COVID-19 AND MEDICAL WASTE MANAGEMENT IN LOW-INCOME COUNTRIES: PROPOSALS FOR AN INFORMAL NEIGHBOURHOOD IN MAPUTO

Abstract

The COVID-19 pandemic and the related prevention measures affected waste generation and its management and disposal. In particular, infectious medical waste has assumed great importance: consequently, its management represents a relevant and current challenge, especially in vulnerable and resource-poor contexts.
During the pandemic period the medical waste generation increases in quantity, its composition and qualitative characteristics – especially related to infectivity – change and it is no longer limited exclusively to healthcare facilities, but includes a wider community area. In low-income countries, these changes have undermined the already fragile and basic management systems, where they exist, causing slowdowns in collection services, interruptions in recycling activities, overloading of hazardous waste treatment facilities and its inadequate disposal.
The HANDS project, in which this work is included, is aimed at the innovative and sustainable development of an informal neighbourhood in a low-income country to respond to the needs of the post-emergency period from COVID-19 pandemic, providing for a medium and long-term medical waste management system. In particular, in this paper, an infectious waste management system is proposed for Chamanculo C, the informal district of Maputo (the capital of Mozambique).
Analysing the current situation and the correct procedures for the infectious waste management, this research shows an application example of practices and interventions for the COVID-19 waste management in low-income countries, highlighting the good practices and providing recommendations that can be generalized and replicated in similar situations.
Since there are no health facilities in the neighbourhood, the designed system considers the infectious waste flows which are generated at the community level by all the inhabitants. The personal protective equipment used (in particular masks and gloves), infectious waste, related to COVID-19 positive patients in isolation in their own homes, and potentially infectious waste, related to people in quarantine who have come into contact with positive individuals, are the three waste flows generated in the neighbourhood, which have to be handled. After an analysis of the qualitative and quantitative characteristics of the identified flows, the waste management system planning is presented, which includes the stages of collection, storage, disinfection treatment, and final disposal.
Infectious and potentially infectious waste is collected together with a door-to-door collection system, performed with the same frequency, the same tools and by the same operators as the municipal solid waste collection in the district. In order to avoid cross-contamination, the waste flows must be kept separated, using different colours bags. This waste is transported by handcart to the storage site, which consists of a large container, where waste is accumulated before being moved to the treatment site, located in the health centre. The treatment consists of an integrated steam sterilization process and shredding, to obtain residues with a negligible infectious load and with a reduced volume. Finally, sterilized waste is disposed of in the landfill.
The waste deriving from PPE is generated by all the inhabitants of the neighbourhood. Therefore, the collection system consists of waste bins, placed in widely frequented and strategic points of the district. Only used PPE is collected in the containers provided, so that a highly specific waste flow is created, in order to optimize the subsequent phases of the management system. At the same time, this collection way involves the population of the neighbourhood, who raise awareness of the topics relating to waste and COVID-19 contamination risks. The PPE waste bags are transported to the storage site, which is located in the health centre, with a frequency regulated by the MSW collection system, by the size of the intervention area, and by the quantity of containers placed in the neighbourhood. Also in this case, waste is treated by the steam sterilization and shredding process, keeping the two flows separated, because of their different final destination. In particular, PPE waste is integrated into the building materials production process, offering an alternative solution to landfill disposal.
Furthermore, alternative treatment is evaluated, if the economic, technological, and managerial constraints of the context are particularly restrictive. It consists of waste quarantine for a certain period, in order to eliminate the viral load of the SARS-CoV-2 virus.
Finally, there are also proposals applicable at the community level for the reduction of medical waste generation in the long term, replacing disposable masks with reusable and cloth ones. Therefore, the fabric masks management system is designed, consisting of the phases of collection, washing, drying, and re-distribution in the health centre.