not only
encouraged me during the research, but she also practically participated in data collection for this

study.

To all those who have directly o r indirectly assisted me in this research, including those w ho have
not been mentioned by names, M AY GOD BLiiSS YOU ALL!

111
TABLE OF CONTENTS
Declaration.................................................................. 1
Dedication..................................................................................................................................11
Acknowledgement...................................................................................................................111
Acronyms...............................................................................................................................v,n
Abstract ................................................................................................................................ ,x

CHAPTER ONE

1.0 BACKGROUND.... 1
1.1 Introduction.............................................................................................................. .1
1.2 Statement of the problem ........................................................................................ 5
1.3 Objectives of the study............................................................................................. .9
1.4 Research hypotheses................................................................................................. 10
1.5 Justification of the Research................................................................................... 10
1.6 Scope and Limitation o f the Study......................................................................... 13
1.7 Definition ofTerms/Operational Concepts............................................................ 14

CHAPTER TWO

2.0 LITERATURE REVIEW.................................................................................................. 17

2.1 Introduction.............................................................................................................. 17
2.2 Waste Stream Analysis............................................................................................ 18
2.3 Waste Minimization Strategies............................................................................... 19
2.4 Waste Separation and Collection............................................................................ 20
2.5 Hospital Waste Management...................................................................................21
2 6 Waste Management Systems Specific to Kenya..................................................24
2.7 Theoretical Framework................................................................................. ......... .27
2.8 Conceptual Framework.......................................................................................... .30

IV
 CHAPTER THREF

3.0 RESEARCH METHODOLOGY MWttTTT —t-—“•“*****"“***»»“* * * * * * * ^

3.1 Introduction.............................................. 32
3 .2 The Study Area................................ 32
3.3 Study Population...................................................................................................... 35
3.4 Sample................................................................................. 35
3 .5 Sampling procedure..................................................................................................36
3.6 Sampling Technique.................................................................................................38
3.7 Data collection ..........................................................................................................39
3.8 Methods of Data Collection.....................................................................................40
3 .9 Nature o f Data Collected......................................................................................... 40
3.10 Data Analysis and Processing.............................................................................. 42
3.11 Hypothesis Testing............................................................................................... 43

CHAPTER FOUR

4.0 MAJOR TYPES OF WASTES, THEIR MANAGEMENT AND IMPACTS......... 44

4.1 Introduction...............................................................................................................44
4.2 Research Findings.....................................................................................................44
4.3 Environmental impacts o f Hospital Wastes.............................................................82
4.4 Management Options for Hospital Waste................................................................88

CHAPTER FIVE

5.0 SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS..... 90

5.1 Summary of Findings................................................................................................ 90
5.2 Conclusion.................................................................................................................. 91
5.3 Recommendations............................................................... 93
Bibliography ••••••••••••••••••••••••••a*•••••••••••••••■••••••••••••••••••••«•••••••••••••••••••••••***•********■*****■•*•*•************** 95

v
 APPENDICES

Quest ionna ir e ............ ................................................................................................................ 1

LIST OF TABLES, FIGURES, MAPS AND PLATES

List ofTables
Table 1: Categories of Hospital W aste....................................................................................... 6
Table 2: Distribution of population by province 1969- 1999.................................................8
Table3: Intercensal Growth Races (in %).................................................................................. 9
Table 4: Hospital Waste Generation in Nairobi........................................................................ 45
Table 5: Containers for General Waste Collection................................................................... 47
Table 6: General Waste Disposal................................................................................................48
Table 7: Pathological Waste Collection Containers.................................................................. 52
Table 8 Pathological Waste Disposal....................................................................................... 55
Table 9: Infectious Waste Collection Containers...................................................................... 57
Table 10: Infectious Waste Disposal.......................................................................................... 59
Table 11: Chemical Waste Collection........................................................................................ 64
Table 12: Chemical Waste Disposal.......................................................................................... 64
Table 13: Containers for Sharps Collection............................................................................... 66
Table 14 Sharps Disposal Methods........................................................................................... 68
Table 15: Pharmaceutical Waste C ollection............................................................................. 70
Table 16: Means of Pharmaceutical Waste Disposal................................................................ 71

List of Figures
Figure 1: The Nature of the Environment.................................................................................. 15
Figure 2: The interrelationship between the functional
elements in a waste management system....................................................................27
Figure 3: The Conceptual Fram ew ork....................................................................................... 30
List of Maps
Map 1 Location of Nairobi in Kenya 34(a)

Map 2: Nairobi C ity........................... 34(b)

List of Plates
Plate I : Wastes suspended in one o f the streams in N airobi....................................................2
Plate 2: Pathological waste Collection Container .................................................................... 51
Plate 3: An incinerator in operation........................................................................................... 60
Plate 4: Wastes dumped outside a building..............................................................................83
Plate 5: Hospital Wastes inside an incinerator..........................................................................85
Plate 6: A riverbank converted to a dumpsite............................................................................ 87

List of Graphs
Graph 1: General Waste Collection Containers.........................................................................49
Graph 2. Pathological Waste Collection Containers................................................................. 53
Graph 3: Sharps Collection Containers....................................................................................... 67

vii
10NYMS
A - Environmental Management and Co-ordination Act

K. - Government o f Kenya
H. - Kenyatta National Hospital
W. - Municipal Solid Waste
C. - Nairobi City Council
AA - National Environment Management Authority
EP - South Pacific Regional Environment Programme
S - Statistical Package for Social Scientists
- United Nations
)P - United Nations Development Programme
iP - United Nations Environment Programme

viu
\BSTRACT

Fhe study aims at examining waste management systems in health facilities within Nairobi city. To
study these systems, specific attention has been focussed on the types of wastes generated,
Election and disposal methods o f these wastes, and their environmental impacts.

\ sample size of 60 health facilities consisting of hospitals, nursing homes, health centres and
clinics have been purposively selected from different areas within Nairobi city, to be used as an
inference to the entire population. The study has relied on both primary and secondary data.
Questionnaires, Key-Informant Interviews and field observations are among the data collection
echniques that have been employed. Data analysis has been aided by SPSS (Statistical Package for
social Scientists) technique, making use o f both qualitative and quantitative statistical analyses. The
'ormer involved the use of pimple descriptives such as averages and percentages, while the latter
nvolved the use of advanced statistical analyses such as Friedman Test and Kruskal Wallis H Test.

The study found out that waste management systems in health facilities are inadequate. They are not
inly unhygienic and a public health concern, but also a threat to the biological and physical
:nvironment. The study therefore recommends that the Government through the relevant authority
hould strictly carry out thorough inspection o f health institutions and firms that are licensed and
:ontracted by Nairobi City Council for wasre disposal, to ensure that hospital waste handling,
:ollection and disposal are carried out within the laid guidelines and are generally safe to the public
lealth and to the environment Future research on management o f home based medical waste has
tlso been recommended by the study.

;x
 CHAPTER ONE

1.0 BACKGROUND

1.1 Introduction
As far back as 8000 io 9000 BC, people learned to dispose of their waste
outside their settlement, to escape or avoid the nuisance o f vermin, odour and
wild animals. In antiquity, in many cities in Europe and Asia, waste was
collected in clay containers and hauled away. In many other areas, pits were
used to collect waste and faeces, which were emptied and cleaned periodically.
There are records o f regulations for the daily sweepings o f the streets by
residents. Waste haulers were required to move the waste at least 2km beyond
the city wall (Tchobanoglous, 1993).

With increasing population, crowding in urban areas and the increasing

industrialisation, the quantity o f waste has increased greatly. These wastes are
generated in form o f solids, sludge, liquids, gases and any combination thereof.
Depending on the source o f generation, some o f the waste may degrade into
harmless products whereas others may be non degradable and hazardous.

Since the advent o f civilization and industrialization, waste management has

drawn a lot of concern globally. The environment has been a recipient of a
wide range of hazardous wastes and chemicals generated from human
activities. For instance, hospitals, committed to patient care and community
health have been cited to paradoxically defy their own objectives. On one hand
they cure patients and on the other hand, have emerged as a source o f several
diseases brcause surprisingly, until recent times, not enough attention has been
paiu to safe disposal oftheii waste.

Hospital waste, according to Federal and California laws, refers to waste that is
generated or produced as a result o f the diagnosis, treatment, or immunization

1
o f humans or animals; in research pertaining to the treatment, diagnosis, or
immunization o f humans or animals; or in the production or testing o f
biologicals (medicinal preparations made from living organisms and their
products including serums, vaccines, and anti-toxins).

Safe handling o f these wastes continues to be a matter of serious concern for

health authorities all over the world. Thousands of tones of biomedical wastes
originating from hospitals, nursing homes, and clinics in the form o f cotton
swabs and bandages infected with blood, fluid bags, needles, catheters, human
tissues, and body parts, among others continue to be dumped in open garbage
bins on the roads in most parts o f the country. The generation o f these
dangerous wastes is expected to increase.

The management of hospital waste is a major problem, especially in urban

centres of developing countries. In recent years, these wastes’ disposal has
posed even more difficulties with the appearance o f disposable needles,
syringes, and other similar items. Pakistan for example is facing this problem
and around 250,000 tonnes o f hospital waste is annually produced from all
sorts of healthcare facilities in the country. This type o f waste has a bad effect
on the environment by contaminating the land, air and water resources.

Plate 1: Wastes o f all kinds suspended in one o f the streams in Nairobi

2
Global figures based on statistical data of the Environmental Protection
Agency o f America and Japan’s Ministry o f Health suggested a volume o f 1 to
1.5 kg/day/bed for hospitals, while, waste produced has been quoted up to 5.2
kg in developed countries.

However, the problem o f hospital waste is more o f quality as compared to

quantity e g. it is estimated that the total amount o f hospital waste in most
developing countries is only 1.5% of the total municipal waste stream. Yet, a
special obligation to deal with this waste in an effective and safe manner is
mandatory due to its composition.

Policies to reduce waste disposal could lead to improved environmental

conditions for three main reasons: first, the problem associated with waste
disposal sites would be vastly reduced, including their location and the
leaching o f dangerous pollutants into the ground and water tables. Secondly, an
integrated approach to waste management implies the reduction o f waste at
source, including packaging mateiial and a concerted effort towards reuse and
recycling. Thirdly, most waste products are potentially inputs for other
industries known as “zero emission production” or “closing the production
loop”. Such policies have so far been promoted only in a few countries but they
constitute viable alternatives for many cities that struggle with the increasingly
politically intractable issue e.g. o f finding a landfill site in someone’s backyard
(Luis and Clarence, 1985).

Hospital wastes are categorized according to their weight, density, and

constituents. The World Health Organization (W HO) has classified medical
*

waste into different categories. These are:

1. General waste: Include domestic type o f waste, packing material,

wastewater from laundries, and waste from the offices, kitchens, rooms,

3
 including bed linen, utensils, paper etc.

2. Pathological waste: This is defined as any recognizable human o r animal

body part and tissue. It thus consists o f tissues, organs, body parts, human
flesh, foetuses, blood and body fluids.
3. Radioactive waste: Includes solid, liquid and gaseous wastes
contaminated with radioactive substances used in diagnosis and treatment

o f diseases.
4. Chemical waste: This comprises o f discarded solid, liquid and gaseous
chemicals eg . from diagnosis, experimental work, cleaning, house
keeping and disinfecting procedures.
5. Infectious waste: This is material containing pathogens in sufficient
concentrations or quantities that, if exposed, can cause disease. It includes
tissue cultures and stocks o f infectious agents from laboratories, waste
t;

from survey and autopsy on patients in isolation wards and dialysis from
infected patients.
6. Sharps: Includes items like disposable needles, syringes, saws, blades,
broken glasses, nails, or any other item that could cause a cut. These are
simply devices with sharp edges capable o f piercing or cutting the skin.
7. Pharmaceuticals waste: This includes pharmaceutical products, drug and
chemicals that have been returned from wards, spilled, outdated,
contaminated, or are no longer required.

Generally, most local authorities have been unable to cope up with collection
treatment and disposal of wastes, more so, the hospital wastes. Nairobi, like
other cities in the developing world, experiences the problem o f waste
management.
According to an Intermediate Technology Development Group (ITDG) 2004
Survey, Nairobi City Council (NC'C), which has the responsibility o f dealing
with waste in Nairobi, has a low capacity o f effectively disposing the
municipal wastes generated within it. According to the same study, the council

4
**
only deals with about 0.6% o f total waste within the city, the majority o f which
is openly dumped at Dandora dumpsite “a haven o f disaster in waiting!”
As such, waste is evident in every comer one turns, whether in the city centre
or in the estates, not to mention the social institutions such as hospitals,
schools, colleges and other institution of higher learning. Hospitals are thus one
o f the major institutions and industries in Kenya that seriously face the
problem o f waste management in Nairobi.

1.2Statement of the Research Problem

Nairobi like all other cities in the developing countries is experiencing a
phenomenal growth in urban population, (refer to Table 2). This is attributed to
rural-urban migration, natural increases, expansion o f the city boundary and
immigrants from neighbouring war and famine stricken countries (refugees).
According to the population census (1999), Nairobi had 2.1 million people.
The resulting population pressure has led to greater demand for more
infrastructural services, provision o f clean water, waste removal and adequate
housing. Also attributed to high population pressure in Nairobi is the
multiplication of health centres, most o f which have not been well planned to
face the challenge o f hygienicaily managing the waste generated within them.
With the problem o f lack o f space and corruption, illegal operation o f hospitals
has cropped up especially within the city centre and slum areas.

When humans are beset with physiological problems, one thing more often
than others come up. They have to go to a hospital. They have to consult a
doctor there and undergo the tests that they have to do. In short, the hospital
for people is an institution o f healing, a center for well-being. Hospitals are
viewed more or less within this framework.

Have people ever dared to think o f the hospital as a source o f very dangerous
wastes capable of spreading an ep'demic? Well, the over-all operations o f a
health institution inevitably produce wastes. These wastes, like ordinary

5
wastes, have to be disposed. This is the focal point o f this study: How do
hospitals manage their wastes?

This study aims to assess the current hospital waste management system in
Nairobi City. This is intended to assist both the city and individual medical
institutions to improve on waste management. This is expected to awaken
people’s awareness on the risks involved as well as to remind the authorities
concerned to come up with a well-designed waste policy that is both affordable
and feasible. Hospitals have a duty to care for our environment and for public
health in relation to the waste they produce. Hospital waste includes all the
wastes generated by health care establishments, research facilities and
laboratories. Between 75% and 90% o f the waste produced by hospitals is
general waste comparable to domestic waste. The remaining 10-25% o f waste
produced is hazardous waste (Table 1).

TABLE 1: Categories o f hospital Waste

W aste Category Description

Waste suspected to contain

Infectious waste
pathogens Human tissues or fluids

Pathological
Human tissues or fluids
Waste

Includes needles, syringes and

Sharps
other sharp objects.

Pharmaceutical
Waste containing Pharmaceuticals
Waste

Waste containing Chemical

Chemical waste
Substances

Radioactive Waste containing radioactive

Waste substances

6
 • What are the common types o f wastes generated in hospitals in

Nairobi?
• What are the types o f containers used in the collection o f the different
types of hospital wastes within the health facilities?
• What are the various methods used in the disposal o f the different

types of hospital waste?

• What are the environmental implications associated with the
generation, handling and disposal o f the hospital wastes?

The study has also given suitable recommendations for proper management of
wastes in health facilities and other related institutions in the city. This will be
helpful to policy makers for adoption. Lastly, the research has highlighted
areas that need further research as far as waste management systems in urban

centres is concerned.
TABLE 2: DISTRIBUTION OF POPULATION BY PROVINCE (1969 -
1999)
Province 1969 1979 1989 1999

Nairobi 509,289 827,775 1,324,570 2,143,254

Central 1,675,647 2,345,833 3,111,255 3,724,159

Coast 944,082 1,342,794 1,825,761 2,487,264

Eastern 1.907,301 2,719,851 3,768,689 4,631,779

North 245,757 373,787 371,391 962,143
Eastern
Nyanza 2,122,045 2,643,956 3,507,160 4,392,196
Rift Valley 2,210,289 3,240,402 4,917,551 6,987,036
Western 1,328,298 1,S32,663 2,622,397 3,358,776
KENYA 10,942,705 15,327,061 21,448,774 28,686,607
Source: Kenya Population Census’ Report, 1999

Nairobi and Rift Valley Provinces’ populations have increased considerably

since 1969 because they have benefited from considerable urban immigration.

