Correlates of domestic waste management and related health outcomes in Sunyani, Ghana: a protocol towards enhancing policy

Recent most pressing challenge facing developing countries is the ever accumulating quantity of waste generated without adequate facilities and resources available for management [1, 2]. In effect, the whole world produces over 500 million tons of waste every year [3], with recent studies indicating approximately 41.8 million metric tons of waste generated worldwide [4]. Health and environmental effects, uncertainty regarding regulations and negative perceptions by both waste handlers and generators are important concerns in global healthcare [5]. In recent studies, campaigns against waste infrastructure have emerged in some developed countries, like the US, UK and France, because of the increasing public anxiety about the impacts of industrialism upon the environment and human health [3]. In addition, ample literature from Ghana exists to show that unplanned development, including sheer migration between rural and urban populations, contribute to accelerate the deterioration of urban environmental quality conditions such as waste deposition [6]. Indicating that globally, more than 8000 people die every day from diseases related to poor sanitation and hygiene conditions [7‐10]. While other countries focus on recycling and recovery of waste as useful materials and for energy purposes [11], most developing countries including Ghana use the landfilling strategy for waste deposition, which is expected to increase due to countries’ shifting practice from open dumping wastes to landfilling [12]. The practice of poor waste management seems common, as it is reported in India, China and Bangladesh, resulting in health threats to the populations as well as major occupational and environmental risk [13]. Considering the wide range of contaminants from waste and different exposure routes, concern remains about the potential human health risks [14]. Other studies however indicates that the motivation driving hygiene behaviors and improved sanitation are sensory issues of smell, disgust and fear of diseases [15]. From recent studies in Ghana, waste workers are prone to various illnesses and injuries from numerous hazards as a result of waste [16]. About 20% of these wastes pose high risk, either of infection and chemical or radiation exposure [17]. In other countries like India, strict laws makes it mandatory for all waste to be handled and managed without any harm to human health and environment [18]. Ghana’s national waste management guideline have stated that waste should be disposed of at land filled sites and should not be deposited or scattered on the surface of open dumps [19]. Similar literature have however indicated that household generated refuse (solid wastes) if not properly managed may create routes for transmission of microbial agents [20]. Additionally, uncollected solid waste by waste management authorities, as is mostly the case of Ghana, become receptacles of large quantities of human excreta which ends up at refuse dumps and water bodies during torrential rains [20]. This is not limited to waste management authorities. Studies by Kumar and collegues [13]) have reported that the waste management practices even among general populations were not appropriate, hence the need for education and training. In Ghana, even though studies have measured waste management, little is known about the practice of waste management among the general population, especially those generated by households. Hence, this study seeks to investigate the generation and practice of waste management among households in Ghana and their related health outcome.

The analysis of results suggest that more than half of the respondents were male as compared to findings by Yuan and Yabe [22] in Beijing, where majority of their respondents were the female population. This high percentage may be because the study was conducted at a time that most female would have been out of the house on farm or feminine duties. The current study reported a majority age group between 31 and 40. In similar studies in Ghana, Yoada and colleauges, [23]) indicated that majority of their study respondents were within this age group and more than half were married, a finding also supporting that of this study.

Even though several literature have cited inorganic components of waste to be quite problematic because of their non-biodegradable nature and lasting effect on the environment [24], a greater proportion of respondents still generate inorganic waste. Indicating that both studies reveal the effects of inorganic waste on both human life and the environment. Contrary to this, more than half of waste generated by respondents in Tehran was biodegradable [25], just a little of such was cited by this study. Regional variations in consumption patterns, production needs and economic policies may sometimes account for such difference in waste generation, but such patterns is an indication of less negative impact on the environment and human health, as most waste generated are easily managed naturally. Nagarajan et al., [26]), in their study in India stated that about 75 t of garbage are generated daily and the daily per capita generation of solid waste ranges from 100 g to 500 g. This however, is far higher than the findings of this study, as this study cited only 0.002 t of waste generated by households. In assessing the level of waste management practice, respondents were asked three main questions which include whether they practiced waste segregation, if they used closed waste bins and if they dispose off waste at designated places. Their responses were then added to give the percentage of respondents practicing waste management.

