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Abstract: This study was conducted to see whether fatalism is an important factor in explaining occupational accidents among medical waste operatives in Dhaka, Bangladesh. Data were collected using a variety of qualitative techniques and included observation, formal and informal dialogue. Sampling strategies included formal representative sampling, purposive and authoritative sampling. Employers did not supply PPE or offer training to their staff. Most workers (73%) did not wear PPE regularly, and a further 18% wore only insufficient PPE. Consequently, most waste workers (95%) reported that they had experienced occupational accidents, mostly (75%) from used needles and other sharps. These observations were associated with fatalistic beliefs among the participants, both managers and employees, who attributed these events to “fate” reflecting their perceived lack of control over such accidents. This study reveals many examples of a lack of organisational awareness that can occur within a culture of fatalism. [Copyright &y& Elsevier]

This paper discusses a significant illicit economy, including black and grey aspects, associated with medical waste scavenging and recycling in a megacity, considering hazards to the specific group involved in scavenging as well as hazards to the general population of city dwellers. Data were collected in Dhaka, Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations (such as recycling operatives) and adaptive sampling for roaming populations (such as scavengers). Extremely hazardous items (including date expired medicines, used syringes, knives, blades and saline bags) were scavenged, repackaged and resold to the community. Some HCE employees were also observed to sell hazardous items directly to scavengers, and both employees and scavengers were observed to supply contaminated items to an informal plastics recycling industry. This trade was made possible by the absence of segregation, secure storage and proper disposal of medical waste. Corruption, a lack of accountability and individual responsibility were also found to be contributors. In most cases the individuals involved with these activities did not understand the risks. Although motivation was often for personal gain or in support of substance abuse, participants sometimes felt that they were providing a useful service to the community. [Copyright &y& Elsevier]

Abstract: A carefully designed survey of medical waste management was undertaken in Dhaka, the capital city of Bangladesh. A range of sampling strategies and data gathering techniques were used. The data gathering techniques included observation, formal structured interview and informal dialogue. Sampling strategies included formal representative sampling for fixed populations and adaptive sampling for roaming populations was developed. Data were collected from healthcare establishments (HCEs) and other waste disposal operatives. Operatives dealing with waste were frequently found to be untrained, and without even a basic understanding of the hazards involved. Personal protective equipment was inadequate in most cases which led to frequent accidental injuries. No HCE was found to have adequate storage facilities for hazardous waste. Thus scavengers were able to gain access to items such as syringes and expired medicines, which they repackaged and resold. The lack of correctly controlled internal storage may be linked to the observation that employees at many HCEs offered contaminated items for sale to scavengers and recycling operatives. In many cases there was no attempt at segregation, but in some cases there was segregation at the point of use, but subsequent remixing with general waste, indicating a lack of management and education rather than a lack of will. In either case, hazardous waste was dumped in city corporation bins, and disposed of on general landfill sites. As well as exposing the waste to scavengers, this could potentially contaminate ground water, especially as the dumps were located in areas subject to frequent flooding. [Copyright &y& Elsevier]

Abstract: There is a concern that mismanagement of medical waste in developing countries may be a significant risk factor for disease transmission. Quantitative estimation of medical waste generation is needed to estimate the potential risk and as a basis for any waste management plan. Dhaka City, the capital of Bangladesh, is an example of a major city in a developing country where there has been no rigorous estimation of medical waste generation based upon a thorough scientific study. These estimates were obtained by stringent weighing of waste in a carefully chosen, representative, sample of HCEs, including non-residential diagnostic centres. This study used a statistically designed sampling of waste generation in a broad range of Health Care Establishments (HCEs) to indicate that the amount of waste produced in Dhaka can be estimated to be 37±5ton per day. The proportion of this waste that would be classified as hazardous waste by World Health Organisation (WHO) guidelines was found to be approximately 21%. The amount of waste, and the proportion of hazardous waste, was found to vary significantly with the size and type of HCE. [Copyright &y& Elsevier]