8
TABLE 3 : 1NTERCENSAL GROWTH RATES (in %)

PROVINCE 1 9 6 9 -1 9 7 9 1 9 7 9 - 1989 1 9 8 9 -1 9 9 9

Nairobi 4.9 4.7 4.8

Central 3.4 2.8 1.8

Coast 3.5 3.1 3.1

Eastern 3.5 3.3 2.1

North Eastern 4.2 2.8 2.3

Nyanza 2.2 2.8 2.3

Rift Valley 3.8 4.2 3.5

Western 3.2 3.6 2.5

KENYA 3.4 3.4 2.9

Source: Kenya Population Census’ Report, 1999

1.3 Objectives of the Study

a. General Aim
To study waste management in selected hospitals in Nairobi city

b. Specific Objectives

i) To identify major types o f wastes generated by hospitals in different

parts o f Nairobi
ii) To find out the methods o f waste collection in hospitals
iii) To investigate the various methods o f waste disposal in different
hospitals within the City
iv) To establish the environmental implications associated with various
disposal methods o f hospital waste.
v) To suggest appropriate recommendations for policy makers on
sustainable management o f hospital waste, and suggest areas for further

9
 research.

1.4 Research Hypotheses

H0. Generation o f hospital wastes in selected health facilities in Nairobi is not

significantly different.
Hi: Alternative.

H0: Containers for collection o f different types o f wastes from health facilities

are not
significantly different.
Hi: Alternative

H„- Methods o f hospital waste collection are similar in different parts o f

Nairobi.
Hi: Alternative

Ho: Methods of disposal o f different types of hospital waste adopted by health

facilities in Nairobi are not significantly different.
Hi: Alternative

H0: Waste disposal methods in hospitals in various areas o f Nairobi are not
significantly different.
Hi: Alternative.

1.5 Justification of the Research

Until late 1999, there was no specific framework on environmental legislation.
The Environmental Management and Co-ordination Act (EMCA), 1999 is a
*
critical component for sustainable environmental management. This is because
it establishes national environmental principles and provides guidance and
coherence to good environmental management. It further deals with cross-

10
sectional issues such as overall environmental policy formulation,
environmental planning, protection and conservation o f the environment,
environmental impact assessment, environmental quality monitoring,
environmental quality standards and environmental quality orders, institutional
co-ordination, and conflict resolution. EMC A (' 1999) does not allow dumping
or discharge o f pollutants into the aquatic environment. A person who
discharges or applies radioactive waste or other pollutants shall be guilty of an
offence, which bears any o f these penalties,
a A fine o f not more than Kshs. 1 million
b Imprisonment for a term of not more than 2 years
c Both such fine and imprisonment.

By induction, it is clear that these regulations also apply to hospitals in terms o f

waste generation, management and ultimate disposal.

Despite the clarity o f

the
management
Act as far as
and
Horror of 20 foetuses
disposal of waste is found at city dumpsite
concerned, a
deficiency in the
management o f the
same is pronounced
all over the country.
Nairobi is much
affected with a
population o f over 2.1
million people
(Population Census, 1999). In May 2004, fifteen foetuses, most likely from a
health centre in Nairobi, were found just about to be dumped in Nairobi River
(May 26th 2004, Daily Nation page 1). This is a show o f negligence in waste

ll
management systems in the hospitals because the foetuses just like other dead
human beings deserve dignity in their disposal, and should not be mixed and
dumped together with plastics and other types o f waste generated in the
hospitals. Plastic papers and several other types o f wastes can be observed
almost everywhere. The dumpsite at Dandora is full o f all kinds o f solid wastes
both hazardous and non-hazardous and, both biodegradable and non-

biodegradable.
This shows clearly that management of wastes within the city including the
hospitals is in a mess.

Despite the benefits that occur with the existence o f hospitals, their negative
aspects cannot be ignored, more specifically the role they play in adding
pollutants in form o f wastes to the environment. Open dumping is neither safe
nor hygienic, and it does not make sense to transfer a health risk from the
source area to nearby suburbs and refer to it as waste management. Many
people are infected and have died o f diseases, which are attributed to poor
handling of wastes. Agricultural productivity in city hinterlands is also a
victim, and so are various species o f life in terrestrial and aquatic systems. The
current state of Nairobi River and dams, coupled with the current state o f the
city hospitals raises concern about the safety and efficiency in the handling and
management of wastes that are generated within them.

Most o f the previous researches have concentrated on the holistic study o f solid
wastes management within the city of Nairobi especially in the residential
estates, the Central Business District (CBD) and in the industrial area (sector),
however, very few have been institutionalized. The proposed research is thus,
justified to investigate waste management systems in hospitals within the city.
Therefore, the study aims to fill the gap in institutionalized research on waste
management in the city of Nairobi.

12
1.6 Scope and Limitation of the Study
The study has been based on investigation o f the different methods o f hospital
waste collection, management and disposal that are being used within the city
o f Nairobi. There are various forms of waste generated in hospitals namely;
liquid, sludge, solids and gaseous, however, this study has not
comprehensively considered liquid and gaseous wastes. Despite the fact that
wastes emanate from virtually all institutions that people operate; this study has
only dealt with those originating f;om health care institutions.

Similarly, the study has restricted itself to its main objectives, studying the
major types of wastes generated in hospitals, the various methods o f collection
in the hospitals, and the methods of disposal o f these wastes generated from the
hospitals. In addition, the study has established the environmental implication
associated with the various waste disposal methods. This study has involved
only selected hospitals in the city. This is to allow in-depth investigation o f the
problems o f waste management in hospitals. However, these are expected to
give an accurate representation of the ideal situations existing in other hospitals
within the city and elsewhere in the country.

Due to the fact that illegal dumping of hospital wastes has received immense
publicity o f late, especially after the last year incidence o f the 15 foetuses,
which were recovered as they were about to be dumped in Nairobi River, the
research has been faced with hostility and lack o f maximum cooperation from
medical officers and staff (employees) o f various health facilities. Again,
isolation o f effects o f hospital wastes from the effects of wastes from other
sources on the environment once both are combined in one dumping site is
problematic. However, in spite o f these, the study has involved a thorough
inquest and as such it has succeeded in providing a representative discussion
on the issues o f concern.

13
1.7 Definition of Terms /Operational Concepts
Hospital: According to the “Heritage Illustrated Dictionary o f the English
Language, International Edition (1975)”, a hospital is an institution providing
medical or surgical care and treatment for the sick and the injured. The present
study considers clinics, nursing homes, and dispensaries as hospitals.

Waste: This refers to any useless, unwanted or discarded material. It may be a

liquid, solid or gas. Examples include used unretumable bottles, worn out
appliances, sewage sludge, and mining and industrial waste among many other

forms o f waste.

Hospital Waste: these are discarded materials that are generated within the
hospitals. They include potentially pathological materials such as used
bandages, needles, syringes and items contaminated with fluids including
blood.

Hazardous Waste: these include any discarded materials that may pose a
substantial threat or potential hazard to human health or the environment when
improperly handled. They include a variety o f toxic, ignitable, corrosive, or
dangerously reactive substances such as acids, cyanides, pesticides, solvents
from drycleaners, compounds o f lead, mercury, arsenic, and cadmium, soil
contaminated with PCBs and dioxin; infectious wastes from hospitals and
research laboratories; improperly treated sewage sludge, obsolete explosives,
herbicides, and low and high level radioactive materials.

Environment: According to the “Heritage Illustrated Dictionary of the English

Language (1975)”, the word “environment” refers to the following:

1. Something that surrounds an organism.

2. The total o f circumstances surrounding an organism or group of organisms,
especially;

14
 a The combination o f external or extrinsic physical conditions that
affect and influence the growth and development o f organisms,
b The complex of social and cultural conditions affecting the nature

of an individual or community.
For this study, the word “environment” refers to the biophysical and socio­
economic and cultural factors that surrounds and influence the life o f an

organism as shown in figure 1.

Figure 1: The Nature o f the Environment,

Source: Muthoka, M B, Rego, A.B, Rimbui, Z.K (2005)

15
Disposal: According to “Webster’s’ Intermediate Dictionary”, the word
‘disposal’ means getting rid o f something or putting something out o f the way.
For this study, disposal means getting rid in a safe manner o f waste generated
from hospitals. Examples o f disposal methods for these wastes include
incineration, land tilling, composting, and open dumping among others.

Leachate: This is water that has percolated through waste and become
contaminated with, among other things, acids from decomposing organic
matter, heavy metals such as lead from discarded paint, and organic
compounds from residues o f cleaning agents. For instance, if a landfill is
situated over permeable material, the leachate can migrate through a great
volume o f material in a matter o f years, and once contaminated, the slow
moving ground water, which is the largest source o f fresh liquid water on earth
and the second leading source o f domestic water supply, remains contaminated
for decades or centuries.

Treatment: Any method, technique or process designed to change the

physical, chemical, or biological character or composition o f any infectious
hazardous or infectious waste so as to render such waste non-hazardous, or less
hazardous; safer to transport, store, or dispose of; or amenable for recovery,
amenable for storage, or reduced in volume. Treatment methods for infectious
waste must eliminate infectious agents so that they no longer pose a hazard to
persons who may be exposed.

16
 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Introduction
The aim o f this literature review is to show the contribution o f past research in
this area o f study, with a view o f pointing out strength, weaknesses and gaps in
their contributions and how relevant they are to the present study.

Globally, several studies have been done on waste management practices most
of which are incorporated in published textbooks on environment. These
studies have focused on effluents, solid, liquid and gaseous wastes, and their
impacts on the environment as a whole.

Literature on waste management is broad in scope for both developed countries

as well as for developing countries. However, few specific studies have been
done that attempts to solve the inherent problems related to urban solid waste
management, particularly for developing countries and more so on
institutionalized wastes such as hospital waste.

Marsh and Grossa Jr. (2000), describe solid waste as assorted, discarded
materials variously described as trash, garbage, refuse and litter from urban and
rural land uses. They further note that in most countries the vast majority o f
solid waste is produced by mining and agriculture mainly at extraction and
production sites. However, the duo failed to consider the role o f institutions
such as hospitals in the waste problem. They ignored the potentiality o f
hospitals as producers o f most o f the harmful wastes including hazardous
wastes.

17
It has been argued that solid waste is an unofficial measure o f prosperity in a
nation, but that individual differences within societies must still be considered.
For instance, Americans are said to be the highest producers o f solid waste on
earth, yet America has not produced the dirtiest cities on earth (Rosenbaum,
1974; Sada 1977). Consequently, the volume of solid waste visible in the cities
of developing countries, like Nigeria, cannot be taken as an indicator of
prosperity (Akinbami, et al). On the contrary, it reveals the inability o f local
urban authorities to manage these inevitable products o f development.

2.2 Waste Stream Analysis

i
Luis and Clarence, (1985) aigue that a thorough understanding o f the
characteristics of the waste is a prior requisite to the making o f a rational
decision on waste management. Hence a sound composition survey is
important. The duo contends that a survey o f composition is essential to the
determination of the dimensions of key elements in waste management.
According to Luis and Clarence, a full knowledge o f the composition o f the
waste is an essential element in:

- The selection of the type o f storage and transport most appropriate to a

' given situation.
- The determination of the potential for resource recovery.
- The determination of the environmental impact exerted by the waste if they
are improperly managed.
*

According to Sada (1977) waste is divided into three major classes; gaseous,
liquid and solid waste. The sensitivity o f different societies to each o f these
kinds o f waste varies depending on the level o f public awareness, technology
and social - economic development, development ideologies and philosophy.
The present study while dealing with hospital waste considers specifically solid
wastes generated from these institutions.

18
According to World Health Organization - WHO (in www healthcarewaste oru
- 2005) hospital wastes are categorized according to their weight, density and
constituents into seven categories namely, general waste, pathological waste,
radioactive waste, chemical waste, infectious waste, sharps and pharmaceutical
waste. The present study has depended on the classification to carry out an in
depth quest into the management o f each category o f the hospital waste.

Akinbami, et al (1986) agree that solid waste can be put into tw o major
categories, depending on its source; industrial waste and commercial -
domestic solid waste industrial waste consists o f refuse generated in the course
of manufacturing and includes metal scraps, clips, grits from machine shops,
s?.w dust, waste paper, pieces o f glass among others. Commercial domestic
solid wastes are the by-products o f housekeeping activities and consumption. It
includes food residues, wrapping paper, empty cans and containers. They went
further to note that some o f these wastes may be toxic, flammable and some
non-biodegradable. According to them, other items such as leaves, bones,
cotton rags and various food leftovers are quite biodegradable and constitute
more o f a nuisance than a danger to the environment, since they can be
decomposed by nature. However, this study is not clear on other harmful
wastes outside the industrial and commercial domestic groups o f waste.

Therefore, waste categorization is very important in any waste management

system. It involves the determination o f the various types o f waste and their
quantity for proper planning and management o f the system.

2.3 Waste Minimization Strategies

South Pacific Regional Environmental Programme (SPREP) (1999) noted that
waste minimization strategies include all actions to reduce the quantity o f
waste requiring disposal. These actions include: reducing waste at source,
reusing materials, recycling waste materials and reducing use o f toxic or
harmful materials.

19
Waste minimization has a number of advantages. These are in terms o f socio­
economic direction, public health concerns and environmental health concerns.
These advantages include reduced volume of waste for disposal, reduced cost
of collection and disposal, reduced disposal sites maintenance and construction
costs, reduced environmental and public health impacts, and reduced costs
through more efficient use o f resources.
African solid waste experts, researchers and consultants have stressed the need
to adopt composting as part o f a strategy to improve Municipal Solid Waste
Management (MSW) in urban areas (Raymond et al 1996). This emphasis
arises from the fact that the compostable fraction o f the waste stream in
I
African cities is very high. The organic waste consists o f food, vegetables,
leaves, and animal droppings generated by households, food vendors,
restaurants and markets. The compostable waste can be diverted from the
dump and recycled into compost.

However, the issue as far as this study is concerned is whether the waste
minimization strategies echoed by these scholars, researchers and consultants
are also practicable when it corner ro hospital waste considering the situation
surrounding their generation and the level o f toxicity in most o f them.

2.4 Waste Separation and Collection

Feinbaum and Gehi (1995), in their study to validate the logistics o f source
separation o f waste found out that in 1990, Alameda County, California waste
management plans estimated that about 4-7% o f the county’s waste stream
were food residues from commercial and industrial sources most o f which
could be kept out o f landfills. This would substantially reduce the cost of
landfill construction and maintenance in the county.

Chanyasak and Kubota (1983) in the study “Source Separation o f Garbage for
Composting” discovered that the application o f composting to municipal refuse
has been very limited mainly because o f the large quantity o f biologically non­

20
biodegradable materials (e.g. plastics, and toxic heavy metals) in municipal
refuse, which seriously restricts the use o f compost product. They concluded
that the source separation maybe the only satisfactory answer to the start of

proper waste management system.

For hospital waste, which in constituents is more varied, source separation is

really very crucial in sound management o f the waste.

Baun and Parker (1974), noted ^hat the collection o f transportation to the point
of disposal and that the method of collection o f the waste is related to the
method o f disposal. This study was done in the United States o f America and
Europe, which are in the developed world. The present study has tried to
investigate collection of waste in hospitals o f a developing country.

2.5 Hospital Waste Management

According to Habitat (1990), managing solid wastes is one o f the costly urban
services to provide as it generally absorbs up to 1% of the Gross Domestic
Product (GDP) and 20 to 40% o f municipal revenues in developing countries.
The research further notes that the objectives o f authorities should be to
remove and dispose of solid wastes safely, reliably and cost effectively. It is
upon this objective that the present research has investigated to what level the
hospital authorities are complying <o waste management ethics.

UN (1992), defines solid w aste as consisting o f that waste generated from

household, industries, hotels, hospitals, as well as those from the streets and
gardens, soiid waste treatment plants and from the digging o f pit latrines. It
also includes waste from all domestic refuse and non-hazardous solid wastes. It
defines solid waste management as the discipline associated with the control o f
generation, storage and disposal o f solid waste in accordance with the best
principle o f public health, economies, engineering, conservation, aesthetics and
other environmental considerations which is also responsive to public attitudes

21
in its scope. This definition by UN considers hospitals as one o f the major
sources o f solid wastes and therefore goes together with the present study’s
aim o f studying waste management in hospitals o f which solid waste is an

important component.

