Assessment on the Causes of Improper Waste Segregation among Second Year Degree Nursing Students at A University, Windhoek, Khomas Region

Background: Africa is facing a growing management crisis while the volume of waste is relatively small compared to the developed region, the mismanagement of waste in Africa is currently impacting human and environmental health. Therefore, this paper was conducted to assess the causes that contribute to improper waste segregation.

Research methodology: A quantitative, descriptive study was used in this study. Simple random sampling was used in this study by selecting the second-year students. The frequency distribution of tables and graphs have been used in this study for data analysis.

Results: The results have revealed that, n=20 (50%) strongly disagrees=18 (45%) strongly agreed, n=2 (5%) disagreed, that there are no signals /posters about color coding in the wards

Conclusion: The finding from this study indicates a lack of knowledge on how to discard waste properly among second-year degree nursing students as a contributing factor to non-adherence to proper waste segregation. The findings also indicated that there were no policies on color coding and unawareness of soiled waste that contributes to improper waste segregation.

Segregation of waste is the amount of waste being generated today caused immense problem [1]. Waste segregation is the grouping of waste into different categories which happens by color coding plastics according to treatment and disposal requirement, [1] ordains that each waste goes into its category at the point of dumping or collection, but sorting happens after dumping or collection [1]. Segregation of waste ensures pure, quality material. Factors associated with improper segregation include inadequate awareness, ignorance, practices, and inadequate management by facility leadership [16].

According to [8], a common problem faced in waste collection and dumping is mainly overflowing garbage bins and waste segregation as per its type. Due to overpopulation, economic growth and overflowing, landfills are impossible to reclaim because of the improper disposal of wastes on outskirts of cities that leads to a reduction in average lifetime of the manual segregator [8].

Waste segregation is seen as a public health problem. According to World Health Organization (WHO) around 75% to 90% of the waste generated across healthcare facilities can be considered as nonhazardous, and approximately10-25 % are infectious, toxic and genotoxic items such waste items pose environmental and occupational health risks [2].  In China in 2018, the municipal waste reached 22.8 million tons, a quantity that is expected to climb up to 409 million tons by 2030 as China continues to urbanize and grow economically [6]. This swelling volume of garbage poses a threat to both the environment and the climate [3, 19]. Africa is facing a growing management crisis while the volume of waste is relatively small compared to the developed region, the mismanagement of waste in Africa is currently impacting human and environmental health. 

In Africa in 2012, approximately, 125 million tons per annum of municipality waste generated, of which 81 million tons (65%) was from sub-Sahara Africa and this is expected to grow to 224 million by 2025 [5, 10], about 80 to 90% of waste produced in African hospital, it’s recyclable which make little sense that more than 90% of waste in Africa is still disposable. 

In Southern Africa [12] has found that Proper Solid Waste Management (SWM) is crucial for environmental protection and the well-being of human beings. If waste is improperly managed may contaminate soils, water and air thereby affecting the quality of life. He further argues that improperly managed waste may also create nuisance and make human beings feel uncomfortable [12]. The main components of SWM are generation, collection, transportation, and disposal whose processes tends to lack more in Africa then the rest of the world [12]. 

According to WHO (2015), healthcare waste is often not separated into hazardous or nonhazardous wastes, making the real quantity of hazardous waste potentially much higher. Meanwhile, an Infection Control Officer from one of the public training hospitals, (Personal communication, March 18, 2014) confirmed that general and infectious wastes were mixed while training and education of health care workers was not done regularly. 

In Namibia [4] in September, it was reported that only 22% of health facilities had policies and guidelines for health care waste and infection control measures.   It is against this background that this current study was conducted to assess and determine the causes of improper waste segregation among the second-year degree nursing students at UNAM, Main campus.

The aim of this study was to assess and explore the causes of improper waste segregation among the second-year nursing degree students at the University of Namibia, Main Campus, Windhoek, Namibia.

