MEDICAL WASTE IN AFRICA

A Solution to a Growing Problem

Ron Cole
Kori Landon
Aaron Doyle

February 12, 2019

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MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 1

TABLE OF CONTENTS

Contents
TABLE OF CONTENTS.................................................................................................................................. 1
INTRODUCTION ........................................................................................................................................... 2
THE GROWING DANGER OF MEDICAL WASTE ......................................................................................... 2
Accidental Exposure ........................................................................................................................... 3
Intentional Reuse ................................................................................................................................ 3
INCINERATION: A VIABLE TECHNOLOGY .................................................................................................. 3
Addfield MP-100................................................................................................................................. 4
Addfield GM-250 ................................................................................................................................ 5
CONCLUSION .............................................................................................................................................. 5
References .................................................................................................................................................... 6
Appendix 1. ................................................................................................................................................... 7

C ov e r p hot o b y W e n dy Sc o fi el d o n U n s pl a s h.
MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 2

INTRODUCTION
Africa is currently home to over
one billion people and is
expected to contain nearly a
third of the world’s population
by 2050 (UNESCO, 2014). To
support this growth, 550,000–
650,000 additional hospital
beds, 90,000 physicians, and
300,000 community health
workers will need to be added
over the next decade (World
Bank, 2008). While this
healthcare expansion will save
lives, it will also create a large
quantity of additional medical
waste - a danger to both Figure 1. Joint medical/surgical training in Burundi
healthcare workers and the Source: Matthew Chlosta
public if not properly dealt with.
This white paper will identify the dangers of medical waste in Africa and will propose a feasible
solution that can be pursued with current technology and infrastructure.

THE GROWING DANGER OF MEDICAL WASTE

Medical waste is a significant and growing problem that can spread illness and disease if not properly
managed. As worldwide populations grow, so does the amount of medical waste produced by
medical facilities serving those populations. A survey of hospitals in South Africa showed that a
district hospital produces 0.65
kg of infectious waste per
patient bed every day, with
national and provincial
hospitals producing over twice
that (Chartier et al., 2014).
Echoing those figures, a district
hospital in Douala, Cameroon,
estimated it produced 80 kg of
medical waste a day (Sexton &
Beaucage, 2018). That is an
amount equal to the weight of a
full-grown adult male (~175
lbs). Medical waste continues
to grow with each patient
treated, getting larger and larger
as modern healthcare infra-
Figure 2. Medical waste at a hospital in Cameroon
Source: Concordia Humana
structure reaches more and
more people in need.
MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 3

Dangerous illnesses such as meningitis, human immunodefiiciency virus (HIV), and hepatitis are
among the diseases that can be contracted by contact with contaminated materials (see Appendix 1).
Two ways this contact can occur is through 1) accidental exposure to or 2) the intentional reuse of
contaminated equipment.

Accidental Exposure
Accidental exposure is defined as
unintended contact with blood or other
bodily fluids. Those exposed risk infection
from numerous illnesses, including HIV,
hepatitis B, and hepatitis C (Nouetchognou
et al., 2016). A slip by a healthcare worker
that results in an accidental stick from a
contaminated needle is one example of
accidental exposure. A child cutting their
foot while playing near a medical waste dump
is also potentially exposed to disease.

Accidental exposures have a rate of infection

of 1.8%-5% for hepatitis C and 0.3% for HIV
Figure 3. A tube and needle for phlebotomy.
(Centers for Disease Control and Prevention, Source: Pxhere
2010; Chartier et al., 2014). Reported injuries
from sharp objects number in the tens of thousands in the United States each year alone, and include
hundreds of cases of associated infections (Chartier et al., 2014).

Intentional Reuse
The intentional reuse of medical equipment that was only designed for a single use can also spread
disease. In 2000, the World Health Organization estimated 40% of new hepatitis C infections and
5% of new HIV cases came from contaminated injections (Hauri et al., 2004). Unsafe injection
practices have been noted in Africa, including Cameroon. There, a survey of public hospital workers
in two health districts of the Northwest Province (Northwest Region) showed that 44% of health
workers practiced some form of unsafe injection equipment reuse (Okwen et al., 2011).