Holmes (1981) noted that the local authorities in many developing countries
are responsible for waste disposal. But the question is “are the local authorities
also responsible for the disposal of hospital wastes?” The present study intends
to answer this question more because hospital wastes are diverse in
composition and far much different from the common refuse o f municipal and
domestic activities. Most o f them are hazardous and therefore require special
attention.

Holmes (1983), in a different publication, “The option facing the public

authorities in disposal and recovery o f municipal waste” notes that to many
committed people, the public authorities may seem to adapt philistine and
insensitive attitudes to waste management or persist in pursuing cheap and
seemingly irresponsible, courses of action. His view is that though the
authorities are faced with pressures from the general public, they are
constrained to operate a vital public service in an efficient and economic way.
This study considers the views o f Holmes and relates them to operations of
both public and private hospitals

Oweis and Khera (1990) in “Geotechnology o f W aste Management”, mention

pharmaceuticals as one source of industrial waste. The duo however, do not
give a specific and in depth study on various pharmaceutical wastes, their
sources, how they are handled, and their ultimate disposal. The present
research has tried to specifically study hospital wastes from generation to
disposal. Oweis and Khera concluded that the amount of waste generated and
the type o f hazardous materials present in the waste stream increases with
increasing industrialization o f the country. This calls for a detailed study

22
focused on a country and its waste management systems from generation to

disposal.

Williams (1998), trying to be specific on hospital wastes, said that it includes

wastes from hospitals, doctors and dentist’s surgeries and health centres,
nursing homes and vetei inary surgeries. He further says that such wastes may
also be generated from research centres (such as National Institute o f Health),
universities and schools o f veterinary medicine. He again notes that such
wastes may invariably include insulation o f wastes. Other wastes from surgery
and autopsy, contaminated laboratory wastes, contaminated sharps,
hypodermis needles, dialysis unit waste, contaminated animal carcasses, body
parts, discarded beddings, contaminated food and other products and
contaminated equipment. The present study in agreement with W illiams’s
definition has singled out hospital wastes as those from hospitals, doctors and
dentists' surgeries, health centres and nursing homes to enable a detailed
investigation into the study topic.
t

SPREP (1999) outlines the steps to go about the planning process from an
integrated waste management plan in the small island developing states in the
Pacific region. The steps he outlined are general and could be applicable to
hospital waste management system. The steps are as follows:
1. Knowing what one is dealing with i.e. understanding the source o f waste,
how it enters the country, the quantity and nature o f the material generated.
This information is essential for sound waste planning.
2. Consulting widely i.e. seeking the views o f people and organizations
currently involved in waste management.
3. Setting of objectives o f the waste management plan. These objectives
should be clear and widely agreed. They make clear what the plan is trying
to achieve, provide target against which its success can be measured and
will assist in setting priorities for action.
4. Identification o f actions needed to overcome the obstacles and achieve each

23
 objective.
5. Prioritisation o f the actions. Ideally all the actions would be implemented at
once, but this is unlikely to be the case. Inevitably constraints o f money and
labour will require implementation o f the plan over a number o f years. It
will be necessary to set priorities. Consider the benefits arising from an
objective, the obstacles to achieving it and the resources available. Then
sort the actions into the immediately achievable, the medium tern and the

long term.
6. Getting agreement on the plan. As the plan is taking shape, the solutions
proposed will not only be technical, for example requiring new equipment.
There will be social and cultural issues also to be addressed. This requires
the involvement o f many stakeholders. The roles o f the stakeholders and
budget provision should be made and agreed.
7. Implementation o f the waste management plan.
8. Reviewing the progress to ensure it is working. This requires periodic
reviewing and updating.

2.6 Waste Management Systems Specific to Kenya

In Kenya, a number of studies have focused on the effect o f waste on the
environment. Most o f these studies have been carried out in the major urban
centres o f the country and the studies have been inclined towards municipal,
domestic and industrial wastes leaving behind hospital wastes.

Rimbui (1988) asserted that over the years, the issue o f solid waste
management has featured prominently, both locally and internationally because
it poses a danger to the environment. She further observes that the rate of
generating waste is so high that even the available technologies o f waste
management cannot cope with the large volume generated. However, it is
important to note that human's activities are so complex that natural process
are no longer able to cope with them especially where non-biodegradable
materials are involved, it is also prudent to recognize the role of technology in

24
“reduce waste, reuse and recycle ’, all of which Rimbui overlooked.

According to lkonya (1991), urban waste can be categorized into four

groupings as listed below:

i) Household garbage and rubbish: This refers to domestic or residential solid

wastes consisting o f kitchens solid wastes such as vegetables, potato
peelings, carrot peelings, food remains, waste papers, tins, and bottles
among others.
ii) Commercial refuse: These consists o f solid wastes from stores, offices, fuel
service stations, restaurants, warehouses and hotels, packaging materials
and containers, used office supplies and food solid wastes.
iii) Sanitary residuals: These include residues from latrines, municipality,
households, and open drains cleaning night soils. Night soils are the wastes
that accumulate in the sanitation system (and most commonly collected at
night) and workers have a tendency to dump the night soil in the closed
possible inconspicuous location relative to their collection area.
iv) Industrial wastes: These consist o f wastes from processing and non­
processing industries as well as utilities. They comprise o f packaging
materials, food wastes generated from both domestic, processing, and non­
processing industries as well as utilities. This method o f categorization as
done by lkonya leaves out the institutional wastes, which have really
increased in Kenya, especially those from hospitals. The categorization
thus ignores the role of wastes from hospitals in environmental degradation
in Kenya.

Otiende et al editors (1991) noted that uncontrolled dumping of toxic wastes

such as outdated or expired medicine is common. The argued that these are
sometimes picked up by scavengers and occasionally re-sold on the black
market, where they often carr> inf ectious diseases, which are easily transmitted
by humans and animals scavenging on the dump site. Even though Otiende and

25
his colleagues recognized the danger associated with improper disposal of
expired drugs, they fail to mention other wastes from hospitals, which can also
pose the same threat to people and the environment. The present study in
filling this gap has holistically dealt with waste from hospitals and the channel
they follow up to their final destination (disposal).

Lastly, Makokha (2002) stated that most hospitals are affected by financial
constraints, which limit their efforts to improve on the waste management
methods in the premises. The present study has tried to investigate whether the
argument is true for both public and private hospitals, and also to find out if
there are other underlying factors, that negatively affect sound solid waste
management in hospitals. Makokha's recommendation for a more detailed
assessment on the environmental impacts o f waste from hospitals, and
consequent advice to the hospital management authorities on the effective
waste management systems which have the least effects on the environment
formed part o f the trigger for the present research.

Recently, it has come to the realization o f scholars and researchers that there
exist poor waste management systems in hospitals and health centres in the
country. This was brought to light by the media in early 2004, when 25
foetuses and other wastes from an unknown hospital were found wrapped in
black polythene bags ready to be dumped in Nairobi River. Then, it did not last
long before another 20 were found in a dumping site in Eastleigh estate (East
African Standard, Saturday September 11, 2004, back page). These and many
other incidences have increased concern not only on the waste management
systems in hospitals, but also on the composition o f hospital wastes. These
incidences have triggered research on hospital waste management including the
present study.

26
2.7 Theoretical Framework
A good understanding o^the waste steam is extremely important in designing a

sustainable waste management system.

In a waste management system, there are six functional elements that need to

be considered (Tchobanoglous, 1993). These are:

i) Waste generation
ii) Waste handling and separation, storage and processing at the source

iii) Collection
iv) Separation and processing, and transformation o f wastes
I
v) Transfer and transport
vi) Disposal
The interrelationship between the functional elements in a waste management
system as outlined in figure 2.

Source: Researcher, 2005

27
 a) W aste Generation:
This encompasses activities in which materials are identified as no longer
being o f value and are either thrown away or gathered together for disposal.

b) Waste handling and separation (Storage and processing at the source)

Waste handling and separation involves the activities associated with the
management of wastes until they are placed in storage containers to point of
collection.
Separation of waste component is a very important step in waste management
especially if there are materials for reuse and recycling.

b) Waste collection:
This involves the gathering o f wastes as well as transportation o f these
materials, after collection to the location w here the collection vehicle is
emptied.

c) Separation, processing and transformation of waste

This encompasses the recovery o f separated materials, the separation and
processing of solid waste components, and transformation o f solid waste that
occurs primarily in locations away from the sources o f waste generation.
Processing often includes the separation o f bulky items, separation o f waste
components size using screens, manual separation o f waste components, size
reduction by shredding, separation o f ferrous metals using magnets, volume
reduction by compaction and combustion.

Transformation processes are used to reduce the volume and weight o f waste
requiring disposal and to recover conversion products and energy. The organic
i
wastes can be transformed by a variety o f chemical and biological processes.
Chemical transformation - involves combustion, which is used in conjunction
with the recovery o f energy in the form o f heat. Biological transformation -

involves aerobic composting.

28
 d) Transfer and transport
Transfer usually takes place at a transfer situation, cars, pickups, handcarts, and
lorries are used to transport w aste or recovered materials to appropriate places.

e) Disposal:
This is the final functional element. A disposal site should not be creating
nuisance o r hazard to public health or safety.

29
 2.8 Conceptual Framework as relates to Hospital Waste
Management System

• Waste quantity
• Waste type
• Availability of Waste handling,
facilities separation and storage
• Incentives olfered
• Environmental
awareness

• Waste distribution
• Distance to dumpsitc ___________t ____
or processing plant 4 • Collection of wastes

• Transport means

_________ i ___________
• Availability technology
------------------------------------------- —

• Funds availability Processing facility for

• Legislation and legal ( recycling, reuse
requirements compositing
• Environmental awareness
• Availability of facilities
• Waste type
Method of waste
disposal

Key
•*------ ► Inter-related impacts
------ ► Effects
Source: Tchobanoglous (1993), modified by Researcher (2005)

30
Explanation of the Conceptual Framework
The conceptual framework focuses on hospital waste management system, and
specifically emphasises on the following aspects:
1. The size o f a hospital, the kinds o f departments and waste minimization
strategies in place at the institution affect the waste generate at the hospital

both in quantity and type.

2. The quantity of waste, type, availability of waste management facilities,
incentives offered on good waste management practices and the level of
environmental awareness in a hospital affect waste handling within the

hospital.
3. Waste distribution, distance to dumpsite or processing plant and transport
means affect collection o f wastes within a hospital setup.
4. Available technology, fiinJs availability, legislation and legal requirements,
environmental awareness, availability o f facilities and waste type affect
method o f waste disposal.
5. In an ideal waste management system in hospitals, maximum efforts are
employed to minimize the amount o f waste generated. However, upon
generation, wastes are analyzed, separated and stored accordingly, after
which they are collected and transported to appropriate points. This could
be a processing facility for recycling, reuse and composting or disposed off
safely.
6. Available technology, financial availability, legislation and legal
requirements and the level o f environmental awareness in various
institutions are key factors affecting waste management systems at the
institution.

31
 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 Introduction
This section describes the procedures that have been followed in conducting
the study. Various techniques that will be used in obtaining and analyzing data
are outlined. In deciding the best research method for this study, various
factors have been taken into consideration including:
> The conditions and situations o f respondent

> Time available

> The quickest way to obtain data

3.2 The Study Area

3.2.1 Historical Background and Introduction
The study is in Nairobi city, which is the capital city o f Kenya. Nairobi was
first established as a transportation centre by the Kenya Uganda Railway
Constructors in June 1899 when they reached the site.

Nairobi was developed because o f the following reasons:

• It was the last flat land before starting to climb the Kikuyu escarpment and
thus was convenient for “rest” and construction o f houses and storage of
railway components such as rails and cross bars.
• There was an absence o f most tropical diseases especially malaria due to
reduced temperatures, which could not support most disease vectors like
mosquitoes.
• There was clean fresh water from Nairobi River, which could be harvested
for domestic use.

32
• It had a climate very similar to that o f Britain hence adaptable by the

Europeans.
By July 1899, the Kenya-Uganda Railway headquarters was moved from
Mombassa to Nairobi thus increasing its potential for growth due to
immigration by labour seekers. Initially, there was no permanent African
settlement since the area was a dry season grazing land and a livestock
watering point for the indigenous Maasai pastoralists, although seasonal barter
trade between the Kikuyu, Dorobo and Maasai took place around this area.
Once the railway depot was established, certain spatial structures emerged,
such as a railway station, senior railway housing, shopping centre, and Indian
Bazaar.

Nairobi is the smallest administrative province in Kenya (refer to figure 2). At

present, Nairobi is a centre for economic, administrative, social and cultural
functions. It is also the major industrial and commercial centre supported by an
extensive transport and communication network, which connects it to all the
other parts o f the country.

Nairobi is also linked to the rest o f the world by airlines through Jomo
Kenyatta
International Airport (JK1A). Wilson Airport caters for local trips within the
African region.

Nairobi continues to influence the rest o f the country at large, especially its
immediate catchment areas and districts. It attracts a large share o f traders from
the neighbouring towns like Kiambu, Limuru, Meru, Naivasha, Nyeri and
Machakos among others. The trader’s reasons for choosing Nairobi as their
trading site include.
• Nairobi offers a large market area. It has a population of approximately 2.1
million (Population Census 1999).
• Nairobi is well linked in terms o f communication lines to various parts of

33
 the country. It thus enables movement o f goods to and out o f Nairobi.

• Increased social interaction with the hinterlands and the city.

• Surplus food crops and other items in the hinterlands of Nairobi find their

way into the city.

3.2.2 Location
The area covered by this study (which is Nairobi city), lies within the latitudes
10°10’S and 10°251S, and longitudes 36°40'E and 37°05'E. The area is bound
by Kiambu town and Kenyatta University in the North, by Ngong town and
Ongata Rongai, to the West, by the Nairobi National Park and by the Athi
River tributaries to the South and Koma Rock and Kateni area to the East
(Refer to figure 1 & 2).

3.2.3 Land Use

Land use in any kind o f permanent or cyclic human intervention to supply
human needs from the complex o f natural and artificial resources, which
together area called land. It is the application o f human controls in a relatively
systematic manner to the key elements within any ecosystem for the purpose of
deriving benefits from it and consequently, improving the social welfare o f the
people.
In Nairobi, land use is very diverse ranging from Central Business District
uses, industrial uses, residential uses, recreational uses, transport uses and of
interest to this research is institutional land uses.

3.2.4 Population and Settlement

The current population of Nairobi is estimated at 2.1 million (Population
Census, 1999). As thousands o f immigrants stream into Nairobi, they are faced
w ith lack o f accommodation. The current population in the city is housed
basically in the three main residential zones based on differences in income
levels as follows: ■

34
 T

40*E

E T H I O P I A

/'

Loke
Turkons
Turk o n o Moyole •

Mo r s a bi t

W ojir

j West
: Pokot

So m J u r l Isio i o

j a: /
.•iBungomo \ >
_.s
/ { osin'V B0, ' ^ a / ic. _...
__
r\ h & \ > ShiXi\ / > (T*.
_/Kokarnega \ Loikipio } —' l c UA
S^ , c ' v T' V NondiZ J ~ P ^ ° V v / y ' - ^ i <■ M e r u c>
..^ K js u ^ ^ T v y ^ i \ V \J \
~ . ... , , . a , , \

°3=’/ r \ u
l^ '3 o rlj^ \° ,Bonneb
\
F.Wcrcr/c / . ^KiambuT-" J

*.J *( v A L L / E Y ^ ^ nL rob ,
\Machokos''
1 -------J * \ K 1rui \

A W ’s T i .
>v Koj i odo '*■ .^ 0 K. /

* x3 \ >». *vV % ' \\ r\ y

\ C 0 /A S T
\ ..........

LEGEN D ' I NDI AN.

I nt er nat i onal boundary Toifa Taveta / Kilifi
••—__..Provincial boundory
0 C E A N-
----------Di stri ct b o u n d a r y N 4° S—
St udy a r e a K w 0 1e
N
\___ 50 10 0 150 20OKm.

