Waste handlers’ health and experiences of healthcare waste management in a Lassa fever treatment centre in Nigeria

Abstract

Objective

Studies on the occupational health risks and experiences of healthcare waste handlers since the decline in coronavirus disease 2019 (COVID-19) incidence are scarce in Nigeria. The current study aimed to examine what seemed as the “hidden” and rarely researched area of practice from the standpoint of different stakeholders in a Nigerian Lassa fever treatment hospital. The primary objective was to understand the nature of waste handlers’ practices and experiences and identify areas for improvement centred on supporting the development of best practices, in accordance with the World Health Organisation (WHO) guidelines.

Methods

This study employed a qualitative case study design, gathering data from healthcare waste handlers (n = 34) through four focus groups. Additionally, four in-depth interviews were conducted with ward managers and the infection control team to gain insight into the organisational framing of waste handling practice, the perceived challenges faced by waste handlers from their perspectives, and the provision of training and support. The qualitative data were audio-recorded and transcribed verbatim through manual processes and subjected to a reflexive thematic analysis conducted manually.

Results

The findings revealed that waste handlers were subjected to various occupational health risks, including back pain, needlestick injuries, psychological distress, fatigue, anxiety, and prolonged exposure to sunlight. Concerns were raised regarding the inadequate supply of personal protective equipment and other essential tools, which suggests a need for organisational commitment to ensure the continual availability of these resources to protect the health and safety of these employees. A critical issue identified was the lack of comprehensive training for waste handlers, highlighting a form of organisational negligence. The consensual views expressed by the waste handlers indicated a sense of dissatisfaction with their working environment, largely attributable to organisational and societal stigmatisation. Furthermore, the study underscored that the hospital management faced significant financial constraints and advocated for increased funding to effectively implement best practice standards.

Conclusion

To effectively manage healthcare waste and reduce hazards to waste handlers, the organisational leadership should prioritise training and support. This initiative will not only benefit the waste handlers but also the patients, other healthcare workers, and the general public. Although the findings focus on the case context of a Nigerian Lassa fever treatment hospital, the wider implications of this study are linked to the role of institutional support for waste handling practice. Moreover, it extends to the potential positions of institutions as displaying a form of “benign anomie” in not ensuring the wellbeing of waste handlers through sufficient regulation and governance focused on prioritisation, processes, and procedures. The study highlights the relevance of embedding WHO guidelines in other similar contexts as part of implementation across institutions involved with waste handling.