The researcher used a quantitative, and descriptive study design. This design was used to identify and justify problems with current practice, measures all relevant variables objectively at a specific time and makes judgment [7].

Survey

The researcher has compiled the self-administered questionnaires in English. The questionnaire was composed of closed- ended questions which the participants have answered. The questionnaires were made of yes and no questions as well as Likert scale questions. The participants answered the questionnaires themselves in the presence of the researcher, and but the researcher had limited herself from being involved.

Interview schedule

Ethical approval

Ethical clearance was obtained through the structures of the University of Namibia. Therefore, the following ethical considerations were written, informed consent was obtained from each participant after the procedure was explained and risks were pointed out after adequate information were conveyed, possible risks were pointed out. Voluntary participation without penalty for withdrawal was pointed out.

The data was collected by the researcher during the second-year nursing degree UNAM student’s clinical rotations as well as during the theoretical block. The questionnaires were written in English and the researcher have obtained the consent from the participants after explaining the whole procedure by making sure that the ethical considerations were clearly explained to them and maintained by the researcher. The questionnaires took approximately 15–20 minutes to complete the questionnaires.  The total number of respondents were 40 second year degree nursing students. The Likert scale was used to rate the students’ responses and the students were asked to indicate whether they strongly agree, agree, neutral, disagree or strongly agree.

Data were analyzed quantitatively. The researcher has carefully checked the completed questionnaires for consistency, accuracy and completeness of data collected. Quantitative data from questionnaires was then prepared for data entry into the computer. After the data entry completion, the researcher did check all the records with the original data. This process included checking and editing the collected data and eventually cleaning coding and analyzing them using SPSS version 26 [13]. Frequency distribution tables, descriptive statistics and measures of variability was used.

The previous chapter has enlightened on the procedure for data collection, data instrument and ethical consideration. This chapter presents all the findings and how the data was analyzed. The researcher has used the questionnaire as a research instrument to carry out her data. The questionnaires were divided into three categories in which section A was composed of demographics, Section-B the causes of improper waste segregation. Lastly, section C about factors contributing to improper segregations. These questionnaires were answered by the second-year degree students at UNAM.

The researcher successfully administered 40 questionnaires with second year degree nursing students at the University of Namibia respectively. All the questionnaires were timely returned, and the questionnaires were answered. The findings on demographic statistic were only captured by questionnaires to second year degree students only.

Results: Section A: Demographic data

This section illustrates the data analyses on demographic data and the results are as follows:

Figure 1: Age statistics

The data presented in figure 1 shows that the majority of the participant fall between the range of 22-30 with (32) 80%, 5 under the age of 21(12.5%), while 2 between the age of 31-39 (5%) and lastly only one from 40 +years (2.5%). The second-year degree nursing students were asked to specify their gender as part of the data collection procedure and the results on this perspective can be summarized as below by figure 2.

Figure 2: Gender statistics

The figure 2 above shows that the nursing students that participated in this study majority are female with the number of 39 (98%) and minority were male with 1 (2%). The student nurses under this study were asked to mention their highest level of qualification. The summary on this perspective is shown below in figure 3.

Figure 3: Highest level of education.

The figure above shows that most of the participants have grade 12 as their highest qualification which are 38(95%) and this also shows that only 2 (5%) of the participants holds the diploma as their highest qualification.

Questionnaire on Causes of improper waste segregation  

Table 1: Causes of Improper Waste Segregation (Participants Yes/No Views), The following section represents data obtained from the study regarding the causes of improper waste segregation, the results are as follows Table 1.

Table 1: Causes of Improper Waste Segregation.

Table 1 above interpret on how the second-year degree nursing students at UNAM have answered the questions for section B.