Source Laikipia D.D Plan, 1 9 9 7 — 2001.

0 Kenya! Location of Nairobi

E« ' A r K (CANA°COLUCTK,^
 c*‘

’2 0'!

LEGEND

— N a irob i City Boundary

NAIROBI NAT! O N A L
M ajor Roads
P A RK □ Some M ajor H ospitals
1 K e n y o t t a Ho s p .
2 N a i r o b i Ho s p .
3 Ago Khon Hosp
4 M b o g o t h i Hos p.
____
5 N a ir o b i Wes t Hosp
6 Pumwoni Maternity

e IO 12 14 16 18 2 0 Km.
=tz =fc= =±= sh z rd
• High-income low-density areas include Lavington, Thomson, Kilimani,
Woodley, Upper Hill, Kileleshwa, Upper Parklands, Muthaiga, and Spring

Valley etc.
• Middle-income middle density residential areas include Ngara, Racecourse,
Nairobi West, BuruBuru, South B, and Donholm etc.
• Low-income high-density residential areas include Dandora, Mathare,
Muthurwa, Makadara, Kibera, and Eastleigh South etc. The acute and ever
increasing shortage o f housing units has been caused by the city’s high
population growth rates and the migration o f people from rural areas into
the city thus more housing units are needed to settle the ever increasing
populations resulting to overcrowding in private and public rental units and
the mushrooming o f uncontrolled irregular settlements. The population
spreads into slums and squatter settlements, which lack adequate sewerage,
water supply, electricity and other basic services. This leads to the
generation o f more uncollected waste as a result o f urban poverty.

3.3 Study Population

A population is defined as a complete set o f individuals, cases or objects with
some common observable characteristics (Mugenda, A.M and Mugenda A.G
1999). Ngechu, M (2000) defines population as a well-defined set o f people,
group o f things, households, firms, services, elements, or events, which are
being investigated.

The population for this research consists o f hospitals, heath centres, nursing
homes, dispensaries, clinics and other health facilities in different areas in
Nairobi city.

3.4 Sample
This is a subset of individuals in a population selected for study. The sample
selected, which consists o f 60 hospitals got from different estates in Nairobi is
considered to be large and representative enough to give an accurate inference

35
to the entire population characteristics. The research would have wished to take
a bigger sample size but due to limited time and resources, the chosen sample
size is considered to be big enough.

3.5 Sampling Procedure

As has been mentioned, health facilities in Nairobi city form the population.
Due to illegal sprouting up o f health centres and private clinics especially in
the slums, there is no updated complete list o f hospitals, dispensaries, nursing
homes, health centres or clinics in Nairobi.

Stratified random sampling has been employed in dividing Nairobi into three
strata. This is to take care o f the unequal income levels in the city’s population.
For the purpose o f representations in the study, there are four strata from which
“hospitals” in the sample have been randomly selected. The strata include:

i. High Income Residential Areas:

For the purpose o f this study, estates and areas that are normally
categorised as middle income residential areas have been considered as
high-income residential areas. This is because health facilities in the typical
high-income residential areas are very few and as such have been ignored
for this study. Therefore the following estates have formed part o f the
sample from this area,
a Five hospitals from Buruburu Estate
b Five hospitals from Donholm
c Five hospitals from Langata
d Five hospitals from Parklands
e Five hospitals from Westlands
>

Total: Twenty-five hospitals

( 36
 ii. Low Income Residential Areas
In this study, the following samples have been drawn from the low-income
residential areas.
a Five hospitals from Mathare Estate
b Five hospitals from Kibera
c Five hospitals from Kangeini
d Five hospitals from Kariobangi.
- e Five hospitals from Dandora
Total: Twenty-five hospitals

iv. City Centre

Six hospitals drawn from the city centre have been included in the sample,

i. Others:
In addition to the already mentioned areas the following hospitals have also
been included in the sample as special cases to make the sample as
representative as possible: -
a) Kenyatta National Hospital
b) Nairobi Hospital
c) Pumwani Maternity Hospital

Hospitals from the city centre are part of the sample so that the research can
capture management o f hospital waste within the CBD or the city centre.

Kenyatta National Hospital has been handled as a special case in the research
because it is a referral hospital and the biggest in Kenya with the highest
population o f patients and workers.

Nairobi hospital is considered because it is one o f the biggest private hospitals

in Kenya with patients from all over East Africa, while; Pumwani has been
handled as a special case because it is the biggest low cost maternity hospital in
Kenya.

37
Sample size: 60

3.6 Sampling Technique

The following methods o f sampling were used to identify the health facilities

that have formed the sample:

i) Stratified Random Sampling
This is a type o f probability sampling whose goal is to achieve desired
representation trom various subgroups o r characteristics in the
population. In this type o f sampling, subjects are selected in such a way
that the existing subgroups/characteristics in the population are more or
less reproduced in the sample. For the present study the main subgroups
have been identified in :he population depending on the income status
o f residents of Nairobi, location, and special characteristics that need to
be represented for a representative research. From the strata, individual
estates from which health facilities have been sampled were selected
purposively. This technique was adopted by the researcher because
these estates were perceived to have the required information with
respect to the objectives o f this study. The estates that were purposively
selected by the researcher were believed to be informative and that they
posses the required characteristics that would make the study as
representative as possible.

ii) Convenient Sampling/Accidental Sampling

This is a non-probability sampling, which involves selecting cases or
units o f observations as they come available to the researcher. It is also
called volunteer sampling. This method has been used to select
individual health centres from the already selected strata. Though this
method has a limitation o f being a non-probability sampling method, it
was adopted because o f the nature o f the study area, since some parts of
the area are not easily accessible and insecure as well.

38
3.7 Data Collection
t
Type of Data Collected
The study relied on both primary and secondary data.

a) Primary Data
i) Field Observation: These include observations that the researcher
makes as he/she carries out the study. General status o f the hospital,
the conditions o f waste collection containers, and the status o f the
dumping site among other issues are part o f data that have been
collected through field observation.
1

ii) Responses to the Interviews: These include information that have

been got from the senior medical staff (proprietors, doctors, clinical
officers etc) o f the health facilities during the interviews conducted by
the researcher on issues related to hospital waste management that
were not exhaustively covered in the questionnaire. Key-Informant
Interviews such as with relevant staff at City Hall and the Provincial
Medical Office belong to this group too.

iii) Responses to the Questionnaires: These include the written answers

that the interviewees fill in the questionnaires depending on the
requirements to specific questions. Most o f the issues regarding waste
collection, handling and uisposal regarding individual health facilities
were collected through this method.

iv) Apart from the above-mentioned sources, any o f the first hand
information relevant to the study topic has been regarded highly.

b) Secondary Data:
Various secondary data sources have been o f use including literature review of
published and unpublished w orks relevant to the study problem, study of

39
demographic and health surveys and other relevant reports, review o f
population census and other government reports such as the National
Development Plan and Economic Surveys, Hospital reports including
admission records etc and relevant baseline map o f the study area, figures and

photographs.

3.8 Methods of Data Collection

Various methods have been used to collect data during the study, including
note taking o f observed situations, use of questionnaire, use o f key informant
interviews and use of photograph among others.

3.9 Nature of Data Collected

The study had five objectives, and data collection was focussed to achieving
these objectives.

O bjectivel: To identify major types of wastes generated by hospitals in

different parts of Nairobi city

To achieve this objective a thorough literature review was done to find out the
internationally accepted categorisation of hospital wastes. Upon finding out the
seven categories of hospital wastes, namely, general wastes, pathological
wastes, infectious wastes, radioactive wastes, chemical wastes, sharps and
pharmaceutical wastes (as put forward by the World Health Organisation), the
research investigated the generation o f these types o f hospital wastes in the
individual health facilities that formed the sample drawn from different areas
o f Nairobi city. The data collected for this objective stated whether all the
hospitals or health facilities drawn from different estates within the city
generated all the seven types o f wastes or whether some types o f wastes are not
generated in certain hospitals.

Objective 2: To find out the methods of waste collection in hospitals

T o achieve this objective, data was collected on the different waste collection

40
containers used in the individual health facilities in the sample to collect the
various types o f wastes. Data on who handles the different types o f wastes
within the facility was considered too. This was based on the assumption that
good management of wastes requires appropriate handling o f the same
beginning from generation to disposal, and as such, containers used for waste
collection and the personnel who handles the wastes at the facility level form
important consideration.

Objective 3: To investigate the various methods of waste disposal in

different hospitals within the city.

To achieve this objective, data was collected on how the individual health
facilities dispose the different types o f wastes generated within them. The data
collected for this objective specified whether disposal is done within the
hospital set up or outside the hospital, and in case o f the latter where and how?
The research also found out the various private firms, which assist the Nairobi
City Council in disposal o f wastes within the city.

Objective 4: To establish the environmental implications associated with

various hospital waste handling methods

Having collected data on generation of different types of wastes, collection,

and disposal methods, the research examined how these practices would impact
negatively on the environment in totality. Data on the observed state of the
dumping site at Dandora and other illegal dumping sites created especially in
the low income residential areas in Nairobi, the physical state of the waste
collection containers, the frequency o f waste removal from within the facilities,
separation o f wastes or its absence at the hospitals, and the state of incinerators
and other on-site waste disposal devices at the time o f the research, among
other issues, were all focussed to establishing the environmental implications
associated with various hospital waste handling methods.

41
Objective 5: To suggest appropriate recommendations for policy makers
on sustainable management o f hospital waste, and suggest areas for

further research

Having reviewed literature and thoroughly analysed data on the research topic,
the research investigated the knowledge gaps that need to be explored in
research. These have been put iater in report as areas for further studies.
Results o f the research have also assisted in providing appropriate
recommendations for policy makers and other agencies concerned with waste
management. These recommendations are related to sustainable management
o f waste in general, and to hospital waste in particular. Therefore the
mentioned objective has been achieved through a thorough process o f study
and research.

3.10 Data Processing and Analysis

Various methods of data analysis and presentation have been used to facilitate
interpretation o f data. There has been use o f both qualitative and quantitative
data analysis techniques. In addition, other cartographic methods have been
employed.

Preliminary data operations entailed processing o f data, cleaning and data

reduction. Data was coded for easy capturing using computer-based technique,
namely; the Statistical Package for Social Sciences (SPSS)

Data analysis was objective based. Both the quantitative and qualitative
techniques have been applied to objectives i, ii, and iii. Verbatim and indirect
reporting was used for objective iv and v.

Quantitative analysis entailed use o f descriptive statistics; summary counts

(frequencies), means and variances. Cartographic presentations such the use of
graphs and pie carts has been used to achieve set objectives and afford data

42
greater meaning. This is largely based on what Bailey calls the theoretical
principle; driven by the researchers goals and theory (Bailey 1978). Further
data analysis entailed subjecting data to statistical tests with the aim o f making

inference on relationship between data sets or variables.

3.11 Hypothesis Testing

The statistical theory o f probability allows us to prove the hypothesis within a
margin o f error. Parametric and non-parametric tests have been used to prove
whether actual hypothesized relationships between variables really exist. It has
also included testing o f null hypotheses to test validity o f the data. The
statistical tests that have been used include Friedman’s test and Kruskal -
Wallis H test. These have been used to test the general difference in the
collection and disposal o f the different categories o f hospital waste, and to test
for difference o f hospital waste management in different parts o f Nairobi,
namely, high income residential areas, low income residential areas, the city
centre and in the special cases category which include Kenyatta National
Hospital, Pumwani Maternity Hospital and Nairobi Hospital.

43
 CHAPTER FOUR

4.0 MAJOR TYPES OF WASTES, THEIR

MANAGEMENT AND IMPACTS

4.1 Introduction
Discussion in this section entails testing o f the hypotheses, reporting on
research findings and discussions based on the objective.

4.2 RESEARCH FINDINGS

Major Types of Hospital Wastes in Nairobi

Hospital waste is generally defined as any solid waste that is generated in the
diagnosis, treatment, or immunization of human beings or animals, in research
pertaining thereto, or in the production or testing o f biologicals, including but
not limited to:

• Blood-soaked bandages
• Culture dishes and other glassware
• Discarded surgical gloves - after surgery
• Discarded surgical instalments - scalpels
• Needles - used to give shots or draw blood
• Cultures, stocks, swabs used to innoculate cultures
• Removed body organs - toncils, appendices, limbs, etc.
• Lancets - the little blades the doctor pricks your finger with to get a
drop o f blood

The amount and type o f waste generated by health care activities depends on
t

several factors, including the nature of the operations, the type and size o f the
facility, and the effectiveness o f minimization efforts.

There are seven major classes o f hospital wastes. These include.

44
 General wastes
Pathological wastes
Infectious wastes
Radioactive wastes
Chemical wastes
Sharps
Pharmaceutical waste

First Hypothesis Testing (Ho)

Ho: Generation o f hospital wastes in selected health facilities in Nairobi is not

significantly different.
H i: Alternative.
This hypothesis is tested by descriptive statistics as shown in the table below:

Table: 4. Hospital waste generation in Nairobi

Type of W aste Frequency of Percentage

Generation
General W aste 60 100.0%
Pathological Wastes 42 70.0%
Infectious Wastes 51 85.0%
Radioactive Wastes 6 10.0%
Chemical Wastes 38 63.3%
Sharps 56 93.3%
Pharmaceutical Wastes 51 85.0%
Source: Researcher, 2005

Interpretation

The generation o f these wastes in Nairobi is not the same as shown in the table
above. General waste is evident in every health facility in Nairobi (100.0%)
followed closely by sharps (93.3%). The generation o f infectious waste and
pharmaceutical wastes is equal at 85.0%. These are followed by pathological
waste at 70.0% and chemical waste at 63.3%. The generation of radioactive
waste is almost insignificant in the city hospitals (10.0) %.

45
Therefore, the null hypothesis is rejected as the alternative hypothesis is
adopted that the generation of different types o f hospital wastes in Nairobi is

different.

1) The General Waste

General waste includes all other waste and materials, which have not been
exposed to human infectious agents. They are also referred to as solid wastes
and they are items that may be recycled or disposed in the trash. Examples are
domestic type o f waste, packing material, waste water from laundries, and
waste from the offices, kitchens, rooms, including bed linen, utensils, paper,

drug sachets, etc.

General waste is generated by any health facility in the city as shown in the
table above. Its generation depends on the operations o f the health facility and
the number o f departments in the hospital. The composition o f general waste
varies from plastics, discarded pt-.per from office operations, drug packets and
food remains from the kitchen ju st to mention but a few.

General waste Collection methods

From the study, collection of this type o f waste varies a lot especially on the
container used for its collection and storage within the health facility before
being disposed. Different kinds o f containers were found to be used for
collection o f the general waste.

46
 Table 5: Containers for general waste collection

Container Frequency Percent

code
1.00 7 11.7
2.00 35 58.3
3.00 5 8.3
5.00 6 10.0
7.00 2 3.3
10.00 5 8.3
60 100.0
Total
___________

Key

1 - Waste paper basket 2 - Dustbin

3 - Pedal bin 5 - Bucket

7 - Carton 10 - Polythene bag

Interpretation of the Table

It is evident from the table tha: a variety of containers are used for the
collection o f general waste in different health facilities in Nairobi. The most
widely used collection containers for general waste is dustbin (58.3%). The
others are waste paper basket (11.7%), bucket (10.0%), pedal bin and
polythene bag (each at 8.3%), and lastly carton (10.0%).

The person responsible for the handling o f this type o f waste in the health
facilities also varies depending on the size o f the facility. Generally in the
bigger facilities (hospitals) there are the domestic staff (cleaners), who are
responsible for the emptying o f the waste collection containers and
subsequently transferring the wastes to a central collection point awaiting
disposal. However in the smalie; clinics, handling o f wastes is a responsibility
o f the medical staff.

The frequency of emptying the container for the waste collection also varies

47
depending on the size o f the health facility and on the number o f patients
attended to in the hospital. The larger hospitals with very many patients to
attend to per day get their waste collection containers emptied as high as four
times per day, while in the smaller clinics they can take up to two weeks before

being emptied.

