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Yangon University of Economics Master of Development Studies Programme Awareness of Pharmaceutical Waste Handling Practice in Pr

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Yangon University of Economics Master of Development Studies Programme Awareness of Pharmaceutical Waste Handling Practice in Pr YANGON UNIVERSITY OF ECONOMICS MASTER OF DEVELOPMENT STUDIES PROGRAMME AWARENESS OF PHARMACEUTICAL WASTE HANDLING PRACTICE IN PRIVATE HOSPITALS (CASE STUDY ON CHAN AYE THAR ZAN TOWNSHIP, MANDALAY DISTRICT) MAY THU THU TIN EMDevS - 20 (15th BATCH) OCTOBER, 2019 i YANGON UNIVERSITY OF ECONOMICS MASTER OF DEVELOPMENT STUDIES PROGRAMME AWARENESS OF PHARMACEUTICAL WASTE HANDLING PRACTICE IN PRIVATE HOSPITALS (CASE STUDY ON CHAN AYE THAR ZAN TOWNSHIP, MANDALAY DISTRICT) A thesis submitted in partial fulfillment of the requirements for the Master of Development Studies (MDevS) Degree Supervised by Submitted by Dr. Khin Thida Nyein May Thu Thu Tin Professor Roll No. 20 Department of Economics EMDevS 15th Batch Yangon University of Economics (2017 - 2019) OCTOBER, 2019 ii YANGON UNIVERSITY OF ECONOMICS MASTER OF DEVELOPMENT STUDIES PROGRAMME This is to certify that this thesis entitled “Awareness of Pharmaceutical Waste Handling Practice in Private Hospitals (Case Study on Chan Aye Thar Zan Township, Mandalay District)” submitted as a partial fulfillment of the requirements for the degree of Master of Development has been accepted by the Board of Examiners. BOARD OF EXAMINERS 1. Dr. Tin Win Rector Yangon University of Economics (Chief Examiner) 2. Dr. Ni Lar Myint Htoo Pro-Rector Yangon University of Economics (Examiner) 3. Dr. Kyaw Min Htun Pro-Rector (Retired) Yangon University of Economics (Examiner) 4. Dr. Cho Cho Thein Professor and Head Department of Economics Yangon University of Economics (Examiner) 5. Dr. Tha Pye Nyo Professor Department of Economics Yangon University of Economics (Examiner) OCTOBER, 2019 iii ABSTRACT The waste generated from the health care activities including the pharmaceutical waste carries a higher potential for infection and injury than any other type of waste. The knowledge and the handling practice of pharmaceutical waste is, therefore, essential for safe environment in our society. This study analyzes knowledge, attitude and practice of the respondents on pharmaceutical waste in 10 private hospitals of Chan Aye Thar Zan Township, Mandalay. The study was conducted by the descriptive method among the private hospitals in Mandalay. This study used primary data with structured questionnaires for knowledge, attitude and practice on handling of pharmaceutical waste. In this study, most of the respondents 80.9% revealed fair level of knowledge while 11.2% had poor knowledge and 7.9% had high level of knowledge on handling pharmaceutical waste. The respondents had positive attitude, 82.2% fairly, 6.6% on highly positive and only 11.2% revealed negative attitude on handling pharmaceutical waste. The practice was 73.0% fair, 13% revealed a high and 13% had poor. This study highlighted the practice was significantly associated with knowledge, attitude and training of the respondents. i ACKNOWLEDGEMENTS First of all, I would like to express my sincere gratitude to Professor Dr. Tin Win, Rector of Yangon University of Economics, Professor Dr. Ni Lar Myint Htoo, Pro-Rector of Yangon University of Economics, Professor Dr. Cho Cho Thein, Programme Director of Master of Development Studies and Head of Department of Economics. I am sincerely and heartily grateful to my Supervisor, Professor Dr. Khin Thida Nyein, Department of Economics, Yangon University of Economics, for the support and guidance given to me throughout my thesis writing. It is a great pleasure to express my greatest gratitude to Dr. Hla Soe Tint, MBBS, DCOHC, DPH, MPH for helping me to conduct this study and for his valuable comments and advices. I am also grateful to all the faculty members of the Department of Development Studies, University of Economics, Yangon and all the guest lecturers from the other departments for their excellent lectures, guidance and encouragement throughout the post graduate course. I gave my heartfelt thanks to all the respondents of the field survey who gave invaluable input. They are highly appreciated for their willingness and patience in providing answers to all of the questions in the questionnaire. I would also like to extend my appreciation to all those who contributed in various ways to my thesis. Finally, it is my great pleasure to thank all of my friends who helped me throughout my difficult time during my Thesis. My thesis could not have been enriched with numerous data and information without help of World Health Organization (WHO) Office, Yangon, Myanmar. Last but not the least I would like to thank my parents, my family and relatives for their understanding, endurance, encouragement and great support to me overcome all the hardships throughout my post-graduate period. I would like to special appreciations is due to my beloved sisters, friends who are cheerfully provided unending emotional support and encourage during my thesis. Thanks are also due to all my colleagues of MSF-OCA for their