• The results in table 1 shows strongly that all 40 (100%) the respondents indicated that nurses don’t always tell the students to throw the waste everywhere. 
• On the lack of knowledge on how to dispose the waste properly and unaware of color coding, 29 (72.5%) participants have indicated yes, and only 11(27.5%) disagree to the statement. 
• The 38(95%) of participants have vindicated that they saw nurses putting all the type of waste in one plastic, so they thought is the right way to dispose the waste, while 2 (5%) respondents indicated no as an answer to that question. 
• All the participants 40(100%) disagree that they said that they thought all waste as a collection belongs to one group.
• All the participants 40 (100%) have indicated that the hospitals don’t have necessary plastics for disposal.
• 20 (50%) of the participant have indicated that Student nurses were not taught from school neither given orientation in hospitals on how to dispose waste properly and the remaining half 20 (50%) did not agree to the statement. 
• All the second-year nursing degree students 40(100%) indicated that cleaners at the hospitals do give plastics to students for disposal. 
• Majority of the respondents 38(95%) indicated that sometimes waste is not lot to discard separately hence they don’t put all in one plastic            and about 2(5%) agree to the statement. 
• With regard to infection control guide, 35(87.5%) participants indicated that there’s no infection control guide in the wards where I was allocated and about 5(12.5%) disagree to this statement
• 37(92.5%) respondents indicated that there’s no guideline and standing orders at the clinics and hospital that encourage proper waste segregation and 3(7.5%) said no to this statement.

Factors Contributing to Improper Waste Segregation

QUESTIONNAIRE ON FACTORS CONTRIBUTING TO IMPROPER WASTE SEGREGATION, on a scale of 1-4 (1=Strongly disagree; 2=Disagree;3=Neutral 4=Agree and 5=Strongly agree), (Please tick in the appropriate box to indicate your ratings).

Table 2:Factors Contributing to Improper Waste Segregation.

The students were asked to indicate on the questionnaire whether they strongly agree, agree, not sure, disagree or strongly disagree. The following are the interpretation of the results presented in the above table 2.

• I don’t know what waste segregation is, all the participants have answered n=40 (100%) strongly disagree.
• Some hospitals and clinics don’t have policies on color coding therefore we don’t know which plastics is for which waste n=30(75%) agreed, n=5(12.5%) strongly agree, n=2 (5%) have disagreed, n=2 Neutral and n=0 strongly disagree showing that majority of the participant have agreed with the statement.
• Hospitals and clinics don’t have dustbins and plastics for disposal, so students are forced to dispose waste anywhere, the majority of the participants strongly disagree n=40(100%) to the statement.
• The nurses in the hospitals and clinics always refuse to give student orientations on waste segregation n=37(92.5%) strongly disagrees, while n=3(7.5%) agrees. 
• I am not aware that discarding soiled waste make cause health hazards=20(50%) strongly disagree, n=17(42.5%), and the remaining n=3(7.5%) agreed.
• Some nurses get angry if we dispose waste properly since it’s the culture to dispose the way they want, n=40(100%) all the participants strongly disagreed to the statement.
• I am always ignorant in disposing waste, n=40(100%), all the participants strongly disagreed to the statement.
• There is no signals /posters about color coding in the wards. n=20(50%) strongly disagrees=18(45%) strongly agreed, while n=2(5%) disagreed.

The demographic data of this study was made up of three questions namely about the age statistics, highest education level and gender statistics. This study had shown that out of n=40 shows that the majority of the participant fall between the range of 22-30 (32) 80%, 5 under the age of 21(12.5%), while 2 between the age of 31-39 (5%) and lastly only one from 40 +years (2.5%) and this that the majority of the second-year degree nursing students that participated in this study are the youngest. 

With regards, to the highest level of education the results have shown that that most of the participants have grade 12 as their highest qualification which are 38(95%) and this also shows that only 2 (5%) of the participants holds the diploma as their highest qualification, which means that most of the participants are only grade 12 holder that makes them still new to the profession and with this it can contributed to improper waste segregation [11]. study shows that lack of knowledge, is one of the causes of improper waste segregation which proves this study right since most of them that partake in the study are straight from high school. On gender statistics, that participated in this study majority were female with the number of 39 (98%) and minority were male with 1(2%) which shows that this study was more carried out by the females.