General Waste Disposal

From the study health facilities employ various agencies and methods to
dispose the general wastes. So far these agencies and the methods o f waste
disposal employed by the facilities also vary depending mostly on size o f the
facility and the location. The agencies for the disposal o f general wastes in the
city include:
• City Bins
• Green City
• Local (estate based) Youth groups
• Nairobi City Council
The methods o f general waste collection adopted by the city health facilities
include:
• Incineration
• Open burning

Table 6: General W aste Disposal

Disposal Frequency Percent

code
2.00 13 21.7
3.00 4 6.7
4.00 13 21.7
5.00 15 25.0
6.00 10 16.7
10.00 5 8.3
Total 60 100.0

48
 10.00

Graph 1: Waste Collection Containers

KEY
2 - City Bins 3 - Green City 4 - Local (estate based) Youth
Groups
5 - Incineration 6 - Open Burning 10 - Nairobi City Council

Interpretation of the Table & the Graph

From the table and graph above on general waste disposal in the city hospitals,
the most method adopted is incineration (25.0%). City Bins and Local (estate
based) Youth Groups are widely adopted waste disposal agencies by the city
hospitals (each at 21.7%) for those health facilities that do not have
incinerators. Open burning is another widely use waste disposal method in
Nairobi (16.7%). Other agencies for waste disposal in Nairobi include Nairobi
City Council (8.3%) and Green City (6.7%).

Most o f the waste disposal agencies transfer the general waste and dispose
them at Dandora dump site while some, especially the estate based youth

49
groups do not have machineries to always transfer the wastes to the dump site,
as such some o f the wastes are burned in the open, dumped in undeveloped
plots o f land, dumped by the river and, at the road sides. This is common in the

low-income residential estates o f city.

2: Pathological Waste:
Pathological waste is defined as any recognizable human or animal body part
and tissue. This type o f waste include tissue, organs, and body parts, body
fluids that are removed during surgery, autopsy, or other medical procedures,
or specimens o f body fluids and their containers, and discarded material
saturated with such body fluids other than urine.

Unlike general waste, pathological waste is not generated by all health

facilities in the city as shown in table 4(for waste generation) above. In fact of
the 60 health facilities sampled only 36 were found to be generating this type
o f waste accounting to 60%. Its generation depends on the operations o f the
health facility and the departments in the hospital.

Pathological Waste Collection

From the study, collection of this type o f waste varies a lot especially on the
container used for its collection and storage within the health facility before
being disposed. Different kinds o f containers were found to be used for
collection o f the pathological waste.

50
Plate 2: A bucket used as a waste collection container in one of the city
health facilities

The different containers used by the different health facilities for collection of
pathological waste include

• Dustbin
• Pedal bin
• Special container
• Bucket
• Metal container with lid
• Polythene bag

The use o f these containers is as shown in the table 7and graph 2 below.

51
Table 7: Pathological waste collection containers

Type Frequency Percent

Dustbin 2 5.6
Pedal bin 9 25.0
Special 2 5.6
container
Bucket 15 41.7
Metal 2 8.3
container
with lid
Polythene 3 8.3
bag
Immediate 2 5.6
disposal
Total 36 100.0

Graph 2: Pathological waste collection containers

52
 30

Interpretation of Table 7 and Graph 2

It is evident from the table that a variety o f containers are used for the
collection o f pathological waste in different health facilities in Nairobi. The
most widely used collection container is a bucket (41.7%), followed by pedal
bin at 25.0%. The others are metal container with lid (8.3%), polythene bag
(8.3%) and dustbin (5.6%). In some health facilities, pathological waste is
disposed immediately it is generated as such they lack containers for waste
collection. These account for 5.6% of the health facilities.

As is the case in general waste, the person responsible for the handling o f this
type o f waste in the health facilities also varies depending on the size of the
facility. Generally in the bigger facilities (hospitals) there are the domestic staff
(cleaners) who are responsible for the emptying of the waste collection
containers and subsequently transferring the wastes to a central collection point

53
awaiting disposal. However in the smaller clinics, handling o f wastes is a

responsibility of the medical staff.

The frequency o f emptying the container for the waste collection also varies
depending on the size o f the health facility and on the number o f patients
attended to in the hospital. The larger hospitals with very many patients to
attend to per day get their waste collection containers emptied as high as four
times or more per day, while in the smaller clinics they can take up to two
weeks or more before being emptied.

Pathological Waste Disposal

From the study health facilities employ various agencies and methods to
dispose the pathological wastes. So far these agencies and the methods of
waste disposal employed by the facilities also vary depending mostly on the
size of the facility and the location. The agencies for the disposal o f these
wastes in the city include:
• City Bins
• Green City
• Local (estate based) Youth groups
The methods o f general waste collection adopted by the city health facilities
include:
• Incineration
• Open burning
• Open dumping
• Pii disposal (placenta pits and pit latrine)

54
 Table 8: Pathological Waste Disposal

Frequency Percent
Method
1.00 3 5.0
2.00 10 16.7
3.00 1 1.7
4.00 7 11.7
5.00 19 31.7
6.00 1 1.7
7.00 1 1.7
Total 42 70.0

KEY
1 —Pit disposal 2 —City Bins 3 —Green
City
4 - Local (estate based) Youth Groups 5 - Incineration 6 - Open

Burning
7 - Open dumping

Interpretation of Table 8
From the table above on pathological waste disposal in the city hospitals, the
most method adopted is incineration (31.7.0%). City Bins and Local (estate
based) Youth Groups are widely adopted waste disposal agencies by the city
hospitals (16.7% and 11.7% respectively) for those health facilities that do not
have incinerators. Open burning and open dumping are also disposal methods
employed by some health facilities in the city. They each account for 1.7%.
Another agency for pathological waste disposal in Nairobi is Green City
(1.7%). This is not a widely used mode in the health facilities.

Most of the waste disposal agencies transfer the general waste and dispose
them at Dandora dump site while some, especially the estate based youth
groups do not have machinery to always transfer the wastes to the dump site, as

55
such some o f the wastes are buir.ee in the open, dumped in undeveloped plots
o f land, dumped by the river and, at the road sides. This is common especially
in the low-income residential estates o f city.

3: Infectious Waste

This is material containing pathogens in sufficient concentrations or quantities

that, if exposed, can cause disease. It includes tissue cultures and stocks of
infectious agents from laboratories, waste from survey and autopsy on patients
in isolation wards and dialysis from infected patients. Hospital waste is
considered capable of producing an infectious disease if it has been, or is likely
to have been, contaminated by an organism likely to be pathogenic to healthy
humans, if such organism is not routinely and freely available in the
community, and such organism has a significant probability o f being present in
sufficient quantities and with sufficient virulence to transmit disease.

Just like the pathological waste, this type o f waste is not generated in all the
health facilities in the city. In the sample 49 out o f the 60 health facilities
generate it. This accounts for 85%. This is shown in the table 4 for waste
generation. Its generation as is the case with other types of wastes depends on
the size o f the health facility arid the operations in the facility including the
number o f patients attended to.

Infectious Waste Collection

From the study, collection o f this type o f waste varies a lot especially on the
container used for its collection and storage within the health facility before
being disposed. Different kinds of containers were found to be used for
collection o f the infectious waste.

56
The different containers used by the different health facilities for collection o f
infectious waste include
• Dustbin
• Pedal bin
• Special waste paper basket
• Bucket
• Metal container with lid
• Polythene bag

The use o f these containers is as shown in the table below.

Table 9: Infectious W aste Collection Containers

Type Frequency Percent

Dustbin 4 8.2
Pedal bin 10 20.4
Bucket 25 51.0
Metal 2 4.1
container
with lid
Special 2 4.1
waste
paper
basket
Polythene 5 10.2
bag
Immediate 1 2.0
disposal
Total 49 100.0

Interpretation of Table 9

It is evident from the table that a variety o f containers are used for the
collection o f infectious waste in different health facilities in Nairobi. The most
widely used collection containers is bucket (51.0%), followed by pedal bin
at20.4%. The others are polythene bag (10.2%) dustbin (8.2%). metal container
with lid (4.1%), and special waste paper basket (4.1%). In some health
facilities, infectious waste is disposed immediately it is generated as such there
are no containers for waste collection. These account for 2.0% of the health

facilities.

As is the case in general and pathological wastes, the person responsible for the

57
handling o f this type o f waste in the health facilities also varies depending on
the size o f the facility. Generally in the bigger facilities (hospitals) there are the
domestic staff (cleaners) who are responsible for the emptying o f the waste
collection containers and subsequently transferring the wastes to a central
collection point awaiting disposal. However in the smaller clinics, handling o f
wastes is a responsibility o f the medical staff.

The frequency o f emptying the container for the waste collection also varies
depending on the size o f the health facility and on the number o f patients
attended to in the hospital. The larger hospitals with very many patients to
attend to per day get their waste collection containers emptied as high as four
times or more per day, while in the smaller clinics they can take up to two
weeks or more before being emptied.

Infectious Waste Disposal

From the study health facilities employ various agencies and methods to
dispose the infectious wastes. These agencies and the methods o f waste
disposal employed by the facilities also vary depending mostly on the size o f
the facility and the location. The agencies for the disposal o f these w astes in
the city include:
• City Bins
• Green City
• Local (estate based) Youth groups

The methods o f general waste collection adopted by the city health facilities
include:
• "incineration
• Open burning
• Open dumping
• Pit disposal (placenta pits and pit latrine)

58
 Tabic 10: Infectious W aste Disposal

Frequency Percent
Method
1.00 1 2.0
2.00 14 27.5
3.00 1 2.0
4.00 9 17.6
5.00 23 45.1
6.00 2 3.9
7.00 1 2.0
Total 51 100.0

K EY
1 - Pit disposal 2 - City Bins 3-
Green City
4 - Local (estate based) Youth Groups 5 - Incineration 6-
Open Burning
7 - Open dumping

Interpretation of Table 10
From the table above on infectious waste disposal in the city hospitals, the
most method adopted is incine:ation (45.1%) followed by City Bins and Local
(estate based) Youth Groups (27.5% and 17.6 %) for those health facilities that
do not have incinerators. Open burning and open dumping are also disposal
methods employed by some health facilities in the city. They each account
fo r i.7%. Another agency for pathological waste disposal in Nairobi is Green
City (1.7%). This is not a widely used mode in the health facilities.

M ost of the waste disposal agencies transfer the general waste and dispose
them at Dandora dump site white some, especially the estate based youth
groups do not have machineries to always transfer the wastes to the dump site,

59
as such some o f the wastes are burned in the open, dumped in undeveloped
plots o f land, dumped by the river and, at the road sides. This is common
especially in the low-income residential estates o f city.

Plate 3: an incinerator in operation at the uon health services clinic at m ain campus

4: Radioactive Waste:
Includes solid, liquid and gaseous wastes contaminated with radioactive
substances used in diagnosis and treatment o f diseases. Radioactive wastes
have some o f the possible combination o f protons and neutrons in their atomic
nuclei that are basically unstable and sooner or later decay to release radiation,
which includes alpha particles, beta particles, and gamma rays. There are two
types o f theses wastes; low-level (LLW) and high-level (HLW) radioactive
wastes. Low level radioactive waste are defined as radioactive materials that
contain only small amounts o f radioactivity and generally consist o f a wide
variety o f items such as residuals or solutions from chemical processing; solid
or liquid plant waste, sludges, and acids; and slightly contaminated equipment,

60
tools, plastic, glass, wood, fabric and other materials.

Most of the LLW generated by health facilities and hospitals falls into several
general waste streams: dry solids, organic liquids, aqueous liquids, biological
wastes, halogenated compounds, liquid scintillation wastes, and sealed sources

Dry solid wastes consist of contaminated laboratory trash and apparatus,

protective clothing, towels, paper, sharps, and packaging materials. Biomedical
research facilities may also generate contaminated solid wastes from patient

care.

Organic liquids include radioactive wastes that may contain alcohols, ethers,
aldehydes, ketones, toluene/benzene/xylene, and other aromatic compounds.
Many o f these wastes are considered low-level mixed wastes, a category o f

multihazardous wastes.

Aqueous liquids include washings from contaminated glassware, cell culture

media, buffers, and nonhazardous reagents contaminated with radioactive
material.

Biological wastes include animal carcasses, human and animal tissues,

bedding, excreta, and clinical samples. Radioactive biological wastes that are
infectious are considered multihazardous wastes.

Halogenated wastes refer to radioactive wastes that contain regulated

concentrations of one or more halogenated organic compounds such as
polychlorinated biphenyls, or chloroform. These wastes are classified as mixed
wastes, a category of multihazardous waste,

Liquid scintillation wastes are generated when samples containing radioactive

materials are analyzed using an organic substance which, when excited by the
ionization o f the molecules due to interaction with the radiation, emits flashes
o f light as the molecules fluoresce.

Significant generation o f this type o f waste is very low in the city. Only 6 out
o f the 60 health facilities in the sample were found to be generating radioactive

61
waste in significant quantities. This accounts for only 10% of hospital waste
generation in the city. In the health facilities where this type o f w aste is
generated, it is mostly collected in a pedal bin or in bucket. Radioactive wastes
from the health facilities are in most cases disposed together with other
hospital; waste. As such they can end up being handled by the waste disposal
agencies (the City Bins, the Green City, the Nairobi City Council or the local
estate based youth groups), or be incinerated, burned in the open, dumped in a
pit or openly dumped. In most o f the health facilities in the city, the generation
o f this type o f waste is very insignificant and therefore do not see the need for
specialised treatment.

5: Chemical Waste:
This comprises o f discarded solid, liquid and gaseous chemicals e g. from
diagnosis, experimental work, cleaning, house keeping and disinfecting
procedures.

Classification; Chemical wastes may be divided into the following groups:

■ Hazardous wastes e g., flammable solvents, acids, bases,

toxic metals.
■ Special wastes regulated under other laws eg.
polychlorinated biphenyls, used oil.
■ Non-regulated hazardous wastes e g., ethidium bromide,
aflatoxin.
■ Chemically contaminated laboratory materials eg.
papers, gloves, glassware
• Non-hazardous chemical wastes e g., sugars, buffers.

Sources: As a broad generalization, health facilities produce smaller amounts

and a larger variety o f chemical wastes and mixtures than industry, which
produces large amounts o f a small number of chemical wastes. The regulated
hazardous and special wastes produced by medical laboratories are primarily

62
mixtures of organic solvents, with lesser amounts o f other materials such as
used oil, contaminated lab ware, and miscellaneous chemicals.

Activities that result in chemical w astes primarily include

■ Disposal o f excess, outdated, and off-specification

chemicals;
■ Molecular biology procedures (e.g., extraction,
purification and sequencing o f nucleic acids, proteins).

■ Analytical procedures (e g ., assays, gel

electrophoresis).
■ Histological procedures (e g., fixatives, stains).
■ Other experimental uses o f chemicals.
■ Cleaning and disinfection;
■ Care and maintenance o f laboratory animals.
■ Film processing.
■ Facility operations (e g., paint, floor cleaners, floor
strippers, batteries, fluorescent light tubes, and ballasts).
■ Disposal o f contaminated lab ware and spill clean-up
residues.

Chemical w aste is not significantly generated in some o f the city hospitals. For
instance out o f the 60 health facilities sampled for the study, this type o f waste
is present in only 37 facilities, accounting for 63.3%.

Chemical Waste Collection

The chemical wastes in aqueous or liquid form are in most cases poured in
special sinks, flushed in the toilet or poured in pit latrines to join the sewage
system. In most o f these cases, the disposal is immediate and as such there is
no need for waste collection container.

In other cases where the waste is in the form o f solid or semi solid, a variety of
containers are used for its collection. These include the following as shown in
the table below.

63
waste in significant quantities. This accounts for only 10% of hospital waste
generation in the city. In the health facilities where this type o f w aste is
generated, it is mostly collected in a pedal bin or in bucket. Radioactive wastes
from the health facilities are in most cases disposed together with other
hospital; waste. As such they can end up being handled by the waste disposal
agencies (the City Bins, the Green City, the Nairobi City Council or the local
estate based youth groups), or be incinerated, burned in the open, dumped in a
pit or openly dumped. In most o f the health facilities in the city, the generation
of this type o f waste is very insignificant and therefore do not see the need for
specialised treatment.

5: Chemical Waste:
This comprises o f discarded solid, liquid and gaseous chemicals e.g. from
diagnosis, experimental work, cleaning, house keeping and disinfecting
procedures.

