Medical and healthcare waste generation, storage, treatment and disposal: A systematic review of risks to occupational and public health

Systems to safely store, handle, treat and dispose of medical (healthcare) waste are well developed in the 21st century. Yet across many parts of the Global South (low- and middle-income countries) such systems, resources and know-how are lacking; to the extent that medical waste could be posing a serious threat to the health, safety and lives of millions of healthcare workers and waste handlers who regularly interact with this material. We present here a novel scope and dimension to investigating the risks and hazards to people who come into contact with medical waste, focusing on activity types and established medical practice. Based on a systematic review of the evidence (PRISMA approach, adapted), we critically analyzed and comparatively summarized data, and identified prevalent combinations of hazards, exposure and risk with a global scope. Subsequently, we assigned indicative comparative risk scores for such combinations. Our critical analysis unveils extensive mismanagement of medical waste globally, including the co-disposal with municipal solid waste (MSW), burning in open pits, and dumping even on public streets. Alarmingly, a small but non-negligible trade in reused medical equipment is proliferated by a cohort of waste reclamation specialists (sub-group of waste pickers): they collect hypodermic needles, and other single use medial items for resale to substance abusers and back into the healthcare system. We also highlight the dilemma faced by medical waste handlers in many parts of the world where a difficult choice is made between creating hazardous emissions from burning waste in the open or discarding it on land (e.g. in dumpsites) from where it risks accidentally infecting people with pathogens.

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Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

10.31234/osf.io/mg5s4 ◽

2018 ◽

Author(s):

Joao Ricardo Nickenig Vissoci

Keyword(s):

Systematic Review ◽

Alcohol Use ◽

Randomized Controlled Trials ◽

Brain Stimulation ◽

Meta Analysis ◽

World Health ◽

Controlled Trials ◽

Middle Income ◽

Brief Motivational Intervention ◽

Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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