Causes of Improper Waste Segregation

As one of the objectives of the study was to assess the causes of improper waste segregation. The study has disclosed strongly that all n=40(100%) the respondents indicated that nurses don’t always tell the students to throw the waste everywhere which means that none of the nurses contributes on the causes the improper segregation of waste. On the lack of knowledge on how to dispose the waste properly and unaware of color coding, majority of the participants n=29 (72.5%) has agreed while n=11 (27%) disagree about the lack of knowledge and color coding that contribute to improper waste segregations. In support of this current study, Liao (2012) reported lack of sensitivity and knowledge on the causes of improper waste segregation.  The majority of the second-year degree nursing students n= 38(95%) of participants have indicated that they have seen the nurses putting all the type of waste in one plastic, and thought that was the correct way to dispose the waste, while the minority n=2 (5%) respondents indicated that that’s not the cause to improper segregation of waste. This finding is similar to WHO study done in 2018 that review that, lack of improvement in the waste segregation may be caused by scarce knowledge about the health and environmental impacts of a waste management and disposal systems, abstinence of training, that could lead a proper waste management (WHO, 2018).

In addition, all the participants n=40(100%) revealed that they did not think all waste as a collection belongs to one group which makes none of this a cause of improper waste segregation. All the participants n= 40 (100%) have indicated that the hospitals don’t have necessary plastics for disposal, and this indicated that the thing that is causing the improper waste segregation is an availability of plastics in the hospitals, clinics for disposal. In support of the current study, [9] states that proper segregation is jeopardized due to unavailability of some plastic bags in the hospitals and clinics, as some wastes ended up in wrong plastic bags. Half of the respondents n=20 (50%) of the participant have indicated that student nurses were not taught from school neither given orientation in hospitals on how to dispose waste properly and n=20 (50%) have indicated that they were given orientation and taught at school. 

All the second-year nursing degree students that participated in the study n= 40 (100%) indicated that Cleaners at the hospitals do give plastics to students for disposal. Majority of the respondents n=38(95%) indicated that, sometimes waste is not a lot to discard separately hence they don’t put all in one plastic and about n=2(5%) of the respondents they didn’t indicate that this is not one of the causes of improper waste segregation. This result is far similar to the following study that review that lack of reliable information about waste generation and availability of appropriated services to treat and dispose these wastes causes to improper waste segregation [17].

Most of the respondents n=35(87.5%) participants indicated that there’s no infection control guideline in the wards where I was allocated and n=5(12.5%) indicated no to this statement which makes this statement one the causes of improper waste segregation.  This results are similar to the study that was conducted  that reviewed that, [14] study shows that lack of knowledge, insufficient waste disposal equipment and improper training are some of the contributing factors to improper waste segregation. Most respondents n=37(92.5%) respondents indicated that there’s no guideline and standing orders at the clinics and hospital that encourage proper waste segregation and n= 3(7.5%) indicated that there are guidelines in the hospitals statement.

Factors contributing to improper waste segregation

Regarding the contribution of the improper waste segregation, the second-year degree nursing students that participated in the study were asked to rate their answers. All the respondents n=40 (100%) strongly disagrees of not knowing what waste segregation is all about. In support of this study findings, [14] study shows that lack of knowledge, insufficient waste disposal equipment and improper training are some of the contributing factors to improper waste segregation. 

Participants has indicated that they n=30(75%) agreed, n=5(12.5%) strongly agree, n=2 (5%) have disagreed, n=2 Neutral that some hospitals and clinics did not have policies on color coding therefore they don’t know which plastics is for which showing that majority of the participant have agreed with this statement. These results have similar findings as the following study that review that, lack of reliable information about waste generation and availability of appropriated services to treat and dispose these wastes contributes to improper waste segregation [17].