Classification: Chemical wastes may be divided into the following groups:

■ Hazardous wastes e.g., flammable solvents, acids, bases,

toxic metals.
■ Special wastes regulated under other laws e.g.
polychlorinated biphenyls, used oil.
■ Non-regulated hazardous wastes e.g., ethidium bromide,
aflatoxin.
■ Chemically contaminated laboratory materials e.g.
papers, gloves, glassware
■ Non-hazardous chemical wastes e.g., sugars, buffers.
■i
Sources: As a broad generalization, health facilities produce smaller amounts
and a larger variety o f chemical wastes and mixtures than industry, which
produces large amounts o f a small number o f chemical wastes. The regulated
hazardous and special wastes produced by medical laboratories are primarily

62
 Table 11: Chemical Waste Collection

Type Frequency Percent

Pedal bin 4 10.8
Specimen 2 5.4
container
Bucket 14 37.8
Metal 1 2.7
container
ivith lid
Special 1 2.7
waste paper
basket
Polythene 1 2.7
bag
Immediate 14 37.8
disposal
Total 37 100.0

From the above table, the most commonly used container for waste collection
is the bucket (37.8%). Other containers for waste collection include pedal bin
(10.8%), specimen container (5 4%), metal container with lid (2.7%), special
waste paper basket (2.7%) and polythene bag (2.7%).

Chemical Waste Disposal

As has been mentioned a variety o f chemical wastes in the form o f liquids and
aqueous solutions are disposed to join the sewage system through flush toilets
and sinks. Other forms o f the chemical wastes were found to be disposed in a
variety o f ways including the use o f waste disposal agencies and methods as
outlined in the table below.

...T able 12: Chemical W aste Disposal

Frequency Percent
Method
l.Ou 3 7.9
2.00 7 18.4
3.00 1 2.6
4.0G 2 5.3
5.00 16 42.1
6.00 1 2.6
8.00 8 21.1
Total 38 100.0

64
KEY

1 - Pit disposal (pit latrine, placenta pit, etc.) 2 - City Bins

3 - Green City 4 - Local (estate based)

youth groups

5 - Incineration 6 - Open burning

8 - Toilet or sink disposal

From the table above on chemical waste disposal, the widely adopted method
for chemical waste (in the form o f solids and semi solids) disposal is
incineration (42.1%), followed by flash toilet & sink disposal (21.1%), pit
disposal (7.9%), and open burning (2.6%). Waste disposal agencies are also
contracted by certain health facilities to assist in the disposal o f these types o f
wastes. These include the City Bins (18.4%), the Local (estate based) Youth
Groups (5.3%), and the Green City (2.6%).

6: Sharps:

This waste include discarded unused sharps and sharps used in animal or
human patient care, medical research, or clinical or pharmaceutical
laboratories, hypodermic, intravenous, or other medical needles, hypodermic or
intravenous syringes to which a needle or other sharp is still attached, Pasteur
pipettes, scalpel blades, or blood vials. This waste also includes other types o f
broken or unbroken glass {including slides and cover slips) in contact with
infectious agents or any other item that could cause a cut. The single most
important aspect of sharps which gives rise to fear and apprehension is their
inherent ability to cause puncture, wounds and/or lacerations, which may
create a portal o f entry for infectious agents.

Almost all the health facilities in Nairobi according to this research were found
to be generating sharps with the exceptions o f strict pharmaceutical shops or
retail chemists. From this study, 56 out of the 60 health facilities in the sample
generate wastes in the form o f sharps in their premises.

65
Collection of Sharps

As is the case with the other types o f wastes in a hospital set up, a number o f
containers are used in the collection of sharps most of which are not
recommended by the Ministry of Health. This is especially evident in the small
clinics mostly operated in the low-income residential areas such as in the
slums. Nevertheless, most health facilities regardless o f their size and areas o f
operation use the recommended sharps (75.0%) container as illustrated in the

table and graph below.

Table 13: Containers for Sharps Collection

Type Frequency Percent

Waste 1.8
paper
aasket
Dustbin 2 3.6
Metal 2 3.6
container
with lid
Carton 2 3.6
Bottle 1 1.8
Polythene 1 1.8
oag
Recomme 42 75.0
nded
Sharps
container
Jerry can 5 8.9
Total 56 100.0

66
 M s sing

w aste paper basket

Graph 3: sharps collection containers

Other containers used for sharps collection in the health facilities include:
• Jerry can
• Dust bin
• Metal container with lid
• Carton
• Waste paper basket
• Bottle
• Polythene bag.
However, the use of these containers in the collection o f wastes in the form o f
sharps is low and as such insignificant.

Disposal of Sharps
Different firms are involved in the disposal o f sharps within the city o f Nairobi.
These waste disposal agencies involved in the disposal of sharps include:
• City Bins

67
 • Local Youth Groups
• Green City

T ablel4: Sharps Disposal Methods

Disposal Frequency Percent

1.00 1 1.8
2.00 15 26.8
3.00 1 1.8
4.00 9 16.1
5.00 29 51.8
6.00 1 1.8
Total 56 100.0

KEY
1 - Pit disposal (pit latrine and placenta pit) 2 - City Bins

3 - Green City 4 - Local (estate based)

Youth Groups
5 - Incineration 6 - Open burning

The most commonly used method o f disposing the sharps from the health
facilities in Nairobi is through incineration. The other method for disposal o f
sharps, which is most likely used in the small clinics especially in the low-
income areas is open burning. Some of the waste disposal agencies (e.g. the
local youth groups) adopt this method. In this case they employ the use high
burning fuels like diesel and petrol to aid in the burning o f this type o f waste.

7: Pharmaceutical Waste:
This includes pharmaceutical products, drug and chemicals that have been
returned from wards, spilled, outdated, contaminated, or are no longer required.

Health facilities directly dispose o f small quantities o f unused drugs and

wastes contaminated with drugs in the course o f their operations. The total

68
amount of drugs disposed o f by medical facilities is negligible when compared
with that disposed o f by society. The pace o f biomedical research and
development is increasing rapidly, and this has the potential to significantly
increase the generation o f waste drugs, manufacturing intermediates, and
wastes contaminated by these substances.

Sources of Pharmaceutical Wastes

The primary sources of drug wastes are pharmaceutical research, development,

and manufacturing, and the use o f drugs by patients. Only a very small
percentage o f the drugs disposed o f by facilities and patients is unused.

Pharmaceutical research and development: The quantities and compositions

of drug-related wastes generated as s result o f activities in the health facilities
depend on many factors, including the type o f facility.

Drug wastes may be in several forms: unused, expired, and residual drugs as
solids and liquids; wastewater from cleaning areas contaminated during the
mixing and administration o f pharmaceuticals; and solid wastes contaminated
with drugs.

Patient excreta; Patient excreta are the primary source o f drug contaminants
in the environment. A big percentage o f a patient's intake of a drug is excreted
as unmetabolized drug or active metabolites.

Disposal via wastewater systems: Unused drugs and drug-contaminated

liquids such as wastewater from mixing drugs and cleaning areas contaminated
with drugs are usually discharged to the sanitary sewer. In most biomedical
facilities, wastewater from the preparation o f cytotoxic agents is an exception,
because it is usually managed and disposed o f as medical waste or hazardous
waste.

69
Disposal with general solid wastes; Unused drugs and materials contaminated
with drug residues may also be discarded with other solid wastes.
Municipalities dispose of these wastes in sanitary landfills or by incineration.

Disposal of unused drugs by patients: Patients accumulate excess, outdated,

or unused drugs at home. These are usually disposed o f via the sanitary sewer

or household trash.

Pharmaceutical waste is gener&v.'.d in almost all the health facilities, which

have pharmacies or dispensing chemists. Out o f the 60 health facilities sampled
for this study in Nairobi, 51 are generating wastes o f pharmaceutical origin
accounting for 85% of the health facilities.

Pharmaceutical waste Collection

As has been the case with the types o f hospital wastes, different containers are
adopted by different health facilities for waste collection, some o f which might
not be recommended by the relevant Ministry. In some health facilities, wastes
o f pharmaceutical nature are gotten rid o f immediately and therefore they don’t
have container for waste collection o f the same as there is no need for it.

Table 15: Pharmaceutical Waste Collection Containers:

Type Frequency Percent

Waste paper 1 2.0
basket
Dustbin 2 4.0
Bucket 11 22.0
Metal 6.0
container
with lid
Carton 25 50.0
Polythene 2 4.0
bag
Immediate 6 12.0
disposal
Total 50 100.0

70
From the table above the widely used pharmaceutical waste collection
container in the health facilities in Nairobi is carton. The use o f bucket is also
notable in a number o f the healtn facilities. Apart from the two other containers

include; dustbin, polythene bag, and waste paper basket in that order.

Pharmaceutical Waste Disposal

Different firms and groups are engaged by different health facilities for the
disposal o f these types o f wastes and the others that have already been
discussed. These agencies include:

• City bins
• Local Youth Groups
• Green City

Apart from these agencies, some health facilities prefer to return their wastes o f
pharmaceutical nature to the manufactures or suppliers o f the same.

In addition, pharmaceutical waste is disposed within the facilities through the

following methods:

• Flash toilets and sinks

• Incineration
• Pit disposal
• Open burning

Table 16: Means o f Pharmaceutical Waste Disposal

71
KEY
1 - Pit disposal 2 - City Bins 3 - Green

City
4 - Local Youth Groups 5 - Incineration 6 - Open

burning
8 - Fiash toilets and sink 9 - Returned to manufactures and suppliers.

Second Hypothesis Testing:

H0: Containers for collection o f different types o f wastes from health facilities

are not significantly different.

Hi: Alternative
As has been discussed earlier various containers are used for collection o f
different types o f hospital waste. The present test wants to find out if different
containers used for collection of different types o f hospital waste in the health

facilities.
For this analysis Friedman test is used.

Friedman Test

Friedman's test is a nonparametric test to compare the distributions o f tw o or

more quantitative variables. Friedman's test does not treat the two factors
symmetrically and it does not test for an interaction between them. Instead, it is
a test for whether the columns are different after adjusting for possible row
differences. The test is based on an analysis o f variance using the ranks o f the
data across categories o f the row factor. This test has been used to test the
general difference in the collection and disposal o f the different types o f
hospital waste.

Assumptions of the Friedman Test

• The data is from a small sample.

• The data is importantly non-normally distributed

72
The measurement scale o f the dependant variable is ordinal (not
interval or ratio).

The Test Analysis

This test analysis has been aided by SPSS

Descriptive statistics

N M ean Std. M inim um M axim um

Deviation
A 6 2.17 0.408 2 3
B 6 3.50 0.837 3 5
C 6 3.50 0.837 3 5
D 6 3.65 1.033 3 5
E 6 5.33 3.882 3 13
F 6 11.00 0.000 11 11
G 6 7.00 0.000 7 7

Ranks
Mean
Rank
A 1.08
l~B 3.33
C 3 33
D 3.33
E 4.25
F 6.83
G 5.83

Test Statistics

N 6
Chi- 31.500
f•
Square
df 6

73
Interpretation
From the analysis above, the calculated value is 31.500, and the degree o f
freedom (df) is 6, the critical value from the Chi-Square table at 0.05
significance level is 12.59. Therefore, the calculated value is greater than the
critical value; hence, the H0 is rejected. The Hi is thus adopted that
“Containers for collection o f different types o f wastes from health facilities are

significantly different” .

The result implies that the health facilities in Nairobi use different waste
containers for collection o f different types of wastes.

Third Hypothesis
Ho: Methods o f hospital waste collection are similar in different parts o f
Nairobi.
Hj. Alternative
As was discussed in the methodology section, health facilities in Nairobi were
stratified into four strata. These are:
• The low income residential areas
• The high income residential areas

• The City Centre

• The special cases

In this analysis, waste collection method has been considered in the context o f
the containers used for waste collection. Kruskal-Wallis H Test has been used
for the analysis.

The Kruskal-Wallis H Test

This is a non-parametric test for deciding whether there is a significant

difference between or among three or more samples. This type o f data is
applied to ordinal data (ranked). The test is used to test the null hypothesis that

74
K independent random samples come from identical universe against the
alternative hypothesis that the means of these universes are not equal.
This test is analogous to the one-way Analysis o f Variance (ANOVA), but
unlike the latter it does not require the assumption that the samples come from
approximately normal populations or the universe having the same standard
deviation.
In this test the data are ranked jointly from low to high or high to low as if they
constituted a single sample. The test statistics is H, which is worked out as
under:

h -
EffBV IT E t ' 301*11
I q f - T j )

CM*- N)

Where

k ■ number of cnegodes
N • number of cues in tte m p k
K, - number of cans to (be Mhcanjory
Ri a m n of toe mnJu In the 1-to csfcgoiy
T, a OBa l r the i-th category

The critical value o f H can be referred to in a table o f the chi-square

distribution with k-1 degrees o f freedom, for a test o f the hypothesis that all k
population distributions are identical.

The Test Analysis

N Mean Std. Minimum Maximum
deviation
A 60 3.10 2.482 1 10
B 36 5.22 2.727 2 13
C 50 5.16 2.411 2 13
D 7 3.86 1.069 3 5
E 37 8.00 4.137 3 13
F 56 10.21 2.410 1 12
G 50 7.02 2.737 1 13
Group 60 1.87 0.965 1 4

75
 Group N Mean
Rank
A: Low income 25 38.64
High income 25 26.28
Special Group 3 25.00
City Centre 7 18.86
Total 60
B: Low income 15 24.47
High income 15 15.83
Special Group 3 7.00
City Centre 3 13.50
Total 36
C: Low income 22 30.07
High income 23 23.57
Special Group 3 9.50
City Centre 2 21.50
Total 50
D: High income 3 4.83
Special Group 2 2.50
City Centre 2 4.25
Total 7
E: Low income 13 22.77
High income 20 17.05
Special Group 2 2.50
City Centre 2 30.50
Total 37
F: Low income 24 29.13
High income 24 29.38
Special Group 3 30.50
City Centre 5 20.10
Total 56
G: Low income 20 22.75
High income 22 27.61
Special Group 2 30.00
City Centre 6 25.42
Total 50

Test statistics (calculated vaiues o f H)

The Chi-square table is then used to read the critical values against the
respective category’s df at 0.05 significance level, and the Ho is either rejected
or otherwise as shown in the table below:

76
 A B C D E F G

df 3 3 3 2 3 3 3

Critical 7.82 7.82 7.82 5.99 7.82 7.82 7.82

value
State Rejected Rejected Rejected Not Rejected Not Not

of Ho rejected rejected rejected

Key
A - General waste B - Pathological waste C - Infectious waste
D - Radioactive waste E - Chemical waste F - Sharps G -
Pharmaceutical waste

Interpretation
From the analysis above, the H« has been rejected for types A, B, C and E,
thereby adopting the Hi that “methods o f hospital waste collection for types A,
B, C and E are not similar in different parts o f Nairobi” . This means that the
area in which a health facility is located within the city is one of the factors that
determine in one way or the other, which containers to be used for collection o f
general, pathological, infectious, and chemical wastes. However, there could
be other factors that determine the waste collection containers for the
mentioned waste types in the health facilities, which this study did not
investigate.

For the wastes types D, F and G the H„ is not rejected. This implies that the
data from the study does not provide enough evidence to reject the H0 that “the
methods of hospital waste collection for radioactive, sharps, and
pharmaceutical waste types are similar in different parts o f Nairobi” .
Therefore, the location o f a health facility in any part o f Nairobi per se may not
determine the type o f containers used for the collection o f the mentioned waste
types within the health facility As such, there could be other factors that
determine the type o f waste collection container adopted by health facilities for
the collection o f radioactive, sharps and pharmaceutical wastes, but, were not

77
investigated by this study.

Hypothesis 4
Ho M ethods o f disposal o f different categories of hospital waste are not

significantly
different.
Hi: Alternative.
This hypothesis is tested by use o f the Friedman Test (the Friedman Test has
already been discussed).