INCINERATION: A VIABLE
TECHNOLOGY
Incineration is one way to deal with medical
waste. Incineration reduces the overall mass
of the infectious material by ~90% while
leaving the resulting ashes safe enough to
landfill (Alvim-Ferraz & Afonso, 2003). It is
even discussed in the World Health
Organization’s Guidelines for the Storage of
Essential Medicines and Other Health
Commodities, which states that proper
Figure 4. Photo of Containerized Addfield MP-500
incineration of medical waste with a high
Source: Addfield
MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 4

temperature incinerator will completely destroy needles and syringes, kill microorganisms, reduce
the volume of waste, and generate less air pollution than low temperature burning (Snow, 2003).

Addfield is a United Kingdom-

based designer and manufacturer
of incinerators with over 35 years
of experience. Their incinerators
can be found throughout the
world, including Kenya, Qatar,
and Pakistan (Addfield, 2019).
Two of the models, the Medical
Pathological (MP) 100 and the
General Medical (GM) 250,
would fit the needs of a small to
moderately-sized hospital in
Africa.

Addfield MP-100
The MP-100 is Addfield’s
standard model for hospitals and
clinics. It is a compact incinerator
with a front-facing loading door
and a maximum capacity of 100
kg per cycle (slightly more than
Figure 5. Photo of the Addfield MP-100 Incinerator
many small hospitals will create Source: Addfield
in a day). It generates the 1100°C
minimum heat previously
required by the European Union’s Waste incineration directive 2000/76/EC (Addfield, 2019), and
will eliminate pathogens from the waste when properly used. It has a rough basic dimension of 1.95
m x 1.15 m, meaning it can fit into a relatively small, out of the way area (though vertical space for
the flue clearance will be required). It does require electrical current to operate, but primarily runs
on either diesel fuel, liquefied petroleum gas (LPG), or natural gas (depending on the model).

There are multiple additional features that can be purchased for the MP-100. It works with the
Venturi System, an advanced flue gas treatment system that further reduces dust, dioxins, and furans
for the environmentally conscious. It can be mounted onto a heavy-duty skid that can be easily lifted
onto a trailer. It can be permanently housed (containerized) in a 20-foot high shipping container,
which would serve as a permanent enclosure for the incinerator and allow it to be transported if
desired. Larger models of similar design with a capacity of up to 500 kg are available. A hydraulic
lift table for safe loading and large fuel storage tanks are also available.
MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 5

Addfield GM-250
The GM-250 is Addfield’s larger-
volume model for bigger hospitals
and clinics. It has a top-loading
chamber and a capacity of 250 kg
per cycle. It works best with bins
and other receptacles that can be
emptied into it. Like the MP, the
GM generates the 1100°C
minimum heat previously required
by the European Union’s Waste
incineration directive 2000/76/EC
(Chartier et al., 2014), and will
eliminate pathogens from the waste
when properly used. It has the
rough basic dimension of 2.9 m x
2.2 m, and requires significant
additional clearance for the flue. It
does require electrical current to
operate, but primarily runs on
either diesel fuel, LPG, or natural
Figure 6. Photo of the Addfield GM-250 gas (depending on the model).
Source: Addfield

Similar to the MP-100, there are

additional features that can be purchased for the GM-250. It works with the Venturi System (used
for scrubbing flue emissions). It can be fitted with a bin tipping unit that empties waste receptacles
in excess of 150 kg, protecting the incinerator’s operator from strain or contact with infectious
materials. Larger incinerator models of similar top-loading design and capacities of up to 2000 kg
are also available.

CONCLUSION
The growing problem of medical waste in
Africa is a massive one, but also one with an
attainable solution. Medical waste
incineration will reduce overall refuse
volume, eliminate pathogens from infectious
materials, and get rid of single-use healthcare
equipment so it cannot be unsafely used
again. By taking this step to provide medical
waste incinerators where they are needed,
the risk of infection from medical waste for a
specific region is reduced and a blueprint for
others to do the same is created.
Figure 7. Workers at a hospital in South Africa.
Hush Naidoo (South Africa)
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References
Addfield. Addfield Medical Incinerators. 02 Feb 2019.
http://addfield.com/machine-categories/medical-incinerators/ Accessed 02 Feb 2019.

Alvim-Ferraz, M. C. M., and S. A. V. Afonso. "Incineration of Different Types of Medical Wastes:

Emission Factors for Gaseous Emissions." Atmospheric Environment, vol. 37, no. 38, 2003, pp.
5415-5422.