All the respondents had n=40(100%) strongly disagree that hospitals and clinics don’t have dustbins and plastics for disposal, so students are forced to dispose waste anywhere [18], states that proper segregation is jeopardized due to unavailability of some plastic bags in the hospitals and clinics, as some wastes ended up in wrong plastic bags. A total of n=37(92.5%) strongly disagrees, while n=3(7.5%) agrees that the nurses in the hospitals and clinics always refuse to give student orientations on waste segregation this result   is similar to the following literature from that revealed that lack of trainings of hospital staff can cause improper waste segregation [18]. 

The respondents n=20(50%) strongly disagreed, n=17(42.5%) disagrees=3(7.5%) agree that they are not aware that discarding soiled waste causes health hazards these results are similar to the following study that reviewed that ,lack of waste management and disposal, insufficient financial and human resource, and low priority given to the topic [14] All the participants, n=40(100%) strongly disagree that some nurses gets angry when  they dispose waste properly since it’s the culture to dispose the way they want. All the participants n=40(100%) has strongly disagreed that they are always ignorant in disposing waste, which makes ignorant not one of the factors that contributes to improper waste segregation. 

The results have revealed that, n=20(50%) strongly disagrees=18(45%) strongly agreed, n=2(5%) disagreed, that there are no signals /posters about color coding in the wards [14]. study highlighted inadequate awareness, poor health care workers attitudes and practices and inadequate management by facility leadership as factors associated with improper segregation and this study have proven that this was not one of the contributing factors to improper waste segregation among the second-year degree nursing students.

The researcher has experienced some limitations during her study. Some targeted respondents refused to answer the questionnaires saying they were too busy with practical and preparing for tests. Some respondents have just answered the questionnaires till the middle. The researcher has not forced the respondents that refuse to partake in the research however she went ahead and look for other respondents that fully agreed to partake in the research without being forced and had free time to answer the questionnaires.

In answering the first research objective of the study which was to determine the factors that contributes to improper waste segregation, the researcher found that the study discovered that most of the second year degree nursing students have lack of knowledge on how to dispose waste properly and color coding, insufficient segregating plastics and the ignorance of the staff members, and this have negatively affected the second year nursing degree students to participate in actual and proper waste segregation. 

To determine the contributing factors to improper waste segregation:

The second objective was to determine the factors contributing to improper waste segregation. The results indicated that there were no policies on color coding and unawareness of soiled waste that can cause hazards, is one of the points the student can’t properly segregate the wastes. The study also revealed that the overall quality of the approach to waste segregation among the second-year degree students at the University of Namibia was poor and poor incentive normally result in non-adherence to proper waste segregation amongst these students. Despite of these factors some of the second-year nursing students were very happy with the quality of waste segregation which the second year UNAM main campus students have yielded so far. The study concluded that there is no specific policy or guidelines to cope with the non-adherence to improper waste segregation issues at the campus under study. Lack of knowledge on how to discard waste properly among second year degree nursing student as a contributing factor to non-adherence of proper waste segregation. 

Competing interest

The authors declared no conflict of interest.

Acknowledgement

We would like to thank all second-year degree nursing students at the university.

Authors contribution 

Zeneyd Andima, prepared the original draft and writing, data analysis of the manuscript.

Joseph Galukeni Kadhila supervised and edited the manuscript.

Funding

No funding was received for this work.

Availability of data materials

Materials are available on reasonable request from the corresponding author Joseph Galukeni Kadhila.

Ethic approval and consent to participate

Written informed consent was obtained from the participants prior to data collection to partake in this study. Ethical clearance was obtained from the School of Nursing and Public Health at the University of Namibia Health Research Ethics Committee to conduct the study. The following ethical principles, respect for a person, justice, maleficence and beneficence where adhered and respected throughout the study according to guidelines.

Consent for publication

None.