Descriptive Statistics
Mean Std. Minimum Maximum
Deviation
N
5 3.80 1.643 2 5
A
B 5 3.80 1.643 2 5
C 5 3.80 1.643 2 5
D 5 3.80 1.643 2 5
E 5 4.40 2.510 2 8
F 5 3.80 1.643 2 5
G 5 800 .000 8 8

The Test Analysis (Ranks)

Mean
Rank
A 3.40
B 3.40
C 3.40
D 3.40
E 4.10
F 3.40
G 5.90

Test Statistics
SI ST~
Chi- 25.765
Square
df 3

78
Interpretation
From the analysis above, the calculated value o f F is 25.765, and the degree o f
freedom (df) is 6, the critical value from the Chi-Square table at 0.05
significance level is 12.59. Therefore, the calculated value is greater than the
critical value; hence, the H0 is rejected and the Hi is adopted that “methods o f
disposal of different categories of hospital waste are significantly different.

The result implies that the health facilities in Nairobi use different disposal
methods and/ or agencies for different types o f wastes.

Hypothesis 5
H0: Waste disposal methods in hospitals in Nairobi are not significantly
different.
Hi: Alternative.

This hypothesis is tested by Kruskal-Wallis H Test (Kruskal-Wallis H Test has

already been discussed elsewhere in this chapter).
As has already been mentioned, the health facilities in Nairobi were divided
into four strata as below:
• Low income residential areas

• High income residential areas

• The City centre
• The special cases
Below were the outputs o f the analysis by SPSS
Descriptive Statistics
N Mean Std. Minimum Maximum
Deviation
A 60 4.58 2.142 2 10
B 42 3.86 1.555 1 7
C 51 3.% 1.455 1 7
D 6 3.67 1.506 2 5
E 38 4.68 2.243 1 8
F 56 3.95 1.367 1 6
G 51 5.78 2.663 1 9
Group 60 1.87 .965 1 4

79
The Test A nalysis (Ranks)

Group N Mean
Rank
Low Income 25 35.96
A
High Income 25 24 26
Special 3 38.00
City Centre 7 30.07
Total 60
Low Income 20 19.95
B
High Income 16 19.88
Special 3 31.00
City Centre 3 31.00
Total 42
Low Income 23 24.98
C 1
High Income23 24.63
Special 3 37.00
City Centre 2 37.00
Total 51
High Income 3 2.67
D
Special 2 5 00
City Centre 1 3.00
Total 6
Low Income 13 17.42
E
High Income 21 18.55
Special 2 28.00
,City Centre 2 34.50
Total 38
Low income 24 [27.21
F
High Income24 p6.96
Special 3 41.00
City Centre 5 34.60
Total 56
Low Income 21 19.95
G
High Income 23 28.37
Special 2 B7.00
City Centre 5 36.10
Total 51

80
 Test S tatistics
A B C l> E F G
Chi- 6.459 4.720 3.447 2.278 5.960 3.373 8.071
S q u a re
df 3 3 2 3 3 3

The Chi-square table is then used to read the critical values against the
respective category’s df at 0.05 significance level, and the H0 is either rejected
or otherwise as shown in the table below:

A B C D E F G

df 3 3 3 2 3 3 3

Critical 7.82 7.82 7.82 5.99 7.82 7.82 7.82

value
State o f Not Not Not Not Not Not Rejected

H0 rejected rejected rejected rejected rejected rejected

Key
A - General waste B - Pathological waste C - Infectious waste
D - Radioactive waste E - Chemical waste F - Sharps G -
Pharmaceutical waste

Interpretation
From the analysis above, the H0 has been rejected for type G
(Pharmaceutical waste) thereby adopting the Hi that “methods of hospital
waste disposal for type G are not similar in different parts o f Nairobi” . This
means that the health facilities in different parts o f the city adopt different
methods when it comes to disposing o f their pharmaceutical wastes. The
methods applied in the High-income residential areas are different from the
ones used in the low-income residential areas, the city centre and in the special
cases. That is, there are differences in the disposal o f pharmaceutical wastes
depending on which are o f the city the health facility is located.

81
For the waste types A, B, C, D, E and F the H0 is not rejected. This implies
that the data from the study does not provide enough evidence to reject the H0
that “the methods o f hospital waste disposal for types A, B, C, D, E and F are
similar in different parts o f Nairobi” . The variables can therefore be
investigated further by adoption o f a bigger sample.

4.3 ENVIRONMENTAL IMPACTS OF HOSPITAL WASTE

After extensive studies conducted in different parts o f the world, (most o f

which under provisions of the Medical Waste Tracking Act o f 1988 (25) o f the
United States o f America) Environment Protection Agency, EPA o f the United
States concluded that the disease-causing potential of hospital waste is greatest
at the point o f generation and naturally tapers off after that point, thus
presenting more o f an occupational concern than a generalized environmental
concern. Risk to the public o f disease caused by exposure to hospital waste is
likely to be much lower than risk for the occupationally exposed

4.3.1: What Are the General Risks Posed by Hospital Waste?

The concern created by medical / hospital waste is that it can cause infection
and/or disease. In order for this to happen, several things must occur. First,
infectious agents (for example, viruses) must be present in the waste. It is
important to keep in mind that certain types o f materials are classified as
hospital waste because they might cause disease. Blood, for example, is
considered infectious because it might contain viruses. Any given sample o f
blood or blood-soaked material may, in fact, be harmless.

Not only must infectious agents be present in the waste for it to cause disease,
they must also survive in the waste in large enough quantities to be able to
cause infection if an exposure occurs. The hepatitis B virus (or "HBV"), for
example, is usually present in the blood of persons infected with hepatitis B in
higher quantities than the AIDS virus (or "HIV") is in persons infected with

82
HIV. For this reason, it is much easier to contract hepatitis than ADDS from
exposure to infected blood. Further, HIV normally does not survive for very
long outside a living organism. Therefore, the chance o f contracting AIDS
from contact with hospital waste outside a health care setting is considered to
be remote.

Second, an exposure has to occur in a manner that will be effective in

transmitting the disease. There are four basic ways that a person can be
exposed to infections: through the skin; through mucous membranes in the
eyes, nose, and mouth; by inhaling infectious agents; and by swallowing them.
Not all o f these "routes" o f infection will actually transmit a given disease. For
example, AIDS can only be transmitted by sexual contact; by contact with the
blood of an infected person on mucous membranes, broken skin, or through
needle sticks; or from a pregnant woman to her fetus. It cannot be transmitted
by inhalation or by touching an infected person.

Plate 4: Wastes, some o f which are m edical in nature are dumped outside a building in
one o f the residences in the low income residential estate in Nairobi

Finally, in order for the exposure to cause disease, enough o f the infectious
agent must be transmitted to the person who is exposed so that his immune

83
system cannot effectively protect him or her from the disease. Even if the
waste does contain a large enough concentration o f a disease-causing agent and
exposure does occur in a way that could transmit the disease, disease may or
may not develop. For example, AIDS can be transmitted through being stuck
by a needle that contains the blood o f an HIV-infected person. However, the
chance o f contracting AIDS from a single needle stick, even if the needle does
contain HIV-infected blood, has been investigated to be very low. The chances
of becoming infected with hepatitis B from a single needle-stick, even if the
needle contains blood of an infected person, is also very low. A person's
chances of not contracting the disease from an exposure are usually better if he
or she receives prompt medical attention.

4.3.2: "What Are the Specific Risks to "Refuse” Workers (or

“Scavengers”) from Hospital Wastes?

The risk to dumpsite workers / scavengers from hospital waste is that o f

contracting hepatitis B or AIDS from needle-sticks or from infected blood or
blood-containing fluids being splashed or rubbed into open wounds, non-intact
skin, or mucous membranes.

Some o f the other diseases that could be transmitted through both hospital
waste and ordinary household waste include the common cold, (bacterial
conjunctivitis), chicken pox, and flu-all o f which can be transmitted by mucous
membrane exposure, inhalation o f airborne particles from soiled articles, or
inadvertent swallowing o f particles after handling soiled articles. Bacterial
infections are less common communicable diseases that can potentially be
transmitted through cuts or abraded skin, following handling o f contaminated
articles.

84
Plate 5: Hospital Waste inside an Incinerator. Some o f the wastes are not completely
incinerated.

4.3.3: Potential Impacts of Hospital Wastes on the Environment

a) Hazardous substances used by health facilities are stored and handled in

small containers and apparatus, and points o f use for these substances are
usually scattered among the numerous separate departments, laboratories and
buildings. The probability of a catastrophic event resulting in the uncontrolled
release o f large quantities of hazardous substances is low.

b) Because the quantities o f hazardous substances in use and disposed o f by

health facilities are usually small, uncontrolled releases would be likely to
impact only localized areas, not the general environment. The specific
characteristics and management requirements for the various types of
hazardous constituents commonly present in hospital waste tend to reduce the
potential for releases and adverse impacts even if they are released.

85
c) Indirect im pacts fro m waste treatm ent and disposal operations.
Incineration and other medical waste treatment processes can generate
secondary wastes and pollutants if treatment facilities are not designed,
constructed, and operated properly. These pollutants may have adverse
environmental impacts, including:

I. A ir em issions. Polychlorinated dioxins and dibenzofiirans, toxic heavy

metals (mercury and cadmium), and corrosive gases (hydrogen
chloride) may be produced by medical waste incinerators. Varying
levels o f pollutants may also be emitted from alternative (non­
incineration) treatment processes, depending on the method used for
pathogen inactivation and the type o f waste being treated. Whether
these pollutants are released into the environment or contained depends
on a number o f operational factors and the level of technological
advancement inherent in the treatment system.
II. W astewater effluents. Another potential source o f indirect impacts is
the use o f chemical disinfectants that may be regulated as toxic
pollutants. Phenolic disinfectants are of particular concern because they
may disrupt wastewater treatment processes or result in discharges o f
toxic effluents.

d) Pharmaceuticals which are not destroyed by incineration or other effective

treatment processes are eventually disposed o f and released to the environment.
Drugs have characteristics that increase their potential to be significant
pollutants. Most drugs are biologically active at low dose levels. They are
relatively stable under environmental conditions, and their use is increasing
rapidly with a population that is growing. The fate and effects o f drugs on the
environment are largely unknown, because monitoring for drug contaminants
in environmental media is very limited. There is no routine testing for
pharmaceuticals in wastewater and drinking water, and analytic methods are
either rarely available or deemed not cost effective. However, it has been
suggested that many drugs may present potentially significant environmental
impacts, for example:

I. Many types o f drugs are not degraded or removed by wastewater treatment

systems or passage through soil.

86
 II. Some drugs are already ubiquitous, mobile, and persistent in the
environment. For example, clofibrate, a lipid-lowering drug, and its derivative,
clofibric acid (CA), have been found in surface water, groundwater, and
marine environments. In fact, the concentrations o f CA found in the North Sea
in the United States and samples from other environmental sources are found at
the same levels as other classic environmental pollutants such as
hexachlorocyclohexane

ID. Drinking water treatment systems may not degrade or remove drug
contaminants as has been discovered by researches that have been done in
other parts o f the world. For example, in a recent sampling survey, 100% o f 64
samples o f drinking water samples collected in Berlin, Germany, contained
clofibric acid (CA)

Plate 6: A river bank converted to a dump site in one o f the Low Income residential
areas o f Nairobi

87
 IV. The discharge o f antibiotics with wastewater may favor growth o f multiple
antibiotic-resistant strains o f bacteria and have adverse impacts on biological
wastewater treatment processes. Antibiotics such as the fluoroquinolones may
be prim ary sources o f genotoxicity in wastewater from hospitals.

V. Drugs known to be hormonally active agents may act as endocrine

disruptors and are found in environmental media and drinking water.

4.4 MANAGEMENT OPTIONS FOR HOSPITAL WASTES

4.4.1 General Hospital Waste Management Options

• V olum e reduction, release to sanitary sewer systems, direct releases to the

environment, decay-in-storage, and land disposal are common components o f
radioactive waste management programmes at that should be adopted in health

facilities.
• H ealth facilities can also compac? wastes to reduce the volume o f waste that
must be transferred off-site.
• Industrial super compactors may be used by waste processing companies to
further reduce the volume o f waste before burial.
• Several facilities utilize incinerators to treat radioactively contaminated
biological wastes, liquid scintillation vials, and dry solid wastes.
• Vitrification o f radioactive waste is an area that can also be exploited in the
Developing world, since it is now commercially available in the Developed
world. This method can be used to achieve great volume reductions in the
waste stream in the range o f 200:1.
• O ther waste treatment methods such as alkaline hydrolysis freeze drying,
and dry distillation may be performed on certain waste types. Aqueous liquid
wastes containing by-product materials may be discharged to the sanitary
sewer.

88
4.4.2 Reuse and Recycling Options

The preferred disposition o f unwanted items is transferring them to others for

reuse or other uses that do not require reprocessing. Reuse, as compared to
reclamation o f materials from waste (recycling), conserves the most value,
usually requires the least amount o f energy, and generates less pollution and
secondary waste.

Health care facilities can develop successful solid waste recycling programs,
particularly for commodities such as aluminum, cardboard, paper, and glass
that are commonly recovered from the general waste (Municipal Solid Waste).
Although the prices paid for such materials are usually not a major source o f
income to facilities, diversion o f these materials from the solid waste stream
eliminates disposal charges, which may be significant. Recycling o f materials
from the harmful and infectious hospital waste is more problematic and may
not be successfully practiced:

89
 CHAPTER FIVE

5.0 SUMMARY OF FINDINGS, CONCLUSION

AND RECOMMENDATIONS

5.1 Summary of Findings

■ There are seven categories o f wastes that can be generated in a hospital
set up. These include; general waste, pathological waste, infectious
waste, radioactive waste, chemical waste, sharps and pharmaceutical
waste. Generation o f these waste types is different; for example,
radioactive waste is not significantly present in most of the city health
care facilities.
■ The health care facilities in Nairobi use a variety of containers for
collection o f their wastes within the facilities, some o f which are not be
recommended by the Ministry of Health. The commonly used
containers are: dust bin, waste paper basket, pedal bin, buckets,
recommended sharps container, jerry can, bottle, specimen containers,
special waste paper basket and polythene bags among others.
■ In most cases the type o f waste collection container used in a health
facility will vary depending on among other factors not investigated by
this jesearch, the part o f Nairobi in which the facility is located. For
example, crude and un-recommended waste containers are evident in
the small heath care facilities in the low-income residential areas
especially in the slums.
■ Most o f the health facilities in Nairobi which understand incineration to
be a disposal method o f waste rather than a treatment method adopt it to
get rid o f their waste after which the remains (whether completely burnt
or not) are transported to the dumpsite in Dandora.

■ Health care facilities, which do not have incineration facilities, opt to

90
 take their waste to neighbouring institutions with the facilities for
incineration, but this is at a small fee. Others however, contract waste
disposal agencies such as City Bins, Green City, and local (estate
based) youth groups.

■ Many health care facilities in the city prefer to return their

pharmaceutical waste to the suppliers for professional handling and

disposal
■ Some o f the waste disposal firms, which claim to be having the
necessary machinery for waste disposal, still take the harmful wastes to
the dumpsite at Dandora, sometimes in the raw form. The estate based
youth groups, however, are notorious for collecting the wastes and
transferring them in hand carts just to dump them by the nearby rivers
o r in undeveloped plots at night, where sometimes the neighbouring
residence wake up in the morning to find big smoke rising from the
burning waste.
■ Treatment o f waste by health facilities before disposal or collection by
the disposing agencies is very minimal. For the hospitals, which adopt
it, JIK disinfection and autoclaving are the most common methods
adopted.

5.2 Conclusion

Hospitals, clinics, nursing homes, laboratories, doctors' and veterinarians'

offices, private households-and many other places have to dispose of materials
that have been used in medical care or treatment. Some of this material is
- infectious-that is, it has the potential to cause some kind of infection and/or
disease. Examples o f medical wastes are used "sharps"-hypodermic needles
and syringes, IV needles, scalpel blades, and glass items; items containing or
soaked with blood or certain other body fluids; human or animal organs or
body parts; lab cultures that may contain disease-causing agents; and things

91
like gloves, bedding, dressings, sponges, and other items that have been used in
surgery, autopsy, o r treatment o f patients with certain contagious diseases.

It is possible for hospital waste to cause infection and/or disease if it enters the
body through broken skin or puncture wounds; if it splashes into the eyes,
nose, or mouth; if it is inhaled; or if it is swallowed.