Chartier, Y., et al. Safe Management of Wastes from Health-Care Activities. 2nd ed., World
Health Organization, Geneva, 2014.
http://www.who.int/water_sanitation_health/publications/wastemanag/en/

Centers for Disease Control and Prevention. “Bloodborne Pathogens and Workplace Sharps
Injuries.” 28 Sep 2010. http://www.cdc.gov/niosh/stopsticks/bloodborne.html Accessed 02 Apr.
2019.

Hauri, Anja M., et al. “The Global Burden of Disease Attributable to Contaminated Injections given
in Health Care Settings.” International Journal of STD & AIDS, vol. 15, no. 1, Jan. 2004, pp. 7–16.
EBSCOhost, doi:10.1258/095646204322637182.

Nouetchognou, Julienne Stéphanie, et al. “Accidental exposures to blood and body fluids among
health care workers in a Referral Hospital of Cameroon” BMC research notes vol. 9 94. 15 Feb.
2016, doi:10.1186/s13104-016-1923-8.

Okwen, Mbah P., et al. "Uncovering High Rates of Unsafe Injection Equipment Reuse in Rural
Cameroon: Validation of a Survey Instrument that Probes for Specific Misconceptions." Harm
Reduction Journal, vol. 8, no. 1, 2011, pp. 1-9.

Sexton, Dan, and Peter Beaucage. Report on Concordia Humana Assessment of Waste
Management at Public Health Facilities in Douala, Cameroon. 23 Feb 2018.
http://www.concordiahumana.org/res/public/doc/hhc/LetterToDelegation.pdf Accessed 02 Feb
2019.

Snow, John. Guidelines for the Storage of Essential Medicines and Other Health Commodities.
DELIVER, in Collaboration with WHO and UNICEF, 2003.
http://apps.who.int/medicinedocs/en/d/Js4885e/

UNESCO. “Priority Africa – Demographic Growth.” Africa Department. 29 Aug. 2014.

http://www.unesco.org/new/en/africa-department/priority-africa/operational-strategy/demographic-
growth/ Accessed 02 Feb. 2019.

World Bank. The Business of Health in Africa: Partnering with the Private Sector to Improve
People's Lives (English). International Finance Corporation, 2008.
http://documents.worldbank.org/curated/en/878891468002994639/The-business-of-health-in-
Africa-partnering-with-the-private-sector-to-improve-peoples-lives Accessed 02 Feb 2019.
MEDICAL WASTE IN AFRICA | A SOLUTION TO A GROWING PROBLEM | COLE, LANDON & DOYLE 7

Appendix 1.

Table 1. Potential infections caused by exposure to health-care wastes,

causative organisms and transmission vehicles
Type of Infection Examples of Causative Transmission Vehicles
Organisms
Gastroenteric infections Enterobacteria, e.g. Faeces and/or vomit
Salmonella, Shigella spp.,
Vibrio cholerae, Clostridium
difficile, helminths
Respiratory infections Mycobacterium tuberculosis, Inhaled secretions, saliva
measles virus, Streptococcus
pneumoniae, severe acute
respiratory syndrome (SARS)
Ocular infection Herpes virus Eye secretions
Genital infections Neisseria gonorrhoeae, Genital secretions
herpesvirus
Skin infections Streptococcus spp. Pus
Anthrax Bacillus anthracis Skin secretions
Meningitis Neisseria meningitidis Cerebrospinal fluid
Acquired immunodeficiency Human immunodeficiency Blood, sexual secretions, body
syndrome (AIDS) virus (HIV) fluids
Haemorrhagic fevers Junin, Lassa, Ebola and All bloody products and
Marburg viruses secretions
Septicaemia Staphylococcus spp. Blood
Bacteraemia Coagulase-negative Nasal secretion, skin contact
Staphylococcus spp.
(including methicillian-
resistant S. aureus),
Enterobacter, Enterococcus,
Klebsiella and Streptococcus
spp.
Candidaemia Candida albicans Blood
Viral hepatitis A Hepatitis A virus Faeces
Viral hepatitis B and C Hepatitis B and C viruses Blood and body fluids
Avian influenza H5N1 virus Blood, faeces
Table 1. A list of potential infections from medical waste (source: Chartier et al., 2014).