understanding and moral support. However, I am the person most responsible for what I have prepared and presented in my thesis. ii TABLE OF CONTENTS Page ABSTRACT i ACKNOWLEDGEMENTS ii TABLE OF CONTENTS iii LIST OF TABLES v LIST OF FIGURE vii LIST OF ABBREVIATIONS viii CHAPTER I INTRODUCTION 1.1 Rationale of the Study 1 1.2 Objective of the Study 4 1.3 Method of Study 4 1.4 Scope and Limitations of the Study 4 1.5 Organization of the Study 5 CHAPTER II LITERATURE REVIEW 2.1 Definition and Classification of Health Care Waste 6 2.2 Pharmaceutical Waste 7 2.3 Guiding Principle for Handling Practice of Pharmaceutical 9 Waste 2.4 Impacts of Pharmaceutical Waste in Society 14 2.5 Review on Previous Studies 16 CHAPTER III PHARMACEUTICAL WASTE HANDLING PRACTICE IN MANDALAY 3.1 National Policy Framework of Health Care 20 Waste Management 3.2 Current Handling Practice of Pharmaceutical Waste in 22 Mandalay 3.3 Hospitals in Mandalay 24 iii CHAPTER IV ANALYSIS OF THE SURVEY 4.1 Survey Profile 27 4.2 Survey Design 27 4.3 Characteristics of Private Hospitals and Respondents 29 4.4 Survey Analysis 35 CHAPTER V CONCLUSION 5.1 Findings 52 5.2 Recommendations 56 REFERENCES APPENDICES iv LIST OF TABLES Table No. Title Page 2.1 Typical Waste Composition in Health Care Facilities 6 2.2 Categories of Health Care Waste 7 3.1 Waste Composition in Medical Waste 23 3.2 List of Public Hospitals in Mandalay 25 3.3 List of Private Hospitals in Mandalay 26 4.1 Frequency Distribution of Socio-demographic Characteristics of 29 Private Hospital (n = 10) 4.2 Frequency Distribution of Compound, Ward inspection and 30 Instruction guide to use Waste Bins in private hospital (n=10) 4.3 Compound Inspection in Private Hospital 31 4.4 Ward Inspection in Private Hospital 31 4.5 Instruction Guide to Use Waste Bins in Private Hospital 32 4.6 Content Analysis of the Waste Bags 32 4.7 Frequency Distribution of Socio-demographic Characteristics of 33 Respondents (n=152) 4.8 Frequency Distribution of Socio-demographic Characteristics of 34 Respondents (n=152) 4.9 Frequency Distribution of Rank of Respondents (n=152) 34 4.10 Frequency Distribution of Education of Respondents (n=152) 35 4.11 Frequency Distribution of Experience of Respondents (n=152) 35 4.12 Knowledge Status of Respondents on Segregation of 36 Pharmaceutical Wastes (n=152) 4.13 Attitude Status of Respondents on Segregation of 37 Pharmaceutical Wastes (n=152) 4.14 Practice Status of Respondents on Segregation of 38 Pharmaceutical Wastes (n=152) 4.15 Knowledge Status of Respondents on Collection of 39 Pharmaceutical Wastes (n=152) 4.16 Attitude Status of Respondents on Collection of 40 Pharmaceutical Wastes (n=152) v 4.17 Practice Status of Respondents on Collection of 41 Pharmaceutical Wastes (n=152) 4.18 Knowledge Status of Respondents on Storage of 42 Pharmaceutical Wastes (n=152) 4.19 Attitude Status of Respondents on Storage of 43 Pharmaceutical Wastes (n=152) 4.20 Practice Status of Respondents on Storage of 43 Pharmaceutical Wastes (n=152) 4.21 Knowledge Status of Respondents on Transportation of 44 Pharmaceutical Wastes (n=152) 4.22 Attitude Status of Respondents on Transportation of 45 Pharmaceutical Wastes (n=152) 4.23 Practice Status of Respondents on Transportation of 45 Pharmaceutical Wastes (n=152) 4.24 Overall Knowledge Level of Respondents on Handling 46 Pharmaceutical Wastes 4.25 Overall Attitude Level of Respondents on Handling 47 Pharmaceutical Wastes 4.26 Overall Practice Level of Respondents on Handling 48 Pharmaceutical Wastes 4.27 Frequency Distribution of Barrier on Handling Practice of 48 Pharmaceutical Waste Management of Respondents 4.28 Frequency Distribution of Barrier on Handling Practice of 49 Pharmaceutical Waste Management of Respondents 4.29 Associations Model between Knowledge, Attitude and Practice 50 vi LIST OF FIGURE Figure No. Title Page 2.1 The Steps of HCW Streams and Keys Points 10 vii LIST OF ABBREVIATIONS AT Attitude Total CCET IGES Center Collaborating with UN Environment on Environmental Technologies DoPH Department of Public Health ECD Environmental Conservation Department ENT Ear, Nose and Throat EQM Environmental Quality Management Company Limited GP General Practitioner HBV Hepatitis B Virus HCFs Health Care Facilities HCV Hepatitis C Virus HCWM Health Care Waste Management HCWs Health Care Wastes HIV Human Immunodeficiency Virus IGES Institute for Global Environmental Strategies IV Intravenous KAP Knowledge, Attitude and Practice KT Knowledge Total MCDC Mandalay City Development Council MoHS Ministry of Health Service PPE Personal Protective Equipment PT Practice Total RHC Rural Health Clinic SOP Standard Operating Procedure UNEP United Nations Environmental Program UNSDGS United Nation’s Sustainable Development Goals WHO World Health Organization YCDC Yangon City Development Council viii CHAPTER I INTRODUCTION 1.1 Rationale of the Study Health care means not only for protecting health, providing treatment and saving lives but also reducing risks that can provoke further health-related issues such as infection, trauma and chemical exposure. As a consequent, medical waste management became one of the important factors to control in every country.
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