Hospital wastes may be dangerous for other reasons besides the risk o f disease-
for example, sharps can cause cuts. Some o f the material disposed o f by
hospitals and other health care facilities may be hazardous for other reasons. It
may contain hazardous chemicals, o r low-level radioactive wastes. If the
hospital waste contains hazardous waste or radioactive waste, it should not go
to solid waste landfills.

On the other hand, not all waste created at such facilities is dangerous.
Hospitals contain offices and cafeterias that create waste that is not dangerous,
and much o f the waste generated by patient care poses no threat at all to
landfill workers. Even materials that have been classified as hospital waste will
not always cause disease-they merely pose a risk that must always be
considered in handling, storage, transportation and disposal.

Apart from hospital wastes being a health risk, their collection, handling,
treatment transportation and disposal contributes significantly to environmental
degradation. For example, incineration, open burning and even their
decomposition release various harmful gases to the atmosphere, thereby
changing the gases composition in the atmosphere.

The required disposal methods for hospital waste depend on the type o f waste
and on the nature o f the facility that created it. "Sharps" (needles and syringes,
scalpel blades, etc.), for instance should be placed in closed, leak proof
containers (though these do not have to be puncture-resistant). This type o f
container must be labeled Typically, hospitals use hard plastic containers for
"sharps," and trash bags for other hospital waste; however, it is important to

92
■ Youth groups, which lack the necessary machinery, should be outlawed
and banned from engaging in waste management activities.

5.3.2 Future Researchers

■ Many diabetics, allergy sufferers, dialysis patients, and other people

who receive medical care at home (not to mention users o f illegal
intravenous drugs) have to dispose needles and syringes and other
wastes o f medical nature. There is therefore, need to carry out a
detailed research on the management of these household based hospital

waste.

94
look at the labeling o r identification on the container. Another indicator o f the
presence o f hospital waste, which may be used, is the "B IO H A Z A R D "

symbol.

Hospital waste from health care facilities must be treated in a way that destroys
its potential for causing disease, prior to disposing it in a landfill. Acceptable
treatment methods may include incineration, steam sterilization (or
autoclaving), and chemical disinfection. Incinerated waste would not be
recognized as hospital waste.

5.3 Recommendation

5.3.1 Policy Makers

■ The government should set aside a central dumping site under strict
professional management solely for wastes o f hospital nature due to
their uniqueness from the ordinary wastes.
■ The Government through the Ministry o f H ealth should carry out
thorough inspection o f health facilities to ensure that they are using the
right containers and techniques for collection and handling o f the waste
generated in them.
■ Health care facilities should make sure that they label their various
containers for waste collection. This would decrease cases o f mistaken
mixing o f wastes and improve sanitation in the health facilities, in
addition to decreasing possible accidents associated with these wastes.
■ The Government through the relevant Ministry should investigate the
operations o f waste collection and disposal firms to ensure that they are
handling and disposing the wastes in the right way safe to human health
and the environment.

93
 BIBLIOGRAPHY

Akinbami, (1986): Environm ental D egradation in Nigeria

Bailey, N. T (1981): Statistical M ethod in Biology 2nd Edition, Hodder and

Stoughton, London.

Baum, B. and Parker, C.H (1974): Solid Waste Disposal, Volume 1

Incineration & Landfill. Ann Arbor Science Publishers Inc. Michigan.

Baum, B. and Parker, C.K. (1974): Solid Waste Disposal, Volume 2

Reuse/Recycle and Pyrolysis. Ann Arbor Science Publishers Inc., Michigan.

Biletewski, et al (1994): Waste M anagement. Spring - Verlag, Heidelberg.

Blalock, H. Jr. (1979): Social Statistics. McGraw - Hill Publishing

Company, New York

Buggy, D.D et al (1966): Statistical M ethods in the Social Sciences. North

Holland Publishing Company - Amsterdam.

Chanyasak, V. and Kubota, H. (1993): Source Separation o f Garbage fo r

Composting. Resecu ch Laboratory o f Resource U tilization. Tokyo Institute o f
Technology. Yokohama, Japan.

Clark, W.A and Hosking, P. L. (1986): _Statistical M ethod fo r Geographers.

John Wilev and sons, New York

Cole J. P. and King, C. A. M (1968): Q uantitative Geography Techniques

and Theories in Geography. John Wiley and sons, New York

95
Croxton,F.E (1971): Applied Statistics, Prentice Hall New Delhi

Cunningham, W. P. and Cunningham, M. A. (2002): Principles of

Environmental Science. McOrs’v Hill component Inc New York

Davies, A.G (1961): Public Cleaning - Present and Future. E & F.N Spon

Limited, London.

Derry G.H.C (1981): A n Introduction to Environm ental Systems. Heinemann,

London.

Goldman, B.A (1986): H aza-do\s Waste M anagement: Reducing the Risk.

Island Press, Washington, DC.

Feinbaum, R. and Gehr, W. (1995): Testing the Logistics o f Source Separation.

Bio Cycle, (April, 1995), Cal Recovery Inc. 94-96.

Goldman, B.A et al (1986): H azardous Waste M anagem ent: Reducing the Risk.
Island Press, Washington, DC.

Grossa Jr. and Robinson (1989): Standard Handbook o f H azardous Wastes.

Habitat (1990): R efuse Collection Vehicles fo r D eveloping Countries, UNEP,

Nairobi.

Habitat (1990): Privatization o f M unicipal Services in East Africa. A

Geographical Approach to Human Settlem ent M anagement. United Nations.

Hammond, R. and McCullagh, P. S (1978): Q uantitative Techniques in

Geography; An Introduction (second edition). Clereton press, Oxford, London

96
Hang, R.T (1980): Principles and Practices. Ann Arbour science publishers,

Me Ann Arbour

Henstock, M E (1983): D isposal and Recovery o f M unicipal Solid Waste. A

Review o f Realistic Options Facing the Public Authorities and Industry.

Butterworth & Co. (Publishers), London.

Holmes, J.R ed. (1983): Practical Waste M anagement, John Wiley & Sons,
Chichester.

Holmes, J.R (1981): Refuse, Recycling and Recovery, John Wiley & Sons,
Chichester.

Ikonya, J.N (1991): Refuse M anagem ent in Residential A reas o f Nairobi. B .A

(Building Economics) Dissertation. University o f Nairobi.

Luis, F.D and Clarence, G.G (1985): S o lid Waste M anagem ent in D eveloping
Countries. Bio Cycle (September, 1985), Cal Recovery System Inc.49-52.

Makokha R.S (2002): H ospital Waste M anagem ent in the C ity o f Nairobi. B .A
(Geography), Dissertation. University o f Nairobi.

Mattezou, S.P et al (ed) (1987): H azardous Waste M anagement. Selected

papers from An international Experts Workshops covered by UNIDO in
Vienna, 22-26 June 1987, Tyco logy. London.

Marsh, W.M and Grossa. J. Jnr (2002): Environm ental Geography. Science,
Land Use and E arth Systems, 2nd Edition. John Wiley and sons, New York

Milafiu E.O. (1993): D isposal and Conservation o f the Urban Environm ent. A
Case Study o f Nairobi. B.A (Geography). Dissertation, University o f Nairobi.

97
?
Mugenda O .M and Mugenda, AG (1999): Research M ethods: Quantitative an d

Q ualitative Approaches. Acts Press, Nairobi

Nobel, B.J ar.d Wright, R.T (1996): Environm ental Science, 5th Edition.

The W ay the Worid Works. Prentice Hall, New Jersey.

Opondo, M..M (1987): The D ynam ics o f Agro- Industrial Food Chain in

K enya. Institute for Africa - Kunde, Hamburg.

Otiende, J.E. et al Editors (1991): An Introduction to Environm ental

E ducation, Nairobi University Press, Nairobi.

Oweis, I. S and Khera, R.P H990): Geotechnology o f Waste M anagement.

B utterw orth’s, London.

Pavoni, J.L (1974): Pressing M a n ’s Environment D ata. Courier, Inc

Louisville, Kentucky

Raym ond, A. (1996): Community Com posting in West Africa. Bio Cycle
(January, 1996), Cal Recovery Inc. 70-96.

M uthoka, M.G, Rego A.B. and Rimbui, Z.K (1998): Environm ental Education.
E ssen tia l Knowledge fo r Sustainable Development. Longhorn, Nairobi.

Rosenbaum , W.A (1974). The P olitics o f Environm ental Concern. Praeger,

N ew York.

Sada, P.O (1977): Environm ental Sanitation in the urban areas o f N igeria.
N igeria Geographical Jouma! 70(1).

Selke, S.E.M (1994): Packaging and the Environment Alternatives, Trends and

98
Solutions. Technomic Publishing Company Inc, Basel.

South Pacific Regional Environmental Programme (SREP) and UNEP (1999):

G uidelines fo r M unicipal Waste M anagement Planning in Sm all Island

D eveloping States in the Pacific Region.

Tchnobanoglous, G. (1993): Integrated Solid Waste M anagement: Engineering

Principles a n d M anagement Issues. McGraw-Hill Inc. New York

Tyler. Mg, Jr (1986): Environm ental Science: A n Introduction. W ads Worth

Publishing Company, Belmont, California.

UN (1992): The Earth Summit Agenda 21: The U nited Nations Programme o f
A ction fro m Rio. United Nations, New York.

UNEP (1985): Solid Waste M anagement. Proceedings o f the International

Symposium on Solid Waste Management for Developing Countries.

Walpole, R E (1968): Introduction to Statistics, 2nd edition. Macmillan

Publishing Company, New York.

William P.T. (1998): Waste Treatment and D isposal. John Wiley and Sons.
Chichester.

http://wwfpak.org/www heaUhcarewasre oru

http://wwfpak.or/www.noharm.org
|
http://wwfpak.org/www.medwastecontest.on’
http://wwfpak.org/www.cleanmed.oru
http://wwfpak.org/www.ed'.:. gov/exposurereport
http://wwfpak.org/www.telmedpak.com.wastedisposal

99
 APPENDIX: I

QUESTIONNAIRE TO HEALTH FACILITIES OPERATORS

(MEDICAL OFFICERS / STAFF)

Introduction and Background

C

Recently, there has been an interest in waste management in the city of

Nairobi. This questionnaire is part o f a research inquiring on issues related to
handling and management of hospital wastes in the city. The researcher is a
post-graduate student at the University of Nairobi undertaking a Master o f Arts
Degree in Environmental Planning and Management. You are kindly requested
to assist in this research by responding accurately to the questions therein to the
best of your knowledge. All your responses will be treated in confidence and
will be used only for this research inquiry

Identification
1. Respondents' code_____________________

2. Name o f health facility______________________________

3. Estate____________________________________________

4. Type of health facility

i) Clinic
ii) Dispensary
iii) Health Centre
iv) Nursing home
v) Referral hospital
vi) Other specify
5. Ownership o f the facility

100
 i) Private (individual)
ii) Central government
iii) Local authority (NCC)
iv) Community
v) Missionary

6. Capacity o f the facility

i) Less than 30 patients
ii) 30 to 50 patients per day
iii) 51 to 100 patients per day
iv) Over 100 patients per day

7. Number o f beds in the facility (for inpatients)

i) Less than 20 beds
ii) 20 to 50 beds
iii) 51 to 100 beds
iv) Over 100 beds

8. Number o f employees in the facility

i) Less than 5
ii) 5 to 15
iii) 16 to 50
iv) More than 50

9. For how long has the facility been in operation?

i) Less than 5 years
ii) 6 to 10 years
iii) 11 to 20 years
iv) Over 20 years

10. Which o f the following sections/departments are present in the facility?

101
i) Reception
ii) Consultation
iii) Injection room
iv) Pharmacy/dispensing chemist
v) Laboratory
vi) Theatre
vii) General ward
viii) Maternity ward
ix) X-Ray room
x) Ultra sound department
xi) Physiotherapy department
xii) Psychiatrist zoom
xiii) Health record store
xiv) Drug store
xv) Administration offices
xvi) Kitchen
xvii) Toilets
xviii) Washrooms
xix) Laundry facilities
xx) Others

102
11. Waste Management
T y p e o f w a s te C o n t a in e r for F requ en cy o f R c s p o n s ib ilit T r a n sp o r ta tio n T r e a tm e n t D isp o sa l

w a s te e m p t y in g y /h a n d le r or tr a n s fe r m e th o d

c o lle c tio n c o lle c tio n m eans

c o n t a in e r

1. G e n e r a l w a s t e e g.

office, laundry, dirty

and linen, dom estic,

from kitchen

2. P a t h o lo g ic a l w a s t e

eg. tissues, organs,

body parts, human

foetuses, blood and

body flu id s

3. In fe c tio u s w a s t e s

e.g. cultures and stocks

of infectious agents

from laboratories,

waste from survey and

autopsy and dialysis

from infected patients

4. R a d io a c t iv e w a s t e s

i.e. solids, liqu ids and

gases wastes

contaminated w ith |

radionucleides

generated in vitro and

vivo testing

S. C h e m ic a l w a s t e s

e.g. discarded solids,

liq u id chem icals, e.g.

from diagnosis,

experimental work,

cleaning etc

6. S h a r p s e.g. needles,

blades, broken glass etc

7. P h a r m a c e u tic a l

wastes e.g. drug and

chem icals that have

1
expired
!_________

103
 \
Example
Container for waste collection: 1. Litter bins, 2. W aste paper basket, 3.

Container with lid

Frequency o f emptying Collection container: once a week
Responsibility/ handler: Hospital steward
Transportation/ transfer means In garbage trolley
Treatment method: No treatment
Disposal: NCC

12. Are there separate containers for different types o f wastes?

i) Yes
ii) No

13. Are the waste collection containers enough?

i) Yes
ii) No
14. Are the waste collection containers suitably located
i) Yes
ii) No

15. Are the containers above labelled appropriately?

i) Yes
ii) No

16. Are the waste collection containers above in good condition?

i) Yes
ii) No

17. Are wastes separated before disposal?

i) Yes
ii) No

104
18. If wastes are disposed by NCC or other firms, does the facility know where
and how they are disposed off?
i) Yes
ii) N o
State and explain_________________________________________ _____

19. W hy does the facility prefer the methods o f waste disposal stated above?

i) _____________________________________________________ __
i i ) _______________________________________________________
i i i ) _________________________________________________ _____
i v ) ______________________________________________ ___ _____

20. Has the institution any complaints from the general public about waste
disposal method used?
i) Yes
ii) No
21. I f yes in 20 above how are they affected?

0 ________________________________________________

i i ) ___________________________________________________
iii) _______________________________________________________
iv) _______________________________________________________
22. I f yes in 20 above, then what measures is the institution taking to address
the complaints?

i ) ____________________________________________________
ii) ______________________________________________________
iii) ______________________________________________________
iv) _____________________________________________________
General Environmental Health and Awareness
23. What is your genera: opinion o f the impacts o f the disposal methods
employed by the institution in?

105
 i) Sanitary condition______________________________
ii) The environm ent_____________________________
24. D o you think the current waste management by the institutions poses a
major environmental problem?
i) Yes
ii) N o
25. I f yes in 24 above how

0 ___________________________________________________ —
*0 _______________________________________________________________________________________________________________________________________________________ -

i i i ) ______________________________________________________
i v ) _______________________________________________________
26. What problem/obstacles have you encountered in trying to achieve the best
method o f waste management?

i) ______________________________________________________ -
i i ) _______________________________________________________
i i i ) ______________________________________________________
i v ) ______________________________________________________ .
27. Suggest ways o f improving the current situation o f waste management
within the city hospitals

i) _______________________________________________________
ii) _______________________________________________________
H i)_______________________________________________________
i v ) _______________________________________________________
28. Does the institution participate in the general improvement o f environment
in the surrounding area?
i) Yes
ii) No
29. If yes in 28 above how?

i) _______________________________________________________
ii) _______________________________________________________
i i i ) ______________________________________________________

106
 i v ) ____________________________________________________
30. Is there a department within the institution responsible for general
environmental health?
i) Yes
ii) No
31. What is the level o f environmental awareness by the staff o f the institution?
i) High
ii) Medium
iii) Low
iv) None at all
32. How can you rate the current situation o f waste management within the

institution?
i) Very good
ii) Good
iii) Fair
iv) Bad
v) Very bad
33. W hat is the general environmental state o f the institution?
i) Very good
ii) Good
iii) Fair
iv) Bad
v) Very bad

Af-KICANA COLLECTKHI
107