Bio-medical waste refers to material produced in the course of health protection, medical treatment and scientific research 1. Bio-medical wastes management is a current issue and inadequate management of bio-medical waste is a serious concern in many developing countries due to the risks posed to human health and the environment 2. In these countries, the quantity of bio-medical wastes has sharply risen in recent years as a result of rapid population growth and increasing demand for healthcare services. Despite large investment in expanding public and private healthcare facilities in most developing nations 3, bio-medical wastes are usually rampantly disposed in the environment without any treatment 4. Bio-medical waste management is the most neglected activity of most health service providers, resulting significant exposure to occupational risks among healthcare personnel, high incidence and prevalence of nosocomial infections and environmental contamination 5.

Recognizing the gaps in knowledge of the environmental impacts of healthcare waste and services underscored the need for increased understanding among health professionals of the integral link between human and environmental health 4. In East African countries, waste disposal has been reported to be problematic. Some of the waste is disposed off in open areas and some others into latrines and in rubbish pits. Various researchers found that wastes generated from healthcare activities are not well managed in East African countries 67. Despite the fact that Ministry of Health and the government of Rwanda have empowered the healthcare services supporting waste management facilities, improper management of bio-medical waste management is still a public health concern.

Rwanda Ministry of Health and other health related sectors together with their different partners are working hard to improve healthcare services including environmental health. Compared to other healthcare programs, the management of waste generated from hospital activities is not strengthened. However, the types of these wastes, and their effects on healthcare personnel, patients and people around the health facilities have not been investigated. Generally, the report from National Institute of Statistics of Rwanda (NISR) showed that unhygienic sanitary facilities for excreta disposal, poor management of solid and liquid wastes and inadequate hygienic practices are responsible for a great portion of Rwanda’s disease burden 8. As there is no study conducted in this area about the present topic, determining the level of knowledge and practice about bio-medical waste management among the healthcare personnel was paramount as to plan for intervention.

Data was collected using a structured questionnaire. It captured the following information: socio-demographic characteristics, knowledge about the bio-medical waste characterization and management and bio-medical waste management practice. The questionnaire used in this study was constructed based on the previous published studies and WHO protocol for bio-medical waste management in the healthcare settings 210.

The overall objective of this study was to assess the knowledge and practice regarding bio-medical waste management among healthcare personnel at a District Hospital. A total of 200 healthcare personnel participated in the study. The findings from this study showed that about a half of respondents (49.0%)had good knowledge about bio-medical waste management process. This is in agreement to a study conducted in India among 100 nurses where 47% had excellent knowledge about bio-medical waste management11. Similarly, a study in Tanzania revealed that the knowledge level in management of medical waste was low among healthcare personnel12. However, the figure (49.0%) was low compared to the recent study conducted in Nigeria which reported that respondents in the various facilities had adequate knowledge of medical waste collection and handling 13. These difference could be probably the sample size and source of the target population.

The study revealed that 53.0% healthcare personnel use color coding to dispose infectious waste, 55.5% segregate general waste from bio-medical waste, and 46.5% daily collect bio-medical waste. These findings are supported by a systematic review of six studies which reported that color coding of wastes was not done by 67% of the subjects 14. Another study found that almost one out of every three respondents (35.7%) did not know that a symbol had been assigned to indicate bio-hazardous wastes. Another study also found that only 57.7% respondents were aware of all four color codes (Blue/White-Black-Red-Yellow) used for the bags into which bio-medical wastes are segregated 15. This shows that there is a need of refresher trainings to ensure sustainability and further improvement.

The overall practice in this study was very low where only 33.5% had good practice on bio-medical waste management. This was similar to the study done in Ethiopia which reported 31.5% 16. However, the result is lower than the study done in Pakistan where 94.3% of the study participants had adequate practice 17. This difference could be explained due to low enforcement or monitoring by the regulatory body in the health facilities.

Bio-medical waste management knowledge and bio-medical waste management practices were significantly associated in the present study where adequate practice was higher among respondents with good knowledge. This is similar to a study carried out in India, which revealed lack of knowledge about waste management significantly affects the safe practices for management 11. This demonstrates that improved knowledge can lead to as accepted practice. It is captivating to imagine a knowledge threshold where theoretical knowledge transcends into practice.

Among the socio-demographic factors, only age group was significantly associated with good practice of bio-medical waste management. The age group of 35 to 45 years had significantly more likely to exercise good practice compared to those aged between 18 to 25 years. This could be indirectly related to the years of experience as it is believed that increased experience will increase safer practices.

Like other cross-sectional studies, the present study does not provide causal relationship between the variables and cannot be generalized nationwide because the study area is small and contains only one district hospital. Another limitation was self-report to assess the practice regarding bio-medical waste management among healthcare personnel. However, the respondents were explained the purpose of the study and the information was obtained by trained research assistants.

Our study found that the knowledge and practice about bio-medical waste management were low at 49.0% and 33.5% respectively. Age group and knowledge were significantly associated with good practice of bio-medical waste management among healthcare personnel.

Therefore, we recommend that the Ministry of health and District Hospitals should undertake vigorous and regular training programs on bio-medical waste management for healthcare personnel. Much improvements and efforts should be made in strengthening and enforcing sanitation policies and practices whereby availing bio-medical waste management regulations and guidelines and their accessibility at all levels. Moreover, proper waste segregation at the source must be implemented and color-coding must work hand-in-hand with segregation.