Data from this study indicate that respondents’ age was a determinant of their waste management practice. Contrary to this, findings by Mamady [27]), suggest that age was not a determinig factor for the practice of waste management. In both this study and the above cited study [27], the gender of a respondent influenced his or her practice of waste management. An earlier study [28], have indicated that there exist a relationship between availability of waste experts and waste management practice, a finding that concur with findings from this current study. Even though both studies have ranked the attitude of respondents to waste management as positive, the current study did not establish any relationship between positive attitude and the practice of waste management. Like this study, earlier studies in Ghana [29] have also established the link between improper waste management practice and disease occurrence and both studies further cited cholera as a common disease resulting from improper waste management. Considering that cholera outbreaks are as a results of poor sanitation, open space refuse dumps within communities can predispose inhabitants to cholera infection, a practice that has been indicated by the current study but was not a determinant of waste management practice. In the current study, distance from respondents’ residence to the waste dumpsite was a predictor of their practice of waste management. This is however contrary to results by Mahmoudkhani and colleaggues [12]) in similar studies done in Iran. This could explain why only 62% of respondents visited the dumpsite on weekly bases and the practice of waste management was as low as 29%.

Available data from a multivariate analysis indicate that sex was an independent predictor of the practice of waste management and the female population was less likely to practice waste management as compared to the male population. In contrary findings, previous literature identified the female population as more likely to influence the practice of waste management [27]. This should be explained with the fact that the female population is mostly house keepers and tend to dominate household sanitation issues. Further studies that seems to agree with findings of this studies are findings by UETA, [30]), where increase in household size tend to reduce the quantity of household waste and the practice of waste management. In this study, household sizes of 4 to 6 and above 7 were less likely to engage in the practice of waste management as compared to household size below 4 people. Conversely, previous studies by Osbjer et al. [31]), found that household practice of waste management is associated with a higher number of people in the households, which could possibly be explained by the need to handle waste generated by larger populations within the household. In considering other variables, respondents of this study did not practice waste management as a result of their household income level; however, the opposite is said of other studies done in Kenya where income significantly influenced the method of waste disposal among households. As compared to individual and local government waste management contractors, respondents acknowledge that the private waste management authorities predominantly influenced their practice of waste management, though the cost of contracting them did not influence their practice. This, however, did not conform with earlier findings elsewhere in Ghana, where most respondents complained of irregular patterns in waste collection and the high cost of contracting private waste collectors [23]. Evidently, other literature further state that respondents with higher income commonly preferred accredited private sector as waste collectors [27]. It is certain that the practice of contracting private waste management agencies and their related cost will have consequences on global efforts to achieving the millennium development goal seven, which is more critical on ensuring environmental sustainability.

Surprisingly, while diseases like malaria were commonly reported among respondents, contrary to asthma reported by Maina & Muriuki, [32]) in Kenya, the frequency of occurrence and types diseases commonly reported were not predictors of waste management practice. Throughout literature, the importance of waste bins and containers for the management of waste have been emphasized [24, 32‐34], and other writers suggest they offer a more cost- effective waste management service, considering that they improve household waste separation and reduces the amount of waste in landfills [23]. In line with this study, the presence of a community container indicated an influence on the practice of waste management. While Tadesse & Kumie, [5]), found that even though containers were present, most had no lids and waste were usually stored for a period of more than 24 h – an indication of poor waste management that suggest a health hazard for both human and environmental health. Like previous literature [27], distance to permitted dumpsites for respondents of this study, was a reason to practice waste management, even though this may also lead to other health complications and mortalities from certain cancers [35]. This study is not without limitations. A major limitation associated with this study is that, only households were included in the study, excluding the views and practices of waste management authorities and office-based establishments. The study was also limited to only Sunyani Municipality, which is considered a small portion of the regional population. It will therefore be inappropriate to generalize the findings of the study. Authors also consider recall bias as one limitation of the study, given that respondents had experienced the practice and it would have been difficult for respondents to remember all experiences during the period under study.

Even though respondents were knowledgeable about waste management, its practice was low. Most respondents still did open dumping at the outskirts of town and a greater proportion still used open containers as waste bins. Respondents also had fair knowledge about improper waste management related diseases but this knowledge did not translate into practice. The greatest challenge mentioned by respondents was however the cost of paying for waste disposal, especially when contracting a private waste management agency. In most households, both organic and inorganic waste were generated, explaining the reasons the practice of recycling predicted waste management practice, even though majority did not adhere to this practice.